Quiz 1 and Midterm Flashcards
Mental health definition
- ability to recognize own potential
- cope with normal stress
- work productively
- make contribution to community
Mental health traits
- Think rationally
- communicate appropriately
- learn
- grow emotionally
- be resilient
- have a healthy self-esteem
- realistic goals and reasonable function within the individual’s roles
Mental illness
disorders with definable diagnosis
DSM-5
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition
- official guideline of the American psychiatric association for diagnosing psychiatric disorders
- identifies disorders based on specific criteria
Advocacy
- Advocate for self, patient safety, and respect
This includes: - report any abuse or neglect to authorities
- protect patients confidentiality
- support pt. right to make decisions about care
- be active and support associations r/t pt. care
- national and local legislation that affect pts. rights
- get involved in policy making
ID
- Primative and instinctual
- pleasure principle
- reflex action
- totally unconscious and impulsive
- source that drives all reflexes, instincts and needs
- lacks ability to solve problems and is illogical
EGO
- Problem solver and reality tester
- navigates the outside world
- Conscious self-awareness and strategy to gain pleasure of ID
SuperEGO
- Moral component
- seeks perfection, as opposed to seeking pleasure or engaging in reason
- develops at age 3-5
- unconscious self criticism (ideal self and inner voice)
- Controls ID impulses
Transference
unconscious feelings that the patient has towards a healthcare work that were originally felt in childhood for a significant other
Countertransference
unconscious feelings that a healthcare worker has towards the patient
Erikson’s Stage 1:
Trust vs. Mistrust
Age: 0-1.5
Forming attachment which lays the foundation for alter trust in others
Hope
Erikson’s Stage 2:
Autonomy vs. Shame/Doubt
Age: 1.5-3
Gaining some basic self control of self and environment
Will
Erikson’s Stage 3:
Initiative vs Guilt
Age: 3-6
Becoming purposeful and directive
Purpose
Erikson’s Stage 4:
Industry vs. Inferiority
Age: 6-12
Developing social, physical, and school skills
Competence
Erikson’s Stage 5:
Identity vs. Role confusion
Age: 15-20
Transitioning from childhood to adulthood, developing a sense of identity
Fidelity
Erikson’s Stage 6:
Intamacy vs. Isolation
Age: 20-35
Establishing intimate bonds of love and friendship
Love
Erikson’s Stage 7:
Generativity vs. Self-absorption
Age: 35-65
Fulfilling life goals that involve family, career, and society and developing concerns that embrace the future
Care
Erikson’s Stage 8:
Integrity vs. Despair
Age: 65+
Looking back on life and accepting its meaning
Wisdom
Type of patient admitted to mental hospital
patients that are a risk to themselves or others
Cultural awareness
ability to work effectively in cross-cultural situations and provide the best possible service to patient from various different ethnic/racial backgrounds and who speak different languages
Cultural competence
Nurse adjust their practices to meet their patients cultural beliefs, practices, needs and preferences
Culturally sensitive
not assuming and actually getting to know the person
Confidentiality
ethical responsibility of healthcare professionals the prohibits the disclosure of privileged information with the patients consent
Right to treatment
- The right to quality care
- The right to be free from excessive or unnecessary medication
- The right to privacy and dignity
- The right to the least restrictive environment
- The right to an attorney, clergy, and private care providers
- the right to not be subjected to lobotomies, electroconvulsive treatments, and other treatments without fully informed consent
Right to refuse treatment
- patients can withdraw consent or withhold consent at any time even if they are involuntarily committed
- Emergencies: patient can be medicated without consent to prevent harm to the patient or others
Right to informed consent
- Informed consent: legal term - patient has been provided with basic information including benefits, risks, and alternatives to treatment
- providers responsibility to secure informed consent
- required for surgery, electroconvulsive treatment or the use of experimental drugs and procedures
Informed consent requirements
- the nature of the problem or condition
- the nature of purpose of a proposed treatment
- the risks and benefits of that treatment
- alternative treatment options
- the possibility that the proposed treatment will be successful
- the risks of not consenting
Implied consent
patient gestures a willingness to do something
Capacity and competency
- To provide informed consent, must have the capacity and competency
- Capacity: person’s ability to make informed decisions
- Competency: degree of mentally soundness a person has to make decisions or carry out specific acts
- Considered competent until proven incompetent
- Incompetent needs a legal guardian or representative to give consent
Rights Regarding Psychiatric Advance Directives
- Patients who experience an episode or severe mental illness can express their treatment wishes
- document prepared while patient is well
- designating someone to make their health decisions, preferences on medications, electroconvulsive therapy, admission into a psych facility, and who can visit them
Rights regarding restraint and seclusion
- Use the least restrictive means for the least amount of time
- Emergency: least restrictive does not need to be tried
- requires an order but nurse can place resistant first and request an order ASAP
Interventions before restraints
- verbally intervening
- reducing simulation
- actively listening
- providing diversion
- offering as needed medications
Orders on restraints
Orders must be renewed during a 24 hour periods and renewal time is based on age. Orders will dissolve after 24 hours and if the order is still needed the physician must physically assess the patient themselves.
- Older than 18: 4 hours
- 9-16: 2 hours
- under 9: 1 hour
When using restraints
- Document the restraint in the treatment plan
- document behaviors leading to restraints
- document time when patient is restrained and release from them
- continuously monitor and assess every 15-30 minutes to provide physical needs like food, hydration, toileting
Standard 1: Assessment
Gathering data
Lab data
MSE
Psychosocial exam (begin by asking the patient why treatment became necessary)
Spiritual and religious assessment
Cultural and social assessment
Validating the assessment (Look at EHR and police reports)
Standard 2: Diagnosis
Three components:
- Problem
- Etiology - related to factor
- Supporting data - as evidenced by factor
Standard 3-Outcome Identification
- Outcomes that reflect the maximal level of patient care that can realistically be achieved through nursing interventions
- reflects the desired change and provides direction for continuity of care
NOC
Method to evaluate the effect of nursing interventions. Each outcome has an associated group of indicators used to determine patient status in relation to the outcome.
Standard 4: Planning
Principles to consider
- Safe
- compatible and appropriate
- realistic and individualized
- realistic based on what the patients can do
- evidence-based
Standard 5: implementation
Basic interventions:
- Coordination of care
- Health teaching and health promotion
- Milieu therapy
- Pharmacological, biological and integrative therapies
Coordination of care
communicates the patients needs, goals and status with the team
Often the family’s advocate
Health Teaching and Health Promotion
coping skills, self-care activities, stress management, and relapse prevention
Milieu therapy
- Secure environment people, setting, structure, and emotional climate to cause positive change
- takes naturally occurring events and turns them into learning opportunities
- consistent routine and structure for trust and predictability
- orienting to rights and responsibilities
- considers need for culturally sensitive care
- nurse selects activities that meet patients physical and mental health needs
- nurse maintains least restrictive environment
Pharmacological, biological and integrative therapies
Monitors patient for negative effects
Communicate the assessment for patient’s response to medication
Standard 6: Evaluation
- Systematic
- Ongoing: allows for revisions of nursing diagnosis, change to more realistic outcomes or change interventions
- Criteria-based
- Supporting data used to clarify the evaluation
Documentation
- Accurately reflects the patients condition, treatment, tests, responses, and any untoward incidents
- medical record = legal document
- Document when a patient refused to do something or does not follow a plan as non-adherence
Empathy
- Understanding the patient without own feelings
- the helping person tries to understand the world from the patients perspective
- Not a technique - attitude of acceptance, validation, and respect of the patients strength
Sympathy
Having the same understanding - DO NOT have sympathy for someone because it makes the situation about you instead of them
Nurse-Patient Relationship: Preorientation Phase
- Preparing for your assignment
- Look at patients chart, condition, and medications
- recognize your own thoughts and feelings
Nurse-Patient Relationship: Orientation Phase
- initial interview and meeting
- establishing rapport
- parameter of the relationship
- formal or informal contract
- confidentiality
- terms of termination
Nurse-Patient Relationship: Working Phase
- Maintaining the relationship and gathering further data
- Promote the patient’s problem solving skills, self-esteem, and use of language
3, facilitate behavior change - overcome resistant behaviors
- evaluate problems, goals and progress
- promote expression and practice of alternative adaptive behaviors
- provide education about the disorder
- symptoms management
Nurse-Patient Relationship: Termination Phase
- Summarize goals and objectives achieved
- discuss ways for patient to incorporate new coping strategies
- review situations of relationship
- exchange memories
Therapeutic Responses
- Identify the needs of the patient and explore them
- establish clear boundaries
- encourage alternative problem-solving approaches
- help the patient develop new coping skills
- support behavioral changes
Non-verbal communication
- 90% of communication is non verbal
- Examples:
Tone of voice, emphasis on certain words, pace of speech, physical appearance, facial expressions, body posture, amount of eye contact, hand gestures, sighs, fidgeting, and yawning
3, the eyes and mouth are the biggest clue for how people are feeling emotionally
Using silence
- Allows for reflection, contemplating what is said, weighing alternatives, formulate new ideas, and gain a new perspective
- some peachy disorders or medications can slow the though process so nurses must be patient and prompt the patient if need to
Reflection
- assists the patient to understand their own thoughts and feelings
- Can be a simple statement or question
- makes patient aware of inner feelings and encourage patient to own them
Miracle Question
‘what does a better tomorrow look like for you?
Spirituality and Religious beliefs
- Help people cope with stress and enhance the immune system and sense of well-being
- Spiritual well-being helps people cope leading to dealing with health issues
- Spiritual solutions can provide comfort and support which leads to healing and lower stress
- Religious beliefs promote optimism and hope, provide structure, and a feeling of belonging and provides a social outlet
Measuring stress
Social readjustment rating scale
Recent life changes questionnaire
Social readjustment rating scale
- Measure level of positive and negative stressful life events over a year period
- each event is assigned a weight depending on severity
- Purpose: assess the person’s vulnerability to stress-related disorders
- Score of 300 or more in 6 months or 500 or more in a year is high stress
- Outdated
Eustress
A positive stress that energizes a person and helps a person reach a goal
Examples: Working or studying
Distress
Negative stress
Affects a person’s life
Neurotransmitters
- Chemical substance that functions as a neurons messenger
2. Alterations of these chemicals are the basis of mental illness and target for pharm treatment
Excitatory neurotransmitters
encourage target cell action
Inhibitory neurotransmitters
decrease target cell action
Monoamine neurotransmitters
- Norepinephrine
- Serotonin
- Dopamine
- Epinephrine
Dopamine
- Controls memory, learning, behavior, movement, coordination, and pleasure/reward center
- High –> Addiction
- Low –> Parkinsons
Epinephrine
- AKA adrenaline
- Fight or flight –> increase HR, RR, BP and decreases digestion
- High –> HTN, Diabetes, Heart disease
- Low –> Depression
HORMONE not neurotransmitter
Serotonin
- inhibitory mood, appetite and sleep regulator
2. Low –> Depression
Amino Acid
- Glutamate
2. GABA
Glutamate
Directly influencing the dopamine relating cells
GABA
- Role in inhibition, excitability and anxiety
- Inhibitory mood regulator
- High –> Sedation
- Low –> Anxiety, Schizop
- Anti anxiety medications act by increasing the effectiveness of the neurotransmitter GABA
Neuropeptides: Acetylcholine
- Excitatory
- Controls muscular contractions, neurological function and memory
- Low –>Alzheimers
- High –> Seizures
Endorphines
- Hormone that is release by the hypothalamus and pituitary related to stress that inhibits pain signals
- High –> Euphoria
- Low –> pain/fibromyalgia
SSRI
- Block the reuptake of serotonin –> more serotonin available
- Very selective –> does not block histamine and muscarinic –> less anticholinergic nap sedation
- Sertraline, Fluoxetine, paroxetine
MAOIs
- Monoamine oxidase is an enzyme that destroys monoamines (epinephrine, norepinephrine, serotonin, and dopamine)
- MAOIs inhibit MAO action –> prevents MAO from destroying monoamines –> increase synaptic level of neurotransmitters
- Examples: Selegiline, Isocarboxazid
MAOI and Tyramine
- MAO in liver destroys tyramine in foods
2. Tyramine is not destroyed –> vasoconstriction –> increase in BP –> HTN crisis
Foods to avoid with MAOI
Aged cheese Pickled foods Smoked Fish Wine/Beer Protein dietary supplements Cured meats Avacados Chocolate Caffeine Fava beans
Drugs to avoid with MAOi
- Anti-depressants
- Sympathomimetics
- Anything that increase epinephrine or serotonin
Lithium
- Positive cation that acts by electrical conductivity in neurons
- Interacts with sodium and potassium to stabilize electrical activity at cell membrane
- Low therapeutic index –> monitor blood levels
Carbamazepine
- Bipolar
- Best in treating acute mania
- Reduces the firing rate of overexcited neurons by reducing the activity of sodium channels
ADR: Anticholinergic, Sedation, Ataxia , Rash during the first 20 weeks of treatment
Valproate
Bipolar
Best for mixed episodes and rapid cycling
Side effects: Tremor, Weight gain, Sedation, Thrombocytopenia, Pancreatitis, Liver failure, Birth defects
Neuroimaging of schizophrenia
1 PET scans are useful in identifying schizophrenia, they show decreased use of glucose in the frontal lobes.
Less blood flow and glucose to prefrontal cortex (planning, abstract thinking, social adjustment, decision making). Frontal lobe with decreased activity = less ability to reason
2. MRI/CT can show structural changes
Side Effects of Lithium
Sinus bradycardia
Convulsions
Tremor at therapeutic doses
Extreme motor dysfunction with overdose
Polyuria, polydispia, edema
Goiter and hypothyroidism (long term use)
Hynonatremia → risk of lithium toxicity (increased renal reabsorption of sodium also leads to increased reabsorption of lithium)
