Quiz 2 Flashcards
Milieu Therapy
a safe, structured, group treatment method for mental health issues.
Uses everyday activities and a conditioned environment to help people with interaction in community settings
Flexible treatment intervention that may work with other treatment methods.
Least restrictive alternative doctrine
Before we restrain, we must:
Offer alternatives / try to “talk it out”
Offer seclusion / alone time
Offer PRN medications
Attempt show of force if needed
Chemical restraints only if necessary
Physical restraints only if necessary
Must document everything you tried BEFORE use of involuntary chemical/physical restraints
Multidisciplinary
Psychiatrist, Clinical Psychologists, Emergency Physicians, MH Nurse Practitioners, Psychiatric Nurses, Social Workers, Lawyers, Guardians, Neurologists, Endocrinologists, Activity Therapists, Mental Health Counselor, Marriage Counselor, Addiction Counselor, Psychotherapist, Pharmacist, Dietitian, OT, PT, Group Therapists, Case Managers, Ad Litems
Assertive
Assertiveness is the ability to express positive and negative ideas and feelings in an open, honest and direct way. It recognizes all parties and their points of views in a respectful way. It involves compromise – not “winners” and “losers”
Assertiveness begins with factual statements that are non-judgmental and are not condescending.
Assertiveness includes “I” statements – no “you” statements
Assertiveness is politely but firmly saying no when you need to without feeling guilty
Example: Nurse is late to their shift frequently.
Assertive: When you are late, I cannot get out of here before the traffic gets congested. I don’t appreciate having to get home late.
Passive
Passive communication: person considers only others needs, wants, and feelings.
Does not stand up for themselves, their believes, their feelings, or their needs.
Easily taken care of. Often “dependent” personality traits. “Martyr” mentality.
Extreme lack of confidence, insecurity conflicts, subservient. Rarely prone to anger unless pushed too far.
Example: Nurse is late to their shift frequenly
Passive: Say nothing but as soon as you leave call a co-worker and complain about the situation.
Aggressive
Aggressive communication: person considers only their needs, wants, and feelings.
Ignores, bullies, criticizes, humiliates, dominates, controls, disrespects others and their ideas
Unwilling to compromise: “winner” and “loser” mentality
Propensity exists for abrupt mood changes, irritability, agitation, low tolerance threshold, outbursts, yelling, potential physical violence
Example: Nurse is late to their shift frequently
Aggressive: This is ridiculous. I am sick and tired of your laziness. Get here on time!
Passive Aggressive
Incongruent Behaviors
Appear passive but act out anger in subtle, indirect ways.
Feelings of being powerless makes them resentful leading them to undermine the object (real or imagined) of their resentments.
Have a hard time communicating their needs, often deny there is an issue, sabotage others and situations, but never address the real issues.
Can become aggressive when pushed too far.
Example: Nurse is late to her shift frequently
Passive Aggressive: So nice of you to join us finally. Aren’t I lucky to be in your esteemed presence.
Robert’s Crisis Intervention Model
First assess SI/HI
Next establish trust and rapport (yes – it is second in crisis!)
Identify: Maslow! What problems do they have and how well are they coping? Not stable – triage to higher level.
Use therapeutic communication to help them express their feelings.
Explore alternatives to help the person problem solve.
Implement an action plan.
Follow up in 1 month and on anniversaries
Suicide Protective Factors
Effective coping and problem-solving skills
Reasons to live, goals, find joy in life
Strong cultural identity
Feeling connected and supported by others
Feeling connected to the community
Availability of quality community resources
Availability of quality healthcare resources
Low access to lethal means of suicide
Cultural, religious, spiritual objection to suicide
Suicide Risk Factors
Talking about being a burden
Being isolated
Increased anxiety
Talking about feeling trapped or in unbearable pain
Increased substance use
Looking for a way to access lethal means
Increased anger or rage
Extreme mood swings
Expressing hopelessness
Sleeping too little or too much
Talking or posting about wanting to die
Making plans for suicide
Suicidal Ideation
Suicidal ideation is a behavior – not a diagnosis.
It can sometimes be prevented!
90% of suicides have a known MH disorder.
90% of survivors DO NOT ATTEMPT IT AGAIN!
1.2 million attempted suicide in 2020 but 3 x that number planned one and 10 times that number seriously contemplated it. 45,979 were successful.
Higher in persons who have experienced physical and sexual violence, child abuse and bullying
2nd leading cause of death ages 10-14 and 25-34. 9th leading cause of death 0 to 65 years of age.
High amount of permanent disability following gunshot, MVA, and asphyxiation attempts.
Narcissistic Defense: DENIAL
Not allowing reality to penetrate to avoid
acknowledgment of a painful aspect of reality
* After surviving a heart attack, a patient insists
on continuing his lifestyle as if nothing had
happened
* A woman prepares dinner for her husband
expecting him to come home, even though he
died a month earlier
Narcissistic Defense: Projection
When a person attributes his own wishes,
desires, thoughts, behaviors or emotions
to someone else
* Internal states are perceived as a part of
someone else or of the world in general* A cheating spouse accuses partner of cheating
* A girl talks about her doll as having certain
feelings, which are really what the girl feels
Narcissistic Defense: Splitting
When people and things in the world are
idealized (all good) or devalued (all bad) * World pictured in extreme terms rather than a
realistic blend of good and bad qualities* “This doctor is a miracle worker, but that doctor is
totally incompetent.”
* “He’s just so perfect and wonderful,” says a
teenage girl in love
Immature Defense: Regression
Returning to an earlier stage of development
already completed (unconscious childish
behavior in an adult)
* A husband speaks to his wife in “baby talk”
when he is sick
* A man assumes a fetal position after a
traumatic event
* A previously toilet trained child wets the bed
following the birth of a new sibling
Immature Defense: Blocking
Temporary or transient block in thinking or an
inability to remember
* A student is unable to recall the fact needed to
answer the exam question, although he recalls
it as he walks out of the exam
* In the middle of a conversation, a woman
pauses, looks confused, and asks what she was
just talking about
* Often happens in embarrassing moments
Anxiety Defense: Repression
When an idea or feeling is withheld from
consciousness
* Also called unconscious forgetting
* A child who was abused by her mother and
treated for the abuse now has no memory of
any mistreatment by her mother
* A man who survived 6 months as a hostage
cannot recall anything about his life during
that time period
* One of the most basic defense
mechanisms
Mature Defense: Sublimation
When impulse gratification is achieved by channeling the
unacceptable or unattainable impulse into a socially
acceptable direction
Jack the Ripper becomes a
surgeon
A patient with exhibitionist
fantasies becomes a
stripper
We maintain our self-esteem and social values remain
intact
FREUD - Id
Pleasure seeking, libido, what you really want to do/experience which may not be acceptable socially or even individually
FREUD - EGO
You in the present, reality, the final judge on what you will or will not do
FREUD - SUPEREGO
Your moral compass, conscience that tries to steer you in the right direction
Erikson’s Stages
Infancy (birth to 18 months) Trust vs. Mistrust Feeding Hope
Early Childhood (2 to 3 years) Autonomy vs. Shame and Doubt Toilet Training Will
Preschool (3 to 5 years) Initiative vs. Guilt Exploration Purpose
School Age (6 to 11 years) Industry vs. Inferiority School Confidence
Adolescence (12 to 18 years) Identity vs. Role Confusion Social Relationships Fidelity
Young Adulthood (19 to 40 years) Intimacy vs. Isolation Relationships Love
Middle Adulthood (40 to 65 years) Generativity vs. Stagnation Work and Parenthood Care
Maturity (65 to death) Ego Integrity vs. Despair Reflection on Life Wisdom
Piaget Cognitive Development Theory
Sensorimotor stage: Birth to 2 years - uses senses and motor skills, items known by use - object permanence learned
Preoperational stage: Ages 2 to 7 - Symbolic thinking, language used, egocentric thinking - Imagination/experience grow, child decenters
Concrete operational stage: Ages 7 to 11 - Logic applied, has objective/rational interpretations - Conservation, numbers, ideas, classifications
Formal operational stage: Ages 12 and up - Thinks abstractly, hypothetical ideas (broader issues) - Ethics, politics, social/moral issues explored.
Trust v. Mistrust
Infancy (birth to 18 months) Trust vs. Mistrust Feeding Hope
Autonomy v. Shame
Early Childhood (2 to 3 years) Autonomy vs. Shame and Doubt Toilet Training Will
Initiative v. Guilt
Preschool (3 to 5 years) Initiative vs. Guilt Exploration Purpose
Industry v Inferiority
School Age (6 to 11 years) Industry vs. Inferiority School Confidence
Identity v Role Confusion
Adolescence (12 to 18 years) Identity vs. Role Confusion Social Relationships Fidelity
Intimacy v isolation
Young Adulthood (19 to 40 years) Intimacy vs. Isolation Relationships Love
Generativity v stagnation
Middle Adulthood (40 to 65 years) Generativity vs. Stagnation Work and Parenthood Care
Ego Integrity v Despair
Maturity (65 to death) Ego Integrity vs. Despair Reflection on Life Wisdom
Sensorimotor Stage
Sensorimotor stage: Birth to 2 years - uses senses and motor skills, items known by use - object permanence learned
Preoperational Stage
Preoperational stage: Ages 2 to 7 - Symbolic thinking, language used, egocentric thinking - Imagination/experience grow, child decenters
Concrete Operational Stage
Concrete operational stage: Ages 7 to 11 - Logic applied, has objective/rational interpretations - Conservation, numbers, ideas, classifications
Formal Operational Stage
Formal operational stage: Ages 12 and up - Thinks abstractly, hypothetical ideas (broader issues) - Ethics, politics, social/moral issues explored.
Right Brain
Right brain controls movement on Left side of body and is more involved with intuition, spatial orientation, art, imagination, music, emotions, dreams, insight, global thinking, holistic thoughts.
Left Brain
Left brain is more involved with critical thinking, logic, reasoning, analysis, language, science, writing, mathematics, speech, processing.
The Brain
Limbic System: Frontal lobe – Main regulator of emotions.
Broca’s: Left hemisphere responsible for expressive language. Damage to this area causes Broca’s Aphasia (Expressive)
Wernicke’s: Left hemisphere responsible for receptive language. Damage to this area causes Wernicke’s Aphasia (Receptive)
Difficulty speaking/swallowing due to damage to cranial nerves 9, 10, 12 is called Dysphagia.
Sensory: Information coming into the brain that must be interpreted such as vision, taste, sound, touch, pressure, temperature etc. (Afferent)
Motor: Information leaving the brain to perform “actions” (Efferent requires Energy)
Acetylcholine
Elevated: Depression Aggression Sexual- Aggression Sweating
Low levels: Alzheimer’s Huntington’s Parkinson’s Myasthenia Gravis
Excess acetylcholine leads to a “cholinergic crisis”
Dopamine
Elevated: Mania, schizophrenia
Low levels: Parkinson’s, depression
DABDA
Five stages of dying
denial
anger
bargaining
depression
acceptance
Adaptive Grief
DABDA
Somatic manifestations: sleeping and eating difficulties, anergia (decreased energy), fatigue, palpitations, headaches.
Psychological manifestations: depressed, irritable anxious mood. Withdrawn, blunted, flat affect.
Remain functional and show some acceptance by 6 months. Maintain hope and self concept.
Maladaptive Grief
DABDA – Do not go through these stages well. Get stuck on denial or anger stage.
Somatic manifestations similar to normal grief but exaggerated.
Psychological manifestations more severe including feeling worthless, experience low self-esteem, substance abuse, psychological distress, clinical depression.
Unable to see past the event and still not at baseline function after 12 months.
Nurse: Enquire about Suicidal ideation*
Risk Factors for Maladaptive Grief
- Financial and psychological dependence on the person that died / divorced or job
- Unexpected loss (sudden death, job termination etc.)
- Lack of coping skills
- Lack of support network.
- Mental health disorder
- Person was young that was lost
Peplau Pre-interaction
Review patient chart, examine self-biases, prepare milieu for patient care
Peplau Orientation
Establish trust, rapport, respect. Establish a contract with patient detailing responsibilities of both parties as well as boundaries. Gather assessment data. Identify patient developmental level, strengths, and limitations. Formulate nursing diagnoses, goals, and plan of action with the patient. Explore patient’s feelings. Be genuine, empathetic, and have unconditional positive regard towards patient. Patient is more dependent on nurse.
Peplau Working
Promote patient insight and perception of reality. Problem solve to overcome resistant behaviors to move patient towards goals. Frequently re-evaluate plan and change as needed. Shift power from nurse to patient.
Peplau Termination
Discuss what the patient has accomplished and share feelings about ending the relationship. Provide a plan for continuation of care with another provider if needed. Maintain professional boundaries. Patient is now independent.
Becks Depression Inventory
20 questions rated 0-3
1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression
PHQ-9
Depression questionnaire
10 questions ranked 0-3
Scoring: add up all checked boxes on PHQ-9
For every 3 Not at all = 0; Several days = 1;
More than half the days = 2; Nearly every day = 3
Interpretation of Total Score
Total Score Depression Severity
1-4 Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression
Coping
the thoughts and behaviors used to manage the internal and external demands of stressful situations.
Berevement
