Quiz #2 Chapters 7, 8, 9, 10 Flashcards
Nursing process
- Assessment
- Nursing diagnosis
- Outcome
- Planning
- Implementation
- Evaluation
Types of assessment
Review of systems
Laboratory data
Mental status examination (MSE)
Psychosocial assessment
Spiritual assessment
Self awareness assessment
Validating assessment
Review of systems
Ex: physical exam taken by the primary care doctor
Obtaining vital signs, historical review of body systems
Laboratory Data
Blood tests to differentiate between a mood disorder and that of an illness
Ex: hyperthyroidism can appear to be magic phase of bipolar disorder. So blood test can rule this out.
Mental Status Examination (MSE)
Differentiating between systemic condition and psychiatric disorders
Example: delirium and dementia
Psychosocial assessment
Obtains the following about the patient
ex:
Central or chief complaint
History of violent behavior
Alcohol and or substance abuse
Family psychiatry history
Current stressors and coping methods
Spiritual assessment
Religious beliefs can have an influence on how ppl understand the meaning and purpose in their lives. And how they use their judgment to solve problems
Self-awareness assessment
Positive trait
Being consciously aware of our personal biases
Examine how you are feeling at the moment before an interview
Our feelings can affect the way we feel about a pts response
Validating assessment
Asking a patient why they were admitted to get validation
Nursing Diagnosis
Actual
Risk
Health promotion (for patients who are ready to go home)
Outcome identification
Use SMART goals
Specific, measurable, achievable, realistic, and timely
Step 4: Planning
This is where we will plan on what to do
Example:
Planning to have a one to one sitter for a patient who is planning to suicide.
This always depends on priority.
Step 5: implementation
Implements the plan using evidence-based interventions whenever possible.
Mileu therapy should be done for every patient (structuring the environment to affect behavioral changes improve psychological health and functioning) it also includes orienting patients to their rights and responsibilities
- ex: lowering the lights to lower stimuli (they should always be maintained in the least restrictive environment.
Therapeutic relationship/counseling
Step 6: Evaluation
Is the treatment working?
Ongoing assessment of data allows for revisions of nursing diagnoses, or changes to more realistic outcomes
Documentation
Use the term “NONADHERENCE” Instead of “NONCOMPLIANT”
NONCOMPLIANT has negative connotations while nonadherent makes us want to figure out what is wrong with the clients ability to take the medication
Factors that affect communication
Personal factors
Environmental factors
Relationship factors
Personal factors
Emotional factors : mood, responses to stress
Social factors : previous experience, cultural differences, language differences
Cognitive factors : problem solving ability, knowledge level
Environmental factors
Physical factors : background noise, lack of privacy
Societal determinants : economic factors, presence of others, expectations of others
Relationship Factors
Being comfortable talking to strangers.
Naturally we have prejudices. Our duty is to guard against negative feelings towards others who seem different from us.
Nonverbal communication
Is the bulk of our communication
Ex: facial expressions, body posture, hand movements
Tone and pitch
Congruent Message
If the verbal and nonverbal messages are matching
Ex: a student says that they need to get good grades (content) and if the student skims through nursing textbook (process, the message is congruent
Noncongruent messages
When verbal and nonverbal messages do not align
(Words do not match the actions)
Use of Silence
Is not the absence of communication it is a channel for transmitting and receiving messages.
Used for listening
Provide meaningful moments
Active listening
Includes the following:
Observing the patients nonverbal behaviors
Listening and understanding
Listening for “false notes” (inconsistencies with what the pt says
Providing the patient with feedback
Clarifying techniques
Verifying the patients messages
Ex:
“I’m not quite sure what you were saying. Did you say you are not going to group tonight”
Helps identify and correct misperceptions
Closed ended questions
Questions that have yes or no answer
Example: “did you sleep well today?”
Instead ask
“How was ur sleep”
Giving advice
This method is nontherapeutic
Ex: you should break up with your boyfriend
Instead say:
What are the pros and cons of your situation
False reassurance
Saying “everything will be alright” this can belittle the patients feelings and give false hope
Instead say
“What do you think could go wrong” this is clarifying why the patient feels the way they feel
Asking “Why?” Questions
“Why did you stop taking your medications” this statement implies blame and patient will feel defensive. Avoid “how” questions as well.
Instead ask “tell me some of the reasons that led you to not taking your medication” this is an example of giving broad openings
Minimizing feelings
“I know what you mean” statements doesn’t allow the attention to focus on the patient
Instead empathize with the patient
“You must be feeling upset”
In cases you can say “I went through something similar” but then always follow up saying “it must have been hard”
Making value judgements
“How come you are still smoking when your wife has lung cancer?”
Instead make observations by saying “I see you are still smoking even though your wife has lung cancer”
Validating and exploring
If patient states “id like to die”
Say “this sounds serious, have you thought about harming yourself” it is important to always address what the patient states.
Telehealth technologies
Electronic means of communication such as video conferencing
Allow for maintaining therapeutic relationships
Remote physical assessment and consults
Facilitating
Communication of distressing thoughts and feelings
Assisting
Patients with problem solving to help facilitate activities of daily living
Helping
Patients examine self defeating behaviors and test alternatives
Promoting
Self care and independence
Social vs therapeutic relationship
Social relationship can be defined as a relationship that is primarily initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task.
Includes giving advice
Boundaries
Patients needs are separated from the nurses needs
Blurring of boundaries can be caused by
-when the relationships slips into a social context
Ex: over helping: doing for patients what they are able to do themselves
controlling: asserting authority and assuming control of patients “for their own good”
narcissism”: needing to find weakness in patients to feel helpful
Transference
A person unconsciously and inappropriately displaces patterns of behavior and emotional reactions toward another person
Ex: patient states “you remind me of my mom”
Countertransference
Refers to the tendency of the nurse to displace onto patients feelings relate to ppl in her past.
Ex: if the nurse is struggling with an alcoholic family member, they may feel disinterested or disgusted towards an alcoholic patient. 
Pre-orientation phase
Information regarding the first clinical phase
Orientation phase
First time nurse and patients meet
Initial interview
- establishing rapport
Working phase
Maintain the relationship
Gather further data
Promote the patients problem solving skills
Facilitate behavioral change
Termination phase
Discuss ways to incorporate skills into life
May occur at discharge
Consistency
Ensuring that a nurse is always assigned to same patient
Pacing
Letting the patient set the pace and letting it fit the patients mood
Listening
Letting the patient talk when needed
Initial impressions
Positive attitude helps develop therapeutic alliance
Comfort and control
Promoting patient comfort and balancing control
Not too strict and not too lenient
Patient factors
Trust on the part of patient
Patients active participation in the relationship
Factors that enhance growth
Genuineness
Empathy
Positive regard: viewing another person as being worthy of caring about
Stress response
“Fight or flight” response
Immediately ready to meet a threat or stressor
PTSD
Can occur in individual who has had trauma severe enough to be outside the range of normal human experience
PTSD symptoms
TRAUMA
T = traumatic event
R =Re-experiencing trauma: flashbacks, nightmares
A = avoidance: attempting to avoid anything that might cause recall of the event
U = unable to function
M = month long symptoms
A = arousal increased : irritability, angry outbursts, self-destructive behavior, exaggerated startle response
Risk factors
Age of traumatic event
Female
History of psychiatric illness
Lower educational level
Acute stress disorder
Resolve within a month
Precipitating traumatic events are the same as PTSD
Compassion fatigue
Aka secondary traumatic stress
Nurses and other health care workers become indirectly traumatized when trying to help someone who has experiences traumatic stress
Symptoms of compassion fatigue
Inability to function
Difficulty separating work from personal life
Dread of working with certain individuals
Depression
Insomnia
Loss of hope
Images of another’s critical experience
