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Psych and Mental Health > Test 1 > Flashcards

Test 1 Flashcards

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1
Q

Criteria to be admitted to inpatient Psychiatric Unit:

A
  • Clear risk of client danger
  • Danger to self or others
  • Failure of outpatient treatment
  • Detox from heavy alcohol/drug abuse
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2
Q

Voluntary

A
  • Inpatient tx is reserved for patients who are acutely ill
  • Person enters treatment facility, participates in tx planning process, and follows thru with tx
  • Person maintains all civil rights and is free to leave at any time even if it is AMA (against medical advice)
  • Must be client/guardian initiated
  • Has a right to demand release, unless client is a minor
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3
Q

Involuntary

A
  • Definition: Confined hospitalization of a person w/o the person’s consent but with a court order
  • Involuntary pts are often high acuity patients, meaning they are at risk for self-harm, elopement, or other risky behavior
  • Nursing implications: monitor very closely
  • Person must be:
    • Mentally disordered
    • Dangerous to self or others
    • Unable to provide for basic needs, “gravely disabled”
  • Pts have the right to receive tx, but also may have right to refuse it
    • Laws about commitment and refusal of medication may vary from state to state
  • Commitment procedures vary among states
    • Most have provisions for an emergency short term hospitalization of 48-92 hours authorized by a certified mental health provider
      • At the end of that period, the individual either agrees to voluntary tx or extended commitment procedures are begun
  • Judge must order the commitment
  • Do not have the right to leave
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4
Q

MSE

A
  • Mental Status Exam
  • Evaluates cognitive process
  • Critical component of assessment
  • Assessment:
    • Establishes rapport
    • Understands problems
    • Assess risk factors
    • Current level of functioning
  • Age, sex, marital status, race, religion, job, living arrangements
  • Grooming, hygiene, dress, pupils, facial expression, height/weight, nutrition, body piercing/tattoos
  • Behavior: body movements, eye contact
  • Speech: rate, volume, stuttering
  • Affect, Mood: flat, bland, animated, withdrawn, sad, euphoric
  • Thought: process and content: disorganized, coherent, flight of ideas, delusions, suicidal ideation
  • Perceptual disturbances: hallucinations
  • Cognition: orientation, LOC, attention, insight, judgment
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5
Q

QSEN

A
  • Quality and Safety Education for Nurses (QSEN)
  • Goal: to prepare future nurses to have knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare systems w/in which they work
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6
Q

milieu

A
  • Refers to surrounding and physical environment
  • Need to supply a comfortable, secure, and SAFE environment for patients
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7
Q

code

A
  • May need to be called in crisis management
    • Medical: chest pain
    • Behavioral: yelling, kicking, punching, pacing
  • Special teams who respond to code in a behavioral crisis are called “Helping Hands”
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8
Q

therapeutic relationship

A
  • Nurse maximizes communication skills, understanding of human behaviors, and personal strengths to enhance client’s growth
  • Clients engage in relationship when clinician’s interactions address their concerns, respect client as a partner in decision making, and use straightforward language
  • Difference b/w social and therapeutic relationships:
    • Social: friendship, intimacy, emotional commitment
    • Therapeutic: focus on client problem and needs
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9
Q

1:1

A
  • May be indicated for actively suicidal clientàneeds to be one staff member assigned to watch the client at all times
  • May be indicated for a client who is escalating and getting upset
    • Offer 1:1 to encourage discussion of feelings
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10
Q

What are the 3 stages of the Nurse-Client Relationship? Describe each stage

A
  • Orientation Phase:
    • Trust established
    • Nurse establishes boundaries of relationship
    • Termination begins during this phase
  • Working Phase:
    • Maintain relationship
    • Gather further data
    • Promote client’s OWN problem solving skills
    • Facilitate change
    • Overcome resistance
  • Termination Phase:
    • Discussed during first interview
    • Feelings: both client and nurse
    • Client may withdraw or regress
    • Summarize goals and objections
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11
Q

cognitive behavioral therapy (CBT)

A
  • Active, time limited, structured
  • How ppl feel and behave is determined by the way they think about their world
    • CBT helps to reframe their way of thinking
  • Homework is usually assigned to the patient
  • Some ppl have schema—unique assumptions about themselves
  • Cognitive distortions: often play a role in how people see their world
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12
Q

What is the significance of the Tarasoff Case?

A

Therapist has the duty to warn a client’s potential victim of potential harm.

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13
Q

List the client rights for voluntary/involuntary clients?

A
  • Least Restrictive Environment: client has right to be treated in the least restrictive environment
    • Person cannot be restricted to an institution when he can be successfully treated in the community
    • Cannot be restrained or locked in a room unless all other “less restrictive” interventions are tried first
  • Right to privacy, confidentiality, respect
  • Right to informed consent
  • Involved in tx team
  • To have visitors
  • To refuse tx
  • To leave AMA
  • To legal counsel
  • To vote
  • To communicate privately by phone
  • To lodge a complaint
  • To participate in religious worship
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14
Q

voluntary vs. involuntary rights of clients

A
  • Voluntary: maintains all civil rights and free to leave at any time even if AMA, can demand release
  • Involuntary: may refuse tx, do not have right to leave
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15
Q

elopement

A

Be aware of clients trying to “elope”—which means to run away

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16
Q

Sexual Acting Out

A

be aware of clients suggestively asking other clients to meet up in another room later

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17
Q

Suicide

A
  • Be aware of clients trying to harm self with objects such as pencils, tableware
  • If a client is suicidal, may need to be placed on a 1:1
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18
Q

Assertive Community Treatment

A
  • ACT
  • Mobile treatment units
  • Respond to clients in community
    • These clients often have repeated hospitalizations
    • Many have schizophrenia
  • Goal: to PREVENT hospitalization
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19
Q

Positive symptoms of Schizophrenia

A
  • Behaviors which may be added as client becomes more ill
    • Delusions: fixed false beliefs
      • Themes: grandiosity, persecution, jealousy, control
      • Ideas of reference: giving personal significance to trivial events, perceiving events as relating to you when they are not
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20
Q

Negative symptoms of schizophrenia

A
  • Behaviors that may be taken away from client as illness takes hold
    • Apathy: flat affect
    • Lack of motivation
    • Anhedonia
    • Poor social functioning
    • Poverty of thought, speech
    • Affective blunting: minimal emotional response
    • Inappropriate affect: incongruent response
    • Bizarre affect: grimacing, giggling
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21
Q

Anhedonia

A
  • Negative symptom of schizophrenia
  • inability to experience pleasure from activities usually found enjoyable, e.g. exercise, hobbies, singing, sexual activities or social interactions
22
Q

Catatonic

A
  • essential feature is abnormal motor behavior
  • onset is usually abrupt
  • prognosis is favorable
  • withdrawn phase and excited phase
23
Q

withdrawn phase of catatonia

A
  • the client may demonstrate posturing, waxy flexibility
    • stereotyped behaviors, extreme negativism
    • when a client is extremely withdrawn, physical needs take priority
      • client may need assistance with hygiene, dressing, grooming
      • explain care in simple, explicit terms
24
Q

excited phase of catatonia

A
  • person talks or shouts continually
  • verbalizations may be incoherent
  • staff communication should be clear and direct
  • major concern: safety of client and others
  • nursing interventions:
    • client may exhibit gross hyperactivity: running, striking out
    • exhaustion and collapse, as well as safety, are primary concerns
    • client may be destructive or aggressive in response to hallucinations or delusions
    • IM administration of antipsychotic med
    • Provision of nutrition, fluids, rest
25
Q

Waxy flexibility

A
  • Associated with the withdrawn phase of catatonia
  • Client’s arm is raised and remains immobile
  • Attempts to reposition the patient are met by “slight, even resistance”, and after being repositioned the patient will typically remain in the new position
26
Q

psychosis

A
  • Disorganization of the personality, deterioration in social functioning, and loss of contact with, or distortion of, reality
  • May be evidence of hallucinations and delusional thinking
  • May occur with or without presence of organic impairment
27
Q

psychosocial rehabilitation

A
  • Helps patient readjust to community living by promoting necessary skills, such as social skills training and basic job skills
28
Q

Akathisia

A
  • type of EPS
  • Restlessness
  • Patient can be hyper, agitated, pacing halls
  • Sometimes this is misinterpreted as part of psychosis, but often a SE of medication
29
Q

Dystonia

A
  • type of EPS
  • Muscle cramping of head and neck
  • Acute dystonic reaction: when client’s head is twisted to one side or they may complain to you that their tongue is thick
  • Nursing intervention: give Cogentin or Artane or Benadryl (usually given IM not PO)
30
Q

Pseudo parkinsonism

A
  • type of EPS
  • Client LOOKS like they have Parkinson’s dz: tremor, impaired gait, stiff muscles, flat affect
31
Q

Tardive dyskinesia

A
  • Persistent EPS
  • Appears after prolonged tx
  • Involuntary tonic muscular contractions
  • “guppy like” mouth movement, tongue protrusions
  • involve tongue, fingers, toes, neck, trunk, or pelvis
  • drugs should be D/C
  • no cure
  • assessment performed using AIMS scale (Abnormal Involuntary Movement Scale)
32
Q

Neuroleptic malignant syndrome

A
  • rare, <1% of cases
  • serious and potentially fatal
  • dec LOC
  • inc muscle tone
  • fever, HTN, tachycardia, tachypnea, diaphoresis, drooling
33
Q

Haldol(Haloperidol)

A
  • traditional antipsychotic
  • ONLY target positive symptoms—hallucinations, delusions, disordered thinking, paranoia
  • Used less frequently, less frequently
  • Cause more EPS
34
Q

Risperidone (Risperdal)

A
  • Atypical antipsychotic
    • ADR: metabolic syndrome (weight gain, dyslipidemia, altered glucose metabolism, HTN)
    • More expensive than Haldol
  • Long acting injectable
  • Fewer SE
  • Target positive and negative symptom
  • Better tolerated
35
Q

Zyprexa (Olanzapine)

A
  • Atypical antipsychotic
    • ADR: metabolic syndrome (weight gain, dyslipidemia, altered glucose metabolism, HTN)
    • More expensive than Haldol
  • Target positive and negative symptoms
  • Fewer SE
  • Better tolerated
36
Q

Cogentin (Benztropine)

A
  • Given to help with dystonia as IM injection
37
Q

which type of anti-psychotics are more likely to cause EPS?

A

traditionals, more so than atypicals

38
Q

Difference b/w Mental Health and Mental Illness

A
  • Mental Health
    • Successful performance of mental functions
    • Able to engage in productive activities
    • Enjoy fulfilling relationships
    • Cope with adversity
  • Mental Illness
    • Psychological syndrome marked by distress or disability
    • All mental disorders with definable diagnoses
39
Q

therapeutic communication techniques

A
  • Goal: to promote growth and change for your client
  • Touch - very important but depends on the pt
  • Silence - provides meaningful moments of reflection
  • Active Listening - observe, listen, understand, provide feedback, restate, paraphrase, clarify, reflect
  • Use open ended questions
  • Never ask Why
  • Safe communication - let client set pace, do not position client btw nurse and the door, avoid a desk barrier
  • Pay attention to body language, verbals, non verbals, facial expression and tones
40
Q

client confidentiality

A
  • Client has a right to know who else will be given the information shared with the nurse
  • And that the information may be shared with others on the health care team
  • Must be away for this right and do not violate it
41
Q

role of psychiatric nurse

A
  • Nursing maintains therapeutic milieu
  • Communication is key
  • Maintains safety on units
  • Makes rounds and makes sure all consult rooms and kitchen is locked during eve/nights
42
Q

differences in cultureal care

A
  • Each culture has different patterns of nonverbal communication
    • Eye contact
    • Personal space
    • Touch
43
Q

Define behavioral Crisis

A
  • Yelling, kicking, punching, pacing
  • Staff trained in CPI (Crisis Prevention Intervention)
  • Special teams who respond to code “helping headings”
44
Q

Understand the term Least Restrictive Environment

A
  • Client has the right to be treated in the least restrictive environment, which means that a person cannot be restricted to an institution when he can be successfully treated in the community
  • They cannot be restrained or locked in a room unless all other “less restrictive” interventions are tried first
45
Q

Verbalize the importance of using restraints only as a last resort

A
  • Behavior has to be harmful to self/ others
  • Less restrictive means don’t work
  • Need MD order and timed limited
  • Need to renew q24h
  • Can place client in an emergency before getting MD order
  • Behaviors must be documented
  • Never used as a punishment
  • Least restrictive as possible
46
Q

Define schizophrenia and how it affects thoughts, emotional, language and social behavior

A
  • Affects: thinking/ language, emotions, social behavior and ability to perceive reality accurately
  • A thought disorder
  • Difficulty with attention, memory, planning and organizing
47
Q

difference between positive and negative symptoms of schizophrenia

A
  • Positive
    • Behaviors which may be added as client becomes more ill
    • Delusions (fixed false beliefs)
    • Hallucinations
  • Negative
    • Behaviors that may be taken away from client as illness takes hold
48
Q

Distinguish between schizophrenia and psychosis

A
  • Psychosis
    • Disorganization of the personality, deterioration in social functioning, and loss of contact with, or distortion of, reality.
    • There may be evidence of hallucinations and delusional thinking
    • Can occur with or without the presence of organic impairment
  • Schizophrenia
    • Brain affected and cannot make connections
    • Thought disorder
    • Difficulty with attention, memory, planning and organizing
49
Q

Define Delusion

A

A fixed, false belief

50
Q

Define Hallucination

A
  • Sensory perceptions for which there is no external stimulus
  • Auditory hallucinations are most common
  • Command hallucinations - voices telling client what to do

Psych and Mental Health (2 decks)

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