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NUR 140 > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Stress

A

Relationship between individual and environment that taxes/exceeds ability to cope and endangers well being

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2
Q

Environmental stress

A

Creates unexpected change in life pattern of the individual, requires significant adjustment in lifestyle, and taxes personal available resources

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3
Q

Reactions/Responses to Stressful Events

A

Biological

Psychological (Individual perception of stressor)

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4
Q

Cognitive appraisal

A

A personal interpretation to a situation and possible reactions to it

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5
Q

Biological Responses

A

The Fight or Flight Syndrome

General Adaptation Syndrome

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6
Q

General Adaptation Syndrome (GAS)

A

Alarm Reaction stage
Stage of resistance
Stage of exhaustion

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7
Q

Alarm Reaction stage

A

Physiological response to the stressor
Sympathetic nervous system and endocrine system are activated
*Epinephrine and cortisol

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8
Q

Stage of resistance

A

Body begins to repair, but still on high alert

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9
Q

Stage of exhaustion

A

Body will adapt and learn how to live with high stress levels, body will continue to secrete cortisol (blood pressure stays elevated)

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10
Q

Stage of exhaustion symptoms

A 
Irritability
Frustration
Poor concentration
Difficulty remembering things
Fatigue
Burn out
Depression
Anxiety
Poor sleep
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11
Q

Epinephrine

A

Increases heart rate to circulate oxygen

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12
Q

Cortisol

A

Elevates blood pressure, blood sugar, and fat

Body is in a hyper metabolic state

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13
Q

Primary appraisal

A

A judgment about the situation
Irrelevant
Benign-positive
Stressful

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14
Q

Irrelevant Primary appraisal

A

The outcome of the stressor has no significance

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15
Q

Benign-positive Primary appraisal

A

Leading to growth, good positive stress, stimulating

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16
Q

Stressful Primary appraisal

A

Outcome is a threat or a challenge, overwhelming (ex: death or new diagnosis

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17
Q

Secondary appraisal definition

A

How cope with stress?
Coping strategies
Choose best option
Ability to be effective

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18
Q

Secondary appraisal (how it’s used)

A

Good or bad coping strategies
Choosing the best options for them
The ability to be effective

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19
Q

Predisposing factors influence our responses/reactions

A

Genetics
Past experiences
Existing Conditions

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20
Q

Individual responses - Two controls

A

Thoughts and reactions

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21
Q

Thoughts

A

What we think and how we feel when stressed

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22
Q

Reactions

A

What do we do, behave or react when we are stressed

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23
Q

Mild Anxiety

A

Anxiety that can enhance learning

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24
Q

Moderate Anxiety

A

Perception diminishes, body aches

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25
Q

Severe Anxiety

A

Attention span very limited, physical and emotional symptoms

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26
Q

Panic (Anxiety)

A

Unable to focus, misperceptions, losing control, communication ineffective

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27
Q

Psychological Adaptation to Stress

A

Grieving
Stages of Grieving
Anticipatory Grief
Maladaptive Grief Responses

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28
Q

Grieving (Psychological Adaptation to Stress)

A

Personal loss
Perception of being alone
Failure

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29
Q

Anticipatory Grief

A

Grief prior to actual loss, may cause emotional disengage

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30
Q

Maladaptive Grief Responses

A

Occur when people lose the ability to function in areas of life, prolonged grief (denial or anger), prevents individual from moving forward

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31
Q

Adaptive Stress Response

A

Homeostasis

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32
Q

Maladaptive Stress Response

A

Disequilibrium

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33
Q

Adaptive coping strategies

A 
Awareness
Relaxation
Meditation
Interpersonal communication with caring other
Problem-solving 
Pets
Music
Nutrition – diet and hydration
Sleep
Physical exercise
Cry
Laughter
Talking
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34
Q

Maladaptive coping strategies

A 
Drinking
Sleeping 
Physical exercise
Smoking
Crying
Laughing
Talking
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35
Q

Defense Mechanisms Purpose

A

Protect ego

Decrease anxiety

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36
Q

Defense Mechanisms Benefits

A 
Adaptive 
Protective mechanisms (unconscious or conscious)
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37
Q

Crisis defined

A

Disequilibrium

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38
Q

Crisis ultimate goal

A

Self esteem and growth

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39
Q

Crisis assistance required

A

Problem solving skills

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40
Q

Common Characteristics of a Crisis

A

All individuals experience
Precipitated by specific identifiable events
Personal by nature
Acute and time limited
Potential for psychological growth or deterioration

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41
Q

Phases in the Development of a Crisis

A

Exposure to stressor
Common coping strategies are not helpful and anxiety increases
Utilize all (recognized) resources to decrease distress
Major disorganization occurs if no resolution

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42
Q

Adaptation to Crisis

A

Perception of event
Availability of support
Availability of adaptive coping mechanisms

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43
Q

Communication

A

Transaction between the sender and the receiver
Both participants perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship

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44
Q

Therapeutic communication

A

Caregiver verbal and nonverbal techniques that focus on the care receiver’s needs and advance the promotion of healing and change
Encourages exploration of feelings and fosters understanding of behavioral motivation
Nonjudgmental, discourages defensiveness, and promotes trust

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45
Q

Nontheraputic communication

A

Barriers to open communication

Decrease effective communication

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46
Q

Active Listening

A

To listen actively is to be attentive to what client is saying, both verbally and nonverbally

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47
Q

SOLER

A 
Sit squarely facing the client
Observe an open posture 
Lean forward toward the client
Establish eye contact 
Relax
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48
Q

Assertive Communication

A

Promotes equality in human relationships and enables us

Helps us feel good about ourselves and increases our self-esteem

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49
Q

Assertive behavior

A

To act in our own best interests
To stand up for ourselves without undue anxiety
To express honest feelings comfortably
To exercise personal rights without denying the rights of others

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50
Q

Nonassertive behavior

A

Sometimes called passive behavior

Seek to please others at the expense of denying their own basic human rights

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51
Q

Aggressive behavior

A

Defend their own basic rights by violating the basic rights of others
Feelings are often expressed dishonestly and inappropriately

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52
Q

Passive-aggressive behavior

A

Respond to others by appearing passive and accepting of other’s demands while behaving in ways that suggest anger and resentment are their true feelings
Sometimes called indirect aggression, the behavior takes the form of passive, nonconfrontational action

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53
Q

Mental Health/Mental Illness - Maslow

A

An individual’s quest for self-actualization

Hierarchy of needs

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54
Q

Hierarchy of needs

A 
Physiologic needs
Safety and security
Love and belonging
Self-esteem and esteem of others
Self-actualization
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55
Q

Jahoda’s 6 Indicators of Mental Health

A 
Positive attitude toward self
Growth, development, and the ability t0 achieve self-actualization
Integration
Autonomy
Perception of reality
Environmental mastery
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56
Q

Mental Health definition

A

“The successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms”

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57
Q

Culture - Mental Illness

A

A particular society’s entire way of living, encompassing shared patterns of beliefs, feelings, and knowledge that guide people’s conduct and are passed from generation to generation

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58
Q

Incomprehensibility - Mental Illness

A

The inability of the general population to understand the motivation behind the behavior

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59
Q

Cultural relativity - Mental Illness

A

The “normality” of behavior is determined by the culture

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60
Q

Mental Illness

A

“Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning”

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61
Q

Recovery Model

A

“Recovery from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential”

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62
Q

4 Dimensions of Recovery

A

Health
Home
Purpose
Community

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63
Q

Guiding Principles of Recovery

A 
Merges from hope
Person- driven
Occurs via many pathways
Holistic
Supported by peers and allies
Supported through relationships and social networks
Culturally- based and influenced
Supported by addressing trauma
Involves individual, family, and community strengths and responsibility
Based on respect
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64
Q

The Tidal Model

A

Mental health nursing recovery model
The metaphor of water is used to describe how individuals in distress can become emotionally, physically, and spiritually shipwrecked.
Focus is on the individual’s personal story

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65
Q

The Tidal Model - 10 Commitments

A 
Value the voice
Respect the language
Develop genuine curiosity
Become the apprentice
Use the available toolkit
Craft the step beyond
Give the gift of time
Reveal personal wisdom
Know that change is constant
Be transparent
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66
Q

The Tidal Model - 10 Competencies

A 
Active listening
Use of stories, anecdotes
Show interest
Unique plan of care
Identify best tools
Best first step
Importance of time
Improve self confidence
Awareness of change
Share all treatment plans
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67
Q

The Wellness Recovery Action Plan (WRAP)

A

A structured system for monitoring uncomfortable and distressing through planned responses, reducing, symptoms and, modifying or eliminating those also includes plans for responses from others symptoms. It when a person’s symptoms have made it impossible to continue to make decisions, take care of him/her and keep him/herself safe

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68
Q

The Wellness Recovery Action Plan (WRAP) - Step 1

A

Developing a Wellness Toolbox

Strategies and skills the individual has used to relieve stress

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69
Q

The Wellness Recovery Action Plan (WRAP) - Step 2

A

Daily Maintenance List

1) Description of wellness
2) List of things needed to do to stay healthy
3) To do list

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70
Q

The Wellness Recovery Action Plan (WRAP) - Step 3

A

Triggers

1) List of possible stressful events
2) Items from toolbox to use if needed

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71
Q

The Wellness Recovery Action Plan (WRAP) - Step 4

A

Early Warning Signs

1) Identify subtle signs indicating that things are getting worse
2) Develop a plan to respond to the early warning signs-should bring relief or prevent escalation

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72
Q

The Wellness Recovery Action Plan (WRAP) - Step 5

A

Things Are Breaking Down or Getting Worse

1) List of symptoms that are occurring that indicate that the situation has worsened
2) Develop a plan to deal with these symptoms

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73
Q

The Wellness Recovery Action Plan (WRAP) - Step 6

A

Crisis Planning

1) Gathers information about the person when well
2) Identifies when someone needs to take over
3) Provides names of support people
4) Includes names of health care providers
5) Includes preferred treatments
6) Includes preferred treatment facilities
7) Includes facilities to be avoided
8) Description of expectations from support people
9) Indicators of when support is no longer needed

74
Q

The Psychological Recovery Model definition

A

“the establishment of a fulfilling, meaningful life and positive sense of identity founded on hopefulness and self-determination” (Andresen, Oades, and Caputi , 2011, pg. 40).
Focuses on the person’s self-determination in the course of his or her recovery process

75
Q

The Psychological Recovery Model - 4 Components

A

Hope
Responsibility
Self and identity
Meaning and Purpose

76
Q

The Psychological Recovery Model - 5 Stages

A 
Moratorium
Awareness
Preparation
Rebuilding
Growth
77
Q

Moratorium

A

Dark despair and confusion, life is on hold

78
Q

Awareness

A

Recovery is possible, a self-capable of being well

79
Q

Preparation

A

Resolution to begin the work of recovery

80
Q

Rebuilding

A

Takes the first steps needed for building a meaningful life

81
Q

Growth

A

Ongoing continual self-improvement

82
Q

Ethics

A

A branch of philosophy that deals with distinguishing right from wrong

83
Q

Bioethics

A

Term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health

84
Q

Values

A

Personal beliefs about what is important and desirable

85
Q

Values clarification

A

A process of self-exploration by which people identify and rank their own personal values

86
Q

Moral behavior

A

Conduct that results from serious critical thinking about how individuals ought to treat others

87
Q

Right

A

A valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service

88
Q

Absolute right

A

When there is no restriction whatsoever on the individual’s entitlement

89
Q

Legal right

A

A right on which the society has agreed and formalized into law

90
Q

Ethical Dilemmas

A

Ethical dilemmas occur when moral appeals can be made for taking either of two opposing courses of action
Taking no action is considered an action taken

91
Q

Ethical Principles - Autonomy

A

Emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected

92
Q

Ethical Principles - Beneficence

A

Refers to one’s duty to benefit or promote the good of others

93
Q

Ethical Principles - Nonmaleficence

A

Abstaining from negative acts toward another, includes acting carefully to avoid harm

94
Q

Ethical Principles - Justice

A

A principle based on the notion of a hypothetical social contract between free, equal, and rational persons. The concept of justice reflects a duty to treat all individuals equally and fairly

95
Q

Ethical Principles - Veracity

A

A principle that refers to one’s duty to always be truthful

96
Q

ECT Electroconvulsive therapy

A

The induction of a grand mal (generalized) seizure through the application of electrical current to the brain
Administered every other day 3X week: most clients need 6 to 12 treatments

97
Q

ECT Electroconvulsive therapy Indications

A

Severe depression or mania after medication therapy has been unsuccessful

98
Q

ECT Electroconvulsive therapy Mechanisms of Action

A

Increases in the circulating levels of serotonin, norepinephrine, and dopamine
The most common side effects are temporary memory loss and confusion

99
Q

What does every patient have the right to do?

A

Refuse medication regardless of admission status

100
Q

Legal Issues in behavioral Nursing

A

Confidentiality and Right to Privacy
Informed Consent
Restraints and Seclusion
Commitment Issues

101
Q

Confidentiality and Right to Privacy - Communication

A

Verbal

Written

102
Q

Written Communication

A

Belongs to client
Excludes child/elder abuse, communicable diseases & information under duty to warn
Privileged communication
Duty to Warn

103
Q

Informed Consent - Rights of Treatment

A

Prepared to make decision
Inform re: available treatments including risks
Consent can be withdrawn at any time

104
Q

Informed Consent - Special Considerations

A

Mentally/legally incompetent to make decision necessary to preserve life or avoid serious injury
Refusing treatment endangers the life or health of another
Emergency in which client in no condition to make decision
Child
Therapeutic Privilege

105
Q

Anger/Aggression definition

A

An emotional state that varies in intensity from mild irritation to intense fury and rage
Causes physiological changes (e.g., increased heart rate, blood pressure, and levels of biogenic amines).

106
Q

Anger/Aggression

A

Anger need not be a negative expression.
Anger is a normal human emotion that, when handled appropriately and expressed assertively, can provide an individual with a positive force to solve problems and make decisions concerning life situations.
Anger becomes a problem when it is not expressed, and when it is expressed aggressively.

107
Q

Anger/Aggression - Assessing Risk Factors

A

Prevention is the key issue in the management of

aggressive or violent behavior

108
Q

Anger/Aggression - Three factors are important considerations in identifying extent of risks

A

Past history of violence
Client diagnosis
Current behavior

109
Q

Anger/Aggression - Client diagnosis

A

Client diagnoses associated with violence:
Substance use disorders
Schizophrenia
Major depression
Bipolar disorder
Neurocognitive disorders
Antisocial, borderline, and intermittent explosive personality disorders

110
Q

Anger/Aggression - “prodromal syndrome”

A 
Rigid posture
Clenched fists and jaws
Grim, defiant affect
Talking in a rapid, raised voice
Arguing and demanding
Using profanity and threatening verbalizations
Agitation and pacing
111
Q

Restraints

A

Leather straps in emergency only
Every 10-15 minutes assess and document
Circulation, Respiration, Nutrition, Hydration, Elimination

112
Q

Seclusion

A

Patient must be informed about seclusion protocol
Must have consent from client, unless emergency
May be requested by client

113
Q

JCAHO guidelines - Restraints and Seclusion

A

Restraints can be applied, or client placed in seclusion without an order in emergency event only
Verbal or written order from MD must be received and documented within 1 hour

114
Q

Restraints and Seclusion - Orders must be renewed

A

Every 4 hours for adults
Every 2 hours for 9-17 year olds
Every hour for under 9 years old

115
Q

Restraints and Seclusion - MD must assess the client within

A

4 hours for adults, 2 hours for clients under 18

116
Q

Restraints and Seclusion - Re-evaluated every

A

8 hours for adults and every 4 hours for under 18

117
Q

Commitment Issues

A

Voluntary admissions

Involuntary commitments

118
Q

Involuntary commitments

A

Emergency commitments
The mentally ill person in need of treatment
Involuntary outpatient commitment
The gravely disabled client

119
Q

Nursing Liability

A

Malpractice and negligence
Invasion of privacy
Assault and battery
False imprisonment

120
Q

Nursing Liability - Types of lawsuits that occur in psychiatric nursing

A

Breach of confidentiality

Defamation of character (Libel, slander)

121
Q

Therapeutic Use of Self

A

“ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions”
Nurses must possess self-awareness, self- understanding, and a “philosophical belief about
life, death, and the overall human condition”

122
Q

The Johari Window

A

Open/public
Blind
Secrets
Unconscious

123
Q

Essential Conditions - Therapeutic Use of Self

A 
Rapport
Trust
Respect (Unconditional positive regard)
Genuineness
Empathy
124
Q

Phases of the Nurse-Patient Relationship

A

Pre-interaction
Orientation
Working
Termination

125
Q

Transference

A

You remind patient of someone, transferring thoughts or feelings to nurse (positive or negative)

126
Q

Countertransference

A

Patient reminds you of someone, thoughts and feelings (positive or negative) are placed on the patient

127
Q

Types of Boundaries

A

Rigid
Flexible
Enmeshed or Nonexistent

128
Q

Unhealthy boundaries

A

Negative role modeling

Abuse or neglect

129
Q

Professional Boundaries

A

Self-disclosure
Gift-giving
Touch
Friendship or romantic association

130
Q

Cultural Concepts

A

“An entire way of living, encompassing shared patterns of belief, feeling, and knowledge that guides people’s conduct and are passed down from generation to generation.” (Griffith, Gonzalez, & Blue, 2003 as cited in Townsend, 2015, pg. 96.)

131
Q

Spiritual Concepts

A

“The human quality that gives meaning and sense of purpose to an individual’s existence. Spirituality exists within each individual regardless of belief system and serves as a force for interconnectedness between self and others, the environment, and a higher power.” (Townsend, 2015, pg. 109)

132
Q

Spiritual Needs

A 
Meaning and purpose in life
Faith
Hope
Love
Forgiveness
133
Q

Risk for Spiritual Distress

A

Risk factors could be physical, psychosocial, developmental, or environmental.

134
Q

Automatic thoughts

A

Occur rapidly in response to a situation and without rational analysis
Often negative and based on erroneous logic
Also called cognitive errors a cognitive distortion

135
Q

Arbitrary inference

A

conclusion with no facts

136
Q

Overgeneralization

A

all or nothing thinking

137
Q

Dichotomous thinking

A

black or white thinking

138
Q

Selective abstraction

A

conclusion based on part of the information that is usually negative

139
Q

Magnification

A

exaggerating the negative

140
Q

Minimization

A

undervaluing the positive

141
Q

Catastrophic thinking

A

always thinking the worst will happen

142
Q

Personalization

A

taking responsibility for all situations

143
Q

Socratic Questioning/dialogue

A

Question the client to help then come to a more realistic point of view

144
Q

Guided relaxation

A

Deep breathing or meditation activity to help the individuals recognize their ability to control their thoughts

145
Q

Role play/ behavioral rehearsal

A

A situation is played out to help the client see the reality of the events and identify their feelings

146
Q

Generating Alternatives

A

Broader range of possibilities why someone is acting the way that they are

147
Q

Examining the evidence

A

Looking at the facts

148
Q

Decatastrophizing

A

Bringing events into proper perspective

149
Q

Reattribution

A

Not to blame for all adverse life events

150
Q

Dysfunctional Thought recordings

A

Rating emotional response

151
Q

Cognitive rehearsal

A

Plan ahead for potential automatic thoughts

152
Q

Cognitive Restructuring (reframing)

A

Replace the negative with positive

153
Q

Behavioral Therapy

A

Behavior is considered to be maladaptive
-If it is age-inappropriate
-If it interferes with social and occupational functioning
-If it is misunderstood by others in terms of cultural inappropriateness
The basic assumption of behavioral therapy is that problematic behaviors are learned and, therefore, can be unlearned

154
Q

Techniques used to modify maladaptive behavior patterns by reinforcing more adaptive behaviors

A 
Modeling
Token system
Time out
Desensitization
Cognitive Behavioral Therapy (CBT)
155
Q

Cognitive Behavioral Therapy (CBT)

A

The client learns to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behavior accordingly.

156
Q

Dialectical Behavioral Therapy (DBT)

A

Intense work with a therapist to help the client change unhealthy or disruptive behavior by changing the view of the world. A dialectic thinker would consider multiple factors in the world before integrating them into their personal way of thinking

157
Q

Well being therapy

A

journal positive events

158
Q

Positive Psychotherapy

A

build positive emotions

159
Q

Identify signature strength

A

personal assessment

160
Q

Gratitude Visit

A

letter, art, phone call, visit…

161
Q

Gratitude Therapy

A

I am thankful for…

162
Q

Daily Affirmations

A

Focus on positives not negatives

163
Q

Build strengths to foster hope

A

small success gives hope for continued success

164
Q

Family

A

A family is whoever they say they are and can be determined by choice or biology

165
Q

Stages of Family Development

A 
Single Young Adult
Newly Married
The Family With Young Children
The Family With Adolescents
The Family Launching Grown Children
The Family in Later Life
166
Q

6 Elements of Family Functioning

A 
Communication
Self-Concept Reinforcement
Family Members Expectations
Handling Differences
Family Interactional Patterns
Family Climate
167
Q

Dysfunctional Family Roles - Addict

A

Trouble, embarrassment

168
Q

Dysfunctional Family Roles - Enabler

A

Super responsible

169
Q

Dysfunctional Family Roles - Adult child/Hero

A

Pride

170
Q

Dysfunctional Family Roles - Scapegoat

A

Diverts attention

171
Q

Dysfunctional Family Roles - Lost child

A

Relief

172
Q

Dysfunctional Family Roles - Mascot

A

Fun and humor

173
Q

Family Systems Theory

A

Differentiation of self

174
Q

Structural Model

A

Facilitate change in the family structure, or transactional pattern that are contributing to the dysfunction in the family

175
Q

Strategic Model

A

Enhanced Communication

176
Q

Double-bind Communication

A

Creating no win situations

177
Q

Pseudo- mutuality

A

Creating the facade that you enjoy one another’s company and like being together

178
Q

Pseudohostility

A

Creating the facade of chronic conflict and alienation in order to deny feelings of tenderness and intimacy

179
Q

Marital Schism

A

Chronic disequilibrium with recurrent threats of separation

Parents compete for the loyalty of the children

180
Q

Marital Skew

A

One partner dominates and has control over the other

181
Q

Strategic Model Techniques - Paradoxical intervention

A

Requesting that the family continue to engage in the behavior they are trying to change

182
Q

Strategic Model Techniques - Reframing

A

Changing the conceptual and/or emotional setting or viewpoint in relation to which situation is experienced and placing it in another frame that changes it’s entire meaning

NUR 140 (7 decks)

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