Unit 1 Flashcards
Mental health
Successful mental functioning leads to productive activities.
Ability to adapt to change
Cope with adversity
Mental illness
Maladaptive responses to stressors from the internal or external environment that are incongruent with local or cultural norms…effects peoples basic needs
Delusion
False fixed beliefs
TNI’s for delusion?
- Listen
- Acknowledge
- Distract with reality based topic
Hallucination?
False sensory perception. No stimuli…can involve all 5senses
Psychosis
Non-reality base thinking that includes hallucinations and delusions and disorganized thought
What is the difference between mental health and mental illness?
Mental illness affects people’s basic needs
What theories relate to the etiology of mental illness?
Hereditary
- Biochemical neurotransmitters
- Physical illnesses..MS, stroke
- Environmental -poverty, socioeconomic status
What is the patients legal status based on?
The type of admission..voluntary or involuntary
What is involuntary admission?
Clients held against their will due to being dangerous to self or others.
What is treatment over objection?
Court ordered tx to inpatient or outpatient. When client refuses care a health team determines it is necessary for the clients well being and improvement.
What are court ordered inpatient settings?
Hospitalization
Can force medications if inpatient
Describe court ordered AOT?
Court ordered assisted outpatient treatment is a 6 month order, which can be renewed.
2. Pts with ongoing illness and had at least 2 involuntary hospitalization so within the past 2 yrs.
What is primary prevention?
Identifying and treating Risk Factors in healthy people!
What is secondary prevention?
Early identification of problems and prompt initiation of treatment. Recognizing symptoms and referral for tx.
What is tertiary prevention?
Long tern after care, resocialization, recovery..reducing residual defects
Give examples of primary prevention?
Teaching parenting skills
Teach stress management
Provide education and support to people in transitional periods..widow, new retires,
Describe trust in a helping behavior.
Feeling of having confidence in a persons presence, reliability
Describe respect in a helping behavior.
Nonjudgmental , believe in the worth of the individual regardless of unacceptable behavior
Describe genuiness in a helping behavior
Nurses ability to be real, open and honest
Describe self understanding as helping behavior
Ability to recognize and acknowledge ones own feelings and be able to your reaction can affect the situation
Describe structuring as a helping behavior
Develop a relationship with client by establishing the amount of time, providing direction and purpose for the therapeutic relationship
Describe empathy
Able to understand the situation from the clients point of view.
Describe self disclosure
Intentional boundary crossing,revealing own personal information-thoughts, feelings. Can only be done to help pt
Describe concretness
Using specific terms when discussing feelings, experiences, and behaviors; avoid using general terms
Describe immediacy in helping behaviors
The ability to work with here and now problems
Describe attentive listening
Listening using all senses, paying attention to verbal and non warble messages
Describe offering self
Being available to client
What is reflection?
Repeat what the client has said.
Reflection of feelings is
Verbalizing the implied feeling expressed by the content of pts communication
Give an example of broad opening
What would you like to discuss?
Where would you like to begin?
Closed ended question is looking for what?
Yes or no answer
What is meant by seeking consensual validation?
Searching for mutual understanding, determining if nurse has understood the client
Give an example of consensual validation.
” tell me whether my understanding agrees with yours…nurse describes what she thinks she heard pt say
What is voicing doubt?
Expressing uncertainty as to the reality of the clients perceptions.
When is voicing doubt used?
Usually with clients experiencing delusional thinking.
Describe a general lead
Gives encouragement to the client to continue
Give examples of general leads
Go on. And then? I see..... Hmm..... Tell me more about...
What is providing feedback?
Sharing ones perception of the clients behavior.
What is this statement an example if? Your contributions helped the group work together.
You interrupted the group leader
Providing feedback
What therapeutic technique is used in this example? During the last half hour we have talked about your plans which are…..
You said that……
Summarizing
When do u use focusing?
When concentrating on a single point by using questions who, what, where, and how
What is the difference btn seeking consensual validation and seeking clarification?
Validation is nurse describes what she thinks she heard client say.
Clarification is to make the meaning clear..when you say…..do you mean…..
What is confrontation?
Identifying a discrepancy between what is said and what was done. “You said you were going to group today but you didn’t.”
Describe stereotyping.
Generalized beliefs about groups, negates their. Uniqueness as individuals
Describe defensive
Attempt to protect something or someone from negative comments
What is challenging?
Demanding proof.
What is meant by probing?
Persistent questioning of pt. Using why or “what makes you” or “what made you”
Describe a social relationship.
No structure No time frame Friends and family No boundaries Meets both parties needs Use sympathy
Describe a therapeutic relationship
Time limit-definite end Common goals and purpose Nurse client Planned Meets the needs of the client only Use of empathy
What are the 3 phases of the nurse client relationship?
Orientation, working, termination
What are typical tasks for the orientation phase of a nurse client relationship?
Creating an environment of trust and rapport
2. Establishing contract for intervention, expectations and responsibilities for both parties
3. Gather assessment data
4 identify strengths and limitations
5. Formulating nursing dx
6. Set goals
7. Explore feelings of both
Describe the working phase in a nurse client relationship
Maintain trust and rapport
2. Promote clients insight and perception of reality
3. Problem solving
4. Overcoming resistance as level of anxiety increases in response to discussion of painful issues
Continuously evaluating progress toward goal attainment.
Describe the termination phase of the nurse client relationship
Progress has been made toward attainment of goals
- Plan for continuing care or assistance during stressful events is mutually established by both parties
- Feelings about termination are explored. Nurse should share feelings of sadness and loss…pt learns they are acceptable feelings.
What is transference?
A client unconsciously displaces feelings to the nurse if she reminds the pt of someone from the past. Can have anger or overwhelming affection. Need to sort out feelings or therapy won’t work with this nurse.
What is counter transference?
Nurse behavior and emotional response to the client maybe related to unresolved feelings toward someone from her past. Nurse over identifies with pts feelings. Could develop a social or personal relationship.
Why is counter transference bad?
Nurse attempts to rescue or give advice
2. Encourages and promotes client dependence
3. Nurses anger can bring feelings of discuss toward pt
4. Nurse is bored and apathetic in sessions
5. Nurse has difficulty setting limits on pts behavior
6. Nurse defends pt behaviors to staff
Should be terminated
Define mood.
An emotion that may have major influence on a persons perception of the world.
What is meant by affect?
The emotional REACTION associated with an experience.
Describe insight
The ability to solve problems and make decisions.
Knowledge about self awareness of limitations. Awareness of consequences of actions. Awareness of illness.
Give examples of thought content
Delusions-unrealistic ideas or beliefs
- Suicidal or homicidal ideas
- Obsessions-magical thinking
- Paranoia
What is thought process?
Flight of ideas, continuous and rapid
Associative looseness-shift from 1 unrelated topic to another
What is ineffective coping?
You are unable to correctly assess the stressors, and/or inability to use available resources.
Define complicated grieving
Occurs after the death of a significant other where grieving process fails to follow the normal expectations and pt becomes functionally impaired.
What is the difference between complicated grieving and risk for complicated grieving?
Complicated grieving is already becoming functionally impaired where risk for, it could happen.
What is ineffective self health management
Unable to integrate a daily therapeutic regime for treating illness and it’s sequela to meet specific health care goals.
What is the difference between Noncompliance and ineffective self health management?
Non compliance is more of a behavioral problem where ineffective self health management is unable to maintain health for financial, physical or transportation reasons
Explain the nursing dx Hopelessness.
Subjective state in which person sees limited or no alternatives or personal choices available and is unable to mobilize energy on own behalf.
What is powerlessness?
Perception that ones own actions will not significantly affect an outcome; a perceived lack of control over the current situation or immediate happening.
What is risk for powerlessness?
Being in a situation where powerlessness could happen, illness, acute injury, aging, dying
Define chronic low self esteem
Long standing negative feelings about yourself and your abilities.
What is situational low self esteem?
Development of negative perception of self worth in response to a current situation.
Describe self mutilation
Deliberate hurting yourself causing non-fatal injury to attain relief of tension.
What would be risks for self mutilation?
Adolescence, autistic, battered child, developmental disorders, sexually abused child, childhood surgery
Describe risk for loneliness?
At risk for experiencing discomfort associated with a desire or need for more contact with others.
What is meant by restraints
A set of leather straps,
Manual restrain
Medicated restraint
When are restraints used?
For those who’s behavior is out of control and who poses a threat to others and themselves
What is meant by seclusion?
A type of physical restraint in which the client is confined alone in a room.
What is verbal contracting?
The RN and pt set up an agreement if the pt experiences symptoms, they will tell the RN before doing anything unsafe.
What is verbal structuring?
Enforce rules consistently
1. Be sure pt is aware of rules
2.
How to keep the unit safe?
- Nurse maintainers their focus outward on the unit.
- Being aware at all times
- Keep an eye on emotional tone of the milieu
- Notice pts sudden behavioral changes
What is 1:1 supervision?
Continuous eyes on client observation. Observer must be within 6 feet of client at all times
What are the precaution guidelines that are taken in regards to a violent pt?
2 staff members must observe pt when in groups observation every 15 minutes with documentation.
Must have 1:1 supervision when using harmful objects.
What are the precautions guidelines that are taken for suicide?
Observation every 15 minutes with documentation
1:1 supervision when using harmful objects
What are the precaution guidelines that are taken for escape?
No lingering in doorways
Check unfamiliar faces
Know which pts are on escape precautions
Use specific staff entrance
What are community limits?
May go off hospital grounds
What are hospital limits?
May leave the locked unit but must remain on hospital grounds.. Scheduled in advance and only lasts 20 minutes
What are unit limits?
Client can not leave the unit
When is a show of force done?
When pt looks like they are losing control.
What is a show of force?
Many staff will gather around the pt to escort them to seclusion or apply restraints.
What are the guidelines for seclusion?
Client must remain in locked room, with little furniture or belongings.
- Pt usually puts on hospital gown instead of personal clothing
- Camera surveillance
- At least 2staff need to be present while opening the door
- Every 15 min checks with doc.
- No conversations with client in seclusion
What are the guidelines for restraint?
Restrained in bed by leather straps
- 4 point restraints are used
- Includes extensive 1:1 supervision by a staff member
- Every 15 min RN checks with documentation
- Monitor pt respirations closely
- Must attend to clients basic needs
What is meant by milieu therapy
Structuring of the environment in order to effect behavioral changes and improve psychological health and functioning.
How does milieu therapy help?
Enhances socialization competency and interpersonal relationship awareness.
What is psychotherapy?
Assists the pt to more effectively deal with emotional and social problems.
What are the goals of psychotherapy?
- Reducing pt discomfort or pain(emotional, psychosocial, or physical)
- Improve the clients social functioning
- Improving the pts ability to perform or act appropriately
Define group therapy
A number of clients meet to share, gain personal insight, and improve interpersonal coping stratagies
What are the functions of a group?
- Socialization
- Support
- Task completion
- Camaraderie
- Informational
- Normative
- Empowerment
- Governance
What is family therapy?
Focus of treatment is on the family as a unit. Family members try to identify and change problematic, meal adaptive, self defeating, repetitive patterns
What is the identified patient?
Family member having symptoms of behavioral disturbance or illness.
What is scapegoating?
When I family member is viewed as different and is singled out and blamed for any problem or trouble that occurs.
What is double blind communication?
Occurs when a person receives simultaneous yet contradictory messages…ie. go ahead and go skiing but don’t blame me if you break your leg.
What describes family dysfunction?
Fails to meet emotional, physical, intellectual,social and spiritual needs of its members.
What is the purpose of behavioral therapy?
Assist the client to change mal adaptive or undesirable behavior by manipulating the environment and behavior. Believe that behavior is learned and can be relearned.
What are the goals of behavioral therapy?
To identify the mal adaptive or undesirable behavior in order to bring about behavioral change. Use positive reinforcement.
What is the purpose of cognitive therapy?
Assist pt to control thought distortions that are the cause of development and continuation of emotional disorders
What are the goals of cognitive therapy?
Obtain symptom relief as quickly as possible
Assist to identify dysfunctional patterns of thinking
Guide the pt to evidence and logic to validate dysfunctional thinking.
What is the difference in behavioral therapy and cognitive therapy?
Behavioral-behavior is learned and can be relearned. Change in environment and behavior will change behavior.
Cognitive- Change in thoughts will change behavior.
Define crisis
A sudden event in ones life that disturbs homeostasis, which usual coping mechanisms can’t resolve the problem.
What is a crisis intervention?
The therapist becomes part of the pts life situation. Because of the pts emotional state, they are unable to problem solve. Needs guidance to find the resources needed to solve the problem.
What is maturational/developmental crisis?
Crisis that occurred as a response to situations that trigger emotions related to unresolved conflicts in ones life. Internal conflicts
What is a dispositional (situational) crisis?
An acute response to an external situational stressor.
What are the phases in the development of a crisis?
Phase 1- pt is exposed to a precipitating stressor. Increase anxiety
Phase 2- previous problem techniques aren’t working..anxiety increases further.
Phase 3.-all possible resources are called on( internal and external) to resolve the problem and relieve discomfort
Phase 4- if resolution does not occur..tension increases to its breaking point.
What does phase 4 of a crisis look like?
Cognitive functions are disordered
Emotions are labile
Behavior may reflect the presence of psychotic thinking.
List the major categories of psychotropic medications.
Antidepressants Anxiolytics -anti anxiety Anti-psychotic (neuroleptic) Anti manic agents (mood stabilizing) Stimulant medications
Name sone TNI’s to maximize medication compliance.
Develop an alliance with pt and family..avoid being judge mental
- Determine reason why they are not compliant
- Assess pts knowledge about med
- Teach pt/family about med..benefits, side effects, management of side effects
- Admin longer acting meds to decrease frequency
- Make med regimen as simple as possible
- arrange for supervision of medication
- Use plastic med-ready boxes
- Arrange for support in obtaining meds (financial, transportation)
Define ego defense mechanisms
consciously or unconsciously are protective devices for the ego in an effort to relieve mild to moderate anxiety.
What defense mechanisms are used consciously?
Suppression
What are the two main emotions we repress?
Anger and sexuality
Define repression
Involuntarily blocking unpleasant feelings and emotions
What is denial?
Refusing to acknowledge the existence of a real situation or feelings associated with it.
What is introjection?
Integrating the beliefs and values of another person into your own ego structure
What is compensation?
Covering up a real or perceived weakness by emphasizing a trait they consider more desirable.
What is displacement.
Placing feelings from one target onto a another.
What is isolation?
Separating a thought or memory from the feeling associated with it.
What is suppression?
Voluntary blocking of unpleasant feelings and experiences from ones awareness.
What is projection?
Attributing feelings or impulses unacceptable to you onto another person.
What is conversion disorder?
Converts stress into a physical disorder. No medical reason for symptoms
What is reaction formation?
Preventing undesirable thoughts from being expressed by exaggerating opposite thoughts.
What is sublimation?
Transforming drives or impulses that are personally or socially unacceptable into something constructive
What is rationalization?
Making excuses or formulating logical reasons to justify an unacceptable feeling or behavior.
What is identification?
An attempt to increase self worth by acquiring certain attributes or characteristics of someone you admire
What is regression?
Responding to stress by retreating to an earlier level of development for more comfort levels
What is undoing?
Trying to make up for a wrong doing.
When are ego defense mechanisms used?
When a person is experiencing mild to moderate anxiety.
What is the purpose of conversion defense mechanisms?
Primary gain
Secondary gain and
Tertiary gain
What is primary gain?
Relief of unconscious conflict and anxiety.
What is secondary gain?
Perceived benefits of being sick…family attention
What is meant by tertiary gain?
Shift in family focus from a conflict to now concern for “sick” family member.
What are the risk factors for anxiety disorders?
Hereditary
Environmental
Physiological-chemical
What does a nurse need to remember when working with pts who have anxiety or anxiety diorders?
Anxiety is contagious
May become frustrated, afraid, sad you can’t help
What is seen with mild anxiety?
Seldom a problem for individuals.
Tension in response to day to day living
Sharpens senses, increases motivation
What is seen in a person with moderate anxiety?
Still able to focus
Movements start
Hand-wringing, fidget, foot tapping
Decreased eye contact
What is seen in a patient with severe anxiety?
Movements are severe
Focus narrows to one specific issue
Mal adaptive
Physically…headaches, palpitations, insomnia
Emotional symptoms…confusion, dread, horror
What is seen in a pt with panic anxiety?
Inability to communicate, move or function
Difficulty breathing
What are the TNI’s for mild to moderate anxiety?
- Make observation …you’re pacing a lot.
- Use distraction
- Encourage thoughts/feelings/and discussions of stressors and alternate responses when client is ready.
What are the TNI’s for someone with severe-panic anxiety
Stay in a calm manner
2. Use a simple, direct, firm, concrete approach
3. Offer self..stay with or walk with client
4. Monitor them
5. Minimize environmental stimuli
medicate if needed.
What is a panic disorder?
Recurrent panic attacks that are unpredictable brought on by intense apprehension, fear, terror. Impending doom. Accompanied by physical discomfort. Do not happen immediately around exposure to anxiety situation.
Define phobia
Fear cued by the presence or anticipation of a specific object or situation…provokes an immediate anxiety attack even though pt knows it is excessive.
What is obsessive-compulsive disorder?
The presence of both obsession and compulsion which the severity causes distress in social, occupational, or other areas of functioning. Pt knows it is unreasonable but because of relief felt by it, is compelled to continue the act.
What is obsession?
Persistent thoughts, impulses or images experienced as stressful and intrusive. Can’t be stopped by logic or reasoning.
What are compulsions
Repetitive behavior or thoughts done to prevent or reduce stress or a dreaded event. Person feels driven to perform actions even though they know it is excessive.
What is generalized anxiety diorder.
Persistent, unrealistic excessive anxiety and worry that have occurred more days than not in 6 months. Cannot be attributed to any specific organic factors….caffeine intoxication or hyperthyroidism.
What is PTSD?
A reaction to an extreme trauma
What is somatic symptom disorder?
Syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and long term seeking of health care assistance.
What is dissociative amnesia?
Inability to recall important autobiographical information, usually of a traumatic or stressful nature. Selective amnesia for specific events
What is dissociative identity disorder
Disruption of identity characterized by 2 or more distinct personality states.
What is depersonalization disorder?
Emotional and physical numbing. Experiences of unreality, detachment or being an outside observer with respect to ones thoughts feelings and body.
What is derealization disorder?
Experiences of unreality or detachment with respect to surroundings.( individuals or objects are experienced as unreal, dream like, foggy lifeless or visually distorted).
What is the classification for lorazepam (Ativan)?
Anti anxiety, sedative, hypnotic
What is lorazepam used for?
- Anxiety
- Irritability in psychiatric or organic disorders
- Preop
- Insomnia
- endoscopic procedures
- Status epileptics
What are the side effects of lorazepam?
- Dizzyness
- Drowsiness
- Confusion
- orthostatic hypotension
- anxiety
- Depression
- Blurred vision
- Tinnitus
- Mydriasis
What are the nursing implications for lorazepam?
Assess; anxiety, mental status, mood, sensorium, affect, sleeping pattern, suicidal tendencies
Renal/hepatic blood levels if on high dose
Physical dependency, withdrawal symptoms
What are the nursing interventions for lorazepam?
- Assist with ambulation at first
- Check to see if swallowed
- Refrigerate parental form
- May be taken with food
- Don’t take for everyday stress or longer than 4 months
- Habit forming
- Avoid OTC meds cold, hay fever, cough
- Avoid driving
- Avoid alcohol and other psychotropic meds I less otherwise directed
- Don’t stop abruptly
- Rise slowly
- Use child birth
What is the classification of clonazepam?
Anticonvulsant
What are the uses for clonazepam?
Absence( petit mal seizure), panic disorder, myoclonic seizures, akinetic (loss of motor function)
What are the side effects of clonazepam?
Insomnia, suicidal tendincies, behavioral changes, slurred speech,increased salivation, nystagmus, diplopia, abnormal eye movements, nausea, constipation, respiratory depression,
What are the nursing implications for clonazepam?
Carry ID bracelet with name, products taken,condition,prescribers name and phone number
- Avoid driving
- Avoid alcohol
- dont discontinue quickly
