W1_TNPR_ASEPTIC Flashcards
Phases of TNPR
Pre-interaction Phase
Phase1: Orientation
Working Phase (Phase2&3)
Phase2: Identification
Phase3: Exploitation
Termination Phase
Phase4: Resolution
ASEPTIC
Appearance & Behaviour
Speech
Emotion
Perception
Thought
Insight
Cognitive
ASEPTIC
- Appeance/ Behavior
Dressing,
Grooming
Hygiene,
BMI
Prominent physical abnormalities
Gait
Postures
ASEPTIC
- Behavior
Behavior
Eye contact
Facial expression
Attitude
Psychomotor activity
Movements
Abnormal behaviours
ASEPTIC
- Speech
Rate
Fluency and Rhythm
Tone of Voice
Volume
Quantity
ASEPTIC
- Emotion (Mood)
Mood (inquired)
Pt’s words describing his/her sustained internal emotional state.
**How can we assess ? **
ask pt questions:
“How are you feeling?”
“What is your current mood?”
place pt’s responds in quotes:
“ I’m happy” “Good” “Happy” “Sad”
How can we better ask the mood?
rate on a scale (1-10)
ASEPTIC
- Emotion (Affect)
Affect (Observed)
Appropriateness to situation/congruence with mood
(mood congruent vs. mood incongruent)
**Quality: **
euthymic (normal), depressed, euphoric (elevated, elated), anxious, angry, etc…
Range:
broad (full) vs. restricted
Intensity:
Blunted, flat
Stability:
stable vs. labile (Fluctuations)
Restricted/ Broad/ Blunted/ Flat/ Inappropriate Affect
Inappropriate and flat are often a/w schizophrenia
Labile mood and labile affect seen with patients with damaged brain function.
ASEPTIC
- Perception
1) Hallucinations:
perceptual experiences with no external stimuli (totally imagined sensory perceptions)
- Auditory, Visual, Tactile, Gustatory, Olfactory
2) Illusions:
misinterpretation of sensory stimuli
3) Obsessions:
recurrent persistent unwanted thoughts, impulses, images
4) De-personalization,
which is a patients’ feelings that he is not himself, that he is strange, or that there is something different about himself that he cannot account for,
5) Derealisation,
which expresses a patients’ feeling that the environment is somehow different or strange but she cannot account for these changes.
ASEPTIC
- Thought Process
**Thought Process (Inq/ Obs) **
1) Normal / Abnormal
2) Loose Associations:
— Tangential/ Circumstantial/ Flight of Ideas/ Clang associations
—Other Unusual Speech
Echolalia, Neologism,
Perseveration, Thought block, Word Salad
ASEPTIC
- Thought Content
**Thought Content **
1) Verbalizations
*Incl. Delusions, Obsessions,
Suicidal & Homicidal thoughts
Phobias, Déjà Vu
2) Primary delusions are unrelated to other disorders.
3) Secondary delusions are based on other psychological experiences.
These include delusions derived from hallucinations, other delusions, and morbid affective states.
Types:
Jealousy, Erotomania, Grandiose, Somatization, Persecutory: others are trying to cause harm most common
often referred to as a paranoid delusion, but that is a misuse of the word paranoid, which is a more generic in meaning and does not imply a specific type of delusion.
4) Ideas of reference
Ideas of influence
5) Thought broadcasting/ insertion/ withdrawal
ASEPTIC
- Insight & Judgement
Insight
Awareness of one’s own illness and/or situation
Intact (full), Impaired (partial), No insight (poor)
Judgement
(inquired/ observed)
An estimate of the patient’s real-life problem-solving skills.
Is the patient realistic about limitations and life circumstances?
The ability of cooperate with treatment?
ASEPTIC
- Cognition
What do we check?
- Altered level of consciousness (observed)
- Orientation (inquired)
(Time, Place, Person) - Memory (inquired)
- Concentration (Inq./ obs)
- General knowledge (Inq./ obs)
- Abstract Reasoning (Inq./ obs)
What is the main goal in the Pre-interaction phase
1) Nurse to conduct self-assessment to assess own knowledge, skills, feelings, attitudes, prejudice,
2) Data collection
3) Prepare goals of the TNPR
Goal of the 1st phase of TNPR
Starts with O.
1) Building trust
2) Establish TNPR,
- T,P,P, Duration
3) Establish confidentiality
Goals in the Working phase of TNPR
- Identification
- Exploitation
Working Phase
- Promote self-esteem
- Overcoming resistance
Identification
Unconditional Acceptance
Assist in expression of needs & feelings
Exploitation
Continues assessment
meets needs as they emerge
Identifies positive factors
Facilitate forward movement of personality
Deals with therapeutic impasse
Goals in termination phase of TNPR
Sustains relationship as long as the client feels necessary.
Promote healthy interaction to assist with goal planning
Self-care
Preventive measures
Uses community agencies
Verbal Communication Skills
- Allow client to take initiative in choosing topics
- Restating
- Clarification
- Reflection of feelings
- Focusing
- Questioning
- Exploring
- Theme identification
- Silence
- Informing (Giving information)
Presenting reality
- Offer correct information when client misinterpreted reality
- Formulating a plan of action
- Suggesting collaboration
Summarizing
Non-therapeutic Communication & Technique
Common mistakes
- Defending *(I’m sure she has your best interest at heart) *This statement implies that the client has no right to express impressions, opinions or feelings.
- Agreeing/ Disagreeing (I agree/think/ don’t think you should do that)
- Reassuring* (e.g. everything will be alright) *
- Giving approval (That’s good, I’m glad that..)
- Giving literal responses (Try to avoid potential triggers)
-
Indicating existence of an external source
“What makes you/ made you/ who told you..”
instead –> “What happened?” - Interpreting (Do not interpret on behalf of the client)
-
Introducing an unrelated topic
(avoidance of client’s existing topic, only the client can identify or confirm the presence of feelings) -
Probing (e.g. tell me .. )
Requesting an explanation* (e.g. why do you think that?)* -
Testing
(e.g. do you know what kind of hospital is woodbridge?) - Using denial* (e.g. don’t be silly)*
Others
Advising
Belittling feelings expressed
Rejecting
Challenging
Making stereotyped comments
What are some of the therapeutic impasses?
- resistance in exploring feelings & experiences
- disagreement in conflict resolution
- unresolved feelings
- Unhealthy relationshio
- unsuccessful therapeutic intervention or modality
- Transference
- Counter-transference
- Boundary violation
What is the definition of tangential associations in mental health?
Tangential associations refer to a thought process where a person starts to respond to a question but then veers off-topic, providing irrelevant information.
True or False: Circumferential associations keep the conversation focused on the main topic.
False
Fill in the blank: Loose associations often result in ____ between ideas that may not be logically connected.
jumps
What is a common mental health condition where tangential associations may be observed?
Schizophrenia
Multiple choice: Which of the following is an example of a circumferential association?
A patient discussing their favorite movie but gradually shifting to unrelated topics like food and weather.
What distinguishes loose associations from tangential associations?
Loose associations involve a lack of logical connection between thoughts, while tangential associations may still have some relevance but drift away from the main topic.
True or False: Loose associations are always indicative of a severe mental illness.
False
Provide an example of a situation where tangential associations might occur.
A person might start talking about their job but then move on to discussing their childhood pets without a clear link.
What therapeutic approach might help address circumferential associations?
Cognitive Behavioral Therapy (CBT)
Multiple choice: Which of the following best describes loose associations?
Thoughts that are loosely connected and may seem random or unrelated.
What role does active listening play in managing tangential associations?
Active listening helps therapists redirect the conversation back to relevant topics.
Fill in the blank: Circumferential associations can often lead to ____ conversations.
circular
How can a therapist identify loose associations during a session?
By noting when a client’s responses lack coherence or logical flow.
True or False: Individuals with bipolar disorder may exhibit tangential thinking during manic episodes.
True
What is one potential benefit of understanding these types of associations in therapy?
It can help in tailoring treatment strategies to improve communication and understanding.
Multiple choice: What is a characteristic of tangential associations?
Responses that diverge from the main topic without clear relevance.
What mental health disorder is most commonly associated with circumferential thinking?
Obsessive-Compulsive Disorder (OCD)
Fill in the blank: Loose associations can be a symptom of ____ disorders.
psychotic
What is the primary challenge for therapists when dealing with circumferential associations?
Keeping the session focused and productive.
True or False: All patients exhibit tangential or loose associations at some point in therapy.
False
What is one technique used to manage loose associations in therapy?
Summarizing or paraphrasing the client’s thoughts to clarify and refocus.
Multiple choice: Which of the following is NOT a type of associative thinking?
Linear associations
What is the significance of recognizing these associations in a clinical setting?
It aids in diagnosing and understanding the patient’s thought processes.
Fill in the blank: Tangential associations can sometimes lead to ____ during therapy sessions.
frustration
What type of association might a therapist encourage to enhance clarity in communication?
Linear associations
What is a tangential association in clinical psychology?
A tangential association is when a person’s thoughts or speech drift off topic but remain somewhat related to the original subject.
True or False: Circumferential associations involve returning to the original topic after digressing.
True
Fill in the blank: Loose associations are characterized by _____ between ideas.
weak connections
Which type of association is most likely to confuse the listener with unrelated ideas?
Loose associations
Provide an example of a tangential association.
A patient discussing their recent vacation but suddenly mentioning a movie they saw that is unrelated to travel.
What is the main difference between tangential and circumferential associations?
Tangential associations drift off-topic without returning, while circumferential associations eventually circle back to the original topic.
Multiple Choice: Which type of association is most organized? A) Tangential B) Circumferential C) Loose
B) Circumferential
True or False: Loose associations can indicate a thought disorder.
True
What might a clinician observe in a patient with loose associations?
Disorganized speech that jumps from one idea to another with little coherence.
Give an example of a circumferential association.
A patient who starts talking about their job, then mentions a work event, and eventually returns to discussing their job responsibilities.
Which association type is most likely to be seen in schizophrenia?
Loose associations
Fill in the blank: In a _____ association, the speaker may appear to have a coherent conversation but frequently digresses.
circumferential
What is the primary concern with tangential associations in a clinical setting?
They can lead to ineffective communication and misunderstanding between the patient and clinician.
Multiple Choice: Which association is least structured? A) Tangential B) Circumferential C) Loose
C) Loose
Describe a scenario where a tangential association might occur.
A patient discussing their anxiety might suddenly start talking about their favorite hobbies without a clear connection.
True or False: Circumferential associations help clarify the main topic.
True
What is a common treatment focus for patients exhibiting loose associations?
Improving thought organization and clarity in communication.
Fill in the blank: Circumferential associations often involve _____ before returning to the main topic.
digressions
Name one disorder where circumferential associations might be observed.
Bipolar disorder during a manic episode.
True or False: Loose associations are considered a typical cognitive pattern.
False
How can clinicians differentiate between tangential and loose associations?
By assessing the degree of relevance and coherence in the patient’s speech.
What type of association might a patient exhibit if they frequently change topics without any apparent connection?
Loose associations
Multiple Choice: Which association type returns to the original topic after several deviations? A) Tangential B) Circumferential C) Loose
B) Circumferential
What role does context play in understanding associations in clinical settings?
Context helps determine the relevance and coherence of the associations made by the patient.
Fill in the blank: A patient with _____ associations may be difficult to follow during a conversation.
loose
Which type of thought process might lead to a patient discussing unrelated topics like food and weather while talking about their job?
Tangential associations
