week 2 Flashcards
Review of systems
physical related
PSYCH no head to toe but do a MSE
what does the nurse look for in a psychosocial assessment
stressors that make the mental illness worse, financial, family etc
self-awareness assessment
we do this ourselves so that were aware of our own personal biases
validating assessment
make sure what the pt is saying is what the chart says
basically ask the pt what brought them in and match it to the chart
Mental status examination
mostly observational
can help to see if the pt is improving
steps of nursing process
- assessment
- nursing diagnosis
- outcome identification
- Planning
- implementation
- evaluation
- documentation
what would be an example of outcome identification
pt will identify 3 triggers by the end of shift
pt will not harm self
what does SMART goals stand for
Specific
Measurable
Achievable
Realistic
Timely
what is milieu therapy
reducing stimuli
make a safe and therapeutic environment
factors that affect communication
personal factors
environmental factors
relationship factors
what are examples of environmental factors that can affect communication
too loud
no phone
lack of privacy
relationship factors
speaking differently to providers compared to friends
verbal communication
straight forward or distorted communication.
we lieeeee
nonverbal communication
most of what we say is through body
body gestures
tone and pitch
cues
examples of cues
someone looks disheveled
Adam Sandler
incongruent
actions and words do not match
double bind or mixed message
congruent
actions and words match
therapeutic communication
helps us to allow the pt to feel safe
always goal directed
therapeutic technique: therapeutic silence
provides meaningful moments of reflection for both participants
a listening response not the absence of communcation and allows the pt to break the silence
therapeutic technique: Active listening
listening attentively
make eye contact
lean forward
providing feedback
seeing if there’s any incongruent messages
therapeutic techniques: clarifying techniques
help to ensure that your interpretation of the message is what the pt meant to say
examples of clarifying techniques
paraphrasing
restating
reflecting
making observations
exploring
what if
miracle question
example of reflecting
well what do you think
do not give advice
example of making observations
I noticed you took a shower today
I noticed you applied for that job
example of exploring
tell me more
what if and miracle questions
help pts with problem solving and coping skills
do not ask closed ended questions yes, no
instead ask how was your sleep
allows the pt to share more information.
never give advice
encourage them to make their own decisions and let them list the pros and cons
do not give false reassurance
“everything will be alright”
instead say what specifically are you worried about
what do you think could go wrong
clarification
never ask why questions
Therapeutic: give broad openings
“tell me reasons that led up to you not taking your medication
never minimize feelings
I know what you mean
therapeutic: empathize
you must me feeling upset
never make valued judgements
Therapeutic: make observation
I noticed you still smoke
do not ask excessive questions
therapeutic: clarifiying
tell me about you eating habits since you’ve been depressed
do not disapprove
I disagree with that
therapeutic: exploring
that’s an interesting point of view, hoe did you get to that conclusion
never give approval/agreeing
I’m proud of you for applying for that job
pt becomes to be dependent on other, pt needs to do things for themselves
I notice that you applied for that job
do not change the subject
therapeutic: validating and exploring
this sounds serious have you thought of harming yourself
only use yes or no if it is in regards to safety
have you thought of harming yourself
this is the only time its okay
therapeutic relationships
the basis of all psychiatric nursing treatment approaches
4 core concepts of nurse-patient relationship
- dignity and respect
- information sharing
- patient/family participation
- pt feels heard and understood
therapeutic relationship goals
- facilitating
- assisting (ADLS)
- helping (cope skills)
- promoting (self care and independence)
therapeutic relationships
focused on the pt
enhances the growth on the pt
social relationships
dependent on eachother
friend helps you get a job somewhere
support each other
BOTH needs of both people matter
boundaries
pts needs are separated from the nurses needs
sharing food, buying them a gift, sharing headphones (blurred boundary becomes more social).
warning signs that a blurred boundary is there
over helping
controlling
narcissism
transference
the process where a person unconsciously and inappropriately transfers behavior onto another person
pt to staff member
countertransference
staff onto pt
define stress response
survival mechanism by which the body and mind become immediately ready to meet a threat
symptoms of PTSD
T traumatic event
R re-experiencing trauma
A avoidance
U unable to function
M month long symptoms
A arousal increased
risk factors of PTSD
- age of traumatic event
- female
- history of psychiatric illness
- lower education level
comorbidities of PTSD
- CVD
- increased susceptibility to infections
- dementia
- depressive disorder
- anxiety disorders
- substance related
- increased risk of suicide
how long does it take acute stress disorder symptoms to resolve
symptoms resolve within 1 month
how much time does it need to be in order to be deemed ptsd
longer than a month
