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Psychosocial WK2

QuestionAnswer
DSM-IV-TR Diagnosis and Statistical Manual of Mental Disorders, 4th edition, Text Revision; Listing of all psychiatric disorders, including diagnostic criteria, associated features, prevalence, and differential diagnosis; Listing of all psychiatric disorders, inclu
Axis I: Clinical disorders (e.g. schizophrenia, major depression, bipolar disorder)
Axis II: Personality or developmental disorders (e.g. paranoid and borderline personality disorders, mental retardation)
Axis III: General medical conditions that relate to axes I and II or have a bearing on treatment (e.g. endocrine disorders)
Axis IV: Severity of psychosocial stressors (e.g. divorce, housing, educational issues) – most important one
Axis V: Global assessment of functioning, on a scale of 0 to 100 – psychologist makes the determination – most people is 85 to 100; must be at least a 50 to be released from hospital
Insight locus of control (internal and external) – typically 1 dominates the other – -External LOC: belief that you have no control over things in your life; lots of apathy, no self-esteem; not much motivation -Internal LOC: the opposite
Outcome Identification Repeat of goals “whether the goal was met or not” Specifies an adaptive behavior Must be realistic, achievable Written in measurable, behavioral terms
Short-term outcomes attainable in 4-6 days
Long-term outcomes require follow-up after discharge
Nursing Diagnosis Identifies patient problems NANDA diagnoses widely accepted
Nursing care plans Often standardized(clinical pathways, critical pathways)
Nursing focus: Facilitation and education-Verbal strategies to guide problem solving
Evaluation Considers patient progress Might lead to: Reassessment Reformulated nursing diagnoses More realistic outcomes
Discharge Summaries Outcomes achieved Outcomes still to be addressed Patient instructions Medication information Follow-up appointments Referrals Make sure safety is maintained when not in the hospital
Individual must adjust to taking on the sick role allows the person to be excused from everyday activities
Psychological Responses to Serious Medical Illnesses Denial Anxiety Shock Anger Withdrawal – leads to depression
Denial A refusal to admit to being ill Short-term denial can be useful in mobilizing internal resources Long-term usually results in maladaptive behavior patterns – creates coping mechanisms
Anxiety Feelings of apprehension and uncertainty about the illness Can produce sympathetic nervous response (fight-or-flight response)
Shock overwhelming emotion that paralyzes the individual’s ability to process information
Anger response to feeling mistreated, injured, or insulted May be directed inward or outward toward other
Withdrawal Removes self from interaction with others and the environment; Often a sign of depression
Nursing Interventions Provide accurate information that aids in the realistic perception of the situation Encourage ventilation of feelings Provide empathetic gestures (silent physical closeness, holding a hand, giving a hug) Identify family supports and adequate coping me
Stigmatizing Medical Illness can't project our values on others – need to keep our personal feelings out of it Example: HIV, Transgender surgery
Human Rights Abuse Refusing to care for patient Labeling with psych diagnosis Inappropriate psych admission – have clear guidelines now to verify psych admission rationale
Delirium & Hospital Based Delirium ICU Psychosis; elderly develop a sense of delirium
Compensation An individual makes up for a “deficiency” in one area by consciously excelling in or emphasizing another area.
Conversion Emotional conflicts are turned unconsciously into physical symptoms, which provide the individual with some sort of benefit (secondary gain).
Denial Reality is denied, it does not exist. Unconscious refusal to admit an unacceptable idea or behavior.
Displacement Unconsciously expressing or discharging pent up emotions/feelings are expressed toward someone or something other than the source of the emotion, less threatening object
Dissociation Unconscious separation and detachment of emotional significance or painful feelings and affect from an unacceptable idea, situation or object.
Identification Individual incorporates a characteristic (thought or behavior) of another individual or group, but does NOT give up his or her personal identity. Can be conscious or unconscious. Modeling after a respected person.
Introjection A quality or attribute of another (like values/attitudes) is unconsciously internalized as if they were your own.
Projection Unconsciously or consciously, blaming someone else for one’s difficulties or placing one’s unethical desires on someone else
Rationalization Conscious or unconscious process of constructing reasonable explanations to explain, prove and justify one’s behaviors.
Reaction formation The conscious behavior is completely opposite to the unconscious feeling.
Regression Behavior, thought, or feelings used at an earlier stage of development are exhibited, usually unconscious.
Repression The barring from conscious thought of painful, disagreeable thoughts, experiences, and or impulses. Unconscious and involuntary.
Sublimation Sexual or aggressive or instinctual drives/impulses are channeled in socially acceptable ways. Conscious or unconscious process.
Suppression An intentional & conscious exclusion of painful thoughts, experiences, or feelings. (***This is not considered a defense mechanism by some***).
Dual Diagnosis the presence of at least one psychiatric disorder in addition to a substance abuse or dependency problem both are axis 1 Will treat psych disorder 1st and then the substance abuse
Co-Morbidity how is this different? - term assoc. w/ med-surg (having 2 med-surg dxs)
Created by: MarieG
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