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OLOL~PsychExam1
N140 OLOL Psych ~ Exam 1
| *CaRd* 1 | *CaRd* 2 |
|---|---|
| What is mental health? | successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. |
| What is a mental disorder? | health conditions marked by alterations in thinking, mood, or behavior that cause distress, impair ability to function, or both. |
| What is mental illness? | clinically significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering disability, or loss of freedom. |
| Who developed a conceptual framework for psychiatric nursing practice, focused on nurse-patient relationships? | Hildegarde Peplau |
| What are the roles of the mental health nurse? | Serve as a member of interdisciplinary team,providing specialized nursing knowledge(has understanding of medical issues that impact the mentally ill);Promote,maintain,restore,&rehabilitate individuals,family,&community;Pt advocate,educator,&case manager |
| A categorical classification system with standard diagnostic criteria listed and used to diagnose a mental disorder. This system gives a more comprehensive picture of the client's functioning. | DSM-TR-IV --> Diagnosis & Statistical Manual of Mental Disorders (uses a 5 axis system) |
| What is Axis 1? | clinical disorders (bipolar disorder, alcohol abuse) |
| What is Axis 2? | personality disorders and mental retardation (borderline personality) |
| What is Axis 3? | general medical conditions (hypertension, Diabetes, COPD) |
| What is Axis 4? | psychosocial and environmental problems (homeless, no family support, no job) |
| What is Axis 5? | global assessment of functioning (GAF), written as numbers (0-100) meaning “current level of functioning/highest level of functioning in the past year” (35/75) |
| What is the main role of the psychiatric mental health nurse? | to provide leaderships for the group |
| What are the Standards of Care? | authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable. |
| What 3 things result from mental health? | resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. |
| What is Stigma? | When society labels or blames the mentally ill individual for his/her problems. |
| What is Dual Diagnosis? | When a person is suffering from both a mental disorder and also a substance. |
| Explain and give an example of tautology. | giving a condition a label does not explain or confer any reality on it other than the name itself and the cluster of behaviors subsumed under it. “He acts like a schizophrenic because he has schizophrenia.” |
| What is the role of the psychiatric nurse as a team member? | The nurse is a member of an interdisciplinary team,recognizing that clients are more than ppl w/ diagnoses,these teams function collaboratively to provide comprehensive care.Collaboration implies that members work toword a common goal&share responsibility |
| What are biological influences on mental health? | prenatal, perinatal, and neonatal events;physical health status;nutrition;hx of injuries;neuroanatomy;& physiology. |
| What are psychological influences on mental health? | interactions with parents,siblings,peers,&others within the environment;intelligence quotient;self-concept;skills;creativity;&emotional developmental level. |
| What are sociocultural influences on mental health? | family stability, ethnicity, housing, child-rearing patterns,economic level,religion,values,& beliefs. |
| What is mood? | self-reported by the patient;what the patient says he/she is feeling.(Nurse:“How are you feeling today? Pt:"Depressed." Nurse:"On a scale of 1-10, how depressed are you?" Pt:"9." Nurse:"Are you thinking of suicide?" Pt:"Yes." Nurse:"What is your plan?") |
| What is affect? | it is what the nurse sees; Does the patient look sad,happy,or smiles frequently? Look at duration,intensity,& appropriation of affect. Usually the first sign of improvement. |
| Flattened affect | decreased emotional range |
| Blunted affect | lack of emotional reactivity |
| Restricted affect | one expression all the time |
| Labile affect | shifting from one affect to another |
| What is a hallucination? | a perception of environment that is not real; can be visual, auditory, tactile(feeling), gustatory(taste), or olfactory(smell). |
| What is a delusion? | false beliefs that cannot be corrected by reason. |
| What is an illusion? | false beliefs that can be corrected by reason. |
| Circumstantiality | unnecessary detail during story, but eventually come back to main idea |
| Flight of ideas | rapidly shifting from one topic to another; seems very fragmented. |
| Loose associations | lacks logical explanation between thoughts and ideas; topics are somewhat linked. |
| Neologism | patient's coin their own words. Ask the patient what the word means. |
| Preservation | excessive continuation of a response, word, phrase, idea, or activity;common in head injury patients. Very repetitive. |
| Tangential | Inability to get the point of a story. Speaker introduces many unrelated topics until the original topic of discussion is lost. |
| Thought blocking | can't remember what they were telling you. Patient loses train of thought. |
| Word salad | incoherent speech consisting of both real and imaginary words, lacking comprehensive meaning, and occurring in advanced schizophrenic states; doesn't make sense, e.g. "horses make sugar cat." |
| Avolition | a psychological state characterized by general lack of desire, motivation, and persistence.Those suffering will not start or complete any major tasks. Commonly seen in patients with schizophrenia. |
| Insight | awareness or ability to understand the true nature of one's own situation&accept some personal responsibility,esp regarding this illness;a person's ability to analyze the problem objectively. |
| Judgment | a person's ability to form vaild conclusions&behave in a socially appropriate manner; to interpret one's environment&situation correctly & adapt one's behavior & decisions accordingly. |
| Psychosis | a mental disorder characterized by symptoms, such as delusions or hallucinations, that indicate impaired contact with reality. |
| Tardive Dyskinesia | a disorder characterized by restlessness and involuntary rolling of the tongue or twitching of the face, trunk, or limbs, usually occurring as a complication of long-term therapy with antipsychotic drugs. |
| Alogia | A poverty of thinking that is inferred from observing the client's language & speech. The pt's inability to speak because of mental deficiency, mental confusion, or aphasia. |
| Anhedonia | Loss of pleasure in hobbies or activities of interest; a characteristic of depression. |
| Immediate Memory | memory of things just exposed to. "What did you have for breakfast?" |
| Recent Memory | happened in the past week. "What have you been doing during the past few days?" |
| Remote Memory | distant past. "What year did you graduate from high school?" "Tell me what you remember about your childhood." |
| Emergency Admission | admission to a psychiatric hospital that occurs when a client acts in a way that indicates that he or she is mentally ill &, as a consequence of the particular illness, is likely to harm self or others. |
| Voluntary Admissions | admission to psych hosp that occurs(1)through a client's direct request by coming to the hosp or(2)following eval of a client who is determined dangerous to self or others or unable to adequately meet own needs in community,but is willing to submit to tx. |
| Battery | touching another person without his or her permission. |
| Forensic Psychiatry | the use of psychiatric knowledge and techniques in questions of law, as in determining legal insanity. |
| Mental health professionals determine whether the defendant is competent by assessing which 3 states of competency? | 1)Ability to assist the attorney with defense;2)Understanding of the nature&consequences of the charge against him or her;3)Understanding of courtroom procedures. |
| Autonomy | the right to make decisions for oneself. It implies that a person not only chooses to make his or her own decisions but freely accepts their consequences. |
| What is a common misconception concerning patients voluntarily admitted to mental hospitals? | that all admissionto a mental hospital involve the loss of civil rights.However, the patient keeps all civil rights. |
| Informal Voluntary Admission | any mentally ill person suffering from substance abuse desiring admission to a treatment facility for diagnosis or treatment may be admitted upon the patients request without formal application. |
| Formal Voluntary Admission | any mentally ill person suffering from substance abuse desiring admission to a treatment facility for diagnosis and/or treatment who is deemed suitable for formal voluntary admission by the admitting physician. |
| 72 hour notice | patient signs a formal request to be discharged and has to be discharged at the end of 72 hours if not committed by the coroner. |
| Legal Hold | a nurse may place a hold on a client for a justified reason (suicidal). The client cannot leave until the physician sees them; These are the nurses responsibility. |
| PEC (Physician's Emergency Certificate) | signed by the physician and good for 72 hours from the time of signature. Patient can be PEC if one or more of the following:Injurious to self (suicidal) or others (homicidal) or gravely disabled |
| CEC (Coroner's Emergency Certificate) | Coroner decides if patient who is PEC’d needs to be committed. Once CEC is signed by coroner, it is good for 15 days from the time that the PEC was signed and dated. |
| OPC (Order of Protective Custody) | a family member can institute this and the patient must be seen by the Coroner, who is a physician within 12 hours to PEC, CEC, or voluntary admit or discharge the patient. If the coroner is not a physician, the MD must see the patient. |
| Noncontested admission | a lawyer can have a patient committed judicially if they are unable to sign a voluntary admission form (patient's with dementia, Alzheimer's). |
| Judicial admission | court orders commitment lasting 30-90 days,then pt must be re-evaluated.If the judge decides on court or judicial commitment in a formal hearing,the court is required to notify the pt so they can retain a lawyer if they choose to contest the commitment. |
| List 6 patient rights. | Right to tx using least restrictive alternative/environment;Right to confidentiality of records;Right to give or refuse consent to tx;Right to freedom from restraints&seclusion;Right to access personal belongings;Right to refuse ECT or psychosurgery. |
| List 4 other patient rights. | Right to daily exercise,visitors,writing material&uncensored mail,use of telephone;Right to access courts&attorneys;Right to employment compensation;Right to be informed of rights. |
| M'Naghten Rule | legal case stating that persons who donot understand the nature&implication of murderous actions bc of insanity cant be held legally accountable for murder;NOT GUILTY by reason of insanity;Provided a basis for legal decisions in American Courts since 1851 |
| Rouse vs. Cameron | man was placed in an institution for illegally carry a dangerous weapon. He was kept for 4 years, but did not receive treatment; therefore he could not improve enough to be discharged. *Right to treatment* |
| Griswold vs. Connecticut | US Supreme Court first recognized *right to personal privacy* |
| Wyatt vs. Stickney | *Right 2 tx*Men Hlth sys of Alabama was sued 4 inadequate tx program&Crt ruled 2 stop using pts 4 hospital labor needs,ensure humane envir,develop&maintain min staffing standards,est institutional human rts committees,&provide least restrictive environmts |
| Rogers vs. Olin | Boston St Hosp sought *right to refuse tx*Ruling prohibitd hosp from forcing nonviolent pts to take meds against their will,based on right to privacy.Informed consent must be given be4 drug tx could begin;Meds can only be forced if 2 MDs say pt needs meds |
| Whitree vs. State of New York | Pt did not receive treatment during his 14 years of hospitalization, and that if he had, he would have been released 12 years earlier*Right to tx* |
| Rennie vs. Klein | *Right to refuse tx based on right to privacy*Legal obligation of mental health professionals 2 obtain informed consent b4 admin psychotropic meds.For adolescent pts at OLOL, parents must be called to obtain informed consent b4 new meds are given. |
| Meier vs. Ross General Hospital | established duty to warn of threatened suicide. Physician was deemed liable for not protecting the patient. |
| Tarasoff vs. the Regent of the University of California | Pt told therapist he planned2kill an identifiable girl when she returned from vac.Therap notified police&they took pt in2 custody but released him;girl returned&he killed her;her parents claimed the therapist had a duty 2warn their daughter of the threats |
| Jackson vs. Indiana & Fouca vs. Louisiana | requires that the nature of the commitment bear some reasonable relation2the purpose for which the individual is committed.Ruling recognized that persons who are no longer mentally ill no longer require hospitalization.*SEXUAL predators are an exception* |
| Megan's Law | New York’s version of the Sex offender registration and notification law |
| Pelau identified 6 sub roles within the work role of the nurse. List them. | Mother-surrogate; Technician; Manager; Socializing agent; Health teacher; Counselor or psychotherapist. |
| Mother-surrogate | fulfills needs associated with mothering basic needs, such as bathing, feeding, dressing, toileting, disciplining, and approving. |
| Technician | the focus is on competent, efficient and correct performance of technical procedures. |
| Manager | management and manipulation of the environment and manipulation of the environment to improve conditions for client recovery. |
| Socializing agent | participation in social activities with the client (Get the client involved—play cards with them). |
| Health teacher | identification of learning and provision of information required by the client or family to improve the health situation. (teach client new coping skills and about their meds. Make sure patient knows what med they need to take, time; quiz them). |
| Counselor or psychotherapist | the use of “interpersonal techniques” to assist clients to learn to adapt to difficulties or changes in life experiences (1 to 1 interaction with patient—be their counselor). |
| Therapeutic Relationships | a close, helping relationship based on trust, which allows the nurse and client to work collaboratively. the purpose: to help clients solve problems, cope more effectively and achieve developmental goals. |
| What is a therapeutic tool? | Self. It is the ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions. Use self when interacting with the client. |
| Trust | implies a feeling of confidence in another person's presence,reliability,integrity,veracity,&sincere desire to provide assistance when requested;the basis of a therapeutic relationship&is linked to self disclosure. |
| Unconditional positive regard | Respect for families and patients implies the dignity and worth of an individual regardless of his or her unacceptable behavior. |
| Genuineness | the ability to be open,honest,& "real" in interactions with the client;implies congruence between what is felt and what is being expressed. |
| What are the obstacles to establishing a therapeutic relationship? | Judgmental attitudes;Excessive probing;Lack of self-awareness;Transference;Counter Transference |
| Transference | the nurse evokes emotion on the patient; i.e. the nurse takes out stress on the patient&the patient feels like a victim. |
| Counter Transference | something the patient does to evoke emotionsin the nurse; (behaviors of abusive patients reminds the nurse of her childhood abuse by her father.) |
| Pre-Interaction Phase | phase to obtain information about the client; examine one's own feelings, fears, & anxieties about working with a particular client. |
| Orientation (Intro) Phase | phase to establish rapport&build a foundation;introduce self&learn the client's name;communicate interests to client;set parameters,let pt know what will happen&what is expected,gather data;discern focal problem,set goal,&begin plan. |
| Before moving from the Orientation phase to the next phase, be sure of what? | that Trust is established;Patient is verbalizing feelings;Patient understands the purpose of the relationship&the nurse's role;Having discussed patient strengths&weaknesses&priorities for nursing interventions. |
| Middle or (Working) Phase | phase in which patient is actively working toward achieving goals;Nurse is giving feedback&support for behavior change;May be some regression;May use therapeutic confrontation. |
| Tasks for Working Phase | Identify past behaviors that are ineffective 4coping w/major prob;Develop plan,prac implementing&evaluating its effectiveness;Integrate a new selfconcept/attitude toward one’s illness;Increased hopefulness toward future;Develop plan of action;Independence |
| Termination Phase | phase begins in orientation;pts may regress bc they fear facing the future alone(loss is a universal fear);review progress of pt,answer questions&celebrate victories;Nurse can share pos feelings for pt,admiration&enjoymt of the relationship;educate family |
| Tasks in Termination Phase | space contacts w/pt further apart;express feelings about loss of relationship;more relaxed interaction,less intense;focus on future;discourage cues that lead to new areas of exploration;referralsto community resources. |
| Self Disclosure | revealing personal information should be limited but appropriate;used to help pt open up to you,not to meet your own needs;keep brief;dont imply your situation is like your pts;dont reveal painful life experiences that you have not mastered. |
| When should the nurse disclose what the patient has shared? | suspected child/elder abuse;criminal cases;government request. |
| What is the purpose of therapeutic communication? | to allow patients the autonomy to make choices when appropriate;communication should always be value-free,advice-free,&reassurance-free.*NO OPINIONS* |
| Therapeutic communication | planned process of interaction in which the nurse demonstrates empathy,uses effective communication skills,&responds to the clients thoughts,needs,&concerns. |
| Non-Therapeutic communication | interactions in which the nurse uses ineffective responses that result in clients feeling defensive, misunderstood, controlled, minimized, alienated, or discouraged from expressing their thoughts and feelings. |
| Verbal | content&context;should be concrete,esp when a pt is experiencing anxiety;*AVOID BEING ABSTRACT* |
| Nonverbal | includes speaker's thoughts,feelings,needs,&values;represents a more accurate/congruent message;It includes body language,eye contact,facial expression,&tone of voice;Body position should be open;Usually,silence,is an excellent therapeutic technique. |
| Active Listening | refraining from other internal mental activities;attentiveness to the patient in a physical&psychological manner. |
| List things that signal active listening. | removal of distractions(turn TV off,turn lights on),using eye contact,close proximity,relaxed physical position,calm voice. |
| Touch | can be comforting&therapeutic, but is an invasion of personal space;Must have relationship with pt;May be misinterpreted by pt with a thought disorder. |
| Active Observations | watching speaker's non-verbal&speech pattern; this includes congruence,anxiety,agitation,& slow processing. |
| Environmental | noise(actual); physiological(hearing loss,sedative effects of meds,pain); psychological(paranoia, anger, fear,& apathy). |
| List other factors that influence communication. | Perception; Past experience; Culture; Gender; Age/Developmental level |
| Listening | Therapeutic communication technique defined as an active process of receiving information&examining one's reaction to the message received. |
| Restating | Therapeutic communication technique defined as repeating to the pt the main thought he has expressed. (eg."You're having a rough time at home?") |
| Sharing perceptions | Therapeutic communication technique defined as asking the client to verify the nurse's understanding of what he is thinking or feeling.(eg."You're smiling,but I sense that you're really angry w/me or it seems like you are upset about something.") |
| Theme identification | Therapeutic communication technique defined as identifying underlying issues experienced by client that emerge repeatedly during the course of the relationship.("It seems that every time you talk about your relationship w/your g/f, u change the subject.") |
| Empathetic understanding | Therapeutic communication technique defined as an understanding from the client's view.("You feel left out bc you feel your mother pays more attention to the baby?") |
| Broad openings | Therapeutic communication technique defined as encouraging the pt to select topics for discussion.Communicates a desire to begin a meaningful interaction.Allows client to define the problem or issue. |
| Immediacy | Therapeutic communication technique defined as focusing on the here & now.("Tell me how that makes you feel now.") |
| Paraphrasing | Therapeutic communication technique reflects meaning of the client's message in the nurse's words.Allows for clarification.Lets pt know the nurse understands the message.("So your saying you won't return 2 live w/your husband even if he goes2counseling?") |
| General leads | Therapeutic communication technique defined as encouraging the patient to continue elaborating; Communicates nurse's interest in listening.("Go on, and, then, uh-huh...") |
| Reflection | Therapeutic communication technique defined as revealing the emotion/feeling underlying the pt's message;Conveys empathy;Repeating to the pt the main thought&feeling he has expressed.("It sounds like you are feeling hopeless about this situation.") |
| Focusing | Therapeutic communication technique that encourages the client to expand upon one part of a statement.Concentrates on a single issue;Useful for clients who are confused or overwhelmed about many issues at the same time.("Let's talk alittle more about__.") |
| Voicing doubt | Therapeutic communication technique defined as a gentle way of challenging the pt's perceptions;Encourages pt to reconsider what he has just said.("Really?,that's hard to believe;I'm not sure I'm getting an accurate picture.") |
| Clarifying | Therapeutic communication technique defined as attempting to put into words vagueideas or unclear thoughts of the pt to enhance the nurse's understanding or asking the client to explain what he means.("I’m not sure what u mean by__,could u elaborate?") |
| Informing | Therapeutic communication technique defined as allowing for teaching & clarification.("You will have several options for group home in Baton Rouge.") |
| Encouraging Formulation of a plan | Therapeutic communication technique defined as encouraging the pt to think about solutions w/out the nurse giving advice;Helps the pt problem solve.("What do you think you should do about this?") |
| Confrontation-Testing Discrepancies | Therapeutic communication technique that helps pt become more aware of inconsistencies in statements vs.behaviors;Allows for gentle confrontation.("You say that you want to participate in this group,but I notice that you have missed the last 3 meetings.") |
| How to confront a patient? | 1)Describe inconsistent behaviors;2)Offer two possible interpretations,ask for feedback. |
| Verbalizing the Implied | Therapeutic communication technique defined as voicing what the pt has hinted at or suggested; Opens area of discussion more specifically.("You seem to feel lonely & deserted.") |
| Suggesting | Therapeutic communication technique defined as presentation of alternative ideas for the pt's consideration relative to his problem solving.(*INCORRECT*-->"Have you ever considered journaling?"); (*CORRECT*-->"You should journal.") |
| Silence | Powerful therapeutic communication technique that demonstrates acceptance of the pt&a willingness to offer self;Allows the pt&nurse time to gather thoughts&decide if they are willing to share feelings;*Can create paranoia in schizophrenic pt* |
| Questions should be ___. Why? | Open-ended. Bc open-ended questions encourage the pt to expand on the subject. |
| Positive Reframing | Therapeutic communication technique defined when you are setting limits,it is better to tell the pt what you want them to do,rather than criticize their negative behavior.("Speak in a calm voice,&tell me what you would like." Rather than "STOP YELLING!") |
| Social Responding | Non-Therapeutic communication technique defined as engaging in superficial conversation that is not client centered. |
| Using close-ended questions | Non-Therapeutic communication technique defined as narrowing the conversation & stifles exploration. |
| Changing the subject | Non-Therapeutic communication technique defined as introducing unrelated topics, usually to decrease nurse's anxiety. |
| Belittling | Non-Therapeutic communication technique defined as discounting the pt's feelings;Making comparisons that imply the pt's problems are smaller than they perceive.("Don’t be silly.Everybody gets down in the dumps sometimes.I’ve felt that way myself before.") |
| Stereotyped comments | Non-Therapeutic communication technique defined as wise sayings that are automatic&lack empathy.("Time heals all wounds.Keep your chin up.Everything happens for a reason.") |
| Giving False Reassurance | Non-Therapeutic communication technique defined as suggesting there is no real problem. |
| Moralizing | Non-Therapeutic communication technique defined as passing judgment by imposing your own values;Implies the pt's thinking is wrong. |
| Interpreting | Non-Therapeutic communication technique defined as making intrusive comments.("I think you are in denial.") |
| Advising | Non-Therapeutic communication technique defined as making specific suggestions.("I think you should try journaling."); Instead offer suggestions.("Some people benefit from journaling.Do you think it would work for you?") |
| Challenging | Non-Therapeutic communication technique defined as denying the pt's perception;forcing the pt to prove what he is saying.("If ou are dead,why is your heart still beating?") |
| Defending | Non-Therapeutic communication technique defined as arguing or justifying your position rather than attempting to hear the pt's concern. |
| Requesting an explanation | Non-Therapeutic communication technique defined as asking the pt to provide reasons for their feelings or behaviors.("Why do you think that?") |
| List Resistance behaviors. | acting out or irrational behavior;superficial talk;transference reactions;counter-transference reactions;gift giving(tell the pt thank you,&you appreciate it,but it is against the rules);'why' questions are not therapeutic;summarizing to terminate convo. |
| What is ECT? | Electroconvulsive therapy |
| Today, modern ECT is used for what? | Major depression |
| ECT is effective because it causes what? | A grand mal seizure,&to be therapeutic, it should last from 30 to 60 seconds. |
| How does ECT work? | It somehow changes the chemical structure of the brain, providing only temporary relief; However, some pt's have to return to the hospital,while others may never need another tx. |
| When may an ECT tx be used? | ECT tx may be used when drugs do not take effect for 3 weeks and pt is severely depressed or psychotic. |
| List Nursing Responsibilities before an ECT. | 1)keep client NPO;2)give Atropine as ordered(given to dry secretions);3)ask client to urinate before tx;4)remove all metal objects;5)take vital signs;6)***Be POSITIVE*** =) |
| List procedures during an ECT. | IV line is inserted;electrodes are placed on temples;insert bite-block;Methohexital(anesthesia)is given;Succinylcholine(muscle relaxer)is given;admin pre-tx O2(100%);electrical impulses are given;seizure will last 20-60secs;monitor HR,BP,&EEG;ventilate pt |
| What are indications for ECT? | severe depression(85-90% of clients treated);catatonia;mania. |
| Contraindications for ECT. | There are no absolute contraindications,but much caution is used if ECT is given to pts w/recent MI, recent CVA, or intracranial lesion;not given to pt's w/brain tumor bc of increased intracranial pressure;*Cardiac&brain lesions are MAIN contraindications |
| Advantages of ECT. | Safe, Fast, & Economical. |
| Why is the patient given 100% O2 as pre-tx for an ECT? | The O2 prepares the patient for periods of apnea when they have the seizure. |
| An ECT produces faster results than ___. | Antidepressants. |
| __ is given 30 minutes before an ECT to dry up secretions & prevent aspiration. | Atropine(an Anti-cholinergic) |
| Disadvantages of ECT. | Only temporarily provides relief; Most pt's receive between 6-10 tx's.(Pt's should be gaining points & improving on mini-mental assessments w/tx's) |
| Who is the 'Father' of Psychosurgery, & won the Nobel prize in 1949? | Moniz. |
| In 1891, the first psychosurgery was performed by __ in Switzerland. There were 6 clients. What was the outcome? | Burckhardt; One died, one developed epilepsy, & one improved. |
| Why are there so many concerns with psychosurgery? | bc of destruction of brain tissue&bc its an irreversible procedure.Many questioned the Informed Consent,arguing whether this consent can truly be informed?Some have suggested that violent ppl have this surgery;Fears of an "ethnic cleansing"approach |
| What are indications for Psychosurgery? | 1)Depression&anxiety;2)Depression-related pain;3)Obsessive-compulsive disorders;4)Aggression. |
| Somatic Therapies | Therapies that do not involve surgery &/or invasive procedures; *Always try to do the "least restrictive" intervention first;(i.e. Time out; Seclusion & Restraint) |
| How are restraints removed from a person? | Restraints are taken off one limb at a time. |
| What meds may be given at any point to avoid using restraints on a pt? | Haldol, Ativan, & Benadryl are the psych 'cocktails'; given IM. |
| List 3 types of restraints. | Seclusion or isolation; 5-point restraint; Chemical restraint. |
| Before any physical restraint or intervention that confines the patient is applied, every effort must be made to assist the patient with other types of intervention. What should be used first? | First, verbal intervention, then remove patient from environment(seclusion). |
| What is the least restrictive measure? Why the least? | Verbal interventions; & they can also prevent further escalation if utilized at the very signs of aggression. Always use LEAST restrictive to avoid false imprisonment!! |
| Isolation | used to decrease stimuli & protect the pt &/or others,as well as to avoid property damage. |
| The nurse needs MD's orders for seclusion or restraints, but what happens in an emergency episode? | Seclude/restrain pt, .... THEN get Dr.'s orders ASAP!! =) |
| What should the nurse document? | Document all least restrictive measures&the client's response;Document client's behavior,the reason for restriction,&justification of the type of restraint used. |
| An inappropriate decision to restrain or isolate a client could expose a nurse to what? | Allegations of assault,battery,or false imprisonment; that is why explicit documentation is required!!! |
| Psychopharmacotherapy | used to manage behavior & is considered a "chemical restraint";meds do not cure mental illness;physical&psychiatric assessmts must be performed before med is prescribed. |
| Purposes of Psychopharmacotherapy. | to relieve or reduce symptoms of dysfunctional thoughts,moods,actions,mental illness,or disorder; Also to improve client's functioning&increase client's adherence/compliance. |
| The psychiatric-mental health nurse provides what? | Structures & maintains a therapeutic environment in collaboration w/the client &other health care providers. |
| Therapeutic Milieu | environment designed to promote healing experience and to promote a corrective setting for the enhancement of the client’s coping abilities, interpersonal skills, social function and activities of daily living. |
| Main purposes of a Therapeutic Milieu. | 1)sets limits on disturbing&maladaptive behavior;2)teaches psychosocial skills;3)teaches adaptive coping skills;4)develops emotional&social skills;5)allows client to participate in 'nursingprocess';6)allows client to have voice in his care. |
| Self-governance | refers to the patient's right to control some decision making. |
| Everything a nurse does is to benefit the patient & promote wellness, by ensuring that..... | the physiological&psychological needs of the client are met. |
| The nurse is also responsible for what? | Med admin&pt response to meds;developmentof a 1-to-1 relationship;setting limits on unacceptable behavior;& client education(a must for psych pt's, to teach coping skills,&what is acceptable,hygeine,etc...) |
| Describe the goals of Milieu management in the care of the mental health clients. | 1)correct client's perceptions of the stressors;2)change the client'scoping mechanisms from maladaptive to adaptive;3)improve client's interpersonal relationship skills;4)teach the client effective stress management strategies; |
| Identify the elements of the therapeutic milieu. | Boundaries;Safe environment;& Trusting environment. |
| Boundaries | provide structure to define the work, goals, and time frame. Maintain inter-personal relationship between client and nurse. Client knows his/her responsibilities. |
| Safe environment | non-threatening; Lets client know it is o to express their feelings. |
| Trusting environment | consistency between words&actions;(follow through with promises&what you say) |
| What is the nurse's role in the Milieu Environment? | to provide&manage a structured environment;set the tone of the uint&see that the guidelines are upheld;serve as an emotional sounding board(open to listening);support client's privacy&autonomy;model supportive&respectful behavior;teach&model coping skills |
| Therapeutic Milieu is designed to meet what? | the emotional&interpersonal needs of the pt;Encourage pt participation;it helps control problematic behaviors&assist pt in developing new coping skills. |
| Behavior Therapy | a mode of tx that focuses on modifying observable&at least in principle,quantifiable behavior by means of systemic manipulation of the environment&variable thought to be functionally related to the behavior;precise approach in behavioral change. |
| Ivan Pavlov | person who stated that learning, or behavioral change, occurs bc of experiences that over time result in conditioned response learning or classical conditioning. |
| Treatment | __ modifies behavior by manipulating the environment. |
| Pavlov's theory of conditioning | theory which states that a stimulus elicits a response(eg. a red delicious apple will stimulate one's salivary glands). |
| Skinner's Theory of Operant Conditioning | theory that states that the results of a person's behavior determines whether the behavior will recur in the future.(a child is permitted to stay home from school bc he did not finish his homework.) |
| Desensitization | helps to eliminate client's fears or anxieties by stressing relaxation techniques that inhibit anxious responses.Pt's are taught ways to relax as they vividly imagine a fear. |
| Behavior Modification | a method of attempting to strengthen a desired behavior or response by reinforcements, either positive or negative. |
| Positive Reinforcement | used to strengthena desired behavior. |
| Negative Reinforcement | involves removing a stimulus immediately after a behavior occurs so that the behavior is more likely to occur; this increases the probability that a behavior will recur by removal of an undesirable reinforceable stimulus. |
| Aversive Stimulus | follows a behavioral response&decreases the probability that the behavior will recur(giving a spanking). |
| Cognitive Therapy | emphasizes the role of thoughts in how people feel&act;teach client to change maladaptive beliefs through positive self-statements&refuting irrational beliefs;uses confrontation;By changing thoughts, a person can change feelings&behavior. |
| Group Therapy | members share a common purpose&are expected to contribute to the group to benefit others&to receive benefit from others in return. |
| Characteristics of a therapeutic group. | cohesiveness,goal-directed,interpersonal communication,group atmosphere. |
| Leader Behavior | clear goals are set, interpersonal communication, create environment in which they feel valued and accepted, democratic styles of leadership promote a more cohesive environment, continually monitor group interactions. |
| Benefits | become aware that one is not alone&that others share the same problems.Gain insight into one’s problems&behaviors&how they affect others.Give oneself the benefit of others.Gain inspiration of hope.Interacting with others&Feeling acceptance&belonging. |
| Culture | it represents the cast structure of ideas,attitudes,habits,languages, rituals,cermonies,&practice peculiar to a particular group of people. |
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