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Chapter 1-8
Med-Surg Mental Health
| Question | Answer |
|---|---|
| asylum | a safe refuge or haven offering protection; in the United States, the term “asylum” was used to describe institutions for the mentally ill |
| boarding | Provision of an adequate number of psychiatric inpatient beds could better meet the needs of clients and might even decrease homelessness, incarceration, and violence. |
| case management | management of care on a case-by-case basis, include accessing medical and psychiatric services and providing assistance with tasks of daily living such as financial management, transportation, and buying groceries |
| deinstitutionalization | a deliberate shift in care of the mentally ill from institutional care in state hospitals to care in community-based facilities and through community-based services |
| Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) | describes all mental disorders and outlines specific diagnostic criteria for each based on clinical experience and research |
| managed care | a concept designed to purposely control the balance between the quality of care provided and the cost of that care |
| managed care organizations | developed to control the expenditure of insurance funds by requiring providers to seek approval before the delivery of care |
| mental health | a state of emotional, psychological, and social wellness evidenced by satisfying relationships, effective behavior and coping, positive self-concept, and emotional stability |
| mental illness | a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress |
| phenomena of concern | describe the 12 areas of concern that mental health nurses focus on when caring for clients |
| psychotropic drugs | drugs that affect mood, behavior, and thinking that are used to treat mental illness |
| self-awareness | the process by which a person gains recognition of their own feelings, beliefs, and attitudes |
| social determinants | nonmedical factors that influence health, such as sense of community, access to adequate resources, intolerance of violence, support of diversity among people |
| standards of care | authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable |
| utilization review firms | developed to control the expenditure of insurance funds by requiring providers to seek approval before the delivery of care |
| akathisia | intense need to move about; characterized by restless movement, pacing, inability to remain still, and the client’s report of inner restlessness |
| anticholinergic side effects | dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision; commonly seen as side effects of medication |
| antidepressant drugs | primarily used in the treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, and psychotic depression |
| antipsychotic drugs | also known as neuroleptics; used to treat the symptoms of psychosis such as the delusions and hallucinations seen in schizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder |
| anxiolytic drugs | used to treat anxiety and anxiety disorders, insomnia, obsessive–compulsive disorder (OCD), depression, PTSD, and alcohol withdrawal |
| black box warning | medication package inserts must have a highlighted box, separate from the text, that contains a warning about the life-threatening or otherwise serious side effect(s) of the medication |
| computed tomography (CT) | a diagnostic procedure in which a precise x-ray beam takes cross-sectional images (slices) layer by layer |
| depot injection | a slow-release, injectable form of antipsychotic medication for maintenance therapy |
| dopamine | a neurotransmitter located primarily in the brain stem; has been found to be involved in the control of complex movements, motivation, cognition, and regulation of emotional responses |
| dystonia | extrapyramidal side effect of antipsychotic medication; includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties; also called dystonic reactions |
| efficacy | refers to the maximal therapeutic effect a drug can achieve |
| epinephrine | derivative of norepinephrine, the most prevalent neurotransmitter in the nervous system, located primarily in the brain stem, and plays a role in changes in attention, learning and memory, sleep and wakefulness, and mood regulation |
| extrapyramidal symptoms (EPSs) | neurologic side effects of antipsychotic medications that are drug and dose related; treated with anticholinergic medication; includes dystonia, pseudoparkinsonism, and akathisia |
| half-life | the time it takes for half of the drug to be eliminated from the bloodstream |
| limbic system | an area of the brain located above the brain stem that includes the thalamus, hypothalamus, hippocampus, and amygdala (although some sources differ regarding the structures that this system includes) |
| magnetic resonance imaging (MRI) | diagnostic test used to visualize soft-tissue structures; energy field is created with a magnet and radio waves and then converted into a visual image |
| mood-stabilizing drugs | used to treat bipolar disorder by stabilizing the client’s mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania |
| neuroleptic malignant syndrome (NMS) | a potentially fatal, idiosyncratic reaction to an antipsychotic (or neuroleptic) drug |
| neurotransmitters | the chemical substances manufactured in the neuron that aid in the transmission of information throughout the body |
| norepinephrine | the most prevalent neurotransmitter in the nervous system |
| off-label use | a drug will prove effective for a disease that differs from the one involved in original testing and FDA approval |
| positron emission tomography (PET) | a diagnostic test used to examine the function of the brain by monitoring the flow of radioactive substances that are injected into the bloodstream |
| postinjection delirium/sedation syndrome (PDSS) | cluster of symptoms, such as slurred speech, confusion, sedation, altered gait, or unconsciousness that result from accidental intravascular injection of a portion of olanzapine (Zyprexa Relprevv) |
| potency | describes the amount of a drug needed to achieve maximum effect |
| pseudoparkinsonism | EPS side effect of antipsychotic medication; includes shuffling gait, masklike facies, muscle stiffness (continuous) or cogwheeling rigidity (ratchet-like movements of joints), drooling, and akinesia (slowness, difficulty initiating movement) |
| psychoimmunology | examines the effect of psychosocial stressors on the body’s immune system |
| psychopharmacology | the use of medications to treat mental illness |
| rebound | temporary return of symptoms; may be more intense than original symptoms |
| Risk Evaluation and Mitigation Strategy/Strategies (REMS) | specific actions and/or safeguards instituted by the FDA that govern the use of drugs that are approved but have infrequent serious side effects that require close monitoring |
| serotonin | a neurotransmitter found only in the brain |
| serotonin syndrome-1 | uncommon but potentially life-threatening disorder called serotonin or serotonergic syndrome; characterized by agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, confusion, and, in extreme cases, coma and death |
| serotonin syndrome-2 | most commonly results from a combination of two or more medications with serotonin-enhancing properties, such as taking MAOI and SSRI antidepressants at the same time or too close together |
| single-photon emission computed tomography (SPECT) | a diagnostic test used to examine the function of the brain by following the flow of an injected radioactive substance |
| stimulant drugs | drugs that stimulate or excite the central nervous system |
| tardive dyskinesia (TD) | a late-onset, irreversible neurologic side effect of antipsychotic medications |
| withdrawal | new symptoms resulting from discontinuation of drug or substance |
| withdrawal syndrome | refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases |
| alternative medicine | therapies used in place of traditional or conventional medical practices |
| behavior modification | a method of attempting to strengthen a desired behavior or response by reinforcement, either positive or negative |
| behaviorism | a school of psychology that focuses on observable behaviors and what one can do externally to bring about behavior changes; it does not attempt to explain how the mind works |
| client-centered therapy | focused on the role of the client, rather than the therapist, as key to the healing process |
| closed groups | structured to keep the same members in the group for a specified number of sessions |
| cognitive behavioral therapy | techniques useful in changing patterns of thinking by helping clients to recognize negative thoughts and to replace them with different patterns of thinking; include positive self-talk, decatastrophizing, positive reframing, and thought stopping |
| cognitive therapy | focuses on immediate thought processing: how a person perceives or interprets their experience and determines how they feel and behave |
| complementary medicine | therapies used in conjunction with traditional or conventional medical practices |
| countertransference | occurs when the therapist displaces onto the client attitudes or feelings from their past; process that can occur when the nurse responds to the client based on personal, unconscious needs and conflicts |
| crisis | a turning point in an individual’s life that produces an overwhelming emotional response; life circumstance or stressor an individual is confronting that cannot be managed through customary coping strategies |
| crisis intervention | includes a variety of techniques, based on the assessment of the individual in crisis, to assist in resolution or management of the stressor or circumstance |
| dialectical behavior therapy | focuses on distorted thinking and behavior based on the assumption that poorly regulated emotions are the underlying problem; involves changing thinking and behavior |
| dream analysis | a primary method used in psychoanalysis; involves discussing a client’s dreams to discover their true meaning and significance |
| education group | a therapeutic group; provides information to members on a specific issue |
| ego | psychoanalytic theory, the balancing or mediating force between the id and the superego; represents mature and adaptive behavior |
| defense mechanisms | cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress aka ego defense mechanisms |
| family therapy | a form of group therapy in which the client and their family members participate to deal with mutual issues |
| free association | psychoanalysis used to gain access to subconscious thoughts and feelings in which the therapist tries to uncover the client’s true thoughts and feelings by saying a word and asking the client to respond quickly with the first thing that comes to mind |
| group therapy | therapy during which clients participate in sessions with others; |
| hierarchy of needs | a pyramid used to arrange and illustrate the basic drives or needs that motivate people; developed by Abraham Maslow |
| humanism | focuses on a person’s positive qualities, their capacity to change (human potential), and the promotion of self-esteem |
| ID | psychoanalytic theory, the part of one’s nature that reflects basic or innate desires such as pleasure-seeking behavior; seeks instant gratification |
| individual psychotherapy | a method of bringing about change in a person by exploring their feelings, attitudes, thinking, and behavior; it involves a one-to-one relationship between the therapist and the client |
| milieu therapy | the concept involves clients’ interactions with one another, that is, practicing interpersonal relationship skills, giving one another feedback about behavior, and working cooperatively as a group to solve day-to-day problems |
| negative reinforcement | involves removing a stimulus immediately after a behavior occurs so that the behavior is more likely to occur again |
| open groups | an ongoing group that runs indefinitely; members join or leave the group as they need to |
| operant conditioning | the theory that says people learn their behavior from their history or past experiences, particularly those experiences that were repeatedly reinforced |
| parataxic mode | begins in early childhood as the child begins to connect experiences in sequence; the child seeks to relieve anxiety by repeating familiar experiences, although they may not understand what they are doing |
| participant observer | this term has been coined for the therapist’s role, meaning that the therapist both participates in and observes the progress of the relationship |
| positive reinforcement | a reward immediately following a behavior to increase the likelihood that the behavior will be repeated |
| prototaxic mode | characteristic of infancy and childhood that involves brief, unconnected experiences that have no relationship to one another; adults with schizophrenia exhibit persistent prototaxic experiences |
| psychiatric rehabilitation | services designed to promote the recovery process for clients with mental illness; not limited to medication management and symptom control |
| psychoanalysis | focuses on discovering the causes of the client’s unconscious and repressed thoughts, feelings, and conflicts believed to cause anxiety |
| psychosocial interventions | nursing activities that enhance the client’s social and psychological functioning and improve social skills, interpersonal relationships, and communication |
| psychotherapy group | the goal of the group is for members to learn about their behaviors and to make positive changes in their behaviors by interacting and communicating with others as members of a group |
| self-actualized | describes a person who has achieved all the needs according to Maslow’s hierarchy and has developed their fullest potential in life |
| self-help group | members share a common experience, but the group is not a formal or structured therapy group |
| subconscious | thoughts or feelings in the preconscious or unconscious level of awareness |
| superego | psychoanalytic theory, the part of a person’s nature that reflects moral and ethical concepts, values, and parental and social expectations; therefore, it is in direct opposition to the id |
| support groups | organized to help members who share a common problem to cope with it |
| syntaxic mode | begins to appear in school-aged children and becomes more predominant in preadolescence; the person begins to perceive themselves and the world within the context of the environment and can analyze experiences in a variety of settings |
| systematic desensitization | behavioral technique used to help overcome irrational fears and anxiety associated with a phobia |
| therapeutic community or milieu | beneficial environment; interaction among clients is seen as beneficial, and treatment emphasizes the role of this client-to-client interaction |
| therapeutic nurse–patient (client) relationship | professional, planned relationship between the client and the nurse that focuses on client needs, feelings, problems, and ideas |
| working phase | therapeutic relationship, the phase where issues are addressed, problems identified, and solutions explored |
| Four distance zones | Intimate zone (0–18 in between people) Personal zone (18–36 in) Social zone (4–12 ft) Public zone (12–25 ft) |
| self-efficacy | a belief that personal abilities and efforts affect the events in our lives |
| broad affect | displaying a full range of emotional expressions |
| blunted affect | showing little or a slow-to-respond facial expression; few observable facial expressions |
| flat affect | showing no facial expression |
| inappropriate affect | displaying a facial expression that is incongruent with mood or situation; often silly or giddy regardless of circumstances |
| tangential thinking | wandering off the topic and never providing the information requested |
| ideas of reference | client’s inaccurate interpretation that general events are personally directed to them, such as hearing a speech on the news and believing the message has personal meaning |
| circumstantial thinking | term used when a client eventually answers a question but only after giving excessive, unnecessary detail |
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