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unit 2
pmh 9,10,11
| Question | Answer |
|---|---|
| client rights in mental health | refuse treatment send/recieve sealed mail have or refuse vistors phone call, right to refuse treament and group |
| clients retain all cival rights unless: | under involentary commitment (cannot leave the hospital ) |
| lomita must be | documented , justifed and involve saftey factors |
| retrictions may include (all patients ) | removal of belts/ shoe laces vistor restriction if aggressive supervised phone calls if threatning |
| involntary commitment | used when client presents danger to slef or others |
| emergency hold : | 48-72 hours rewuires 2 dr certification at 24 and 24h to continue then court hearing determins continued hospitalization |
| risk after dischard ; | stopping medications - liabilty issue if harm occurs |
| voluntary admission | client seeks treatment and may request discharge |
| mandatory outpatient treatment | court ordered continuation of treatment after discharge include medication adherence, appointments, therapy |
| benifits of outpatient treatment | shorter inpatient stays, reduced morality, cost effective |
| conservatorship/ guardianship | court apponits guardian for clients unable to make descisions client loses legal rights to contract mange finances or consent independently |
| least restrictive environment | clients must be treated in the least restrictive setting, without unnecessary restraint or seclusion |
| types of retraints | human (staff physically holding ) mechanical (wrist/ankle devices) chemical (medication to restrict movement ) |
| retraints only used when | actually injurying not just 'about to ' |
| seclusion | locked room with continues montiring used for imminent aggression physician order required ; room must be safe; documentation continous. |
| confidentially & HIPPA | protects oral written and electronic health information ' break the glass' legitimate reasons mental health and substance use records have inhanced privacy protections exceptions apply with duty to warm |
| duty to warn/tarasoff | clinician must warn identifiable third parties when client makes credible threats state laws vary (mandatory, vs permissive ) nurse must report threats and document thoroughly |
| insanity defnese | legal, not medical - term rarely successful |
| tests include | M'Naghten (did not understand wrongfullness) irresisitble impulse substanial capacity durham rule (act caused by mental diseaase) |
| nursing liability | must provide safe, competent, legal ethical care following ANA standards |
| types of torts | unintentional ; negligence, malpractice intentonal; assult, battery, false improsonment |
| elements of malpractice has to be all 4 | duty breach injury/damage caustion |
| ethical principles | autonomy benefience nonmaleficene justice veracity fidelity |
| autonomy | right to self determination |
| beneficence | promote good |
| nonmaleficence | do no harm |
| justice | fairness |
| veracity | truthfulness |
| fidelity | keeping commitments |
| etical delemmas | occur when priniples coflict (autonomy vs personal saftey ) |
| common ethical dilemas | refusing medication (autonomy dont get benifits from medicine ) forced treatment cofidentiality issues seclusion/restraint |
| anger | normal, not 'bad' emotional respoinse to fustration, threat or fear |
| hostility | VERBAL agression (threats, rule breaking, yelling) |
| physical aggression | INTENT to harm people/property ofen escalation of unresolved anger restrain yes if saftey involved |
| anger is | healthy when expressed assrtivitly , using 'i feel.." statements or 'i would like.." |
| aggression grows though stages of | triggering escaltion crisis recovery postcrisis |
| triggering | provoking event |
| escalation | loss of control increases - let off steam- say ' id really like to not for saftey" |
| crisis phase | physical loss of controll- (restrin/ regain control ) |
| recovery phase | regaining equilibrium |
| postcrisis phase | reintgrration - return to muile if possiible |
| assesment finding - SIGNS OF AGITATION | PACING - clenched fists loud voice, threats restlessness |
| evaluate risks factors proior to | violance, substance use, psychosis, victimization history |
| interventions by phase triggering phase | calm non threating aprouch encourage verbalization of feelings offer physical walk outlets (walk/ quet area) suggest relaxing techniques |
| interventions by phase; excalation | take control, give firm/direct instructions offer medication again - if willing show of force (additonal staff near by) 4-6 may need |
| interventions by phase crisis phase | saftey is priority seclusion/resrtain if needed 4-6 trained staff trained for physical restriants obtain physicians order |
| recovery and postcriss interventions | encourage processing of triggers document events and staff injuries debriefing for staff return client to milue as appropriate provide feedback on regaining control |
| paranoid delusions | belief others intend to harm |
| command hallucinations | voices" directing violoence - MOST DANGEROUS ' |
| traumatic brain injury | (DISORDERS LINKES TO AGGRESSION ) |
| personality disorders | antisocial , borderlibe |
| substance abuse | (DISORDERS LINKES TO AGGRESSION ) |
| nEUROBIOLOGICAL FACTORS | LOW SEROTONIN- INCREASED AGGRESSION HIGH DOPAMINE/NOREPINEPHRINE- IMPULSE VIOLOENCE LIIMBIC/FRONTAL LOBE INJUSRY INCREAES RISK |
| PSYCHOSOCIAL FACTORS | poor impulse control, dysfuncational fmaily dynamics early child hood rejection low self eseem learned agressive behavior patterns |
| cultrual considerations | gender norm infuence anger expression (women and girls ) |
| culture specific sydroms include : | hwa-byung- korea amok (southeast asia) bouffee delirante (west africa/haiti ) |
| medications | lithium - bipolar, conduct disorder carbamazepine/valproate (Dementia, psychosis) atypical antipsychotics (psychosis related aggression benzodiazepines (older adults with orratability ) - antianziety haloperiodl & lorazapam for acute aggitation |
| saftey and enviroment control | clear staff roles strong leadership structured schdeule , groups and activites reduce ovestimulation one on one interventions protect vunerable clients |
| grief | emotional response to loss (subjecive) |
| mourning | outward express of grief (rituals ) proccess of which one grievs |
| bereavemnt | period of grieving after loss |
| anticipatory grief | grieving before the actual loss occurs grief before loss |
| types of loss (maslows needss framework ) | physiological satey secuirty/belonging self esteem self actualization |
| Physological | limb loss surgery mobility changes - health isues |
| saftey | domestic violence, disatsters PRIORITY |
| Security and belonging | relationship changes death, divorce |
| self estemm o | job loss retiement |
| self actualization | unfufilled dreams and goals |
| the grieving process is | individualized, dynamic, and fluctuating there is no right way to grieve (people move back and forth between stages ) |
| kubler ross stages | denial anger bargaining depression acceptance |
| congnitive resposes | difficulty making sense of loss review of beleifs, values meaning of life need some sense of reasoning questioning fairness of life/world attempting to maintain ongoing bond (eg talking to the deceased internally ) |
| emotional responses | anger, sadness, anxiety guilt (especially in suddent/ violent deaths) emotional waves :numbness, panic, yearning, reorganizing identity |
| behavioral responses | crying, withdrawal, searching behaviors irritability, hotility, avoidance,of reminders maladaptive coping: sbstance misuse, suicidal behavior |
| physiological responses (fight ad flight) cholorgenic/anticholergenic- sympythetic | insomnia headache appeite loss/weightloss palpation gi upset immune/endocrine changes |
| cultural considerations | all cultures grieve, but ritualsvary widley i:e wakes funerals specific religious rites (islam, judism, hinduism, christianity ) some cultures prhibit cremation; others require constant body attendence |
| Disenfranchied grief | occurs when grief is not acknowledged socially unreconized relationships (same sex partners affairs) unrecognized losses (prenatal death, pet death, job loss) stigmatized losses (death by sucied, incarceration/ xecution ) |
| complicated griving | prolonged, disabling giref |
| complicated griving RISK FACOTRS | Low self esteem psychiatric history multiople losses sudden/violent death (sucide, homicidde, disasters) |
| comlicated grieving | can lead to depression, health decline, increased mortality |
| nursing asesment,and interventions- grieving | assess meaning of the loss, coping patterns, support systems encourage expression of feelings (verbal, and non verbal) teach self care: sleep melas exercise |
| nursing asesment,and interventions- greiving | watch fro suicidal ideation or sever withdrawal reinforce healthy coping and community support provide culturally sensitve care |
Created by:
mmishue