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MH Chap1,2,3,5,6,8

Therapeutic Comm, Erickson, Peplaus, Restraints, Legal

Accepting Belief/agree; conveys positive regard; "I can imagine how that might feel"
Giving Recognition Acknowledgeing; indicating awareness; " I notice ur wearing a new dress."
Using Silence Allows client to take control of discussion, if they so desire; Gives the client opportunity to collect or process thoughts; *Sitting quietly*
Offering Self Making oneself available on an unconditional basis, increasing the clients feelings of self-worth; "I'll stay with u awhile."
Broad Openings Allows client to select topic; Emphasizes importance of the clients role in the interaction; "Tell me what u r thinking"
Offering General Leads Minimal encouragement; Encourages the client to continue; "Go on" "uh-huh" "and after that"
Placing the Events in Time or Sequence Clarifies the relationship of events in time so that the RN and client can view them in perspetive; "When did u first notice..."
Making Observations Verbalizing what is observed or perceived; This encourages the client to recognize specific behaviors & compare perceptions with the RN; "I notice u r pacing alot"
Encouraging Description of Perception Asking client to verbalize wat is being perceived; Often used with clients experiencing hallucinations; "R U hearing the voices again"
Encouraging Comparison Client compares similaritiesw & differences in ideas, experiences, or relationships;Helps client recognize experiences that recur or that r chaqngable "Wat was ur response last time this occured"
Restating (Repeat) Lets a client know whether an expressed statement has or has not been understood; Cl-I cant study, my mind keeps wondering RN- U have difficulty concentrating
Reflecting (ab pt. feelings) Directs ?'s or feelings back so that they may be recognized & accepted, & they may recognize their point of view haqs value: Use when client asks RN for advice Cl-My sis want help with mother, i do it all RN-U feel angry when she doesnt help
Focusing Taking notice of a single idea or even a single word; Works with clients who rapidly move from 1 thought to another: "This point seems worth looking at more closely, perhaps U & I can discuss it together"
Exploring Delving further into a subject, idea, experience, or relationship; Helpful with clients who tend to remain on a superficial level of communication; "Tell me more about that particular situation"
Seeking Clarification & Validation (Clarifying) Strivng to explain wat i vague & searching for mutual understanding; Clarifying wat has been said; "Do I understand that u said..." "Could U explain more ab that to me..."
Presenting Reality Clarifying misconceptions that may be expressed When pt. has misperception of enviroment, RN defines reality or indicates perception of situation "I understand the voices seem real to u, but I do not hear any voices"
Voicing Doubt Expressing uncertainty as to the reality of the clients perceptions; Often used with clients experiencing delusional thinking; "I find that hard to believe"
Verbalizing the Implied Put in words wat has is implied or said indirectly;Clarifies wat is implicit rather than explicit;Cl-Its a waste of time,I cant talk to U.RN-R U feeling no one understands. CL-mute.RN It must have been very difficult for U when ur hubby died in the fire
Attempting to Translate Words into Feelings Putting into words the feelings the clien has expressed only indrectly & to find clues to the underlying true feelings; CL- Im way out in the ocean RN U must be feeling very lonely now
Formulating Plan of Action Striving to prevent anger or anxiety escalating to unmanageable levels when stressor recurs "Next time this comes up, wat might U do to handle it more appropriately"
Peplau's interpersonal Theroy Infancy Learning to count on others learn to communicate in various ways w primary caregiver in order to have comfort needs fulfilled
Peplau's interpersonal Theroy Toddlehood Learning to delay satisfaction Learn the satisfaction of pleasing others by delaying self-gratification in smaqll ways
Peplau's interpersonal Theroy;Early Childhood Identifying oneself Learn appropriate roles & behaviors by acquiring the ability to perceive the expectations of others
Peplau's interpersonal Theroy Late Childhood Developing skills in participation Learn skills of comprmise, competition & cooperation w othrs; establishment of a ore realistic view of the world & a feeling of one's place in it
Freud's Psychosexual Development Oral Birth - 18 months Relief from anxiety through oral gratification
Freud's Psychosexual Development Anal 18 months - 3 yrs Learning independence and control, with focus on the excretory function
Freud's Psychosexual Development Phallic 3-6 yrs Identification with parent of same sex; Development of sexual identity; Focus on genital organs
Freud's Psychosexual Development Latency 6-12 yrs Sexuality repressed; Focus on relationships with same-sex peers
Freud's Psychosexual Development Genital 13-20 yrs Libido reawakened as genital organs mature; Focus on relationships with members of the opposite sex
Erikson's Psychosocial Theory Infancy Birth-18 months; Trust vs Mistrust; Develope a basic trust in mother figure & generalize it to others
Erikson's Psychosocial Theory Early Childhood 18months-3yrs Autonomy vs Shame & Doubt; To gain some self-control & independence within the enviroment
Erikson's Psychosocial Theory Late Childhood 3-6 yrs Initiative vs Guilt; To develope a sense of purpose & the ability to initiate & direct own activities
Erikson's Psychosocial Theory School Age 6-12 yrs Industry vs Inferiority; To develope a sense of self-confidence by learning, competing, performing successfully & receiving recognition from peers, significant others & acquantances
Erikson's Psychosocial Theory Adolescence 12-20 yrs Identity vs Role Confusion; To integrate the task mastered in the previous stages into a secure sence of self
Erikson's Psychosocial Theory Young Adulthood 20-30 yrs Intimacy vs Isolation; To form an intense lasting relationship or a commitment to another prson, cause, institution, or creative effort
Erikson's Psychosocial Theory Adulthood 30-65 yrs Generativity vs Stagnation; To achieve life goals established for oneself, while also considering the welfare of future generations
Erikson's Psychosocial Theory Old Age 65- Death Ego Integrity vs Despair; To review one's life & derive meaning from both (+) and (-) events, while achiving a positive sense of self-worth
When can restraints/seclusion be initiated without a MD order Only for emergency situation where the client's behavior is out of control & poses a risk to the physical safety& psychological well-being of the client or staff
When is a MD notified of the initiation of restraints/seclusion ASAP, but no later than 1 hr after the initiation of restraints/seclusion
When does the orders for restraints/seclusion have to be reissued for 18 yrs & above q4h
When does the orders for restraints/seclusion have to be reissued for persons 9 - 17 yrs q2h
When does the orders for restraints/seclusion have to be reissued for persons under 9yrs q1h
How often and what assessments are observed on a client in restraints/seclusion q 10-15 mins. Assessment of circulation, respiration, nutrition, hydration, and elimination. Also documented
Before restraints/seclusion what other measures are used to decrease agitation Verbal intervention (talking down) Chemical restraint ( tranquilizing meds)
Utilitarianism "The greatest-happiness principle" This principle holds that actions r right to the degree that they tend to promote happiness & wrong as they tendto produce the reverse of happiness; It looks at end results
Kantianism Ethical theory by which decisions r based on a 'sense of duty'; It is not the end result that makes an action right r wrong, but it is the principle or motivation on which the action is based that is the morally decisive factor
Christian Ethics To treat others as moral equals & to recognize the equality of others by permitting them to act as we do when occupying a position similar to ours; "Golden Rule" Do unto othr as U would have them do unto U
Natural Laws Theories 'Do good and avoid evil' Ethics must be grounded in a concern for the human good; Evil acts r never condoned, even if they r intended to advance the noblest of ends
Ethical Egoism Decisions are based on what is best for the individual making the decision
GAF 1-10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.
GAF 11-20 Some danger of hurting self or others(suicide attempts without clear expectation of death;frequently violent;manic excitement)R occasionally fails to maintain minimal personal hygiene(smears feces) R gross impairment in communication(incoherent or mute).
GAF 21-30 Behavior is influenced by delusions/hallucinations R serious impairment,in communication/judgment sometimes incoherent,acts grossly inappropriate,suicidal preoccupation)R inability to function in most areas(stays n bed all day,no job,home,friends)
GAF 31-40 Some impairment in reality testing/communication(speech at times illogical,irrelevant)R major impairment n several areas,like work r sch,family relations,judgment,thinking,mood(depressed man avoids friends,neglects fam,is unable to work;child beatsup youn
GAF 41-50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).
GAF 51-60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).
GAF 61-70 Some mild symptoms (depressed mood/mild insomnia)R some difficulty in social,occupational, school functioning (occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
GAF 71-80 If symptoms are present,they are transient and expectable reactions to psychosocial stressors (difficulty concentrating after family argument)no more than slight impairment in social,occupational,school functioning(temporarily falling behind n schoolwork)
GAF 81-90 Absent/minimal sympt(mild anxiety before exam)good functioning n all areas,interested & involved n wide range of activities,socially effective,generally satisfied with life;no more than everyday problems/concerns(an occasional argument with family members
GAF 91-100 Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.
A handicapped boy who is unable to participate in sports works hard and becomes a great scholar - this is an example of which defense mechanism? Compensation
Individuals continuing to smoke cigarettes even though they have been told of the health risk involved is an example of which defense mechanism? Denial
A boy who is teased and hit by the class bully on the playground comes home after school and kicks the dog - is an example of which defense mechanism? Displacement
A teenage girl emulates the mannerisms and style of dress of a popular female rock star - is an example of what defense mechanism? Identification
A young Psych professor receives a letter from his fiancee breaking up with him. He shows no emotion and instead analyzes his fiancees behavior reasoning the relationships failure - is an example of which defense mechanism? Intellectualization
A psychiatric client claims to be the Son of God, drapes himself in sheet and blanket and refuses to respond unless addressed as Jesus Christ - is an example of what defense mechanism?Introjection Introjection
A young woman describes being attacked and raped by a street gang. She displays an apathetic expression and no emotional tone - is an example of what defense mechanism? Isolation
A young soldier who has an extreme fear of participation gin military combat tells his sergeant that the others in his unit are "a bunch of cowards" - is an example of what defense mechanism? Projection
A young man is unable to afford the sports car he wants. He tells the salesperson, "I'd buy this car but I'll be getting married soon. This is really not the car for a family man." - is an example of what defense mechanism? Rationalization
The young soldier who has an extreme fear of participating in military combat volunteers for dangerous front-line duty. - is an example of what defense mechanism? Reaction Formation
A person who is depressed may withdraw to his or her room, curl up in a fetal position on the bed, and sleep for long periods of time. - is an example of what defense mechanism? Regression
A women cannot remember being sexually assaulted when she was 15 years old. - is an example of what defense mechanism? Repression
A teenage boy with strong competitive and aggressive drives becomes the star football player on his high school team. - is an example of which defense mechanism? Sublimation
which defense mechanism is defined as the voluntary blocking of unpleasant feelings and experiences from one's awareness? Suppression
hich defense mechanism is defined as symbolically negating or canceling out an experience that one finds intolerable? Undoing
What are Kubler-Ross's five stages of grief? 1. Denial, 2. Anger, 3. Bargaining, 4. Depression, 5. Acceptance
When a person experiences a significant loss however does not experience the emotional pain associated with the loss and anxiety disorders are evident, is an example of what maladaptive grief response? Delayed or Inhibited Response
Which maladaptive grief response is characterized by the individual turning anger inward on the self, consumed with overwhelming despair, and is unable to function in normal ADL's? Distorted Response
What are the two major, primary responses to stress? Anxiety and grief
What are the five axis that individuals are evaluated on for psychiatric diagnoses by the American Psychiatric Association? 1. Major Mental disorders, 2. Personality disorders/developmental level, 3. general medical conditions, 4. psychosocial and environmental problems, 5. level of functioning
What are the initial stress response steps of the "fight or flight syndrome"? Stressor activates the Hypothalamus, stimulates the sympathetic nervous system which innervates body systems.
what are the steps for the sustained stress response for the "fight or flight syndrome"? Hypothalamus stimulates the Pituatary Gland which releases Adrenocorticotropic hormone (ACTH), Vasopressin (ADH), Growth Hormone, Thyrotropic hormone, gonadotropins
Wat r the 3 criteria To Sign in Voluntarily-LA Person realizes he/she is in a psychiatric facility; Person realizes he/she is making an application for admission; Person understands the nature of his/her status and provisions governing discharge or conversion to an involuntary status
Wat r the 3 Involuntary Admission in LA. By Emergency Certificate (PEC) By Peace Officer BY Protective Custody (OPC)
Who can sign an Emergency Certificate (PEC) physician, psychologist, or psychiatric nurse practitioner
Wat is the time limit on the Emergency Certificate (PEC) Coroner is to examine a person on PEC within 72 hours and may extend the PEC for up to 15 days until a hearing is held
Why can a person be addmitted by an Emergency Certificate (PEC) Can be signed if a person is deemed to be in need of immediate care and treatment because the person is gravely disabled, dangerous to himself, dangerous to others
Wat is the time on a Protective Custody (OPC) The order is valid for 72 hours, but the person must be brought to a treatment facility or the coroner’s office within 12 hours of being taken into protective custody
Who can have another person taken under the Protective Custody (OPC) Upon request of a credible person ,the coroner or a judge of a court of competent jurisdiction may order a person to be taken into protective custody and taken to treatment facility or coroner’s office for evaluation
Wat r the 3 Legal Issues in Psychiatric/Mental Health Nursing Invasion of privacy Assault and battery False imprisonment
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)
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.
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.
Created by: mromerobr