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Mental Health sum#1

Note cards for first test

1 The 5 A’s Ask a question, Acquire literature, Appraise the literature, Apply the evidence, Assess the performance
1 attending refers to an intensity of presence, being there for and in tune with the patient
1 Caring is the most natural and most fundamental aspect of human existence
1 Clinical algorithms are step by step guidelines prepared in a flowchart format
1 Clinical pathways are usually specific to the institution using them, they serve as a map for specified treatments and interventions
1 Clinical practice guidelines are systematically developed statements that identify, appraise, and summarize the best evidence about prevention, diagnosis, prognosis, and therapy
1 Evidence based practice the method for using treatment approaches to medical and mental health illness that are scientifically grounded
1 Patient advocate the person who speaks up for the patient
1 Psychiatric-mental health nursing employs a purposeful use of self as its art and a wide range of nursing, psychosocial, and neurobiological theories and research evidence as its science.
1 Recovery model is seen as the social model of disability rather than the medical model
1 Hildegard Peplau mother of psychiatric nursing
1 Three areas inherent in the art of nursing caring, attending, and patient advocacy
2 mental health successful performance of mental functions resulting in the ability to engage in productive activities, and cope
2 mental illness is considered a clinically significant behavioral or psychological syndrome experienced by a person and marked by distress, or disability
2 mental disorders are medical diseases
2 DSM-IV-TR manual that classifies mental disorders
2 Psychiatry’s definition of normal mental health changes over time and reflects changes in cultural norms, society’s expectations, professional biases, individual differences, and political climate
2 resiliency the ability to recover from or adjust to misfortune and change
2 seven aspects of mental health happiness, control over behavior, appraisal of reality, effectiveness in work, healthy self-concept, satisfying relationships, and coping strategies
2 epidemiology is the quantitative study of the distribution of mental disorders in human populations
2 prevalence rate is the proportion of a population with a mental disorder at a given time
2 factors that affect mental health support system, family, developmental events, cultural beliefs, health practices, negative influences
2 biologically based mental illness a mental disorder caused by a neurotransmitter dysfunction, abnormal brain structure, or inherited genetic factors
2 types of biologically based schizophrenia, bipolar, major depressive, OCD, panic, PTSD, autism
2 In disorders- There is much physical in mental disorders, and much mental in physical disorders
2 The three things that affect mental illness the most are family, religion, and sex
2 intrinsic factors are inherited factors
2 extrinsic factors are environmental factors
2 5 Axis I. clinical disorder II. personality disorders and mental retardation III. General medical condition IV. Environmental problems V. Gaf
2 NANDA describes a nursing diagnosis as a clinical judgment or response to health problems and life processes
2 Gaf Global assessment of functioning the higher the gaf the better functioning
3 psychotherapy talk therapy, focusing on the inner workings of the mind
3 freuds three layers of mental activity conscious, preconscious, and unconscious
3 conscious current awareness
3 preconscious lying below the surface, but accessible
3 Unconscious where our primitive feeling drives and memories reside
3 id primitive pleasure seeking part of our personality that resides in unconscious mind
3 ego sense of self, balances id and superego by using defense mechanisms, rational mind
3 superego our conscience, influenced by our morals
3 psychoanalytic therapy knowing the unconscious mind to uncover the truth, long and expensive
3 transference patient projects intense feelings onto the therapist related to previous relationships
3 countertransference when therapist projects feelings from past experiences onto the patient
3 interpersonal theory focuses on what goes on between people
3 anxiety interpersonal is transmitted empathetically from parent to child, also from approval or disapproval felt by child
3 according to Sullivan all behavior is aimed at avoiding anxiety and threats to self-esteem
3 good me focusing on positive attributes
3 bad me hiding the negative aspects from others and possibly ourselves
3 not me most drastic, things we find so objectionable that we can not even imagine them being part of us.
3 interpersonal therapy therapists guide and challenge maladaptive behaviors and distorted views, with focus on life
3 behavior therapy attempts to eliminate maladaptive behavior
3 Ivan Pavlov famous for classical conditioning, response to stimuli
3 Systematic desensitization learned responses can be reversed through facing your fear
3 Aversion therapy antabuse, eradicate unwanted habits by associating unpleasant consequences with them
3 Biofeedback people learn to control body reactions through relaxation
3 cognitive therapy seeks to modify negative thoughts that lead to dysfunctional emotions and actions
3 schema assumptions about ourselves or the world
3 automatic thoughts unthinking responses based on schemas
3 cognitive development dynamic progression from primitive awareness and simple reflexes to complex thought and responses
3 piaget stages sensorimotor- 0-2 yrs, preoperational 2-7 years, concrete operations 7-11 yrs., formal operations 11-adulthood
3 Object permanence when child can conceptualize objects that are no longer visible
3 operations term for thinking about objects
3 conservation when child can see from another’s point of view and can see a variety of solutions to a problem.
3 Kohlberg’s 3 stages of moral thinking pre-conventional, conventional, post-conventional
3 biological model current, dominant model, mental disorders are believed to have physical causes, will respond to physical treatment
3 biological therapy psychopharmacology is primary treatment for mental disorders
3 major classifications of meds antidepressants, antipsychotics, antianxiety, mood stabilizers, and psychostimulants
3 Hildegard Peplau name most commonly associated with psychiatric nursing
3 Peplau four stages of anxiety mild, moderate, severe, panic
3 mild anxiety day to day, stimuli are perceived and understood
3 moderate anxiety heightened sense of awareness, perceptual field narrowed, requires more direction
3 severe anxiety interferes with clear thinking, perceptual field greatly diminished, behavior directed at reducing anxiety
3 panic anxiety overwhelming, dangerous, cannot follow directions, panic attacks
3 Peplaus four phases of therapeutic relationship preinteraction, orientation, working, termination
3 preinteraction before meeting, report, read chart
3 orientation meets patient, set up times for meetings, anxiety, formulates nursing diagnosis, sets goals
3 working trust is built, patient identifies and works on problems, growth is evident
3 termination final, feelings of loss and anxiety, goals achieved, plans made
5 Psychiatric Assessment establish rapport, obtain chief complaint, review physical status, assess risk factors, preform MSE, assess psychosocial status, identify goals, formulate plan
5 Mental Status Exam objective data, behavior, nonverbal, appearance, speech, mood, thought content, perceptions, conative ability, judgment
5 psychosocial assessment subjective data, patients complaint, history, drug abuse, family, coping mechanisms, personal info, beliefs, patients goals
5 nursing diagnosis problem, etiology, supporting data
5 outcomes patient centered outcome hopes, wrote positively
5 planning pathways, or individual, use best interventions, must be safe- appropriate- individualized- and evidenced based
5 EBP nurses use of clinical skill with relevant research
5 implementation putting the plan into action
5 evaluation should be systematic, ongoing, and criterion based
5 documentation seventh step, must be focused, organized, and pertinent
6 therapeutic communication professional, goal directed, and scientifically based
6 communication can be 90% nonverbal
6 stimulus one person has a need to talk to another
6 sender person sending the message
6 message information sent
6 media how the message is sent
6 receiver person receiving the message
6 feedback response to the sender
6 Peplaus 2 principals that guide communication clarity and continuity
6 clarity ensures the meaning of the message is understood by both parties
6 continuity promotes connections among ideas and feelings conveyed in those ideas
6 factors that affect communication personal, environmental, and relationship
6 symmetrical when two participants are equal
6 complementary one participant is superior to the other
6 content the verbal part of a message
6 process the nonverbal part of a message
6 useful tools for nurses when communicating silence, active listening, and clarifying
6 silence the absence of communication
6 active listening notes patients verbal and nonverbal responses as well as their own
6 clarifying corrects misunderstandings before they create problems
6 paraphrasing restating in different ways using shorter length
6 restating mirrors the patients message
6 reflecting statement that conveys the nurses observation of a patient when sensitive issues are discussed
6 sharing observations shows acceptance, makes pt aware of inner feelings and helps them own them
6 exploring enables the nurse to examine important information more fully
6 excessive questioning makes nurse look like interrogator
6 giving approval or disapproval may lead patient to try to please nurse, implies judgment
6 giving advice can foster dependency
6 asking why questions implies criticism
7 basis of all psychiatric nursing treatment therapeutic nurse patient relationship
7 goals of therapeutic communication facilitating, assisting, helping, promoting
7 facilitating helps communicate distressing thoughts and feelings
7 assisting helps problem solve to complete ADL’s
7 helping help patients to examine self-defeating behaviors and test alternatives
7 promoting promotes self-care and independence
7 social relationship primarily for friendship, enjoyment, or accomplishing a task
7 in social relationships roles may shift
7 in therapeutic relationship nurse assumes variety of roles, but relationship is constantly focused on patients problem
7 accountability nurses assume responsibility for their actions
7 focus on patient needs nurse focuses on best interest of patient
7 clinical competence nurse bases her conduct on knowledge
7 delaying judgment nurse refrains from judging patients
7 supervision nurse is supervised by a more experienced nurse
7 during orientation phase nurse forms a formal or informal contract with patient
7 what helps a relationship consistency, pacing, listening, impressions, comfort and control, and patient factors
7 what hurts a relationship inconsistency and unavailability, lack of self-awareness
7 positive regard ability to view another person as worthy of caring about
7 space interment 0-18”, personal 18-40”, social 4-12’, public 12+ feet
7 communication can be facilitated by offering leads (go on), statements of acceptance (uh-huh)
17 crisis acute, time limited occurrences experienced as emotional reactions
17 crisis intervention what nurses do to assist those in crisis to cope
17 three types of crisis maturational, situational, adventitious
17 maturational crisis each stage of Erickson is a maturational crisis
17 situational crisis from external source, (death, divorce)
17 adventitious crisis
17 how many phases of crisis four
17 phase 1 person is confronted with a problem, anxiety increases, defense mechanisims kick in
17 phase 2 if defense fails, anxiety continues to increase, functioning becomes disorganized, trial and error begin
17 phase 3 trial and error fails, anxiety increases to sever and panic, automatic relief behavior kicks in, resolution may be reached
17 phase 4 if problem not solved coping skills are ineffective, anxiety can overwhelm, serious personality disorganization, depression, violence, or suicide
17 crisis assessment adverse affecters unrealistic perception of problem, inadequate supports, inadequate coping mechanisms
17 implementation has two basic goals patient safety, and anxiety reduction
17 primary care promotes mental health and reduces mental illness to decrease the incidence of crisis
17 secondary care establishes intervention during an acute crisis to prevent prolonged anxiety, primary goal ensure safety
17 tertiary care provides support for those who have experienced a severe crisis and are noe recovering from a disabling mental state
17 critical incident stress debriefing seven phase group meeting that offers individuals the opportunity to share in a safe environment
17 introductory phase CISD purpose of meeting explained, participants motivated, confidentiality assured, guidelines explained, questions answered
17 fact phase discusses facts of incident, introductions and tell what happened from their perspective
17 thought phase participants discuss thought about the accident
17 reaction phase engage in discussion about whole event, talk about worst most painful part
17 symptom phase describe conative, emotional, and behavioral experiences since incident
17 teaching phase symptoms acknowledged and affirmed, talk about future symptoms, stress management techniques taught
17 reentry phase review old material, introduce new topics, bring closure
17 Evaluation usually occurs 4-8 weeks after initial interview, anxiety should be back to precrisis levels
22 grief reaction to loss
22 acute grief 4-8 weeks
22 active symptoms of grief 3-6 months
22 work of mourning 1-2 years
Bereavement social experience of dealing with the death of a loved one
22 mourning culturally patterned expressions of bereavement and grief
22 disenfranchised grief when incurs a loss that can not be openly acknowledged or publicly mourned
22 public tragedies a loss whose effect is felt broadly across a community
22 Kubler Ross identified distinct phases of the human response to death and dying: denial, anger, bargaining, depression, and acceptance
22 denial a bereaved persons first response to death
26 ethical dilemma when there is a conflict between two courses of action
26 ethics the study about what is right and wrong in society
26 bioethics ethical questions that arise in healthcare
26 beneficence duty to act for the good of others
26 autonomy respecting the rights of others to make their own decisions
26 justice duty to distribute resources or care equally
26 fidelity maintaining loyalty and commitment to the patient
26 veracity ones duty to communicate truthfully
26 law and ethics are closely related because law tends to reflect the ethical values of society
26 deinstitutionalization in 1963 when care shifted from state care to community care
26 civil rights people with mental illness have the same civil rights
26 writ of habeas corpus where a patient can challenge commitments
26 least restrictive alternative doctrine most important concept applicable to civil commitment, least drastic means taken
26 voluntary admissions have the right to obtain and demand release
26 involuntary admission made without the patient consent
26 hold for commitment where they can hold you 1-10 days if you are a danger to yourself or others
26 when voluntary demands release hospital starts a 4 hr. letter that allows time for Dr to intervene
26 conditional release requires outpatient treatment for a specified time
26 treatment must meet criteria must be humane, staff must be qualified, plan must be individualized
26 right to refuse treatment patients can refuse treatment, judge can force them in some cases
26 informed consent patients right to know and self-determine, psych hospitals must get on all meds
26 restraints must have a dr order signed within 24 hrs, patient checked every 15 to 30 minutes
26 tort civil wrong in which money damages may be collected
26 malpractice act that breaches duty of care
26 duty measured by standard of care
26 breech of duty conduct that exposes the patient to an unreasonable risk of harm
26 abandonment when nurse fails to leave patient safely back in the hands of another healthcare provider
Created by: 100000602352444