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181 Cards in this Set
- Front
- Back
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Seven Signs of Mental Health
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Happiness, Control of own behavior, Appraisal of reality, Effectiveness in work, Healthy self-concept, satisfying relationships, effective coping strategies
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Mental Health
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able to recognize own potential, cope with normal stress, work productively, make contribution to community
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Traits of Mental Health
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ability to: think rationally, communicate appropriately, learn, grow emotionally, be resilient, have a healthy self-esteem
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Mental Illness
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considered CLINICALLY SIGNIFICANT when marked by client's distress, disability, loss of freedom, culturally defined
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Diathesis-Stress Model
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Most accepted explanation for mental illness
Biological Pre-Disposition + Living Environment =Mental Illness Nature PLUS Nurture |
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Diathesis
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biological predisposition (Diathesis-Stress Model)
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Stress
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environmental stress or trauma (Diathesis-Stress Model")
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Diagnostic & Statistical Manual of Mental Disorders (DSM-5)
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manual used to classify diagnostic categories for psychiatric disorders.
- diagnoses clustered by symptom similarity - diagnosis is a label, not an explanation - culturally biased |
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DSM-5 Multiaxial System
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system that determines the components of mental illness...
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Axis 1
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Mental disorders that is the focus of treatment, developmental disorders, substance abuse disorders
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Axis 2
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Personality disorders and mental retardation diabilities
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Axis 3
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General medical disorder relevant to the mental disorder in axis 1 and physical disorders
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Axis 4
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Psychosocial and environmental problems
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Axis 5
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Global Assessment of Functioning (GAF)
scale of 1-100: measures a person's functioning |
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Levels of Psychiatric Nursing Practice
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1. Basic Level
2. Advanced Practice |
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Factors Affecting Mental Health and Nursing Assessment
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Support systems, family influences, developmental events, neurological integrity, cultural beliefs and values, health practices, negative influences
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Freud's Psychoanalytic Theory: Levels of Awareness
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conscious, preconscious, unconscious
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Freud's Psychoanalytic Personality Structure
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Id, Ego, Superego
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Id
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(Freud)
Pleasure principle, reflex action, primary process , impulses, immediate gratification (primitive thinking- out of control part of us) |
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Ego
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(Freud)
problem solver, reality tester (in the middle, mediator) |
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Superego
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(Freud)
Moral component |
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Psychoanalytic Theory
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Anxiety is inevitable, defense mechanisms, operate on unconscious level, deny, falsify, or distort reality to make it less threatening, to decrease anxiety, range from primitive to sophisticated intellectually
ex. "split personality" to "intellectualization" |
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Freud's Psychosexual Stages of Development
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Oral, Anal, Phallic, Latency, Genital
-NEED TO GO THROUGH IN A CERTAIN ORDER: POSSIBLE TO GET STUCK IN A CERTAIN LEVEL |
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Psychosexual Stages of Development correspond to:
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person's age, expected physical and social development, age appropriate developmental tasks within relationships, types of defenses usually used
MENTAL ILLNESS RESULTS FROM AN INTERRUPTION OF NORMAL PROGRESSION THROUGH STAGES |
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Transference
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when the patient's experiences feelings toward the nurse or therapist that were originally held toward significant others in his/her life.
ex. reaction to authority figures? |
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Transference r/t healthcare worker
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the healthcare worker's unconscious, personal response to the patient.
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Countertransference
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when someone responds to another person out of his/her transference, and then that 2nd person reacts from his/her own transference
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Freudian Theory and Nursing
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role of defense mechanism in protecting the person from anxiety, importance of individual talk sessions, attentive listening, transference, countertransference
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Hind Sight on Freud
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psychic structures and processes are inferred, not outwardly observed.
Contribution: 1) anxiety and defense mechanisms 2) spawning thinking in others about mental processes |
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Erikson's Ego Theory
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8 stages of development
personality continues to develop through old age FAILURE AT ONE STAGE CAN BE RECTIFIED AT ANOTHER STAGE |
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Erikson's 8 Stages of Development
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Trust vs. Mistrust
Autonomy vs. Shame and doubt Initiative vs. Guilt Industry vs. Inferiority Identity vs. Role Confusion Intimacy vs. Isolation Generativety vs. Self-absorption Integrity vs. Despair |
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Erikson's Theory & Nursing
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helps determine what types of challenges a person may be facing in relationships (work, identity, etc)
Suggest interventions which might be most effective |
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Sullivan's Interpersonal Theory
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foundation of Peplau's Nursing Theory
purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety |
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Sullivan's definition of anxiety
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any painful feeling or emotion that arises from social insecurity or prevents biological needs from being satisfied
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Sullivan's Theory and Nursing
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people will do whatever it takes to decrease anxiety. this underlies behavior.
-recognize role/source of anxiety in patients' behaviors -normalize anxiety |
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Behavioral Theories
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Pavlov's classical conditioning theory, Watson's behaviorism theory, Skinner's operant conditioning theory: are LEARNED and can be modified in a particular environment through conditioning
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Conditioning
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pairing a behavior with a condition that either reinforces or diminishes the behavior's occurrence +/-
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Behavioral Theories & Nursing
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Give positive reinforcement to to behaviors you want to INCREASE
do NOT give reinforcement to behaviors you want to DECREASE |
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Cognitive Theories
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based on the belief that your thoughts CREATE your feelings, so modify the thoughts in order to address the problematic thoughts
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Rational-Emotive Behavior Therapy (Ellis)
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aims to eradicate irrational beliefs & recognize thoughts that are not accurate
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Cognitive-Behavioral Therapy (Beck)
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Test distorted beliefs and change way of thinking; reduce symptoms
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Maslow's Hierarchy of Needs
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human beings are active participants in life, striving for self-actualization
Basic needs MUST always be met before more sophisticated emotional lives can develop |
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Maslow's Theory and Nursing
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-prioritizing nursing actions in the nurse-client relationship.
-very practical: with what level of need(s) is the patient challenged? -emphasis on human potential and client's strength |
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Maslow's Levels
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(Bottom to Top)
Physiological, Safety, Love/Belonging, Esteem, Self-actualization |
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Biological Theories
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focus on neurological, chemical, biological, genetic.
Emotions, memories, perceptual experiences |
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Hildegard Peplau
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Mother of psychiatric nursing (influences by Sullivan)
major paradigm shift in nursing (nurse-patient relationships as therapeutic partnership) OBSERVATION, INTERPRETATION, INTERVENTION |
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Milieu Therapy
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environment therapy: manipulate the environment
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Brain (monitor)
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internal/external environments (sensory perception)
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Brain (regulate)
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contractions of skeletal muscles, internal organs, mood and emotions, sleep cycle, basic drives
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Brain (store and retrieve)
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memories
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Brain (think and perform)
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intellectual functions
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Brain (produce and interpret)
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language
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Brain (process)
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Visual and auditory data
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Function of neurons
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conduct electrical impulses, release chemicals
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Computed tomography (CT)
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three-dimensional imaging with computed radiographs
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Magnetic resonance imaging (MRI)
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three-dimensional visualization with a magnetic field and computed radio waves emitted by cells
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Positron emission tomography (PET)
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- injected radioactive tracer travels to brain and concentrates in areas of high activity
- scanned images are relayed to a computer for three-dimensional imaging |
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PET Scan- What it does
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compare brain activity during periods of depression (left) with normal brain activity (right). An increase of blue and green colors, along with decreased white and yellow areas, shows decreased brain activity due to depression.
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CT looking for?
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Schizophrenia: cortical atrophy, third ventricle enlargement
Cognitive disorders: abnormalities |
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MRI looking for?
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Schizophrenia: enlarged ventricles, reduction in temporal lobe and prefrontal lobe
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PET looking for?
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Schizophrenia: increased dopamine receptors in caudate nucleus, abnormalities in limbic system
Mood disorder: abnormalities in temporal lobes Adult ADHD: decreased utilization of glucose |
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Depression
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deficinecy of norepinephrine &/or serotonin
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Schizophrenia
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excess dopamine
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Anxiety
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deficiency of gamma-aminobutyric acid (GABA)
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Norepinephrine
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alertness energy
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Dopamine
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attention, motivation, pleasure, reqRD
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serotonin
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obsessions, compulsions
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Neurotransmitters most linked with mental activity
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norepinephrine, dopamine, serotonin, GABA, glutamate, acetylecholine
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S/E of Psychotropic Drugs
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particular transmitter is often used by different neurons to carry out different activities, alterations in mental status. accompanied by changes in basic drives, sleep patterns, body movement, and autonomic functions
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Standard (First-Generation) Antipyschotic Drugs
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strong antagonists (Dopamine blocking agents)
- Bind to D2 receptors (subtype of dopamine receptor) - block attachment of dopamine - reduce dopaminergic transmission -ex. Thorazine & Haldol |
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Aytpical Antipsychotics
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bind to dopamine receptors in the limbic system
- less S/E -decrease motor s/E - Clozaril, Zyprexia, Abilify, Risperdal |
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Lithium
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alters electrical conductivity in neurons (mood stabilizer)
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Antiepileptic drugs
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can also play a role in mood stabilizers
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Antidepressant Drugs
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Typical or standard antidepressants:
- Tricyclic antidepressants (TCAs) - SSRIS (selective serotonin reuptake inhibitors) - MAOIs (monoamines oxidase inhibitorsA) |
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Tyramine
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a MAOI, in many foods (aged cheeses, pickled or smoked fish, wine)
-produces significant vasoconstriction -> HTN crisis - when taking MAOI= too much tyramine |
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Anti anxiety/ Anxiolytic Drugs
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GABA, Benzodiazepines
- Diazepam (Valium) - Clonzepam (Klonopin) - Flurazepam ( Xanax) |
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Herbal Medicine
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Long term effects: nerve, kidney, liver damage
Adverse chemical reactions: w/ other substances, w/ conventional medications |
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Therapeutic Milieu
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maintain a calm environment. hold everyone responsible for their own behavior. RN task
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documentation
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professional standards, legal issues, reimbursement by insurers, peer review, research. RN task
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psychopharmacology
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safe administration of meds, PRN meds, monitoring of effects. RN task
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Medical Crisis Management
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medical clearance first, emergency interventions, clinical skills. RN task
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Behavioral Crisis Management
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violence, behavioral code teams, maintain client's rights. RN task
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Community Mental Health Centers Act
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1963, antipsychotic meds, to de-institutionalize, care from institution to community
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Federal Entitlement Programs
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1960s, social security disability, supplemental security income, medicaid, medicare, housing assistance, food stamps
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Problems w/ De-institutionalize
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few choices for outpatient, limited funding, more clients than resources, resistance of seriously mentally ill patients to treatment
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Commission on Mental Healht
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1980s, establish treatment guidelines, clinical parameters, more sophistication in policy and treatment
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4 Elements for Psychiatric Nursing in the Community
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1. housing adequacy & stability
2. income and source of income 3. family and support system 4. substance abuse history and current use |
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Inpatient Treatment
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security provided by staff, 24 hour supervision, boundaries est. by staff, therapeutic milieu, stabilization and discharge
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Community Treatment
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client responsible for own security, intermittent supervision, client est own boundaries, improved level of functioning
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Partial Hospitalization Program Role of RN
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Intensive short term treatment: intake interviews, teach groups, clients, families, daily assessments, monitor meds, attend team meetings, review discharge plans
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Psychiatric Home Care
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intake interviews, assess client's home, includes case manager
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Assertive Community treatment (ACT)
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mobile crisis intervention team, target populations having hard time keeping up w/ traditional care.
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Community Mental Health Center
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free standing, emergency, adult, child services. day & residential services, care management
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Barriers to Treatment
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stigma, scarcity of services, affordability, fragmentation of care, substance abuse, jail, homeless
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ethics
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the study of philosophical beliefs about what is considered right or wrong in a society
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bioethics
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the study of specific ethical questions that arise in health care
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Beneficence
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the duty to promote good
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autonomy
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respecting the rights of others to make their own decisions
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justice
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distribute resources or care equally
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fidelity (non-maleficence)
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maintaining loyalty and commitment. doing no wrong to a patient
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veracity
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one's duty to always communicate truthfully
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5 principles of ethics
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1. beneficence
2. autonomy 3. justice 4. fidelity (non-maleficence) 5. veracity |
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specific client rights
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client consent, communication, freedom from harm, dignity & respect, confidentiality, BAKER ACT DOES NOT= INCOMPETENT
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voluntary admission
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sought by the client and/or guardian. right to demand release BUT client status may be changed to involuntary
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involuntary admission
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w/o client's consent, need of psych treatment, danger to self/others, unable to meet basic needs, physicians must agree, family members notified, right to legal counsel
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Baker Act
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Florida Mental Health Act of 1971, Maxine Baker, allows for involuntary examination of an individual. can be initiated by : judges, police, physicians, NP
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Baker Act qualifications
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must be evidence of mental illness, harm to self, others, or self-neglect
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Baker Act timeframe
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may last up to 72 hours
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Marchman Act
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for people w/ substance abuse issues. significant impairment of judgement, risk of harm to self/others
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Marchman Act Timeframe
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120 hours of involuntary admission
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Who can file Marchman Act
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police, MD, spouse/guardian, 3 responsible adults who have personal knowledge of person's substance abuse impairment
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Involuntary Admission: Marchman Act
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right to legal council, freedom from unreasonable body restraints, right to informed consent, right to refuse medications
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Client Confidentiality
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HIPPA, rights after death, professional communications, HIV status.
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Exceptions to Client Confidentiality
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duty to warn and protect third parties, child and elder abuse reporting statues
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Legal Issues in Psych Care
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failure to protect patients, false imprisonment, failure to report suspected abuse, failure to intervene, failure to report
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Documentation of Care
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client has the right to review the record. records belong to the facility. use of medical records. medical records as evidence.
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Assessment in Mental Status
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construct database: observations of language and behavior. MSE. psychosocial assessment. physical examination. history taking. interview. standardized rating scales
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Mental Status Exam (MSE)
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1. personal info 2. appearance 3. behavior 4. speech 5. affect & mood 6. thought (content, structure) 7. perceptual disturbances 8. cognition
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Mini Mental Status Exam (MMSE/MME)
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quick exam to establish mental ability.
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Assessment- data collection
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primary source, secondary source
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Assessment- personal consideration
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transference
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Assessment- age considerations (developmental level)
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children, adolescents, elderly
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Purposes of Psychiatric Assessment
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establish rapport, identify baseline behaviors, obtain understanding of problem, assess psychological functioning, identify goals, perform mental status examination, identify behaviors to be changed, formulate a plan of care
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Nursing Diagnosis
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1. identify problem and etiology
2. construct nursing diagnosis and problem list 3. prioritize nursing diagnoses |
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Formulating a Nursing Diagnosis
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3 structural components:
1. problem: unmet need 2. etiology: probable cause 3. supporting data: S/S |
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Concept Map
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Symptom Cluster ->Nursing Diagnosis->Desired Outcome/Goal->Intervention->Evaluation
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Nursing Diagnoses
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-Nursing Diagnoses
-Goals for the client to achieve -Nursing Interventions -How will nursing interventions be evaluated?gm |
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Step 1 to stop client's anger
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minimize factors contributing to frustration and aggression, where possible
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Step 2 to stop client's anger
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De-escalate problem behaviors before they reach the crisis point
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Step 3 to stop client's anger
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Safety (clients, staff, self)
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Social Relationships
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initiated for the purpose of friendship or meeting a goal. mutual need are met. communication to give advice.
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Intimate Relationships
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individuals have an emotional commitment, mutual needs are met, mutual goals, personal and intimate information shared
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Therapeutic Relationships
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consistently focused on the client's problems and needs, potential solutions to problems discussed, solution of client's choice implemented by client, new coping skills develop, behavioral change encouraged
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Therapeutic Nurse-Client Relationship
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BASIS OF ALL PSYCHIATRIC NURSING TREATMENT....est an understanding in the client that the nurse-client relationship is safe, confidential, reliable, w/ clear boundaries
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Detrimental Nurse-Client Relationship
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nurse tries to get his/her own needs met, nurse tries to solve the client's problems, nurse takes the role of a family or friend member of the client, lack of boundaries, nurse has power issues
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Personal Characteristics of the Nurse that Help promote change and growth in clients
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Genuineness, empathy, positive self-regard
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Genuineness
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-self awareness of one's feelings
-ability to communicate one's feelings -key in building trust -congruence (alignment) between nurse's words and non-verbal behavior |
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empathy
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feelings and ideas of clients accurately perceived & accurate understanding of client's communication
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positive self-regard
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-respect communicated indirectly by actions
-work seriously w/ client to strengthen use of personal resources (behavior, emotions, etc) -nonjudgmental focus on client's thoughts and feelings to understand behavior |
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Boundaries of the Nurse-Client Relationship
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client's needs are separated from the nurse's needs.
self-awareness is critical |
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Evidence of Blurred Boundaries
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when nurses are overly helpful, controlling, narcissistic
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Transference
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person unconsciously displaces onto individual current life emotions and behaviors from childhood that originated in relationships w/ significant others.
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Transference (nurse)
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nurse displaces onto client feelings r/t people in nurse's past. common signs of transference in nurse over identification w/ the client, over reaction to client's behavior, attitude, or emotion
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Phases of Nurse-Client Relationship
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1. orientation phase
2. working phase 3. termination phase |
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Orientation phase
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establish: trust, parameters, formal/informal contract, confidentiality
termination begins |
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working phase
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maintain relationship, gather further data, promote clients: problem-solving skills, self-esteem, use of language
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termination phase
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deal w/ intense feelings regarding the experience, summarize goals and objectives achieved, finalize termination
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Factors Beneficial to Nurse-Client Relationships
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consistent, regular, and private interactions w/ client. being honest and congruent in stated feelings and their outward expression, letting client set the pace, preserving client's integrity
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Factors Hampering Nurse- Client Relationship
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lack of nurse availability or lack of contact. lack of nurse self-awareness, ignoring the "humanity" of the client
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Clinical Interview
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content and direction of the clinical interview are decided by the client
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Purpose of Clinical Interview
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get clear in your own mind about what you want to accomplish
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Setting of Clinical Interview
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privacy, comfortable
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Seating in Clinical Interview
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good eye contact, nonthreatening, door should be available to healthcare worker, avoid desk barrier
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Introductions in Interview
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name, who you are, school, purpose of meeting, how long, what time, how client would be addressed
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Communication: verbal
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ALL WORDS A PERSON SPEAKS
communicates, convey |
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Communication: verbal misinterpretation
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language, culture, use of humor, use of sarcasm, client delusions filter message
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Communication: nonverbal
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65-95% of sent message, body behaviors, facial expressions, emotions expressed in eyes, voice related behaviors
OBSERVABLE autonomic physiological responses |
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Goal of therapeutic communication
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intends to support dignity and respect of client, and to validate the client
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tools for enhancing communication
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use of silence, active listening, clarifying techniques
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Goals of active listening
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increase skill of accurately hearing what client is saying.
develop abilities to "hear" what the client is not saying |
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Active Listening
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attention to body language, facial expressions, vocal tone.
observes for congruency, identifies what the patient says, facilitates communication |
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open-ended questions
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require more than one word answers, are valuable for encouraging interaction, opening phases, facilitating communication
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closed-ended questions
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ask for specific answers/ information, elicit specific information, can close an interview
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Tactics to avoid
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arguing with client's delusions.
advising. speculating. moralizing. participating in criticism. |
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stress
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results from the perception that one's coping resources will be overwhelmed
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Kinds of Crises
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situational, developmental, community wide, cultural
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situational crises
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event for an individual
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developmental crises
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r/t life stage
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community wide crises
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disaster
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cultural crises
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culture shock
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stress response process
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people first use the coping resources that have worked in the past
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eustress
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good stress: sharpen attention, concentration, memory
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distress
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bad stress
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GAS (General Adaptation Syndrome)
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Alarm (acute stress)
Resistance Stage (adaptation) Exhaustion Stage (resources depleted) |
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GAS: Alarm Stage
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brief, extremely intense, cannot be sustained for long, fight or flight
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GAS: Resistance Stage
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adaptation, sustained and optimal resistance to the stressor
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GAS: Exhaustion Stage
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resources are depleted, chronic stress, wide array of psychological and physiological responses, death
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Biophysiological Model
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Psychoneuroimmunological model (PNI)
-hypothalamic-pituitary-adrenal -sympathetic-adrenal medullary axes -pro-inflammatory cytokines LINKS AMONG STRESS, THE IMMUNE SYSTEM, DISEASE |
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Cognitive-Behavioral Methods
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the most effective ways to reduce stress.
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Behavioral Approaches to reduce stress
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Relaxation techniques, muscle relaxation and exercise, biofeedback
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Relaxation techniques to reduce stress
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Benson's relaxation techniques, meditation, guided imagery, breathing exercises, physical exercise
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