• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/136

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

136 Cards in this Set

  • Front
  • Back

Alert

Responsive and attentive

Lethargy

Able to open eyes and respond but drowsy and falls asleep readily

Stupor

Requires vigorous or painful stimuli to elicit a response

Coma

No response

Coma Posturing


Decorticate rigidity

flexion and internal rotation of upper-extremity joints and legs

Coma posturing


Decerebrate rigidity

neck and elbow extension, wrist and finger flexion

Assess knowledge

What he knows about current illness

Assess ability to calculate

count backward from 100 in serials of 7

Assess ability to think abstractly

Interpret a cliche

Assess client's judgement

answer to hypothetical question

Assess client's rate and volume of speech as well as quality of his language

articulate, meaningful and appropiate

Glascow coma scale

Eye, verbal and motor response is evaluated


Highest is 15


< 7 indicates coma

Mental health interventions

Counseling


Milieu therapy


Promotion of self-care activities


Psychobiological interventions


Cognitive and behavioral therapies


Health teaching


Health promotion and health maintenance


Case management

Beneficiance

Quality of doing good and can be described as charity

Autonomy

Client's right to make her own decisions but must accept the consequences of those decisions and respect the decisions of others

Justice

Fair and equal treatment for all

Fidelity

Loyalty and faithfulness to the client and to one's own duty

Veracity

Being honest when dealing with a client

Voluntary commitment

Client's choice

Involuntary (civil) commitment

May be by emergency, observational, long-term

Emergency involuntary commitment

Hospitalized to prevent harm to self or others.


Up to 10 days

Observational involuntary commitment

Obeservation, diagnoses and a treatment plan

Long-term involuntary commitment

imposed by the courts , usually 60-180 days

Intrapersonal communication

Communication that occurs within an individual

Interpersonal communication

Communication that occurs between two or more people

Public communication

Communication that occurs within big groups

Transpersonal communication

Communication that addresses an individual's spiritiual needs and provides interventions to meet that

Vocabulary

Words used to communicate either a written or spoken message

Denotative/conotative

when communicating, participants must share meanings

Clarity/brevity

Shortest, simplest and most effective communication

Timing/relevance

When to communicate and make the message more attentive to the listener

Pacing

rate of speech

Intonation

Tone of voice

Nonverbal communication techniques

Appearance, posture, gait, facial expression, eye contact, gestures, sounds, terrioriality, personal space and silence

Components of therapeutic communication

Client-centered, pureposeful, planned, goal-directed, adequate timing, active listening, caring, honesty, trust, empathy, nonjudgemental

Effective communication

silence, active listening, open-ended questions, clarifying (restating, reflecting, paraphrasing, exploring), offering general leads, acceptance and recognition, focusing, asking questions, giving info, presenting reality, summarizing, offering self, touch (TABLE PG.23)

Defense mechanism


Altruism

Dealing with anxiety by reaching out to others

Defense mechanism


sublimation

Dealing with unacceptable feelings or impulses by unconciously substituting acceptable forms of expression

Defense mechanism


Suppression

Voluntarily denying unpleasant thoughts and feelings

Defense mechanism


repression

Putting unacceptable ideas, thoughts and emotions out of concious awareness

Defense mechanism


Displacement

Shifting feelings related to an object, person or situtation to another less threatening object, perosn or situation

Defense mechanism


reaction formation

overcompensating or demonstrating the opposite behavior of what is felt

Defense mechanism


undoing

Performing an act to make up for prior behavior

Defense mechanism


rationalization

Creating reasonable and acceptable explanations for unacceptable behavior

Defense mechanism


dissociation

Temporarily blocking memeories and perceptions from conciousness

defense mechanism


splitting

Demonstrating an inability to reconcile negative and positive attributes of self or others

Defense mechanism


projection

Blaming others for unacceptable thoughts and feelingss

Defense mechanism


denial

Pretending the truth is not reality to manage the anxiety of acknowledging what is real


Defense mechanism


regression

Demosntrating behavior from an earlier developmental level, often exhibited as childlike or immature behavior

Healthy defense mechanisms

Altruism and sublimation

Intermediate defense mechanisms

repression, reaction formation, displacement, rationalization and undoing

immature defense mechanisms

projection, dissociation, splitting and denial

Mild level of anxiety

Normal experience of everyday


Increase ability to perceive reality


Identifiable cause


Mild discomfort, restlessness, irritability, impatience and apprehension


Finger/foot tapping, fidgeting and lip biting


Moderate level of anxiety

Ability to think clearly is hampered but learning and problem solving still occur


Concentration difficulties, tiredness, pacing, change in voice pitch, voice tremors, shakiness and increased HR/RR


Headache, backache, urinary urgency and frequency, insomnia


Direction of others

Severe level of anxiety

Learning and problem solving don't occur


Functioning in ineffective


Confusion, feelings of impending doom, hyperventilation, tachycardia, withdrawl, loud and rapid speech, aimless activity


Not able to take direction from others


Panic-level of anxiety

Disturbed behavior


Lose touch with reality


Fright and horror


Hyperactivity or flight


Immobility can occur


Dysfunction in speech, dilated pupils, severe shakiness, severe withdrawl, inability to sleep, delusions, hallucinations

Interventions for mild-moderate anxiety

Active listening


Calm presence


Evaluate past coping mechanisms


Explore alternatives


participation in activities is encouraged


Interventions for severe-panic anxiety

Provide safe environement


Minimal stimulation


medications and restraints as last minute


Gross motor activities encouraged


Set limits


Direct to acknowledge reality

Factors that positively affect the development of the therapeutic environment


Nurse

Consitant approach


Adjustemnt of pace to client's needs


Attentive listening


positive initial impressions


comfort level during the relationship


Self-awareness


Consitent availabilty

Factors that positively affect the development of the therapeutic environment


client

Trusting


Willingness to talk


active participant


consistent availability

Phases of a therapeutic relationship

orientation, working, termination

Transference

occurs when the client views a member of the health care team as having characteristics of another person who has been significant to the client's personal lifeCo

Countertransference

occurs when a health care team member dispaces characteristics of people in her past onto a client

Characteristics of the therapeutic milieu


physical setting

Clean and orderly


Comfortable furniture to promote interaction, solitary spaces for reading and thinking, comfortable places conducive to meals and quiet areas for sleep


Client scheme appropiate for age


Characteristics of the therapeutic milieu


health care team responsibilities

Promote independence


Treat as individuals


Allow choices


Apply rules for fair treatment


Model good social behavior


Work cooperatively


Maintain boundaries


Proffessional appearance


Safety


Open communication


Feelings of self-worth

Characterictics of the therapeutic milieu


emotional climate

Feel safe from harm


Cared for and accepted by staff and others

Primary prevention

Promotes health and prevents mental health problems from occuring

Secondary prevention

Focuses on early detection of mental illness

Teritary Prevention

Focuses on rehabilitation and prevention of further problems in clients previously diagnosed

Community based mental health programs

Partial hospitalized, assertive communication treatment, community mental health centers, psychosocial rehabilitation programs and home care

Psychoanalysis

Thereaputic process of assessign unconcious thoughts and feelings, and resolving conflict by talking to a psychoanalyst. Sessions over months or years.

Psychoanalysis therapeutic tools

Free association, dream analysis, transference, defense mechanisms

Psychotherapy therapeutic tools

Therapist-to-client, interpersonal psychotherapy and cognitive therapy

Priority restructuring

Assists clients to identify what requires priority, such as devoting energy to pleasurable events

Journal keeping

Helps cleints write down stressful thoughts and has positive effect on well being

Assertiveness training

Teaches clients to express feelings, and solve problems in a nonaggresive manner

Monitoring thoughts

Helps clients to be aware of negative thinking

Modeling

Therapist or others serve as role models for client, who imitates to improve behavior

operant conditioniong

Client recieves positive rewards for positive behavior

Systemic desensitization

Planned, progressive or graduated exposure to anxiety-provoking stimuli in real life situations or by imagining events that cause anxiety. During exposure the client uses relaxation techniques.

Aversion therapy

Pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote change in behavior

Mediatation, guided imagery, diaphragmatic breathing, muscle relaxation, biofeedback

Control pain, tension and anxiety

Phases of group development

initial (purpose and goals), working (control issues possible, problem-solving), termination (end of session)

Areas of functioning for families

Communication, management, boundaries, socialization, emotional/supportive

GAS

Body's response to an increased demand

s/o acute stress data

Apprehension, unhappiness or sorrow, decreased appetite, increased RR, HR, cardiac output and BP, increased metabolism and glucose use, depressed immune system

s/o prolonged stress data

anxiety, panic attacks, depression, chronic pain, sleep disturbances, increased risk for MI, poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate, increased risk for infection

Advance directives

legal documents that direct end-of-life issues

Necessary loss

Part of cycle of life, anticipated

Actual loss

Loss of valued person or item

Perceived loss

Defined by client but not obvious to others

Maturational loss

Normally expected due to the developmental processing of life

Situational loss

Unanticipated loss caused by external event

Theories of grief

Denial, anger, bargaining, depression and acceptance

Normal grief

Uncomplicated


Anger, resentment, withdrawl, hopelessness, guilt but change to acceptance


Acceptance 6 months after loss


Chest pain, palpitations, headaches, nausea, changes in sleep and fatigue

Anticipatory grief

Letting go before the loss


Grieve before the actual loss

Dysfunctional grief

Difficult progression


Grief is prolonged, s/s sevre and may result in depression of exacerbation


Suicidal ideation, intense feelings of guilt, lowered sellf-esteem


Exended period of time

Disenfranchised grief

Experienced loss that cannot be publicly shared or isn't socially acceptable

Grief by public tragedy

Loss shared by community or group of individuals

Recovery model

consumers as partners


mental health care consumer & family driven


Increasing consumer's ability in coping, facilitating recovery and building resilence


Individual care consumer centered and recovery oriented

EBP model

1990's decade of the brain


scientific evidence for psychological and sociological treatments


neurology of psychiatric disorders


Psychopharmacology


Decrease gap between research and practice


medical model

5 A's of multistep EBP

Ask a question (problem/need for change)


Acquire the literature (scientific studies & articles)


Appraise the literature (Evaluate for validity, relevance & applicability)


Apply the evidence (Interventions)


Assess the performance (Evaluation & documentation)

4 dilemmas nurses face when they seek the best evidence for their interventions

Who interprets the "best evidence"


Not all nursing problems are able to be reduced to a clear issue solvable by scientific experiments


Relatively few studies backed by rigorous quantitative research are available for guide


Finding time to research literature

Four resources nurses can use as guidelines for best-evidence interventions

Internet mental health resources


Clinical practice guidelines


Clinical algorithms


Clinical and critical pathways

Clinical algorithm

Step-by-step guidelines in a flowchart


Alternative diagnostic & treatment approaches are described based on decisional points using a large database


Helpful in deciding what medication to use, considering the patient's personal situation

Attributes of nursing

Caring


attending


Patient advocacy

Attending behaviors examples

Listening


touching


attentive physical care


active listening

Caring is...

giving of self


leads to happiness


is evidenced by empathic understanding, actions and patien


most natural and fundamental aspect of human existance

Caring concepts

Competent


Need a base of knowledge and skills


May be competent but unable to demonstrate caring

Patient advocate...

speaks up for another's cause


defending and comforting


can be a lawyer

Advocacy in nursing includes

Committing to patient's health


Alleviating suffering


Promoting peaceful, comfortable and dignified death

Nurses advocate for patients when they

Advice patients of their rights


Accurate and current information

In nursing being a patient advocate is

not a legal role but an ethical one

7 signs of mental health

Happiness


Control over behavior


Appraisal of reality


Effectiveness in work


Healthy self-concept


Satisfying relationships


Effective coping

Mental Illness

Major depressive disorder


Control disorder


Schizo & other


Adjustment with work


Dependent personality disorder


Borderline personality disorder


Substance dependency

Factors that affect mental health of an individual

Available support system


Spirituality


Family influence


Developmental events


Personality traits and states


Demographic and geographic


Negative influences


Cultural/subcultural beliefs and values


Health practices and beliefs


Hormonal influences


Biological


Inhereted


Environmental

Dynamic factors that contribute to to making clear-cut definition of mental health elusive

Plagued by myths and misconceptions


No consistent line between mental health and mental illness


Definition of mental health changes and reflects cultural norms, society's expectations, values, professional biases, individual differences, political climate, psychology of women, issues of homosexuality

Stigma

Collection of negative attitudes, labeling, seperating, and status loss or discrimination in a context of power imbalance, social isolation, and reduced opportunities


Stigmatizing

Attitudes toward individuals who are mentally ill have harmful effects on the individual and family

DSM diagnosis

Focuses on research and clinical observation when constructing diagnostic categories of a mental disorder


Considered the bible for mental health workers

Nursing diagnosis

NANDA describes a nursing diagnosis as a clinical judgement about responses to health problems


Psychiatric- mental health nursing includes the diagnosis and treatment responses to mental health problems

How the consideration of norms and other cultural influences affect making an accurate DSM diagnosis

Used to diagnose a psychiatric disorder


Includes information specifically related to culture in three areas:


Discusses cultural variations for each clinical disorder


Describes culture-bound syndromes


Outline assists clinicians in evaluating and reporting the impact of an individuals cultural context

Axis II

Small category


Personality disorders and/or mental retardation only


Charts will often read deferred

Axis III

General medical conditions-huge category with 1000 possibilities (ICD-9-CM codes 001-999)


Such as hypertension, diabetes mellitus


Meds should relate to either axis I or III

Axis IV

Psychosocial and environmental problems


Axis V

Global assessment of function GAF scale ranges from 0-100


Fraction-First # is current and second # is highest reached in the last 12 months. Helps put illness in perspective and helps goals to be achievable

DSM-IV-TR

Axis I psychiatric disorder can be more than 1


1. major depression recurrent severe with psychotic fx


2. ETOH deficiancy


3. Anorexia nervosa

Freud's Psychoanalytic Theory

Id (pleasure principle, reflex action, primary process), Ego (problem solver and reality tester) and Superego (moral component)


Conscious (current awareness), preconscious (accesible) and unconscious (large chunk, primitive feelings, drives and memories)


Defense mechanisms

Freud & Nursing

Formation of personality


Conscious and unconscious influences


Individual talk sessions


Attentive listening


Transference


Countertrasnference

Erickson's 8 stages of development

Infant (trust vs mistrust)


Toddler (autonomy vs shame/doubt)


Preschooler (Initiative vs guilt)


School-age child (industry vs inferiority)


Adolescent (Identity vs role confusion)


Young adult (intimacy vs isolation)


Middle-age adult (generativity vs stagnation)


Older adult (integrity vs despair)

Sullivan's interpersonal theory

The purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety

Hildegard Peplau

Mother of mental health


Foundation includes participant observer, mutuality, respect, unconditional acceptance, empathy

Behavioral theories and therapies

Pavlov's classical conditioning


Watson's behaviorism


Skinner's operant conditioning



Modeling


operant conditioning


Systemic desensitilzation


Aversion therapy


Biofeedback



Cognitive theories

Rational-Emotive Behavior therapy (Elis)- Eradicate irrational beliefs, recognize thoughts that aren't accurate



Cognitive-Behavioral therapy (Beck)- Tests distorted beliefs and changes way of thinking, reduce symptoms

Maslow's hierarchy of needs

Basic needs, D motivates, deficiency needs (air, water, food)


Self-actualization, B motivates, Being needs (esteem)



1. Physiological needs


2. Safety needs


3. Love and belonging needs


4. Esteem needs


5. Self-actualization needs

Biological theories

Focus on neurological, chemical, biological, genetic



How do the body and brain interact to create emotions, memories and perceptual experiences?