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136 Cards in this Set
- Front
- Back
Alert |
Responsive and attentive |
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Lethargy |
Able to open eyes and respond but drowsy and falls asleep readily |
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Stupor |
Requires vigorous or painful stimuli to elicit a response |
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Coma |
No response |
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Coma Posturing Decorticate rigidity |
flexion and internal rotation of upper-extremity joints and legs |
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Coma posturing Decerebrate rigidity |
neck and elbow extension, wrist and finger flexion |
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Assess knowledge |
What he knows about current illness |
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Assess ability to calculate |
count backward from 100 in serials of 7 |
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Assess ability to think abstractly |
Interpret a cliche |
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Assess client's judgement |
answer to hypothetical question |
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Assess client's rate and volume of speech as well as quality of his language |
articulate, meaningful and appropiate |
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Glascow coma scale |
Eye, verbal and motor response is evaluated Highest is 15 < 7 indicates coma |
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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 |
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Beneficiance |
Quality of doing good and can be described as charity |
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Autonomy |
Client's right to make her own decisions but must accept the consequences of those decisions and respect the decisions of others |
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Justice |
Fair and equal treatment for all |
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Fidelity |
Loyalty and faithfulness to the client and to one's own duty |
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Veracity |
Being honest when dealing with a client |
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Voluntary commitment |
Client's choice |
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Involuntary (civil) commitment |
May be by emergency, observational, long-term |
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Emergency involuntary commitment |
Hospitalized to prevent harm to self or others. Up to 10 days |
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Observational involuntary commitment |
Obeservation, diagnoses and a treatment plan |
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Long-term involuntary commitment |
imposed by the courts , usually 60-180 days |
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Intrapersonal communication |
Communication that occurs within an individual |
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Interpersonal communication |
Communication that occurs between two or more people |
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Public communication |
Communication that occurs within big groups |
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Transpersonal communication |
Communication that addresses an individual's spiritiual needs and provides interventions to meet that |
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Vocabulary |
Words used to communicate either a written or spoken message |
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Denotative/conotative |
when communicating, participants must share meanings |
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Clarity/brevity |
Shortest, simplest and most effective communication |
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Timing/relevance |
When to communicate and make the message more attentive to the listener |
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Pacing |
rate of speech |
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Intonation |
Tone of voice |
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Nonverbal communication techniques |
Appearance, posture, gait, facial expression, eye contact, gestures, sounds, terrioriality, personal space and silence |
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Components of therapeutic communication |
Client-centered, pureposeful, planned, goal-directed, adequate timing, active listening, caring, honesty, trust, empathy, nonjudgemental |
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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) |
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Defense mechanism Altruism |
Dealing with anxiety by reaching out to others |
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Defense mechanism sublimation |
Dealing with unacceptable feelings or impulses by unconciously substituting acceptable forms of expression |
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Defense mechanism Suppression |
Voluntarily denying unpleasant thoughts and feelings |
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Defense mechanism repression |
Putting unacceptable ideas, thoughts and emotions out of concious awareness |
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Defense mechanism Displacement |
Shifting feelings related to an object, person or situtation to another less threatening object, perosn or situation |
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Defense mechanism reaction formation |
overcompensating or demonstrating the opposite behavior of what is felt |
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Defense mechanism undoing |
Performing an act to make up for prior behavior |
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Defense mechanism rationalization |
Creating reasonable and acceptable explanations for unacceptable behavior |
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Defense mechanism dissociation |
Temporarily blocking memeories and perceptions from conciousness |
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defense mechanism splitting |
Demonstrating an inability to reconcile negative and positive attributes of self or others |
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Defense mechanism projection |
Blaming others for unacceptable thoughts and feelingss |
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Defense mechanism denial |
Pretending the truth is not reality to manage the anxiety of acknowledging what is real
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Defense mechanism regression |
Demosntrating behavior from an earlier developmental level, often exhibited as childlike or immature behavior |
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Healthy defense mechanisms |
Altruism and sublimation |
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Intermediate defense mechanisms |
repression, reaction formation, displacement, rationalization and undoing |
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immature defense mechanisms |
projection, dissociation, splitting and denial |
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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
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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 |
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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
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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 |
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Interventions for mild-moderate anxiety |
Active listening Calm presence Evaluate past coping mechanisms Explore alternatives participation in activities is encouraged
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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 |
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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 |
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Factors that positively affect the development of the therapeutic environment client |
Trusting Willingness to talk active participant consistent availability |
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Phases of a therapeutic relationship |
orientation, working, termination |
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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 |
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Countertransference |
occurs when a health care team member dispaces characteristics of people in her past onto a client |
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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
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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 |
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Characterictics of the therapeutic milieu emotional climate |
Feel safe from harm Cared for and accepted by staff and others |
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Primary prevention |
Promotes health and prevents mental health problems from occuring |
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Secondary prevention |
Focuses on early detection of mental illness |
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Teritary Prevention |
Focuses on rehabilitation and prevention of further problems in clients previously diagnosed |
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Community based mental health programs |
Partial hospitalized, assertive communication treatment, community mental health centers, psychosocial rehabilitation programs and home care |
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Psychoanalysis |
Thereaputic process of assessign unconcious thoughts and feelings, and resolving conflict by talking to a psychoanalyst. Sessions over months or years. |
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Psychoanalysis therapeutic tools |
Free association, dream analysis, transference, defense mechanisms |
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Psychotherapy therapeutic tools |
Therapist-to-client, interpersonal psychotherapy and cognitive therapy |
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Priority restructuring |
Assists clients to identify what requires priority, such as devoting energy to pleasurable events |
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Journal keeping |
Helps cleints write down stressful thoughts and has positive effect on well being |
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Assertiveness training |
Teaches clients to express feelings, and solve problems in a nonaggresive manner |
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Monitoring thoughts |
Helps clients to be aware of negative thinking |
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Modeling |
Therapist or others serve as role models for client, who imitates to improve behavior |
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operant conditioniong |
Client recieves positive rewards for positive behavior |
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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. |
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Aversion therapy |
Pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote change in behavior |
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Mediatation, guided imagery, diaphragmatic breathing, muscle relaxation, biofeedback |
Control pain, tension and anxiety |
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Phases of group development |
initial (purpose and goals), working (control issues possible, problem-solving), termination (end of session) |
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Areas of functioning for families |
Communication, management, boundaries, socialization, emotional/supportive |
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GAS |
Body's response to an increased demand |
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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 |
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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 |
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Advance directives |
legal documents that direct end-of-life issues |
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Necessary loss |
Part of cycle of life, anticipated |
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Actual loss |
Loss of valued person or item |
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Perceived loss |
Defined by client but not obvious to others |
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Maturational loss |
Normally expected due to the developmental processing of life |
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Situational loss |
Unanticipated loss caused by external event |
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Theories of grief |
Denial, anger, bargaining, depression and acceptance |
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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 |
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Anticipatory grief |
Letting go before the loss Grieve before the actual loss |
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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 |
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Disenfranchised grief |
Experienced loss that cannot be publicly shared or isn't socially acceptable |
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Grief by public tragedy |
Loss shared by community or group of individuals |
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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 |
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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 |
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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) |
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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 |
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Four resources nurses can use as guidelines for best-evidence interventions |
Internet mental health resources Clinical practice guidelines Clinical algorithms Clinical and critical pathways |
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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 |
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Attributes of nursing |
Caring attending Patient advocacy |
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Attending behaviors examples |
Listening touching attentive physical care active listening |
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Caring is... |
giving of self leads to happiness is evidenced by empathic understanding, actions and patien most natural and fundamental aspect of human existance |
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Caring concepts |
Competent Need a base of knowledge and skills May be competent but unable to demonstrate caring |
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Patient advocate... |
speaks up for another's cause defending and comforting can be a lawyer |
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Advocacy in nursing includes |
Committing to patient's health Alleviating suffering Promoting peaceful, comfortable and dignified death |
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Nurses advocate for patients when they |
Advice patients of their rights Accurate and current information |
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In nursing being a patient advocate is |
not a legal role but an ethical one |
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7 signs of mental health |
Happiness Control over behavior Appraisal of reality Effectiveness in work Healthy self-concept Satisfying relationships Effective coping |
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Mental Illness |
Major depressive disorder Control disorder Schizo & other Adjustment with work Dependent personality disorder Borderline personality disorder Substance dependency |
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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 |
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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 |
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Stigma |
Collection of negative attitudes, labeling, seperating, and status loss or discrimination in a context of power imbalance, social isolation, and reduced opportunities
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Stigmatizing |
Attitudes toward individuals who are mentally ill have harmful effects on the individual and family |
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DSM diagnosis |
Focuses on research and clinical observation when constructing diagnostic categories of a mental disorder Considered the bible for mental health workers |
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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 |
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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 |
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Axis II |
Small category Personality disorders and/or mental retardation only Charts will often read deferred |
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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 |
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Axis IV |
Psychosocial and environmental problems
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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 |
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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 |
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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 |
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Freud & Nursing |
Formation of personality Conscious and unconscious influences Individual talk sessions Attentive listening Transference Countertrasnference |
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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) |
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Sullivan's interpersonal theory |
The purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety |
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Hildegard Peplau |
Mother of mental health Foundation includes participant observer, mutuality, respect, unconditional acceptance, empathy |
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Behavioral theories and therapies |
Pavlov's classical conditioning Watson's behaviorism Skinner's operant conditioning
Modeling operant conditioning Systemic desensitilzation Aversion therapy Biofeedback
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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 |
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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 |
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Biological theories |
Focus on neurological, chemical, biological, genetic
How do the body and brain interact to create emotions, memories and perceptual experiences? |