Reading...
Play button
Play button
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;
204 Cards in this Set
- Front
- Back
|
Define Mental Health Nursing
|
a specialized area of practice
committed to promoting mental health through assessment, dx, & treatment of human responses to mental health problems & psychiatric disorders it employs a purposeful use of: self as art wide range of nursing psychosocial & neurobiological theories & research evidence as its science |
|
|
What are the levels of nursing intervention?
|
Primary (preventive)
Secondary (restorative) Tertiary (rehabilitative) |
|
|
What are some examples of primary nursing intervention?
(for psychiatric mental health nursing) |
Health education
Consumer education Marriage/relationship enrichment |
|
|
What are some examples of secondary nursing intervention?
(for psychiatric mental health nursing) |
Crisis intervention
Emergency treatment Psychotherapy Hospitalization Self-help groups |
|
|
What are some examples of tertiary intervention?
(for psychiatric mental health nursing) |
Vocational rehabilitation
Resocialization Partial / transitional hospitalization Discharge clinics |
|
|
What are primary nursing interventions?
|
aimed at reduction of illness BEFORE the illness occurs
(preventive) |
|
|
What are secondary nursing interventions?
|
reducing the acuteness of an actual illness
there is an actual problem trying to RESTORE to a normal healthy state |
|
|
What are tertiary nursing interventions?
|
focus on decreasing residual impairment do to illness
(ex. Acuteness of stroke over, now has residual paralysis) (rehabilitative) |
|
|
What are the 5 key concepts to the nurse-client relationship?
|
Caring
Empathy Positive Regard Self Awareness Therapeutic Use of Self |
|
|
Describe the concept of caring.
|
help pt grow & actualize himself
Caring is the opposite of using the other person to satisfy one’s own needs is a PROCESS, a way of relating to someone that involves DEVELOPMENT, through mutual TRUST |
|
|
Describe the concept of Empathy.
|
the ability to SEE things from the other person’s perspective & COMMUNICATE this understanding & ACCEPTANCE of the client & his or her situation
(in someone else's shoes, through someone else's eyes) |
|
|
Describe the concept of Positive Regard.
|
implies RESPECT (unconditionally).
It is the ability to view another person as being worthy of caring about & as someone who has strengths & achievement potential. Respect is usually communicated indirectly by actions rather than directly by words. |
|
|
Describe the concept of Self Awareness.
|
is needed to be able to offer EMPATHY & POSITIVE REGARD
Personal values & needs must be set aside in order to keep focus on client needs (know your strengths, weaknesses, & biases) |
|
|
Describe the concept of Therapeutic Use of Self.
|
Using interpersonal interactions in a goal-directed manner for the purpose of assisting clients with emotional or physical health needs.
It involves communication, non-verbals, trust, etc. coming together to help pt. |
|
|
What is the nurse-client relationship?
|
A nursing theory developed in 1952 by Hildegard Peplau.
She based her theory on Harry Stack Sullivan's Interpersonal Theory. (She took his theory & personalized it to nursing). There are 3 phases (our book adds a 4th: preorientation) |
|
|
What are the 3 phases of the nurse client relationship?
|
orientation
working termination |
|
|
What does the preorientation phase intell?
|
Examining one’s own anxiety prior to first clinical experience
|
|
|
There are 5 key areas for the nurse to implement during the orientation phase. What are they?
|
BCCTT:
Boundaries of the relationship Contract: formal or informal Confidentiality Trust Termination |
|
|
What areas are key to cover during the working phase?
|
MOPED:
Maintain relationship Overcome resistance behaviors Promote problem solving, behavior changes/adaptations, use of language, self esteem evaluate problems & goals Data (gather) |
|
|
What happens during the termination phase?
|
Summarize goals & objectives achieved in the relationship
Feelings are aroused in both client & nurse in regard to the experience they have had - should be recognized & shared nurse can be role model for how to say good-bye |
|
|
What behaviors may the client exhibit during the orientation phase?
|
Testing
anxiety stick to safe/superficial topics transference |
|
|
What behaviors may the client exhibit during the working phase?
|
Imitate healthy behaviors
resistance to growth & change talk about significant topics & express feelings demonstrate insight participate in problem solving try new behaviors mild anxiety |
|
|
What behaviors may the client exhibit during the termination phase?
|
past good-bye issues arise
loss/abandonment feelings or anger & depression anxiety may increase |
|
|
What is transference & when may it occur?
|
the process whereby a person unconsciously & inappropriately displaces/transfers onto individuals in his or her current life, those patterns of behavior & emotional reactions that originated with significant figures from childhood
may happen in orientation phase |
|
|
What is counter-transference?
|
the tendency of the nurse to displace onto the client feelings caused by people in the therapist’s past
Frequently, client’s transference to nurse evokes counter-transference feelings in nurse |
|
|
What are the 2 levels of practice in psychiatric-mental health nursing?
|
Basic & Advanced
|
|
|
What nurses practice under the Basic level?
|
RN & RN,C
(RN,C = an RN Certified in specific area. They have BSN, experence, continuing education & passed additional certification exam) |
|
|
What nurses practice under the Advanced level?
|
APRN (advanced practice registered nurse)
RN,CS (certified clinical specialist) NP (nurse practitioner) These nurses have masters degree, experence, continuing ed & passed additional certification exam. |
|
|
What additional privileges may the Nurse Practitioner have?
|
prescriptive authority
inpatient admission privileges other specialty privileges |
|
|
What professional organizations are of interest to the psychiatric mental health nurse? (4)
|
American Nurses Association (ANA)
American Psychiatric Nurses Association (APNA) International Society of Psychiatric Mental Health Nurses (ISPN) National League of Nursing (NLN) |
|
|
What does the National League of Nursing (NLN) do?
|
Sets standards of nursing EDUCATION & certifies schools (ACCREDITATION)
|
|
|
What is the American Nurses Association (ANA) responsible for?
|
Standards of practice & certifies INDIVIDUALS
|
|
|
What are the ANA standards of practice & their purpose?
|
AD [O] PIE
(O = outcome identification/Goal) purpose is to provide a foundation of clinical decision making & encompass all significant action taken by nurses in providing care to pts. |
|
|
Who sets the standards of practice for psychiatric mental health?
|
ANA along with APNA & ISPN
|
|
|
Describe the 1st standard of mental health nursing.
|
Assessment:
collect comprehensive health data pertinent to the patient’s health or situation. |
|
|
Describe the 2nd standard of mental health nursing.
|
Diagnosis:
analyze assessment data to determine diagnoses or problems, including level of risk. |
|
|
Describe the 3rd standard of mental health nursing.
|
Outcome Identification (Goals):
identify expected outcomes for a plan individualized to pt or situation. |
|
|
Describe the 4th standard of mental health nursing.
|
Planning:
develop a plan that prescribes strategies & alternatives to attain expected outcomes. |
|
|
Describe the 5th standard of mental health nursing.
|
Implementation:
implement the identified plan |
|
|
Describe the 6th standard of mental health nursing.
|
Evaluation:
evaluate progress toward attainment of expected outcomes |
|
|
Implementation can involve a variety of therapies & approaches.
What are they? (7) |
CCMPPTT/PIB:
Coordination of care Consultation Milieu therapy Psychotherapy Prescriptive authority Teaching health & promotion Therapies: Pharmacological Integrative (alternative) Biological |
|
|
What does health teaching & health promotion involve?
|
Nurse employs strategies to promote health & a safe environment
|
|
|
What does Milieu therapy involve?
|
Nurse provides, structures, & maintains a safe and therapeutic ENVIRONMENT in collaboration with patients, families, and other healthcare clinicians.
|
|
|
Which implementation therapies/approaches can only be carried out by an Advanced Practice nurse?
|
The P's:
Psychotherapy Prescriptive Authority |
|
|
What is the mental health continuum?
|
a continuum ranging from adaptive to maladaptive (or constructive to destructive)
One way of looking at this continuum is to look at an individual’s relationship with self, with others, & with the environment. |
|
|
What is the definition of mental health?
|
When an individual is self aware, likes, respects & accepts him/herself for what s/he is, acknowledges his/her limitations & seeks improvement.
It is an EVOLVING PROCESS in which inner needs of the individual can be in harmony with the reality of environmental demands. |
|
|
What should be included in the assessment of culture?
|
Cultural…
Identity Explanation of illness/health Factors r/t psychosocial environment & levels of functioning |
|
|
What are the Western cultural influences on mental illness?
|
SCIENCE:
Identity is found in individuality Value autonomy, independence, self-reliance Mind-body seen as separate disease has a specific, measurable, observable cause & treatment is aimed at cause Time is linear (always moves forward) |
|
|
What are the Eastern cultural influences on mental illness?
|
BALANCE:
Family is basis for identity family interdependence & group decision making are the norm Mind-body-spirit seen as one entity, no separation from physical & psychological illness disease caused by fluctuations in opposing forces (yin-yang) Time is circular & recurring (reincarnation) belief in fate |
|
|
What are the Indigenous cultural influences on mental illness?
|
HARMONY:
Basis for identity is the tribe, no concept of person (an entity only in relation to others) Mind-body-spirit is one (may not have separate words for them) disease seen as lack of harmony of individual with others or environment. |
|
|
What does DSM-IV-TR stand for?
|
Diagnostic & Statistical Manual of Mental Disorders, 4th edition, text revised
|
|
|
What is the DSM used for?
|
Classifying/Categorizing mental illness diagnoses
|
|
|
What does Axis I represent?
|
Clinical disorders
(or conditions that may be focus of clinical attention) |
|
|
What does Axis II represent?
|
Personally disorders & Mental retardation
|
|
|
What does Axis III represent?
|
(current) General medical conditions
|
|
|
What does Axis IV represent?
|
(Contributing Stressors)
Psychosocial/environmental problems that may affect dx, tx, prognosis of mental disorder. Potential problem areas: primary support group social environment educational economic access to health care |
|
|
What does Axis V represent?
|
GAF
Global Assessment of Functioning (mental health continuum scale of 100-0) 45 & below = hospitalization |
|
|
What are ethics?
|
Philosophical beliefs about what is considered right or wrong in a society.
Discussions of ethical practice in nursing involve the topics of morals & values |
|
|
What is bioethics?
|
ethical dilemmas surrounding client care
|
|
|
What are the 5 principles of bioethics (ethical concepts)?
|
FABJV:
Fidelity Autonomy Beneficence Justice Veracity |
|
|
What is Fidelity?
|
maintaining loyalty & commitment
|
|
|
What is Autonomy?
|
right to make own decisions
|
|
|
What is Beneficence?
|
promoting good
|
|
|
What is Justice?
|
treating fairly & equally
|
|
|
What is Veracity?
|
duty to tell the truth
|
|
|
What are the 2 main types of mental health admission?
|
Voluntary, Involuntary (commitment)
|
|
|
What is voluntary admission?
|
Client requests admission
Admit form contains 72 hour clause If client requests discharge against medical advice, the physician may hold client involuntarily for up to 72 hours for further assessment of safety If client is dangerous to self or other, physician may initiate a petition for involuntary commitment within 72 hrs **as nurse, make sure papers are in chart & signed!**. |
|
|
3 different commitment PROCEDURES are commonly available to admit someone involuntarily. What are they?
|
Judicial determination
administrative determination agency determination |
|
|
Involuntary admission can be categorized by the nature & purpose. What are they?
|
Emergency
Observational (or temporary) Indeterminate (or extended) |
|
|
What are some legal issues in nursing?
|
CCCARRD:
Competency Confidentiality Consent (informed) Admission (types) Rights (of client) Restrictive interventions Duty to Warn |
|
|
How are laws defined?
|
Through statutes, regulations or court decisions
|
|
|
How is nursing practice regulated?
|
Through licensure & nurse practice act
|
|
|
What is an emergency involuntary admission?
|
Admission of mentally ill persons who are a danger to self or others to prevent harm.
Persons are designated by statutes: police officers, drs, mental health professionals. |
|
|
What is an observational or temporary involuntary admission?
|
It is of longer duration than emergency commitment & purpose is to observe, dx, tx persons who have mental illness or pose danger to self or others.
The time is dictated by statute. Application for admission is made by guardian, family member or dr. 2 or more Drs are required to certify pt is mentally ill or a judicial or administrative review & order is required. |
|
|
What is an Indeterminate or extended involuntary admission?
|
primary purpose is extended care & tx of mentally ill
Committed by judicial, administrative, or medical certification. |
|
|
Describe the Involuntary commitment process.
|
Client is outside hospital:
request (by family member) is submitted to a magistrate Magistrate will issue order for law enforcement officer to pick up / transport client to facility for evaluation 2 separate qualified physicians must assess & determine (within 24 hr) if client poses a danger to self or others (mentally ill) Client may be involuntarily admitted to inpatient facility Must have civil commitment hearing within 10 days of petitions District Court judge issues order for involuntary commitment – specifies maximum number of days (court order in chart, amt of days usually in 30 day increments) If client stills poses danger to self or others at end of commitment period, new petitions & hearing must be initiated for continued hospitalization |
|
|
What is competency?
|
The quality of being capable of making own decisions
|
|
|
What are restrictive interventions?
|
the use of restraints or seclusion
|
|
|
What are some guidelines for using restrictive interventions?
|
Use least restrictive intervention 1st
Dr. must order specific intervention to be done & see pt within 1 hr of order pt must be assessed (& documented) at regular intervals for physical needs, safety & comfort. |
|
|
What is seclusion?
|
Locking a pt in a small room to limit space & decrease stimuli
|
|
|
What is a physical restraint?
|
Physically retaining limbs
|
|
|
What is the duty to warn?
|
The expectation that nurse will tell treatment team/Dr. or verbal threats against a 3rd party.
Dr will warn the 3rd party. |
|
|
What is informed consent?
|
consent to perform treatment or procedure after being informed of:
nature of the problem/condition nature/purpose of treatment risks & benefits alternative options probability of success risk of not consenting |
|
|
What is the federal act that protects a clients confidentiality?
|
HIPPA
|
|
|
What are some factors that put the nurse at risk for becoming chemically impaired?
|
easy access to meds
stress shift work sleep deprivation overtime missed breaks |
|
|
What are some indicators of a chemically impaired nurse?
|
discrepancies in narcotic counts
pt complaints of meds not working changes in mood or behavior pupils dilated disheveled appearance or hygiene attendance changes erratic behavior extended breaks |
|
|
What are the responsibilities of peers working with a chemically impaired nurse?
|
Report
Keep pts safe |
|
|
What is the NC board of nursing's philosophy of discipline for the chemically impaired nurse?
|
They support an opportunity for the nurse to seek treatment & appropriate interventions.
They believe, dependency is a disease, the nurse should accept accountability for his/her actions and provide an alternative program for nurses to recover from impairment in a therapeutic, non-punitive & confidential process. |
|
|
What was the focus of care of mentally ill in the Pre-nineteenth century?
|
Start of scientific thoughts/attitudes.
Philosophers explained life hospitals established witch hunting rebirth of humane attitudes |
|
|
What was the focus of care of mentally ill in the Nineteenth century?
|
Shift toward more humane care, hypnotism, Dix, Linda Richards
|
|
|
What was the focus of care of mentally ill in the Twentieth century?
|
Classifications of mental disorders
differentiated 3 types of schizophrenia Freud Sullivan milieu ego defense mechanisms legislation advances in somatic therapies Peplau funding |
|
|
What was the focus of care of mentally ill in the Twenty-first century?
|
DSM-IV published
scope of practice revised plan for mental health reform little federal funding for mental health |
|
|
What is the philosophy of the community mental health movement?
|
1963, Kennedy signed Community Mental Health Centers Act
shifting care from institution to community with belief that community care would be more humane & less expensive. Community treatment hinges on enhancing client strengths in same environment in which daily life must be maintained. |
|
|
What is the key legislation that influenced the evolution of community based care?
|
1963, Mental Retardation Facilities & Community Mental Health Centers Construction Act by Kennedy
1965, Amendment to 1963 Act to provide staffing funds & other mandates by Johnson 1981, Omnibus Reconciliation Act created block grants for funding to state by Reagan |
|
|
What are some mandates for community mental health centers?
|
Accessible to community
catchment areas all are eligible for tx Board members from community contributes to total community by primary, secondary, & tertiary intervention Five essential services: 1. Consultation & Education (primary intervention) 2. Emergency Services (secondary intervention) 3. Inpatient (secondary intervention) 4. Outpatient (secondary intervention) 5. Partial Hospitalization (tertiary intervention) |
|
|
What is deinstitutionalization?
|
The shift of mental health care from hospitals/institutions to the community
(happened in late 1960's) |
|
|
What is the role of the psychiatric nurse in community based care?
|
member of multidisciplinary community team
biopsychosocial care manager (coordinator of services) |
|
|
What are some current issues of community mental health care?
|
stigma
geographical factors financial factors scarce services in rural areas |
|
|
Describe the concept of management.
|
accomplishment of tasks either by oneself or by directing others
getting a job done or accomplishing a goal |
|
|
Describe the concept of leadership.
|
The interpersonal process that involves motivating & influencing others to strive for a vision, goal or to change behavior.
We model/demonstrate behavior. |
|
|
What is the nurses role in the treatment team?
|
to relay side effects, sleep patterns, etc.
we are considered more "equal" |
|
|
What is the 1st thing done on a new admission?
|
The pt is searched
|
|
|
What is a nurses primary job?
|
To keep pt SAFE!
|
|
|
There are 12 or more members of the psychiatric interdisciplinary team. Name them.
|
4P's MRR C.C. LSD:
Psychiatrist (MD) Psychologist (PhD) Pharmacist (PharmD) Physician Extender (PA or FNP) Medical physician (MD) RN Rehab therapists CNA Chaplain LPN Social Worker Dietician |
|
|
Describe the role of the Psychiatrist.
|
(an MD)
Dx, Tx, admit, discharge, provide in-depth psychotherapy or medication therapy Often function as leaders of team because they prescribe & write orders. |
|
|
Describe the role of the Psychologist.
|
(a PhD)
Provides psychological testing, consultation & direct services such as individual, family or marital therapies. |
|
|
Describe the role of the Pharmacist.
|
Can offer a safeguard for coordinating combinations of psychotropic & other medications.
They check accuracy of meds while techs prepare them. |
|
|
Describe the role of the Physician Extender.
|
PA = BA in any field with 2 yr training as PA
FNP = BA & MS in nursing with FNP training. |
|
|
Describe the role of the Medical Physician.
|
Provide medical diagnosis & treatments on consultation basis.
|
|
|
Describe the role of the RN.
|
Assumes bulk of managing daily functioning of the inpatient unit including safety, assessments, delivery of services & therapeutic activities.
|
|
|
Describe the role of the Rehabilitation therapists.
|
Assist clients in gaining skills that help them cope more effectively, gain or retain employment, use leisure time to benefit their mental health, & express themselves in healthy ways.
OT has a MS & works with pt on ADLs & independent living. Recreation therapists have BA. |
|
|
Describe the role of the CNA.
|
Vitals, ADLs, pt checks, can lead community group activities
function under direction & supervision of RN to provide assistance in meeting basic needs & help community remain supportive, safe & healthy. |
|
|
Describe the role of the Chaplain.
|
has Masters of Divinity on various religions & councils pts.
|
|
|
Describe the role of the Social Worker.
|
Help client prepare a support system (discharge planning) including contacts with day treatment centers, employers, sources of financial aid, & landlords.
A LCSW can provide individual, family & group therapies. An MSN is a medical SW & cannot provide therapy. |
|
|
Describe the role of the Dietitian.
|
MS degree
|
|
|
What is the purpose of examining the roles of the health care team members?
|
To know we are working with/along side highly trained personnel.
|
|
|
Differentiate the scope of responsibility between licensed and unlicensed personnel.
|
Licensed personnel are able to make assessments, plan, implement and evaluate client care
Unlicensed personnel assist in the implementation of client care under the supervision of a licensed person. |
|
|
Identify the RNs role for delegation of care.
|
We may DELEGATE some aspects of care to other nursing personnel: LPNs & CNAs
Delegation of nursing activities must be in accordance with each state’s Nurse Practice Act. |
|
|
What is the psychiatric nurse's collaborative roll in implementation of mental health therapies?
|
We use many types of collaborative interventions & therapies that have evolved from various THEORIES of mental illness.
|
|
|
What are the 3 categories of therapies used in mental health?
|
PEB:
Biological/Somatic therapies (focus on body) Psychodynamic therapies (aka psychotherapy) Environmental therapies (involve safety, relationships, structure) |
|
|
What are the 3 therapies that fall under the biological/somatic category?
|
PEB:
Pharmacological ECT Biofeedback |
|
|
What are the 4 therapies that fall under the environmental category?
|
MORE:
Milieu Occupational Recreational Expressive |
|
|
What are the 6 therapies that fall under the psychodynamic category?
|
BICHIP:
Behavior modification Individual/group/family psychotherapy Cognitive Hypnotherapy Interpersonal Psychoanalysis |
|
|
What does pharmacological therapy involve?
|
medications
Nurses have independent & collaborative roles. Responsible for admin of meds, assessing therapeutic & adverse effects (titration against side effects), & med education. (pts with anxiety seem to notice SE more). |
|
|
What does electroconvulsive therapy involve?
|
the use of an electric stimulus to produce a grand-mal seizure in the brain
primarily used for major depression. Dr. pushes the switch. |
|
|
What does biofeedback therapy involve?
|
program designed to help control the autonomic nervous system using monitoring devices to control heart rate, BP, skin temp, or relax certain muscles.
With practice, an individual can invoke a relaxation state at will. |
|
|
What does psychoanalysis therapy involve?
|
by Sigmund Freud
pt talks about anything while Dr. listens (doesn’t respond to pt) provides a basis for understanding psychopathology theory teachs us not to take behavior a face value & encourages exploration of the meaning behind human behavior Psychoanalysis is conducted on a 1 to 1 basis only by a psychiatrist with specialized training in analysis. Used infrequently. |
|
|
What does individual/group/family psychotherapy involve?
|
Clients work with individual therapist 1 x week with focus on crisis, intervention, problem solving, or long term insight oriented therapy.
|
|
|
What does hypnotherapy involve?
|
direct or indirect trance & story telling
a sleep-like state is induced during which the client may be asked questions or given suggestions May be used to help a client disclose repressed material. |
|
|
What does interpersonal psychotherapy involve?
|
Meyer & Harry Stack Sullivan
theory provides basis for using & understanding concepts of anxiety, security, & trust as basic to formation of therapeutic nurse-client relationships. |
|
|
What does behavior modification therapy involve?
|
changing behavior with reward system
used to reinforce adaptive behaviors & diminish/ extinguish maladaptive behaviors Helpful for clients with limited abstract abilities or insight. |
|
|
What does cognitive therapy involve?
|
Beck
change the way you think to change the way you feel goal is to change the way a client thinks by helping pt reconsider stressors & identify faulty thinking/beliefs used with mood disorders. |
|
|
What does milieu therapy involve?
|
1950’s by Harry Stack Sullivan
Based on concept that physical & interpersonal surroundings should be therapeutic 24 hours/day. |
|
|
What does occupational therapy involve?
|
Purposeful, goal-oriented activity used to treat psychosocial dysfunction or physical disabilities.
May include use of splinting or adaptive equipment in teaching ADLs & community living skills. |
|
|
What does recreational therapy involve?
|
a variety of individual & group activities, crafts, & games are used to teach leisure & social skills
|
|
|
What does expressive therapy involve?
|
Art, music or drama may be used as a means of expressing thoughts or feelings that a client might not be able to verbalize
|
|
|
What are the nursing responsibilities for psychodynamic therapies?
|
An advanced practice nurse can function as a primary therapist for individual, group, or family therapy.
All nurses can apply basic principles from the psychodynamic & interpersonal models to establish therapeutic nurse-client relationships. Principles from behavior modification & cognitive therapy are used to reinforce behaviors & thought patterns which are adaptive & to decrease those behaviors which are maladaptive. |
|
|
What are the nursing responsibilities for milieu therapy?
|
Has primary responsibility of assessing & structuring the therapeutic milieu
nurse-client relationship & group interactions help assist client to identify maladaptive behaviors & develop problem solving skills RN also supervises other personnel such as LPN & CNA. |
|
|
What are the nursing responsibilities for occupational, recreational & expressive therapies?
|
Therapy is provided by a licensed therapist but nurse reinforces skills & participation during times when therapist is not available
|
|
|
What is a thought disorder?
|
A COGNITIVE PROBLEM of disturbance of speech, communication, or content of thought (eg, delusions, ideas of reference, poverty of thought, flight of ideas, perseveration, loosening of associations, etc)
TDs can be functional emotional disorders or organic typically associated with psychosis SCHIZOPHRENIA is a thought disorder. |
|
|
What is Schizophrenia?
|
a devastating brain disease that affects a person’s thinking, language, emotions, social behavior, & ability to perceive reality accurately
a thought disorder |
|
|
How is thinking affected in schizophrenia?
|
disordered
concentration is difficult connecting thoughts into logical sequences is difficult thoughts are impoverished |
|
|
How are emotions affected in schizophrenia?
|
affect is flat or blunted, speech a monotone
|
|
|
How is social behavior affected in schizophrenia?
|
hygiene and grooming are not maintained
relationships with family & friends are difficult to maintain keeping a job is difficult |
|
|
How is the ability to perceive reality accurately affected in schizophrenia?
|
ego functioning is impaired
|
|
|
How is language affected in schizophrenia?
|
associative looseness
neologisms echolalia clang association word salad etc. |
|
|
There are 4 theories of what causes (etiology) a thought disorder. What are they?
|
Neurobiological
Neuroanatomical Nongenetic Genetic |
|
|
Descibe the neurobiological theory on cause of thought disorders.
|
Theory that thought disorders occur due to changes at neurotransmitters.
(ex. Dopamine hypothesis) |
|
|
Describe the neuroanatomical theory on cause of thought disorders.
|
Theory that thought disorders are caused by differences in size of ventricles.
|
|
|
What are some nongenetic risk factors thought to cause thought disorders?
|
Caused by viruses?, happens enutero?
|
|
|
What are the 5 subtypes of schizophrenia?
|
PCRUD:
Paranoid Catatonic Residual Undifferentiated Disorganized |
|
|
What are positive symptoms?
|
hallucinations
delusions bizarre behavior formal thought disorder & speech patterns paranoia & alterations in thinking/speech |
|
|
What are negative symptoms?
|
The A's:
Affective flattening Alogia (poverty of speech & blocking) Avolition apathy (impaired grooming, lack of work/school) anhedonia asociality (lack of pleasure, interests, relationships) Attention deficits (social inattentiveness) Anergia (lack of energy) |
|
|
Describe paranoid schizophrenia.
|
Dominate symptoms are hallucinations & delusions
(these are positive symptoms) No disorganized SCAB: Speech Catatonia Altered Affect Behavior |
|
|
Describe disorganized schizophrenia.
|
Dominate symptoms of
disorganized speech, behavior (positive symptoms) & inappropriate affect (negative symptom) If present, hallucinations & delusions are fragmented (positive symptom) associated features: oddities of behavior grimacing mannerisms |
|
|
Describe catatonic schizophrenia.
|
Motor immobility (waxy flexibility or stupor)
agitation/excessive motor activity negativism or mutism echolalia/echopraxia peculiar voluntary movements: Posturing Prominent mannerisms Prominent grimaces Stereotyped movements |
|
|
What is affect?
|
how the face reflects mood
|
|
|
What are hallucinations?
|
Sensing something that is not there (no stimulus).
Can come from any of the 5 senses. |
|
|
What are delusions?
|
Fixed, false beliefs.
|
|
|
At what level of anxiety is a paranoid schizophrenic?
|
Panic
(wouldn't you be with hallucinatins & dilusions?) |
|
|
What is ment by inappropriate affect?
|
affect doesn't match the situation.
i.e. laughing when sad |
|
|
What is waxy flexability?
|
When the person is able to stay in a placed position for an extended period of time.
|
|
|
What is echolalia?
|
pathological repeating of another's word by imitation
(often seen in catatonia) |
|
|
What is echopraxis?
|
mimicking of the movements of another
(often seen in catatonia) |
|
|
Describe residual schizophrenia.
|
No active phase symptoms
(i.e. no delusions, halluciantions, disorganized speech or behaviors) Persistence of some symptoms are noted: (AISLE) affect blunted or inappropriate impairment in function social isolation/withdrawl lack of initiative/interest/energy eccentric behavior/beliefs |
|
|
Describe undifferentiated/mixed schizophrenia.
|
positive symptoms of hallucinations, delusions, bizarre behaviors
& no 1 clinical presentation dominates (e.g. paranoid, disorganized, catatonic) |
|
|
What are Bleuler's 4 A's of schizophrenia?
|
Affect (flat, blunted, inapproprate or bizarre)
Associative looseness (confused thinking in jumbled & illogical speech & reasoning) Autism (thinking not bound to reality such as hallucinations, delusions & neologisms) Ambivalence (holding to opposite emotions, attitudes, ideas at the same time - can be paralyzing as the pt vacillates between opposing positions) |
|
|
What common defense mechanisms are used by a person with a thought disorder?
|
DRLP:
Denial/fantasy Regression Lack of suppression Projection |
|
|
Describe the defence mechanism Denial/fantasy
|
escaping unpleasant realities by ignoring their existence
|
|
|
Describe the defence mechanism Regression.
|
loss of mature development leading to immature behavior
|
|
|
Describe the defence mechanism Projection
|
rejects personal emotions/feelings and attributes them to other people
|
|
|
What is the typical age of onset for a thought disorder/schizophrenia?
|
late teens, early twenties
|
|
|
Are men & women at equal risk of getting a thought disorder?
|
yes
|
|
|
What are the charicteristics of individuals with early onset thought disorders/schizophrenia?
|
(age is 18-25 yo)
more often male have poorer premorbid adjustment (were not well adjusted before illness) more evidence of structural brain abnormalities more prominent negative symptoms |
|
|
What are the characteristics of individuals with late onset thought disorders/schizophrenia?
|
(age is 25-35 yo)
more often female have less evidence of structural abnormalities have better outcomes |
|
|
Does childhood schizophrenia exhist?
|
yes, it is rare
|
|
|
What are some cultural factors to keep in mind when evaluating a pt for thought disorder?
|
Delusions related to sorcery or witchcraft may be common in other cultures
Visual/auditory hallucinations with religious content may be normal part of a religious experience Assessment of disorganized speech may be difficulty due to linguistic variation (think movie Nell) Assessment of affect also varies by culture |
|
|
What are some types of delusions?
|
JG SCRIPT:
delusions of Jealousy (mate unfaithful) delusions of Grandeur (feel very powerful) Somatic delusions (change in body) delusions of being Controlled (mind or body is being controlled) Religious delusions (obsessed with ideas/behaviors) Ideas of reference (ppl talking about them or to them) Paranoid/persecutory (someone will hurt them) Thought broadcasting/insertion/withdrawl (thoughts heard by others, being inserted into mind, taken out of mind) |
|
|
What is another description for "form of thought"?
|
Alteration in speech
|
|
|
What are some types of form of thought/alterations in speech?
|
Associative looseness:
circumstantiality (round & round talking) Tangentiality (on tangent that doesn't make sense) Word Salad (jumble of words that is meaningless) Neologisms (nonsensical word) Echolalia (copy what you're saying) Clang Associations (words grouped by sound or rhyme) |
|
|
What is concrete thinking?
|
overemphasis on specific details & impairment in ability to use abstract concepts
takes things literally |
|
|
What are 2 types of sensory perceptions?
|
Hallucinations (sensory-perceptual experience in which there is no stimulus)
Illusion (an error in the perception of a sensory stimulus) |
|
|
What are some examples of alterations in behavior?
|
motor agitation
stereotyped behaviors automatic obediance (do what told but nothing else) waxy flexibility stupor (motionless) negativism agitated behavior |
|
|
What are some possible nursing diagnoses for a pt with a thought disorder?
|
ANNSSS TV:
Anxiety (specifiy level) Noncompliance Nutrition: imbalanced Sleep pattern disturbed Sensory-perception disturbed (specify sense) Social isolation Thought processes, disturbed Violence, risk for other/self directed |
|
|
What are some nursing interventions that correspond with the Interpersonal theory?
|
Build trust by…
Giving information Maintaining interpersonal space that is comfortable to client Short/frequent contacts |
|
|
What are some nursing interventions that correspond with the Communication theory?
|
Keep communication appropriate to client’s anxiety level
Focus on “here and now” reality Give client feedback if his/her communication is unclear |
|
|
What are some nursing interventions that are useful for the delusional client?
|
Don’t challenge or reinforce false, fixed beliefs
Address theme of delusion, not the content Meet client’s needs for safety |
|
|
What are some nursing interventions that are useful for the hallucinating/illusions client?
|
Assess for presence of command hallucinations
Respond to the process of the hallucination, not the content Meet client’s needs for safety (e.g. you must be very frightened) |
|
|
What is a biological intervention for the client with a thought disorder?
|
provide medications
|
|
|
What is a psychodynamic intervention for the client with a thought disorder?
|
Psychotherapy &/or counseling
(more important during maintenance & stabilization phases of tx) - during acute/psychotic phase, medication & medical stabilization a priority |
|
|
What are some environmental interventions for the client with a thought disorder?
|
Provide:
safety of the milieu structure routine daily schedule restrictive interventions as needed (least restrictive measures 1st) |
|
|
What are some occupational/recreational interventions for the client with a thought disorder?
|
These interventions will more likely be used when client is more stabilized:
For positive symptoms – used to help client stay focused on reality For negative symptoms – used to rebuild social skills & functioning |
|
|
What are some expressive interventions for the client with a thought disorder?
|
These interventions will more likely be used when client is more stabilized:
For positive symptoms – used to help client stay focused on a “here & now” activity For negative symptoms – used to facilitate expression of feelings & interaction with others. |
|
|
Discuss atypical antipsychotic medications.
|
New generation
Often chosen first line now More expensive Action: serotonin-dopamine antagonists (5-HT2A receptor antagonists) Target: Both Positive & negative symptoms |
|
|
What are some examples of atypical antipsychotics?
|
Oral:
Clozaril, Risperdal, & Zyprexa (come in orally disintegrating tablet/wafer) Injectable: long acting - Risperdal Consta short acting - Zyprexia |
|
|
Discuss typical antipsychotic medications.
|
TYPICAL = Standard/Traditional
Older generation Less expensive Action: dopamine antagonist (D2 receptor antagonist) Target: positive symptoms |
|
|
What are some examples of typical antipsychotics?
|
Oral:
some come in liquid form Injectable = Long acting: Haldol Deconoate Prolixin Deconoate |
|
|
What are extrapyramidial side effects (EPS)?
|
Get mostly from typical meds:
a group of side effects induced by neuroleptic meds. They include: akathisia (internal restlessness) Dystonia (twitching of muscles, cramps of face & neck, may be life threatening) Parkinsonism (stiffening of musculare activity of face, body, extremities) Tardive dyskinesia (involuntary muscle spasms involving tongue, fingers,pill rolling, toes, neck, trunk, pelvis) do AIMS exam |
|
|
What are the 3 more common EPSs?
|
Acute dystonia
akathisia pseudoparkinsonism |
|
|
What is neuroleptic malignant syndrome (NMS)?
|
A potentially fatal syndrome typically occuring after acute reduction of dopamine levels
occurs in 0.2-1.0% fatal in 10% of cases usually occurs early in tx. |
|
|
What are the signs of NMS (neuroleptic malagnant syndrome)?
|
decreased LOC
increased muscle tone autonomic dysfunction: Drooling Diaphoresis Hyperpyrexia Labile hypertension Tachycardia Tachypnea |
|
|
What is the treatment for NMS (neuroleptic malagnant syndrome)?
|
MMR TED:
Manage fluid balance monitor complications reduce temp treat with IV Dantrium or ECT early detection discontinue antipsychotic |
|
|
What are some other antipsychotic medication side effects/adverse reactions?
|
Anticholinergic SE
orthostasis (low BP) lowered seizure threshold agranulocytosis |
|
|
What is agranulocytosis?
|
a decrease in granulocytes (WBCs)
is serious, can be fatal liver involvment can occur need to monitor abs neutophil count occurs most often with clozaril |
