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252 Cards in this Set

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What is meant by the corporatization of health care?
Small operating facilities such as hospitals or physicians offices are merging into large scale organizations.
What is meant by intragrated health care delivery systems?
This is when individual healthcare organizations merge into one system to provide all needed services under one corporate umbrella.
Acute care hospitals do what?
They provide care to individuals who require close observation in equipment that cannot be provided in the home.
What is the difference between a decentralized and a centralized organization?
In centralized organizations to control the financial management and changes regarding nursing care delivery confirmation from authority. In a decentralized organization, subordinates are getting a wide range of authority that involves decision-making and even policy formation.
Goals should be?
Specific, measurable, attainable, realistic, and timed.
Goals should answer?
Who, what, and when and match the nursing diagnoses
What is the Milieu theory?
The concept of the milieu theory or therapy was originally developed by Sullivan, and involved patients in her actions with each other, practicing interpersonal relationships, giving each other feedback about behavior, and working cooperatively as a group to solve day-to-day problems.
The Limbic system includes what?
This area of the brain is located above the brainstem and it includes the thalamus, hypothalamus, hippocampus,and the amygdala.
Standards of professional nursing practice included the following, what are some?
Perform nursing assessments regarding the health status of the client. Make a nursing diagnosis which will serve as the basis for the strategy of care. Develop a plan of care are based on the assessment and nursing diagnosis. Implement the nursing care. And evaluate the client's response to the nursing interventions.
The nursing assessment includes two steps, what are the?
A first step involves collection and verification of data from a primary source the client and a secondary source family, health professionals, and the medical record. The second step involves the analysis of all the data as a basis for developing and nursing diagnosis and an individual plan of care for the client.
Ego defense mechanisms are?
reaction formation
All the definitions do these are found in the Vidbeck textbook around page 51 depending on which text you have.
Id is what?
One of Freud's components of personality. The id includes innate desires, pleasure seeking, aggression, and sexual impulse.
Superego is what?
One of Freud's components of personality. It includes morals, ethical values, and being parental.
Ego is what?
One of Freud's components are personality. It includes mature adaptive behavior.
Freudian slip is what?
Freud believed that much of what we do and say is motivated by our subconscious. An example Freudian slip would be saying "you portly today" instead of saying "you look pretty today".
Ego defense mechanisms are?
reaction formation
All the definitions do these are found in the Vidbeck textbook around page 51 depending on which text you have.
Id is what?
One of Freud's components of personality. The id includes innate desires, pleasure seeking, aggression, and sexual impulse.
Superego is what?
One of Freud's components of personality. It includes morals, ethical values, and being parental.
Ego is what?
One of Freud's components are personality. It includes mature adaptive behavior.
Freudian slip is what?
Freud believed that much of what we do and say is motivated by our subconscious. An example Freudian slip would be saying "you portly today" instead of saying "you look pretty today".
Describe Freud's theory
Psychoanalytic theorist who believed in the personality components ID, Ego, Superego He also believed in Ego defense mechanisms and the 5 stages of psychosexual development
What is the ID
ID = the innate desires, pleasure seeking, aggression, and sexual impulse (the devil)
What is the EGO
EGO = the mature adaptive behavior the mediator of the ID and SUPEREGO (the person)
What is the SUPEREGO
SUPEREGO = Moral, ethical, values, parental (the angel)
Define Repression
The exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness. It is considered the cornerstone of defense mechanisms and it is the first line of psychological defense against anxiety. EXAMPLE: Woman has no memory of yesterday's rape.
Define sublimation
An unconscious process of substituting constructive and socially acceptable activity for strong impulses that are not acceptable in their original form. Usually these impulses are aggressive or sexual in nature. EXAMPLE: A mother whose son was killed by a drunk driver channels her anger and energy into being president of MADD
Define regression
The ego returns to an earlier, more comforting, although less mature way of behaving. EXAMPLE: An adult who cannot have own way, pouts and whines and behaves in a manner that got him his own way as a child
Define displacement
A transfer of emotions associated with a particular person, object, or situation to another person, object, or situation that is non-threatening. EXAMPLE: Boss yells at man; man yells at wife; wife yells at child; child kicks the dog
Define projection
The person unconsciously rejects emotionally unacceptable features and attributes them to other people, objects, or situations through projection EXAMPLE: Blaming or scapegoating
Define compensation
Make up for deficits in one area by excelling in another area in order to raise or maintain self-esteem EXAMPLE: An unsuccessful actor becomes a successful playwright
Define reaction-formation
Unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion EXAMPLE: Ann hates nursing. She attends nursing school to please her parents. During career day she speaks to perspective students about the excellence of nursing as a career
Define denial
Escaping unpleasant realities by ignoring their existence EXAMPLE: A woman whose health has deteriorated because of alcohol abuse, denies she has a problem with alcohol by saying she can stop drinking whenever she wants
Define conversion
Transforming anxiety on an unconscious level to a physical symptom that has no organic cause EXAMPLE: A professor develops laryngitis on the day he or she is scheduled to defend a research proposal to a group of peers
Define undoing
Makes up for an act or communication. It can be viewed as cleansing oneself of a perceived unacceptable act or thought EXAMPLE: Giving a gift to undo an argument or compulsive hand washing
Define rationalization
Justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanation that satisfy the teller as well as the listener EXAMPLE: Everybody cheats, so why shouldn't I?
Define identification
An unconscious mechanism used to protect the person against anxiety and loss by imitation of mannerisms or behaviors of a person or group EXAMPLE: Hero worship
Define introjection
Intense identification in which a person incorporates or takes into his or her own personality qualities or values of another person with whom or with which intense emotional ties exist EXAMPLE: A child integrates their parents' value system into the process of conscience formation. A child says to a friend, Dont cheat it's wrong
Define suppression
The conscious putting off of awareness of disturbing situations or feelings EXAMPLE: A student who has been studying for the State Board Exam says, I Can't worry about paying my rent until after my exam tomorrow
Define intellectualization
Avoiding unacceptable emotions by focusing on the intellectual aspects EXAMPLE:focusing on the details of a funeral as opposed to the sadness and grief
Diagnostic and statistical manual of mental disorders
Define AXIS I
Major psychiatric disorders, except mental retardation and personality disorders EXAMPLE: Recurrent Major Depression
Define AXIS II
Personality disorders and developmental disorders EXAMPLE: Mild Mental Retardation
Physical disorders and conditions EXAMPLE: Colitis
Define AXIS IV
Severity of psychosocial stressors - rated on scale EXAMPLE: Marital separation, loss of employment - rated severe
Define AXIS V
Global assessment of functioning (highest level of adaptive functioning) EXAMPLE: Suicidal Idealation - 50
What are the five stages of freud's psychosexual development
Oral - birth to 18 months Anal - 18-36 months Phallic/oedipal - 3-5 yrs Latency - 5-11 or 13 yrs Genital - 11-13 yrs
Define transference
Happens when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships
Define countertransference
Happens when the therapist displaces onto the client attitudes or feelings from his or her past
What are eriksons eight psychosocial stages of development
Trust vs mistrust (infant) Autonomy vs shame and doubt (toddler) Initiative vs guilt (preschool) Industry vs inferiority (school age) Identity vs role confusion (adolescence) Intimacy vs isolation (young adult) Generativity vs stagnation (middle adult) Ego integrity vs despair (maturity)
What are sullivans Interpersonal three developmental cognitive modes of experience
Prototaxic mode = characteristics of infancy and childhood, involves brief unconnected experiences that have no relation to each other Parataxic mode = begins in early childhood as the child begins to connect experiences in sequence Syntaxic mode = begins to appear in school-age children and becomes more predominant in preadolescence, the person begins to perceive himself or herself and the world within the context of the environment and can analyze experiences in a variet of settings
Abnormalities in the frontal lobes are associated with
schizophrenia, attentiondeficit/hyperactivity disorder and dementia
Disturbances in the limbic system have been implicated in
memory loss seen in dementia poor impulse and emotional control psychotic or manic behavior
Define neurotransmitters
chemical substancdes manufactured in the neuron that aid in the transmission of information throughout the body. They either excite or stimulate an action in the cells (excitatory) or inhibit or stop and action (inhibitory)
What are the major types of neurotransmitters
Dopamine Norepinephrine (noradrenaline) Epinephrine (adrenaline) Serotonin Histamine Acetylcholine Neuropeptides Glutamate Gamma-aminobutyric acid (GABA)
generally excitatory implicated in schizophrenia, psychoses as well as movement disorders such as parkinsons disease
Norepinephrine and its derivative epinephrine
Neurotransmitter also known as noradrenaline and adrenaline excess norepinephrine has been implicated in a variety of anxiety disorders; deficits may affect memory loss, social withdrawal, and depression epinephrine also controls the fight-or-flight response in the peripheral nervous system
Neurotransmitter found only in the brain plays an important role in anxiety and mood disorders and schizophrenia. It has also been found to play a role in the delusions, hallucinations, and withdrawn behavior seen in schizophrenia. It is also derived from tryptophan
neurotransmitter found in the brain, spinal cord, and peripheral nervous system, particularly at the neuromuscular junction of skeletal muscle. studies have shown that persons with Alzheimer's disease have a decreased number of acetylcholine-secreting neurons, and persons with myasthenia gravis have a reduced number of acetylcholine receptors
Gamma-aminobutyric acid (GABA)
amino acid and is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than providing a dircet stimulus Benzodiazapines increase GABA function
What is the Physiologic effect of Dopamine
Excitatory Controls complex movements, motivation, cognition; regulates emotional response
What is the Physiologic effect of Norepinephrine (noradrenaline)
Excitatory Changes in attention, learning and memory, sleep and wakefulness, mood
What is the Physiologic effect of Epinephrine (adrenaline)
Excitatory Fight or flight response
What is the Physiologic effect of Serotonin
Inhibitory Control of food intake, sleep and wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions
What is the Physiologic effect of Acetylcholine
Excitatory or inhibitory Sleep and wakefulness cycle; signals muscles to become alert
What is the Physiologic effect of Neuropeptides
Neuromodulators Enhance, prolong, inhibit, or limit the effects of principal neurotransmitters
What is the Physiologic effect of GABA
Inhibitory Modulates other neurotransmitters
Define Depot injection
a time released form of medication for maintenance therapy. The vehicle for these injections is sesame oil so it is absorbed slowly over time
Name two antipsychotics that are available in depot injection
Fluphenazine (Prolix): 7 to 28 day duration Haloperidol (Haldol) 4 week duration condition must be stabilized with oral types befor administering depot injections
Define Antipsychotic drugs
Also known as neuroleptics and are used to treat symptoms of psychosis such as delusions and hallucinations They work by blocking receptors of dopamine
What are some main side effects of antipsychotic drugs
Extrapyramidal symptoms (EPS) Neuroleptic malignant syndrome (NMS) Tardive dyskinesia (TD) Anticholinergic side effects
What is Extrapyramidal symptoms (EPS)
These are serious neurologic symtoms they include acute dystonia, pseudoparkinsonism and akathisia
Define Acute Dystonia
includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and in severe cases laryngospasm and respiratory difficulties usually occurs in first week of treatment
Define torticollis r/t acute dystonia
twisted head and neck
Define opisthotonus r/t acute dystonia
tightness in the entire body with the head back and an arched neck
Define oculogyric crisis r/t acute dystonia
eyes rolled back in a locked position
What is the TX for persons with Acute Dystonia symptoms
anticholinergic drugs such as IM benztropine mesylate (cogentin) or IM or IV diphenhydramine (benadryl)
Define pseudoparkinsonism
symptoms resemble those of parkinson's disease and include a stiff, stooped posture; masklike facies; drcreased arm swing; a shuffling, festinating gait with small steps; cogwheel rigidity; drooling; tremor; bradycardia; AND COARSE PILL-ROLLING MOVEMENTS OF THE THUMB AND FINGERS WHILE AT REST TX change to another antipsychotic med or by adding an oral anticholinergic agent or amantadine
Define akathisia
The intense need to move about. The client appears restless or anxious and agitated, often with rigid posture or gait and lack of spontaneous gestures TX change in antipsychotic med or that additon of an oral agent such as a beta-blocker, anticholinergic, or benzodiazepine
Define Neuroleptic malignant syndrome
potentially fatal, idiosyncratic reation to an antipsychotic drug. The major symptoms are rigidity, high fever, autonomic instability, such as unstable blood pressure, diaphoresis, and pallor, delirium and elevated levels of enzymes particularly CPK. Clients usually are confused and often mute; may fluctuate from agitation to stupor TX immediate discontinuance of all antipsychotic medications and the institution of supportive medical care, such a srehydration and hypothermia until stabalizes
Define Tardive dyskinesia
a syndrome of permanent, involuntary movements, is most commonly caused by the long term use of typical antipsychotic drugs. Symptoms incluced involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature, tongue thrusting and protrusion, lip smacking, blinking, grimacing, and other excessive, unnescessary facial movements The involuntary movement scale is used to assess TD; TD is irreversible
Define Anticholinergic side effects
side effectgs used with antipsychotics and include orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion, and decreased memory; usually decrease in 3-4 wks
What are some other common side effects of antipsychotic drugs
increased blood prolactin levels which will cause breast enlargement and tenderness in men and women; diminished libido and erectile and orgasmic dysfunction, menstrual irregularities, and an increase risk for breast cancer
What are some typical antipsychotic medications
thorazine, trilafon, prolixin, mellaril, serentil, stelazine, navane, haldol, loxitane, moban
What are some atypical antipsychotics
clozaril, risperdol, zyprexa, seroquel
Define Antidepressants
primarily used in the tx of major depressive illness, panic disorder and other anxiety disorders, bipolar depression and psychotic depression
What are the four groups of antidepressants
Tricyclic SSRI MAOI Other
Name some Cyclic compounds (antidepressants)
tofranil, norpramin, elavil, pamelor, sinequan, surmontil, vivactil, LUDIOMIL, ASENDIN, anafranil
Info about cyclic compounds
Block cholinergic receptors, resulting in an anticholinergic effects; Used for antidepressants but can be used for insomnia and panic disorders; more side effects then SSRI's including varying degrees of sedation, orthostatic hypotension, anticholinergic side effects, they are also lethal if taken in an overdose
What is ludiomil
tetracyclic antidepressant that may cause seizures, especially in clients with hx of alcoholism
What is asendin
tretracyclic antidepressant used judiciously since it has similar side effect to the antipsychotic medications
What are some MAOI's
Parnate, nardil, marplan eldepryl
What are some side effects of MAOI's
Sedation, insomnia, weight gain, sexual dysfunction Orthostatic hypotension, nausea, hypertensive crisis if foods with tyramine are eaten or ineraction with other antidepressants (14 day gap)
What are the foods to avoid when taking MAOI's
Cheese except cottage cheese & cream Aged or cured meat or fish Broad bean pods, tofu, soybeans Bananas, rasberries Draft beer, wine Sauerkraut, soy sauce, yeast, soups, pizza, MSG, some chocolates
What are some drugs to avoid when taking MAOI's
Asthma meds Sinus meds Narcotics *Demerol Stimulants
Name some SSRI drugs
prozac, luvox, paxil, zoloft, lexapro
What are some side effects of SSRI's
anxiety, agitation, akathisia, nausea, insomnia, and sexual dysfunction, specifically diminished sexual drive or difficulty achieving an erection or orgasm less common is sweating and continued sedation
Name some mood stabilizing drugs
#1 LITHIUM anticonvulsants such as Tegretol and Depakote, Depakene, Neurontin and Lamictal Klonopin
What are mood stabilizing drugs used for
they are used to treat bipolar affective disorder by stabilizing the clients highs and lows
What is involved in the pre-lithium work up
thyroid, renal and cbc, lytes & chem panel
Lithium dosage and toxicity level
usually given in 1-3 300 mg doses per day it takes up to 2 wks to have an effect on mood *Small therapeutic window of 0.5-1.5
Signs of lithium toxicity
severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination; can lead to renal failure, coma & death
What are some common side effects of lithium
mild nausea or diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, and a metallic taste in the mouth and fatigue or lethargy
What are some antianxiety drugs
BENZODIAZEPINES Xanax, librium, klonopin, tranxene, valium, dalmane, ativan, serax, restoril, halcion NONBENZODIAZEPINES buspar
What are antianxiety drugs used for
used to treat anxiety and anxiety disorders, insomnia, OCD, depression, post-traumatic stress disorder, and alcohol withdrawl
__________, emphasized an individuals motivation in the continuous quest for self-actualization. Identified 5 levels of needs 1- physiological needs 2- safety and security 3- love and belonging 4- self-esteem, esteem of others 5- self-actualization
________, wanted to know how to change behaviors, how do people learn. Worked at getting people to change their beliefs. hottest therapy today. A- situation B- beliefs C- emotional D- change behaviors
Aaron Beck and Albert Ellis
__________, people learn by watching people. -good role models
___________, looked at children with stages. Sensorimotor- birth-2 Pre-operational- 2-6 Concrete operations - 6-12 Formal operations- 12-15 +yrs
Jean Piaget
________, applied interpersonal theory to nursing practice and to nurse-patient relationship-development 4 stages: 1. orientation 2. identification 3. exploitation 4. resolution
________, believed that people developed because of relationships with others.(therapeutic relationships) major concepts include: anxiety satisfaction of needs interpersonal security self-system
_______, created these stages: 1- oral stage (birth-18 months) 2- anal stage ( 18 months- 3yrs) 3- phallic stage (3-6) 4- latency stage (6-12) 5- Genitial stage (13-20)
_______, looked at Freuds development of age-related stages and thought it focused more on tasks to get to the next stage. Trust vs mistrust autonomy vs shame and doubt initiative vs guilt industry vs inferiority identity vs role confusion
_______, the perfection principle. It internalizes the values and morals set forth by primary caregivers. -important in the socialization of the individual because it assists the other two. -right and wrong
_______, also called rational self or the reality principle begins to develop between ages 4 and 6 months. -experiences the reality of the external world, adapts to it and responds to it. -maintains harmony
_______. the pleasure principle. -present at birth -driven behaviors are impulsive and may be irrational
________, combination of good and bad traits that make us who we are.
Name the 3 illness that can be traced in family history (biological) 1. 2. 3.
1. schizophrenia 2. bipolar 3. depression
Defense Mechanism____________________- an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires. Ex- a teenager who required lengthy rehabilitation after an accident decides to become a physical therapist as a result of his experiences.
Defense mechanism_______________- an attempt to avoid expressing actual emotions associated with a stressful situation by using the intelluctual processes of logic, reasoning & analysis Ex- sarah's husband is being transferred with his job to a city far away from her parents. she hides anxiety by explaining the advantages associated with the move to her parents.
defense mechanism_______________- integrating the beliefs and values of another individual into ones own ego structure. Ex- children integrate their parent's value system into the process of conscience formation. A child says to a friend " don't cheat, it's wrong"
defense mechanism___________________- separating a thought or memory from the feeling, tone or emotion associated with it. Ex- a young women describes being attacked and raped with showing any emotion.
Defense mechanism________________- attributing feelings or impulses unacceptable to ones self to another person. Ex- Sue feels a strong sexual attraction to her track coach and tells her friend "he's coming on to me"
Defense mechanism_________________- attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors. Ex- John tells the rehab nurse " I drink because its the only way I can deal with my bad marriage and my worse job"
Defense mechanism__________________- preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors Ex- Jane hates nursing. she attended nursing school to please her parents. During workday, she speaks to perspective students about the excellence of nursing as a career
Reaction formation
Defense mechanism___________________- retreating in response to stress to an earlier level of development and the comfort measures associated with that level of functioning. Ex- when 2yr old Jay is hospitalized for tonsillitis, he drinks only from a bottle, even though his mom states he has been drinking from a cup for 6 months.
Defense mechanism_______________- involuntarily blocking unpleasant feelings and experiences from one's awareness. Ex- an accident victim can remember nothing about his accident
Defense mechanism________________- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. Ex- a mother whose son was killed by a drunk driver channels her anger and energy into being the President of the local chapter of mothers against drunk drivers.
Defense mechanism_______________- The voluntary blocking of unpleasant feelings and experiences from one's awareness. Ex- Scarlet O'Hara says, "I don't want to think about that now, I'll think about that tomorrow".
Defense Mechanism- symbolically negating or canceling out an experience that one finds intolerable. Ex- Joe is nervous about his new job and yells at his wife. On his way home he stops and buys her some flowers and himself a new video game.
Defense mechanism________________- The transfer of feelings from one target to another that is considered less threatening or that is neutral. Ex- a patient is angry at his physician does not express it, but become verbally abusive with the nurse.
Defense Mechanism_________________- Refusing to acknowledge the existence of a real situation or the feelings associated with it. Ex- a women drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem.
Defense mechanism_______________- Covering up a real or perceived weakness by emphasizing a trait one considers more desirable. Ex- a physically handicapped boy is unable to participate in football, so he _________ by becoming a great scholar.
Therapeutic technique______________- Gives the patient the opportunity to collect and organize thoughts, to think through a point, or to consider introducing a topic of greater concern than the one being discussed.
Using silence
Therapeutic technique__________- Conveys an attitude of reception and regard. Ex- Yes, I understand what you said. eye contact; nodding
Therapeutic technique_______________- Includes acknowleding and indicating awareness. It is better than complimenting which reflects the nurse's judgement. Ex- "hello Mr. J, I notice that you made a ceramic ash try in OT" "I see you made your bed"
Giving recognition
Therapeutic technique______________- Making oneself available on an unconditional basis, thereby increasing patients feelings of self-worth. Ex- "I'll stay with you awhile" "we can eat out lunch together" "I'm interested in you"
Offering self
Therapeutic technique_______________- allows the patient to take the initiative in introducing the topic; it emphasizes the importance of the patients role in the interaction. Ex- What would you like to talk about today?" Tell me what you are thinking.
Giving broad openings
Therapeutic technique______________- Offers the patient encouragement to continue. Ex- "yes, I see" "go on" "and after that"
Offering general leads
Therapeutic technique_________________- Clarifies the relationship of events in time so that the nurse and patient can view them in perspective. Ex- "what seemed to lead up to ..." "Was this before or after...?" "when did this happen?"
Placing the event in time of sequence
Therapeutic technique_____________- Verbalizing what is observed or perceived. This encourages the patient to recognize specific behaviors and compare perceptions with the nurse. Ex- "you seem tense" "I notice you are pacing a lot" "you seem uncomfortable when you..."
making observations
Therapeutic technique_____________- Asking the patient to verbalize what is being perceived; it is often used with patients experiencing hallucinations. Ex- "tell me what is happening now" " are you hearing the voices again?" "what do the voices seem to be saying"
Encouraging description of perceptions
Therapeutic technique_______________- Asking the patient to compare similarities & differences in ideas, experiences or interpersonal relationships. This helps the patient recognize life experiences that tend to recur and those aspects of life that are chageable. Ex- "Was this something like...?" "what was your response the last time this situation occurred?" "how does this compare with the time when..."
Encouraging comparison
Therapeutic technique_____________- The main idea of what the patient has said is repeated; this lets the patient know whether or not an expressed statement has been understood and gives him/her the chance to continue or to clarify if necessary. Ex- pt-"I cant study, my mind keeps wandering" Nurse- You have difficulty concentrating pt- I cant take that new job, what if I cant do it? nurse- Youre afraid you will fail in this new position
Therapeutic technique______________- questions & feelings are referred back to the pt so that they may be recognized & accepted & so that the pt may recognize that their point of view has value. Good technique to use when the pt asks the nurse for advice Pt- "what do you think I should do about mary's drinking?" Nurse- "what do you think you should do" Pt- "my sister wont help. I have to do it all" Nurse"you feel angry when she doesn't help"
Therapeutic technique____________- taking notice of a single idea or even a single word; it works esp. well with a pt who is moving rapidly from one thought to another. Not therapeutic when the pt is very anxious. Focusing should not be pursued until the anxiety level has subsided. Ex-"this point seems worth looking at more closely. Perhaps you and I can discuss it together"
Therapeutic technique____________- Delving further into a subject, idea, experience or relationship; it is esp. helpful with pt's who tend to remain on a superficial level of communication. However, if the pt chooses not to discuss further info, the nurse should refrain from pushing or probing in an area that obviously creates discomfort. ex- "please explain that situation in more detail" "Tell me more about that particular situation"
Therapeutic technique______________- Includes striving to explain that which is vague or incomprehensible & searching for mutual understanding; clarifying the meaning of what has been said facilitates & increases understanding for both pt and nurse. Ex- "i;m not sure that I understand. would you please explain" "tell me if my understanding agrees with yours" Do I understand correctly that you said"
Seeking clarification and validation
Therapeutic technique______________- when the pt has a misperception of the environment, the nurse defines reality or indicates his/her perception of the situation for the pt. "I understand that the voices seem real to you, but I do not hear any voices" "there is no one else in the room but you and me"
Presenting reality
Therapeutic technique_________________- Expressing uncertainty as to the reality of the pt's perceptions; it is ofen used with pt's experiencing delusion thinking. Ex- "I find that hard to believe" "That seems rather doubtful to me"
Voicing doubt
Therapeutic technique_____________- Putting into words what the pt has only implied or said indirectly; it can also be used with the pt who is mute or is otherwise experiencing impaired verbal communication. Clarifies what is implicit rather than explicit. pt- "it a waste of time to be here. I can't talk to you or aqnyone" Nurse-"are you feeling that no one understands?" pt- (Mute) Nurse"it must have been very difficult for you when you husband died in the fire"
verbalizing the implied
Axis____________- clinical disorders and other conditions that may be a focus of clinical attention. Includes all mental disorders (except personality disorders and mental retardation)
Axis I
Axis___________ Personality disorders and mental retardation. These disorders usually begin in childhood or adolescence and persist in a stable form into adult life.
Axis II
Tyoe of relationship built on trust. -needs and goals of patient -time element: comes to an end
________treatment plan- everyone on team need to sign off, plan must be generated within 1st 8 hrs of admission. Nurse usually does 1st one. Within 1st 24 hrs the team meets and updates the plan.
Interdisciplinary treatment plan
Person who has input into the care of the patient. attend weekly client care conferences and provides inservice education. -serves as leader of the team -responsible for diagnoses and treatment of mental disorders. -performs psychotherapy, prescribes meds and other somatic therapies.
Type of relationship where it is superficial. -no particular focus, only looks at social needs.
This person is responsible for negotiating with multiple health care providers to obtain a variety of services for the pt. -need a baccalaureate degree in nursing with 3 yers of appropriate clinical experience.
Case worker/manager
This is the 1st person. they have to sign off on care plan they have direct involvement
Therapeutic _______________, -short relationship -assess pt, offer yourself for 10 min to listen to patients feelings, validate them, but don't work on them.
Personal value system-__________________, -don't be phony -don't put on an act -if you say something, follow through
Type of technique that when the nurse denies that a problem exists, he/she blocks discussion with the patient and avoids helping the patient identify and explore areas of difficulty. pt- "I'm nothing" nurse- "of course your something. Everybody is somebody" Better to say- "you're feeling like no one cares about you right now"
Using denial
Type of technique that attempts to protect someone or something from verbal attack. To defend what the pt has criticized is to imply they have no right to express ideas, opinions, or feelings. defending does not change the pt's feelings any may cause the pt to think the nurse is taking sides. "No one here would lie to you" "You have a very capable doctor" BETTER TO SAY- I will try to answer your questions & clarify some issues regarding your treatment.
Technique of ____________________- -sanctioning or denouncing the pt's ideas or behavior; it implies that the nurse has the right to pass judgement on whether the pt's ideas or behaviors are good or bad and that the pt is expected to please the nurse. "That's good, I'm glad that you ..." BETTER TO SAY: "let's talk about how your behavior invoked anger in the other patients at dinner"
GIving approval or disapproval
Non- therapeutic technique____________- what you really mean is ... Unconsciously you are saying...
Non- therapeutic technique_____________- why are you upset? Why do you think that? Why did you do that?
Requesting an explanation
Personal Value system________________- establishing a special connectiveness with someone, through verbal/nonverbal communication
Non- therapeutic technique____________- I know just how you feel. Everyone gets depressed at times
Belittling the clients feelings
Technique___________________- Good morning, Mr. Jones I see you showered this morning
Making observations
Technique__________________- client- I have so much to do. I take care of the house and 3 kids, I work part-time. How can you expect me to fit in 30 min for relaxation exercises? Nurse- It's hard for you to see how you could fit one more activity into your busy day.
Restating (paraphrasing)
Technique__________________- Encourage a person to speak by waiting
Using silence
Technique__________________- Is there something you'd like to talk about? Share with me how your pass went? Where would you like to begin?
Focused opening statement
_____________behavior, general attitude. How they are interacting and how much.
Interactive behavior
__________________, someone depressed
_______________, normal expression
Full range affect
Axis______-Psychosocial & environmental problems that may affect the diagnoses, treatment and prognosis of mental disorders named on other axis's. Include problems r/t primary support group, social environment, education, occupation, housing economics, access to health care services, interaction with legal system or crime and other types of psychosocial and environmental problems
Axis IV
_________, makes things bigger than what they are
Type of relationship that involves an emotional commitment on our part. -more in depth -a particular goal, people try hard to maintain this relationship. -trust goes into this relationship
_________________, conducts individual group and family therapy. -administers, interprets and evaluates psychological tests that assist in the diagnostic process
Clinical psychologist
Phase of therapeutic alliance:_________- -involves preparation for the 1st encounter with the patient -tasks involve: obtaining valuable info about the patient -examining one's feelings, fears, and anxieties about working with a particular patient -initial assessment is done/ begun
Pre-interaction (pre-orientation)
Type of boundary_________- -occurs when 2 peoples boundaries are so blended together that neither can be sure where one stops and the other begins or one's individuals boundaries may be blurred with anothers. -may be unable to differentiate their feelings, wants and needs from the other persons.
Personal value system-________________- -Basis is communication -Look at someone through their point of view
Technique________________- cliches and trite expressions are meaningless in a nurse-pt relationship. when the nurse makes empty conversation, it encourages a like response from the patient. "I'm fine and how are you?" "hang in there, it's for your own good" "Keep your chin up" BETTER TO SAY- The therapy must be difficult for you at times, how do you feel about your progress at this point?"
Making sterotyped comments
Techinique_________________- asking the pt to provide the reasons for thoughts, feelings, behaviors and events. Asking "why" a pt did something or feels a certain way can be very intimidating and implies that the pt must defend their behaviors or feelings. "why do you think that?" "why did you do that?" BETTER TO SAY- "describe what you were feeling just before that happened."
Requesting an explanation
Technique_________- telling the pt what to do or how to behave implies that the nurse known what is best and that the pt is incapable of any self-direction. It nurtures the pt in the dependent role by discouraging independent thinking. "I think you should..." "why don't you..." BETTER TO SAY- "what do you think you should do?"
Giving advice
Non-therapeutic technique__________- pt- they pounded nail in my head nurse- That must have hurt. pt- They're looking in my head with a television
Giving literal responses
Non-therapeutic technique_________- pt- I'm really depressed. Nurse- Oh, did you have visitors this afternoon?"
Changing the subject
Non-therapeutic technique___________- Nice weather today it's for your own good keep your chin up
Making stereotyped comments
Personal value system______________- -where are you coming from -Deal with it, come to grips with who you are.
Self awareness
Non-therapeutic technique____________- I think you should... why don't you.... What you should do is....
Giving advice
Technique_____________________- Have I got this straight? You've said that... During the past hour you and I have discussed...
Technique________________- I'm not sure that I follow What would you say is the main point of what you said?
Technique___________________- pt- I'm confused about this Nurse- You're confused? pt- my brother has the nerve to ask for money. Nurse- asking for money makes you angry?
Reflecting content and feelings
Technique_____________________- with this technique the therapist seeks to make conscious that which is unconscious, to tell the pt the meaning of his experience. "What you really mean is..." "unconsciously you're saying..." Better technique- the nurse must leave interpretation of the pt's behavior to the psychriatrist. the nurse has not been prepared to perform this technique and in attempting to do so may endanger other nursing roles with the patient.
______________- normal mood to fit the situation
_________, -pulled in -they don't give you the full expression
Constrictive range
Poverty of speech means_____________
_________________, actual stimulation but misinterpretation.
Personal value system_____________, #1 characteristic. Pt must feel that you care , that your compassionate and will look after the patients best interest.
___________, Process by which nurses provide care for patients in need of psychosocial intervention
________________, assist the patient and family members with psychosocial issues, including those associated with the diagnosis of mental illness. -provides information on community resources
Social worker
Therapeutic __________________- -will develop with long term care - a long term relationship
Type of boundary -new ideas or experiences can't get in. -a person who has a narrow perspective on life, see's things one way and can't discuss matters that lie outside their field of vision -may be difficult to bond with
Phase of therapeutic alliance________- -the nurse & pt become acquainted. -tasks include: creating environment for trust and rapport, establishing a contract for intervention, identifying patients strengths and limitations, nursing diagnosis, setting goals, develop plan of action, exploring feeling
Orientation (Introductory phase)
Phase of therapeutic alliance_______- -therapeutic work of the relationship tasks include: maintaining trust and rapport, promoting the pt's insight and perception of reality, problem solving using the model, overcoming resistance, behaviors on the part of the pt as the level of anxiety rises in response to discussion of painful issues, continously evaluating progress toward goal attainment
Working phase
Technique__________- attributing the source of thoughts, feelings and behavior to others or to outside influences. This encourages the pt to project blame for their thoughts or behaviors on others rather than accepting the responsibility personally. "What nakes you say that?" "What made you do that?" "what made you so angry last night?" Better TO say: "You became angry when your brother insulted your wife"
Indicating the existence of an external source of power
Technique_____________- Indicating accord with or opposition to the pt's ideas or opinions; it implies that the nurse has the right to pass judgement on whether the pt's ideas or opinions are right or wrong. Agreement prevents the pt from later modifying their point of view without admitting error. Disagreement implies inaccuracy provoking the need for defensiveness on the part of the patient. "Thats right, I agree" "I don't believe that" Better to say- "Lets discuss what you feel is unfair about the new rules"
Agreeing/ disagreeing
Technique________________- Indicates to the pt that there is no cause for anxiety, thereby devaluing the pt's feelings; it may discourage the pt from further expression of feelings if they believe they will only be downplayed or ridiculed. Better- "we will work on that together" Don't say- "I wouldn't worry about that if I were you" "Everything will be all right"
Giving reassurance
Non-therapeutic technique___________- But how can you be president? If you're dead, why is your heart beating?
Person value system-________________- -acceptance of individual -everybody has worth -unconditional acceptance
Non-therapeutic technique___________- Your doctor is quite capable This hospital is well equipped She's a good nurse
Non-therapeutic technique____________- I wouldn't worry about... Everything will be all right You're coming along fine
Using reassuring cliches
Technique________________- I see no one else in this room That sound was a car backfiring I don't hear any voices other than your and mine
Presenting reality
Technique__________________- I'll stay with you a little while I would like to sit with you for a while
Offering self
Technique_________________- and then? Tell me about it
_______________- interpret sensory and data that really isn't there. -no stimulation -Brain plays tricks on them
_______________, a changing mood. Depressed one minute and then happy the next. mood changes with the situation
Labile mood
_____________-, a lot of flatness with some appropriate affect (expression)
Axis__________- -global assessment of functioning. allows the clinician to rate the patients overrall functioning on the global assessment of functioning scale (GAF). This scale represents in global terms a single measure of the pt's psychological, social and occupational functioning.
Axis V
____________, Can't organize their thinking, words or thoughts, everything is scrambled.
Word salad
____________, acts as case manager for care. Assesses the patient and family need, establishes the goal of care. Supervises and assists caregivers, evaluates care, serves at pt advocate and provides educational information as needed to pt, family and caregivers. provides physical care when needed
Type of boundary___________- -healthy boundary -individuals are able to let go of their boundaries and limits when appropriate. -one must be aware of who is considered safe and when it is safe to let others invade our personal space
Phase of therapeutic alliance__________- -end of relationship, can be difficult. Tasks include: bringing a therapeutic conclusion to the relationship. This occurs when: -progree has been made toward attainment of mutally set goals -a plan for continueing care of for assistance during stressful life experiences is mutually established by the nurse and patient
Termination phase
Technique- Persistent questioning of the patient or pushing for answers to issues the pt does not wish to discuss. This causes the pt to feel used and valued only for what is shared with the nurse and places the patient on the defensive. "tell me how your mother abused you" "tell me how you feel toward your mother now that she is dead" Better : The nurse should be aware of the pt's response and d/c the interaction at the first sign of discomfort
Technique_____________- When the nurse misjudges the degree of the pt's discomfort, a lack of empathy and understanding may be conveyed. The nurse may tell the pt to perk up or snap out of it. This causes the pt to feel insignificant or unimportant. When one is experiencing discomfort,it is no relief to hear that others are or have been in similar situations. pt- I have nothing to live for, I wish I was dead Nurse-Everybody gets down in the dumps, I feel that way at times myself. Better- "You must be very upset. Tell me whar you are feeling right now"
Belittling feelings expressed
Technique___________________- -refusing to consider or showing contempt for the pts ideas or behavior. this may cause the pt to discontinue interaction with the nurse for fear of further rejection. "let's not discuss..." "I dont want to hear about..." Better to say- "Let's look at that a little closer"
Non-therapeutic technique_________- Let's not talk about that. I don't want to hear about...
Personal value system_______________, -implies risk taking -need to convey a level of confidentiality.
Non-therapeutic technique___________- You're wrong That's not true No it isn't
Disagreeing with the patient
Technique___________________- Yes Uh HUm I follow what you said Nodding
encouraging Continuation
Technique:_____________________ My name is ... Visiting hours are.... My purpose in being here is... I'm taking you to the...
Giving information
Technique_____________________- You sound very upset with this situation you appear tense
observing feelings
Technique_________________- Changing the subject causes the nurse to take over the direction of the discussion. This may occur to get something that the nurse wants to discuss with the pt or to get away from a topic that they would prefer not to discuss. pt- I dont have anything to live for nurse- did you have visitors this weekend. Better technique- the nurse must remain open and free to hear the pt, to take in all that is being conveyed both verbally and nonverbally.
Introducing an unrelated topic
____________- a substantial emotion over a period of time. (depressed, anxious, tired) -how they feel doesnt change
____________- observing facial expressions
Axis_______________- General medical conditions. Include any current general medical condition that is potentially relevant to the understanding or management of the individuals mental disorder.
Axis III
Thinking about body parts
First insane asylum called__________
St. Marys of Bethelem
Dorothy ________ was the first to start a mental hospital that looked at treating people differently.
First mental hospital that looked at more humane ways of treatment was located in ___________________.
A reformer in medical education who became known as the father of american psychiatry.
Benjamin Push
Dementia praecox= dementia in the young in the early 1900's. Blueler termed this by another name called_____________
First antipsychotic drug that was used by accident in 1952
Drug used for depression
Predominant illness in hospital is ________.
Community mental health act of 1963. What did the act do? -passed by J.F. Kennedy
Act provided federal money to local governments to establish infra-structures for people who were homeless.
Case management started in the ____ ACT- team that intensly case manages high risk people
_______________- established in 1979. -a public service
Act that passed in 1990 where Industry cannot discriminate against people with a mental illness in the work place
American Disability act