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123 Cards in this Set
- Front
- Back
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Factors that can influence mental health
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genes, care-giver relationship, past experiences, unique vulnerabilities, personal perception, life circumstances, environment, culture
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What are the cultural explanations for mental illness
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1. supernatural causes
2. physical-physiologic 3.sociopsychologic 4.natural phenomena and cosmic forces 5.karma |
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Characteristics of mental illness
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1. misperceptions (delusions)
2. Inappropriate connections (anxious atttachments) 3. Emotions (skewed) |
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What is the definition of mental illness
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Mental illness is the maladaptive repsonse to stressors (both internal and external)
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What is the definition of mental illness?
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1. maladaptive behaviors are inconsistent with norms of the age, family, culture, and society.
2. interferes with the individuals functioning |
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True or False:
Mental health care is on a constant continuum. |
True:
Mental health care is about the right time and right place. |
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What are the five axis of the DSM?
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1. clinical syndrome
2. Personality/development disorders 3. Physical disorders 4. Psychosocial stressors 5. Hightest level of adaptive functioning |
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What does axis I of the the DSM describe
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Clinical syndrome aka primary diagnosis
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What does axis II of the DSM describe
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Personality/developmental disorders (personality disorder and MRDD)
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What does axis III of the DSM describe
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Physical Disorders--medical issues along with the mental illness
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What does axis IV of the DSM describe
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Psychosocial stressors --any stressors and the severity of it.
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What does axis V of the DSM describe
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Highest level of adaptive function--total picture of the individual at their best functioning level
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What is the criteria for mental illness in the state of Ohio?
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A substantial disorder in thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize others
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what are the criterias for psychiatric hospitalization?
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1. presensce of pyschiatric disease
2. gravely disabled 3. presence of psychological distress 4. legal/criminal involvement 5. substantial risk of harm to self or others |
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What criterias are there for voluntary commitment?
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1. Sought by the patient (18yrs of age)
2. Must give consent to treatment 3. able to demand and obtain release (only if showing improvement) |
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What are the criterias for involuntary commitment?
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1. not sought for by the patient
2. not able to keep one self safe 3. Must be a "burden of proof" 4. legal mandate for a psych eval 5. warrant of detention |
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Who are the ones to have extended involuntary commitment?
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the criminally insane, those who are unable to regain competency.
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Define unconditional discharge
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Release from the hospital that is given once the patient shows their condition has improved and does not need continued outpatient treatment
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Define conditional discharge
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Release from the hospital requires ongoing outpatient treatment. Noncompliance can result in involuntary readmission.
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Define Battery
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Harmful or offensive touching
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Define Assault
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Verbal abuse
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Define Tort
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civil wrong
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Define false imprisonment
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detaining patient against his/her will
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Define defamation
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to give false malicious injurious information about someone
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define Consent
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Permission
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Define slander
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Oral defamation
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Define libel
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Written defamation
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What legal implication is there:
The nurse assists the physician with electro therapy on his client who has refused to give consent |
Battery
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What legal implication is there:
When the local newspaper calls to inquire why the mayor has been admitted to the hospital, the nurse replies, "He's here b/c he is an alcoholic" |
Defamation of character
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What are the legal implications:
A competent, voluntary client has stated he wants to leave the hospital. The nurse hides his clothes in an effort to keep him from leaving |
False imprisonment
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What are the legal implications:
Joe is very restless and is pacing a lot. The nurse says to Joe, "If you don't sit down in the chair and be still, I'm going to put you in restraints!" |
Assault
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What are the 3 criterias of a good psycho therapeutic management of a patient
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1. Nurse patient relationship
2. psycho pharmacology 3. milieu management |
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What is the goal of the nurse patient relationship?
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To promote health and influence change
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What is the goal of psycho pharmacology?
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To promote health at the bio-cellular level
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List the characteristics of a therapeutic relationship.
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1. Fostered by the nurse
2. Promote wellness 3. Patient problem focused 4. Clear and separate identities 5. They are interdependant 6. Each has various roles 7. Always on going evaluation |
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What interpersonal qualities must a nurse have to foster a therapeutic relationship?
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1. empathy
2. be non-judgemental 3. be genuine 4. be sensitive especially to change 5. be involved 6. be caring and hopeful 7. empowering 8. be patient and persistent 9. be an advocate |
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What are beliefs?
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Ideas and thoughts that are believed to be as true
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What are attitudes?
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Frame of reference for our emotions toward a belief
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What is the importance of self-awareness?
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1. Reduce bias, prejudice, and differences
2. accepts one's strenghts and limitations 3. allow therapeutic use of self |
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What are the 3 phases of the nurse-patient relationship?
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1. orientation phase
2. Working phase 3. Termination phase |
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What is the goal of orientation phase?
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To develop trust and to establish parameters
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What is the goal of working phase?
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To work on a resolution of the patient's problem
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What is the goal of termination phase
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to review learning and to transfer this learning into every day life
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What is transference?
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the patient transfers onto the nurse, the same feelings he has about significant others
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What is counter transference?
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tenancy for the nurse to displace feelings belonging to people in her/his life onto others
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What are the properties of therapeutic communication?
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1. It's a vehicle for change
2. It is an active force 3. It drives the relationship 4. It is reciprocal 5. It is dynamic 6. It is therapeutic |
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What are the 4 types of listening?
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1. defensive
2. selective 3. deliberate 4. emphatic |
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what type of listening should the nurse achieve for and why?
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Deliberate and emphatic.
Deliberate - b/c it shows active listening. Emphatic- b/c listening w/o judgment and with openness |
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What is the importance of congruence?
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It makes certain that the message received and sent along with the words and nonverbal behavior are the same.
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What are the Factors that influences communication?
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1. Cultural view
2. Unique organization of the individual 3. Sender/receiver relationship 4. Purpose of the interaction 5. Content and context of the message 6. Time and Location |
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What should be the goals of communication?
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1. Establish Rapport
2. Gather Data 3. Give Information 4. Facilitate expression of thoughts and feelings 5. Problem solve and explore solutions 5. conclude a conversation |
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A client states " I refuse to shower in this room. I must be very cautious. The FBI has placed a camera in here to monitor my every move." Which of the following is a therapeutic response? what is the response called?
a) That's not ture. b) I have a hard time believing that is true |
B: I have a hard time believing that is true.
Voicing Doubt - expresses uncertainty as to the reality of the patient's perception. |
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Nancy, a depressed client who has been unkempt and untidy for weeks, today comes to group therapy wearing a clean dress, makeup, and having washed and combed her hair. Which of the following responses by the nurse is most appropriate? what is the therapeutic communication used?
a) "Nancy, I see you have put on a clean dress and combed your hair." b. "Nancy, you look wonderful today!" |
A.Giving recognition. Acknowledges and indicates awareness. Establishes connection. Fosters interest and concern.
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Why is silence so important?
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Silence allows the nurse and the client to the opportunity to collect and organize thoughts, to think through a point.
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What is the therapeutic technique in the following statement?
P: I hear voices all the time, especially in the day time. N: "Yes, I see. Go, on" |
General Lead - offers the client encouragement to continue
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What is the therapeutic technique in the following statement?
N: You seem tense. I notice you pacing a lot. |
Making an observation - Verbalizing what is observed or perceived. This encourages patients to recognize specific behaviors
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What is the therapeutic technique in the following statement?
P: I can't study. My mind keeps wandering. N: You have difficulty concentrating. |
Restating - repeating the main idea or words that the patient has spoken. Implies the nurse is listening nd offers patient an opportunity to further continue or clarify or explain.
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Characteristics of Schizophrenia
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1. Gross distortion of reality
2. Withdrawal from social interaction 3. Disorganization of thoughts, perception, and emotions |
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What is an undifferentiated schizophrenic?
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A person who present a variety of both positve and negative symptoms of shizophrenia
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What is a paranoid schizophrenic?
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A Schizophrenic that displays extreme suspiciousness and lack of trust
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What is a catatonic schizophrenic?
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A Schizophrenic with severe motor disturbances
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What biological factors make a person predisposed for schizophrenia?
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1. genetics --those with family hx of the disease increases likelihood
2. excessive dopamine - found in the limbic system 3. Physical conditions - abnormal fetal development, MRDD, Head injuries..etc 4. Abnormal Neuro structures - enlarged ventricles, atrophy of frontal lobe. |
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What are example of positive signs of schizophrenia?
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1. hallucinations
2. delusions 3. abnormal thought formations 4. bizarre behaviors |
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What are examples of negative signs of schizophrenia
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1. flat affect
2. anhedonia - inability to experience pleasure 3. alogia - loss of speech 4. avolition- loss of desire 5. anergia -deficiency of energy |
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Why makes symptoms of schizophrenia negative or positive?
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Positive - adds to the norm of a person.
Negative- takes away from the norm of a person |
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What can cause positive signs of schizophrenia?
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excessive amount of dopamine
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What can cause negative signs of schizophrenia?
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1. atrophy of the frontal lobe
2. enlarged ventricles 3. excessive blood and fluid to the ventricles |
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what are the prodromal signs of schizophrenia?
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1. marginal function in life
2. tendency to be isolated, withdrawn, and loss of interest in life. 3. poor hygiene/grooming 4. odd expressions of beliefs and experiences 5. unprovoked anger 6. Usually precipitated by a major stressor |
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Patient states:
"We wanted to take the bus, but the airport took all the traffic. Driving is the ticket when you wan to get somewhere. No one needs a ticket to heaven. WE have it all in our pockets." What kind of thought process is this? |
Loose association - speech in which ideas shift from one unrelated topic to another.
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A condition in which the individual retreats to their inner world of fantasy while distorting or excluding the external environment.
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Autism
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Identify type of thinking is being stated.
N: "You seem blue today." P: "But my skin isn't blue." |
Concrete thinking - thinking in the literal sense.
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Identify type of thinking is being stated.
P: "She's putting ideas in my head, she made me do it." |
Thought insertion - belief that others are controlling/inserting their thoughts into them
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Identify type of thinking is being stated.
N: "Are you finished?" P: "Finished, finished, finished, finished, finished, finished..." |
Perseveration - repeating a word/thought over and over
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Identify type of thinking is being stated.
N: "Tell me what brings you here?" P: "Well it was a sunny day, I was walking, the sidewalk was nice, the trees were swaying, my nails were short." N: "Well that was good, but please tell me what specifically brought you here today." |
Circumstantiality - excessive attention to the irrelevant details with seeming lack of focus
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Identify type of thinking is being stated.
N: "What did you eat today?" P: "A salad. Salads are great. Great like Alexander. Alexander the great was king of mesopatamia." |
Tangentiality - conversation seems to go no where but in random tangents.
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Define Delusions
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Fixed false beliefs that are not validated in reality
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What is the purpose behind Delusions?
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They are exaggerated defense mechanism; a maladaptive process which to alter what is unacceptable.
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What type of delusion is this person experiencing?
"I know they are talking about me. I can see it in their eyes. I hear the whispering behind my back It's because of the floods in Iran, it's my fault." |
Delusion of reference - All references are pointed to themselves.
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What type of delusion is this person experiencing?
"I am Napoleon Bonaparte, I am the grand sultan of the world!" |
Delusions of grandeur - exaggerated sense of self importance
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What type of delusion is this person experiencing?
P: "I'm 70 yrs old and I will be the oldest person ever to give birth. The doc says I'm not pregnant, but I know I am." |
Somatic Delusion - belief that the body is changing in an unsual way
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What type of delusion is this person experiencing?
P:"God is calling upon me and he says we should all worship the pudding." |
Religiosity - Having god like qualities
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What type of delusion is this person experiencing?
P: "The FBI has 'bugged' my room and they are gonna kill me, I just know it." |
Delusions of Persecution - individual feels threatened and believes that others intend harm or persecution toward him or her in some way
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What are hallucinations?
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They are a false sensory impression; a dysfunction in normal sensory acitivty
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List the types of hallucinations
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1. auditory
2. visual 3. gustatory 4. tactile 5. olfactory |
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What type of speech is following:
"Bang. bang, bang, bang, bang." |
echolalia
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What type of speech is following:
"Supercalafragilisticexpaladocious, that's how I feel today!" |
Neologism - coinage of a new word
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What type of speech is following:
"The sky was blue. It was true. So I could sue. You are too." |
Clang association - association by sound
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What type of speech is following:
N: "How are you today?" P: "Super teddy building lamp dirt." |
Word salad - illogical linking of ordinary words
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What is emotional ambivalence?
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coexistence of opposite emotions toward the same object, person, or situation.
i.e. having a love hate relationship with their mom, makes it hard to make a phone call to mom. |
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What motor behavioral/motor disturbances can be associated with schizophrenia?
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withdrawal, stupor, rocking/pacing, waxy flexibility, echopraxia, hyperactivity, stereotypical behavior, automatic obedience, negativism, deterioration in appearance
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Define echopraxia
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Repeating the movements of another
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What is negativism as it pertains to schizophrenia?
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It's when the individual acts opposite of what is being asked for. Patient has no thought about it.
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What is waxy flexibility?
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when a person places body parts in bizarre or uncomfortable positions.
i.e. extending arm for BP and keeping it up in the air even when the BP cuff is taken off. |
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What are the 3 nursing systems of Nursing care according to Orem?
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Wholly compensatory
Partly Compensatory Educative/supportive |
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What area of the brain do typical psychotropic drugs work on?
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The whole brain --- Dopamine (D1) receptors in the limbic, cerebral cortex, basal ganglia, hypothalamus, brain stem and medulla
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What is primary effect of the typical psychotropic drugs?
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Works on positive symptoms of schizophrenia. i.e. hallucinations and delusions
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Where are the typical psychotropic drugs metabolized?
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liver and kidneys; important to assess the function of these organs
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what is the peak and duration of typical psychotropic drugs?
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2-3 hours and 2-4 weeks for full therapeutic effect
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What are the therapeutic effects of the the typical psychotropic drug?
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1. slows down the CNS -decreases violence, agitated emotions
2. decreases psychotic features - less hallucinations and delusions 3. improves thought process 4 improves sleep and nutrition |
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True or False: Drugs lower in potency have higher extrapyramidal side effects and are less sedating
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False: Drugs lower in potency have less side effects and are more sedating in nature
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True or False: you can give a typical psychotropic via IV
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FALSE: Never give these drugs via IV
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what is the reason behind the Extrapyramidal side effects?
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The acetylcholine and dopamine balance is off due to a decrease in dopamine level
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List the EPS from least concern to most.
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Dystonic reactions
Akathisisa Pseudo-parkinsonims Tardive Dyskinesia |
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What are dystonic reactions? and give examples.
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sustained muscle contractions cause twisting and repetitive movements or abnormal postures.
I.e. Torticollis - painful spasm of neck and jaw. Abnormal eye movements --roll back facial grimacing |
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Define akathisia
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an effect of motor restlessness; inability to sit still causing pacing
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What are the signs of pseudo-Parkinson?
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1. motor retardation
2. pill-rolling movements w/hand 3. rigidity 4. salvation 5. shuffling gate |
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Define Tardive Dyskinesia and why it is important to watch out for.
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TD is involuntary uncontrollable movements of the face, tongue, trunk, extremities. This associated with long term use of typical psychotropic drug use and is IRREVERSIBLE.
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How and what do you use to treat EPS?
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Anticholonergic drugs.
1. cogentin (benzotropine) 2. benadryl (diphenhydramine) 3. artane (trihexyphenidyl) |
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What are the side effects associated with anticholonergics on the muscarnic level?
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drowsiness, sedation, dry mouth, blurred vision, urinary retention, constipation, photo sensitivity
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What nursing education/management is needed for the patient on anticholonergic drugs for the side effects on their muscarnic system?
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1. avoid alcholol
2. increase fluids 3. exercise 4. increase fiber 5. avoid sun exposure and use visual aides |
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What are the side effects associated with anticholonergics on the vascular level?
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1. tachycardia
2. potential hypotension 3. impotence |
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What nursing education/management is needed for the patient on the SE on the vascular system caused by anticholonergics?
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1. monitor vs
3. increase fluid intake 3. rise slowly 4. promote open communication |
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What are the side effects associated with anticholonergics on the endocrine system?
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1. weight gain (50-60lbs)
2. sedation 3. gynecomastia 4. hypothyroidism |
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What nursing education/management is needed for the patient on the SE of anticholonergics on the Endocirine system?
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1. monitor caloric intake
2. stress healthy diet and exercise 3. routine thyroid panel 4. check prolactin levels 5. short naps 6. adjust dosage PRN. |
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How do atypical psychotropic drugs work?
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They work on SPECIFIC receptor sites in select areas of the brain
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How do atypical psychotropic drugs differ from typical ones?
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1. they work on both positive and negative symptoms
2. they have less EPS 3. they are used as first line of treatment |
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What are the SE of the atypical drugs?
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1. hypersenstivity
2. potential for seizures 3. Tardive dyskinesia 4. Neuorleptic Malignant Syndrom (NMS) 5. Agranulocytosis |
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What is Agranulocytosis and what test would you use to check for it?
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Agranulocytosis - a blood dyscrasia, that involves leukocyte production, affects healing and increase risk for infection.
TEST: CBC w/differential |
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What is Neuroleptic Malignant syndrome?
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Condition caused by over depletion of dopamine causing a lowered amount of muscle synthesis.
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What are the signs of NMS?
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Hyprexia - high fever
muscle rigidity cardiac dysrhythmias =>death! |
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How do you approach a patient with delusions?
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1. recognize that it is a defense mechanism
2. accept the patient need for the delusion. 3. respond to the underlying anxiety 4. refrain from arguing/discussing/reasoning about the delusion. 5. do not convey acceptance of the delusion 6. set limits on delusional content 7.. present reality/give facts/reasonable doubt 8. redirect to concrete reality/activity |
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How do you approach a patient with delusions?
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1. observe for behavior/validate observations -- ask what the delusions are.
2. inquire for command hallucination 3. suggest humming/whistle/opening mouth 4. Offer ear plugs/headphones 5. encourage verbal elimination --say go away! |
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What are the factors that can influence the outcome of schizophrenia?
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1. age - older do better
2. satisfactory adjustments- well adjust individual do better 3. emotional warmth- those that express openness and support do better 4. family support - more support less relapse 5. compliance 6. relapse - more time in wellness is the norm, keep that in mind! |
