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57 Cards in this Set
- Front
- Back
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The therapeutic use of self
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A specialized skill set used by nurses, especially in psychiatric-mental health nursing practice
Therapeutic use of self is complex and involves a process of self-awareness through one’s own growth and development as well as one’s interactions with others |
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Purpose of a nurse in a mental health setting
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Helps create a relationship and space for the patient to be able to:
-discuss needs and wants w/o judgement or criticism -Gain insight, like problems, expectations, abilities, & resources -Process life changes -Heal mental and emotional wounds -Promote growth |
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Establish the nurse-client relationship:
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Client must know that the relationship is:
Safe Confidential Reliable Consistent But at the same time with clear boundaries |
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Goals and Functions of the nurse-client relationship:
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-Facilitate communication of distressing thoughts and feelings
-Assist patient with problem solving -Help patient examine self-defeating behaviors and test alternatives -Promote self care and independence |
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Nurse-client relationship phases
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Orientation
Working Termination |
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Factors that help the nurse-patient relationship:
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Listening
Staying calm and being attentive Being present Genuine Empathy Positive regard Suspending value judgments Helping patients develop resources |
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Least restrictive alternative
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Use least restrictive environment
Use least restrictive treatment And most clinically appropriate treatment |
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Nursing responsibilities in psychiatric care:
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assessing, for safety and physical needs
document behavior offer food and fluid toileting monitor vital signs patient need observation a lot if in restraints |
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Right to be restraint free
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Always use alternatives first
always keep people safe document what you did use as last resort assess and monitor notify family members |
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Documentation in the medical record
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Legal document
Communication with other professionals Validation for reimbursement Support for ongoing care/chosen care level |
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Motivational Interviewing
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A collaborative conversation style for strengthening a person's own motivation and commitment to change.
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Core MI Communication Skill
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Open questions
Affirmations Reflective Listening Summarizing |
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Risk factors for mood disorders
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Genetics (family history)
Biological models (ie abnormalities in brain structures, dysregulation of neurotransmitters, endocrine system, kindling, sleep-wake cycle disturbance) |
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Norepinephrine
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Mood, cognition, perception, locomotion, cardiovascular functioning, sleep and arousal
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Dopamine
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Movement and coordination, emotions, voluntary judgment, release of prolactin
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Serotonin
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Sleep and arousal, libido, appetite, mood, aggression, pain perception, coordination, judgment
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Depression + Adrenal Corticotropic Releasing Hormone
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Feedback loop interrupted so as a result a higher level of cortisol in the blood chronically
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Cognitive theory
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Depression related to negative processing of thoughts
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Learned helplessness/hopelessness
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Depression related to perceived lack of control over events
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Psychodynamic theory
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Depression related to loss
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Life events and stress
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as a risk factor for depression
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Criteria for a Major Depressive Disorder to be diagnosed clinically
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-5 or more from criteria list (plus one or both of essential from list)
-Must inhibit daily functioning -Must have them for a certain length of time |
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Dysthymic Disorder
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Depressed mood for most of the day, for more days then not
Must be feeling this way for at least 2 years Two or more of ACHEWS symptoms |
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SAD (Depression with a seasonal pattern)
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Regular episodes of MDD that coincide with a certain time of the year
Must last for at least two years Must present with change in sleep, change in appetite and weight, change in energy, craving for carb |
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MDD with peripartum onset (during pregnancy)
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Can be postpardum blues, full on post pardum depression, postpardum psychosis
Common to happen for a couple weeks, if severe needs to be treated using antidepressants |
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Premenstrual Dysphoric Disorder
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If occurs in majority of menstural cycles for the duration of a year
At least 5 symptoms must be present for diagnosis Occurs in the week before menses Becomes minimal or absent in week after menses Clinically significant distress or interference with work/school/usual social activities/relationships with others |
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Disruptive Mood Dysregualtion Disorder
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Severe recurrent temper outbursts (behaviorally and/or verbally) (worse than normal proportion in intensity or duration to a situation and worse than what is normal for a normal developmental situation)
Angry or irritable most of the day, nearly every day, noticeable even by others Symptoms last for more than 12 years Symptoms present in at least two of three settings Children change and mature over time, so this dx is made for children who are still growing. This dx is to prevent over diagnosis of children by diagnosing them with bipolar disorder or depression |
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Manic Episode
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Abnormal and persistent elevated mood that lasts for at least 1 week with at least three of DIGFAST symptoms
Person feels invincible and engages in risky and high pleasurable activity. Don't sleep or get enough nutrition sometimes because there is too much to do. The higher you climb the harder you fall into severe depression. |
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Hypomanic Episode
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Persistently elevated mood lasting in at least 4 days, which is clearly elevated and different from non-depressed mood
Three or more of DIGFAST symptoms Not severe enough to change functional ability but is still a noticeable change to others |
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Bipolar I
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Current or past experience of a manic episode
Manic episode is extreme and severe depression lasts longer. Mania climbs really high. |
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Bipolar II
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Recurrent major depressive episodes with at least one hypomanic episode
Severe depression phase does not last as long as Bipolar I, mania does not climb as high as Bipolar I |
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Cyclothymic Disorder
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Mild form of bipolar disorder
Presence of numerous periods of hypomanic symptoms but not quite meeting criteria for hypomania paired with numerous periods with depressive symptoms that do not meet criteria for MDD episode |
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Assessment-mood/affective
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Key element is seeing a CHANGE in a person, important to know their baseline, and when it is someone you do not know you take a very thorough history
Must assess mood/affective traits of their depressive moods and their manic moods. |
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Assessment-Physiological
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Must also assess the physiological traits of the depressive moods and the manic moods. Sometimes it is easier for patients to talk about the physiological pain and symptoms because there is not as much stigma and it is easier to talk about, do not disregard these things
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Assessment-cognitive
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Must assess their thoughts, safety is a HUGE issue that the nurse is concerned about because of the risk of suicidal thoughts and concern for them harming themselves.
Assess environment to make sure they are safe Patient needs to have space to breathe Assess Maslow's hierarchy of needs and always be thinking of what they could be needing |
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List off where the brain anatomy parts are
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Frontal
Parietal Temporal Occipital Cerebellum Brain stem |
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Frontal Lobe
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Executive functioning and personality
-Voluntary motor function -Production of speech -Thinking -Judgement -Emotional experience -Expression |
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Parietal Lobe
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Body Sensations
-Sensory perception (from all the senses) -Spatial orientation -Comprehension of language |
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Temporal Lobe
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Emotion and Memory Circuits
-Auditory information -Memory Circuits -Emotional tone to memories |
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Occipital Lobe
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Vision
-Visual input -Linking visual information with memory |
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Basal Ganglia
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Middle of the brain surrounding things
-Movement initiation, complex motor functions -Learned automatic actions -Involuntary motor activities (muscle tone, posture, coordination of movement) |
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Limbic System
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The two skis
The Emotional Brain |
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Limbic System: Thalamus
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Gate keeper for sensory information (but not smelling)
Filtering incoming information related to emotions Key relay station |
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Limbic System: Hypothalamus
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Major control center: autonomic, endocrine, emotional, and somatic functions
-Secretion of hormone by pituitary -Emotions -Homeostasis (appetite, hunger, thirst, sleep/wake, body temperature, libido) |
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Limbic System: Hippocampus
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Memory Structure
Learning and recall/memory Assigns the time and place to an event |
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Limbic System: Amygdgala
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Cups on the skis
Emotional responses Memory consolidation |
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Serotonin (5HT)
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In charge of:
sleep, eating pain perception mood states temperature regulation regulation of aggression libido |
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Norepinephrine (NE)
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In charge of:
alertness, vigilance Focused attention Learning, memory Orientation Mood, anxiety |
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What neurotransmitters are involved in regulating mood?
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Norepinephrine, dopamine, serotonin
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Response to antidepressants:
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First: sleep disturbances, concentration difficulties, and appetite
In first couple weeks--> increased energy (SAFETY CONCERN, what if before they had suicidal thoughts but no energy to act on them? and now...?) Depressed mood and anhedonia take 4-6 weeks to return to pre-depressed level |
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SSRIs: recognize these
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citalopram (celexa)
escitalopram (Lexapro) sertraline (Zoloft) fluoxetine (Prozac) paroxetine (Paxil) fluvoxamine (Luvox) |
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SSRI early adverse effects
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Decreased Appetite
N/D Weight loss (but return to baseline later) Agitation Anxiety Headache |
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SSRI other adverse effects
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Sweating
Sexual dysfunction Weight gain Mania |
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Venlafazine (Effexor), Duloxetine (Cymbalta)
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Dual Acting Antidepressant
SNRI Inhibit dual reuptake |
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Bupropion (Wellbutrin)
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Dual Acting Antidepressant
NDRI (NE/DA) reuptake inhibitor, inhibit dual reuptake |
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Nefazodone (Serzone), Trazodone (Desyrel)
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Serotonin 2 antagonist/Reuptake inhibitor
SARI Blocks 5HT 2A receptors and 5HT/NE reuptake pump |
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Serotonin Syndrome
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Life-threatening crisis that may include:
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