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234 Cards in this Set
- Front
- Back
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Physical Level
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structure and function of the brain
- neurotransmission - neurotransmitter |
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Bioamine/ Biologic Model
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neurotransmission and neurotransmitters
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Dopamine
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Rational
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Seratonin
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mood appropriateness
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NE
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energy/mood
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GABA
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inhibitory
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Personal Level
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caring for self, feelings about selk
- listen= therapeutic communication |
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INterpsonal Level
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interactions with other
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Society level
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social condition and cultural conext
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Resiliency
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emerge unscathes from negative life events
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2 key concepts for mental health
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resiliency
spirituality |
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Roles of MEntal Heath Nurse
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socializing agent
teachers role model advocate couselor role player Milieu Manager |
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Tera Soff Law
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1976
Duty to warn |
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Hildegard Peplau
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nurse theorist for mental health nurse and developed this concept "the therapeutic use of self"
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Peplau's Key Points of the Nursing- CLient Relationship
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NOT social
client-focused goal-specific theory based |
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Phases of Therapeutic Relationship
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- Intro
-working -termination |
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Introduction Phase
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coping skills and problem solving= contract
concept of confidentiality discuss termination |
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Working Phase
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working together towards mutually established goals= therapeutic alliance
- CLient education and problem soliving teach - trandferrence and countertransferrance |
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Transferance
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unconscious displacement of feeling owned by theclient on the nurse
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Countertransferrance
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unconscious feelings owned by the nurse on the client
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Termination Phase
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review how the client progressed
traumatic review of the future _introduced during introductory |
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#1 Nursing outcomes
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SAFE!
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Signs of metal illness
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personality change over time
confusion in thinking depression, apathy or experiencing "highs and lows" Excessive anxiety, fear, suspiciousness, blaming others |
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Axis 1
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Manifestations
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Axis 2
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personality disorders and mental impairment/ retardation/ developmental delay
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axis 3
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General Medical Conditions
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Axis 4
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Psychosocial and Environmental problems
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Axis 5
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Global Assessment of Functioning
0-100 |
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Assessment of Client
- ABCs |
A- affective assessment
B- Behavioral Assessment C- Cognitive Assessment |
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Socio-culture
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relationships with other, conflict management, level of assertiveness or passiveness
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Illusions
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the misinterpretation of an environmental stimulus of sight, sound, touch, smell, or taste
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Hallucinations
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occurence of sight sound touch smell or taste without andy external stimulus
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Depersonalization
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client feels sense of identity has been altered- therefore feels "strange to self/ or unreal"
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Derealization
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clients feels the the environemtn has changed around hum or her and is unreal in natures
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Forms of Though problems
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thought blocking
circumstantiality confabulation flight of ideas loose associations Neologisms tangential speech |
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Thought blocking
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sudden stop in speech or train of thought
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circumstantiality
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overly detailes and tedious in communication of thought
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confabulation
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filling in memory gaps with imagined material ( unconscious) - AZ
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Flight of ideas
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rapid and fragment thoughts expressed in a pressured speech format
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Loose associations
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totally disconnected thoughts being verbalized and makes no real sense to the listener
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Neologisms
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client makes up "new words" that men something to the client but not understood by the listeneer
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Tangential speech
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thoughts veer away from the main idea being expressed by the client and it derails- never gets back to central idea
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Delusiosn
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firm fixed beliefs in contrary to others- grandiosity, religious, erotomaniac
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COmpulsions
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the thoughts or fear used to decrease fear or guilt- accompanied by a obsession- riutalistic
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Ruminations
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mood congruency relating usually to depression or anxiety states
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Thought insertion
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some outside stimulus is placing ideas in the persons mind and thinking
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thought broadcasting
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thoughts from the person are being hear and played out in other media forms such as tv or radio
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Voluntary Admission
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willingly enters and consents
civil rights maintained discontinue when they choose all rights and privelages |
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Involuntary Admissions
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against wll due to threat to self or others, inability to meed basic needs, can't recognize needs
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Listeriosis Sources
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1) Soil, water, plants
2) Cold damp environments 3) Humans 4) Domestic and wild animals |
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Duty to Warn
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Tarasoff 1976
therapists must wanr other when a client in the mental health setting or any other setting implies, verbalizes or imposes danger or threat to someone else |
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Seclusion
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last resort
"safe" room must be monitored by all staff at all times |
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restraints
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last resort
includes chemical restraints applied in ER situation |
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Incompetence
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court system will determine
- must have legal guardian |
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Informed consent
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reason for tx
tx choices and right to refuse known risks with treatment |
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RN role in informed consent
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witness to client's signature
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Assault
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when a person puts another person in fear or harmful or offensive contact
- implied or threatened |
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Battery
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the intentional touching of anothers body without their consent
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Invasion of Privacy
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privacy of client, confidentiality, intrusion on private client or family matters
sharing client info with unauthorized person |
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False IMprisonment
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not allowed to leave a halth care facility when NO LEGAL JUSTIFICATIOn is present to detain the client
- restraining devices |
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Against Medical Advice
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when the client refused care and is competent to make such a decision
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Defamation:
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writing ( libel) oral ( slander) false communication or disregard for the truth that cause damage to someone's resputation
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Fraud
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results from deliberate deception intended to produce unlawful gain from another person
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Psychobiology
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study of relationships among the structure and funcion of thebrain, biochemical and hormonal processes, genetics, environmental experiences and the interactions of human behavior
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Frontal Lobe
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Higher order thinking ( goals)
Abstract reasoning and decision - making motivation social judgement voluntary muscle movement |
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Parietal Lobe
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sensory
body position reading and amth right/left orientation |
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Dysfunction of Frontal Lobe
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illogical thinking
psychotic thinking disinhibition incoherent speech patterns |
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Dysfunction of parietal lobe
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spatial ability lobe
body image distortions self-care deficits |
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Occipital Lobe
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visual function
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Dysfunction of Occcipital lobe
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illusions or hallucinations
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temporal Lobe
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judgment, memory, smell, senosry interpretations and understanding sound
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Dysf. of Temporal lobe
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aggression, violent behaviors, olfactory and auditory hallucinations and language abnormalities
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THalamus
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receives and relays sensory information input
memory mood regulation |
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Dyfunction of Thalamus
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learning problems
fluctuating moods mania depression problems with learning |
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Hypothalamus
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MAIN VISCERAL CONTROL
ANS body temp hunger thirst circadian and sex drive hormonal output and anterior |
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LIbic System
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seratoning NE and DA
- "Emotional Brain" - emotional status and sense of well-being |
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Cerebellum
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balance
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Neurotransmitters
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chemical messengers that either carry and inhibitory or stimulation message from one neuron to another via a spce called synapse
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Seratonin
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5-HT
sleep, hunger, mood = depression, anxiety, eating increace levels to improve mood with depression |
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Dopamine
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Schizophrenia and Psychosis
- antipsychotics BLOCK DA --logical thinking is the result increased during mania states |
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NE
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stim, of sympathetic branch
fight or flight increased in mania, anxiety and schizo decreased in depression |
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GABA
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inhibitory transmitters
increase GABE-- decrease anxiety |
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Anti-Anxiety
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INCREASE GABA
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Acetylcholine
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memory, learning and mood regulation
-decreased in AD - increase in depression |
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Peptides
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neuromodulators
- somatostatin ( AZ) -----dereased in AD and memory problems with ACH |
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Assessment
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abuses early in life
family history thyroid dysfunction hormonal levels |
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Freud
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intrapsychic proces, CONFLICT and psychosexual development
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ID
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instincts and impulses-
pleasure principle |
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EGO
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"reality" based component of who we are
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SUPEREGO
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morals, values, beliefs which form the person's standards of behavior
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Freud/ Anxiety
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response to unconscious conflict or threat to the ego
low-mild levels of anxiety enhance learning |
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Freud/ Defense MEchanisms
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protect the ego and self-esteem
UNCONSCIOUS ( except for sublimation) |
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Psychosexual Development
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Oral- meets security through mouth
Anal- bodily functions Phallic- establish sexual identity Latency- onset of puberty Genital- relationships with oppostie sex |
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Application of Freud to Nursing
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assess anxiety levels
smoking overeating ( oral gratification) |
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Harry Stack Sullivan
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Anxiety is caused from an interpersonal phenomena by interpersonal relationship conflicts and problems
- anxiety is passed |
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Harry STack Sullivan ? Anxiety
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anxiety is learned
- latching with breast feeding |
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HSS/ SAfety and security
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basic low level needs on Maslow's Hierarchy of Needs
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Erik Erikson
- EGO development |
crisis when they don't move from one stage to the other
self-esteem results from social interaction re-learning is possible on erikson's beliefs = nursings most identified theorist |
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Piaget
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COncrete OPerations
- learning in a systemic way Formal Operations -abstract thinking and concepts |
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Behavioral Framework
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Rewards/ Punishments
Pavlov- Classic COnditioning Skinner- Operant Conditioning |
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Operant Conditioning
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Positive Reinforcement
Negative Reinforcement |
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Operant COnditioning
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Positive Punishment
Negative Punishment |
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Mental illness by Behavioral Approach
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maldaptive behavirs can be changed for persons without the person developing insight into the underlying cause
--anxiety disorders, substance abuse, anger management |
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Operant Techniques
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Modeling
Rewards Systemic Desensitization Aversive Therapy Biofeedback Relaxation Techniques Assertiveness Training |
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Cognitive Framework
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examinig distorted and negative thought patterns that lead to maladaptive and symptomatic feelings and behaviors
--Internal/External Locus of control |
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Internal locus of control
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believes their own powers to affect the outcome of a situation
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External Locus of control
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they are controlled by powerful outside forces
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Cognitive Mileu
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certain types of thinking or thought processes can be identified as misperceptions by the individual
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Arbitrary Inference
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holding of beliefs in the absence of supporting evidence
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Selective Abstraction
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focus on a single detail while ignoring the whole
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Overgeneralization
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reaching global assumptiong based n an idolated event
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Magnification
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exaggerating a situation
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Minimizations
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belittling self of personal abilities actions or responses
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Dichotomous Thinking
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all or nothing patterns of thought
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Thought Stopping
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taught to say "stop" to maladaptive thinking processes
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Cognitive restructuring
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client changes maladaptive or self-deprecating beliefs by making positive statements of self
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Rational Emotional Therpay
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- ALbert Ellis
- teaching the client to dismiss irrational beliefs |
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Gestalt Theory
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- Firtiz Pearls
promotion of clients self-awareness and increase self responsibility in addressing and meeting needs |
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Humanistic Framework
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the "here and now" by examining current behaviors issues and problems
- incorporates spiritual values and meaings as important processes in coping and stress management |
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Maslow
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- humanistic
Client centered therapy Empathy- Acceptance- resepct --reflective listening and therapeutic responses |
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3 domains of communication
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Affective Analysis
Behavioral Analysis - nonverbal ( STRONGEST) Cognitive Analysis |
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Non-verbal communication
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2/3 of communication
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PPM
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Positive POsture and Movements
- Body Language |
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Zones of Space
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Intimate: 0-18
Person 18-36 Social 4-12 feet Public 12-25 feet |
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Listening
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holding back on what you have to say
avoiding interruption controlling the urge to give adivce |
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Types of Messages
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Overt- spoken words
Covert- using body positions, gestures, facial expression ( MORE POWERFUL) |
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Characteristics of Caring Persons
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non-judgemental
acceptance warmth emapthy authenticity congruency trustowrthiness self-disclosure |
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Close Ended Questions
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yes/ no
non-therapeutic appropraite when in anxiety |
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Open- ended questions
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allow for ventilation
therapeutic technique can't be answered in a few words |
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Accepting
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indicates reception
does not indicate agreement |
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Nodding
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therapeutic communication
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Broad Openings
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allowing the client to take the initiative in introducing the topic
client has the lead |
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Consensual Validation
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search for mutual understanading for according in the meaning of the words
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Encouraging description of perceptions
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asking the client to verbalize what he or she perceives
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Exploring
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delving further into a subject or an idea
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Focusing
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concentrating on a single point
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Formulating a plan of action
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asking the client to consider kinds of behavior likely to be appropriate in future situations
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General Leads
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giving encouragement to continue
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Nodding
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therapeutic communication
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Giving Information
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make available the facts that the client needs
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Making Observations
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verbalizing what the nurse perceives
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Broad Openings
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allowing the client to take the initiative in introducing the topic
client has the lead |
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Nodding
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therapeutic communication
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Consensual Validation
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search for mutual understanading for according in the meaning of the words
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Broad Openings
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allowing the client to take the initiative in introducing the topic
client has the lead |
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Encouraging description of perceptions
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asking the client to verbalize what he or she perceives
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Consensual Validation
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search for mutual understanading for according in the meaning of the words
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Exploring
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delving further into a subject or an idea
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Encouraging description of perceptions
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asking the client to verbalize what he or she perceives
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Focusing
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concentrating on a single point
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Exploring
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delving further into a subject or an idea
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Formulating a plan of action
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asking the client to consider kinds of behavior likely to be appropriate in future situations
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Focusing
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concentrating on a single point
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General Leads
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giving encouragement to continue
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Formulating a plan of action
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asking the client to consider kinds of behavior likely to be appropriate in future situations
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Giving Information
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make available the facts that the client needs
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General Leads
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giving encouragement to continue
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Making Observations
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verbalizing what the nurse perceives
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Giving Information
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make available the facts that the client needs
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Making Observations
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verbalizing what the nurse perceives
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placing event in time and sequence
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clarifying the relationships of events in time
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Offering SElf- making onseself available
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I will sit with you awhile
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Presenting Reality
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offering for consideration of what is real
(good if they aren't in touch with reality) |
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Reflection
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directing client actions, thoughts and feelings back to the client
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Restating
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repeating of the main idea that has been expressed
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Slience
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absence of verbal communication which proveds time for the client to put thoughts or feelings into works, to regain composure or to continue talking
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Suggesting COllaboration
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offering to share, to strive, and to work with the client for his benefit
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Voicing Doubt
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expressing uncertainty about the reality of the clients perceptions
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Non-therapeutic
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cut off communication
"WHy" |
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Therapeutic 1:1
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what you said
how the client responded what is was |
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Denial
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refusal to believe or accept an unpleasnt reality
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Intellectualization
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use of thinking to avoid experiencing emotions that are unpleasant
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Repression
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exclusion of unpleasant or unwanted expreienced emotions or ideas from the conscious awareness
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Projection
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attributing ones own feelings or wish ; unaccpetable to ones self to another person
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Reaction Formation
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adoption of a bahvior or feelings that are exactly OPPOSITE of ones true emotions
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Identification
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adopting the thinking or behavioral patterns of another
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Isolation
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separation of emotions from a precipitating event or situation
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Rationalization
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attempt to justify one's behavior by presenting emotions that sounds logical
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Sublimation
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the substituting of constructive and socially accpeting behaviors for strong impulses that were NOT acceptable in their former form
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Regression
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resorting to an earlier more comfortable level of funtioning that is characteristically less demanidng and responsible
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Undoing
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the personj relieves guilt by making reparations by former actions and words that cause some disapproved thoughts or feelings
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Tasks of the FAcilitator
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stay in the group
feel free to share and explore code of behavior and norms with the group |
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Support Groups
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members share thoughts and feeling and heal each toher
turns over to a higher power |
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12 step prgrams
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spiritual
life-long process sponsor close meetings vs. open meetings |
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Family Therapy
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mental illness affects everyone
family is treated as a unit help families cope, improve their communication and interpersonal skills establish boundaries and moderate family cohesion and felxibility |
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Play therapy
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under 12
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Art therapy
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painting, drawing, and sculpting for children and adults to pull from the UNCONSCIOUS level of conflict
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Stress
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anything from a moinor disturbance to a significant even that can cause no problems with health patterns all the way to chronic health alteration including effects on the immune system, relationship difficulties and even death
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Hans Seyle ( stress)
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a non-specific response to an demand placed on the body
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Physical Stress
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burns, hypoxia, infectious disease
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emotional distress
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dx of cancer, divorce, financial loss
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GAS Theory
GEneral Adaptaion Syndrome |
Alarm Reaction Stage
Stage of resistance Stage of Exhaustion |
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Alarm Reaction
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fight or flight
sympathetic nervous system Epi and NE |
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Stage of Resistance
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physiologic reserves are mobilized to combat stress
if they don't adapt- go into exhaustion with can lead to death |
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Exhaustion stage
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the origianl stage can biefly retunr ( when dying)
HR will go back up, eyes may blink |
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Physiologic REsponses Associated with stress and anxiety
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HYPOTHALAMUS-- corticotropin---ACTH--increase in glucocorticoids
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Stress Reactions
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increase in blood glucose
increase in HR and BP response to epi and NE |
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Inhibition of the INflammatory Response ( stress)
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immune system- interleukins
decreased number of leukocytes and cytokines ( bacteria killers) |
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Increased Susceptibility to Stress
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Increase in the ECF
(increase in aldosterone and sodium) |
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Neuro CHanges with Stress
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prefrontal area of cerebral cortex
- reduces speed of the stiumlus temporal lobe response- auditory sensation Limbic system- mediator of emotions and behavior --survival and self |
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emotional distress
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dx of cancer, divorce, financial loss
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GAS Theory
GEneral Adaptaion Syndrome |
Alarm Reaction Stage
Stage of resistance Stage of Exhaustion |
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Alarm Reaction
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fight or flight
sympathetic nervous system Epi and NE |
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Stage of Resistance
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physiologic reserves are mobilized to combat stress
if they don't adapt- go into exhaustion with can lead to death |
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Exhaustion stage
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the origianl stage can biefly retunr ( when dying)
HR will go back up, eyes may blink |
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Physiologic REsponses Associated with stress and anxiety
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HYPOTHALAMUS-- corticotropin---ACTH--increase in glucocorticoids
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Stress Reactions
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increase in blood glucose
increase in HR and BP response to epi and NE |
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Inhibition of the INflammatory Response ( stress)
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immune system- interleukins
decreased number of leukocytes and cytokines ( bacteria killers) |
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Increased Susceptibility to Stress
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Increase in the ECF
(increase in aldosterone and sodium) |
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Neuro CHanges with Stress
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prefrontal area of cerebral cortex
- reduces speed of the stiumlus temporal lobe response- auditory sensation Limbic system- mediator of emotions and behavior --survival and self |
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Cognitive stress
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understand that stress in life wil produce anxiety, can't be avoidede nd you can change your behavior to deal with it, without getting rid of the stimulus
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Must Assess for ___
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SUPPORT SYSTEMS!!!
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Ineffective Coping
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inability to form a valid appraisal of stressors, inadequate choices or practices responses and or the inability to use avalable resources
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Compromised Family COping
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usually supportive promary person providing insufficient or compromised suport, comfort, assisstance, or encourage that is needed by the client to master the adaptive tasks
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Role of Nurse with stress
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facilitate and enhance the process of coping and adaptation to stress
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Anxiety Strategies
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progressive muscle relaxation
guded imagery thought stoppign music biofeedback |
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Complimentary and Alternative THerapies
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St, John's Wort
Yoga Kava Ginseng |
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Crisis ( stress)
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4-6 weeks
response rooted in the inability of the person to efectively utilize any interventions provided by the health care team |
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Cognitive Reframing
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changing of belief patterns
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Assertiveness Training
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helpful in stress associated with conflict
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4 levels of Anxiety
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mild
moderate severe panic |
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Mild anxiety
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normal
good for learning and problem solving restlessness and irritability |
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MOderate Anxiety
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perceptula field narrows
selective inattention problem solving assistance needed physical ss increased HR, BP, sweats |
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Severe anxiety level
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focus on only one thing
learning/problem solving not present death due to CV collapse |
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Developmental Crisis
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maturational or internal
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Situational
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divorce, dating, rape, war
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Drugs for Anxiety and Stress
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Benzodiazepines
act on limic system and RAF by potentiating the effects of GABA NO ALCOHOL TOxic: overdose |
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BZA overdose
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ABCs
VS Gastric lavage MAZINCON |
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Azaspirones
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balance 5-HT activity
Busparone |
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Psychopharmacology Primary Actions
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altering amounts of neurotransmitters at the synapse
binding to a specific receptor site either pre or post synaptically |
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Neurons do 3 things:
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respond to stimuli
conduct electrical impulses release chemicals called neurotransmitters |
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Impulse Control
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rendered more or less likely to fire an impulse
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Acetlcholinesterase
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destroys the neurotransmitter ACH
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Nt are reused and destroyed/balaned by intracellualr enzymes
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MOA
destroys NE, DA, 5-HT |
