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58 Cards in this Set
- Front
- Back
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DSM-5 |
Mental disorders are considered a manifestation of a behavioral, psychological , and biological dysfunction of the individual |
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Milieu Therapy |
Controlling the environment where you are working- want it to be safe and secure, good area to learn and recover |
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17th/18th Century Mental Health |
Views: caused by demon that had taken possession of a person treated through exorcism, prayers, incantations, or concoctions Religious context women=witches |
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19th Century Mental Health |
Humanitarian movement started Warehouses=mental health hospitals Isolation and self contained communities--> thought it was contagious; incurable and dangerous people |
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Dorothea Dix (1802-1887) |
Civil war nurse; good with hospice -crusaded for humane treatment -superintendent of Female nurses in Union Army -Mental hygiene movement -Drew attention to inhumane treatment and poor physical condition |
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Humanitarian movement |
Phillipe Pinel: peooneered treatment at LaBicetre--> treated patients as sick huans instead of beasts Benjamin Rush--> father of american psych -mental illness caused by psychological and social stressors -treatment with moral management |
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Phillipe Pinel |
Pioneered humanitarian treatment at laBicetre -treated patients as sick humans not beasts -light airy rooms -approached with compassion and understanding -treated with dignity -restore reason through comforting counsel and purposeful activity |
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Benjamin Rush |
Father of American Psychiatry -Mental illness caused by psychological and social stressors ----cruelty, stress, poor living -treatment= moral management -faulty blood circulation in the brain--> lots of blood draws |
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Erikson's Stages |
Trust vs mistrust autonomy vs shame and doubt initiative vs guild industry vs inferiority identity vs role confusion intimacy vs isolation generativity vs stanation ego integrity vs despair |
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Trust vs Mistrust (Infancy-18months) |
Develop basic trust in mothering figure and generalize it to others -self confidence, -optimism -hope for future -gratification Bad: caregivers fail to respond to infant distress |
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Autonomy vs Shame and Doubt (early childhood-3yrs) |
gain some self-control and independence within the environment -sense of self-control -self confidence -parents encourage and provide opportunity for independent activity |
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Initiative vs Guilt (late childhood-6years) |
Develop sense of purpose and the ability to initiate and direct own activities -exercise restraint and self control of inappropriate behavior -assertiveness and dependability -learning and achievement |
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Industry Vs Inferiority (6-12yrs) |
achieve self-confidence by learning, competing, performing successfully, and receiving recognition from significant others peers, acquaintances |
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Maslow's Hierarchy of Needs |
emphasis on human potential and the clients strengths prioritize nurse-client relationship -focus on physiological and safety needs when acutely ill 1. self actualization: self fulfillment and highest potential 2. self esteem: seeks resect and works to achieve success 3. love and belonging: needs for affection, compashionship, relationships 4. safety and security: avoid harm and maintain comfort, order, structure, freedom from fear 5. Physiological needs: basi fundamental needs of food, water, air, sleep, exercise, elimination, shelter |
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Peplau
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*Developed first systematic theoretical framework for psych nurses* -nurse patient relationship -therapeutic communication=key wrote: interpersonal Relatons in Nursing |
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Depression Neurotransmitters |
Deficiency of norepinephrine, serotonin, or both inc ACTH |
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Serotonin |
decreased in depression -sleep and arousal, libido, appetite, mood, aggression, pain perception |
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Dopamine |
inc in schizophrenia |
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GABA |
dec in anxiety |
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Beneficence |
doing good for others |
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Autonomy |
right to make own decisions |
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Nonmaleficence |
doing no harm |
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Justice |
treating people fairly and equally |
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Veracity |
telling the truth |
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Duty to Warn |
healthcare team is not bound by confidentiality, the person who is in danger can be warned -asessment of a threat of violence -identification of the intended victim -ability to intervene in a feasible, meaningful way |
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Voluntary Commitment |
Written application for admission -discharge initiated by patient -civil rights fully retained --patient is voluntarily seeking help |
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Involuntary Commitment |
Admission did not originate with the patient -discharge by hospital or court -civil rights vary -mentally ill with danger to self or others, need for treatment, unable to meet own basic needs |
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Empathy |
Ability to see beyond outward behavior and understand the situation from the clients view -validating a persons feelings--> listen carefully, eye contact, nodding "it sounds like you are very frustrated" focus on patient and their feelings |
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Mood |
"how are you feeling today" |
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Affect |
your observation of pt appearance, gestues, facial expression, behavior |
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Mental Status |
appropriateness of clhing, responsiveness, orientation |
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Psychosis |
delusions (fixed false beliefe), bizarrem strand, unrealistic mind is taken over by alens" Hallucinations |
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Potential for Violence |
Seld directed, self, harm, towards others |
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Depression DSM-5 Criteria |
-depressed mood -anhedonia -weight loss -insomnia -psychomotor agitation or retardation -fatigue or loss of energy -feeling worthlessness or excessive/inappropriate guild -dimiished ability to think/concentrate/indecisive -recurrent thoughts of death, suicidal ideation, or attempt |
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Depression Nursing Interventions |
1. provide a safe environment 2. maintain physical health --> nutrition, elimination, personal hygiene 3. emotional support -dont ignore -be neutral -encourage expression of positive emotion -gradually increase social activity -journaling -art therapy -monitor and teach: -meds: delayed effect ECT Coping skillys |
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SSRI |
Block reuptake of serotonin *prefered for depression -Citalopram (celexa) -Fluoxetine (Prozac)(Sarafem) -Paroxetine (Paxil) |
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SSRI side effects |
sexual dysfunction agitation sleep disturbances tremors tension headaches dry mouth weight change mild nausea loose bowel movement |
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SSRI teaching |
Takes a long time to have effect and be therapeutic (4-6 weeks) take in the morning |
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SNRI |
Venlafaxine (Effexor) Duloxetine (cymbalta) Mirtazepine (Remeron) Trazedone (desyrel) monitor BP |
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DNRI |
Bupropion (Wellbutrin) |
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TCA's |
Inhibit repute of norepinephrine and serotonin -Amitriptylene (Elavil) -Desirpramine (Norpramin) |
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TCA side effects |
dry mouth blurred vision constipation urinary retention drowsiness increased appetite orthostatic hypotension sweating |
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TCA Considerations |
Give at hs b/c makes you sleepy full effects delayed don't give with older and fall risk - oath hypo -dont give with CV issues |
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ECT |
Depressed and suicidal -side effect: short term memory loss -grand mal seizure under general anesthesia not effective: dysthymic disorder, atypical depression, personality disorders, drug dependent clients, social/situational depression |
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Bipolar I Disorder |
one manic or mixed episode usual onset before 40yo equal in men and women 90% recurrence |
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Manic Episodes |
abnormal, persistent elevated or irritable mood with -inflated self esteem decreased sleep pressured sleech -flight of ideas -distractibility -increased activity or agitation |
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Mood Stabilizers |
Lithium Carbonate Therapeutic blood level: 0.9-1.5mcg/dL side effects: go, tremor/weakness, cans, toxicity, seizures/coma -affects kidneys with long term use |
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Anticonvulsants |
Divalproex (Valproic Acid) Lamotrigine (Lamictal) Carbamazepine (Tegretol) Gabapentin (Neuronton) Topriamate (Topamax) side effects: sedation, ataxia more tired at first |
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Antipsychotics |
Olanzapine (Zyprexa) used for mania with delusions or psychosis and need to be calmed down quickly have PRN - haldol, risperdal |
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Bipolar Nursing Interventions |
-snacks, sleep, rest -limit setting: identify needs--> communicate expected behavior-->inform limits--> enforce --> help verbalize feelings -use empathy and identify feelings -calm and quiet -intervene with delusions -avoid overstimulation -no competative games |
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Cultural and Spiritual issues |
need to be open, not egocentric, don't be closed minded and judgemenal, use interpreters -adapt care to clients cultural needs and preferences |
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Cultural Competence |
Combination of culturally congruent, behaviors, practice attitudes, and policies -care specific to client and their norms and values |
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Ethnocentrism |
evaluation and belief that ones own value system or beliefs are superior |
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Suicide Red Flags |
"planning to go away for awhile" -hopelessness: no plans for future -past attempts -giving away personal items -plan to harm |
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Suicide Precautions |
1:1 with staff member q15 checks high surveillance and security verbal contract |
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Suicide Epidemiology |
-Most prevalent in ages 15-24; and over 75 mood disorders=top rates |
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Suicide assessment |
Thoughts? plans? means? Directly question -do you feel your life is to worth living -do you wish you won't wake up |
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Suicide Interventions |
-explain precautions -tell about supervision -remove dangerous objects -look through belongings -meals on isolation tray -check that meds are swallowed -shared living space -no suicide contract |
