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90 Cards in this Set

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What is the goal of treatment in mental health?
To treat in the least restrictictive environment.
What are some sites of mental health care?
Hospital, crisis stabilization unit, outpatient setting, home, free standing psych hospitals.
Name the members of the interdisciplinary team.
Patient, Nurse, Psychiatrist (physician), Social Worker, Clinical Psychologist, Pastoral Counselor, Occupational Therapist, Physical Therapist.
What does the case manager do?
Makes sure the patient shows up for appointments, takes meds, etc.
What is a community mental health agency?
Where people go who are medicated but not hospitalized. Counseling is available, job training, alcohol/drug rehab.
What are 3 patient hospitalization goals?
Stabilize behavior
What is the role of the physician in the interdisciplinary team?
Serves as leader of the team. Responsible for diagnosis and treatment of mental disorders. Performs psychotherapy, prescribes medication.
What is the role of the nurse in the interdisciplinary team?
Provides ongoing assessment of clients condition, mental & physical. Manages the therapeutic milieu. Administers meds. Assists clients w/ therapeutic activities as required.
What is the role of the social worker in the interdisciplinary team?
Conducts therapy. Concerned w/ client's social needs, such as placement, financial support, community requirements. Works with client and family to meet discharge needs.
What is the role of the clinical psychologist in the interdisciplinary team?
Conducts individual, group and family therapy. Administers, interprets & evaluates psychological tests.
Steps in the Interdisciplinary Treatment Plan.
Initial assessment is made by the admitting psychiatrist, nurse, ets. A treatment plan is initiated in the first 8 hours. The IDT Plan is reviewed w/in 24 hours.
What is the number one priority for the nurse managing the milieu?
Safety
Some properties of a social relationship.
Non-threatening
Some properties of an intimate relationship.
More involved
Some properties of a therapeutic relationship.
Nurse-client
The basis of all therapeutic relationships
Caring
Elements of the Jaharia window
Know yourself, Others know you, Things hidden from others, Things hidden from self
What is rapport?
Establishing a comfortable relationship with the client. Sharing, talking.
What is trust?
People willing to expose themselves to others. Information is confidential.
What is respect?
Unconditional regard for the person regardless of their behavior or inappropriate ways of dealing with life.
What is genuineness?
Truthfulness, not fake.
What is empathy?
The ability to walk in someone else's shoes and know where they're coming from.
What are some types of boundaries?
Flexible, rigid, diffuse, loose, enmeshed,
4 Stages of a therapeutic encounter.
Preinteraction
Orientation
Working
Termination
What is transference?
When a current relationship triggers an old relationship memory. (You remind the client of someone)
What is countertransference?
When the patient reminds the nurse of someone.
What are the 2 components of communication?
The sender and the receiver contribute.
3 types of communication
Verbal (speech)
Non-verbal (body language)
Paralanguage (tone of voice, etc.)
Name 6 listening skills
Be on same level (sit with client)
Maintain good eye contact
Maintain proper distance
Sit open to the client
Don't use a table
Keep non-judgmental face
Technique - Reflecting content and feeling
Is there something you'd like to talk about?
Share with me how your pass went.
Where would you like to begin?
Technique - Exploring
C: I'm confused about this
N: You're confused?
C: My brother has the nerve to ask me for money.
N: Asking for money makes you angry?
Technique - Exploring
And then?
Tell me about it?
Technique - observe feelings
You sound very upset with this situation. You appear tense.
Technique - using silence
Encourage a person to speak by waiting.
Technique - offering self
I'll stay with you a little while
I would like to sit with you for a while.
Technique - Restating
C: I have so much to do. I take care of the house and 3 kids. I work part-time. How can you expect me to fit in 30 minutes for relaxation exercises?
N: It's hard for you to see how you could fit one more activity into your busy day.
Technique - giving information
May name is...
Visiting hours are...
My purpose in being here is...
I'm taking you to the...
Technique - Clarifying
I'm not sure that I follow.
What would you say is the main point of what you said?
Technique - Presenting reality
I see no one else in this room.
That sound was a car backfiring.
I don't hear any voices other than yours and mine.
Technique - summarizing
Have I got this straight?
You've said that...
During the past hour you and I have discussed...
Technique - Making observations
Good morning, Mr. Jones.
I see you showered this morning.
Technique - Encouraging continuation
Yes.
Uh Hum.
I follow what you said.
Nodding.
What is an assessment?
A collection/interpretation of data.
How often is a mental status exam done?
Every shift
Words that can be used for appearance.
clean, showered, dirty, odor, slumped, upright, dressed gaudy, etc.
Motor activity assessment.
Observe gait
Lithium gives ataxic gait (unbalanced)
observe body activity (tremors, calm)
Speech assessment
Observe how thought processes are coming together. Observe quantity and quality.
Poverty of speech
Client talks very little.
Pressured speech
Client talks very fast, under force. Seen in manic depressive people.
Retarded speech
Very slow speech. Seen in depressed people.
Hesitant speech
Client speaks slowly and stops occasionally.
Blocking
Client stops in mid-sentence. Loses train of thought. May indicate problems in thought process.
Mood
Sustained emotion over time
Affect
Facial expression
Congruence
Mood and affect match
Incongruence
Mood and affect don't match.
Labile mood
Mood changes frequently
Behavior style
cooperative, hostile, suspicious, guarded, friendly.
Degree of interaction
Withdrawn, quiet, talkative, seclusiveness, inwardly focused. Pay attention to who they interact with.
Thought processes
Organized
Loose - disorganized thoughts
Word salad - sentences mixed up
Tangential thinking - change topics
Flow of thought
Normal, rapid (zooming), Racing thoughts - common in hypo manic or manic patients.
Flight of ideas
Many thoughts being said rapidly. Disorganized thoughts.
Content
Compare what the client says to reality. Reality is fluid - dependes on culture.
Delusion
A fixed belief that is not grounded in reality.
How do we judge reality?
Against common beliefs
Religious Grandiosity
Client believes they're God
Somatic delusions
Delusions of the body
(bugs inside, empty inside)
3 main types of mental illness
Depression
Schizophrenia
Mania
Illusion
Data is interpreted incorrectly (magic)
Hallucination
Brain gets data that isn't there.
Dementia quality
Common to have visual hallucinations.
Delirium quality
Very common to have visual hallucinations.
Schizophrenia quality
Common to have auditory hallucinations.
Psychosis
Serious psychiatric disturbances characterized by the presence of delusions or hallucinations and the impairment of interpersonal functioning and relationship to the external world.
Test for long term memory
Who was the last president?
What type of memory is lost in dementia?
Short term memory is lost. Long term memory may remain intact.
Concrete thinking
Taking info. exactly how it is said. (Stole a base)
Abstract thinking
Take words and infer from them. Occurs at around age 8 or 9.
Test for judgement.
Letter under mailbox. What would you do if you won the lottery?
What are some vegetative symptoms?
Physical functions such as sleep, appetite, libido, excretory functions.
6 factors that increase risk of suicide.
Suicidal ideations
Suicidal gestures
Family history
Drugs/alcohol
No support system
Own a gun
Self concept
Overall feeling of self. Body image, self esteem, personal identity.
Spiritual life
What gives meaning to your life. What helps you through trouble?
Religion
An organized group who share common beliefs.
Aftercare Plans
Where will the client go after they leave? Transportation, finances?
Medical category Axis I
Clinical psychiatric disorders. Include drug/alcohol problems - dual diagnosis.
Medical Category Axis II
Personality disorder and mental retardation.
Medical category Axis III
Significant medical conditions that impact recovery (diabetes, hypertension)
Medical Category Axis IV
Psychosocial/environmental problems.
Stressors - homelessness, divorce, children leaving home, etc.
Medical Category Axis V
Global Assessment of Functioning GAF Scale of 1-100