Roberge Mental Health Final

Front 1

Diathesis (stress model)

Stress

Back 1

Biological Predisposition (Nature)

Environmental Stress or trauma (Nurture)

Front 2

Mental health is from..

Back 2

a combination of genetic vulnerability and a negative environmental stressors.

Front 3

DSM-IV-TR

Axis I:

Back 3

Mental Disorder
(focus of treatment)

Front 4

Axis II:

Back 4

Personality disorder/Mental Retardation. (Dislexia)

Front 5

Axis III:

Back 5

Medical Disorder
(Relation to Axis I)
(Brain injury and DM2)

Front 6

Axis IV:

Back 6

Psycho social and Environmental Problems. (Marital Issues/School Environment)

Front 7

Axis V:

Back 7

Global Assessment of functioning (GAF explains the level of functioning from 0-100)

Front 8

Mental disorders are considered a manifestation of:

Back 8

Behavioral, Psychological or Biological.

Front 9

The DSM-IV-TR is used to..

Back 9

classify diagnostic categories for psychiatric disorders.

Front 10

The 6 Standards of Care:

Back 10

Assesment, Diagnosis, Outcome identification, Planning, Implementation, Evaluation.

Front 11

THERAPEUTIC RELATIONSHIP:

Basis of all nursing treatment approaches is to establish that the nurse is:

Back 11

Safe
Confidential
Reliable
Consistent
KEEP THE RT clear W boundaries.

Front 12

Goals and Functions for therapeutic communication: For the patient and Nurse relationship:

Back 12

Facilitate communications of distressing thoughts and feelings.

Assist patient with expressing problem solving.

Help pt examine self-defeating behaviors and test alternatives.

Promote self-care and independence.

Front 13

How to help promote patient independence?

Back 13

Encourage patients consistently to use their own resources (as appropriate) to help minimize patient's feelings of helplessness and dependency. (Can they do what you are asking them to?)

Front 14

What could you do if a patient asks you for a drink in the in patient setting?

Back 14

Show them where it is and how to get it.. don't do it for them you are taking their independence.

Front 15

Social Relationships

Back 15

Initiated for the purpose of friendship or meeting a goal.

Mutual needs are met.

Communication to give advice, give or ask for help.

Content of communication superficial.

Front 16

Therapeutic Relationships

Nurse and Patient

Back 16

Needs of patient ID and explored.

Clear boundaries established.

Problem solving approaches taken.

New coping skills developed.

Behavioral changes encouraged.

Front 17

Necessary Behaviors for Nursing: (Therapeutic comm.)

Back 17

Accountability (trust)
Focus on patients needs
Clinical competence
Delaying Judgement
Supervision
You are NOT friends!

Front 18

Establish Boundaries as the Nurse:

Back 18

Physical Boundaries
The contract
Personal Space

Front 19

Blurring of Boundaries as a Nurse:

Back 19

When the relationship slips into social context (don't get hit on)

When nurse's needs are met at expense of patient's needs.

Front 20

Transference

Back 20

Patient unconsciously displaces onto individual in current life emotions and behaviors from childhood that originated in relationships with significant others.

Front 21

Countertransference

Back 21

Nurse displaces feelings relating to people in nurse's past onto the patient.

Common sign is the nurse OVER identifying with the patient. (too close)

Front 22

NURSE Values belief and self awareness:

Back 22

not right for everyone
reflect own culture/subculture
derived from range of choices
Chosen from a variety of influences and role models.

Front 23

Peplau's model of Nursing
Patient relationship
Orientation Phase:

Back 23

Establishing rapport
Parameters of the relationship
Formal or info contract
Confidentiality
Terms of termination

Front 24

Peplau's model of Nursing
Working Phase:

Back 24

Maintain Relationship-Gather further data.
Promote patients- problem solving skills, self-esteem and use of language.
Facilitate behavioral changes.
Overcome resistant behaviors.
Evaluate problems and goals (redefine as needed)
Promote practice and expression of alternative adaptive behaviors.

Front 25

Peplau's model of Nursing
Termination Phase:

Back 25

Summarize goals and objectives achieved.
Discuss ways for patient to incorporate new coping strategies learned.
Review situation of relationship.
Exchange memories.

Front 26

Factors that help nurse-pt relationship

Back 26

Consistency, pacing (when not ready to achieve) listening, initial impression.

Front 27

Factors that encourage and promote patient growth:

Back 27

Genuineness-Empathy (not sympathy)
Positive regard (attitudes and actions)
Attending suspending value judgement
Helping patients develop resources.

Front 28

The Communication Process:
Factors that affect communication:

Back 28

Personal factors (what you believe in)
Environmental Factors (Whats going on around you)
Relationship Factors

Front 29

Nonverbal Communication

Back 29

Tone of voice
Emphasis on certain words
Physical appearance
Facial expressions
Body posture
Amount of eye contact (50% is normal)
Hand gestures

Front 30

Verbal Communication

Back 30

All words
Communicates beliefs and values
Perceptions and meaning
Words can convey:
interest and understanding
insult and judgement
Double or mixed messages

Front 31

Therapeutic Communication Techniques: Tools for enhancing communication:

Back 31

Silence
Active Listening
Listening with empathy
Conveying acceptance
table 10.2 on pg 181

Front 32

Clarifying Techniques

Back 32

Paraphrasing
Restating
Reflecting
Exploring

Front 33

Questions should be

Back 33

Open ended questions to start
Close ended questions for clarification.

Front 34

Nontherapeutic Communication Techniques

DONT DO

Back 34

Excessive questioning
Giving approval or disapproval
Giving advice
Asking "why" questions
See table 10.3 pg 184

Front 35

Cultural Considerations with Communication

Back 35

Communication Style
Eye contact
Touch (specific pt have more boundaries than others)
Cultural filters- form of bias or prejudice.

Front 36

Preparing for interview as the RN

Back 36

Pace (Not too Fast/Slow)
Setting
Seating
Introductions
Initiating the interview

Front 37

Behavior to monitor as the RN:
Foundation of the interview:

Back 37

Eye contact
Body Language
Vocal quality
Verbal tracking

Front 38

Process Recording

Back 38

Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse a useful tool for identifying communication patterns.

Front 39

How to communicate to other health professionals:

Back 39

Identify
Situation
Background
Assessment
Recommendation
Read Back

Front 40

NT:

Acetylcholine:

Back 40

Brain memory and muscle contractions

(excitatory)

Front 41

NT:

Dopamine:

Back 41

Pleasure

(Inhibitory)

Front 42

NT:

GABA:

Back 42

Produces sleep, reduces anxiety, and forming memories.

(Inhibitory)

Front 43

NT:

Glutamate:

Back 43

Learning and Memory.

(Excitatory)

Front 44

NT:

Norepinephrine:

Back 44

Regulates blood pressure and calmness (used in fight or flight response)

Front 45

NT:

Serotonin:

Back 45

Mood, appetite, and sensory perception. Also pain pathways in the spinal cord.

Front 46

Process Recording

Back 46

Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse a useful tool for identifying communication patterns.

Front 47

How to communicate to other health professionals:

Back 47

Identify
Situation
Background
Assessment
Recommendation
Read Back

Front 48

Antianxiety and Hypnotic drugs

DO what?

Back 48

Enhance the effects of GABA.

(Highly addictive)

Front 49

NT:

Acetylcholine:

Back 49

Brain memory and muscle contractions

(excitatory)

Front 50

Antianxiety example

Back 50

Benzodiazepines
Such as:
Diazepam (Valium)
Clonazepam(klonopin)
Alparazolam(Xanax)
Lorazepam (Ativan)

Front 51

NT:

Dopamine:

Back 51

Pleasure

(Inhibitory)

Front 52

NT:

GABA:

Back 52

Produces sleep, reduces anxiety, and forming memories.

(Inhibitory)

Front 53

NT:

Glutamate:

Back 53

Learning and Memory.

(Excitatory)

Front 54

NT:

Norepinephrine:

Back 54

Regulates blood pressure and calmness (used in fight or flight response)

Front 55

NT:

Serotonin:

Back 55

Mood, appetite, and sensory perception. Also pain pathways in the spinal cord.

Front 56

Antianxiety and Hypnotic drugs

DO what?

Back 56

Enhance the effects of GABA.

(Highly addictive)

Front 57

Antianxiety example

Back 57

Benzodiazepines
Such as:
Diazepam (Valium)
Clonazepam(klonopin)
Alparazolam(Xanax)
Lorazepam (Ativan)

Front 58

Hypnotic drugs

Back 58

Put you to sleep

Front 59

Hypnotic Drugs
Example:

Back 59

Short acting Sedative- Hypnotic Sleep Agents (Z-hypnotics)
Zolpidem (Ambien)

Front 60

Antidepressant Drugs

Back 60

Typical, Standard, SSRI or Tricyclic antidepressants.

TCA high likelyhood of fatality overdose.

Front 61

An antidepressant selective serotonin reuptake inhibitor (SSRI)

Back 61

Fluoxetine (Prozac)
Sertraline (Zoloft)

Front 62

Paroxetine (Paxil)
Cialopram(Celexa)
Escitalopram (Lexapro)
Fluvoxamine (Luvox)

Back 62

SSRI for Depression

Front 63

SSRI side effects

Back 63

Nausea headache drowziness

Front 64

Serotonin Syndrome

Back 64

can happen if patient is taking one or more serotonergic drug.

Changes in mental status agitation and confusion. Diaphoresis lethargy and diarrhea. Muscle twitching and jerks and tremors.

Front 65

SSRI patient teaching

Back 65

May take 4-6 weeks to feel effects of the drug
May be able to discontinue after6-12 mo if symptoms were not longstanding
DO NOT suddenly stop taking SSRIs Serotonin syndrome symptoms will occur.

Front 66

SNRIs are?

Back 66

Serotonin-Norepinephrine Reuptake Inhibitors (SNRI's)

Front 67

MAOI

Back 67

Monoamine oxidase inhibitors (Antidepressants)

Front 68

MAOI potential side effects

Back 68

Hypertensive crisis if administered with sympathomimetics (cocaine)
Avoid foods high in tyramine such as red wine, beer, over aged meats cheese or fruits and vegatables.)

Front 69

Antidepressant drugs

Back 69

Wellbutrin (Bupropion)

Front 70

Mood stabilizer

Back 70

Lithium
Anticonvulsant drugs such as:
Valproate
Carbamazepine (Tegretol)

Front 71

Antipsychotic Drugs

Back 71

Strong antagonists (blocking agents)
Bind to D receptors
Block attachment of dopamine
Reduce dopaminergic transmission

EX inc Haloperidol and Chlorpromazine

Front 72

ANTIPSYCHOTICS

First Generation or Conventional Antipsychotic drugs
ANTAGONISTS of RECEPTORS for:

Back 72

Acetylcholine
Norepinephrine
Histamine

Front 73

Atypical Antipsychotic (second generation)

Back 73

Bind to dopamine receptors inthe limbig system
Preferentially over dopamine receptors
Decrease motor sideeffects

Front 74

Atypical antipsychotic

Back 74

Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Paliperidone (Invega)

Front 75

Alzheimer's Disease DRUGS

Back 75

Anti Colinestrate drugs

Tacrine (Cognex)
Donepezil (Aricept)
Galantamaine (Razadyne)
Revastigmine (Exelon)
Memantine (Namenda)

Front 76

Spirituality

Back 76

Know that spirituality is important to assess from the patient.

Front 77

Major Depressive Disorder

Back 77

History of one or more MAJOR DEPRESSIVE EPISODES.
No history of manic or hypomanic episodes.
Symptoms interfere with life.
May include psychotic features.

Front 78

Dysthymic Disorder

Back 78

Chronic depressive syndrome
Present for most of the day
More daysthan not
At least 2 years

Front 79

Bipolar disorder

Back 79

manic episodes extreme changes of mood from 'hot to cold'.

Front 80

BIPOLAR DRUGS

Back 80

Lithium Carbonate
Anticonvulsant drugs:
Valproate (Depakote)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)

Front 81

BIPOLAR OTHER DRUGS

Back 81

Antianxiety/mood Stabilization drugs

Benzo:
Clonazepam (Klonopin)
Lorazepam (Ativan)

Atypical Antipsychotics
Olanzapine (Zyprexa)
Risperidone (Risperdal)

Front 82

Panic Disorders

Back 82

such as Panic disorder
Panic disorder with Agoraphobia (Worry about busy places or outside of their comfort zone)
Simple Agoraphobia (no escape)

Front 83

Gaba's relationship to Anxiety

Back 83

GABA - Benzo theory

Benzodiazepine are linked to a receptors that inhibits the activity of GABA.
The release of GABA slows neural transmission= a calming effect.

This theory proposes that ABNORMALITIES of the BZD receptors may lead to unregulated anxiety levels.

Front 84

Obsessuve-Compulsive Disorder

Back 84

Obsession (thoughts that recur)
Compulsion (Ritualistic behaviors in an attempt to reduce anxiety)
Excessive anxiety or worry about numerous things (6 months or longer)

Front 85

PTSD

Back 85

Flashbacks and avoidance of stiumli associated with trauma, persistant symptoms of increased arousal, occurs within 1 month after exposure to highly traumatic event.
Displays 3 dissociative symptoms during or after event. Resolves within 4 weeks.

Front 86

Eugen Bleuler's 4 A's of Schizophrenia

Back 86

Affect
Associative looseness
Autism
Ambivalence

Front 87

Schizophrenia is

Back 87

Paranoid, catatonic, disorganized, undifferentiated, or residual.
Lifetime prevalence of schizophrenia is 1% world wide.

Front 88

Comorbidity with Schizophrenia

Back 88

Substance abuse disorders (nicotine)
Anxiety, Depression, and Suicide
Physical health or illness
Polydipsia

Front 89

Etiology of Schizophrenia

Back 89

Biological factors (Genetics)
Neurobiological (Dopamine theory)
Brain Structure Abnormalities

Usually relating too Psychological and Environmental Factors such as:
Prenatal Stressors
Psychological Stressors
Environmental Stressors

Front 90

Interventions for Psychosis RT schizophrenia: MEDS

Back 90

Antipsychotic Medications:
Conventional antipsychotics (Typical or first generation)
Atypical antipsychotics (second generations)

Front 91

FOR Schizophrenia
Atypical Antipsychotics treats what symptoms?

Back 91

Both positive and negative

(can cause weight gain)

Front 92

Atypical Antipsychotics

(Schizophrenia)

Back 92

Clozapine (clozaril)
Risperidone (Risperdal)

Front 93

Anger

Back 93

Emotional response to frustration of desires

Front 94

Agression

Back 94

action or behavior that results in verbal or physical attack

Front 95

Assessment for anger and aggression

Back 95

Assess for signs and symptoms that indicate risk of escalating anger.

Trauma-informed care
Focus on the patients' past experiences of violence or trauma and the role aggression currently plays in their lives.