Ati Psych Ch. 1-3

Front 1

Psychosocial History

Back 1

Perception of own health, beliefs about illness+wellness
Activity/leisure activities, how PT passes time, use/abuse substances, stress level+ coping abilities+strategies+support systems, culture, spiritual

Front 2

5 Levels of consciousness

Back 2

Alert, lethargy, obtundation, stupor, coma

Front 3

Alert

Back 3

PT is responsive and able to fully respond by opening eyes+attending to a normal tone of voice and speech. She answers questions spontaneously + appropriately.

Front 4

Lethargy

Back 4

PT is able to open eyes and respond but is drowsy and falls asleep readily

Front 5

Obtundation

Back 5

PT needs to be lightly shaken to elicit response, but she may be confused and slow to respond

Front 6

Stupor

Back 6

PT requires painful stimuli (pinching tendon or rubbing sternum) to elicit a brief response. She may not be able to respond verbally.

Front 7

Coma

Back 7

No response can be achieved from repeated painful stimuli.
-Abnormal posturing in PT who is comatose
-Decorticate rigidity: flexion+internal rotation of upper-extremity joints and legs
Decerebrate rigidity: neck+elbow extension, wrist and finger flexion

Front 8

Decorticate Rigidity

Back 8

Flexion + internal rotation of upper-extremity joints and legs

Front 9

Decerebrate rigidity

Back 9

Neck + elbow extension, wrist and finger flexion

Front 10

Physical Appearance

Back 10

Exam includes: assess person hygeine, grooming, and clothing choice. Expected findings = PT well kept, clean, dressed appropriately for given environment

Front 11

Behavior

Back 11

Exan includes assess of voluntary + involuntary body movements and eye contact

Front 12

Mood

Back 12

Mood provides info about emotion that PT is feeling

Front 13

Affect

Back 13

An objective expression of mod, such as flat affect or lack of facial expression

Front 14

Recent Memory

Back 14

Ask PT to repeat series of numbers or a list of objects

Front 15

Remote

Back 15

Ask PT to state a fact that is verifiable, (birth date, mother's maiden name)

Front 16

Assessing Speech

Back 16

Assess rate and volume, + quality of his language. His speech should be articulate and his responses meaningful and appropriate.

Front 17

Assessing Judgement

Back 17

Based on answer to hypothetical question - "what would you do if there were a fire in your room?" Response to question should be logical.

Front 18

Mini Mental State Examination (4)

Back 18

1. Orientation to time and place
2. Attention span + ability to calculate by counting backward by seven
3. Registration and recalling of objects
4. Language, including naming of objects, following of commands, and ability to write

Front 19

Glasgow Coma Scale

Back 19

Used to obtain baseline assessment of Pt's level of consciousness, and for ongoing assessment. Eye, verbal, and motor response is evaluated. Number value based on response is assigned. Highest value = 15. Score of 3 indicates that the client is in a coma.

Front 20

Mentally Healthy Children + Adolescents

Back 20

Should trust others, view world as safe, accurately interpret environment, master developmental tasks, and use appropriate coping skills

Front 21

Mental health + development disorders are not always easily diagnosed b/c....

Back 21

Lack of ability/necessary skills to describe what is happening

A wide variation of "normal" behavior, especially in different developmental stages

Front 22

Assess children + adolescents for..

Back 22

mood, anxiety, developmental, behavioral, and eating disorders. Risk of suicide should also be considered.

Front 23

Other things included in older adult assessment (4)

Back 23

1. Functional ability - like ability to get up out of chair
2.Economic + social status
3. Environmental factors, such as stairways in the home, that may affect the PT's well-being and lifestyle
4. Physical assessment

Front 24

Standardized Assessment Tolls that are specific to the older population: (4)

Back 24

1. Geriatric Depression Scale (short form)
2. Michigan Alcoholism Screening Test (geriatric version)
3. Mini Mental Status Exam
4. Pain assessments including visual analogue scales, wong-baker FACES Pain Rating Scale, the McGill Pain Questionnaire, Pain Assessment in Advanced Dementia

Front 25

The DSM-IV-TR

Back 25

Uses a multiaxial system to assess PTs in mental health setting. It assesses for abnormal behavior, comorbid mental conditions, conditions within the environment, and level of functioning

Front 26

Axis I

Back 26

All mental health diagnosis except for thouse found in Axis II

Front 27

Axis II

Back 27

Any personality disorder diagnosis and mental retardation

Front 28

Axis III

Back 28

Any general medical diagnosis, such as asthma

Front 29

Axis VI

Back 29

Pertinent psychosocial problems and problems that may affect diagnosis, treatment and prognosis of mental disorders

Front 30

Axis V

Back 30

Global assessment of functioning - assessment of present + past year functioning that rates PT's level of functioning in the areas of work performance, social abilities, and psychological ability on a scale 1-100

Front 31

Global Assessment of Function (GAF) score 80-100

Back 31

generally indicate normal or near-normal function

Front 32

Global Assessment of Function (GAF) score 60-80

Back 32

Indicates moderate problems

Front 33

Global Assessment of Function (GAF) score 40 or below

Back 33

Serious mental disability and/or functioning impairments

Front 34

Counseling

Back 34

Uses therapeutic communication skills, assisting with problem solving, crisis intervention, stress management

Front 35

Milieu Therapy

Back 35

Orienting client to physical settinging, identifying rules and boundaries of the setting, ensuring a safe environment for client, assisting the client to participate in appropriate activites

Front 36

Promote of self-care activites

Back 36

Offering assistance w/self-care tasks, allowing time for the client to complete self-care tasks

Front 37

Psychobiological Interventions

Back 37

Administering prescribed medications, providing teaching to pt/family, monitoring for side effects and effectiveness of therapy

Front 38

Cognitive and Behavioral Therapies

Back 38

Modeling, operant conditioning, systematic desensitization

Front 39

Health Teaching

Back 39

Teaching social and coping skills

Front 40

Health Promotion and Health Maintenance

Back 40

Assisting the client with cessation of smoking, monitoring other health conditions

Front 41

Case Management

Back 41

Coordinating holistic care to include medical, mental health, and social services

Front 42

Beneficence

Back 42

Relates to quality of doing good/can be described as charity

ex: nurse helps new client w/psychosis feel safe in environment of facility

Front 43

Autonomy

Back 43

PT's right to make his own decisions. But PT must accept the consequences of those decisions. PT must also respect the decisions of others.

ex:Rather than giving advice to a PT who has difficult making decision, as nurse helps the PT explore all alternatives and arrive at a choice.

Front 44

Justice

Back 44

This is defined as fair and equal treatment for all.

During treatment team meeting - nurse leads a discussion regarding whether or not 2 PTs who broke the same facilitiy rule were treated equally.

Front 45

Fidelity

Back 45

R/t loyaly and faithfulness to PT and one's duty

PT asks nurse to be present when she talks to her mom for the 1st time in a year. Nurse remains w/client during this interaction

Front 46

Veracity

Back 46

This refers to being honest when dealing with a client.

ex: Pt says you and other staff member were talking about me, weren't you? - RN replies truthfully - we were discussing ways to help you relate to the other PTs in a more positive way

Front 47

Voluntary Commitment

Back 47

PT or guardian chooses commitment to a mental health facility in order to obtain treatment. A voluntary committed client has the right to apply for release at any time. PT considered competent, and has the right to refuse medication and treatment.

Front 48

Involuntary (civil) Commitment

Back 48

PT enters the mental health facility against her will for an indefinite period of time. Commitment is based on the PT's need for psychiatric treatment, the risk of harm to self or others, or the inability to provide self-care. The need for commitment could be determined by a judge of the court or by another agency. The number of physicians - usually 2 - required to certify that the PTs condition requires commitment, varies from state to state.

Front 49

Emergency Involuntary Commitment

Back 49

Type of involuntary commitment in which PT is hospitalized to prevent harm to self or others. Emegerncy commitment is usually temporary (may be up to 10 days). This type of commitment is usually imposed by PCPs, mental health providers, or police officers.

Front 50

Observation/temporary involuntary Commitment

Back 50

PT is in need of observation, a diagnosis, and a treatment plan. The time for this type is controlled by state statue and varies greatly btw states. This may be imposed by a family member, legal guardian, PCP, or mental health provider.

Front 51

Long-term of formal involuntary Commitment

Back 51

Similar to temporary commitment but must be imposed by the courts. Time of commitment varies, but is usually 60-180 days. Sometimes there is no set release dates.

Front 52

PTs admitted under involuntary commitment

Back 52

Still considered competent and have right to refuse treatment, unless gone thru legal competency hearing and have been judged incompetent. PT who has been judged incompentent has temporary or permanent guardian, usually a family member if possible - appointed by the court. The guardian can sign informed consent for the client. The guardian is expected to consider what the client would want if he were still competent.

Front 53

Seclusion and/or restraint must never be used for:

Back 53

1. Convenience of the staff
2. Punishment of PT
3. PTs who are extremely physically or mentally unstable
4. PTs who cannot tolerate the decreased stimulation of a seclusion room

Front 54

Following must occur in order for seclusion or restraint to be used:

Back 54

1. Treatment must be orderd by PCP in WRITING
2. Order must specify duration of treatment
Provider must rewrite order, specifying type of restraint, q 24 hrs or the frequency of time specified by facility policy

Front 55

In order for restraints - nursing responsibilities must be identified in protocol, including how often the PT should be:

Back 55

1. assessed (safety/physical needs), and PT's behavior documented
2. Offered food+fluid
3. Toileted
4. Monitored for VS

Front 56

Complete documentation of use of restraints includes:

Back 56

precipitating events and behavior of the PT prior to seclusion or restraint
Alernative actions taken to avoid seclusion/restraint
Time treatment began
PT's current behavior, what foods or fluids were offered and taken, needs provided for and VS
Medication administration

Front 57

Emergency situation + restraints/seclusion

Back 57

An ER situation must be present for charge nurse to use seclusion or restraints w/out first obtaining a provider's written order. If treatment is intiated - nurse must obtain written order w/in a specified period of time (usually 15-30 min)

Front 58

Tort: False Imprisonment

Back 58

Confining PT to specific area, such as seclusion room, is false imprisonment if the reason for such confinement is for the convenience of the staff.

Front 59

Assault

Back 59

Making a threat to a PT's person, such as approaching PT in a threatening manner w/a syringe in hand, is considered assault

Front 60

Battery

Back 60

Touching a client in a harmful or offensive way is considered battery. This would occur if the nurse threatening the client with a syringe actually grabbed the PT and gave the injection.

Front 61

3 Levels of Basic Communication

Back 61

Intrapersonal
Interpersonal
Public
Transpersonal

Front 62

Intrapersonal Communication

Back 62

Communication that occures w/in an individual. Also identified as "self-talk". This occurs within one's self and is the internal discussion that takes place when an individual is thinking thoughts and not outwardly verbalizing them. In nursing - it allows the nurse to assess a pt AND/OR SITUATION AND CRICIALLY THINKING ABOUT THE PT before communicating verbally

Front 63

Interpersonal Communication

Back 63

Communication that occures betwen 2 or more ppl in a small group. This form is the most common in nursing and requires an exchange of info w/an individual or small group.

Front 64

Public Communication

Back 64

Communication that occurs w/in large groups of people. In nursing - this commonly occurs during educational endeavors where the nurse is teaching a large group of individuals - community setting.

Front 65

Transpersonal Communication

Back 65

Addresses an individual's spiritual needs and provides interventions to meet those needs.

Front 66

Verbal Communication/ Content of the message:
Denotative/Conotative Meeting - when communicating, participants must share meanings

Back 66

Words that have multiple meanings may cause miscommunication if they are interpreted differently

Front 67

Verbal Communication/ Content of the message:
Clarity/Brevity: shortness, simplest communication is usally most effect

Back 67

Communication that is long and complex may be difficult to understand

Front 68

Verbal Communication/ Content of the message:
Timing/Revelance: Knowing when to communicate allows the receiver to be more attentive to the message

Back 68

Communicating w/a PT who is in pain or distracted will make it difficult for the message to be conveyed

Front 69

Verbal Communication/ Content of the message:
Pacing - the rate of speech can communicate a meaning to the receiver

Back 69

Speaking rapidly may communicate the impression that the nurse is in a rush and does not have time for PT

Front 70

Verbal Communication/ Content of the message:
Intonation - tone of voice can communicate variety of feelings

Back 70

RN can communicate feelings, such as acceptance, judgment, and dislike thru tone of voice.

Front 71

Nonverbal Communication

Back 71

Appearance, posture, gait, facial expression, eye contact, gestures, sounds, territoriality, personal space, silence

Front 72

Characteristics of Therapeutic Communication

Back 72

Client centered - not social or reciprocal
Purposeful, planned, and goal directed

Front 73

Essential Components of Therapeutic Communication

Back 73

-Time (allow for enough)
-Attending behaviors
-Eye contact
-Body language/posture
Vocal quality
Verbal tracking (provides feedback by restating or summarizing a pt's statements)
Caring attitude
Honesty
Trust
Empathy
Nonjudgemental attitude

Front 74

Empathy

Back 74

Convery an objective awareness and understanding of the feelings, emotions, and behaviors of others - including trying to envision what it must be like to be in the position of the PT and Pt's family

Front 75

Communication w/Children

Back 75

-Use simple, straightforward language
-Be aware of own nonverbal messages - children sensitive to nonverbal communication
-Enhance communication by being at the child's eye level
- Incorporate play in interactions

Front 76

Communication w/Older Adults

Back 76

-Recognize that PT may require amplification
-Minimize distractions, and face the PT when speaking
-Allow plenty of time for the PT to respond
-When impaired communication is assessed, ask for input from caregivers or family to determine the extent of the defecits and how best to communicate

Front 77

Communication - Planning

Back 77

Minimize distractions, provide for privacy, identify mutually agreed-upon client outcomes, set priorities according to the PT's needs, plan for adequate time for interventions

Front 78

Clarifying techniques

Back 78

Restating
Reflecting
Paraphrasing
Exploring

Front 79

Offering Self

Back 79

Demonstrates willingness to spend time w/PT. Limited personal info shared. Relevant self-disclosure by the nurse allows the PT to see that his experience is shared by others and understood

Front 80

Touch

Back 80

Only if appropriate - provides comfort to PT

Front 81

Barriers to Effective Communication

Back 81

Asking irrelevant personal q's
Offering personal opinions
Giving advice
Giving false reassurance
Minimize feelings
Changing topic
Ask "why" questions
Offering value judgements
Excessive questioning
Responding approvingly or disapprovingly