NUR2459 Mental Health study Guide

"Termination Phase" of the Nurse-Client Relationship anwers- Summarizing the goals and objectives achieved, discussing ways to incorporate new coping strategies, reviewing situations that occurred and exchanging memories "Working Phase" of the Nurse-Patient Relationship anwers- Maintaining the relationship, gathering data, promoting problem solving skills and self-esteem, facilitate discharge, overcome resistance, evaluate problems and goals Cognitive Behavioral Therapy (CBT) anwers- Theory behind this therapy: Everyone has schemata-unique assumptions about self, others, and the world around them What is a therapeutic milieu or milieu therapy? anwers- A health environment, combined with a healthy social structure within a inpatient or outpatient setting supporting and treating those with mental illness Difference between a social relationship and the nurse-client relationship anwers- Focus on the patient's problems and concerns encouraging them to find their own situations, not "being a friend" or meeting the needs of the nurse Examples of Non-Therapeutic Communication techniques anwers- Reassuring, giving advice, giving approval, disapproving, changing the subject What is "Exploring"- a therapeutic communication technique? anwers- "Tell me more about that" "Would you describe it more fully?" What are examples of therapeutic communication techniques? anwers- Paraphrasing, summarizing, clarifying, exploring, silence, touch What is "False Reassurance"- a non-therapeutic communication technique? anwers- "Don't worry everything will be alright", "You'll be fine". "There's nothing to worry about" What is minimizing feelings- (a non-therapeutic communication technique anwers- Patient: "I wish I were dead. "Nurse: 'I know what you mean." What is affect? anwers- Client's emotional display of mood being experienced What are levels of consciousness? anwers- Alert, Lethargic, Stuporous What is "flight of ideas"? anwers- Rapid changes from one thought to another related thought What is perseveration? anwers- Repeating the same words in response to different questions What is judgement? anwers- Ability to evaluate choices and make appropriate decisions What is autonomy? anwers- Respecting the rights of others to make their own decisions (Big choices: Do you want CPR? Surgery?. Little choices: What would you like to take your medicine with?) =CHOICE/SELF DETERMINATION What are the reasons to use seclusion? anwers- Being a harm to self or others, decreasing sensory overload, patient request What is a violation of the patient's rights? anwers- Forcing client to eat, wash, or dress self What is "Duty to Warn"? anwers- Informing medical staff about a client's threat to harm a specific individual What is the right to leave against medical advice, privacy, and all belongings? anwers- The difference in the rights of clients involuntarily admitted vs. voluntary What is Cognitive Behavioral Therapy? anwers- In this type of therapy, the individual is taught to control negative thoughts to maintain and manage emotions. Uses both cognitive and behavioral approaches to assist client with anxiety management. What is "Autonomy vs. Shame and Doubt"? anwers- During this Erickson's task successful completion would include gain self-control and independence within the environment What is generativity vs. stagnation? anwers- This task-achieve life goals and obtain concern and awareness of future generations What is Maslow's Hierarchy of Needs? anwers- Most basic needs require fulfillment before those at higher levels can be achieved What is identity vs. role confusion? anwers- This task integrates all the tasks previously mastered into a secure sense of self What is empathy? anwers- The ability to feel what others feel and respond to and understand the experience of others on their terms What are the components of MSE? anwers- Appearance, Behavior, Speech(rate,volume, cluttering), Mood (subjective) and affect (what we see/no change of facial expression), Perceptions, Thought process (order of thinking), Thought content (thinking about), Cognition What is outcome identification? anwers- This must be completed prior tp developing implementation and planning steps What are the types of groups that could be lead by a Registered Nurse? anwers- Medication education, multifamily groups focusing on education, symptom management group, self care group, and stress management groups What are considerations for assessing the elderly client? anwers- Being aware of physical limitations, sensory deficits, motor or medical condition that may increase anxiety, stress or physical discomfort What is displacement? anwers- Redirecting of energies to another person or object; Eed the door because you got mad at your parents What is sublimation? anwers- Unconscious channeling of unacceptable behaviors into constructive, more socially approved areas What is rationalization? anwers- The use of "good" reason to explain behavior to make an unacceptable motivation more acceptable What is denial? anwers- Refusal to acknowledge conflict and thus escape reality of situation. What is projection? anwers- Putting of one's own acceptable thoughts, wishes, emotions onto others What is giving broad openings? anwers- Encouraging the client to select topic discussion which emphasizes the role of the client in the interaction What is reflecting? anwers- Directing questions and feelings back to the client What is seeking clarification? anwers- Attempting to put into words vague ideas or unclear thoughts of the client What is giving advice? anwers- Telling the client what to do or how to behave implying the nurse knows best What is non-verbal communication? anwers- Appearance, body motions, use of space and non-language sounds (verbalizations without words) What is cultural competence? anwers- Nursing awareness of personal culture, beliefs, and practices of individual patients What is "culture"? anwers- Traditions of thought and behavior such as language and history that can be socially acquired, shared and passed on to new generations What are cultural assessments? anwers- Tools that allow us to learn how clients perceive and cope within their world What is "ethnicity"? anwers- Affiliation or identity within a group of people bound by common ancestry and culture What are expressions of culture? anwers- Language, works of art, music, dance, ethnic clothing, customs, traditions, diets and expressions of spirituality What is transference? anwers- Unconsciously displaces feelings formed toward a person from their past onto the nurse What is mental illness? anwers- Disturbance in one's ability to cope with adversity What is the criteria for involuntary admission? anwers- Person must be a danger to him or herself and others, Must be mentally ill and in need of treatment, Unable to provide for his or her own basic needs What are potential causes for mental health disorders? anwers- Neurochemical imbalances, environmental and interpersonal factors What is ECT/vagus nerve stimulation/transcranial stimulation? anwers- Biological intervention as treatment option for severe depression Denial anwers- Pretending the truth is not reality to manage unpleasant anxiety-causing thoughts or feelings Flooding anwers- Exposing a client to a great deal of undesirable stimulus in an attempt to turn off the anxiety response Family Therapy anwers- Focus: Family needs and problems within family dynamics. Improving family functioning. Dialectical Behavioral Therapy anwers- Cognitive behavioral therapy for clients who exhibit self-injurious behaviors such as personality disorders; expression of language Group Therapy anwers- Helping individuals develop more functional and satisfying relations within a group setting Individual Therapy anwers- Focus: Client needs and problems, the therapeutic relationship Interpersonal Psychotherapy anwers- Assists in addressing specific problems. Goal is to improve interpersonal and social functioning Systematic desensitization anwers- Planned, progressive, gradual exposure to anxiety-provoking stimuli Interpersonal psychotherapy anwers- Assists in addressing specific problems. Goal is to improve interpersonal and social functioning Displacement anwers- Shifting feelings related to an object, person or situation towards another less threatening object, person, or situation Which statement by a client receiving classical psychoanalysis indicates understanding of this form of therapy? anwers- "The therapist will focus on my past relationships during our sessions" A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following actions should the nurse implement with this form of therapy? anwers- Gradually expose the client to an elevator while practicing relaxation techniques A nurse is assessing a client immediately following an Electroconvulsive Therapy (ECT) procedure. Which of the following findings should the nurse expect?SATA anwers- Memory loss, Confusion A nurse is planning care for a client following the surgical implantation of a Vagnus Nerve Stimulation (VNS) device. The nurse should plan to monitor for which of the following adverse effects? SATA anwers- Voice Changes, Cough, Neck pain A nurse us caring for a client who smokes and has lung cancer. The client reports, "I'm coughing because I have that cold that everyone has been getting." The nurse identifies the client is using which of the following defense mechanisms? anwers- Denial Gathering information regarding the client from the chart or other team members and examining ones feelings about caring for the client occurs in what phase? anwers- Pre-orientation phase Phase where trust and rapport is developed anwers- Orientation phase What are formulated goals mutually agreed upon anwers- Nursing diagnoses Phase where trust and rapport is maintained, problem solving and promoting client changes happen anwers- Working phase Phase is the conclusion of the relationship; discharge anwers- Termination phase Personal Information anwers- Single, Married, Widowed, Divorced Fund of Knowledge Example: anwers- Knowing the last four presidents Speech anwers- talking slow, talking fast Abstraction Example anwers- "People who live in glass houses shouldn't throw stones" Perpetual Disturbances example anwers- Visual Hallucinations Level of Consciousness example anwers- Confused Affect examples anwers- feeling happy, sad, anxious, content, surprised but the face doesn't change SMART goal anwers- Specific, Measurable, Attainable, Realistic, Timely Which of the following statements by a newly licensed nurse indicates the understanding of mental status examinations? SATA anwers- -To assess cognitive ability, I should ask the client to count backwards by seven -To assess affect, I should observe the client's facial expressions -To assess language ability, I should instruct the client to write a sentence What is the DSM (Diagnostic Statistic Manual) ? anwers- guidance used by Psychiatrists to provide a psychiatric diagnoses Freud - Id anwers- primitive pleasure seeking principle Ex.: "want,want,want" take, take take! Freud- SuperEgo anwers- deals in the extremes Ex.:"I will never" Freud: Ego anwers- chooses between what to do; subject to anxiety Defense Mechanisms anwers- unconscious effort we deal; cope within a reaction to things Reaction Formation (defense mechanism) anwers- turning a negative into a positive Maslow's Hierarchy of Needs (bottom to up) anwers- -Physiological Needs -Safety -Love & Belonging -Self Esteem -Self Actualization Erickson's stages of psychosocial development: Trust vs MisTrust anwers- Birth - 1 yo; action in response when they are crying (building trust)/leading to hope Erickson's stages of psychosocial development: Autonomy vs Shame anwers- 1 1/2 - 3 yo develop in confidence Autonomy (letting them do something (Shame) shouting at them Erickson's stages of psychosocial development: Initiative vs Guilt anwers- 3-6yo think about imaginary Erickson's stages of psychosocial development: Industry vs Inferiority anwers- 6-12 yo develop competition Erickson's stages of psychosocial development: Identity vs Role Confusion anwers- 12-20 yo; recognize they are their own person Erickson's stages of psychosocial development: Intimacy vs Isolation anwers- 20-30 yo; ability to love and be loved/long lasting relationships Erickson's stages of psychosocial development: Generativity vs Stagnation anwers- 30-65 yo; nurturing generations, "what are you doing with your life?" Erickson's stages of psychosocial development: Ego Integrity vs Despair anwers- 65+ yo; acceptance of mortality and life leading to wisdom/positive sense of life experiences Pregnancy is not a contraindication anwers- for ECT