NURS 3481 Psych Exam 1 Review – University of Texas | NURS3481 Psych Exam 1 Review – University of Texas (100% Reliable)

NURS 3481 Psych Exam 1 Review – University of Texas Psych Exam 1 Review: Chapter 1: Describe the continuum of mental health and mental illness. 1. Health 2. Well being: occasional stress to mild distress; no impairment 3. Emotional Problems or concerns: mild to moderate distress; mild or temporary impairment 4. Mental Illness: marked distress; moderate to disabling or chronic impariment Explore the role of resilience in the prevention of and recovery from mental illness and consider resilience in response to stress. Resilience is not being unaffected by stressors; it is coping with stressors well in a stressful situation. The more resilient you are, the better your outcome is during a crisis Identify how culture influences the view of mental illnesses and behaviors associated with them. The view on mental illnesses is entirely dependent on culture. Each culture views things differently. Discuss the nature/nurture origins of psychiatric disorders. Psych disorders were originally viewed as a psychological process that could be directed with therapy. Then they found that chlorpromazine (Thiazine) was effective in treating different disorders. This caused researchers to question if the disorders were caused by a biological imbalance. They have decided that a combination of biological imbalances plus psychological imbalances lead to psychiatric disorders. Summarize the social influences of mental health care in the United States. Mental illnesses used to be a very negative thing. Lots of people have worked to get rid of the stigma associated with mental illness. The concept of recovery has also been heavily pushed. Explain how epidemiological studies can improve medical and nursing care. Epidemiology helps researchers identify high risk groups and high risk factors associated with mental illnesses. Incidence is the number of new cases of mental disorders in a healthy population within a given time. Prevalence is the total number of cases in a given time period. Clinical epidemiology studies natural history, studies of diagnostic tests, and experimental studies. Identify how the Diagnostic and Statistical Manual, 5th edition (DSM-5) is used for diagnosing psychiatric conditions. It is the official way to diagnose disorders. Has 157 different disorders Describe the specialty of psychiatric mental health nursing and list three phenomena of concern. “Promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders” • Promotion of optimal mental and psychical health and prevention of mental illness • Impaired ability to function related to mental distress • Alterations in thinking due to mental distress • More on page 13 Compare and contrast a DSM-5 medical diagnosis with a nursing diagnosis. The DSM-5 lists out psychiatric diagnoses for different patients. It is a medical diagnosis. A nursing diagnosis is intended to help a patient reach a goal. Discuss future challenges and opportunities for mental health care in the United States. • Educational challenges • Aging population • Cultural diversity • Science, technology, and electronic health care Chapter 2: Describe the evolution of therapies for psychiatric disorders. Page 20-33 Identify ways each theorist contributes to the nurse’s ability to assess a patient’s behaviors. 20-33 Provide responses to the following based on clinical experience: An example of how a patient’s irrational beliefs influenced behavior: if a patient believes the world is being invaded by aliens, they might put foil everywhere to protect their mind from being read An example of countertransference in your relationship with a patient: Countertransference: an unconscious feeling a health care worker has towards a patient An example of the use of behavior modification with a patient: Conditioning: paring a behavior with a condition that reinforces or diminishes the behavior’s occurrence Operant Conditioning: voluntary behaviors are learned through consequences and behavioral responses are elicited through reinforcement, which causes the behavior to occur more frequently Positive Reinforcement: receiving a reward for good behavior Negative Reinforcement: removal of negative stimuli Punishment: unpleasant consequence Extinction: absence of reinforcement Identify Peplau’s framework for the nurse-patient relationship: She developed the first systematic theoretical framework for psychiatric nursing. She identified psychiatric mental health nursing as an essential element of nursing. Nursing should be shifted from what the nurse does to the patient to what the nurse does with the patient. She helped shift the focus from a model focused on medical treatment to an interpersonal relational model of nursing practice. Chapter 3: Discuss major functions of the brain and how psychotropic drugs can alter these functions. • Monitor changes in the external world • Monitor the composition of body fluids • Regulate skeletal muscles • Regulate internal organs • Initiate and regulate basic drives • Mediate conscious sensation • Store and retrieve memories • Regulate mood and emotions (psychotropic drugs affect this) • Think and perform intellectual functions • Regulate sleep cycle • Produce and interpret language • Process visual and auditory data Identify how specific brain functions are altered in certain mental disorders (e.g., depression, anxiety, and schizophrenia). Schizophrenia: excess of dopamine Depression: deficiency of serotonin and norepinephrine Anxiety: decrease in GABA Psychosis: deficient glutamate and dopamine Describe how a neurotransmitter functions as a chemical messenger. Neurotransmitters cross the synapse of one neuron to another. The amount of neurotransmitters released and the number of receptors determines the effect of the neurotransmitter Describe how the use of imaging techniques can be helpful for understanding mental illness. Table 3-2 Develop a teaching plan that includes side effects from dopamine blockage (e.g., antipsychotic drugs) such as motor abnormalities. High dopamine levels can cause EPS Describe the result of blockage of the muscarinic receptors and the a1 receptors by the standard neuroleptic drugs. The results are blurred vision, dry mouth, constipation, and urinary hesitancy. Also cause EPS; usually found in first generation antipsychotics Identify the main neurotransmitters that are affected by the following psychotropic drugs and their subgroups: o Antianxiety and hypnotic drugs: GABA o Antidepressant drugs: Norepinephrine and serotonin o Mood stabilizers: lithium o Antipsychotic drugs: dopamine o Psychostimulants: norepinephrine and dopamine o Acetylcholinesterase Inhibitors: acetylcholine Identify special dietary and drug restrictions in a teaching plan for a patient taking a monoamine oxidase inhibitor. Need to avoid things with tyramine: aged cheese, pickled or smoked fish, and wine Antidepressants and sympathomimetic drugs should be avoided; must be off for at least two weeks before you can go on MAOI Identify cautions you might incorporate into your medication teaching plan with regard to the following: o Herbal medicine Don’t take St. John’s wort- can cause serotonin syndrome Check with doctor o Genetic pharmacology (i.e., variations in effects and therapeutic actions of medications among different ethnic groups) Old people don’t metabolize things the same way. Chapter 4: Compare the process of obtaining care for physical problems with obtaining care for psychiatric problems. Physical problems are straightforward and usually east to treat. Psychiatric problems are different. People try to hide their illness for fear of judgment. It is also sometimes hard to make yourself seek care when you have a mental illness. The symptoms can also be confused with other illnesses, making it hard to determine what is going on. Analyze the continuum of psychiatric care and the variety of care options available. Figure 4-1 page 67 Describe the role of the primary care provider and the psychiatric specialist in treating psychiatric disorders. The PCP is typically the first line of care. The patient may be having physical symptoms of depression, which they see their primary for. They may diagnose some psychiatric issues, but if they are complex, they will likely refer them to a psychiatrist. The specialists are trained to deal with a wide variety of psych illnesses. They have different options for treatment. The care with a specialist is more extensive. Explain the purpose of patient-centered medical homes and implications for holistically treating individuals with psychiatric disorders. This type of care refers to taking care of the whole patient. The care is patient centered and the patient is involved in their own care. They take care of mental, physical, and all other types of patient needs. Evaluate the role of community mental centers in the provision of community-based care. Community mental health centers are available for those who cannot afford private care. They can help with diagnoses, medication administration, substance abuse, and therapy. Identify the conditions that must be met for reimbursement of psychiatric home care. 1. Homebound status of the patient 2. Presence of psychiatric diagnosis 3. Need for the skills of a psychiatric registered nurse 4. Development of a plan of care under a physician Discuss other community-based care providers including assertive community treatment (ACT) teams, partial hospitalization programs, and alternate delivery of care methods such as telepsychiatry. ACT: intensive type of case management in response to hard to engage, community-living needs of people with serious, persistent psychiatric symptoms and repeated hospitalizations. They work in whatever setting the patient is in. Partial Hospitalization: Intensive, short-term treatment similar to inpatient care, expect the patient returns home each day. Usually 5-6 hour days for 1 to 2 weeks Telepsychiatry: telephone crisis counseling Describe the nursing process as it pertains to outpatient settings. Table 4-1 page 71 List the standard admission criteria for inpatient hospitalization. 1. imminent danger of harming self 2. Imminent danger of harming others 3. unable to care for basic needs and/or gross impairment of judgment, placing an individual at imminent risk based on inability to protect oneself Discuss the purpose of identifying the rights of hospitalized psychiatric patients. Box 4-2 page 75 Explain how the multidisciplinary treatment team collaborates to plan and implement care for the hospitalized patient. Box 4-3 Discuss the process for preparing patients to return to the community for ongoing care and promoting the continuation of treatment. Ensure serious symptoms are under control. Teach the patient to deal with stressors that caused the crisis originally. Collaboration with community mental health services and intensive case management programs help with the transition. Ensuring a proper support system greatly increasing success in transition. Chapter 5: Explain the importance of culturally relevant care in psychiatric mental health nursing practice. This is important because you need to meet the needs of culturally diverse patients. Different actions can mean different things for each culture. It is important to act in a way that is not offensive to each different culture. Discuss potential problems in applying Western psychological theory to patients of other cultures. Western culture promotes individuality, while Eastern culture promotes the family. Because these are very different core values, you cannot apply western medicine practices to eastern patients and expect the same outcome. Table 5-2 page 86 Compare and contrast Western nursing beliefs, values, and practices with the beliefs, values, and practices of patients from diverse cultures. Table 5-4 Table 5-5 page 88-89 Perform culturally sensitive assessments that include risk factors and barriers to quality mental health care that culturally diverse patients frequently encounter. • What do you call this illness? (diagnosis) • When did it start? Why then? (onset) • What do you think caused it? (etiology) • How does the illness work? What does it do to you? (course) • How long will it last? Is it serious? (prognosis) • How have you treated the illness? How do you think it should be treated? (treatment) Chapter 7: Compare the different approaches you would consider when performing an assessment with a child, an adolescent, and an older adult. Children: Gather data from a variety of sources, including child and parent. Consider developmental levels and that the child may be reverting back to a previous level. Found to be better if provider is same gender as child. Combine interview techniques with observation of how the child acts and plays Adolescent: Ensure privacy of records. Explain how information will be shared with treatment team. Use box 7-2 HEADSSS technique Older Adults: Don’t stereotype. Identify physical deficits and make accomodations for them. Differentiate between the use of an interpreter and a translator when performing an assessment with a non–English-speaking patient. Interpreter: More likely to unconsciously try to make sense of what the patient is saying, and inserts own understanding of situation Translator: Avoids interpreting and simply states exactly what patient says Conduct a mental status examination (MSE). Box 7-4 page 121 Perform a psychosocial assessment, including brief cultural and spiritual components. Box 7-5 page 121 Explain three principles a nurse follows in planning actions to reach agreed-upon outcome criteria. • Safe • Compatible and appropriate • Realistic and individualized • Evidence-based Identify three advanced practice psychiatric mental health nursing interventions. • Prescriptive authority and treatment • Psychotherapy • Consultation Compare and contrast Nursing Interventions Classification (NIC), Nursing Outcomes Classification (NOC), and evidence-based practice (EBP). NIC: Research based, standardized listing of interventions reflective of current clinical practices the nurse can use to plan care NOC: Includes standardized outcomes that provide a mechanism for communicating the effect of nursing interventions on the well-being of patients, families, and communities EBP: Combination of clinical skill and the use of clinically relevant research in the delivery of effective patient-centered care Chapter 8: Explain the three phases of the nurse-patient relationship. 1. Preorientation: gathering information on the patient before you meet and recognizing any potential issues or biases 2. Orientation: first time nurse and patient meet; initial interview conducted; rapport is established; a formal or informal contract is made; confidentiality is established; terms of termination are laid out 3. Working phase: maintain the relationship; share information; gather further data; promote problem solving skills, self-esteem, and use of language; facilitate behavioral change; support adaptive behaviors; evaluate progress 4. Termination: summarize goals and objectives achieved; discuss way to use coping strategies in daily life; review situations that occurred; exchange memories to validate experience Compare and contrast a social relationship and a therapeutic relationship regarding purpose, focus, communications style, and goals. Social: initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task; mutual needs are met; give advice; meeting basic dependency needs; communication typically remains superficial Therapeutic: nurse uses skill to facilitate patient; needs of patient are identified and explored; clear boundaries are established; alternative problem-solving approaches are taken; new coping skills are developed; behavioral change is encouraged Identify at least four patient behaviors a nurse may encounter in the clinical setting. Table 8-2 page 135 Define and discuss the roles of empathy, genuineness, and positive regard on the part of the nurse in a nurse-patient relationship. Empathy: helping person attempts to understand the world from the patient’s perspective Genuineness: self-awareness of one’s feelings as they arise within the relationship and the ability to communicate them when appropriate Positive regard: ability to view another person as being worthy of caring about as someone who has strengths and achievement potential Identify two attitudes and four actions that may reflect the nurse’s positive regard for a patient. Attitudes: willingness to work with patient; respect Actions: attending-special kind of listening that refers to an intensity of presence; suspending value judgments; helping patient develop resources Analyze what is meant by boundaries and the influence of transference and countertransference on boundary blurring. Transference: occurs when the patient unconsciously and inappropriately displaces onto the nurse feelings and behaviors related to significant figures in the patient’s life Countertransference: occurs when nurse unconsciously and inappropriately displaces onto the patient feelings and behaviors related to significant figures in the nurse’s past Chapter 9: Describe the communication process. 1. one person needs to communicate with another for information, comfort, or advice 2. the person sending the message initiate interpersonal contact 3. the message is the information sent or expressed to another 4. the message can be sent through a variety of media 5. the person receiving the message then interprets the message and responds to sender Identify three personal and two environmental factors that can impede communication. Personal: emotional, social, and cognitive factors Environmental: Background noise; lack of privacy; uncomfortable accommodations Discuss the differences between verbal and nonverbal communication. Verbal: all the words a person speaks Nonverbal: tone, pitch of voice, and body language Identify two attending behaviors the nurse might focus on to increase communication skills. 1. silence 2. active listening 3. clarifying 4. questions Compare and contrast the range of verbal and nonverbal communication of different cultural groups in the areas of (a) communication style, (b) eye contact, and (c) touch. Give examples. Page 158 Relate problems that can arise when nurses are insensitive to cultural aspects of patients' communication styles. Unrecognized differences in cultural identities can result in assessment and interventions that are not optimally respectful of the patient and can be inadvertently biased or prejudiced Demonstrate the use of four techniques that can enhance communication, highlighting what makes them effective. Table 9-2 page 154-155 Demonstrate the use of four techniques that can obstruct communication, highlighting what makes them ineffective. Table 9-3 page 156 Identify and give rationales for suggested (a) setting, (b) seating, and (c) methods for beginning the nurse-patient interaction. Setting: • Safe • Private • Within view of others • Home setting allows you to see how the patient lives Seating: • Chairs should be arranged so that conversation can take place in normal tones and eye contact can be comfortably maintained or avoided • Assume the same height, either sitting or standing • Avoid face to face, 90 or 120 degree angle • Provide safety for exits; don’t block patient in; don’t let them block you in • Avoid desk barrier Methods: • Introduce self • Ask what patient wants to be called • Ask open ended questions page 160 Explain to a classmate the importance of clinical supervision. Can be therapeutic process for the nurse The opportunity to examine interactions, obtain insight, and devise alternative strategies for dealing with various clinical issues enhances clinical growth and minimizes frustration and burnout. Helps professional growth and helps minimize the development of nontherapeutic nurse-patient relationship. Discuss the mechanism of action of Lithium, including the relationship to glutamate and the flow of sodium and impact on nerve and muscle cells (Chap. 3). The mechanism is not well understood. It is thought that lithium possibly affects electrical conductivity of neurons. This helps stabilize electrical activity, thus slowing the brain down. Sodium and potassium (the sodium potassium exchange pump) depolarize and repolarize cells, resulting in electrical activity. Lithium somehow interacts with the two, and helps stabilize the electrical activity. Low sodium can increase lithium toxicity because increased absorption of sodium in the kidneys also increases the absorption of lithium. It is also thought that lithium increases levels of glutamate, which helps stabilize moods. Compare and contrast the muscarinic receptor blockade effects and dopamine-blocking effects of psychotropic drugs and identify important teaching for your patient. Dopamine Blockage: the blockage of D2 prevents overexcitation of the limbic system, which helps control many positive symptom of schizophrenia. These symptoms include paranoia, grandiose ideas, and hallucinations. Side effects include EPS, increased prolactin, and amenorrhea Muscarinic Blockage: Acetylcholine receptors are blocked. It is unknown if this blockage is beneficial, but it does cause a lot of the side effects such as dry mouth, blurred vision, urinary retention, constipation, and tachycardia. Discuss each of the following major neurotransmitters (GABA, Acetylcholine, Dopamine, and Serotonin) and the role they play in common psychiatric diagnosis. GABA: major inhibitory neurotransmitter in the CNS. Antianxiety drugs target GABA, which helps calm the patient. Serotonin: Lack of serotonin has been linked with depression. Norepinephrine: Lack of norepinephrine has also been linked with depression Dopamine: Too much dopamine is thought to cause schizophrenia Glutamate: Glutamate may have a direct influence on the activity of dopamine releasing cells, which in turn can increase side effects of schizophrenia Acetylcholine: Causes many side effects of psychotropic drugs. Blocking acetylcholine inhibits nerve impulses in the nervous system, causing motor dysfunctions Compare and contrast the impact/effect of psychiatric medications on neurotransmitters in the parasympathetic nervous system and identify resulting side/adverse effects that you may see in your patient (review chapter 3 for specific receptor site impact and related effects). Figure 3-19 page 59 Explain to your depressed patient the neurotransmitter mechanism of action of the SSRI their psychiatrist just ordered. SSRIs block the reuptake of serotonin, which makes more serotonin available in the body. Increases of serotonin levels helps elevate mood. Compare & contrast side effects resulting from the combination of medications used to treat your hypertensive patient diagnosed with schizophrenia & create a teaching plan to help your patient manage potential side and adverse effects. I really don’t know. Discuss legal issues related to documentation, confidentiality, patient rights and the concept of least restrictive. If you didn’t document it, it didn’t happen Everything remains confidential unless disclosure is necessary to protect the patient, other persons, or the public health. Duty to warn is breaking confidentiality for the purpose of protect a person who might be in harm’s way. Must report all forms of abuse to proper authorities. Compare and contrast battery and assault in the context of nursing Battery: Harmful/offensive touching Assault: When a patient feels threatened that they might be in danger, but no physical contact has occured Compare and contrast legal ethical concepts such as beneficence, maleficence, tort, autonomy and justice. Beneficence: duty to act to benefit or promote the good of others Maleficence: committing harm Tort: a civil wrong for which money damages (or other relief) may be obtained by the injured party from the wrongdoer Autonomy: respecting the rights of others to make their own decisions Justice: the duty to distribute resources or care equally, regardless of personal attributes Compare contrast and give examples of primary, secondary and tertiary levels of prevention Primary: occurs before there is a problem and seeks to reduce the incidence of new cases Secondary: early identification of problems aimed at reducing incidence Tertiary: treatment of disease with focus on preventing its progression Compare and contrast Typical (1st generation) and Atypical (2nd/3rd generation) Anti-Psychotic Medications as they relate to compliance, side effect profile, and positive and negative symptoms of schizophrenia. Page 58-61 Compare and contrast terms associated with schizophrenia such as thought blocking, neologisms, word salad, thought insertion/deletion, anasognosia, echolalia and give examples of each. Thought blocking: a reduction in the amount of thinking; an abrupt stoppage of thought that derails the conversation Neologisms: made up words that have meaning for the patient but have a different or nonexistent meaning to others Word Salad: jumble of words that is meaningless to the listener and possibly the speaker Thought insertion: feeling that one’s thoughts are not one’s own and that they were inserted into one’s mind Thought deletion: a belief that one’s thoughts have been taken or are missing Anasognosia: unawareness of one’s disability or illness Echolalia: pathological repeating of another’s words and is often seen in catatonia Compare and contrast positive and negative symptoms of schizophrenia giving examples of each. Positive symptoms: alterations in thought, behavior, speech, and perception; page 205-207 Negative symptoms: cannot maintain conversations or relationships; cannot maintain employment; can’t make decisions or follow through on plans; cannot maintain adequate hygiene page 207 Review the use of therapeutic communication and approaches you should use during the assessment of your patient with Schizophrenia who is experiencing hallucinations, delusions, ideas of reference. Page 212-213 Compare and contrast extrapyramidal side effects (EPS) pseudoparkinsons, dystonia, akathesia, akinesia, oculogyric crisis, tardive dyskinesia, and describe assessment tools nursing interventions and medication protocols for each. Table 12-4 page 216 Compare and contrast Neuroleptic Malignant Syndrome & Agranulocytosis, identify specific medications that may cause, describe and discuss symptoms of each and best practice interventions and treatments. Table 12-4 page 216-218 Compare and contrast concepts related to serious mental illness including characteristics, medication compliance, lack of insight and the importance of case management for this population. Page 586-589