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What are 3 componants of psychotheraputic management?
- theraputic nurse/patient relationship
- Milieu management
- psychotropic medications
What are environmental elements of milieu management?
- limit setting
What criteria are needed before a person can be involuntarily contained?
- Gravely disabled
What population is most likely to commit suicide?
White males over 65 with health issues
Who has the power to begin an immediate detention?
Police - lasts for 24 hours
When can drugs be forced on a patient against their will?
- if they are violent or a threat
- If they are under a court ordered containment
What are patient rights?
- Least restrictive environment *most important*
- freedom from restraints
- freedom from seclusion
What is the best way of managing a patient who is withdrawn, depressed or apethetic?
Frequent short interactions, acknowledgement of accomplishments
What is the best way of managing sexual advances?
Point out and remind patient that their actions are inappropriate
What is the best way of managing inappropriate boundaries?
reminding patient of their role
What is the best way of managing manipulation?
setting limits and addressing what is happening
What is the best way of managing severe anxiety?
Frequent brief contact; offering support
What are the axis of the DSM?
- 1: clinical disorders
- 2. personality/development disorders
- 3. general medical disorders
- 4. psychosocial stressors
- 5. global assessment of functioning
What is the difference beteween a coping strategy and a defense mechanism?
- Coping strategies decrease anxiety and/or eliminate the source of the problem.
- Defense mechanisms are used to avoid anxiety
What are psychomotor and emotional signs of mild anxiety?
- Slight muscle tension
- confident and alert
What are psychomotor and emotional signs of moderate anxiety?
- preparation for action
- keyed up, irritable and lowered concentration
What are psychomotor and emotional signs of severe anxiety?
- preparation for fight or flight
- defensiveness with threats, poor reasoning and problem solving
What are psychomotor and emotional signs of panic?
- actual fight or flight or immobility
- out of control, out of contact with reality, irrational reasoning
What are different coping methods for the different levels of anxiety?
- Mild - adaptive
- Moderate - palliative
- Severe - maladaptive
- Panic - dysfunctional
What are interventions for the different levels of anxiety?
- Mild - normal. Can discuss and problem solve
- Moderate - refocus, relaxation techniques, PO meds
- Severe - decrease stimuli, firm directions, time out/seclusion. IM meds
- Panic - need to physically take control. Restraints, IM meds.
What is the difference between projection and displacement?
Projection is conciously blaming someone else. Displacement is unconsciously taking a stressor and taking it out on someone else.
What is undoing?
A conscious defense mechanism where a person is nice after a mean act.
What is confabulation?
A defense mechanism where the mind fills in gaps
What is the long term goal of crisis management? Short term?
- To return the person to the previous level of functioning
- To keep them safe and secure and ensure that the crisis does not escalate.
What are suicide risk factors?
- Presence of medical and/or mental illness
- Hx of past suicide attempts
- current or past use of drugs/ETOH
- recent stressors
What are componants of a suicide assessment?
- finding out risk factors
- determining suicidal idiation
- checking for a suicide plan
What are risk factors for agression?
- Impulse control disorders
- Medication non-compliance
- Perceptual disturbances
- traumatic brain injury
- ETOH or drug use or withdrawal
What are the five phases of assault?
- post crisis depression
What does the frontal lobe do?
it is most involved in mental illness. It controls reasoning and higher level thinking
What does hte Limbic system do and where is it located?
It controls emotion and is located around the brainstem and beneath the cerebral cortex.
Where is the amgdala located and what does it do?
It is located deep in the temporal lobe and it controls complex emotions like aggression
What does the hippocampus do and what affects it?
It transfers information from long term to short term memory and it is affected by a thiamine deficiency
What does the substancia nigra do?
It produces and sends dopamine to the basal ganglia. It is implicated in schizophrenia.
What does the basal ganglia do?
modulates voluntary movement.
What happens in the Diencephalon?
- Thalamus - all sensory pathways (except olfactory) synapse here
- Hypothalamus - influences food and fluid intake and endocrine secretions.
What does the reticular formation do and where is it located?
It screens for stimuli and is in charge of alertness and LOC. It is located in the brainstem.
What does the cerebellum do?
It recieves sensory imput regarding how muscles are to be directed and it coordinates fine motor movement.
What is the major neurotransmitter for schizophrenia?
What is the major neurotransmitter for depression?
Seratonin and norepinephrin
What is the major neurotransmitter for anxiety?