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2013-04-12 13:58:05

Foundational Theories in MH, Interdisciplinary Approach, Treatment settings, Legal Concerns
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  1. Define mental health
    • successful adaption to stressors from the internal or external environment, evidenced by :
    • thoughts, feelings and behaviors that are age appropriate and congruent with local and cultural norms
  2. Incomprehensibility vs. cultural relativity
    Incomprehensibility-when the general population cant understand the motivation behind a certain behavior.

    Cultural relativity-behavior is considered normal or abnormal based on their cultural and societal norms
  3. mental illness
    maladaptive responses to stressors from the internal or external environment that are incongruent with the local and cultural norms....AND they interfere with the individuals social, occupation and/or physical functioning.
  4. Physical response to stress....3 parts

    alarm reaction-fight or flight is initiated

    stage of resistance-defenses engaged

    stage of exhaustion-defenses depleted,  illness occurs
  5. illnesses as a result of adaptation to stress
    • headaches
    • mental disorders
    • CAD
    • ulcers
    • colitis
  6. anxiety
    feelings of uncertainty and helplesness arising from chaos and confusion in our life
  7. mild anxiety
    associated with tension experienced in response to day to day living...prepares people for action
  8. moderate anxiety
    anxiety level increases and the persons perceptual field diminishes.

    They are less alert, cant focus, need assistance with some problem solving
  9. Severe anxiety
    perceptual field is greatly diminished and the concentration centers cant handle much.

    attention span is greatly diminished, cant complete simple tasks, headaches, palpitations, insomnia, confusion, dread, horror.

    Now all overt behavior is aimed at relieving their anxiety
  10. Panic anxiety
    intense, person cant focus on even one thing.

    • Misperceptions are common, and they have lost site of reality.
    • Hallucinations, delusions, wild and desperate actions or extreme withdrawl, cant communicate with others, terror feelings, losing control, emotionally weak
  11. Describe the relationship between the stress response and anxiety development as a primary psychological response.
    our response to stress can be anxiety and the extent to which our thoughts, feelings and behaviors are altered in this direction will determine how we function
  12. What's the relevance of Erikson's psychosocial development theory to nursing practice.
    there is an influence of social process when it comes to the development of our personality. 

    There are specific tasks associated with each stage, and they must be completed for resolution of a crisis and for emotional growth to occur
  13. Id
    pleasure principle

    present at birth....are impulsive and can be irrational.

    instinctual drives to satisfy needs and achieve immediate gratification
  14. Ego
    rational self

    experiences the reality of the external world, adapts and responds to it

    primary function of the ego is to maintain harmony among the external world, the id and the superego
  15. Superego
    perfection principle

    it is when the person internalizes the values and morals set forth by the primary caregivers.
  16. ego ideal
    when a childs good behaviors are rewarded, their self esteem is enhanced and the behavior becomes part of their value system
  17. How is the conscience formed?
    when the child is consistently punished for bad behavior.

    The child learns what is considered morally right or wrong.
  18. Describe least restrictive alternatives/settings to treatment
    • outpatient
    • day hospital

    treating symptoms with verbal rehabilitative techniques, then to behavioral, chemical interventions, mechanical restraints or electrotherapy
  19. Voluntary admission
    the individual makes a direct application to the institution for services and may stay as long as treatment is deemed necessary.

    They can sign in and out as they want....unless the nurse assesses and finds them a threat to themselves or others.
  20. Involuntary committment
    done only: (person seeking must show probably cause)

    • in an emergency situation when pt is dangerous to self and others
    • for observation and treatment of a mentally ill person
    • when a person is unable to take care of basice personal needs (gravely disabled)
  21. mileu therapy
    therapy involving the environment

    • goal is to manipulate the environment so that all aspects of the client's hospital experience are considered therapeutic
    • provides a safe environment for personal growth
  22. What must a person learn in mileu therapy?
    • adaptive coping
    • interaction skills
    • relationship skills
  23. Topics of client education for therapeutic mileu
    • ways to increase self esteen
    • how to deal with anger appropriately
    • stress management
    • recognition of increasing anxiety
    • normal signs of grieving
    • assertiveness techniques
    • relaxation techniques
    • Medication and their effects on the body
    • Problem solving skills
    • Thought stopping-swtiching techniques
    • Sex Ed.
    • Good nutrition
  24. How does the nurse communicate empathy to a patient?
    when the nurse accurately perceives and understands the meaning and relevance of the clients thoughts and feelings.

    Done by attempting to translate words and behaviors in to feelings.

    "You feel angry and embarassed by what happened at lunch today"  Encouragment of the patient to cry if she feels like it or to express their anger
  25. Which ineffective techniques may indicate that the RN is being judgemental?
    • rejecting
    • disapproving
    • disagreeing
  26. informed consent
    permission givent to a Dr. by the patient to perform a therapeutic procedure.

    this procedure was presented to the pt prior to this, and explained and pt given enough time to consider pros and cons
  27. Legal and Civil Rights of the Psychiatric Client
    • to wear their own clothes and use own personal possessions
    • can spend reasonable sum of own $$
    • have access to individual storage space for private use
    • can make and receive reasonable and confidential phone calls
    • can write and receive mail
    • right to refuse experimental treatment, electroconvulsive therapy and lobotomy
  28. What happens if a client admitted with a mental disorder refuses medications that the Dr. believes is essential for effective treatment?
    Pt. has the right to refuse, Dr. will have to get a court order and show the patient is unable to care for him/herself and hope to get the judge to agree
  29. What is meant by duty to disclose?
    a psychiatrist/psychologist has the obligation to protect a client from themself, but also to anybody they are threatening to harm and be warned.
  30. Interdisciplinary care
    when care is provided for a client in which members of various disciplines work together with common goals and shared responsibilities for meeting these goals
  31. Examples of defense mechanisms
    • compensation(cover up a weakness w/a trait considered more desireable
    • denial
    • displacement
    • isolation
    • projection
  32. Maslows Hierarchy
    • physiological needs
    • safety and security
    • love and belonging
    • self esteem
    • self actualization
  33. Transference
    • CLIENT-
    • this occurs when the client unconsciously attributes (transfers) to the nurse feelings and behavioral predispositions formed toward a person from his or her past
  34. Countertransference
    • is when the nurse's behavioral and emotional responses to a client are from unresolved feelings toward a significant other from the nurses past.
  35. collaboration
    working with others on a joint project (pt)
  36. 5150
    • 72 hour the minute.
    • person must be a danger to self, others or be a grave disability

    person will be evaluated, treated and put in a locked facility
  37. 5250
    • certification for lock up for additional 14 days (reconsidered daily)
    • must be a danger to self, others or a grave disability

    person will be in intensive treatment, will be provided with a "probable cause hearing" to dispute if they want
  38. Defense mechanisms
    our subconscious processes that protect the person from anxiety or painful realities
  39. competency
    legal determination if a patient can make reasonable decisions
  40. commitment
    does not indicate that a patient is incompetent.  Patients continue to have the right to make decisions about their treatment
  41. What happens if a client admitted with a mental disorder refuses medications that the Dr. believes is essential for effective treatment?
    You can get a Reise hearing-

    judge determines if a patient is competent to make decisions regarding meds.  If granted, the patient will receive medications against their will. 
  42. What are the consequences to the health  care provider if treatment is given without informed consent?
    Battery charges can be filed
  43. Emotional Intelligence
    understanding yourself and others

    it is necessary for negotiating demands as a nurse and managing conflict
  44. epigenetics
    study of how peoples experiences and environment affect the function of their genes, social development.

    Factors that modify expression of our genes
  45. congruence
    genuineness, honesty with a client
  46. respect
    acceptance, unconditional positive regard towards a client
  47. positive self regard
    self esteem, worth and positive self image.

    We achieve this by experiencing the positive regards others show us while growing up
  48. client centered
    the client states what is wrong
  49. reflection
    mirroring of emotional communication
  50. Diathesis stress model
    a biologically vulnerable person is exposed to stress or triggers.  This will develop a disease that they were predisposed to.

    It is genetics interacting with environmental experiences
  51. The nurse-patient relationship is....
    • therapeutic
    • client centered
    • goal specific
    • collaberative
    • theory based
    • open to supervision by peers
  52. 3 continuous phases of nurse-patient relationship
    • introductory
    • assessment
    • explanation of role
  53. 1st step in a therapeutic relationship
    self awareness
  54. What does a psychiatric nurse do?
    • pt assessment
    • management of care
    • mileu management
    • modeling-teaching
    • counseling
    • psycho-bilologic interventions
    • patient advocate
    • safety hawk
  55. What are the patient goals?
    to p rogress toward a lower level of care by providing:

    • safe and protected care
    • stabilization of symptoms
    • improving level of functioning
    • improved adaptive coping
  56. Ethical issues in psychiatric nursing....
    • patients have the right to refuse medication
    • patients have the right to the least restrictive treatment alternative
  57. Which therapeutic communication techniques best reflect empathy?
    • silence
    • acceptingrestating
    • focusing
    • seeking clarification
    • exploring
  58. Which techniques would indicate the RN is being judgmental?
    • rejecting
    • give reassurance
    • give advice
    • request explanation
    • belittle feelings
    • use denial
    • change subject
  59. List some conditions when treatment may be performed without obtaining informed consent
    **In the case of therapeutic about a treatment may be withheld if the Dr. can show that full disclosure would hinder or complicate necessary treatment, cause severe psychological harm or be too upsetting for a person to make a rational decision