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Role of psychiatric nurse
develop and maintain a therapeutic nurse-client relationship
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Focuses on pts needs and is goal specific, theory based and open to supervision
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Purposeful, goal direct, safe, confidential, reliable and consistent,Focus on pts ideas
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Preinteraction phase
prep for first encounter, gather info from chart, family, other staff
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Introduction
establishing contract, establishing parameters, confidentially, preliminary care plan
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Working
CP implemented through therapeutic alliance, transference (pt), countertransferrence
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Termination
review progress and plans for the immediate future
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Physical comp
procedure/technical skills
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Psychosocial
positive regard, nonjudgment, empathy, authentic
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Spiritual
connectiveness, respect for diverse needs
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Power component
beliefs about the locus of control
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Role of nurse in crisis
assess, plan, intervene, evaluate/anticipatory planning
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SOLER communitation
sit squarely facing patient, observe an open posture, lean forward, establish eye contact, relax
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AFAs medical care
spiritualist
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Handshake for native americans
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Latin Americans
folk healer
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Muslim men may not
shake hands with muslim women
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Touch in the U.S.
moderate touch indicates personal warmth and conveys caring
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Low touch cultures
may be considered an overt sexual gesture capable of stealing the spirit of another or taboo between women and men
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High touch cultures
people touch one another as frequently as possible
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Ethical issues in psych nursing
right to refuse medication; right to least restrictive treatment alternative
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Justice
fair and equitable treatment for all
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Autonomy
pt right to make own decision
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Fidelity
loyalty and faithfulness to client and ones duty
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Mental health issues
HIV status, duty to warn and protect third parties and abuse
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Rights of mental health pt
right to humane treatment and care, right to vote, right to due process, right to press legal charges, informed consent, refuse treatment, written POC and DC info and review of treatment plan
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Clients in restraints to seclusion must be
observed and assessed every 10-15 minutes
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Natural law
do good and avoid evil
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Christian ethics
golden rule
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Utilitarianism
greatest happiness principle (end result)
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Kantianism
I make this choice because it is morally right (dont care about end result)
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CT scan
accuracy of brain structure to detect possible lesions, abscesses, areas of infarction or aneurysm; identify anatomical differences in clients with schizophrenia, organic mental disorders and bipolar
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Effect of GABA
associated with short inhibitory interneurons; interrupts the progression of the electrical impulse at synapse junction producing a significant slowdown of body activity; decreased level in anxiety, huntingtons and epilepsy
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Effect of norepinephrine
fight or flight, found in ANS; regulation of mood; decreased in depression, anorexia and increased in mania, anxiety and schizophrenia
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Schizophrenias effect on the brain
enlargement in cerebral ventricular size, decreased temporal lobe; caused by an excess of dopamine dependent neuronal activity in the brain; increase prolactin
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Mental health
ability to see oneself as others do and fit into the culture and society where one lives; mental illness is inability
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Id
pleasure principle; immediate gratification; impulsive and irrational
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Ego
rational self; 4 to 6 months of age; mediator-maintain harmony between external world, id and superego
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Superego
perfection principle; internalizes values and morals set forth by primary caregivers; assists ego in control of id impulses; when superego becomes rigid and punitive, problems with low self esteem and self-confidence
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Oral
birth to 18 mo; relief of anxiety through oral satisfaction
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Anal
18 mo to 3 yrs; learning independence and control
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Phallic
3-6 years; identification with parent of same gender; development of sexual identity
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Latency
6-12 years; sexually repressed; relationships with members of same sex peers
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Genital
13-20; libido reawakened and focus on relationship with opposite gender
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Sullivan theory
individual behavior and personality development are the direct result of interpersonal relationships; major concepts were anxiety, satisfaction of needs, interpersonal security, self-system
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Infancy
birth-18 mo; relief of anxiety through oral gratification of needs
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Childhood
18 mo-6 years; learning to experience a delay in personal gratification without undue anxiety
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Juvenile
6-9 years; learning to form satisfactory peer relationships
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Preadolescence
9-12 years; same gender feelings
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Early adolescence
12-14 years; relationships with opposite gender; developing sense of identity
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Late adolescence
14-21 years; self identify; opposite gender relationship
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Sullivans theory related to nurses
therapeutic relationships to successfully interact with others
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Mahlers theory related to nurses
help nurse assess the clients level of individuation from primary caregivers
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Mahler stage 1
birth-1 month; normal autism; fulfillment of basic needs for survival and comfort
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Mahler stage 2
1-5 months; symbiosis; development of awareness of external source of need fulfillment
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Mahler s stage 3A
5-10 months; differentiation; commencement of a primary recognition of separateness from the mothering figure
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Mahlers stage 3B
10-16 months; practicing; increased independence through locomotor functioning; increased sense of separateness of self
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Mahlers stage 3C
16-24 months; rapprochement; acute awareness of separateness of self; learning to seek emotional refueling from mothering figure to maintain feeling of security
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Mahlers stage 3D
24-36 months; consolidation; sense of separateness established; resolution of separation anxiety
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