Basic Concepts & Foundations in Psychiatric Mental Health Nursing

Question 1

Historical Overview
* Primitive beliefs
* Ancient beliefs
* Colonial Americans
* The 19th century
* Today

Answer 1

* Etiology based on superstitions related to the supernatural
* Leaders such as Benjamin Rush, Dorothea Dix, Linda Richards

Question 2

Maslow’s hierarchy of needs

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is the fulfillment of one’s highest potential

Answer 2

Self-actualization

Question 3

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Viewed as “the successful adaptation 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”

Answer 3

Mental health

Question 4

___ response

* Behavior that disrupts the integrity of the individual

* Negative or unhealthy

Answer 4

Maladaptive

* Remember, there is no definitive definition of stress.

Question 5

___ response

* Maintains the integrity of the individual

* Positive, healthy

Answer 5

Adaptive

Question 6

Psychological Adaptation to Stress: Anxiety

* A diffuse, vague apprehension that is associated with feelings of uncertainty and helplessness

* Low levels are adaptive, motivator

* Problematic when interferes with ability to meet basic needs

* Peplau’s 4 levels of anxiety (mild, moderate, severe, panic)

* Behavioral adaptation responses to anxiety

Answer 6

* Anxiety and grief as 2 primary psychological responses to stress

* Behaviors associated are coping mechanisms, ego defense mechanisms, psychophysiological responses, psychoneurotic responses, and psychotic responses

Question 7

Stress as

* Biological event (fight-or-flight response)

* Environmental event

* Transaction between the individual and environment

Answer 7

Defense Mechanisms

* Some defense mechanisms are more adaptive than others

Question 8

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Failure to acknowledge real issues (conflicts and situations), especially those that are painful

Answer 8

Denial

Question 9

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Overachieving or emphasizing a desirable trait to cover a real or perceived deficiency

Answer 9

Compensation

Question 10

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Modeling of behavor, attitudes, or belief of an admired individual

Answer 10

Identification

Question 11

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Transfer of intense feelings to less threatening person(s) or not at fault

Answer 11

Displacement

Question 12

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Integration of another person’s beliefs or values into one’s own ego

Answer 12

Introjection

Question 13

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Acknowledging the facts of a situation without acknowledging the feelings

Answer 13

Intellectualization

Question 14

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Separating a thought or memory from the feeling, tone or emotions associated with it

Answer 14

Isolation

Question 15

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Attributing feelings or impulses unacceptable to oneself to another person

Answer 15

Projection

Question 16

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Unacceptable thoughts or feelings or behaviors are prevented from being exhibited by exaggerating the opposite behavior

Answer 16

Reaction Formation

Question 17

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Justification of unacceptable feelings or behaviors with logical reasons

Answer 17

Rationalization

Question 18

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Involuntarily blocking unpleasant feelings or experiences from one’s conscious awareness

Answer 18

Repression

Question 19

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Retreating in response to stress to an earlier development and comfort measures associated with that level of functioning

Answer 19

Regression

Question 20

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Voluntary blocking of unpleasant thoughts or feelings from conscious awareness

Answer 20

Suppression

Question 21

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Rechanneling or substitution of drives of socially or personally unacceptable into activities that are constructive

Example - a mother whose son was killed by a drunk driver becomes president of MADD

Answer 21

Sublimation

Question 22

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Symbolically negating or canceling out an experience that one finds intolerable

Example - a man yells at his wife because he is stressed about his new job at work and buys her flowers on his way home from work

Answer 22

Undoing

Question 23

Psychological Adaptation to Stress: Grief

* Emotional (mourning)

* Physical

* Social

* May be prolonged

* Anticipatory grieving

* Kubler-Ross’ 5 stages of the grief response (__, __, __, __,__)

* Maladaptive grief

Answer 23

Denial > anger > bargaining > depression > acceptance

Question 24

Psychobiology

The study of the biological foundation of cognitive, emotional, and behavioral processes

* Neurophysiological

* Psychoneuroimmunology

* Genetics

* Neuroendocrinology

Answer 24

* Psychiatric nursing moving from a psychosocial to biopsychosocial focus

* Psychoneuroimmunology examines the relationship between psychological factors, the immune system, and the nervous system

* Genetics can be implicated in the etiology of schizophrenia, bipolar, depressive disorder, panic disorder, anorexia, alcoholism, and OCD

Question 25

Cerebral Lobes ? Perception and interpretation of sensory information

Answer 25

Parietal

Question 26

? \* Thinking \* Judgement \* Expression of feelings

Answer 26

Frontal

Question 27

? \* Hearing \* Short term memory \* Sense of smell \* Expression of emotion

Answer 27

Temporal

Question 28

? \* Reception of visual output and interpretation \* Spatial relationships

Answer 28

Occipital

Question 29

What are the 2 components of the diencephalon?

Answer 29

Thalamus, hypothalamus

Question 30

? Regulates pituitary gland, ANS, temperature, appetite, BP, circadian rhythm

Answer 30

Hypothalamus

Question 31

? \* Integrates all sensory input (except smell) \* Temporarily blocking minor sensations \* Impacted by dopamine

Answer 31

Thalamus

Question 32

? The "emotional brain" Associated with feelings of fear, anxiety, anger, rage, aggression, love, joy, and hope; sexuality and social behavior

Answer 32

Limbic system

Question 33

? Generates and transmits electrochemical impulses across synapses

Answer 33

Nerve tissue

Question 34

Neurotransmitters (are chemicals that convey information across synaptic clefts to neighboring target cells) \* Associated with numerous disorders \* Central to the therapeutic action of many psychotropic medications \* ? Process of neurotransmitter INACTIVATION; neurotransmitter is reabsorbed \* Classified into categories based on their chemical structure or their effect

Answer 34

Reuptake

Question 35

? \* Study of the interaction between the nervous system and endocrine system - Can affect various hormones of cognitive, emotional, and behavioral functioning including the pituitary and anterior pituitary glands - Hormones, in their circadian rhythm of regulation, significantly influence a number of physiological phenomenon including mood, sleep, arousal, stress response, appetite, libido, and fertility

Answer 35

Neuroendocrinology

Question 36

Psychopharmacology Psychotropic meds - Effect psychic function, behavior, or experience - Not a cure - Intended to be used as ADJUNCTIVE therapy with individual or group

Answer 36

Role of the nurse involves assessment, medication administration and evaluation, and patient education

Question 37

Ethical & Legal \* ANA Code of Ethics for nurses \* Psychiatric Mental Health Nursing Scope and Standards of Practice

Answer 37

Ethical Principles \* Autonomy \* Beneficence \* Nonmaleficence \* Justice \* Veracity

Question 38

? Involves the principle of to do no harm

Answer 38

Nonmaleficence

Question 39

? Is the duty to benefit; to serve the client's best interest(s)

Answer 39

Beneficence

Question 40

? Is to be honest and to tell the truth

Answer 40

Veracity

Question 41

? Is the right of the individual to be treated equally regardless of race, sex, marital status, diagnosis, social and economic status, and religion

Answer 41

Justice

Question 42

? Where patients are capable of making independent choices Determining of one's own destiny

Answer 42

Autonomy

Question 43

Hospitalizations \* Voluntary \* Involuntary \* Emergency \* Involuntary outpatient

Answer 43

Emergency commitments are time-sensitive and a court hearing is scheduled usually within 72 hours. The court may decide if the client can be discharged or if deemed necessary, voluntary admission is refused by the client an additional period of involuntary hospitalization may occur

Question 44

Ethical & Legal Issues in Psychiatric Mental Health Nursing \_\_\_ is conduct that falls below the standard of care or a claim and does not protect the patient If patient care was not rendered in a manner that is consistent with a standard of care or the patient was injured, this can result in \_\_\_. ___ can be applied to professional persons whereas ___ can be applied to anyone

Answer 44

Negligence Malpractice; malpractice; negligence

Question 45

Avoiding Liability \* Responding to the patient; educating the patient; complying with the standards of care; supervising care; adhering to the nursing process; documenting carefully; and following up on evaluating the care that was given \* Good interpersonal skills are the mainstay to avoid liability

Answer 45

Cultural & Spiritual \* Generalization \* Stereotyping

Question 46

6 cultural phenomena \* Communication \* Space \* Social organization \* Time \* Environmental control \* Biological variation

Answer 46

Spirituality \* Meaning and purpose \* Spiritual needs \* Religion Implications for the nurse - Cultural - Spiritual - Religious

Question 47

Psychotropic Medications \* Medication that affects psychic function, behavior, or experience \* Intended to be used as an adjunctive therapy to individual or group psychotherapy

Answer 47

Ethical & Legal Implications \* Most states adhere to a client's right to refuse treatment except in emergency situations where a client is likely to harm themselves or others

Question 48

Baseline Assessment \* History and physical examination \* Ethnocultural assessment \* Comprehensive medication assessment

Answer 48

Role of the Nurse \* Assessment \* Monitor for side effects, adverse effects, and therapeutic effects \* Client education

Question 49

How these meds work \* Psychotropic medications affect neurotransmission \* Most psychotropic medications affect the neuronal synapse, producing changes in neurotransmitter release and the receptors to which they bind \* **Reuptake** is the process of neurotransmitter _inactivation_

Question 50

? \* Increasing concentration of norepinephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (TCAs, tetracyclics, SSRIs, SNRIs) \* Inhibiting the release of MAOIs \* Serotonin syndrome \* Interactions with MAOIs \* Black box warning for SSRI's

Answer 50

Antidepressants

Question 51

Mood-stabilizing Agents \* Lithium (is affected by fluid and salt intake; _has a narrow therapeutic range_) \* Anticonvulsants (Depakote, valproic acid)

Answer 51

Antipsychotics - Typical vs atypical \* Typical - medications that have been around much longer such as haloperidol, Thorazine \* Atypical - are newer and include risperidone (Risperdal) - Clozapine = agranulocytosis - EPS = extrapyramidal side effects \* Involves abnormal movements like tremors, shuffling gait; pseudoparkinsonism - TD = tardive dyskinesia - NMS = Neuroleptic Malignant Syndrome - Prolonged QT intervals \* This can put the patient at risk for ventricular tachycardia or ventricular fibrillation