midterm Flashcards
(121 cards)
1
Q
important legislation
A
- BCMHA
- freedom of information & protection of privacy act (FOIPPA)
- adult guardianship act (AGA)
- criminal code of canada (assault/sexual)
2
Q
psychiatric nursing definition
A
- promotion, maintenance, and restoration of health, focus psychosocial, mental, emotional health
- prevention, treatment, and palliation of illness and injury, focus psychosocial, mental or emotional disorders, & associated comorbid physiological conditions primarily assessing health status, planning, implementing, and evaluating interventions and coordinating services
3
Q
what guides your practice
A
- prof standards
- practice standards
- scope of practice
- code of ethics
4
Q
prof standards
A
- TR
- competent, evidence-informed
- professional responsibility & accountability
- leadership and collaboration in quality
- professional ethical practice
5
Q
code of ethics values
A
- safe competent & ethical practice ensure to protection of public
- respect for the inherent worth, right choice, and dignity of persons
- health, mental health, and well-being
6
Q
4 levels of control
A
- regulation & legislation
- BCCNM standards, limits & conditions
- organizational policies
- individual nurse competence
7
Q
scope of practice
A
activities that a group of professional are educated and authorized to perform rather than what any individual can do
8
Q
autonomous scope of practice
A
non-restricted activities and restricted activities (does not require order)
9
Q
activities that aren’t restricted
A
don’t need orders, daily responsibilities
10
Q
restricted activities that don’t require order
A
- wound care
- nursing diagnosis
- inhalation
- IV
- assessing clients and treating conditions
11
Q
restricted activities with order
A
require order!!
rpns be sure restricted activities fall within scope even with order from listed health professional
12
Q
listed professionals are
A
regulated bodies with authorization to give rpn order
physician, dentist, midwife, naturopath, pharmacist, RN, NP
13
Q
activities that require orders
A
- procedures below body surface
- administering a substance
- putting items into body openings
- putting substancecs in ear
- medications
14
Q
rpns have authority to diagnose conditions only t/f
A
true
15
Q
cultural safety principals
A
- self reflective practice
- building knowledge through education
- anti-racist practice
- cerating safe health care experiences
- person-led care (relational care)
- strengths based and trauma informed practice
16
Q
foippa
A
- personal & private information required to be kept confidential
- some conditions when personal and private information can be accessed or shared
- people ahve right to access their personal and private information
17
Q
stress
A
normal response to situational pressures especially if perceived as threatening
repsonse to a changing environmental conditions
18
Q
limitations of the recent life changes questionnaire
A
- perception = could be good or bad thing
- coping
- implications of chronic or re-occurring event
19
Q
stress symptoms
A
- physical (headache, fatigue)
- emotional (crying, upset, nervous, overwhelmed)
- cognitive (memory loss, difficulty making decision)
- behavioural (isolation, compulsive eating)
20
Q
emotional response
A
situation = something happens
thought = situation is interpreted
emotion = feeling occurs as a result of thought
behaviour = action in response to emotion
21
Q
primary appraisal
A
evaluates whether in danger or threat
- demands, role expectations, what to do, goals
22
Q
if answer is NOT feeling a threat then…
A
stress will resolve
23
Q
if answer is YES feeling a threat then….
A
secondary appraisal
24
Q
secondary appraisal
A
considers options for dealing with situation
look into toolbox & try strategies (coping, medication, deep breathing)
25
allostasis
mechanisms that change the controlled variable by predicting what level will be needed and overriding local feedback to meet anticipated demand
26
fight, flight, fawn
- anger, range
- fear, anxiety
- passive, pleasing, clinging
27
vulnerable individuals are...
ppl traumatized & victimized & more suspectible
- youth, women, first nations, elderly, LGBTQ+, refuges
28
resolution of crisis
depends on realisitic perception of events, strategies available and support system
29
coping
individual's constantly changing cognitive and behavioural efforts to manage specific external or internal demands that are appraised as taxing or exceeding their resources
30
positive coping
leads to adaption (well-being & max social functioning)
31
inability to cope
leads to maladaption = illness, poor self-concept, reduced social functioning
32
problem focused coping (2)
inner-directed strategies
outer-directed strategies
33
inner directed strategies
= altering one's own beliefs, attitudes, responses
34
outer directed strategies
attempt to eliminate or alter a situation or another's behaviour
35
emotion focused coping
seek to manage own emotional distress (exercise, meditation, talking to friends)
36
nursing interventions = stress, panic, and crisis
1. establish or re-establish routine (self care, exercise, sleep)
2. observe, assess, explore, discuss (changes in behaviour & mental status, social supports, appraisal of significant life events & stressors)
37
small stress can be good thing, give you push you need, motivating to do best (t/f)
TRUE
38
crisis
coping and defensive mechanism that has been used to solve problems and adapt to change is no longer effective
39
situational crisis
sudden & unexpected (accidents, natural disasters)
40
developmental crisis
occur as part of the process of growing and developing through various periods of life
sometimes predictable part of life cycle
(leaving home, having baby)
41
existential crisis
inner conflicts related to things such as life purpose, direction, and spirituality
(person questions if life has meaning, purpose, value)
42
phases of crisis response
1. problem arise, increase anxiety, stimulates usual problem-solving techniques
2. usual problem-solving techniques are ineffective, anxiety continue to rise, trial & error attempts made to restore balance
3. trial & error fail, anxiety escalates to severe/panic, person adopts automatic relief behaviours
4. doesn't work, anxiety overwhelms person = serious personality disorganization which signals person in crisis
43
seven stage crisis intervention model
1. conduct crisis & biopsychosocial assessment (lethality measures)
2. establish rapport & relationship
3. identify dimensions of presenting problems ("last straw of crisis precipitants)
4. explore feelings and emotions (including active listening and validation)
5. generate and explore alternatives (untapped resources and coping skills)
6. develop and formulate plan
7. follow up plan and agreement
44
crisis intervention
provision of emergency psychological care to assist victims in returning to an adaptive level of functioning and to prevent or moderate the potentially negative effects of psychological trauma
45
5 principles of crisis intervention
1. early intervention
2. stabilization
3. facilitating understanding
4. focusing on problem solving
5. encouraging self reliance (empowerment)
46
benzo for anxiety
- short term use, quick relief (30 mins)
- dependence & withdrawal (2 week use)
- s/e: interactions, resp depression, drowsiness, poor memory, confusion
47
paradoxical effect benzo
increased anxiety, irritability, agitation, aggression, mania, impulsive behaviour, hallucinations
48
withdrawal sx benzo
increased anxiety, insomnia, depression, pounding heart
49
ssri anxiety
slow down nervous sx
- 4-6 weeks for improvement
- ineffective short term
- taper!
50
buspirone anxiety
- mild tranq
- improvement = 2 weeks
- increasing serotonin & decreasing dopamine
- low risk dependence
- GAD
- no PRN
51
beta blockers (propranolol, atenolol)
- blocks effects of norepinephrine
- improve physical symptoms, NO psych symptoms
52
bupropion
- GAD & anxiety r/t depression
- improvements noted shortly after starting
- not first choice, no PRN
53
hydroxyzine
antihistamine
- sx = nervousness & tension
- alters histamine & serotonin
54
delusions
false fixed belief, based on incorrect, inference about reality, not shared by others, inconsistent with individual's intelligence or cultural background and which cannot be corrected by reasoning
55
thought insertion
belief that thoughts are being inserted into one's mind by someone else
56
thought broadcasting
belief that one's thoughts are obvious to others or are being broadcast to world
57
ideas of reference
belief that other people, objects are related to or have a special significance for one's self
58
schizotypal
social & interpersonal deficits, having difficulty forming relationships, holding odd/unusual beliefs which are not consistent with cultural or societal norms, and abnormalities in thought form/speech
59
delusional disorder
- presence of delusions, includes several subtypes: erotomania, grandiose, jealous etc and unspecificed or with bizarre content
- no hallucinations
- thoughts organized & logical
60
delusional disorder duration
1 month or longer
61
brief psychotic disorder
uncommon, brief duration and sudden onset
- pre-existing conditions predispose
- duration = at least 1 day but less than month
62
schizophreniform
same criteria A schizophrenia, shorter duration
early manifestation of schizophrenia?
interruption in one or more areas of daily functioning
63
schizophreniform duration
lasts at least 1 month but less than 6 months
64
schizophrenia
impacts ability to think clearly, manage emotions, and interact with others
65
positive (first rank) sx
excess or distortion of normal functioning (hallucinations)
66
negative (second rank) sx
lessening or loss of normal functions (affective flattening, alogia, avolition, anhedonia
67
schizophrenia duration
continuous sugns persist for at least 6 months with 1 month of symptoms
68
schizoaffective
similar sx to schizophrenia (+, -, neurocognitive sx) in addition to mood instability (depression & mania)
69
schizoaffective duration
delusions & hallucinations for 2 or more weeks in absence of major mood episode
70
psychotic disorder due to another medical condition
medical condition that causes hallucinations which result in clinically significant distress or impairment in functioning & not better explained by another mental disorder
71
examples of psychotic disorder d/t another medical condition
- brain tumor
- lupus
- hypoglycemia
- parkinsons
- dementia
- HIV
- huntingtons
- malaria
72
delirium
temp disorder of physical origin with an abrupt onset characterized by fluctuating consciousness and attention
73
risk factors for developing delirium
- post op opioid
- old age
- severe illness
- polypharmacy
- alcohol abuse
- infection
- pain
74
assessment for psychosis
- MSE, head to toe, diagnostics, critical thinking, RISK assessment, history, collateral
75
risk assessmetn
- tetrad lethality
- risk factors
- history of aggression, suicide, self harm
- CASE
- substance
- protective factors
76
priorities of care psychosis
- establish safety
- MSE & HTT
- rule out medical causes (MMSE, MOCA, scans, BW)
77
interventions psychosis
identify interventions most appropriate based on factors: setting, treatment goals, rapport & relationships, safety, resources, stage of treatment (acute, stabilization, maintenance, relapse)
78
examples of interventions for psychosis
- therapeutic self of self
- acknowledge distress
- choices
- decrease environmental stimuli
- set limits
- de-escalation techniques
- education
- reality feedback
- PRN
79
antipsychotic meds psychosis (1st)
- reduce + sx, min effect on - & cognitive sx
block dopamine
s/e: EPS, elevated prolactin, ortho hypotension, anticholingeric
80
2nd gen antipsychotics
- block dopamine and effect serotonin
- treat - + cog
- lower EPS
81
s/e antipsychotic meds
- cardio: QT prolongation, ortho hypo, myocarditis
- metabolic: weight gain, T2DM, dyslipidemia
- neuro: EPS
- agranulocytosis
- NMS
82
dystonia, akathisia, parkinsonism, TD medications
benztropine, procyclidine, propranolol, lorazepam, clonazepam
83
acute dystonia med
benztropine, diphenhydramine
84
aggression
defined as verbal statements & physical actions that re intended to threaten
abusive or intimidating behaviour
85
violence
threatned, attempted or actual physical harm to someone
86
affective violence
- intense anger or emotion, impulsivity to act out, often in response to interpersonal stress, frequently under influence of drugs
87
predatory violence
- often premeditated or preplanned
- frequently the predator derives pleasure from violent act
88
prevention of violence
- trauma informed approach
- recovery oriented & person centered practice
- cultural awareness
- sex & gender competence
89
- trauma informed approach
- recovery oriented & person centered practice
- cultural awareness
- sex & gender competence
looks like >>>>>
- respect, acceptance, empathy
- recognition of individual, their journey, & link b/w their experience
- promotes physical & psychological safety
- decreases chance of triggering client
- decrease misunderstandings b/w client & care provider
- helps to build the therapeutic relationship
90
important to remember with violence
- focus on safety & engagement
- recognize the need for physical and emotional safety
- recognize need for choice and control in decision making
91
predicting violence/aggression
1. past violence
2. male, young, environment (grew up in impoverished area with frequent violent behaviours)
3. presence of psychiatric disorder
4. relationship instability, employment problems, lack of insight, lack of interpersonal support
92
tetrad of lethality
- presenting with recent violent episode
- presenting with dangerous psychotic process
- indication from interview that pt intends to engage in violence
- indication from interview that pt lying and collaborative evidence suggests intended violence
93
chronological assessment of dangerous events (CADE)
1. presenting event
2. exploration of recent violent events
3. elicitation of past violent events
4. elicitation of immediate violent or homicidal ideation
94
physiologcal & behavioural cues of anger
internal: increased pulse, respirations, BP
prickly sensation, numbness, nausea, choking sensation
external: increased muscle tone, clenched fists, changes to eyes, lips pressed together, flushing, sweating
95
core pains
loneliness, self loathing, wronged, grief, loss of external/internal control, loss of meaning, fear of unknown, physical pain
96
type 1 moments of angry disengagement
1. confrontational disagreement
2. oppositional behaviours
3. passive aggressive attitudes
97
type 2 potentially disengaging questions
provocative qts that, depending on how they are managed by clinician, may lead to disengagement
98
methods for transforming points of disengagement
sidetracking, content response, process response, combo
99
tips for crisis prevention
- empathetic
- clarify messages & focus on feeling
- respect personal space
- flexible
- ignore challenging qt
- avoid overreacting
- nonverbal cues nonthreatening
- set & enforce reasonable limits
100
minimizing nurses own risk
1. use nonthreatening body language
2. respecting the client's personal space & boundaries
3. positioning themselves so that they have immediate access to the door of room in case
4. choosing to leave door open to an office while talking to client
5. knowing where colleagues are and making sure those colleagues knwo where they are
6. not wearing clothing that could be used to harm
101
crisis prevention institute stages
anxiety level (pt acting different) --> supportive approach (know pt, intervene gently)
defensive level (irrational) --> directive approach (calm, be in control)
acting out level (loses control & be verbally/physically aggressive) --> non-violent physical intervention (keep everyone safe, witness present, make report)
tension reduction (emotionally & physically drained) ---> therapeutic rapport (allow rest & relax, debrief)
102
de-escalation
interactive process of calming and redicting a patient who has an immediate potential for violence directed at others or self
103
de-escalation strategies
- comfort rooms/carts/boxes (mats, art, books)
- comfort plans (written guide developed collab w/ client & staff)
- safety plans
104
code white
call for help when workers perceive themselves to be in danger of physical harm
team approach
105
rule for seclusion
- least restrictive & least amount of time possible
- focus is prevention, reduction, and elimination of seclusion
106
chemical restraints
medications to manage behaviours
- prn given with client specific orders
- offer choice & use TR
107
3 meds used for chemical restraints
- benzo, typical & atypical antipsychotics
108
administer prn upon early signs of agitation to prevent further escalation & violence (t/f)
TRUE
109
benzo can be used for
alcohol withdrawal, seizures, agitation, panic/axniety
110
typical antipsychotics target
++ sx & effective in reducing agitation & violent behaviour
111
a client placed in restraints can not be ....
behind locked door or in closed seclusion room
112
seclusion flow sheet...
legal doc goes in chart
113
seclusion care
- q15 checks
- assessed by dr q24hr
- specific order
- food & fluids
- hygiene
114
What are the 4 elements necessary for a formal complaint to be about a nurse with BCCNM.
- name & contact info of person making complaint must be included
- full name of nurse whom complaint is about
- location where complaint occurred
- details of complaint
115
What are the 2 ways in which a formal complaint to BCCNM is resolved?
- consensual complaint resolution: consent agreements (legal agreement b/w BCCNM & registrant to address issue & take measures to better)
- investigation, inquiry: formal hearing, discipline committee decides disciplinary action
116
What health authority policy should you review prior to providing information to Law Enforcement if you are unsure if the information should be provided or withheld?
- release of information & belongings to law enforcement policy
117
Provide an example and rationale for 3 nursing interventions to help a client manage acute stress and/or panic.
- Re-establish routine and ADLs
- Facilitate in the development of positive coping skills
- Pharmaceutical interventions using benzodiazepines and antidepressants
118
What are 3 benefits to stress?
- Increases learning
- Increases alertness
- Develops resilience
119
The Psychiatric Nursing Assessment is not just the MSE. What other elements of the psychiatric nursing assessment are necessary? Why?
- Risk assessment for self-harm or suicide, important to establish safety measures
- Previous history of violence or aggression, important to become aware of potential behaviors
- Substance use history, may affect mood and behavior, health concerns
- Protective factors and supports, Helpful for planning resources and instilling hope/recovery
120
Consider the examples of Nursing interventions listed in the PowerPoint. Select four of these interventions and provide a rationale for each.
- Decrease environmental stimulation: Reducing stimulus can help to natural de-escalate
- Ask the client what they need: Inquiring and providing choice helps collaboration and problem-solving
- Administer medication: Sometimes medication is needed first in order to establish other interventions
- Allow space: Distance and time alone can help to alleviate feelings and emotions
121
What are the main significant potential side effects of antipsychotic medication, and what are the characteristic symptoms of each?
EPS
- acute dystonia: involuntary muscle contractions
- parkinsonism: mask-like face, drooling, tremors
- akathisia: restlessness
- akinesia: absence of movement
- pisa: leaning to one side
- rabbit syndrome: rabbit movement of face
Agranulocytosis
- flu-like symptoms (fever, headache, muscle aches, fatigue)
- decreased WBCs
Neuroleptic Malignant Syndrome (NMS)
- Changes in LOC
- Increased HR
- Diaphoresis
- Incontinence
