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5th Semester: Nursing > NURS 465: Exam 1 > Flashcards

NURS 465: Exam 1 Flashcards

(65 cards)

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1
Q

Introductory Statement

A

made at the beginning of a conversation/ meeting with a patient and includes: name, position/credentials, role/function in relation to the patient and approximate time to spend with patient

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2
Q

Closed questions & statements

A

Can be answered with yes or no statements, one-word answers
Ex: “Did you do your homework?”
Does not use who, what, when, where, and how in the question

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3
Q

Open-ended questions & statements

A

Can’t be answered with yes/no/one word
Questions start with who, what, when, where and how
Ex: “What’s the reason for not studying?
Exceptions: “could, would” can be used as open ended

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4
Q

General leads

A

Generic/ basic open questions to help open conversations

Ex: “How are you? Tell me about yourself”

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5
Q

Focusing questions and statements

A

Done in response to a patient listing several things they may be worried about, or having several problems or feelings
Ex: “Which of the things you mentioned worry you the most?”
“Tell me more about feeling depressed”

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6
Q

Clarification questions & statements

A

Type of open-ended question/statement used in clarifying the patient’s emotions
Ex: “What do you mean when you say…”
“I don’t quite understand what that means to you”

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7
Q

Emotional metaphor

A

Metaphor used to convey feelings

Ex: “stressed out, on my last limb”

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8
Q

Mixed feelings

A

Used in emotional metaphors; these particular emotions and depth of the emotions is not clear
Ex: upset, torn, confused, unsure

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9
Q

Clarifying questions

A

Appropriate response to emotional metaphors and mixed feelings to get a better understanding of what is being said by patient

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10
Q

Restatement

A

Simple and brief, repeat of the exact words of the patient’s last statement

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11
Q

Minimal encouragement

A

Brief verbal utterance

Ex: “Oh.. Mmm. I see”

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12
Q

Paraphrasing

A

Saying in your own words, and without changing the means, what you hear the patient is saying.
Effective paraphrasing: personalization (patient’s name); most important key words of the patient; distilled, shortened and clarified version of the patient’s statement, which catches the essence of what was said

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13
Q

Reflection of Feelings (ROF)

A

Reflecting back to the patient an unspoken emotion (feeling)
Complete reflective statement: includes and connects a feeling and a content issue and in some instances, a behavior
2nd type: simple statement or reflection by the nurse about a patient’s affect, or nonverbal communication which suggests an unspoken feeling

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14
Q

Check-out

A

Closed question that is asked following a paraphrase, reflection, or summarization
Less formal: change voice to a questioning tone at the end of a paraphrase, ROF, summary statement

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15
Q

Expression of empathy (empathic statement)

A

Short statement to express that you identify with the patient’s situation

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16
Q

Simple observation statement

A

Making a statement of a simple observation that the nurse has made of the patient’s current behavior, not feelings

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17
Q

Summarizing

A

Concise, tying together, or review of important thoughts, feelings and behaviors expressed by the patient during the interview
- summarize q2–30 min in the conversation

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18
Q

Circular questioning

A

Interventive questioning
Used when working with families or groups
Focus on the impact that the illness/injury has had on the functioning of the family system

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19
Q

Self-disclosure

A

Sharing something about the nurse with the patient that will help the patient toward specific health promotion goals
Must be used sparingly with the patient specific health promotion goals in mind and must be brief

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20
Q

Keeping self-disclosure “therapeutic” involves the following?

A
  1. Adhering to the goal of helping the patient open up to you and assist with “reality testing”
  2. Keeping disclosure brief
  3. Not implying that your own experience are the same as the patient’s experiences
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21
Q

Reframing

A

Presenting the patient situation, or what the patient has said from a different perspective

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22
Q

Normalizing

A

Help with reality testing

Telling patients and families that what they are going through is normal

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23
Q

Concepts of the nurse-patient relationship

A

Establish that the nurse is safe, confidential, reliable and consistent
Relationship with clear boundaries

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24
Q

Establish boundaries

A

Physical boundaries; the contract, personal space

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25
Transference
Patient unconsciously and inappropriately displaces onto nurse feelings and behaviors related to significant figures in patient's past - intensified in relationships of authority
26
Countertransference
Nurse displaces feelings related to the people in nurse's past onto patient - patient's transference to nurse results in countertransference in nurse - Common sign of countertransference in nurse is over-identification with the patient
27
Peplau's model of nurse-patient relationship
Orientation phase Working phase Termination phase
28
Orientation phase
``` Establishing rapport Parameters of the relationship Formal or informal contract Confidentiality Terms of termination ```
29
Working phase
Maintain relationship Gather further data Promote patient's problem-solving skills, self-esteem and use of language Facilitate behavioral change Overcome resistant behaviors Evaluate problems and goals (redefine them as necessary) Promote practice and expression of alternative adaptive behaviors
30
Termination phase
Summarize goals and objective achieved Discuss ways for patient to incorporate new coping strategies learned Review situations of relationship Exchange memories
31
Communication Process
Stimulus for information, comfort or advice 1. Sender - initiates contact 2. Message - sent or expressed 3. Variety of media - hearing, visual, touch, small 4. Feedback received
32
Process recording
Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse Useful tool for identifying communication patterns
33
MH-4
Filled out by MD after pt is brought to the hospital, through the ER. 48 hr emergency commitment
34
MH-5
Voluntary admission form signed by adult on admission
35
MH-5a
Voluntary admission form signed by minor done at the hospital. Family court sends an officer to sign the pt in once the pt is in the hospital
36
MH-6
Petition for involuntary commitment. MD completes form after 48 hr time period on the MH-4 and pt continues to show signs of dangerousness to self or others and is in need of tx for mental disorder. Max confinement is 90 days
37
Ethics
Study of philosophical beliefs about what is considered right or wrong in a society
38
Bioethics
Used in relation to ethical dilemmas surrounding health care
39
Ethical dilemma
Conflict between >2 courses of action, each with favorable and unfavorable consequences
40
5 principles of bioethics
``` Beneficence Autonomy Justice Fidelity/ nonmaleficence Veracity ```
41
Informal admission
Sought by Pt | MH-5
42
Voluntary admission
Sought by pt or guardian | MH-5/ MH-5a
43
Temporary admission
Person confused or demented So ill, he/she needs emergency admission MH-4
44
Involuntary admission
Without patient's consent | MH-6
45
Long-term involuntary admission
Medical certification, judicial review, administrative action MH-6
46
Conditional release
Required outpatient treatment for a specified period to determine the pt's adherence with medication protocols, ability to meet basic needs, and ability to reintegrate into the community
47
Unconditional release
termination of a patient-institution relationship
48
Release against medical advice (AMA)
Disagreement between mental health care providers and the pt whether hospital stay is necessary.
49
Patients' rights under the law
``` Right to treatment Right to refuse treatment Right to informed consent Right surrounding involuntary commitment and psychiatric advance directive Rights regarding restraint and seclusion Right to confidentiality ```
50
Patient Confidentiality
HIPAA Confidentiality after death Confidentiality of professional communications Confidentiality and HIV status Exceptions to the rule - Duty to warn and protect third parties - Child and elder abuse reporting statuses
51
Tort
Civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (defendant)
52
Intentional tort
Willful or intentional acts that violate another person's rights or property - assault, battery, false imprisonment, invasion of privacy, defamation of character (slander/libel)
53
Unintentional tort
Unintended acts against another that produce injury or harm | - negligence, malpractice
54
Documentation of care
A record's usefulness is determined by evaluating - when the record is read later - how accurately and completely it portrays the patient's behavioral status at the time it was written
55
When doing MSE for children and adolescents, consider:
Consider developmental level; Involves the family; Observational ; Use tools such as toys, play, stories, drawing; Reporting of neglect or abuse
56
When doing MSE for geriatrics, consider:
Changes in social roles in retirement; Brian changes; Decline of senses; Memory loss; Poly-pharmacy; High risk for suicide
57
Mental Status Exam (MSE)
Evaluation for medical, psychiatric and neurological disorders Nurse's observation of patient's behavior described in an objective manner Evaluation of the patient's current state
58
MSE: General appearance and behavior
Grooming, level of hygiene, clothing. Unusual physical characteristics/movements. Attitude. Ability to interact with interviewer. Psychomotor activity. Agitation/retardation. Degree of eye contact.
59
MSE: Affect
Affect—External range of expression— quality, range, and appropriateness. flat—absence of all or most affect blunted/restricted—moderately reduced range labile—multiple abrupt changes in affect full/wide-range—generally appropriate
60
MSE: Mood
Mood—Internal emotional tone— | dysphoric, euphoric, angry, anxious, euthymic
61
MSE: Thought Process
Thought Process—quality, quantity of speech. Tone, fluency Pressured speech. Rapid speech (manic) Poverty of speech. Minimal response, yes/no. Blocking. Sudden cessation, often in middle of statement. Flight of Ideas. thoughts jump idea to idea Loosening of association. Illogical shifting—unrelated topics. Tangentiality. wanders from the original point Circumstantiality. digression, eventually reaches the point Echolalia. Echoing of words and phrases. Neologisms. Invention of new words Clanging. rhyming, punning. Preservation. Repetiton of phrases or words Ideas of reference. tv talking directly to them.
62
MSE: Thought Content
Thought Content—perceptual disturbances Hallucinations. auditory, visual, tactile, gustatory, olfactory. Delusions. Persecutory, erotomanic, grandiose, somatic Derealization. Feelings of unrealness—outer environment Depersonalization. Observing self from outside the body Suicidal/Homocidal Ideation—intent, plan
63
MSE: Cognitive Evaluation
Level of consiousness Orientation. Person, place, date attention and concentration. WORLD short-term memory. Recall 3 objects after 5 minutes fund of knowledge. Name past 5 presidents, 5 lg cities. Calculations. Serial seven subtraction, simple math Abstraction. Proverb interpretation, similarities
64
MSE: Insight
Able to show understanding of current problems/implication
65
MSE: Judgment
Ability to make sound decisions regarding daily activities | Best evaluation by pt's hx of decision making, not hypothetical questions

5th Semester: Nursing (1 decks)

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