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NUR 3015 exam 1 > study guide exam 1 > Flashcards

study guide exam 1 Flashcards

1
Q

what are the 4 lobes of the brain

A

frontal, parietal, occipital, temporal

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2
Q

what are the 4 parts of the limbic system

A

hippocampus, amygdala, anterior thalamus, hypothalamus

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3
Q

describe the frontal lobe

A

executive function and personality
- maintains & focuses attention, organize thinking, speech & motor activities
- weights consequences , set goals, modulates emotions, integrates ideas, emotions & perceptions

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4
Q

describe the parietal lobe

A

body sensations, maintains focused attention
- motor activités - attention & perception of spatial relations
- processes sensory impulses from thalamus

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5
Q

describe the occipital lobe

A

vision and visual memory
- reading, language formation, reception of vestibular, acoustic and tactile stimulus (hearing)

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6
Q

describe the temporal lobe

A

processing of auditory stimuli, emotion, learning, and memory circuits
- gives emotional tone to memories. is involved in making moral judgements, registers acts of aggression
- “warm memory”

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7
Q

describe the limbic system (LOBE)

A
  • paleomammalian brain
  • response for emotions, behaviors, LTM, olfaction (smell)
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8
Q

function of hippocampus

A

LTM for recall, learning, sensory integration

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9
Q

function of amygdala

A

reward, fear, anxiety, anger, emotion, social behavior, impulsive gut responses
- ex: addiction (no processing)

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10
Q

function of anterior thalamus

A

relays sensory & motor signals to cerebral cortex along with regulating of consciousness, sleep, and alertness
- ex: insomnia, wake up throughout the night

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11
Q

function of hypothalamus

A

regulates homeostasis, hunger, thirst, temperature, body functions, corticosteroid production

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12
Q

5 neurotransmitters learned DANGS

A

dopamine
norepinephrine
GABA
acetylcholine
serotonin

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13
Q

describe acetylcholine

A
  • derived from coenzyme A
  • widely distributed in: cortex
  • plays a role in: learning, memory, movement
  • implication in nicotine dependence
  • contributes to excessive arousal of thought with use of cocaine & amphetamines
  • tip: feeds addiction
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14
Q

describe GABA (NT Gamma-Amino butyric acid)

A
  • inhibitory NT widely distributed throughout: nervous system
  • responsible for: slowing activity of nerve cell
  • inhibitory effect involved in: anxiety, agitation, seizures
  • involved in sedative effects of benzodiazepines, barbiturates, and ETOH (alcohol)
  • helps with relaxation, sleep, slows body and brain down
  • tip: calms anxiety
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15
Q

describe glutamate (NT GLU)

A
  • derived from proteins in the diet
  • excitatory NT found throughout the brain
  • important in learning
  • triggered w/ hallucinogens (PCP- acid, LSD, extra psychotic effects)
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16
Q

describe norepinephrine (NT NE)

A
  • derived from tyrosine (amino acid)
  • projects broadly throughout the brain
  • responsible for arousal & response to stress
  • most likely activated in ADHD & anxieties (too much NE)
  • cocaine & amphetamines affect the transmission of NE & contribute to the stimulating & pleasurable effects of these drugs
  • TIP: fight/flight, energy, appetite, BMR, socializing
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17
Q

describe serotonin (NT 5HT)

A
  • derived from tryptophan (amino acid) (milk, turkey)
  • initiates in midbrain & broadly projects throughout the cortex, hypothalamus and limbic system
  • receptors found in brain, gut, platelets, and spinal cord
  • path most likely involved in pain, movement, sleep, appetite, anxiety, depressive mood mental health disturbances
  • tip: LSD & ecstasy have their primary effects in the serotonin pathways. Cocaine, amphetamines, ETOH & nicotine also affect serotonin transmission. SSRIs cause GI upset r/t receptors
  • plays a role in sleep regulation, hunger, pain perception, aggression and sexual behavior
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18
Q

describe NT dopamine (DA)

A
  • derived from tyrosine (amino acid)
  • projects to amygdala, nucleus accumbens (deep midbrain), through limbic system * many paths
  • involved in movement, learning, pleasure, motivation
  • 4 pathways: mesolimbic, mesocoritcal, basal ganglia, pituitary, thalamus
  • pleasure, socializing, food seeking, reward, addiction
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19
Q

describe mesolimbic path for DA

A

reward path activated by most drugs of abuse
- path most likely activated in mania, psychosis, schizophrenias (increase DA = flat affect, poverty though/emotion, triggered hallucinations)
- all antipsychotics work by decreasing DA in this path

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20
Q

describe mesocortical path

A

mediates cognitive and affective sx.
- path is considered one of executive function
- most likely to be activated in depression, catatonia, decreased attention, concentration, mania, schizophrenia
- decreased DA = negative sx.
- antagonist antipsychotics work by decreasing dopamine

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21
Q

describe basal ganglia path

A

extrapyrimidal system
- path is prominent for motor control
- most likely path activated in Parkinson’s, EPS, movement disorders, coreas
- antagonist antipsychotics work by decreasing DA (but path is also saturated w/ ACH)
- when DA drops = ACH increase which can cause EPS (akathisia, dystonia, TD or peudoparkinsonism)

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22
Q

describe pituitary path

A

projects from hypothalamus to anterior pituitary
- path considered sexual dysfunction, weight gain, hyperprolactinemia (increase lactation/ breast enlargement in men)
- all antagonist antipsychotics work by decreasing DA
- when DA drops = release of prolactin -> breast enlargement, galatorhea (breast milk secretion) or amenorrhea

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23
Q

NT DA and mental health correlation

A
  • increase DA = schizophrenia, mania, psychosis, + sx.
  • decrease DA = depression, Parkinson’s disease
  • responsible for: pleasure, socializing, food seeking, reward, addiction
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24
Q

NT NE and mental health correlation

A
  • increase NE: arousal, mania, anxiety states, schizophrenia
  • decrease NE: depression
  • responsible for: fight/flight, energy, appetite, BMR, socializing
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25
Q

NT GABA and mental health correlation

A
  • increase GABA: reduced anxiety
  • decreased GABA: anxiety disorders, schizophrenia
  • responsible for: inhibitory NT, emotional balance, sleep
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26
Q

NT ACH and mental health correlation

A
  • increase ACH: depression
  • decrease ACH: Parkinson’s disease, Alzheimer’s disease, Huntington chorea
  • responsible for: memory
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27
Q

NT 5HT and mental health correlation (serotonin)

A
  • decrease 5HT: depression, worthlessness, suicidal ideation, appetite, sleep
  • increase 5HT: anxiety states, expansive irritable mood, grandiosity, agitation (bipolar)
  • responsible for: sleep regulation, hunger, pain perception, aggression and sexual behavior
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28
Q

describe activities of neurons

A
  • conduction along neuron involves inward movement of sodium ions followed by outward movement of potassium ions
  • when current reaches end of the cell, neurotransmitter is released
  • the neurotransmitter crosses the synapse and attaches to a receptor on the post synaptic cell
  • attachment of neurotransmitter to receptor either stimulates or inhibits postsynaptic cell
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29
Q

describe cellular reuptake

A
  • once receptor reaches postsynaptic cell and exerts its influence, it separates from receptor and gets destroyed by enzyme starting with the NT name and ending was -ase
  • 1/2 ways NT can be destroyed
  • meaning: NT taken back into presynaptic cell from which they were originally released and either reused or destroyed by intracellular enzymes
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30
Q

describe voluntary admission to psychiatric units

A
  • client seeks admission through written application
  • has the right to demand release (usually) -> provider says no, pt. cannot leave (liability)
  • has the right to demand release
  • staff may detain if the client is at risk
  • client may refuse meds & treatment
  • may be restrained, secluded or given “prn” medications against their will if a danger to self or others
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31
Q

describe involuntary admissions to psychiatric units

A
  • admission made without consent
  • made if client is a danger to self or others; not able to meet own basic needs; judgement is so impaired that does not understand need for treatment, and has a diagnosed mental illness
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32
Q

describe involuntary commitment procedure

A

1) petition by concerned individual
2) cert #1: attests to code def. of MI, done by MD or PhD, within 72 hours
3) cert #2: done within 24 hours of 1st, by MD
—if patient disagrees—
4) court docket within 7 days
5) pt. seen by psychological lawyer, case reviewed
6) probate court: judge hears evidence and rules
7) client has right to trial (w/ jury if desired) and be represented by an attorney (court appointed if needed)
8) testimony from petitioner, MD, or PhD, patient given
9) judgement based on testimony and least restrictive setting treatment option (outpatient privileges)
10) if committed, client must take medications
11) may be discharged earlier than ruling based on MD assessment

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33
Q

what are the rights of a hospitalized patient

A
  • to be treated with dignity
  • to be involved with treatment planning
  • to refuse treatment
  • to leave the hospital
  • to have legal representation
  • to have private conversations, use of phone
  • confidentiality (be mindful to patients, ask if comfortable)
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34
Q

inpatient vs. community setting

A

—–inpatient——
- locked unit
- staff set boundaries
- regular food, housekeeping, security services
- medication encouraged
- milieu (wandering around nurses station)
- health care team support
——CMH—–
- locked apartment
- client set boudandaries
- erratic food, housekeeping, security services
- client may be noncompliant (up to pt.)
- social isolation (or opposite)
- limited support (need education)

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35
Q

inpatient vs. community goals

A

——inpatient——
- client symptoms will be stabilized
- client will return to community
—–CMH—-
- client will maintain stability in the comunity
- client will participate as active member of treatment team
- client will demonstrate improved ability to function

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36
Q

inpatient vs. community interventions

A

—–inpatient——
- enforced by seclusion and restraint
- development short term therapeutic relationship
—–CMH——-
- access negotiated with client or gained through family, police, or landlord
- maintain long term relationship

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37
Q

inpatient vs. community medication/socialization activities

A

—inpatient—-
- supervised, even court-ordered
- socialization: provided and required
—–CMH——
- negotiate consent for and adherence to taking medication
- assist client to identify and use community resources (self-governed activities, integrate into community)

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38
Q

inpatient vs. community self care, nutrition, health care activities

A

—-inpatient—-
- assist self care, nutrition
- health assessment and intervention prn
——CMH—–
- negotiate meaning of adequate self care, nutrition, and health care with client and social support system
- assist client in assessing for needed community services (DHS, rides -> provider)

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39
Q

inpatient vs. community sociocultural context

A

—inpatient—-
- develop plan of care that attends sociocultural context of individual
—-CMH—–
- work with client and support system to plan and implement care consistent with sociocultural belief system and context
- want family to be involved

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40
Q

what is anxiety vs. fear

A

anxiety: reaction to an unspecified danger
fear: reaction to a specific danger

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41
Q

physical sx. associated w/ anxiety

A
  • palpitations
  • sweating
  • trembling
  • SOB
  • feelings of choking
  • chest pain/discomfort
  • nausea
  • feeling dizzy
  • unsteady
  • chills or heat sensations
  • paresthesias (N/T)
  • feelings of detachment
  • fear of losing control
  • fear of going “crazy”
  • fear of dying
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42
Q

substances inducing anxiety 8

A
  • alcohol
  • caffeine
  • cannabis
  • hallucinogens
  • inhalants
  • opioids
  • amphetamines
  • cocaine
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43
Q

4 stages of anxiety

A

mild, moderate, severe, panic

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44
Q

mild anxiety

A
  • perceptual field heightened
  • grasp what is happening
  • identifies disturbing things
  • can work toward a goal
  • examine alternatives
  • experiences slight discomfort
  • restlessness, irritability
  • mild tension reliving behaviors
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45
Q

moderate anxiety

A
  • perceptual field narrows
  • selective inattention
  • needs to have things pointed out
  • problem solving ability moderately impaired
  • benefits from guidance
  • shaky voice, concentration difficult
  • SNS symptoms
  • somatic complaints
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46
Q

severe anxiety

A
  • perceptual field greatly reduced
  • attention scattered
  • self absorbed
  • can’t attend events or see connections
  • perceptions distorted
  • feelings of dread/doom
  • SNS symptoms
  • confusion, purposeless activity
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47
Q

panic level anxiety

A
  • unable to focus on environment
  • terror, emotional paralysis
  • hallucinations/delusions
  • muteness, severe withdrawal
  • immobility or extreme agitation, severe shakiness
  • disorganized, irrational thinking
  • unintelligible speech
  • sleeplessness
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48
Q

interventions: mild to moderate anxiety

A
  • help identify anxiety & antecedents to anxiety
  • anticipate anxiety provoking situations
  • demonstrate interest
  • encourage talk about feelings and concerns
  • keep communication open
  • use clarification to understand
  • encourage problem solving
  • use role playing, modeling
  • explore behaviors use in past
  • provide outlets for excess energy
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49
Q

interventions: severe to panic anxiety

A
  • maintain calm manner
  • remain with client
  • minimize environmental stimuli
  • use clear, simple statements and repetition
  • low pitched voice, speak slowly
  • reinforce reality if distortions occur
  • listen for themes
  • meet physical and safety need
  • set verbal limits/physical limits
  • assess need for medication or seclusion
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50
Q

defenses against anxiety (defense mechanisms)

A
  • automatic coping styles, most people use a variety
  • protect and manage conflict & lower anxiety
  • blocks feelings, memories
  • are relatively unconscious, not always apparent
  • are reversible
  • are adaptive as well as maladaptive
  • consider frequency, intensity, duration of use
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51
Q

criteria for OCD

A
  • obsession
  • compulsion
  • rules rigidly applied (cleaning, ordering, counting, checking, repeating words silently)
  • person knows obsessive/compulsion are excessive & unreasonable
  • cause increased distress & is time consuming (more than 1/hour day)
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52
Q

describe obsession

A

persistent unwanted thoughts, urges, intrusive (taboo, aggressive, sexual, religious, harm)

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53
Q

describe compulsions

A

repetitive behaviors or mental acts; driven to perform in response to an obsession

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54
Q

OCD intervention

A
  • anticipate needs, esp. for information
  • focus on clients rather than on rituals
  • monitor nutrition/sleep; encourage meals/rest
  • avoid hurrying client
  • do not arbitrarily forbid rituals; give positive reinforcement for non-ritualistic activity
  • psychoeducation: medication, interrupting obsessive thoughts
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55
Q

criteria for PTSD

A
  • person witnessed or experienced a life threatening event (learned that the event occurred to close friends or family)
  • event is persistently re-experienced
  • avoidance of stimuli associated with trauma
  • persistent symptoms of arousal
  • begin within the first 3 months after trauma or delayed by months or years. increased suicide risk
  • can occur in children, duration more than one month
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56
Q

ex. of person witnessed or experienced a life threatening event

A
  • death to self or others
  • violence
  • sexual assault
  • horror
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57
Q

ex. of event is persistently re-experienced

A
  • images
  • dreams
  • flashbacks
  • distressing memories
  • psychological distress
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58
Q

persistent symptoms of arousal ex.

A
  • insomnia
  • irritability
  • angry
  • outbursts
  • difficulty concentrating
  • alt. in mood
  • amnesia
  • reckless or self-destructive behavior
  • problems with concentration
  • exaggerated startle response
  • sleep
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59
Q

PTSD interventions

A
  • assess type of trauma, immediate action -> later coping
  • early intervention is key
  • assess pre and post trauma functioning, including drug and ETOH use
  • explore shattered assumptions
  • promote discussion of possible meanings of event (individual or group therapy), meds of anxiety/depression, anxiety reduction techniques
  • suggest that client not responsible for event, but is responsible for coping
  • identify social support and encourage us of support group
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60
Q

OCD interventions

A
  • anticipate needs, esp. for information
  • focus on client rather than on rituals
  • monitor nutrition/sleep; encourage meals/rest
  • avoid hurrying client
  • do not arbitrarily forbid rituals; give positive reinforcement for non-ritualistic activity
  • psychoeducation: meds, interrupting obsessive thoughts
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61
Q

criteria of phobia

A
  • irrational fear or an object of situation that persists although the person recognizes it as unreasonable
  • anxiety is severe if the object of situation is encountered
  • types include: agoraphobia, social phobia, specific phobias
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62
Q

phobia intervention

A
  • determine type of phobia & onset
  • explain anxiety ds.
  • have client list consequences of contacting feared object
  • identify therapies for phobias
  • systematic desensitization
  • teaching relaxation techniques - deep breathing, progressive muscle relaxation, meditation, visual imagery
  • model unafraid behavior - therapist is active, coach
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63
Q

medications for anxiety disorder

A
  • anxiolytics drugs: benzodiazepines (valium, xanax, Ativan, klonopin, etc.)
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64
Q

describe anxiolytics (use

A

useful on short term basis if anxiety is moderate to severe

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65
Q

describe anxiolytics (side effects)

A

sedation, decreased cognitive function, ataxia, dependence and addiction may develop

66
Q

describe anxiolytics (teaching)

A
  • avoid liquor
  • caffeine
  • pregnancy
  • breast feeding: may cause withdrawal if used for 3 months or more
  • DO NOT STOP ABRUPTLY: reduces the ability handle machinery - very important
67
Q

medication for depression

A

tricyclics drugs: antidepressant medications

68
Q

tricyclic use

A

used to prevent panic attacks, phobias, PTSD

69
Q

tricyclic drugs

A

anafranil (good for OCD) (elavil), tofranil, pamelor

70
Q

describe SSRIs

A

selective serotonin reuptake inhibitors

71
Q

SSRI use

A

treat OCD, panic, agoraphobia, GAD (generalized anxiety ds.)
- inhibits reuptake of serotonin so that more serotonin is available “feel good hormone”

72
Q

SSRI drug

A

buspar: non benzo anti anxiety medication
- 2-4 weeks to work, not addicting, good for long term

73
Q

interventions for dealing with anxiety

A
  • assess level first
  • if moderate: stay with client, decrease stimulation, determine trigger if possible, try talking to patient if possible, journaling, exercising, thought stopping, CBT
  • if severe to panic: use slow simple communication, quiet, non stimulating safe environment, deep breathing, visualization, progressive muscle relaxation, meds PRN!!
  • monitor own feelings
74
Q

antidepressants SSRIs

A
  • citalopram (celexa)
  • escitalopram (lexapro)
  • fluoxetine (prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
75
Q

anti anxiety agents: benzodiazepines

A
  • alprazolam (xanax)
  • diazepam (valium)
  • lorazepam (Ativan)
76
Q

serotonin partial agonists

A

buspirone (BuSpar)

77
Q

other classes: beta blocker, antihistamine

A

beta blocker: propranolol (inderal)
antihistamine: duphrenhydramine (Benadryl)

78
Q

SNRI’s meds

A

duloxetine (Cymbalta)
venlafaxine (effexor)

79
Q

tricyclics meds

A

amitriptyline (evail)
clomipramine (anafranil)
imipramine (tofranil)

80
Q

what is mental health

A

successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and ability to cope with challenges

81
Q

what is mental disorders

A

health conditions characterized by alterations in thinking, mood, and or behavior associated with distress and or impaired functioning

82
Q

what is mental illness

A

refers to all diagnosable mental disorders

83
Q

some attributes of mental health

A
  • accurate appraisal of reality
  • ability to experience joy
  • ability to take responsibility for own actions
  • ability to control own behavior
  • think clearly
  • relate to others
  • ability to work and be productive
  • ability to play and laugh
84
Q

mild characteristics of mental health (2)

A
  • daily joys and sorrows
  • manageable anxiety levels inherent in living - not w/o s/sx but coping and functional ADLs
85
Q

moderate to severe characteristics of mental health

A
  • anxiety ds.
  • personality ds.
  • eating ds. - marked distress
  • notable s/sx with moderate impairment in function and ADLs
86
Q

severe to psychosis characteristics of mental health

A
  • depressive & bipolar ds.
  • schizophrenia ds.
  • cognitive ds.
  • severe/chronic s/sx resulting in impairment in quality of life, unable to manage ADLs or societal role successfully
87
Q

culture and diversity

A

what does a group accent as normal? varies amongst cultures and groups

88
Q

what is the DSM V

A

diagnostic and statistical manual (5th edition)
- provides specific criteria for the diagnosis of 157 mental disorders (20ch.)
- classifies ds., useful in clinical, research, and teaching
- environmental problems listed as codes
- global functioning measured by WHO disability assessment
- provides uniformity across practice settings
- available online through WSU library system

89
Q

ex. of DSM 5 disorders

A
  • autism spectrum disorder: autistic DO, Rhett’s DO, aspergers DO
  • major neurocoginitive ds: dementia, Alzheimer’s type
  • alcohol use ds: alcohol intoxication
  • schizophrenia: no changes
  • mood ds: bipolar, MDD, no changes
  • anxiety ds: panic, PTSD, GAD, phobia, no changes
90
Q

what is stress

A

state produced by a change in the environment perceived as threatening, challenging, or damaging to well being

91
Q

what does stress produce

A

biochemical, physiological, cognitive and behavior changes directed at adjusting to the effects of the stress

92
Q

________ & ________ are central to psychiatric ds. and provision of mental health care

A

stress; our responses

93
Q

early life exposure to stressful events related to greater incidence of?

A

all mental illnesses as adults (ETOH, drug dependence, eating disorders, PTSD, suicidal behaviors

94
Q

what does the stress-diathesis model state

A
  • genetic combinations
  • emotional and psychiatric disorders arise form interaction of negative life events with pre-existing vulnerabilities
95
Q

what are the 4 types of stressors

A
  • environment
  • social
  • demanding
  • life events
96
Q

what is the general adaptation syndrome

A
  • perception of threat
  • 3 stages: alarm, resistance, exhaustion
97
Q

what is the alarm stage of general adaptation syndrome

A
  • acute, brief, adaptive (fight or flight); sympathetic
  • hypothalamus -> adrenals -> catecholamine adrenalin (increases HR, RR, BP for strength/speed, pupils dilate, blood diverted away from GI tract and kidneys)
  • adrenal cortex -> corticosteroids (muscle endurance. stamina)
  • endorphins released to create sense of pain and injury
98
Q

what is the resistance state of general adaptation syndrome

A
  • AKA adaptation, sustained and optimal resistance to stressor occurs
99
Q

what is the exhaustion stage of general adaptation syndrome

A
  • when attempts to resist fail, resources are depleted, stress may become chronic -> wide array of physical/psychological sx. even death may occur
100
Q

distress

A

negative draining energy - anxiety, depression, confusion, helplessness, hopelessness. fatigue

101
Q

eustress

A

positive, beneficial energy, motivates and results in feelings of happiness, purpose, etc.

102
Q

what is stress on males

A

fight or flight

103
Q

what is stress on females

A
  • tending and befriending
  • protection of young
  • reliance on social network for support
  • more sensitive to corticotropin - reading factor (peptide hormone release in response to stress)
104
Q

there is a strong relationship between

A

stressful life events and depression

105
Q

what are the 4 phases of interpersonal process

A

orientation: getting to know patient, building rapport and trust
identification: main problem?
working: interventions, teaching, counseling
resolution: problems resolved, no longer in range of hurting themselves or others

106
Q

nursing role in mental health

A
  • focus is on client
  • nurse is participant observer
  • nurse has awareness of role
  • nursing is investigative
  • nurses use theory
  • developed processed recording
107
Q

agonists drug vs neurotransmitter

A

mimics the effects or neurotransmitters naturally found in the human brain by binding to and stimulating the receptor site

108
Q

antagonists drug vs neurotransmitters

A

block neurotransmitters, thereby obstruct neurotransmitter’s action

109
Q

what are the 3 types of defenses against anxiety

A

repression
displacement
rationalization

110
Q

what is repression

A

stressful, painful proving memories are actively prevented from entering conscious thoughts, but patient still feels sad
-ex: patient has repressed memories of abuse/trauma as a child, difficult time forming relationships

111
Q

what is displacement

A

taking out emotions onto safe object or person

112
Q

what is rationalization

A

making excuses

113
Q

what are defense mechanisms

A

temporary protection until patient can accept what’s happening
- blocks feelings and memories
- freud: “things are going on in the unconscious mind that birth defense mechanisms”

114
Q

adaptive vs. maladaptive defense mechanisms

A
  • adaptive: helps you by blocking overwhelming anxiety
  • maladaptive: blocks reality from ever reaching consciousness
115
Q

what is the mental status exam

A

part of the assessment in all areas of medicine
- analogous to the physical exam in general medicine and the purpose is to evaluate an individual’s current cognitive process
- aids in collecting and organizing objective information

116
Q

what does the nurse observe in mental status exam

A
  • patient’s physical behavior
  • nonverbal communicatoin
  • appearance
  • speech patterns
  • moods and affect
  • thought content
  • cognitive ability
  • insight and judgement
117
Q

what are the 4 therapies learned

A

short term, cognitive, behavioral therapy

118
Q

what is short term therapy

A
  • fewer than 10 sessions
  • for relatively healthy and well function clients
  • rapid, back and forth between client and therapist
  • based on present problems
  • goals is to help client understand and cope better
119
Q

what is cognitive therapy

A
  • active, directive, structure, and time limited
  • based on theory that thoughts affect mood
  • goal: identify, reality test, and correct distorted thinking to help mood and behavior
  • client learns to question and challenge their thinking (ex; what is the evidence for this: am I overgeneralizing, catastrophizing, assuming worst case scenario)
120
Q

what is behavioral therapy

A
  • focus: learning more adaptive behavior
  • applications: operant condition, modeling, systematic desensitization, aversion therapy, relaxation
  • therapist: active and directive
121
Q

what are neurotransmitters

A

chemical signals between the neurons (neurotransmitter) allow for communication between neurons
- neuromessenger
- released from axon terminal at presynaptic neuron on excitation
- crosses synapse to adjacent postsynaptic neuron, where it attaches to receptors on the neuron’s surface
- once attached to receptor and exerting its influence on postsynaptic cell, neurotransmitter separates from the receptor and is destroyed

122
Q

how do neurotransmitters work

A
  • neurons have the ability to communicate by conducting an electrical impulse from one end of the cell to another
  • cellular membranes are electrically charged due to ions inside and outside cell
  • communication between neurons occurs mainly through sodium (Na) and potassium (K) ions.
  • resting state: unequal distribution of these two on the inside of the cell membrane and the outside. there are lots of positively charged potassium ions just inside the membrane and lots of sodium ions (along with some potassium ions) on the outside.
  • intracellular space is more negative when compared with the extracellular space ions
123
Q

what are the 2 ways neurotransmitters are destroyed

A
  • specific neurotransmitters (acetylcholine) at post synaptic cell
  • other neurotransmitters (norepinephrine) are taken back into presynaptic cell, from which they were originally released by a process called reuptake
  • either reused or destroyed by intracellular enzymes
124
Q

what is suicide

A
  • 8th leading cause of death in US (75 a day)
  • rate increasing for 15-24 year olds
  • highest risk: elderly males, over 65, increases with age, illness, losses
  • men > women to commit (men are more lethal)
  • risk factors: depression, ETOH, hopelessness
125
Q

what are the suicide warning signs

A
  • suicidal talk
  • death preoccupation (planning funeral, giving away things, giving away career)
  • behavioral changes/signs of depression (lack hygiene, low mods, increased substance use)
  • giving away possessions, finishing business
  • appetite/sleep disturbances
  • taking excessive risks, increased drug use
126
Q

what is the suicide assessment

A
  • ask if thoughts are present?
  • if so, is there a plan?
  • what is the plan?
  • do they have access to the plan
  • how lethal is the plan? make a contract & ALERT
  • assess risk factors: past attempts, family hx., degree of hopelessness, isolation, medical condition, social supports (or lack thereof)
    “you sound like you’re suicidal, are you thinking about ending your life”
127
Q

what are the nursing interventions for suicide

A
  • if in hospital = precautions (1:1, q15min, GSP)
  • observe mood, behavior, thoughts, secure unit, follow unit policies
  • PRN’s if antipsychotics needed
  • establish rapport & rally supports
  • drug therapy, psychotherapy (providers aware)
  • crisis hotline phone number given at DC
  • encourage ventilation & problem solving (general safety protocol)
128
Q

minimizing suicidal opportunity

A
  • suicide precautions 1:1 monitoring OR
  • suicide observations q15m visual checks PLUS
  • plastic utensils, dinnerware
  • do not assign to private room
  • do not allow extended time alone in room
  • break away shower rods, recessed shower nozzles
  • short electrical cords
  • lock unbreakable windows and safety screens
  • lock utility and examining rooms, kitchens, stairwells, offices, closets
  • remove harmful objects from clients: belts, shoelaces, metal nail files, scissors, razors, tweezers, matches, meds, cords, perfume, glass containers
  • inspect gifts from visitors and remove harmful objects
  • ensure that visitors do not leave harmful objects
  • some agencies inspect client unit after visiting hours
  • search client for harmful objects on return from pass
129
Q

what are the characteristics of high risk patients for suicide

A
  • 1:1 status
  • client verbalizing clear intent to harm self
  • unwilling to make contract
  • no insight into problems
  • poor impulse control
  • delusional, hearing voices
  • prior attempts
130
Q

suicide can be

A
  • impulsive or have lots of thoughts and planning put into it
  • intentional: self harm, have a plan
  • unintentional: OD
  • study shows that population of people with past suicide attempts, only 10% were really intent on carrying it through
131
Q

goals of therapeutic relationship

A
  • facilitate communication of distressing thoughts & feelings
  • assist in problem solving
  • help examine self defeating behaviors and test alternatives
  • promote self care and independence
132
Q

types of relationships

A

social, intimate, therapeutic

133
Q

social relationship

A

primarily for friendship or task accomplishment
needs are mutually met
communication
- often superficial
- techniques: advice, meeting dependency needs

134
Q

intimate relationship

A
  • between two individuals with an emotional commitment to each other
  • mutual needs met
  • communication (personal info., intimate desires, fantasies shared)
135
Q

therapeutic relationship

A
  • between nurse/client to enhance client growth
  • focus on client issues, problems, and concerns
  • communication (therapeutic technique used to identify and explore needs, set goals, assist in development of new coping skills encourage behavioral change
136
Q

factors enhancing growth in others 4

A
  • genuineness: congruence
  • empathy: understanding ideas expressed and feelings present in the other
  • positive regard: implies respect: attitudes, actions (attending, suspending value judgements)
  • helping clients develop resources: awareness, encouragement
137
Q

bounding blurring

A

relationship slips into a social context
- nurse behavior meets personal needs at expense of client: (1) over helping, (2) controlling, (3) transference, (4) countertransference

138
Q

4 phases of relationship (peplau)

A
  • preorientation
  • orientation
  • working
  • termination
139
Q

preorientation relationship

A

pre meeting concerns

140
Q

orientation relationship

A

setting atmosphere
begin rapport
nurse’s role defined
confidentiality
problems are identified
set time, place, and duration of meeting

141
Q

working relationship

A

problem solving
work on change
support efforts
alternative adaptive behaviors

142
Q

termination relationship

A

summarize goals achieved
incorporate into daily life
exchange memories that validate the experience

143
Q

factors beneficial to relationships

A
  • consistent, regular and private interactions with client (w/ assigned nurse, regular routine of activities)
  • being honest/congruent
  • letting client set the pace
  • listening to client concerns
  • positive initial attitudes and preconceptions
  • promoting client comfort and balancing control
  • client demonstrating trust and actively participating in relationship
144
Q

factors of the client interview (how to start)

A
  • setting: open area, physical space, confidentiality, set tie
  • seating: arms length, eye contact if permitted
  • introductions
  • turning it over to the client: “where should we start?” “tell me a little about what has been going on” “what are some of the stresses you’ve been dealing with lately” “perhaps you could start by telling me what brought you to the hospital”
145
Q

factors to help the client (4)

A
  • identify and explore problems relating to others
  • discover healthy ways of meeting emotional needs
  • experiences satisfy interpersonal relationships
  • feel understood and comfortable
146
Q

active listening components (5)

A
  • observing nonverbal behaviors
  • listening to/understanding verbal messages
  • understanding in context of life
  • listening for inconsistencies
  • giving feedback
147
Q

4 therapeutic techniques

A
  • silence
  • active listening
  • clarifying
  • questions
148
Q

silence therapeutic technique

A

meaningful moments, reflection

149
Q

active listening technique

A
  • observing verbal/nonverbal
  • understanding & reflecting on verbal message
  • context
  • inconsistencies
  • helps strengthen pt’s ability to solve problems
150
Q

clarifying technique

A

paraphrasing
restating
reflecting
exploring

151
Q

questions technique

A

open ended (what, how, what if..)

152
Q

clinical interview guidelines

A
  • speak briefly
  • when you don’t know what to say, say nothing
  • lead with empathy
  • when in doubt, focus on feelings
  • don’t always rely on questions
  • pay attention to non verbal cues & possibly comment on them
    ex: open ended question (what, where, when, tell me about), clarifiers (I’m not sure I understand, who is they), explorers (tell me more about your relationship with your wife, give me an example of how she was “mean” to you), empathetic statements (that must have been really hard for you, I can see how upset you are about the marriage ending)
153
Q

obstructive techniques

A
  • asking close ended questions (unless during intake interviews)
  • giving approval/disapproval
  • advising
  • asking “why” questions -> try “what”
  • giving premature advice (give none period)
154
Q

what are the components of the mental status assessment

A
  • appearance
  • behavior
  • speech
  • mood & affect
  • thought process/content
  • perceptual disturbances
  • cognition
    (obj/subj data)
155
Q

what is the nursing process in mental health nursing

A

serves as problem solving approach for:
- safe, competent, relevant, quality care
- for patients, families, groups
- based on theory
- serves as foundation for the standards of practice
- special considerations for children, adolescents, elderly, language barriers

156
Q

what is part of the assessment

A
  • psychosocial
  • spiritual/religious
  • mental status examination
  • history taking
  • interviews
  • standardized rating scales (screeners)
  • verify the data - secondary sources (family)
157
Q

nursing diagnosis for mental health

A
  • based on NANDA
  • unmet need or problem
  • etiology or probable cause
  • supporting data
  • common Nsg Dx: domains 5,6,9 (& others)
    ex: ineffective impulse control, impaired verbal communication, hopelessness, risk for loneliness, disturbed personal identity, chronic low self esteem, ineffective coping
158
Q

goals and outcomes for mental health

A
  • goals are broad, rider to the nursing diagnosis statement, can be short term or long term
  • outcomes are measurable, specific, and support the goal; a way of defining the goal
159
Q

interventions for mental health

A
  • coordination of care
  • health teaching
  • pharmacological
  • biological
  • strive for evidence based actions
160
Q

evaluation for mental health

A
  • patient’s response to treatment
  • systematic ongoing criteria based
  • allows for revision of care plan (nursing diagnosis) or interventions

NUR 3015 exam 1 (3 decks)

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