Summary nur 2488 mental health nursing final exam key concepts

Chapter 1 Patient Advocacy –What does it mean to advocate for your patient? Page 8 Chapter 2 Depression - Even major depression, a common psychiatric disorder, may interfere with motivation to seek care Chapter 3 Rationalization pg 170 Maslow’s Hierarchy of needs (ch 3pg 31) Address what needs first based off of Maslow’s Needs? Physiological, safety, love & belonging, esteem needs, self-actualization, self-transient needs fig 3-2 Freud- what did he contribute to psychiatric setting? Theory of psychoanalysis- to learn unconscious thought patterns; concept of Id, Ego, Superego Review table 3-2 (pg 38) Freud development of personality theroy Oral—birth to 1½ years Pleasure-pain principle Id, the instinctive and primitive mind, is dominant Demanding, impulsive, irrational, asocial, selfish, trustful, omnipotent, and dependent Primary thought processes Unconscious instincts—source-energy-aim-object Mouth—primary source of pleasure Immediate release of tension/anxiety and immediate gratification through oral gratification Task—develop a sense of trust that needs will be met Anal—1½ to 3 years Reality principle—postpone immediate discharge of energy and seek actual object to satisfy needs Learning to defer pleasure Gaining satisfaction from tolerating some tension-mastering impulses Focus on toilet training—retaining/letting go; power struggle Ego development—functions of the ego include problem-solving skills, perception, ability to mediate id impulses Task—delay immediate gratification ****Phallic—3 to 7 years Superego develops via incorporating moral values, ideals, and judgments of right and wrong that are held by parents; superego is primarily unconscious and functions on the reward and punishment principle (sexual identity attained via resolving oedipal conflict) Conflict differs for boy and girl masturbatory activity Task—develop sexual identity through identification with same-sex parent Latency—7 to 12 years Desexualization; libido diffused Involved in learning social skills, exploring, building, collecting, accomplishing, and hero worship Peer group loyalty begins Gang and scout behavior Growing independence from family Task—sexuality is repressed during this time; learn to form close relationship(s) with same- sex peers Genital phase (adolescence)—13 to 20 years Fluctuation regarding emotion stability and physical maturation Very ambivalent and labile, seeking life goals and emancipation from parents Dependence vs. independence Reappraisal of parents and self; intense peer loyalty Task—form close relationships with members of the opposite sex based on genuine caring and pleasure in the interaction Chapter 4 Acetylcholine is deficient in Alzheimer's pg 53-54 Buspirone (BuSpar) is a drug that reduces anxiety; the potential for addiction that exists with benzodiazepines does not exist for buspirone. 61 NMS -rare but life-threatening complication Chapter 6 Legal, Ethical, and Cultural Give examples of negligence, Autonomy, Justice, Beneficence, Fidelity, and Veracity Autonomy: Patient has the right to make his/her own decision, even if it’s not in his/her best interest. (ex: pt has right to refuse meds) Justice: Provide fairness in care and allocation of resources (ex: nurse spends the appropriate amount of time with each pt based on individual needs) Beneficence: Do what is best for the patient; do good. (ex: Spending extra time with an extremely anxious pt) Fidelity: Keep your promises; loyalty, faithfulness. (ex: if you tell pt you’ll be back in 5 min. BE BACK IN 5 MIN.) Veracity: tell the truth! (honesty); (ex: if pt asks about their dx but family tells you not to tell them, you must tell pt the truth) Nonmaleficence: Do no harm. (ex: maintaining expertise in nursing skills through education) Negligence: Unintentional tort;(ex: forgetting to set bed alarm for a pt at risk for falls) Malpractice: (ex: med error that harms pt) Rights for Voluntary and Involuntary Admission- p 82 - Involuntary commitment requires that the patient retain freedom from unreasonable bodily restraints as well as the right to informed consent and the right to refuse medications, including psychotropic or antipsychotic medications. - Patients who sought informal or voluntary admission, have the right to request and receive release Refusal of treatment: Even if the pt is involuntarily admitted, they have the right to refuse treatment; • the only exception to this is if the patient is a danger to him or herself or others while on the unit and requires restraints or a sedative in order to be safe. • Pts who are incompetent lose the right to make informed decisions by themselves • A court-appointed guardian may give or refuse consent for treatment. Advanced psychiatric directives may identify guardian and or treatments - Right to treatment - Right to refuse treatment - Right to informed consent - Right to have least restricted restraint used for shortest duration Psychiatric Nursing Assessment – priority interventions, nursing dx, etc. (pg 101) Chapter 7 A nursing diagnosis (pg 105 – 107) has three structural components: 1.Problem (unmet need) 2.Etiology (probable cause) 3. Supporting data (signs and symptoms) Chapter 8 - Therapeutic Communication Be able to given examples of verbal and non-verbal communication Non-verbal- maintaining eye contact, body behaviors (posture, gestures), facial expressions, tone, pitch, stuttering, eye casts, personal appearance, physical characeristics (ht, wt, complexion) Understanding therapeutic and non-therapeutic techniques of communication - pg 120- 121 Review table 8-1, 8-2, 8-3 Phases of the Nurse-Patient Relationships - Describe relationship during each phase What is active listening? Observing pts nonverbal behaviors, listening to and understanding pts verbal message, listening to and understanding the person in the context of the social setting of his/her life, listening for “false notes” (inconsistencies or things pt says that needs more clarifications), providing the pt with feedback about him/herself of which the pt might be unaware. Chapter 9 What to Do If the Patient Gives the Nurse a Present – pg. 141 - The nurse may feel uncomfortable when offered a gift. The meaning needs to be examined. Is the gift (1) a way of getting better care, (2) a way to maintain self-esteem, (3) a way of making the nurse feel guilty, (4) a sincere expression of thanks, or (5) a cultural expectation? Possible guidelines: If the gift is expensive, the only policy is to graciously refuse. If it is inexpensive, then (1) if it is given at the end of hospitalization when a relationship has developed, graciously accept; (2) if it is given at the beginning of the relationship, graciously refuse and explore the meaning behind the present. o “Thank you, but it is our job to care for our patients. Are you concerned that some aspect of your care will be overlooked?” If the gift is money, it is always graciously refused. Termination phase – Page 143 - the final, integral phase of the nurse-patient relationship; it includes: o Summarizing the goals and objectives achieved in the relationship o Discussing ways for the patient to incorporate new healthy ways into daily life, & any new coping strategies learned during the time spent with the nurse o Reviewing situations that occurred during the time spent together o Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship Empathy- know what empathy is – Pg 144 - Review table 9-1 False reassurance example pg. 146 “change is always possible”, “things will be better soon” A judgmental response would be the following: Nurse A: “So your promiscuous sexual and compulsive gambling behaviors really haven't brought you much happiness, have they? You are running away from your problems and could end up with AIDS and broke.” A more helpful response would be the following: Nurse B: “So, your sexual and gambling activities are part of the picture also. You sound as if these activities are not making you happy.”pg 145 Chapter 10 Major depression–think of priority nurse intervention –pg157- risk for suicide/self-harm Stress Reduction Techniques- meditation, prayer, mindfulness, yoga, running, walking briskly; reframing your thoughts, going to sleep earlier, lower/limit caffeine intake Review box 10-1 & table 10-1 Chapter 11 Anxiety Disorders Anxiety Levels & Stages Review table 11-1, 11-2, 1. Help the patient identify anxiety. “Are you comfortable right now?” 2. Anticipate anxiety-provoking situations. 3. Use nonverbal language to demonstrate interest (e.g., lean forward, maintain eye contact, nod your head). 4. Encourage the patient to talk about his or her feelings and concerns. 5. Avoid closing off avenues of communication that are important for the patient. Focus on the patient’s concerns. 6. Ask questions to clarify what is being said. “I’m not sure what you mean. Give me an example.” 7. Help the patient identify thoughts or feelings before the onset of anxiety. “What were you thinking right before you started to feel anxious?” 8. Encourage problem solving with the patient.∗ 9. Assist in developing alternative solutions to a problem through role play or modeling behaviors. 10. Explore behaviors that have worked to relieve anxiety in the past. 11. Provide outlets for dissipating excess energy (e.g., walking, playing table tennis, dancing, exercising) 11-9 – meds for anxiety Benzodiazepines – commonly given, side effects & teaching needed for patients: Common names: alprazolam (Xanax), Diazepam, Lorazepam, Chlordiazepoxide. Indications: Anxiety, seizures, muscle spasms, alcohol withdrawal. Side effects: Sedation, respiratory depression, amnesia, dependency/withdrawal Pt Ed: • for short term use only!!! don’t stop abruptly!! • Medications should be taken w/ food reduce GI discomfort. • Avoid alcohol and caffeine • don’t take if breastfeeding/pregnant • Drug interaction: • Antacids - delay absorption • cimetidine - increased sedation • CNS depressants: alcohol and barbiturates - increased sedation • phenytoin - serum concentration may become too high Antidote= Flumazenil Table 11-4- Understand and Describe Defense Mechanisms Discuss the benefits of buspirone Understand PTSD- symptoms, medications used, and nursing interventions for clients - Implement Stress Reduction Techniques- meditation, prayer, mindfulness, yoga, running, walking briskly; reframing your thoughts, going to sleep earlier, lower/limit caffeine intake - Psychotherapy (e.g., exposure-based cognitive behavioral therapy [CBT]) - Family therapy - Vocational rehabilitation - Group therapy with others who have shared similar experiences (e.g., veterans, partner abuse, sexual violence) - Relaxation techniques - Psychoeducation and methods to help obtain control of thoughts and feelings - Learning skills First-line treatment for Depression – Can you name them? Pg 183-184 SSRIs Defense Mechanism – reaction formation - Pg 170 Sertraline – SSRI –183-184 Obsessions - Compulsions pg.177 Chapter 12 Review table 12-1 Signs and Symptoms Nursing Diagnoses (NANDA) Inability to meet occupational, family, or social responsibilities because oInf e symptoms Ine Inability to participate in usual community activities or friendships Im because of psychogenic symptoms Ine ffective coping ffective role performance paired social interaction ffective relationship Dependence on pain relievers; distortion of body functions and Po symptoms; presence of secondary gains by adoption of sick role Dis Pai werlessness turbed body image n (acute or chronic) Inability to meet family role function and need for family to assume role Int function of the somatic individual Ine errupted family processes ffective sexuality pattern Assumption of some of the roles of the somatic parent by the children Im paired parenting Shifting of the sexual partner’s role to that of caregiver or parent and ofRis the patient’s role to that of recipient of care k for caregiver role strain Feeling of inability to control symptoms or understand why he or she Ch cannot find help Sp ronic low self-esteem iritual distress Development of negative self-evaluation related to losing body function, feeling useless, or not feeling valued by significant others Inability to take care of basic self-care needs related to conversion Fo symptom (paralysis, seizures, pain, fatigue) cus on self-care deficit (hygiene, dressing, feeding, toileting)