NUR 2459 Mental Health Exam 1 Modules 1-3 Questions &Answers .

NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A what are some psychiatric historical events that have occurred in the early psychiatric era? - ANS-18th century- state asylums created, 600,000 residents were in them, 1st school or psychiatric nursing was created in 1882, deinstitutionalization, shift in role of the nurse from custodial care to professional care. explain what early use of phenothiazine was for in early psych nursing. - ANS-it was discovered to help control psychotic behaviors and improve/ clear thinking. what were the two nursing interventions associated with somatic therapy in early psych nursing? - ANS-insulin therapy ECT therapy explain significance of insulin therapy in the early psych era. - ANSinsulin was administered until the client was comatose, this could kill the patient because the blood sugar could drop below normal levels, but it helped relive psych symptoms. explain significance of early ECT therapy. - ANS-an electrical stimulus was given to the brain with the result of a grand-map seizure. now we can control the shock given and give medications to sedate the client and stimulate the seizure and for proper monitoring throughout the procedure. explain what deinstitutionalization is. - ANS-there was a massive discharge of psychiatric patients from mental hospitals back to their original communities. what is significant about the impact of deinstitutionalization? - ANS-many of the psych patients who needed services were forced onto the streets, potentially leading them to more harm and crime. 3 main reasons deinstitutionalization was initiated. - ANS-the belief that treatment in the hospitals was inhumane hope that medications would offer a cure lack of funding at the state and federal level what is the order of maslows hierarchy of needs bottom to top? - ANS- physiological needs-safety need- love and belong needs- self esteem- self actualizationNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A what is important to know about maslows hierarchy of needs? - ANSmotivation is continuous quest for self actualization, can reverse levels based on life circumstances, lower level needs must be met first before advancement to higher level psychological needs.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A examples of psychotherapy - ANS-behavioral therapy, cognitive therapy, didactical behavior therapy based on a verbal therapist to client interaction examples of open environment therapies - ANS-family, group and milieu therapy examples of Brian stimulation techniques - ANS-ECT, transcranial magnetic stimulation, vagus nerve stimulation explain what behavioral therapy is. - ANS-aims to modify maladaptive behavior patterns. based that a behavior is learned and has consequences and abnormal behavior results from an attempt to avoid painful feelings and reduce anxiety. what is the nurses role with behavioral therapy? - ANS-Role of the nurse: to use the nursing process to assist the client with behavior modification. This can be through 1 on 1 groups, different ways like classical and operant conditioning explain what cognitive therapy is. - ANS-focuses on individual client thoughts and behaviors to solve current problems. Based on changing the way one thinks. what is the role of the nurse with cognitive therapy? - ANS-the nurse will plan psychoeducation, use of the therapeutic relationship and counseling interventions. They also reevaluate to determine if intervention was successful with the therapy. explain what cognitive behavioral therapy is (CBT) - ANSuses both cognitive and behavioral approaches to assist a client with anxiety management. explain what family therapy is - ANS-therapy based on family dynamics and improving family functioning by learning the ways for dealing with mental illness in the family, improving understanding among family members, maximizing positive interaction with family members. explain what milieu therapy is - ANS-creates an environment that is supportive and therapeutic and safe to benefit clients and promote coping within a safe place. explain what group therapy is - ANS-therapy focused on helping individuals develop more functional and satisfying reactions within a group setting with common feelings, experiences and thoughts that lead to positive behavior changes from interactionNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A and feedback.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain what ECT is used today - ANS-the induction of a grand-mal seizure through the application of electrical currents to the brain during anesthesia. Electrodes are placed bilaterally and an appropriate dose of electrical current is sent through the brain to enhance the effects of certain neurotransmitters.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A what types of disorders can ECT help with? - ANS-Used as a last resort in depression, mania, schizophrenia, and psychosis when medication and treatment has failed. side effects from ECT - ANS-confusion and memory loss, headache what is the role of the nurse during ECT? - ANS-often during the preop and post-op phases. Complete assessment should be completed before the client goes back to the procedure, including medication reconciliation and a signed consent form. places the IV, gives pre procedure medications, takes vitals before and after procedure. after procedure : placing the patient on the side, orient the client, describe what happened, allow the patient to have therapeutic communication based on their feelings, assisting them as needed until fully awake. what will actually happen during the ECT procedure? - ANS-When in the treatment room, the nurse will help position the patient while the CRNA gives the patient a short acting anesthetic and medication to induce the seizure.a bp cuff, pulse ox and oxygen may be given as needed and a bite block and electrodes to monitor EKG.once asleep, the provider will decide how much electricity the client will get and will shock the client and monitor for any changes, the CRNA will wake the patient up when finished, all people in the room will monitor for adverse reactions. medications that may be given during ECT - ANS-atropine sulfate, succinylcholine, sedative medication and medication to help client relax. what is trans-cranial magnetic stimulation? - ANS-a noninvasive therapy that uses magnetic pulsations to stimulate the cerebral cortex of the brain for those with depression who have not been responsive to medications. What is vagus nerve stimulation? - ANS-provides electrical stimulation through the vagus nerve of the brain through a surgically implanted device to increase neurotransmitter levels to treat depression resistant to other methods of treatment and medication. which system is responsible for how the body changes with stress? - ANS- fight or flight system- everyone will react differently explain what stress is. - ANS-maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings and behaviors that are incongruent with the local andNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A cultural norms, and interfere with the individual, social, occupational and physical functioning.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A which two defense mechanisms are always healthy? - ANSalturism and sublimation Role of psychiatric nurse - ANS-maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings and behaviors that areNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A incongruent with the local and cultural norms, and interfere with the individual, social, occupational and physical functioning. explain the role of EEG and EKG with ECT - ANS-This allows for cardiac monitoring, and also observation of brain activity (seizure activity in the brain). what is the role of the stranger - ANS-first interaction with the nurse and treating the patient with respect. what is the role of the resource person - ANS-will give answers in a way the patient can understand based on their healthcare information. what is the role of the teacher - ANS-the nurse identifies learning needs and information related to the patients healthcare. what is the role of the leader - ANS-encourages both the nurse and the patient to have a democratic relationship and be active in the plan of care. what is the role of the surrogate - ANS-the patient may see the nurse as a mother figure, sibling, or another nurse in the past where the situation may generate feelings similar to ones felt in the past. what is the role of the technical expert - ANS-understands technical devices and clinical interventions needed for the best interest of the patient. what is the role of the counselor - ANS-the nurse uses interpersonal techniques to assist patients in adapting with changes in life experiences and to help them understand what they are going through in the present situation. which of the roles of nurse are most apparent in psychiatric nursing and why - ANS- Counselor- They must have skills developed to provide helpful individual, group, or family therapy. The staf f nurse should have general knowledge of basic counseling techniques and to have a therapeutic or helping relationshi explain altruism - ANS-dealing with anxiety by reaching out for others example of altruism - ANS-It is very cold and a man takes of f his jacket and gives it to someone who cannot afford a coat. explain compensation - ANS-covering up a real or perceived weakness by emphasizing a trait one considered more desirableNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A example of compensation - ANS-Someone who is too small to make theNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A wrestling team becomes a talented member of the debating team.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain denial - ANS-refusing to acknowledge the existence of a real situation or feelings associated. example of denial - ANS-A woman who drinks alcohol daily, refuses to acknowledge she has a problem. explain displacement - ANS-shifting feelings related to an object, person, or situation to another less threatening object, person or situation. example of displacement - ANS-A man is angry with his boss and when he comes home, he yells at his children. explain projection - ANS-attributing one's unacceptable thoughts and feelings onto another who does not have them example of projection - ANS-A woman has feelings for someone other than her husband, but blames him for being unfaithful. Explain identification - ANS-conscious or unconscious assumption of the characteristics of another individual or group Example of identification - ANS-The student nurse imitates the nurturing actions of the instructor. explain intellectualization - ANS-separation of emotions and logical facts when analyzing or coping with a situation or event. example of intellectualization - ANS-A wife is moving far away from her family because of her husband's job transfer. She explains to her family all the advantages of the move. explain rationalization - ANS-creating reasonable and unacceptable explanations for unacceptable behavior example of rationalization - ANS-A boy justifies cheating in a card game because he said everyone cheats. explain reaction formation - ANS-preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. example of reaction formation - ANS-A girl is angry with someone, but expresses exaggerated friendliness when she sees her. explain regression - ANS-sudden use of childlike or earlier developmental behaviors that do not correlate with age orNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A developmental stage.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A example of regression - ANS-An adult throws a temper tantrum when she doesn't get her way. explain repression - ANS-unconsciously putting unacceptable feelings, ideas and thoughts out of awareness. No memory. example of repression - ANS-A trauma victim is unable to remember anything about his accident. explain suppression - ANS-voluntary denying or putting away stressful feelings example of suppression - ANS-A student states, "I'll worry about that exam tomorrow." explain conversion - ANS-responding to stress through the unconscious development of physical manifestations of illnesses. example of conversion - ANS-A girl is unable to speak just before she is to try out for chorus. explain splitting - ANS-demonstrating an inability to reconcile negative and positive attributes of self to others. example of splitting - ANS-Someone says she has the best friend ever, until her friend is not able to attend her party. Then she says she never wants to see her again. explain sublimation - ANS-dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression example of sublimation - ANS-A mother whose child has cystic fibrosis, develops a support group for other parents with children diagnosed with the illness. explain undoing - ANS-performing an act to make up for prior behavior. example of undoing - ANS-A man argues with his wife and the next day brings her flowers. explain what the therapeutic use of self means and the role of the nurse - ANS-The ability to use one's personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention. The nurse must possess self-awareness and self understanding based on the belief of the human condition. The nurse must understand the ability to effectively help others in timeNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A ofNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A need is influenced strongly by the internal values one has. conditions essential for a therapeutic relationship to be established - ANS-rapport, trust,NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A respect, genuineness, empathy explain what rapport is - ANS-implies special feelings on the part of both the patient and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude explain what trust is - ANS-one must feel confident in that person's presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested. demonstrated through nursing interventions that convey a sense of warmth and caring to the patient. explain what respect is - ANS-believe in the dignity and worth of an individual regardless of his or her unacceptable behavior explain what genuineness is - ANS-nurse's ability to be open, honest, and "real" in interactions with the patient. To be real is to be aware of what one is experiencing internally and to allow the quality of this inner experience to be apparent in the therapeutic relationshi explain what empathy is - ANS-conveys an objective awareness and understanding of the feelings, emotions, and behaviors of others, including trying to envision what it must be like to be in the position of the client and the clients family. explain the therapeutic nurse patient relationship - ANS-pre orientation, orientation, working, termination explain what happens during pre orientation phase - ANSinvolves preparation for the first encounter with the patient. The nurse obtains information from the chart, significant others, or other team members. They also may examine one's feelings, fears, and anxieties about working with a specific patient and how they may affect the ability to care for the patient. no bias explain the orientation phase - ANS-involves the nurse and the patient becoming acquainted. Introductions. Creates environment with trust, identifies strengths and limitations and assess and create goals, discuss the termination phase. explain the working phase - ANS-the therapeutic work of the relationship is accomplished, and interventions take place. maintain trust and rapport, problem solving, overcoming resistance saviors, advancing to reaching ones goals.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain transference - ANS-when the patient unconsciously displaces to the nurse feelings formed to a person from his or her past from feelings orNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A personality that remind the patient of another person, but also be dependency on the nurse based on unreal patient expectations.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain countertransference - ANS-the nurse's behavioral and emotional responses in which the nurse transfers feelings about past experiences to the patient that can interfere with the relationship explain termination phase - ANS-occurs when the goals are reached, the client is discharged, or the shift ends. Can be difficult for all parties involved and therapeutic conclusions must be developed and feeling of sadness and loss may occur. explain therapeutic communication - ANS-caregiver verbal and nonverbal techniques that focus on the care receivers needs and that advance the promotion of healing and change. It fosters the exploration of feelings and understanding of behavioral motivation. Nonjudgemental, discourages defensiveness, and promotes trust. explain non therapeutic communication - ANS-barriers to open communication between the nurse and patient that lead to anxiety, non healing, judgment, and defensiveness. No trust and rapport. what is verbal communication? - ANS-communication by word or sound. Nurses must be cautious about the word choices or sounds they make, as some works or phrases may not be therapeutic or healing. what is non verbal communication? - ANS-communication that expresses one's attitudes and feelings with body language, physical appearance, movement, posture, touch, facial expressions, eye contact, and vocal cutes. explain what active listening is - ANS-occurs nonverbally and is important to have a desire to hear and understand what the patient is saying. explain the acronym SOLER and active listening - ANS-S- sit squarely facing the patient O- observe a open posture with legs and arms not crossed. L- lean forward to the patient and allow them to see your interest in what they are saying E- eye contact should be established to show interest R- relaxing will show that you are comfortable and have full interest in the patient explain nonverbal techniques that are therapeutic - ANSappearance is nice and groomed appropriately, body movement is minimal per conversation and posture is upright with an open figure, no touch, facial expression is pleasant, eye contact isNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A maintained, vocal cues are followed and tone of voice is neutral explain nonverbal techniques that are non therapeutic - ANSappearance isNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A disheveled, body language is very negative (arms crossed, should shrugging), mood does not equal affect, posture is too relaxed or slouched, touch is used, eye rolling or looking at the clock, door or not the patient, vocal cues seem very conscientious and forcefulNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain using silence - ANS-encourages the patient to organize thoughts and time to think. Can also provide the nurse with information about patient concerns. explain accepting - ANS-conveys an attitude of reception and regard. explain giving recognition - ANS-acknowledging awareness rather than complementing that reflects judgement. explain offering self - ANS-willingness to spend time with the patient and show interest unconditionally to increase self worth. explain broad openings - ANS-allows patients to direct focus on interaction and emphasizes the importance of patients' role in the communication process. explain offering general leads - ANS-offers the patient encouragement to continue with minimal nursing input. explain placing the event in time or sequence - ANS-allows the patient to identify the sequence of events and when they occurred to organize thoughts. explain making observations - ANS-allows patients to develop awareness of how they are perceived by others and prompts exploration of issues. explain encouraging description of perceptions - ANS-allows for development of awareness or understanding based on their perceptions and reality. explain encouraging comparison - ANS-asking the patient to compare similarities and differences in ideas or relationships helps the patient recognize recurring experiences and things they can change. explain restating - ANS-repeating the main idea of what the patient said helps to let the patient know there is either understanding or a need for more clarity. explain reflecting - ANS-questions and feelings are referred back to the patient so that the patient is empowered to actively engage in problem solving techniques. explain focusing - ANS-taking notice of a single idea or word and exploring it even more. Hard with those who have anxiety. explain exploring - ANS-when an issue or theme is relevant, the nurseNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A mayNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A instruct the patient to explore it further and understand awareness about the event or feelings. explain seeking clarification - ANS-striving to achieve understanding of vague statements can help for understanding.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain presenting reality - ANS-when there is a misperception of reality, the nurse will express their perception of the situation without changing the patients. explain voicing doubt - ANS-expressing uncertainty as to the reality of the patient's perceptions during delusional thinking. explain verbalizing the implied - ANS-putting into words what the patient has implied or said indirectly. explain translating words into feelings - ANS-the nurse will symbolize what has been said to find the underlying feelings. explain formulating a plan of action - ANS-encouraging identification of a behavior change will allow for better coping skills. explain material boundaries - ANS-can be seen, like a fence that borders land. explain social boundaries - ANS-hese are established within a culture and define how individuals are expected to behave in social situations. explain personal boundaries - ANS-these are boundaries that individuals define for themselves. explain physical/distance boundaries - ANS-how close individuals will allow others to enter their physical space. explain emotional boundaries - ANS-how much individuals choose to disclose their most private and intimate sleeves to others. explain professional boundaries - ANS-limit and outline expectations for appropriate professional relationships with patients. space between nurses power and patient vulnerability. Imbalance of power does exist because the nurse can see patient records. They must avoid conflict where a personal gain may be achieved within the relationship. explain self disclosure - ANS-appropriate when the information could therapeutically benefit the patient. Not undertaken to meet the nurses needs. explain gift giving - ANS-Nurses should not accept gifts but also use professional judgement based on the type of gift and patient care and thought behind it. Refusal should be based on patient sensitivity.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain touch - ANS-Touching is required to do the therapeutic procedures and care, but caring touch in times where they have no need to do so isNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A inappropriate. Touch should be appropriate, therapeutic, and welcomed. Many need to avoid it based on the situation and culture.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain friendship/romantic association - ANS-all relationships should be professional. If unable to do this, one should withdraw from the relationship. Romantic relationships should not occur. complications if boundaries are breeched - ANS-threatens the integrity of the nurse patient relationship, can cause boundary violations. Potential for the nurse to be fired or to lose their license. signs that boundaries may be breeched - ANS-favoriting patients, keeping secrets, changing dress for working, swapping assignments, giving special attention to one client over another, spending free time with patients, thinking about patients when away from work, shoring personal concerns with patient, receive gifts or have contact with the patient after discharge explain giving false reassurance - ANS-conveys the outcome is already known and minimizes the patient's feelings and concerns and prevents further expression of feeling "everything will be okay", "you will be better soon" explain rejecting - ANS-refusing to consider or showing contempt for patients ideas or behavior may cause patients to discontinue the relationship. explain approving/ disapproving or agreeing/disagreeing - ANSindication accord or opposition based on good or right behaviors and bad or wrong behaviors that prevents modification without admitting error, or to please the nurse . Creates defensiveness. explain giving advice - ANS-telling the patient what to do or how to behave implies the nurse knows what is best and discourages patient independence. "you should do this because it will help you" explain probing - ANS-persistent questioning and the push for answers the patient does not wish causes the patient to feel used and valued for what information the nurse is only seeking, consistently talking about a traumatic childhood event by bringing up things about the clients childhood explain defending - ANS-minimizes or completely ignores the patients concerns and encourages taking sides. explain requesting an explanation - ANS-involves asking the client why they have certain behaviors or thoughts and that they must defend their feelings. "why do you feel depressed" explain indicating there is a external source of power - ANSattributing the thoughts to an outside source encourages theNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A patient to project blame for their thoughts on others rather than accepting their own responsibility.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain minimizing feelings - ANS-encourages a lack of empathy and understanding based on their concerns being irrelevant and not important. explain stereotyping - ANS-using meaningless expressions to encourage a similar response from the patient explain using denial - ANS-denying a problem exists blocks discussion with the patient and avoids getting help in areas they need it, explain interpreting - ANS-attempts to tell the patient the meaning of his or her experience. explain introducing an unrelated topic - ANS-changing the topic indicates the nurse does not want to discuss the topic the patient wants to discuss. explain how to use the nursing process with psychiatric disorders - ANS- assessment- collecting information about past medical history, assessing physical and emotional state diagnosis: medically will be through the DSM5 but can use NANDA as well for nursing dx's palling: independently and individualized with multiple disciplines involved. planning/ implementation: the nurse plans intervention with the client and are then acted out evaluation: did the client meet the goals or do we need to change things. explain the parts of the mental status exam - ANS-appearance, motor activity, speech patterns, attitude, emotions, affect, thought processes, cognitive ability explain what appearance means in relation to the mental status exam - ANS-- Grooming -Personal hygiene -Posture -Level of eye contact -Evidence of scars or other distinguishing skin marks explain what motor acitvity means in relation to the mental status exam - ANS--Tremors -Tics -Mannerisms -Hyperactivity -Restless or agitated -Aggressive -Echopraxia-mimicking the movements of othersNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A -Psychomotor retardation-extremely slow movements explain what speech patterns means in relation to the mental status exam - ANS-- Slowness or rapid speech -Pressure of speech (frenzied)NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A -Volume -Aphasia (difficulty in forming/thinking of specific words) explain what attitude means in relation to the mental status exam - ANS-- Cooperative/uncooperative -Friendly/hostile -Uninterested/apathetic -Guarded/suspicious explain what emotions means in relation to the mental status exam - ANS- Mood -Depressed -Irritable -Anxious -Elated -Euphoric -Fearful -Guilty -Labile (mood swings) explain what affect means in relation to the mental status exam - ANS-the behavioral expression of emotion -Constricted or blunted (minimal emotional expression) -Flat (absence of emotional expression) -Appropriate -Inappropriate explain what thought processes means in relation to the mental status exam - ANS-- Form of thought -Content of thought (hallucinations/delusions) explain what cognitive ability means in relation to the mental status exam - ANS--Level of alertness Clear-minded/attentive - Orientati o n Time Place Person Situatio nMemo r y Recen t Remot eNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A Confabulation (create content for memory gaps) What is the mini mental status exam? - ANS-Brief screening tool to assess cognition and change over timeNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain shaping - ANS-reinforcements are given for increasingly closer approximations for the desired response. Ex: teachers may reward an autistic child for doing things to form words, rewarding one step at a time. explain modeling - ANS-learning new behaviors by imitating the behavior of others. Ex: role models, children imitating the behaviors of their older siblings or parents, observing television- can lead to maladaptive behaviors. Explain Premack Principle - ANS-a frequently occurring response can serve as positive reinforcement to response 2 that occurs less frequently, Applied when response 1 to only occur after response 2 has been performed. Ex: a parent allows the child to go to the beach with her friend after all her chores are done for the day. The fun stuff response. explain extinction - ANS-gradual decrease in frequency or disappearance of a response when positive reinforcement is withheld. Ex: tantrums with kids- the behaviors continue when the parent is close to them but they stop when they walk away form the child. explain contingency contracting - ANS-a contract is drawn up among all parties involved and the desired behavior change and reinforcers and stated explicitly and the negative consequences will be taken if terms of the contract are broken. Specific to how the reinforcers or punishment stands. explain token economy - ANS-"Treasure Box", reinforcers for desired behaviors are presented in the form of tokens which consist of items the client likes. Tokens are awarded for desired behaviors and are exchanged for privileges or things the client likes. The hope is the desired behavior will stick even after the removal of the token system. explain time out - ANS-aversive stimulus or punishment where the client is removed from the unacceptable environment with the unacceptable behavior and is isolated. explain reciprocal inhibition - ANS-decreases or eliminates a behavior by introducing a more adaptive behavior, but one that is incompatible with the unacceptable behavior. Ex: relaxation for phobias. explain overt stimulation - ANS-aversion therapy that produces unpleasant consequences for undesirable behaviors. Ex: disulfiram given for ETOH abuse. It causes N/V. Instead of pleasure, the patient gets punished with the medication.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain covert stimulation - ANS-version therapy that relies on the individuals imagined unpleasant symptoms or negative consequences that is under the clients control and can be used whenever and wherever ifNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A required. A negative image is visualized and the image can induce the negative feelings.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain systemic denensitization - ANS-a technique for assisting individuals to overcome their fear of a phobic stimulus. It is systemic in that there is a hierarchy of events that cause anxiety and then are taken one step at a time as the patient progresses. Paired with relaxation activities. explain flooding - ANS-the individual gets stimulated all at one with undesirable stimuli until it no longer causes anxiety. what are the goals of cognitive therapy? - ANS-Monitor negative automatic thoughts. Recognize the connections between cognition, affect, and behavior. Examine the evidence for and against distorted automatic thoughts. Substitute more realistic interpretations for biased cognitions. Learn to identify and alter dysfunctional beliefs that predispose to distortions. Explain principles of cognitive therapy - ANS-based on an everlasting formulation of the patient and their problems in cognitive res a sound therapeutic sizes collaboration and active oriented and problem ally emphasized the tive, aims to teach the patient to be their own therapist, and emphasizes relapse to be time limited. structured, eaches patients to identify, evaluate, and respond to their dysfunctional thoughts and a variety of techniques to change thinking, mood and behaviors. explain automatic thoughts - ANS-thoses that occur in response to a situation quickly and without analysis. Negative and not logical. explain arbitrary influence - ANS-an individual automatically comes to a conclusion without facts or evidence to support. explain overgeneralization - ANS-sweeping, all or nothing conclusions. explain dichotomous thinking - ANS-views situations in a good-bad way. explain selective abstraction - ANS-a conclusion based on only a selected portion of the evidence that is negative and what is viewed as a failure. explain magnification - ANS-exaggerating the negative significance.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain minimization - ANS-under valuaing the positive significance of an event. explain catastrophic thinking - ANS-always thinking that the worst will occur without considering the positive outcomes.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain personalization - ANS-the person takes complete responsibility for the situation without considering the situations behind it.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain socratic dialogue - ANS-the therapist questions the client to elaborate the who what where why how of the situation and describe feelings associated. explain guided relaxation - ANS-aimed at reducing autonomic responses to anxiety. Deep breathing, imagery, meditation. Controls awareness over breathing, anxiety, and thoughts explain behavioral rehearsal - ANS-role play allows the client to practice new ways to approach situations and try out scenarios in real life. Can also be used with thoughts with cognitive rehearsal. explain questioning the evidence - ANS-they view the thought as a hypothesis and they question the facts with cognition. explain examining options and alternatives - ANS-helps a client see a broader range of possibilities. explain Decatastrophizing - ANS-the client examines the validity of a negative thought and develops a plan of action. explain reattribution - ANS-aims to reverse negative attribution by self blame or placing the blame on others. explain DRDT - ANS-used to help clients identify and modify automatic thoughts in a 3 column thought record and rate the thoughts they have and explain more rational approaches. explain what ethics is - ANS-is the branch of philosophy that addresses methods to determine if one's actions are right or wrong. explain what bioethics is - ANS-applies to these same principles when referring to concepts in medicine, nursing and allied health. what are the ethical principles of nursing? - ANS-· Autonomy · Beneficence · Non-maleficence · Justice · Veracity ·Fidelity explain autonomy - ANS-right to self determination and to make their own independent choices about their medical and psychiatric care. Incapable individuals with serious mental health disorders may need someone appointed to make those decisions.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A should act in their clients best interests and have good interests that will serve the client the best care in a good way, with sensitivity to wishes, beliefs, and feelings. explain nonmalefience - ANS-oing no harm to clients. A big part of this patient safety when it comes to psychiatric disorders, as nurses we want to make sure everyone is safe while receiving care. explain justice - ANS-giving fair treatment to all patients regardless of condition, past, race, gender, etc . All care resources should be given equally to all, and the nurse should favor all clients equally. explain veracity - ANS-the duty to be honest and truthful. The nurse should never deceive or mislead patients. explain fidelity - ANS-keepings one's promise. the nurse should never break a promise if one is made explain moral behaviors - ANS-conduct that results from serious critical thinking about how individuals treat others explain values - ANS-personal beliefs about what is important or desirable. what is utilitarianism? - ANS-actions are right to the degree that they promote happiness and are wrong as they produce the reverse of happiness. what is kantianism? - ANS-not the consequences that make an action right or wrong but the motivation on which the action is based that is the morally decisive factor. Action bound by a sense of duty, and decisions are made in respect to the moral law. what is christian ethics? - ANS-focused on the life and teachings of Jesus Christ based on forgiveness, love, and honesty. Golden rule. Right and wrong center around love for God and treating others with respect. what is natural law theory? - ANS-based on st thomas aquinas and advances the idea about right vs. wrong being based on human nature. what is ethical egoism? - ANS-exposes what is right and good and what is best for the individual making a decision. explain beneficence - ANS-the duty to promote the good of others. NursesNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A what is the right to humane treatment? - ANS-must have a clean, safe environment and be given care under any circumstances, and will be given care that does not harm the client or in unrealisticNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A what is the right to refuse treatment or medication? - ANS-the patient can refuse it unless it is required to prevent death or cause serious harm to a person or themselves.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A must consider the client and situation before forcing any medications in the psych area. Can also be an involuntary or court mandated force to help with treatment. what is the right to the least restrictive treatment? - ANS-no sedation, restraints, or seclusion unless they actively need it to prevent the harm of themselves and others. least restrictive hospitalization to the most based on treatment and care. no confining against will. explain what an ethical dilemma is? - ANS-a situation requiring the nurse to make a choice between 2 equally unfavorable alternatives based on moral rightness. No clear reason often. what things should the nurse think about when dealing with an ethical dilemma? - ANS-- gathering subjective and objective data -consider personal values about the situation -identify the conflict -explore benefits and consequences of alternatives - act on the decision made -evaluate the situation -assess needs of all parties involved, but remember it is the patients right to determine their course of action (in most situations) What are statutory laws? - ANS-enacted by a legislative body- nurse practice acts. what are common laws? - ANS-from decisions in previous cases that arise from court decisions. Per state. what are civil laws? - ANS-protects the private and property rights of individuals and businesses what is a tort? - ANS-iolation of civil law where an individual has been wronged. Malpractice and negligence. what are contracts? - ANS-one party asserts the other in failure to fulfil obligations. what are criminal laws? - ANS-provides protection from conduct deemed injurious to the public. punishment for those involved with conduct, like theft of hospital supplies. what are client specific rights in mental health? - ANS--informed consent -right to refuse meds/ tx -right to least restrictive tx * are not valid when the client is at risk of harming self or others*NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A what is the role of HIPAA? - ANS-protect a person's private health information. IN psych, individuals have the rights to their medical records, have corrections made, and decide who they can share them with.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A Explain the two breeches of HIPAA that can occur in psych nursing - ANS- duty to warn others that a patient is dangerous to others, child abuse or elder abuse that should be immediately reported to authorities explain what a voluntary admission is - ANS-The client or client's guardian chooses admission to a mental facility. A voluntarily admitted client may request release at any time. explain what a temporary emergency admission is - ANS-The client is admitted for emergent mental health care due to the inability to make decisions regarding care. After the admission is initiated by a healthcare provider, the client is evaluated by another healthcare provider. This temporary admission varies by client's needs and state laws. explain what a involuntary admission is - ANS-The client enters against her/his will for an indefinite period time. This is based on the client's need for psychiatric treatment, the risk of harm to self or others, and the inability to provide selfcare. Physicians(generally) certify the client's condition meets the above criteria. The client can request a legal review. explain competent/incompetent client in regards to involuntary admissions - ANS-can be competent or competentthe client can make decisions regarding refusal of treatment/meds. if incompetent- by the court, someone will sign the consent for the client. how long is an involuntary admission lasting? - ANS-60 days least restrictive restraint measures include: - ANS--verbal intervention -diversion or redirection -providing a calm, quiet environment -offering medication (chemical restraint is less restrictive than mechanical restraint) we should never use restraints or seclusion for: - ANS--punishment -convenience of staff -clients who are physically or mentally unstable if a restraint or seclusion is used, we should do the following: - ANShave the provider prescribe it in writing, see the patient face to face, have a order rewritten every 24 hrs, assess frequently every 30 mins safety, behavior, food, fluids, toiling, vitals, pain, skin assessment.NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A how long should restraints be applied to someone 18 years or older? - ANS-4NUR 2459 Mental Health Exam 1 Modules 1-3 Q&A hrs how long should restraints be applied to someone 9-17 years old ? - ANS-2 hrsNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A how long should restraints be applied to someone 8 years or younger? - ANS-1 hr explain what a crisis is - ANS-psychological disequilibrium in a person who experiences a situation that constitutes a problem that cannot be escaped or solved with usual problem solving techniques. what does the client need while they are in a crisis that the nurse can help with? - ANS- In this type situation, guidance and support must be provided to help mobilize resources needed to resolve the crisis and restore equilibrium. phase 1 of the crisis development stage is: - ANS-The individual is exposed to a precipitating stressor. phase 2 of the crisis development stage is: - ANS-When previous techniques to handle the stressor are not effective,the individual begins to feel a great deal of discomfort. phase 3 of the crisis development stage is: - ANS-Resources, both internal and external are called upon to resolve the problem but fail,and the individual becomes more anxious. phase 4 of the crisis development stage is: - ANS-Anxiety reaches a panic level. Cognitive functions are disordered, emotions are labile and behavior may reflect unrealistic thoughts and actions. what can we do if there is a emergency and a patient needs restraints or seclusion quickly? - ANS-In an emergency, the nurse can use seclusion or restraint without first obtaining an order, but must obtain the written order within a certain amount of time. *The nurse must be aware of state, federal, and facility policies that govern the use of seclusion and restraints. explain the purpose of crisis intervention - ANS-is designed to provide rapid assistance to the client what is the initial intervention when giving interventions to one in a crisis situation? - ANS-assess the client's potential for suicide or homicide. what are some of the other interventions we can do for a client needing crisis interventions? - ANS--Identify the problem and direct intervention for resolution -Take an active, directive role with the client -Help the client set realistic goalsNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A -Provide for client safetyNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A -Attend to physical needs first Use reality-oriented approach -Remain with the individual -Show unconditional acceptanceNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A -Practice active listening -Discourage lengthy explanations -Set firm limits -Clarify the problem with the individual through a problem-solving process -Discuss alternative strategies -Identify external support what is the role of the nurse when a disaster occurs? - ANS-an event that overwhelms local resources and threatens the function and safety of the community. Can cause destruction and leave victims with a sense of anxiety and damaged sense of safety. The nurse can provide interventions that not only help the patient but help the community to address needs. what are protective factors for a client in crisis? - ANS-Resilient temperament Social competency Skills in problem solving, coping, conflict resolution. Positive expectation, optimism for the future, identification of future goals. Connectedness to family, school, community. Presence and involvement of caring people. Integration in social networks. Culture and religious beliefs that discourage suicide Access to social services and clinical healthcare. Support with ongoing disorders Restricted access to suicidal methods. explain culture - ANS-a particular society's entire way of living, encompassing shared patterns of belief, feeling, and knowledge that guide people's conduct are passed down from generation to generation explain ethnicity - ANS-groups of people who identify with each other because of a shared cultural, national, or ancestral heritage. explain spirituality - ANS-the human concept that gives meaning and sense of purpose to an individual's life. Religion is a set of beliefs, values, and rights adopted by a group of people. This is one way in which an individual's spirituality is expressed. what should the nurse be when taking care of patients with different cultural background? - ANS-culturally competent- have knowledge and acceptance to care for all clients in whatever culture they believe inNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain the spiritual needs - ANS-emphasize a meaning and sense of purpose in life. faithNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A hop e lov e forgiveness meaning and purposeNUR 2459 Mental Health Exam 1 Modules 1-3 Q&A explain religion - ANS-a set of beliefs, values, rites and rituals that a group of people follow from a certain leader. define common religions that may be seen healthcare - ANSChristianity Jewish Islam Jehovah Witness Mormon s Hindu what things should we do to assess ones spirituality and culture? - ANS- asses their spiritual background, ask if they believe in a higher power, ask if they go to church, ask if they would prefer certain gentrified staff, ask about food preferences or dietary restrictions, ask about fasting and blood provisions, and about any ritualistic movements they would like to perform. common nursing dx for culture and spirituality are: - ANS-RIsk for spiritual distress Risk for impaired religiosity Readiness for enhanced spiritual well being