Term
| Incomprehensibility (one of two universal elements of mental illness) |
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Definition
| The community does not understand the individual's behavior |
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Term
| Cultural Relativity (one of two universal elements of mental illness) |
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Definition
| One's own culture labels the behavior as mental illness |
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Term
| Describe Hans Selye's "Fight or Flight response to stress" (stages) |
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Definition
1. Alarm reaction stage
2. Stage of resistance
3. Stage of exhaustion |
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Term
| Biological responses to stress: immediate response |
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Definition
1. Hypothalamus stimulates the sympathetic nervous system
2. pupils dilate
3. VS increase
4. Gastric motility decreases |
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Term
| Biological responses to stress: sustained response (3 hormonal responses) |
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Definition
Response when person remains stressed for an extended period of time. The hypothalamus stimulates the pituitary gland to release hormones.
ACTH stimulates adrenal cortex --> decreases immune and inflammatory responses
Vasopressin increases fluid retention and BP
Gonadotropins cause decrease in sex hormones resulting in decreased libido and impotence |
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Term
| Long periods of stress lead to sustained physical responses. This sustained response increases susceptibility to which TYPE of diseases? |
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Definition
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Term
| What are the psychological responses to stress? How is adaptation to these responses determined? |
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Definition
Anxiety- vague feeling of apprehension or fear. Common.
Grief
Adaptation is determined by the extent to which the thoughts, feelings, or behaviors interfere with an individual's functioning |
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Term
| Name Peplau's four levels of anxiety |
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Definition
| Mild, moderate, severe, panic |
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Term
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Definition
| Adaptive. May provide motivation for survival or help you do well on an exam |
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Term
| Moderate anxiety. Definition and symptoms. |
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Definition
Perceptual field diminishes.
Perspiration, hr increase, muscle tension, gastric distress |
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Term
| Severe anxiety (def and symptoms) |
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Definition
perception field is so diminished that concentration centers on one detail only or many extraneous details
Unable to concentrate, diarrhea/constipation |
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Term
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Definition
Most intense state of anxiety
Some people may be hospitalized, panic attacks/impending doom, feel nothing but terror |
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Term
| What are some coping mechanisms to stress? At which level of anxiety are they used. |
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Definition
Eating, drinking, sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they feel comfortable
Mild level |
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Term
| At which level(s) of anxiety does the ego call on defense mechanisms for protection |
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Definition
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Term
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Definition
| Defense mechanism. Covering up a real or perceived weakness by emphasizing a trait one considers more valuable. |
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Term
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Definition
| Refusing to acknowledge the existence of a real situation or the feelings associated with it |
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Term
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Definition
| Transfer of feelings from one target to another that is considered less threatening |
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Term
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Definition
| Attempt to increase self-worth by assuming characteristics of an individual one admires |
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Term
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Definition
| Attempt to avoid expressing actual emotions by using intellectual logic, reasoning and analysis |
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Term
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Definition
| Integrating the BELIEFS and VALUES of another into one's own ego structure |
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Term
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Definition
| An attempt to make excuses or use logic to justify unacceptable feelings or behaviors |
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Term
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Definition
| Separating a thought or memory from the feeling or emotion associated with it |
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Term
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Definition
Attributing feelings or impulses unacceptable to one's self onto another person
E.g. saying, "you look so nervous, today!" when the speaker is really feeling nervous. |
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Term
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Definition
| responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning |
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Term
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Definition
| preventing unacceptable thoughts from being expressed by exaggerating opposite thoughts or behaviors |
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Term
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Definition
Involuntary blocking unpleasant feelings and experiences from one's awareness
ex) victim of sexual abuse |
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Term
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Definition
| Re-channeling of unacceptable impulses into activities that are constructive |
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Term
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Definition
| Voluntary blocking of unpleasant experiences from one's awareness |
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Term
| What level of anxiety leads to physiological disorders, when left untreated for an extended period of time? What are some examples? |
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Definition
| moderate to severe level. Examples: migraines, IBS, cardiac arrhythmias. |
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Term
| Examples of anxiety disorders- avoidance |
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Definition
| Phobias, OCD, Panic disorders, PTSD |
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Term
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Definition
Physical symptoms with no pathology.
Hypochondria, conversion disorder (loss or change of body function caused by mental problem), somatization disorders (anxiety is translated into physical symptoms or complaints), and pain disorders |
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Term
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Definition
Altered perception
Dissasciative fugue: like leading double lives, unknowingly
Depersonalization disorder: out of body experiences |
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Term
| Extended periods of panic-level anxiety leads to what? Examples? |
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Definition
| Psychotic behavior: schizophrenic, schizoaffective, delusional disorders |
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Term
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Definition
| Loss of ego boundaries. characterized by the presence of delusions or hallucinations, and the impairment of interpersonal functioning with outside world. Cannot function in outside world without treatment. Person needs to be hospitalized and stabilized. |
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Term
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Definition
| -Exhibit minimal distress (flat affect) -*Unaware that behavior is maladaptive -*Unaware of psychological problems -Exhibit flight from reality into a less stressful world, or into one which they are attempting to adapt |
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Term
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Definition
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance |
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Term
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Definition
| The experiencing of the greig process before the actual loss occurs, like if you've been expecting someone close to die for a long time and have gone through all the stages, but then the hang on for a long time |
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Term
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Definition
| Length of the grief process is individual! May last weeks to years. Resolution of grief occurs when the client accepts both the pleasures and the disappointments of the association |
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Term
| 3 maladaptive grief responses |
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Definition
| prolonged response, delayed/inhibited response, distorted response |
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Term
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Definition
| Focus of clinical attention. Includes all mental disorders EXCEPT personality disorders and mental retardation |
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Term
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Definition
| Personality disorders and mental retardation |
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Term
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Definition
| General medical conditions |
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Term
| Axis IV: Psychosocial and environmental problems |
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Definition
| Problems that may effect the diagnosis, treatment, and prognosis on axis I and II. |
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Term
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Definition
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Term
| Hospitalized patient's are likely to have a GAF score of what or below? |
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Definition
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Term
| Which axis would unemployment fall under? |
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Definition
| Axis IV. Unemployment may make treatment for metal disorders more difficult. |
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Term
| What happens in personality development that is a problem in psych? |
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Definition
| Individuals may become fixed in a certain stage and remain developmentally delayed |
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Term
| According to the DSM-IV-TR, when do personality disorders occur? |
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Definition
| When personality traits become inflexible, maladaptive, causing either significant functional impairment or subjective distress |
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Term
| According to Freud, when was the basic character formed? What were the 3 major components of personality? |
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Definition
| Age 5. Id (desire), Ego (rational), Superego (parent, controlling, protection) |
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Term
| If an individual is obese as an adult, Freud may have thought this was the developmental cause |
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Definition
| Weren't fed when hungry as a baby- undeveloped oral stage. |
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Term
| A person who has control issues may have been underdeveloped during which one of Freud's stages? |
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Definition
| Anal stage, 18 months-3 years |
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Term
| Stage which child identifies with parent of the same sex |
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Definition
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Term
| Stage when child identifies with peers of the SAME sex |
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Definition
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Term
| Stage when child identifies with peers of the OPPOSITE sex. What might poor development during this phase cause? |
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Definition
| Genital stage. May cause problems with commitment, intimate relationships |
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Term
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Definition
Trust/Mistrust 0-18 mo
Autonomy/Shame and doubt 18mo-3yrs
Initiative/guilt 3-6yrs
Industry/Inferiority 6-12yrs
Identity/role confusion 12-20 yrs
Intimacy/isolation 20-30yrs
Generativity/Stagnation 30-65yrs
Ego/Despair 65-death |
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Term
| Important facts about Peplau |
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Definition
-correlation between personality development in childhood and stages of progression of illness
-Believes nurse can facilitate client learning that was not achieved in earlier experiences |
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Term
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Definition
I: Infant- learning to count on others
II: Toddler- Learning to delay satisfaction
III: Early Childhood- Identifying self
IV: Late Childhood- Developing skills in participation. Compromies, compete, and cooperate. |
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Term
| Six roles of the nurse (peplau) |
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Definition
Resource person
Counseler
Teacher
Leader
Technical Expert
Surrogate |
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Term
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Definition
| From peripheral receptor (skin) to CNS |
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Term
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Definition
| From CNS to peripheral effector (muscle) |
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Term
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Definition
| Neurotransmitter moves across a synapse and CAUSES another electrical response |
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Term
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Definition
| Neurotransmitter moves across a synapse and does NOT cause another response |
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Term
Neurotransmitter that controls movement, cognition and emotion
Low levels in Parkinson's disease and depression
High levels in Schizophrenia and mania |
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Definition
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Term
| How do antipsychotic medications work? |
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Definition
| Block dopamine receptors and reduce dopamine production |
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Term
Neurotransmitter that involves control of food intake, sleep and arousal, temperature regulation, pain, sexual and emotional behavior
High levels in schizophrenia and anxiety
Low levels in depression |
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Definition
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Term
Neurotransmitter involved in sleep, arousal, pain perception, movement, memory
Disorders of behavior and memory
Low levels in alzheimers and huntingtons
High levels in depression |
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Definition
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Term
Neurotransmitter involved in attention, learning, memory, sleep and wakefulness and mood
Increased in anxiety, mania, schizophrenia
Decreased in memory loss, social withdrawal, depression |
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Definition
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Term
| Which three neurotransmitters are involved in sleep and wakefulness? |
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Definition
| Serotonin, acetylcholine, and norepinephrine |
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Term
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Definition
| Conduct that results from serious critical thinking about how individuals ought to treat others |
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Term
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Definition
| ideals or concepts that give meaning to the individual's life |
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Term
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Definition
| process of self-exploration through which individuals identify and rank their own personal values |
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Term
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Definition
| A valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service |
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Term
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Definition
| When there is no restriction whatsoever on the individual's entitlement (right to refuse treatment) |
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Term
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Definition
| A right on which the society has agreed and formalized into law |
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Term
| Ethical theory that promotes actions based on the end results that produce the most good (happiness) for the most people |
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Definition
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Term
| This theory suggests that decisions and actions are bound by a sense of duty. "Do unto others as you would have them do unto you." |
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Definition
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Term
| Do good and avoid evil; evil acts are never condoned, even if they are intended to advance the nobelist of ends |
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Definition
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Term
| Decisions are based on what is best for the individual making the decision |
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Definition
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Term
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Definition
when moral appeals can be made for taking either of two opposing courses of action
TAKING NO ACTION IS AN ACTION TAKEN |
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Term
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Definition
| persons are autonomous moral agents whose right to determine their destiny should be respected |
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Term
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Definition
| to promote the good of others |
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Term
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Definition
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Term
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Definition
| Always be truthful (always be truthful about side effects of medications, when the patient asks) |
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Term
| 5 steps in the model for making ethical decisions |
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Definition
Assessment
Problem identification
Plan
Implementation
Evaluation |
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Term
| Three criteria that must be met to force medication |
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Definition
Hospital Association Bill of Rights
1. Behavior dangerous to self or others 2. Medication must have reasonable chance of working 3. Client judged to be incompetent to decide |
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Term
| According to the Hospital Association Bill of Rights, the patient has which two rights? |
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Definition
Right to refuse medication
Right to least restrictive treatment available |
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Term
| Order of treatment from least to most restrictive |
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Definition
1. Talk therapy
2. Medication
3. Mechanical restraints/seclusion room (used if patient is at risk for hurting self or others and not able to decelerate behavior through talking or medication) |
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Term
| Any restriction to a client's rights must be made by one of two types of orders |
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Definition
Court order
Physician's order |
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Term
| Any restriction to a client's rights must be made by one of two types of orders |
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Definition
Court order
Physician's order |
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Term
| What are some examples of restrictions to client rights that may be made with a doctor or court order? |
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Definition
suicidal client may not have belt, shoelaces or scissors
Aggressive client may have visitor restrictions
Client making threatening phone calls may be permitted only supervised calls |
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Term
| True or false: in a life threatening event, medical information may be released without consent |
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Definition
| True. This is the only instance. |
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Term
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Definition
| Patient has the right refuse treatment to the extent permitted by law and to be informed of the consequences of doing so. |
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Term
| Who has the right to refuse treatment of a 12 year old? |
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Definition
| Only the parents until 18yrs. The child must take medication, even if they do not want to. |
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Term
| What is therapeutic privilege? |
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Definition
| Witholding of information when knowledge may cause severe psychological harm (mother murders children in psychotic episode and is unaware of what she has done, this information may be withheld until she is stabilized) |
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Term
| Prior to using restraints, these three tools must be utilized. |
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Definition
1. Talk down (verbal intervention)
2. Change of environment (walk client to quiet area)
3. Show of force |
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Term
| Does the client have the right to freedom from restraint or seclusion if the situation is considered an emergency? |
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Definition
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Term
|
Definition
| direct application of physical force to a person without their permission. May be human, mechanical, or chemical |
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Term
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Definition
| Physically touch and control the patient or move them to seclusion |
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Term
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Definition
| Devices fastened to bed frame to limit physical agression |
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Term
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Definition
| Behavior controlling medication (Haldol) |
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Term
| What is the goal of restraints? |
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Definition
| To allow the patient to regain control of themselves. NEVER as punishment. |
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Term
| In what situation may restraints be used without an order? How long does the nurse have to obtain a verbal or written order after instituting restraints? |
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Definition
| In an emergency. One hour. |
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Term
| Orders for restraints and seclusion must be re-issued ever ___ hours for adults |
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Definition
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Term
| Orders for restraints and seclusion must be re-issued ever ___ hours for ages 9-17 |
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Definition
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Term
| Orders for restraints and seclusion must be re-issued every ___ hours for children 8 and younger |
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Definition
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Term
| An in-person evaluation must be made by an MD within___ hours of initiating a order for restraints in adults |
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Definition
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Term
| An in-person evaluation must be made by an MD withing ___ hours of initiating a order for restraints in those 17 and younger |
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Definition
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Term
| In an emergent situation, a nurse restrains a 22 year old patient at 9:00 am. By what time must the nurse obtain an MD order for the restraint? When does the MD need to make an in person evaluation? At what time does the order need to be re-issued? |
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Definition
Order by 10 am.
First in person evaluation by 2:00pm (if order is obtained at 10:00am- 4 hours after order is issued), in person evaluations Q8H thereafter.
Order re-issued by 2:00pm (if order received at 10am) and q4H thereafter |
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Term
| A client in restraints muse be observed AT LEAST ___? What are we assessing for? |
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Definition
| At least Q10-15 min. Assessing for circulation, respiration, hydration and nutrition, elimination. |
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Term
| What must the staff inform the restrained patient of? |
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Definition
| The criteria that will be used to determine when to decrease or end the use of the restraints. |
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Term
| What portion of clients are voluntarily committed? |
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Definition
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|
Term
| What is the criteria for involuntary commitment? |
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Definition
| Client is a danger to themselves or others. They may be committed until they no longer pose a danger. |
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Term
| There are 4 types of involuntary commitment. What are they? |
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Definition
| Emergency, mentally ill in need of treatment, involuntary outpatient, gravely disabled client. |
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Term
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Definition
Client is a danger
Client is detained for 48-72 hours until hearing is held
If client refuses treatment, court may order additional commitment-- usually 7-21 days |
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Term
| Mentally ill person in need of treatment |
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Definition
admitted involuntarily
-Defined by state as mentally ill
-Admitted for observation and treatment
-Unable to make informed decisions because of illness
Because of illness, cannot perform basic personal needs necessary for heath and safety |
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Term
| Involuntary out patient commitment |
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Definition
Usually substance abuse
-court ordered
likelihood that client will deteriorate without treatment and require inpatient admission
-severe mental illness limits client's awareness and increases risk of jailed or violent behavior
-individualized treatment plan that is likely to be effective |
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Term
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Definition
-unable to care for personal needs due to severe mental illness
-danger of serious physical harm due to inability to provide basic needs such as food, shelter, clothing and personal safety
-unable to make use of resources
-a guardian or conservator is appointed by the court to manage person or estate |
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Term
| negligence vs malpractice |
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Definition
Negligence is failure to exercise reasonable standard of care that a prudent person would in a similar situation
malpractice is negligence by a professional
nursing malpractice includes failure to conform to the required standard of care, actual injury, and a connection between the nurse's conduct and patient's injury |
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Term
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Definition
deliberate and unauthorized confinement of a person using verbal or physical means
restraining anyone who has been admitted to hospital voluntarily
if voluntary admit declines to point restraint or seclusion is needed, court intervention determines competence and involuntary commitment is required |
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Term
| In determining an empathetic response as opposed to a sympathetic response, what is the goal of the interaction? |
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Definition
| The goals is to get the patient to reflect back, talk more about themselves and their feelings. |
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Term
| 4 phases of relationship development |
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Definition
pre-interaction
orientation (introductory) phase
working phase
termination phase |
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Term
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Definition
obtain info about client from chart, significant others or health care team
examine one's own feelings, fears and anxieties about working with a particular client |
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Term
| Orientation (introductory phase) |
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Definition
Create environment for trust and rapport
Establish contract for intervention
Gather assessment data
Identify client's strengths and weaknesses
*Nursing dx
set goals
Develop realistic plan
Explore feelings of both client and nurse |
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Term
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Definition
| maintain trust/rapport Promote client's insight and perception of reality Use problem-solving model to work toward achieving goals Avoid: transference and counter transference |
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Term
| What is transference? During which phase might it occur? |
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Definition
Client unconsciously displaces to the nurse feelings formed toward a person from their past.
Working phase. |
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Term
| What is counter-transference? When might it occur? |
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Definition
Nurse has an emotional response to the client (over-identifies, develops personal relationship, tries to rescue, feels angry toward client)
Working phase |
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Term
|
Definition
| therapeutic conclusion of relationship. Occurs when: Progress has been made toward goals, plan for action for coping has been established, feelings about termination of the relationship are recognized. |
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Term
| What are some pre-existing conditions that may be present in therapeutic relationship? |
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Definition
Values, attitudes, beliefs
Culture, religion
Social status
Gender
Age/developmental level
Environmental aspects |
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Term
|
Definition
| closest distance that individuals allow between themselves and others |
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Term
|
Definition
| distance for interactions that are personal in nature such as close conversation with friends |
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Term
|
Definition
| distance for conversation with strangers/acquaintances |
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