Psychiatric-Mental Health Nursing, Multiaxial Diagnosis, and Nurse-Patient Relationship

Vocabulary practice flashcards generated from the psychiatric nursing lecture transcripts covering multiaxial assessment, admission criteria, mental status examination, nurse-patient relationship phases, communication techniques, and milieu management.

DSM-5-TR

The Diagnostic and Statistical Manual of Mental Disorders; the standard classification of mental disorders used internationally to facilitate communication and assign alphanumerical codes for reporting and payment.

Axis I

The multiaxial classification category covering Clinical Disorders (such as major depression, schizophrenia, and generalized anxiety disorder) and other conditions needing clinical attention like bereavement or treatment noncompliance.

Axis II

The multiaxial classification category covering Personality Disorders (such as Borderline, Narcissistic, Avoidant, and Dependent Personality Disorders) and Intellectual Disability.

Axis III

The multiaxial classification category covering General Medical Conditions (such as cancer, hypertension, and diabetes) that may influence psychiatric symptoms.

Axis IV

The multiaxial classification category covering Psychosocial & Environmental Problems (such as divorce, homelessness, and unemployment) critical for prognosis and discharge planning.

Axis V

The multiaxial classification category representing the clinician's evaluation of the patient's overall level of psychological, social, and occupational functioning on the Global Assessment of Functioning Scale ($0-100$).

Voluntary Admission

An inpatient admission where a patient aged $16$ years or older agrees to treatment, signs an admission form, displays insight, and can terminate treatment by signing a $72$\,hour notice.

Involuntary Admission

Hospitalization occurring without patient consent when mental impairment prevents recognizing the need for treatment and specific legal criteria, such as danger to self or others, are met.

Emergency Petition

A document initiated by a relative, friend, neighbor, or health professional allowing an individual with a mental disorder who poses a danger to self or others to be taken to an emergency room for evaluation.

Mental Status Exam (MSE)

A routine diagnostic tool performed by psychiatric nurses to gather subjective information regarding a patient's current emotional and cognitive functioning.

• appearence

• speech

• motor activity

• attituide/behvior toward examiner

• mood

• affect

• perceptions

• thought content/process

• cognitive funtioning

Mood

The patient's internal, sustained emotional state as subjectively reported by the patient.

Affect

The outward, physical manifestation of emotion displayed by the patient as observed by the nurse.

Labile Affect

An emotional expression characterized by rapid and abrupt shifts in emotion, such as moving quickly from laughing to hysterically crying.

Flat Affect

The absence of emotional expression, characterized by a monotone voice and an immobile facial expression.

Hallucinations

False sensory impressions involving any of the five senses (auditory, visual, tactile, gustatory, or olfactory) without real external stimuli.

Illusions

An inaccurate sensory perception or misinterpretation of a real physical external stimulus, such as mistaking a shadow for a person.

Delusions

Strongly held, fixed false beliefs that others clearly see as false, such as believing one is president of the United States.

Thought Broadcasting

The belief that one's internal thoughts can be heard aloud by other people.

Thought Insertion

The belief that thoughts are being placed directly into one's mind by external people or forces.

Ideas of Reference

The belief that external sources, such as television or radio broadcasts, contain special secret messages intended specifically for the patient.

Flight of Ideas

A thought process disturbance characterized by continuous, rapid shifting from one topic to another.

Thought Blocking

A sudden interruption in the stream of processing where thought stops quickly, often in the middle of a sentence.

Word Salad

Incomprehensible, gibberish speech consisting of a random mixture of words.

Clang Association

Speech governed by rhyming word patterns rather than logical meaning.

Neologisms

Newly invented or coined words made up by a patient that have no standard linguistic meaning.

Remote Memory

Long-term memory recall involving events from the patient's past personal history.

Recent Memory

Memory recall covering events that occurred over the past week or so.

Immediate Memory

Short-term memory recall tested over seconds or minutes, such as asking a patient to repeat three objects.

Judgment

The cognitive capability to make sound decisions and understand the likely outcomes of one's actions.

Insight

The patient's awareness and comprehension that they are ill or experiencing an altered state of functioning.

Therapeutic Relationship

A professional, goal-directed, client-focused interaction between a nurse and patient where input from both fosters healing, growth, and illness prevention.

Preinteraction Phase

The first phase of the nurse-patient relationship where the nurse examines personal feelings and anxieties, reviews therapeutic goals, and gathers patient information prior to the first interaction.

Orientation Phase

The second phase of the nurse-patient relationship focused on exchanging names, establishing a contract, building trust and rapport, setting confidentiality, and identifying patient problems.

Working Phase

The third phase of the nurse-patient relationship dedicated to accomplishing therapeutic work, problem-solving, developing patient insight, and overcoming potential resistance.

Termination Phase

The final phase of the nurse-patient relationship focused on bringing closure, evaluating goal attainment, and planning post-discharge care.

Broad Openings

A therapeutic communication technique using open-ended prompts (e.g., 'What would you like to talk about today?') to allow the patient to guide the interaction.

Reflection

A therapeutic communication technique where expressed feelings are directed back to the patient to encourage self-awareness.

Focusing

A therapeutic technique that zeroes in on a single word or concept to gather more detailed information and build insight.

Restating

Repeating the main idea of what the patient said back to them to clarify and confirm understanding.

Resistance

Unwillingness to change during the working phase, often manifested by superficial conversation or holding back pertinent information.

Transference

The patient's displacement of emotions or feelings onto the nurse, usually stemming from unresolved past relationships.

Countertransference

The nurse's displacement of personal emotions or unresolved feelings onto the patient.

Deinstitutionalization

The movement starting in the $1960\text{s}$ that transitioned severely mentally ill individuals out of state hospitals and into community settings.

Therapeutic Milieu

A controlled inpatient environment designed to enhance patient learning, healing, and adaptive coping skills.

• containment

• support

• structure

• involvement

• validation

Containment

A essential element of therapeutic milieu management that prioritizes physical well-being, security, and safety.

Crisis Stage

treatment goal: stabilization

nursing assessment: discuss risk factors

nursing intervention: environmental management

expected outcome: no harm to self or others

Acute Stage

treatment goal: remission

nursing assessment: focus upon symptoms and coping responses

nursing interventions: treatment planning, role modeling, and teaching

expected outcome: symptom relief

Maintenance Stage

treatment goal: recovery

nursing assessment: functional status and strengths
nursing interventions: support, ongoing therapy, and community integration
expected outcome: sustainable coping strategies and improved functioning

Health Promotion Stage

treatment goal: optimal level of wellness

nursing assessment: quality of life/well-being

nursing intervention: inspiration and validation

expected outcome: optimal quality of life

Sharing perceptions

nurses checks in with patient to see if that the nurse is seeing (nonverbal) or hearing (verbal) is accurate

Theme Identification

pointing out repeated patterns of behavior

Silence

allows for patient to collect thoughts, think through point, or consider switching to a more concerning topic

Humor

can be used as a therapeutic tool to help patients cope with stress, foster rapport, and provide relief during difficult conversations. USE WITH CAUTION

Informing

is providing patients with essential information that helps them understand their treatment options, diagnosis, and care plan. NOT GIVING ADVICE

Suggesting

is offering ideas or recommendations to patients that can empower them to explore options and make decisions about their treatment. It encourages patient participation in their care. NOT GIVING ADVICE

Goal Directed

thoughts are on target

logical

thoughts make sense

rambling

thoughts are unrelated

racing

rapid thoughts

remote memory

past events

recent memory

memory over the past week

immediate memory

memory ofver seconds and minutes