final exam (exam 1 & 2 review content) - psych

what is the DSM?

Diagnostic and Statistical Manual of Mental Disorders

"psych bible" but not perfect

what are manifestations of mental disorders?

behavioral, psychological and biological dysfunction of the individual

what are maslow's hierarchy of needs?

self-actualization: desire to become the most that one can be

esteem: respect, self-esteem, status, recognition, strength, freedom

love & belonging friendship, intimacy, family, sense of connection

safety needs: personal security, employment, resource, health, property

physiological needs: air, water, food, shelter, sleep, clothing, reproduction

what must be met first according to maslow?

physiological needs

how is maslow's hierarchy of needs relevant to the nursing profession?

used to prioritize nursing care

what was peplau theory based around?

art of nursing & science of nursing

how did peplau's theories influence nursing?

focus was placed on the nurse patient relationship

use of therapeutic communication as direct means to help client

how did peplau's define the nurse/patient relationship?

relationship can be healing because of empathy

three phases of therapeutic relationship (peplau)

orientation, working, termination

nurses role in orientation phase of the therapeutic relationship

introduce self

set contract

build trust

set goals

assess patient

patient's role in orientation phase of the therapeutic relationship

meet nurse

agree to contract

understand expectations

participate in goal setting

nurse's role in working phase of the therapeutic relationship

maintain relationship

facilitate expression

foster change

patient's role in working phase of the therapeutic relationship

examine own world view

test new behaviors

try alternate solutions

nurse's role in termination phase of the therapeutic relationship

summarize achievements

validate experiences

maintain limits

patient's role in termination phase of the therapeutic relationship

examine thoughts

discuss plans

accept termination

what emotions does dopamine effect?

pleasure & satisfaction

what happens if dopamine is too high?

anxiety, mania, stress

what happens if dopamine is too low?

depression, low motivation

what emotions does adrenaline effect?

fight or flight

what happens if adrenaline is too high?

anxiety, stress, restless

what happens if adrenaline is too low?

limited response to stress

what emotions does serotonin effect?

mood

what happens if serotonin is too high?

confusion, agitation, restless

what happens if serotonin is too low?

depression, anxiety, sleeping problems

what emotions does GABA effect?

tranquility

what happens if GABA is too high?

unsteady balance, slurred speech, unclear thinking

what happens if GABA is too low?

poor impulse control, mania, insomnia

a particular transmitter is often used by different neurons to carry out ________ ________

different activities

bizarre

impossible, not understandable and unrelated to normal life

anhendonia

loss of joy/pleasure in things that used to make patient happy (connected with depression)

alert (LOC)

awake, responsive

lethargic (LOC)

dozing, can shake patient's shoulder to wake

stuporous (LOC)

pressure needed to respond (ex: sternal rub)

comatose (LOC)

no response, just reflexes

expansive (affect)

over the top, big gestures

euthymic

baseline, appropriate

constricted/blunted/flat (affect)

progression loss of expression

tangetial (speech)

jump between unrelated topics, going off on tangents

circumstantial (speech)

long route to answer question (talk in circles)

hallucination (perception)

sense (hear, smell, see, taste, touch) perceptions not real

*auditory most common

dissoociation (perception)

out of body experience - derealization & depersonalization

derealization (perception)

situation in which the individual loses a sense of the reality of the external world

depersonalization (perception)

person feels like they are not real

suicidality (thoughts)

thoughts to wanting to harm self

homicidality (thoughts)

thoughts of harming others

delusions (thoughts)

thought process not reality based

types of delusions (thoughts)

paranoid/persecutory (most common)

grandiose (ex: smartest person ever)

thought broadcasting insertion (other hear thoughts, insert thought into others/their head)

religous (are/see/connected to a god)

what is the first step of therapeutic relationship?

self assessment

validation therapeutic communication technique

acknowledging the emotions without judgement

separate from actions

doesn't work without empathy

non-therapeutic communication techniques

asking irrelevant/personal questions

offering personal opinions

giving advice

giving false reassurance

minimizing feelings

changing the topic

asking "why" questions

offering value judgments

excessive questioning

giving approval or disapproval

rejecting

agreement

states of change in motivational interviewing

1. precontemplation

2.contemplation

3. preparation

4. action

5. maintenance

precontemplation state of change

before patient has even thought about making a change

contemplation state of change

thinking about making the change

preparation state of change

getting ready to make the change

action state of change

making the change

maintenance state of change

maintaining change

main barrier to change

ambivalence (lack of energy/belief to change)

what right does every patient have?

treatment in the least restrictive setttings

confidentiality legal considerations

HIPPA

patient's employer (don't give reason)

Americans with Disabilities Act

rights after death

patient privilege

HIV status

nurses are mandatory reporters: child, dependent adult, elder abuse

voluntary status

written application for admission

discharge initiated by patient

civil rights are fully retained by the patient (patient is voluntarily seeking help)

voluntary per guardian

legal hold

temporary emergency admission

48 business hours in Iowa to evaluate need to stay

court hearing with judge for commitment

involuntary/commitment

admission did not originate with the patient (any two people can file with court - family, hospital staff)

discharge initiated by hospital/court

civil rights according to state law (can force patients to take medications in Iowa)

required if 1+: dangerous to self/others, need for treatment, unable to meet own basic needs

2 types: mental health & substance abuse

serotonin syndrome s/sx

pryexia/sweating

anxiety/agitation

confusion

tremors

ataxia

hypertension

tachycardia

seizures

management of serotonin syndrome

recovery within 24 hours

mild: stop antidepressants and monitor

moderate-severe: manage each symptom (antiseizure meds, antihypertensives, antipyretics/cooling blankets, benzodiazepine)

assumptions of therapeutic community skinner

every interaction is an opportunity for therapeutic intervention

nurses role in milieu therapy

one-to-one relationships with patients

best results with therapy happen if a patient can

think conceptually and think logically

assumptions according to CBT

basic rules for living

attitudes that tend to be global

judgmental

if-then statements

affective shift If violated

what mental illness are BEST treated with CBT?

neurosis, depression and anxiety

what mental illnesses are BEST treated with DBT?

personality disorders or self-harm behaviors

what does DBT focus on?

emotional regulation

electro-convulsive therapy (ECT)

brief seizure activity while patient is under anesthesia

treatment is 2-3 times a week with a total of 6-12 treatments

illness treated by ECT

depression not responding to treatment or in need of faster treatment

schizophrenia with catatonia or schizoaffective disorder

acute manic episodes with rapid cycling or not responding to mood stabilizer medications

high risk complications with ECT

CV disorders: recent MI, HF, arrhythmias

cerebrovascular disorders: hx of stroke, brain tumor, subdural hematoma

what is administered during ECT procedure

short term anesthetic (propofol) & muscle relaxant (succinylcholine) given before seizure

common side effects of ECT

short term memory loss

HA

muscle sorenss

nausea

*no indication of long-term side effects

crisis treatment that is

brief

focused

time limited

goal of crisis interventions

assist in healthy resolution to the immediate problem

get the person back to baseline

individual to return to pre-crisis level of functioning

what should you assess post-crisis?

nature & strength of patient's support systems & coping resources

crisis intervention pyramid

environmental manipulation (base)

general support

generic approach

individual approach (top)

environmental manipulation

interventions that directly change patient's physical of interpersonal situation

ex: find a shelter for a person who is a flood victim

general support

interventions that convey feeling nurse is on patient's side & will be helping person

implies the nurse use empathy, be nonjudgmental, offer information on support services, etc

generic approach

specific method to all people faced with similar type of crisis

grief group, debriefing, etc

ex: usually mean that something common has happened, such as a broken hip, and the nurse can handle many of the victim's needs in the same way as others who break their hip

individual approach

treatment of a specific problem with specific patient

five core interventions

five core interventions of individual approach

restore psychological safety

provide information - on timeline/what happened

correct misattributions

restore & support effective coping

ensure social support

phases of grief process

denial: "this can't happen"

anger: "how could this happen"

bargaining "just give me a few more

depression "nothing has meaning"

acceptance/reestablishment "new normal"

uncomplicated grief

"normal" grief

also called acute grieving

does NOT lead to dysfunction

when does anticipatory grief occur?

occur when someone expects loss in advance

types of dysfunctional grieving

delayed/inhibited grief

dysfunctional/distorted/exaggerated

chronic/prolonged

delayed/inhibited grief

absence of grief where you would normally expect

what stage of grief is delayed/inhibited grief stuck in?

denial

dysfunctional/distorted/exaggerated grief

symptoms of normal grief are exaggerated

what stage of grief is dysfunctional/distorted/exaggerated grief stuck in?

anger

chronic/prolonged grief

careful with diagnosing this

individuals vary greatly

normal grieving

self-esteem remains intact

person can accept comfort

biggest indicator/risk for aggression

past history of aggression

biggest indicative behavior of aggression

CHANGE

nursing interventions for aggression

provide safe environments for all

follow policies of your institution

assess for triggers or preconditions that may escalate your patient

pre-assaultive interventions

remain calm and in control

encourage verbal expresion of feelings

allow as much personal space as possible

maintain eye contact

get on patient's level

describe options clearly and offer choices

communicate calm and directly what patient must do

inform patient of consequences of behavior

physical activity to deescalate anger and behaviors

assaultive interventions

follow training and institutional policies

prevent injury of staff and patients

make sure care is be provided to other patients still