Psych Quiz 2 - Ms Stone

Nursing Assessment, Interventions and Care Modalities for the Psych Patient

1. Case Management

  • Work with multiple health-care providers to obtain services for the patient

    • Organize care and plan discharge

2. Nursing Role

  • Assist patients and help them adapt to stressors

    • Patients arrive at a crisis point when they come in

  • Create goals directed towards change

    • Example: Motivational interviewing helps patients create goals for change in their lives

  • Document care and interventions

Nursing Mental Health Assessment

  • Always send mail through the post office

    • Components of the assessment include:

      • Appearance, speech, mood/memory, thoughts, perceptions, orientation

      • General description includes:

        • Mood: Internal emotions

        • Affect: Outward expression of emotions

        • Loose associations: Severe lack of connection between ideas

        • Circumstantiality: Lengthy conversation that delays the overall point

        • Tangentiality: Never reaching a point in conversation

        • Concrete thinking: Thinking literally; lacking abstract thinking

        • Clang associations: Rhyming words or nonsensical puns

  • Form of thought includes:

    • Flight of ideas: Rapid and spontaneous shifts from one idea to another

    • Neologisms: Made up words

    • Word salad: A jumble of words without coherent meaning

    • Echolalia: Repeating or mimicking speech of another person

    • Mutism: Refusal to speak

    • Speech poverty: Very limited speech

  • Content of thought includes:

    • Delusions: Strongly held false beliefs

    • SI/HI: Suicidal and homicidal ideations

    • Obsession: Persistent thoughts that are intrusive

    • Paranoia: Irrational belief that others intend harm or deceit

    • Magical thinking: Belief that unrelated events are causally connected

    • Religiosity: Preoccupation with religious themes or beliefs

    • Phobias: Irrational fears of specific objects or situations

    • Poverty of thought: Perception of emptiness in thought process

  • Perceptions include:

    • Hallucinations: Sensory experiences without an external stimulus (auditory, visual, tactile, olfactory, gustatory)

    • Illusions: Misinterpretations of actual stimuli

    • Depersonalization: Altered perception of self

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3. Psychosocial Interventions for Crisis Intervention

  • Individual therapy: One-on-one support

  • Psychoanalysis: In-depth therapy exploring unconscious conflicts

  • Psychotherapy: Brief version of psychoanalysis focused on specific issues

  • Interpersonal Therapy: Particularly effective for depression

  • Reality Therapy: Focus on unmet needs such as power, belonging, freedom, fun, and survival

  • Cognitive Based Therapy (CBT): Alters negative thought patterns and addresses trauma

  • Dialectical Behavior Therapy (DBT): Similar to CBT but emphasizes emotional regulation

    • Often conducted in group settings

  • Milieu Therapy: Structured therapeutic environment promoting social interactions

    • Focus on socialization and normative influences

    • Nursing Interventions: Show support, discuss strengths/weaknesses

  • Relaxation Therapy: Techniques such as deep breathing, meditation, and yoga

  • Assertiveness Training: Teaches patients to express feelings without defensiveness

  • Spiritual Care: Focus on religious or spiritual growth

  • Group Interventions: Foster support and empowerment among patients

  • Prolonged Exposure Therapy: Patients repeatedly discuss traumatic events to reduce fear response

4. Crisis Interventions

  • Defined as acute events where the patient cannot cope without support

  • Management must be time-sensitive, addressing Trauma & Stressor Related Disorders

5. Traumatic Events

  • Experiences causing severe emotional shock with potential long-lasting psychological effects

  • Possible development of PTSD (Post-Traumatic Stress Disorder)

    • Predisposing factors include the severity & duration of stressors, exposure to death, effectiveness of coping mechanisms

    • Cognitive Theory: Vulnerability arises when traumatic experiences invalidate fundamental beliefs, resulting in helplessness

    • Acute Stress Disorder (ASD): Symptoms last up to one month

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6. PTSD

  • Symptoms can persist indefinitely

    • Veterans may struggle to connect symptoms with conditions like TBI, PTSD, depression, and substance abuse disorders

  • Signs/Symptoms of ASD and PTSD: Include recurrent dreams, avoidance of reminders, hypervigilance, etc.

7. Adjustment Disorder

  • Reaction to stress manifests as mood or behavior changes

    • Triggers include bullying, relocation, loss of a loved one, etc.

    • Symptoms are generally less severe compared to PTSD

8. Nursing Interventions for PTSD, ASD, & Adjustment Disorders

  • Engage in therapeutic communication and create a safe environment

  • Assess for suicidal ideation

  • Utilize grounding techniques and suggest deep breathing during panic attacks; involve sensory experiences

  • PTSD-EMDR: Eye Movement Desensitization and Reprocessing

  • Learning Theory: Negative reinforcement diminishes undesirable behaviors without reinforcing positive behaviors

  • Types of Trauma: Emotional and physical trauma

9. Trauma-Informed Care

  • A practice that fosters recovery by recognizing trauma symptoms

    • Dissociative Amnesia: Inability to recall stressful events

    • Dissociative Identity Disorder: Multiple personality disorder