Term
|
Definition
provides standards and nomenclature for medical staff to apply rules to diagnose mental illness
to present defining characteristics of mental illnesses
to identify possible underlying causes of mental illness |
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Term
|
Definition
Axis 1 All psychotic disorders except MR and personality d/o.
Axis 2 MR and personality d/o
Axis 3 Medical conditions that may affect the mental illness or it's tx.
Axis 4 psychosocial stressors
Axis 5 Global GAF 0-100, mentally ill pts usually score 20-30. |
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Term
| Therapeutic relationships |
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Definition
| Hildegard Peplau discusses the 3 phases of a nurse/pt relationship. |
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Term
| Phases of a therapeutic relationship |
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Definition
Phase 1 Orientation: establish rules, purpose of being in hospital, build trust, show empathy
Phase 2 Working Identification phase, RN works with patient to identify feelings, behaviors, patient perceptions, goals
Phase 3 termination(resolution): RN says good bye, patint takes responsibiltiy for own tx |
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Term
|
Definition
| Environment in which staff take care of patients where the patients feel safe and secure. |
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Term
| Milieu Management-3 effective elements |
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Definition
Limit setting and boundaries, patients are told schedules, areas that are off limits, personal items allowed, group times to attend.
Safety for the patient, staff and fellow patients.
Stabilization |
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Term
| Involuntary admission-legal considerations |
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Definition
Involuntary(committed) 1 of 3 criteria must be a fact(no gray area)
1. harm to self or others
2. inability to provide basic needs
for themselves
3. Judgement is too impaired they
don't realize they need help
Can be committed by MD, RN, judge, family member.
Being committed the pt. does not lose any rights except to leave facility. |
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Term
| Voluntary admission -legal considerations |
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Definition
Pt. signs themself into facility under MD care. Patient can only leave under doctor's discharge order or sign form "AMA"-against medical advice.
If patient decides to leave against medical advice MD/RN/Judge can decide to committ patient if necessary. |
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Term
| Medication against patients will -Legal considerations |
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Definition
pt. is allowed to refuse medication based on the principle of autonomy except if a danger to self or others, then this right is forfeit.
Pt. must sign and informed consent form for meds stating that the meds have been explained to them(SE, use, etc) except in emergency situations. This form protects both staff and pt. |
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Term
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Definition
| 22 states make it a legal obligation of medical staff to warn if a threat has been made to another person. SC states "may warn jurisdiction" stating that it is not a legal obligation, but it would not violate any hippa laws if done. Gives permission to warn but not required. |
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Term
| Seclusion legal considerations |
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Definition
| all patinets have the right to tx in the lease restrictive setting. Seclusion is a contained environment with minimal stimulation. It is involuntary confinement of a person in a room from which the person is physically prevented from leaving. No evidence of therapeutic value. |
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Term
|
Definition
All health care professionals must be properly trained on seclusion and restraints and alternative tx techniques such as deescalation
patient must be seen by MD w/in 1hr
there must be a time limit of 4hrs(2hrs for adolescent)to be reassessed to continue seclusion or not. |
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Term
|
Definition
face to face 24hr observation(may monitor on video only with audio)
Containment of safe environment
isolation pt may need to isolate to calm self
decrease sensory input |
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Term
|
Definition
| device attached to or adjacent to patients body that cannot be easily removed and restricts the freedom or movememnt or access to ones body. Physical, chemical, mechanical |
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Term
| Restraints legal considerations |
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Definition
orders good for 24hrs
Need order
If order states prn status must have specific rationale |
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Term
| Seclusion/Restraints-Nursing indications |
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Definition
Last resort
Health care personnel must meet
biological needs-toileting, food,
water offered q2hrs
RN must communicate with patient, maintain pt autonomy, dignity, |
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Term
| Seclusion/restraint-Nsg Dx |
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Definition
Risk for Injury
Self directed/other directed violence
Anxiety
Ineffective coping |
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Term
| Seclusion/restrain-Nsg goals |
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Definition
| Pt will regain physical and emotional self control |
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Term
| Seclusion/Restraint Nsg interventions |
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Definition
#1 nsg intervention when patient is put into restraints is definitely assess circulation and respiration(pallor, pulses, cap refill, tightness of restraints)
admin prescribed meds
convey calm quiet atmosphere
remove all dangerous objects
call MD for order and eval, pt must be seen by MD within 1hr of entering seclusion
restraints don't need to be seen by MD, but do need an order
debriefing of patient |
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Term
| Seclusion/restraints - nsg evaluation |
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Definition
pt. maintains reality orientation
pt cause no harm to self or others
pts anxiety maintained at level which client feels no need for aggression
pt contracts for safety |
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Term
| Family & support system considerations-Barriers |
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Definition
Family attitudes/stigma of mental health
Financial barriers to getting help/meds
Professional bias/fears |
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Term
|
Definition
formed to address the needs of people
facilitates therapeutic growth in the patients
pts come from varied backgrounds
members give/receive feedback |
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Term
|
Definition
Group structure- size 7-10pts
Length lower functioning 20-40 min.
MDD, Suicidal, Manic, Schizo
higher functioning 60-120min
group work
communication observable verbal/nonverbal elements of group communication |
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Term
| Components of group therapies-Group processes(phases)No select order |
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Definition
1. Formin-first get together,polite superficial conversation, nonevasive, nonspecific, no personal topics
2. Storming-get to know people in group better, arguements start to develop, pecking order develops
3. Norming feeling of group cohesiveness, family feeling, start to support and trust each other, share personal stories, learn about weakness/strengths
4. Performing help each other, offer suggestions, advice. |
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Term
| Group therapy-Cognitive Behavioral Therapy (CBT) |
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Definition
concentrates on changing the negative thougth process, on how one negatively percieves a thought-cognitive distortion.
Usually 12-20 wkly sessions
Primary goals: increasing activity , reducing unwanted behavior, increase pleasure, enhancing social skills
first step to therapy is to get to underlying problem. Why cognitive distortion??? |
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Term
| Group therapy-Family therapy(early 1900) |
|
Definition
purpose is to improve interpersonal skills, communication, behavior, and functioning
Indications for use: marital problems, sibling conflicts, no improvement in individual therapy(which usually means there is underlying family problem)
goal aimed at engaging/encouraging familites to be active participants. Teach family about disease processes and what each individual member can do to make unit better. |
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Term
|
Definition
| MDD, Bipolar Affective Disorder, Seasonal Affective Disorder |
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Term
| Major Depressive Disorder -MDD |
|
Definition
oldest/most common psychiatric illness
2x women than men, women respond less
to tx.
Mid to late 20's
non biased, hits all people
psychosocial stressors may precipitate
may be related to medical conditions-
most cases don't know which came
first the depression or the medical
condition |
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Term
|
Definition
genetics
biological-electrolyte abnormalties,
decrease Na&K levels
disfunction of autonomic NS
Brain imaging
Endocrine system-hypersecretions of
hormone levels-cortisol levels released by stress never decrease w/MDD pts. dx test DST Dexamethasone(steroid that supresses cortisol) suppression test
Neurotransmission-decreased
serotonin&epinephrine,
decreased hippocampus
(learning&memory in brain) |
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Term
| MDD diagnostic criteria by DSM IV |
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Definition
| 2+wks of sad mood or lack of interest in life activites w/ at least 4 other symptoms of depression |
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Term
|
Definition
Gender- women
70% more likely to be diagnosed again
if prior episode of depression
stressful life event
current substance abuse
medical illness
few social supports
3+ children at home
lost mother before age 11yrs old |
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Term
|
Definition
First thing to ask is are you suicidal?
poor dress, poor hygiene, poor eye contact, psychomotor retardation
Affect-anodonia(no energy), flat(no facial expression) depressed, blunted(slow to react)
Mood- hopeless, helpless, anxious(1-10) mood scale (1-10)rate to show improvement from day to day
Speech(latency to respond)may take 30-60sec to respond, loudness, flow, quantity, speed(slow, mumbled)
Bad/limited insight-don't understand how thier disease affect others too. |
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Term
|
Definition
Thyroid stimulation hormone decreased
MRI of hippocampus
PET evaluates intensity of brain activity. MDD pts brain goes into "hibernation"
DST Dexamethasone suppression test
(cortisol)
Electrolytes(Na & K) UDS |
|
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Term
|
Definition
guide to see if pt is improving-
GAF scale
Beck Depression Inventory (BDI)
Hamilton Rating Scale for Depression
Suicide Risk Scale |
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Term
| MDD treatment- pharmocological |
|
Definition
Antidepressants-SSRIs are first line
of defense d/t least
likely to overdose
TCAs can overdose, cause cardiotoxicity
MAOIs- 3rd cannot eat foods with tyramine such as cheese, aged meat, wine, chocolate, d/t bad interactions with other meds, may cause hypertensive crisis. Must wait 10-14 days after stopping med for it to be out of body.
Benzodiazepines, antipsychotics |
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Term
| MDD treatments somatic therapies |
|
Definition
ECT-quick immediate results
Phototherapy for mild cases
TMS transcranial magnetic stimulation-
out patient 30-40 min qday
VNS Vagus nerve stimulation-
electrical nerve impulses to brain
SE-parasthesia, h/a, seizure, light
headedness |
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Term
|
Definition
#1 risk for suicide
Ineffective coping
Anxiety
Chronic low self esteem
Social isolation
Sleep disturbance
Self care deficeit
Hopelessness
Imbalanced nutrition |
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Term
|
Definition
Contract for safety
Provide unconditional positive regards
Observation
Monitor I&O, wkly weights
Help pt explore feelings
Thought stopping/substitution
Increase socialization
Teach appropriate coping skills
Assist with ADL's if needed(anodonia)
Simple structured activities at first
Sleep interventions
Give sense of hope, self disclosure |
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Term
|
Definition
Increase mood (scale 1-10)
Decrease anxiety (1-10)
No suicidal ideations
verbalization of feelings |
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Term
|
Definition
Maladaptive self-destructive behavior, self harm, self injury
females attempt more than males, males accomplish more than females
rates highest older adults
15% of MDD eventually kill themselves
90% suicides have mental illness at time of death |
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Term
| Suicide Neurobiological theories |
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Definition
Dysregulation of the hypothalamic
High production of cortisol |
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Term
|
Definition
Gender female attempt, males accomplish
Hx
Borderline personality d/o
decreased support systems
Major health problems
Age
Mental Illness
Life stressors
Hx &/or current substance abuse |
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Term
|
Definition
Passive Suicidal ideation-thought without intent to act
Active Suicidal ideation Thoughts with plans to cause one's own death |
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Term
|
Definition
| Risk factors, Personality traits(hostility, w/drawn,decrease self esteem, decreased trust, feelings of powerlessness, rigid inflexible way of thinking, verbal/non verbal |
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Term
|
Definition
| Gunshot, hanging(only need 7pds of pressure), jumping, carbon monoxide, drug overdose- physicians highest risk of suicide. |
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Term
| Suicide Assessment questions |
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Definition
| ideation, plan, method, access, where, when, timing |
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Term
|
Definition
Risk for injury, risk for suicide
Non compliance of meds
Risk for self directed violence |
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Term
| Suicide Nsg Interventions |
|
Definition
Observations 1:1 q15min, q30min
contract for safety
protect patient from harm
Rn should communicate hope
educate(hotline) resources
crisis plan-intervention, coping skills
Identify what led up to this ideation |
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Term
| Bipolar Affective D/O(BPAD) |
|
Definition
Affects females use to affect males & Females equal
psychosocial stressors can precipitate the onset of illness episodes |
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Term
|
Definition
genetic-genes on chromosomes 11, 18, 21
neuroanatomical -thalamus, prefrontal cortex, abnormal white brain matter.
Chronobiology- study of the circadian rhythm(sleep/wake cycle) |
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Term
| Bipolar Affective D/O criteria DSM IV |
|
Definition
at least one week of unusual and incessantly hieghtening, gradious, or agitatied mood
3+ of the following:
exaggerated self esteem, sleeplessness, pressurd speech, Flight of ideas, severe consequences (high risk activities) |
|
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Term
| Bipolar Affective D/O psychosocial assessment |
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Definition
| hx, appearance, affect-incongruence(inappropriate emotional responses), no insight of disease, impulsive |
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Term
| Bipolar Affective D/O Treatment pharmacologic |
|
Definition
Mood stabilizer Lithium-old, narrow therapeutic range 0.5-1.5, tx of mania 1.0-1.4.
Anticonvulsants
Dapakote-50-100units, wt gain d/t increased appetite
Tegratol 4-12units
Lamictal
antidepressants may put into manic
phase so prescribe w/mood stabilizers
Benzo-Ativan, klonopin, Xanax
Calcium Channel Blockers-
(if cannot tolerate lithium, brain injury, or pregnancy)
Verapamil Procardia
Antipsychotics-if having psychosis-
Risperdal, Zyprexa, Geodon |
|
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Term
| Bipolar Affective D/O Treatments |
|
Definition
ECT
Psychotherapy-Cognitive behavioral & Family therapy |
|
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Term
|
Definition
Risk for other directed violence
Risk for injury
Imbalanced nutrition=fluid volume
deficit=electrolyte
imbalance=cardiac problems
ineffective coping
noncompliance-don't feel they need meds
disturbed sleep pattern |
|
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Term
|
Definition
small, light, high protein meals
I&O, wkly wts
finger foods
provide exercise
limit environmental stimuli prior sleep
set limits and boundaries, explain consequences for overstepping boudaries
short simple sentences
Teach warning signs of mania-less sleep, less food, more social
Medication compliance-pill custodian |
|
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Term
|
Definition
Pt will not harm self or others
pt establish balance of sleep/activity
pt will have appropriate nutrition
pt will engage in appropriate behaviors
pt will verbalize knowlege of his illness |
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Term
| Thought d/o Schizophrenia |
|
Definition
schizo-split, phrena-mind,
chronic illness
periods of remission and exacerbation |
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Term
| Schizophrenia pathophysiology |
|
Definition
biological
genetic-on chromosomes 4,8,15,22
viral infection
neurobiology-prefrontal,limbic cortex
abnormal brain volume
biochemical-dopamine |
|
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Term
|
Definition
| disorganized, paranoid, catatonic |
|
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Term
| Disorganized schizophrenia |
|
Definition
onset normally before age 25
disorganized speech, incoherent,
clang associations
disorganized behavior, lack of
motivation, inability to do ADLs
Affect flat and inappropriate
inappropriate seasonal dress,
hallucinations, delusions, social w/d, confused orientation.
Hard time living alone, having relationships, working, etc... |
|
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Term
|
Definition
can function in nomal day to day life
preoccupation w/1+ delusions
frequent auditory hallucinations
very intelligent
Does NOT have:
disorganized speech, disorganized/catatonic behavior
flat/inappropriate affect |
|
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Term
| Catatonic schizophrenia-rare d/t antipsychotic meds |
|
Definition
must have 2+ of the following:
motor immobility
excessive motor activity
voluntary assumption of bizarre posture
echolalia(repeat words)/echopraxia
repeat actions |
|
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Term
| Schizophrenia occurs in phases |
|
Definition
phase 1 schizoid: pt begins to w/d, lose interest in relationships, emotional abilities limited
phase 2 prodromal: negative symptoms, impairment in role functions, neglect personal hygiene, lack of interest in old hobbies
Phase 3 Schizophrenia Dx: positive sx, delusions, disorganized speech/thoughts
phase 4 Residual: period of remission, negative symptoms, decrease in ADLs/job function |
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Term
|
Definition
need to ask if compliant with meds and if not why not?
safety #1 priority-ask of hx of violence
tangentiality-jumping from topics
clanging-rhyming without reason
word salad, loose associations,difficulty with concrete operations, take things literally |
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Term
| Schizophrenia assessment tools |
|
Definition
| abnormal involuntary Movement scale (AIMS) |
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Term
| Schizophrenia treatments pharmacologic |
|
Definition
antipsychotic-conventional(typical)
extra piramidal side effects
atypical-clozeril-may cause agranulocytosis, need to monitor WBCs wkly
Geodon, zyprexa, less se, control -&+ symptoms, |
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Term
| EPS extra piramidal side effects (3 parts) |
|
Definition
Dystonia-muscle rigidity/cramping, stiff thick tongue, difficulty swallowing, neck and head stiffness
Parkinsonism-stiff,stooped posture, decreased arm swing, shuffling, drooling, pill rolling.
Akathesia- restless, anxious, can't sit still.
Can give anticholinergics (Cogentin, benedryl) to fight EPS |
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Term
| EPS extra piramidal side effects (3 parts) |
|
Definition
Dystonia-muscle rigidity/cramping, stiff thick tongue, difficulty swallowing, neck and head stiffness
Parkinsonism-stiff,stooped posture, decreased arm swing, shuffling, drooling, pill rolling.
Akathesia- restless, anxious, can't sit still.
Can give anticholinergics (Cogentin, benedryl) to fight EPS |
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Term
|
Definition
permanent involuntary movements of the tongue,facial/neck muscles, upper/lower extremities.
S&S: tongue thrusting/protruding, lip smacking, blinking, grimacing |
|
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Term
|
Definition
permanent involuntary movements of the tongue,facial/neck muscles, upper/lower extremities.
S&S: tongue thrusting/protruding, lip smacking, blinking, grimacing |
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Term
|
Definition
Risk for violence(safety)
altered thought process
sleep pattern disturbance
self care deficit
social isolation(negative symptoms) |
|
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Term
|
Definition
Risk for violence(safety)
altered thought process
sleep pattern disturbance
self care deficit
social isolation(negative symptoms) |
|
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Term
| Schizophrenia Nsg interventions |
|
Definition
#1-safety, protect pt.
set limits
supportive-directive communication
ID community resources
employ alternative activities
reorient to surroundings |
|
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Term
| Schizophrenia Nsg interventions |
|
Definition
#1-safety, protect pt.
set limits
supportive-directive communication
ID community resources
employ alternative activities
reorient to surroundings |
|
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Term
|
Definition
pt will be compliant with medication
pt. will not harm self or others
pt will attend to ADLs
pt verbalize feelings appropriately
decrease or no delusional thoughts |
|
|
Term
|
Definition
pt will be compliant with medication
pt. will not harm self or others
pt will attend to ADLs
pt verbalize feelings appropriately
decrease or no delusional thoughts |
|
|
Term
| EPS extra piramidal side effects (3 parts) |
|
Definition
Dystonia-muscle rigidity/cramping, stiff thick tongue, difficulty swallowing, neck and head stiffness
Parkinsonism-stiff,stooped posture, decreased arm swing, shuffling, drooling, pill rolling.
Akathesia- restless, anxious, can't sit still.
Can give anticholinergics (Cogentin, benedryl) to fight EPS |
|
|
Term
|
Definition
permanent involuntary movements of the tongue,facial/neck muscles, upper/lower extremities.
S&S: tongue thrusting/protruding, lip smacking, blinking, grimacing |
|
|
Term
|
Definition
Risk for violence(safety)
altered thought process
sleep pattern disturbance
self care deficit
social isolation(negative symptoms) |
|
|
Term
| Schizophrenia Nsg interventions |
|
Definition
#1-safety, protect pt.
set limits
supportive-directive communication
ID community resources
employ alternative activities
reorient to surroundings |
|
|
Term
|
Definition
pt will be compliant with medication
pt. will not harm self or others
pt will attend to ADLs
pt verbalize feelings appropriately
decrease or no delusional thoughts |
|
|
Term
| EPS extra piramidal side effects (3 parts) |
|
Definition
Dystonia-muscle rigidity/cramping, stiff thick tongue, difficulty swallowing, neck and head stiffness
Parkinsonism-stiff,stooped posture, decreased arm swing, shuffling, drooling, pill rolling.
Akathesia- restless, anxious, can't sit still.
Can give anticholinergics (Cogentin, benedryl) to fight EPS |
|
|
Term
|
Definition
permanent involuntary movements of the tongue,facial/neck muscles, upper/lower extremities.
S&S: tongue thrusting/protruding, lip smacking, blinking, grimacing |
|
|
Term
|
Definition
Risk for violence(safety)
altered thought process
sleep pattern disturbance
self care deficit
social isolation(negative symptoms) |
|
|
Term
| Schizophrenia Nsg interventions |
|
Definition
#1-safety, protect pt.
set limits
supportive-directive communication
ID community resources
employ alternative activities
reorient to surroundings |
|
|
Term
|
Definition
pt will be compliant with medication
pt. will not harm self or others
pt will attend to ADLs
pt verbalize feelings appropriately
decrease or no delusional thoughts |
|
|
Term
|
Definition
Panic, Phobias, Obsessive-Compulsive d/o (OCD), and Post Traumatic Stress d/o(PTSD)
Most prevalent mental disorder in the US |
|
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Term
|
Definition
face anxiety on daily basis
necessary for survival
provides motivation for acheivement
more common in women
most prevalent 19 million affected
anxiety can be so severe pts can
become suicidal |
|
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Term
|
Definition
when response is disproportionate to risk and/or severity of the danger or threat
response continues beyond existence of danger or threat
intellectual, social,or occupational functioning is impaired
person suffers from a psychosomatic effect(cholitis, dermatitis) |
|
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Term
|
Definition
Mild anxiety-alert, grasps more info, felt when you missed the bus, good anxiety, may help learning
Mod anxiety-selective in attention, focused on immediate concerns anxiety felt when taking an exam-ATI physical symptoms at this level.
Severe-perceptual field greatly reduced-anxiety flet when witnessing a car accident.
Panic-Markedly disturbed behavior. anxiety felt when experiencing an earthquake and being unable to cope. panic attack-lose all rational thought processes. |
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Term
| Panic disorder DSM IV criteria |
|
Definition
panic attack or intense anxiety continuously with 4+ symptoms:
palpitations
sweating, tremors, SOB, sense of suffocation, chest pain(may feel like having a heart attack), nausea, dizziness, abdominal distress |
|
|
Term
| Panic disorder(anxiety d/o) risk factors |
|
Definition
agoraphobia-fear of being alone or in public places
asthma
cardiovascular disease
familial pattern
stressful lifestyle
high correlation of substance abuse and panic d/o d/t self medicating
suicide is thought about often |
|
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Term
| panic disorder assessment |
|
Definition
| sweating, pacing, fidgeting, mute, rambling, nervous, anxious, edgy, flat, blunted, disoriented thought process, feels out of control, poor self esteem, social withdrawal, decreasing functions |
|
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Term
|
Definition
1st stage experienced after a variety of stressors(sometimes no stressors)
2nd stage individual begins to live in fear that they may have another attack
3rd stage individual may develop intense avoidant behaviors and refuse to participate in social events. Trying to avoid what caused the attacks or what they percieved to have caused the attacks |
|
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Term
|
Definition
Risk for suicide
impaired thought process
anxiety |
|
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Term
|
Definition
| irrational fear that causes very intense anxiety |
|
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Term
|
Definition
significant anxiety provoked by a specific object or situation
leads to avoidance behavior
interferes with person's life
difficulty in occupational functioning |
|
|
Term
|
Definition
psychopharmacology & therapy:
behavioral
systematic desensitization-teach relaxing techniques, use from least anxiety provoking situation to most anxiety provoking until learn to deal with situation/objects.
flooding-pavlov's dogs-expose stimuli to pt in high doses. Once pt realizes that the stimuli isn't going to harm can reduce fear. |
|
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Term
| Anxiety d/o OCD DSM IV criteria |
|
Definition
| obsession that cause marked anxiety and compulsions that attempt to neutralize anxiety. |
|
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Term
|
Definition
Pharmacology and Behavioral Therapy
Exposure response prevention therapy |
|
|
Term
|
Definition
Anxiety
ineffective coping
fatigue |
|
|
Term
|
Definition
support
expression of feelings
relaxation techniques
Monitor for suicidal ideations
diary |
|
|
Term
|
Definition
#1 goal is that pt will state they have control over their thoughts and behaviors
pt will complete routine activities within time frame
pt will demonstrate effective use of relaxation techniques
pt will spend less time performing rituals |
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