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Psych/Mental Health Nursing General Question Themes/subject matters: Paralanguage: use of vocal effects, such as tone and tempo to convey a message. Example includes a client being more anxious and speaking louder and faster than usual. Holmes and Rahe’s Theory: suggests that all life events (especially significant), whether positive or negative, causes stress Flight of Ideas: is a pattern of thinking, characterized by a client changing topics rapidly. Example: when a client is relaying a past psychiatric history they change topics rapidly Abuse and Neglect: lead to poor self concept and role confusion; and are the basis for unhealthy personal boundaries; Clients lack of eye contact during interview or assessment: be sure to observe if this is normal for the clients culture; assess to see if this is normal for the client and part of their normal behavior patterns Exploring: is a communication technique designed to get the patient to explore their feelings; it is used if the nurse asks “Do you want to talk more about it” Goal in crisis intervention: use problem solving techniques and structured activities to relief the crisis immediately; the patient is in crisis because they cannot problem solve and their structure has broken down; This is a priority case/instance. Clients seeing their chart: tell client they have a right to see their chart, but they need to speak with their primary care provider; they have the right to see their chart as long as it is not detrimental to their health Psychiatric Nursing & Primary Prevention: includes providing sexual education classes for adolescents; education programs that promote mental health that prevent future psychiatric episodes Discussing hypothetical ethical considerations: helps nurse to assess clients mental status and judgment Alternative modes of expression: could be play therapy (drawing, puppetry); helps people express feelings they can’t articulate. Therapeutic Nurse-Client Relationship: begins with the nurse assessment of their own self-awareness and understanding in order to fully understand clients and their condition. Making Observations: is a communication technique that gives a client feedback about their attitude and behavior: Displacement: is a defense mechanism used when the client transfers their feelings for one person towards another who is less threatening. Cross-Tolerance: is one drug that a client is using/prescribed/given that lessens their response to another drug. Group Therapists: must have a masters degree in psychiatric nursing with credentials Self-Acceptance: serves as the basis for healthy relationships with others and is the main accepted mental health criterion. Displacement: when feelings of anger and rejection are discharged or focused in an indirect way that is considered safe and doesn’t directly harm other people. Elderly clients reactions to medications: slow metabolism of drugs put elderly people at higher risk of adverse effects. 18 to 25 developmental task: Postulated by Erikson; it is intimacy vs. isolation Antisocial personality disorder: it is important to consistently enforce unit and facility policy; firmness and consistency should be the main part of a careplan with a patient who has antisocial personality disorder. Electroconvulsive Therapy (ECT): is indicated for patients with major depression; it is deemed effective if the patient has/reports a dry mouth; you may need to reorient client to time/place/person also short term memory loss can occur. Patient Confidentiality: unless a court order is in place or you have explicit patient permission, you cannot reveal that a patient is undergoing chemical/substance abuse treatment; do not violate patient confidentiality Nurse using self-disclosure: must make sure it is brief and refocus the conversation/interaction on the patients experiences; self-disclosure needs to be used to achieve a specific therapeutic goal Self Mutilation: if you are dealing with a self-mutilating patient it is important to shift the conversation to from the mutilation to helping the client express their feelings. Example: “What were you feeling before you hurt yourself” Ego and Psychosexual Theory: put forth by freud; the ego tests reality and directs behavior. Assessing Full Leather Restraints: must be done every 10 to 15 minutes to make sure patients circulation isn’t impacted and skin and nerve damage is not occurring. Avoidant Behavior: is a personality disorder; consists of social inhibitions, hypersensitivity to negative evaluation, fear of criticism, and social ineptitude. Emergency restraints or seclusion: when a patient is combative or is presents a danger to self or others; you can restrain the patient but must get a physicians order in 8 hours. Medication Tolerance: a diminished response to a drug so that more of the drug is required to achieve the same previous therapeutic effects; this includes substances like alcohol, morphine, opioids, etc. Restraining a violent client: first priority is to checking to make sure the restraints are properly applied (safety); second priority make be bathroom and rest breaks and water, etc. A sexually assaulted client sitting quietly in an exam room: may be exhibiting denial o Denial is: a protective and adaptive reaction to increased anxiety Focusing: is used to suggest to that a client may want to explore a specific topic during group or one-on-one sessions. Working Phase of the nurse-client relationship: during this phase the client and RN will evaluate and refine goals set during the orientation phase. Group Therapy: if client is demanding, interrupting others, and taking up a lot of group time, the best thing to do is focus the client; example: “Will you briefly summarize your point because others need time also.” Orientation phase: the first task during this phase is to form a contract with a patient; a contract begins with an exchange of names and an explanation of the roles and limits of the relationship; Critical Pathways of Care: provides outcome based guidelines for goal achievement within a specific length of stay; it is used by all of the care staff; it is essentially a length of stay and not a specific therapy; Establishment of Trust and Rapport with a Client: is a priority when dealing with clients with mental health issues; Situational low self esteem: is a nursing diagnosis characterized by a client presenting with complaints/symptoms of fatigue, sensitivity to criticism, feeling selfconsciousness. Body Dysmorphic Disorder: when a client is diagnosed with this encourage them to discuss stressful life situations and fears, which helps them focus on the underlying issues. Priorities in the therapeutic Setting: client safety in the environment is the most important priority in the therapeutic setting; Stimulant withdrawal symptoms and physical tolerance: are characterized by fatigue, mental depression, and confusion. Reflecting: is a communication/therapeutic technique; that involves the nurse referring client statements back to the client to explore; CNS depressants: can produce an initial and temporary excitatory response when inhibitory synapses are depressed. Erotomanic type delusional disorder: is characterized by delusions that another person loves you and you need to send them gifts, etc. in order to get their attention Delegation to nursing assistant: it is ok to delegate tasks such as looking for sharp objects or to place someone on a one-to-one. Denial: is characterized by an avoidance of reality by ignoring or refusing to acknowledge a stressful event or unpleasant incident. Medication abuse: is more prevalent in clients with low self esteem and unresolved rage; they will search for solace in addictive medications. ________________ Obsessive Compulsive disorder: when caring for a client with OCD the goal is to systematically decrease the undesirable behavior; it is important to allow time (or Focus) for the client to perform their compulsive behavior Client Experiencing an Anxiety Attack: priority nursing intervention is to stay with the client and to speak in short sentences; Potentiating Effect: refers to a drugs ability to increase the potency of another drug when taken together. Do not mix antianxiety agents and with alcohol or other CNS depressions Clients with acute anxiety: it is important not to touch the patient if trust and rapport has not yet been established; clients with anxiety have an increased heart rate; Panic Attack: during a panic attack it is important to stay with the client and use interventions which focus on decreasing anxiety, to reduce environmental stimuli, and retain calmness and be direct and professional. Understanding clients fears: is important to due FIRST so you can intervene effectively; Panic Disorder with Agoraphobia: the overall goal is to get the patient to function in their environment as effectively as possible, so they can begin to resume normal activities and develop coping mechanisms.