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Chap 2 - 38
Terms in this set (79)
What is stigma?
a mark of shame, disgrace, or disapproval that results in an individual being shunned or rejected by others. Public stigma, self-stigma, and label avoidance are three types of stigma people with mental illnesses experience.
Stigmas increase the risk of mentally ill people to be subject to prejudice and discrimination; Stigmatization robs individuals of work, independent living, and meaningful relationships
What is public stigma?
Occurs after individuals are publicly "marked" as being mentally ill.
When individuals with mental illness act or say things that are odd or unusual or tell others that they have a mental illness, they are at risk of being publicly identified as having a mental illness and are subject to prejudice and discrimination.
Common stereotypes include being dangerous, unpredictable, and incapable of functioning independently.
Stigmatization robs individuals of work, independent living, and meaningful relationships.
What is label avoidance?
Avoiding treatment or care in order not to be labeled as being mentally ill - this is one of the reasons that so few people with mental health problems actually receive help. By avoiding treatment, they avoid the stigma of mental illness. They may ignore their symptoms or refuse to seek treatment because of the stigma associated with being mentally ill
What is self-stigma?
Occurs when negative stereotypes are internalized by people with mental illness. Patients are aware of the public's negative view of mental illness and agree with the public's perceptions.
They begin to believe that they are unpredictable, cannot become productive members of society, or have caused their illness. As a result of the application of the negative stereotype to self, they have low self-esteem and loss of self-respect
What is the continuum of care? Who is it for? Where must is take place?
Consists of an integrated system of settings, services, health care clinicians, and care levels, spanning illness-to-wellness states - coordinated through a case management system
For: patients with chronic mental illnesses
Where: least restrictive environment
What's the definition and use of "acceptance" in verbal communication techniques?
Encouraging and receiving information in a nonjudgmental and interested manner
Used in establishing trust and developing empathy
What's the definition and use of "confrontation" in verbal communication techniques?
Presenting the patient with a different reality of the situation
Used cautiously to immediately redefine the patient's reality. However, it can alienate the patient if used inappropriately. A nonjudgmental attitude is critical for confrontation to be effective
What's the definition and use of "doubt" in verbal communication techniques?
Expressing or voicing doubt when a patient relates a situation
Used carefully and only when the nurse feels confident about the details. It is used when the nurse wants to guide the patient toward other explanations
What's the definition and use of "interpretation" in verbal communication techniques?
Putting into words what the patient is implying or feeling
Used in helping the patient identify underlying thoughts or feelings
What's the definition and use of "observation" in verbal communication techniques?
Stating to the patient what the nurse is observing
Used when a patient's behaviors (verbal or nonverbal) are obvious and unusual for that patient
What's the definition and use of "open-ended statements/questions" in verbal communication techniques?
Introducing an idea and letting the patient respond
Used when helping the patient explore feelings or gain insight
What's the definition and use of "reflection" in verbal communication techniques?
Redirecting the idea back to the patient for classification of important emotional overtones, feelings, and experiences; it gives patients permission to have feelings they may not realize they have
Used when the patient is asking for the nurse's approval or judgment; use of reflection helps the nurse maintain a nonjudgmental approach
What's the definition and use of "restatement" in verbal communication techniques?
Repeating the main idea expressed; lets the patient know what was heard
Used when trying to clarify what the patient has said
What's the definition and use of "silence" in verbal communication techniques?
Remaining quiet but nonverbally expressing interest during an interaction
Used when the patient needs to express ideas but may not know quite how to do it; with silence, the patient can focus on putting thoughts together
What's the definition and use of "validation" in verbal communication techniques?
Clarifying the nurse's understanding of the situation
Used when the nurse is trying to understand a situation the patient is trying to describe
What's the definition and technique of "advise" and why is it non-therapeutic?
Telling a patient what to do
The nurse solves the patient's problem, which may not be the appropriate solution and encourages dependency on the nurse.
What's the definition and technique of "agreement" and why is it non-therapeutic?
Agreeing with a particular viewpoint of a patient
The patient is denied the opportunity to change his or her view now that the nurse agrees
What's the definition and technique of "challenges" and why is it non-therapeutic?
Disputing the patient's beliefs with arguments, logical thinking, or direct order
The nurse belittles the patient and decreases the patient's self-esteem. The patient will avoid relating to the nurse who challenges
What's the definition and technique of "reassurance" and why is it non-therapeutic?
Telling a patient that everything will be OK
The nurse makes a statement that may not be true. The patient is blocked from exploring his or her feelings
What's the definition and technique of "disapproval" and why is it non-therapeutic?
Judging the patient's situation and behavior
The nurse belittles the patient. The patient will avoid the nurse
What is the defense mechanism of denial? Give an example
Definition: Refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others (psychotic denial is used when there is gross impairment in reality testing)
Example: A teenager's best friend moves away, but the adolescent says he does not feel sad
What is the defense mechanism of projection? Give an example
Definition: Falsely attributing to another one's own unacceptable feelings, impulses, or thoughts
Example: A child is very angry at a parent but accuses the parent of being angry
What is the defense mechanism of sublimation? Give an example
Definition: Channeling potentially maladaptive feelings or impulses into socially acceptable behavior
Example: An adolescent boy is very angry with his parents. On the football field, he tackles someone very forcefully.
What is the process of understanding one's own beliefs, thoughts, motivations, biases, and limitations, and recognizing how they affect others?
Why is this important for nurses?
Important b/c the development of self-awareness will enhance the nurse's objectivity and foster a nonjudgmental attitude, which is so important for building and maintaining trust throughout the nurse-patient relationship
Within the Psychiatric-Mental Health Nursing Process, what is assessed in the physical domain? (5 things)
Current and past health status
Physical exam (body systems review, neuro status, lab results)
Physical functions (elimination, activity/exercise, sleep, appetite/nutrition, sexual activity, hydration, self care,
Strengths and wellness assessment
Within the Psychiatric-Mental Health Nursing Process, what is assessed in the psychological domain? (6 things)
Mental health problems
Mental status exam (assesses current psych state - not past or present)
Self Concept (body image, self esteem, personal identity)
Stress and coping patterns
Risk assessment (suicidal, homicidal, assaultive ideation)
Within a mental status exam, what is assessed?
Mood and affect
Cognition and intellectual performance
-Attention and concentration
-Abstract reasoning and comprehension
-Insight and judgement
Within the Psychiatric-Mental Health Nursing Process, what is assessed in the social domain? (7 things)
- Family assessment
- Cultural assessment
- Community support and resources
Quality of life
Psychological strengths and wellness assessment
What is judgement? How do you assess for it?
Judgment is the ability to reach a logical decision about a situation and to choose a course of action after examining and analyzing various possibilities.
Throughout the interview, the nurse evaluates the patient's ability to make logical decisions.
For example, a way to examine a patient's judgment is to give a simple scenario and ask the person to identify the best response. An example of such a scenario is asking, "What would you do if you found a bag of money outside a bank on a busy street?" If the patient responds, "Run with it," his or her judgment is questionable
How do you assess for abstract vs concrete thinking?
To test abstract reasoning and comprehension, the nurse gives the patient a proverb to interpret.
Examples include "People in glass houses shouldn't throw stones," "A rolling stone gathers no moss," and "A penny saved is a penny earned."
What triggers general adaptation syndrome (GAS)?
Distress/threat (real or perceived)
List and define the 3 stages of general adaptation syndrome (GAS)
The alarm reaction (a threat is perceived, and the body responds physiologically)
Stage of resistance (coping mechanisms are used to try to reestablish homeostasis)
Stage of exhaustion (occurs if homeostasis is not achieved)
What is Allostatic Load (AL) & what causes it?
the cumulative changes of the biologic regulatory systems (cardiovascular, metabolic, and immune) due to chronic stress (continued levels of increased cortisol).
As wear and tear on the brain and body occurs, there is a corresponding increase in the AL. The greater the AL, the greater the state of chronic stress and ultimately, the more negative changes in health
Acute stress causes an increase in circulating _________________.
Explain the physiologic process of this increase.
If levels of this remain increase, what is affected?
Biology behind cortisol release → the sympathetic nervous system activates the HPA axis. When the hypothalamus secretes corticotropin-releasing hormone (CRH), the pituitary gland increases secretion of adrenocorticotropic hormone (corticotropin), which in turn stimulates the adrenocortical secretion of cortisol.
Over time, excessive exposure of cortisol contributes to the dysregulation of the autonomic nervous system
What it cortisol? What does it do?
Cortisol - is primarily immunosuppressive and contributes to reduction in lymphocyte numbers and function (primarily T-lymphocyte and monocyte subsets) and natural killer (NK) activities
Children who have suffered psychological neglect, abuse, or parental loss are more likely to ______________ or _______________ disorders during adulthood
mood or anxiety disorders
Elevation of ________________ cell counts and lower counts of ________, ________, and __________ cells are found in those who face academic examinations, job strain, caregiving for a family member with dementia, marital conflict, and daily stress.
Elevation of white blood cells cell counts and lower counts of T , B , and NK cells
Altered parameters of ___________________ are present in those with negative moods (chronic hostility, depression, and anxiety), social isolation, and marital disagreement
Health disparities found in which 3 groups of people may be partly explained by the chronic stress they tend to experience
lower socioeconomic groups
racial and ethnic minorities
Explain the diathesis-stress model
When stress is associated with the development or exacerbation of a mental illness, a diathesis-stress model is applied (diathesis -a genetic predisposition) increases susceptibility of developing a disorder
Why is effective anger management important?
Effective anger management is important in maintenance of emotional wellness and holistic health → also essential to social and occupational success. People with poor anger control have more conflict at work, change jobs more frequently, take more unwise risks, and have more accidents than people with adaptive anger behavior
How to manage anger without violence?
Always identify the cause of the anger if possible
What are the 3 goals of anger intervention?
(1) effectively modulate the physiological arousal of anger
(2) alter any irrational thoughts fueling the anger
(3) modify maladaptive anger behaviors (e.g., blaming, attacking, or suppressing) that prevent problem solving in daily living
What is the most important predictor of potential for aggression and violence
The patient's history is the most important predictor of potential for aggression and violence.
Early life adverse circumstances, such as inadequate maternal nutrition, birth complications, traumatic brain injury, and lead exposure can contribute to risk for aggressive and criminal behaviors in adulthood.
Important markers in the patient's history include previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control
What are 7 different interventions to avoid aggression and violence?
1) Listening --> encourage patient to talk about it
2) Validating --> makes patient feel understood/supported
3) Providing choices (rather than open-ended statements --> gives them more sense of control
4) Providing patient education --> use "teachable moments" to convey important principles of anger management
5) Prevention --> escalation of feelings, thoughts, and behavior from calmness to violence may follow a particular pattern --> need to disrupt that pattern
6) Reducing environmental stimulation
7) Creating a culture of nonviolence
What are techniques to prevent anger/violence?
Counting to 10
Using a relaxation or breathing technique
Removing oneself from interactions or stimuli that may contribute to increased distress (voluntarily taking "time-out")
Doing something different (e.g., reading, listening to quiet music, watching television)
What is a situational crisis?
Occurs whenever a specific stressful event threatens a person's physical and psychosocial integrity and results in some degree of psychological disequilibrium. The event can be an internal one, such as a disease process, or any number of external threats. If a person enters a new situation without adequate coping skills, a crisis may occur
What is a maturational crisis?
A normal part of growth and development and successfully resolving a crisis at one stage allows one to move to the next. According to this model, the child develops positive characteristics after experiencing a crisis. If he or she develops less desirable traits, the crisis is not resolved
What is a traumatic crisis?
Initiated by unexpected, unusual events that can affect an individual or a multitude of people. In such situations, people face overwhelmingly hazardous events that entail injury, trauma, destruction, or sacrifice.
What is adjustment disorder?
When there are significant emotional or behavioral symptoms in response to an identifiable stressful situation - difficulty adjusting to a crisis
What are 5 immediate goals of crisis intervention?
Possibly preventing the person from committing suicide or homicide
Arranging for food and shelter (if needed)
Mobilizing social support
Determine if clients are grounded (no presence of psychotic thought)
Always ensure safety
Regarding grief, what is the dual process model (DPM)?
The dual process model (DPM) offers a nonlinear explanation of how grieving persons and families come to terms with their loss over time
What's the difference between loss-oriented coping and restoration-oriented coping?
loss-oriented coping = preoccupation with the deceased
restoration-oriented coping = preoccupation with stressful events as a result of the death (ex: financial status)
What are the biggest two priorities when treating patients with PTSD?
Communicate that the patient is in a safe environment
Try to get rid of any thoughts of patient self-blame
What is the end goal of therapy for PTSD? How is this achieved?
Development of healthy coping strategies
This is done by developing goals and implementing wellness strategies, physical health interventions, medication interventions, or psychosocial interventions
Overdose symptoms (2)
Long term effects (4)
- very elevated mood
- tooth decay
- potential for violence
- Elevate body temperature
- Stimulate seizure
Long term effects
- Dependence and addiction psychosis (paranoia, hallucinations)
- Mood disturbances, repetitive motor activity
- Stroke, weight loss, extensive tooth decay
- Binge and crash
What are the symptoms of having an Alcohol Use Disorder?
Sedation, decreased coordination, slurred speech, nausea
Respiratory depression, cardiac arrest
Severity based on length and amount of use
What are the symptoms of withdrawal from having an Alcohol Use Disorder?
What are the 2 most severe symptoms?
Increased HR and BP, diaphoresis (sweating)
Mild anxiety, restlessness, hand tremors
Seizure, sensation of bugs crawling on skin
- Acute withdrawal syndrome
- Autonomic hyperarousal, disorientation, hallucination, tremor
Grand mal (tonic-clonic) seizure
What are the components of CIWA? (9)
Nausea and vomiting
Tactile disturbances, auditory disturbances, visual disturbances
Tremor, anxiety, HA/fullness in head
Agitation, orientation/clouding of sensorium
Max score = 67
Score < 10 no additional meds required
What does opiate use do to your pupils?
What does opiate withdrawal do to your pupils?
Use - pin-point pupils
Withdrawal - dialates
What are the signs/symptoms of opiate withdrawal?
Lacrimation, dilated pupils, muscle pain, flu-like symptoms
What are the signs/symptoms of cocaine use?
Cocaine rush → sudden burst of mental alertness and energy; feeling of self-confidence
Cocaine crush → intense let-down effect in which one feels irritable, depressed, tired; craves more
Stimulation of sympathetic nervous system
Dilated pupils, tachycardia
Increase body temperature
What is motivational interviewing?
Method of therapeutic intervention
- Seeks to elicit self-motivational statements from pts
- Supports behavioral change
- Creates a disconnect between pt's goals and their continued alcohol/drug use
Exploring pt's ambivalence to change
- Considered normal
- Dealt by working with pt's own concerns about their use
What are benzodiazepines used for during withdrawal treatment?
Titrated use over several days as a substitute for alcohol
Antianxiety and sedating drugs
Help with withdrawal and seizures
What drug is usually used to treat alcohol withdrawal? When after the last drink can this be given?
Diazepam (valium) → longer half-lives, smoother tapers
12 hours after last drink
What medication is given to older adults or those with liver impairment when treating alcohol withdrawal?
What drug is used to produce negative responses when alcohol is ingested & can be used with therapy? What does it caused when mixed with alcohol?
Causes nausea, vomiting, & possible heart attack
When conduction a Mental Health Assessment of Children and Adolescents,
What is self-concept and how is it assessed?
Elicit view of oneself and the world
Beliefs about self, body image
Self-esteem, personal identify
Ways to assess
- Ask what they would wish for if they had 3 wishes
- Ask the child to make up an ending for a story
- Draw a picture of themselves
What is mood?
Predominant state of feeling
Pervasive/sustained emotion that influences one's perception of the world and how one functions
What is affect?
Outward emotional expression
What is temperment?
Person's characteristic intensity, activity level, threshold of responsiveness, rhythmicity, adaptability, energy expenditure, and mood
Correlated with emotional and behavioral problems
What type of temperament shows:
Positive mood, regular pattern of eating/sleeping
Positive approach to new situations; Low emotional intensity
What type of temperament shows:
Irregular sleep/eating patterns
Negative response to new stimuli, slow adaptation
Negative mood, high emotional intensity
What type of temperament shows:
Negative, mildly emotional response to new situations
Intensity and initially slow adaptation
Evolves into positive response
Regarding the Mental Health of Children and Adolescents, interventions and assessments should be ________________________.
Regarding the Mental Health of Children and Adolescents, what is considered not confidential?
- Suicidal ideation
- Determine if pt has a plan
- Let the parent know the child is suicidal
- Make plan to keep child safe
- Neglect or physical or sexual abuse
- Required by law to report to state's Department of Child and Family Services
What are the differences between dementia and delirium?
Dementia - Characterized by chronic cognitive impairments; Differentiated by underlying causes, not by symptom patterns;
progressive, much slower; irreversible; impaired cognition and orientation;
Delirium - typically medical; sudden; can be reversed; visual/aud hallucinations; disoriented; speech & movement altered; need to immediately find out what the issue is to treat it (UTI/polypharm)
What causes delirium?
Typically medical (UTI, medication interactions/polypharmacy)
Medications, infections, fluid and electrolyte imbalances
Metabolic disturbances, hypoxia, ischemia
What's the difference between Cortical dementia & Subcortical dementia?
- Results from disease process that globally afflicts cortex
- Ex) Alzheimer disease (most prevalent)
- Caused by dysfunction/deterioration of deep gray or white matter structures inside the brain and brainstem
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