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What are 3 componants of psychotheraputic management?
- theraputic nurse/patient relationship
- Milieu management
- psychotropic medications
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What are environmental elements of milieu management?
- Safety
- Structure
- norms
- limit setting
- balance
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What criteria are needed before a person can be involuntarily contained?
- Homicidal
- Suicidal
- Gravely disabled
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What population is most likely to commit suicide?
White males over 65 with health issues
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Who has the power to begin an immediate detention?
Police - lasts for 24 hours
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When can drugs be forced on a patient against their will?
- if they are violent or a threat
- If they are under a court ordered containment
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What are patient rights?
- Least restrictive environment *most important*
- freedom from restraints
- freedom from seclusion
- confidentiality
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What is the best way of managing a patient who is withdrawn, depressed or apethetic?
Frequent short interactions, acknowledgement of accomplishments
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What is the best way of managing sexual advances?
Point out and remind patient that their actions are inappropriate
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What is the best way of managing inappropriate boundaries?
reminding patient of their role
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What is the best way of managing manipulation?
setting limits and addressing what is happening
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What is the best way of managing severe anxiety?
Frequent brief contact; offering support
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What are the axis of the DSM?
- 1: clinical disorders
- 2. personality/development disorders
- 3. general medical disorders
- 4. psychosocial stressors
- 5. global assessment of functioning
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What is the difference beteween a coping strategy and a defense mechanism?
- Coping strategies decrease anxiety and/or eliminate the source of the problem.
- Defense mechanisms are used to avoid anxiety
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What are psychomotor and emotional signs of mild anxiety?
- Slight muscle tension
- confident and alert
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What are psychomotor and emotional signs of moderate anxiety?
- preparation for action
- keyed up, irritable and lowered concentration
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What are psychomotor and emotional signs of severe anxiety?
- preparation for fight or flight
- defensiveness with threats, poor reasoning and problem solving
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What are psychomotor and emotional signs of panic?
- actual fight or flight or immobility
- out of control, out of contact with reality, irrational reasoning
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What are different coping methods for the different levels of anxiety?
- Mild - adaptive
- Moderate - palliative
- Severe - maladaptive
- Panic - dysfunctional
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What are interventions for the different levels of anxiety?
- Mild - normal. Can discuss and problem solve
- Moderate - refocus, relaxation techniques, PO meds
- Severe - decrease stimuli, firm directions, time out/seclusion. IM meds
- Panic - need to physically take control. Restraints, IM meds.
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What is the difference between projection and displacement?
Projection is conciously blaming someone else. Displacement is unconsciously taking a stressor and taking it out on someone else.
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What is undoing?
A conscious defense mechanism where a person is nice after a mean act.
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What is confabulation?
A defense mechanism where the mind fills in gaps
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What is the long term goal of crisis management? Short term?
- To return the person to the previous level of functioning
- To keep them safe and secure and ensure that the crisis does not escalate.
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What are suicide risk factors?
- Presence of medical and/or mental illness
- Hx of past suicide attempts
- current or past use of drugs/ETOH
- recent stressors
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What are componants of a suicide assessment?
- finding out risk factors
- determining suicidal idiation
- checking for a suicide plan
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What are risk factors for agression?
- Impulse control disorders
- Medication non-compliance
- Perceptual disturbances
- traumatic brain injury
- ETOH or drug use or withdrawal
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What are the five phases of assault?
- triggering
- escalation
- crisis
- recovery
- post crisis depression
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What does the frontal lobe do?
it is most involved in mental illness. It controls reasoning and higher level thinking
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What does hte Limbic system do and where is it located?
It controls emotion and is located around the brainstem and beneath the cerebral cortex.
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Where is the amgdala located and what does it do?
It is located deep in the temporal lobe and it controls complex emotions like aggression
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What does the hippocampus do and what affects it?
It transfers information from long term to short term memory and it is affected by a thiamine deficiency
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What does the substancia nigra do?
It produces and sends dopamine to the basal ganglia. It is implicated in schizophrenia.
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What does the basal ganglia do?
modulates voluntary movement.
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What happens in the Diencephalon?
- Thalamus - all sensory pathways (except olfactory) synapse here
- Hypothalamus - influences food and fluid intake and endocrine secretions.
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What does the reticular formation do and where is it located?
It screens for stimuli and is in charge of alertness and LOC. It is located in the brainstem.
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What does the cerebellum do?
It recieves sensory imput regarding how muscles are to be directed and it coordinates fine motor movement.
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What is the major neurotransmitter for schizophrenia?
Dopamine
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What is the major neurotransmitter for depression?
Seratonin and norepinephrin
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What is the major neurotransmitter for anxiety?
GABA
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