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Milieu Therapy
Environment - Therapeutic environment
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Standards of Care
- Standard V. Implementation
- The psychiatric/mental health nurse implements the interventions identified in the plan of care. Specific
- interventions:
- Standard
- a. Counseling: to assist clients in improving coping skills and preventing mental illness and disability
b. Milieu therapy: to provide and maintain a therapeutic environment for client
c. Self-care activities: to foster independence and mental and physical well-being
- d. Psychobiological interventions: to restore the client’s
- health and prevent further disability
- e. Health teaching: to assist clients in achieving satisfying,
- productive, and healthy patterns of living
- f. Case management: to coordinate comprehensive health
- services and ensure continuity of care
g. Health promotion and health maintenance: implements strategies with clients to promote and maintain mental health and prevent mental illness
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Advanced Practice Interventions
h. Psychotherapy: provides therapy for individuals, groups, families, and children to foster mental health and prevent disability
- i. Prescriptive authority and treatment: provides pharmacological intervention, in accordance with state and federal laws and regulations, to treat symptoms of psychiatric illness and improve functional health status
- Anti-psychotics
- anziolytics
- mood stabalizers
j. Consultation: provides consultation to enhance the abilities of other clinicians to provide services for clients and effect change in the system
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Mental Health
- How the person responds to a stressor
- Normal - what everyone else is doing
- Mental Health is characterized by culture
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Maslow
- Maslow identified:
- A “hierarchy of needs”
Self-actualization as fulfillment of one’s highest potential
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Physical responses to stress
Hans Selye defined stress as “the state manifested by a specific syndrome which consists of all the nonspecifically induced changes within a biologic system.”
- “Fight-or-flight” syndrome
- Initial stress response
- Sustained stress response
- Sustained physical responses to stress promote susceptibility to diseases of adaptation
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Selye’s General Adaptation Syndrome
Alarm reaction stage
Stage of resistance
Stage of exhaustion
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Anxiety
A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness
Extremely common in our society
Mild anxiety is adaptive and can provide motivation for survival
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Peplau’s four levels of anxiety
- Mild - seldom a problem
- At the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include eating, drinking, sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they
- feel comfortable.
- § Moderate - perceptual field diminishes
- Anxiety at the moderate to severe level that remains unresolved over an extended period can contribute to a number of physiological disorders--for example,
- migraine headaches, irritable bowel syndrome, and cardiac arrhythmias.
- Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving--for example, anxiety
- disorders and somatoform disorders.
§ Severe - perceptual field is so diminished that concentration centers on one detail only or on many extraneous details
- § Panic - the most intense state
- Extended periods of functioning at the panic level of anxiety may result in psychotic behavior; for example, schizophrenic, schizoaffective, and delusional disorders.
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Defence Mechanisms - mild to moderate level of anxiety
§Compensation
§Denial - choose to ignore it
§Displacement
§Identification
§Intellectualization
§Introjection
§Isolation
§Projection
§Rationalization
§Reaction formation
§Regression
§Repression
§Sublimation
§Suppression
§Undoing
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Psychotic behavior
a break with reality
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Grief
The subjective state of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived.
- Elisabeth Kübler-Ross
- (5 Stages of Grief)
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Resolution of the grief response is thought to occur when an individual can look back on the relationship with the lost entity and accept both the pleasures and the disappointments of the association.
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DSM-IV-TR Multiaxial Evaluation System
Axis I - Clinical disorders and other conditions that may be a focus of clinical attention
Axis II - Personality disorders and mental retardation
Axis III - General medical conditions - Medical Dx - not mental health related
Axis IV - Psychosocial and environmental problems - not being able to pay the rent (environmental)
- Axis V - The measurement of an individual’s psychological, social, and occupational functioning on
- the GAF Scale
- GAF -
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