1. mental status exam
    objective part of assessment
  2. purpose of psychiatric assessment
    • 1. establish a rapport
    • 2. obtain understanding
    • 3. assess psychological funtioning
    • 4. identify goals
    • 5. perform MSE
    • 6. identify behaviors, beliefs, ideas, etc to be modified to effect positive change
    • 7. formulate plan of care
  3. countertransference
    the nurse's reactions to a client that are based on the nurse's unconscious needs, conflicts, problems, or view of the world.
  4. purpose of gathering data
    • understand current problem
    • assess for risk factors
    • assess current level of psychological funtioning and psychosocial status
  5. through the assessment the nurse should identify?
    • strengths and weaknesses
    • usual coping strategies
    • cultural beliefs and practices that may affect implementing traditional treatment
    • spiritual beliefs or practices that are an integral part of your client's lifestyle
  6. used to diagnose a psychiatric disorder, while a well-defined nursing
    diagnosis provides the framework for identifying appropriate nursing
    interventions for dealing with the phenomena a lcient with a mental
    health disorder is experiencing
  7. those who violate social norms and thus threaten (or make anxious) those ovserving them
    mentally ill person
  8. DSM-IV-TR classifies?
    disorders that people have
  9. Axis I includes
    clinical disorders or other conditions that may be a focus of clinical attention
  10. Axis I example
    Major Depression
  11. Axis II includes
    personality disorders and mental retardation
  12. Axis II example
    dependent personality disorder
  13. Axis III includes
    general medical conditions
  14. Axis III example
  15. Axis IV includes
    psychosocial and environmental problems
  16. Axis IV example
    divorce 3 months ago
  17. Axis V includes
    global assessment of functioning (GAF score) the highest it has been in the past year and the current
  18. Axis V example
    31 yr old and unable to work or respond to family and friends with a GAF score of 23 and a high of 75 in the past year
  19. psychiatric mental health registered nurse - basic level
    completed a nrusing program and passed the state licensure examination
  20. psychiatric mental health registered nurse, certified - basic level
    holds a baccalaureate degree in nursing and may become certified as a psychiatric mental health registered nurse, certified (RN,C) after acquiring experience and ongoing CE in this specialty.
  21. advanced practice registered nurse - psychiatric mental health (APRN-PMH)
    a licensed RN who is educationally prepared at the master's degree level in psychiatric nursing.
  22. APRN-PMH, certified specialist
    indicated certifed advance practice in the specialty by iether a psychiatric mental health clinical nurse specialist or a psychiatric mental health nurse practitioner (NP)
  23. areas a basic level RN can practice in psych mental health
    for individuals with mental health problems in various settings and perform a varietyh of roles - ie - staff nurses, case managers, nurse managers, and other nursing functions
  24. RN, C - BSN
    signifies that they have more experience than a beginning RN
  25. APRN-PMH can practice in what areas?
    clinical nurse specialist or the nurse practitioner whose education and experience in psychiatric nursing practice meet criteria established by the profession. they apply knowledge, skills, and experience autonomously to complex psychiatric mental health problems.
  26. APRN-PMH, certified specialist - practices in what areas?
    may be a psychotherapist, may be eliglible to write scrips, inpatient admisison privileges, third pary reimbursement, and other specialty privileges
  27. the main focus of the psychiatric nurse si to?
    promote and maintain optimal mental functioning, to prevent mental illness (or prevent further dysfunction) and to help cliens regain or improve their coping abilities.
  28. interventions of the basic level PMH RN
    • counseling, crisis intervention
    • managing therapeutic environment (millieu)
    • assist clients with self-care activities
    • administer and monitor psychobiological treatments
    • health teaching - psychoeducation
    • pschiatric rehabilitation
    • providing telehealth services
    • working in a community-based care and outreach activites
    • providing culturally relevaan health promotion and disease prevention strategies
    • performing case management
    • participating in advocacy
  29. APRN-PMH specialist is qualified to provide?
    • psycotherapy (individual, group, family, and other tx)
    • prescription of pharmacological agents, ordering and interpretation of diagnostic and lab testing
    • constultation-liason activities
    • complementary interventions (relaxation, therapeutic touch, light therapy)
    • clinical supervisory activities
    • expanded advocacy activities
  30. advocacy role of a nurse entails?
    • protecting the rights of the clients, especially those with psychiatric disabilities
    • identifying and reporting incidents of abuse and neglect
  31. ways a nurse can be a patient advocate (5)
    • improve their observation, listening, and communication skills
    • need to develop and implement policies and procedures that affect the client's quality of care
    • need to know that unaddressed, ongiong abusive or neglectful behaviors may be brought to the attention of a Protection and Advocacy (P&A) system from any source, including nurses
    • can provide mental health consumers with the telephone number of the appropriate P&A system; it should be posted next to the patient's phone
    • have a vital role in the administration of meds
  32. ways a nurse can improve their observation, listening and communication skills
    • ensure that a nursing care plan exists
    • that ADL's and personal hygiene are addressed
    • that bodily functions are monitored and assisted
    • be sensitive to assessing consumer's comfort levels regarding noise, temperature, lighting and access to personal belongings
  33. policies and procedures that affect the client's quality of care
    • patient's bill of rights
    • informed consent
    • policies addressing confidentiality
    • seclusion and restraint
    • policies for reporting and providing appropriate remedies for staff abuse
  34. examples of behaviors to be reported to P&A
    • assault
    • failure to provide appropriate mental health or medical diagnostic evaluation or tx
    • financial exploitation
    • failure to provide discharge planning
  35. P&A is authorized to?

    not authorized to?
    investigate incidents of abuse and neglect of mentally ill individuals

    protect nurses from retaliation from employers (reports can be anonymously though)
  36. nurses responsibility regarding med admin
    • ensure that the appropriate med is administered at a dose that makes sense
    • immediately note side effects, and report and address them
    • see that pts are provided with understandable med teaching plans
  37. pharmacodynamics
    action of drug on person
  38. pharmacokinetics
    action body has on drugs
  39. neurotransmitters
    monamines, amino acids, cholinergics, peptides
  40. monamines
    dopamine, norepinephrine, seratonin, histamine
  41. amino acids
    • gamma-aminobutric acid (GABA)
    • glutamate
  42. cholinergics
  43. peptides
    substance P, somatostatin, neurotensin
  44. dopamine effects
    attention, motivation, pleasure, reward
  45. norepinepherine works on
  46. serotonin works on
    obsessions and compulsions
  47. dopanine, norepinepherine and serotonin together effect
  48. norepinepherine and serotonin together affect
  49. Pysch drug classifications (5)
    • antianxiety and hypnotic drugs
    • antidepressants
    • mood stabilizers
    • anticonvulsants
    • antipsychotic drugs
  50. antianxiety (axiolytics) and hypnotic drug ex's (5)
    • bensodiazepines
    • short acting sedative hypnotics
    • melatonin receptor agonists
    • burspirone
    • antidepressants
  51. antidepressant ex's (6)
    • tricyclic antidepressants
    • selective serotonin reuptake
    • serotonin - norepinephrine reuptake inhibitors
    • serotonin - norepinephrine disinhibitors
    • monoamine oxidase inhibitors
    • other antidepressants
  52. what diet to be on when on MAOI's
    tiramine free
  53. mood stabilizer and anticonvulsant ex's (7)
    • lithium
    • valproate
    • carbamazepine
    • lamotrigine
    • gabapentin
    • topiramate
    • oxcarbazepine
  54. when taking lithium you must?
    monitor closely because of low lethal dose
  55. when taking mood stabilizers and anticonvulsants monitor?

    can cause?
    amount in blood levels, CBC, and liver enzymes

  56. antipsychotics ex's
    • conventional - old block dopamine
    • atypical - effects are positive and negative - cause less of the Parkinson's looking SE and EPS
  57. other psychoparmacological drugs to consider (3)
    • ADHD
    • alzhiemer's disease
    • herbal treatments
  58. effects:
    fine muscle movements
    integration of emotions and thoughts
    involved with decision making
    stimulants hypothalamus to release hormones (sex, thyroid, adrenals)
  59. a decreases in dopamine causes

    an increase causes?
    Parkinson's disease and depression

    schizoprenia and mania
  60. effects mood, stimulates sympathetic branch of ANS for "fight or flight"
    norepinephrine (NE)
  61. a decrease in norepinephrine causes?

    an increase causes?

    mania, anxiety states, schizophrenia
  62. effects sleep regulation, hunger, mood states and pain perception and plays a role in aggression and sexual behavior
  63. a decrease in serotonin causes?

    an increase?

    anxiety states
  64. plays a role in inhibition, reduces aggression, exitation and anxiety; may play a role in pain perception; effects anticonvulsant and muscle-relaxing properties
  65. a decrease in GABA causes?

    an increase?
    anxiety disorders, schizophrenia, huntington's chorea

    reduction of anxiety
  66. plays a role in learning, memory; mood regulation, manic and sexual agression; stimulates parasympathetic nervous system
  67. a decrease in acetylcholine causes

    an increase causes
    alzheimer's disease, huntington's chorea, parkinson's disease

  68. effects alertness, inflammatory response, stimulates gastric secretion
  69. decrease in histamine causes
  70. dopamine blockage can cause
    movement defects such as - parkinsonian sx, akinesia, akathasia, tardive dyskinesia

    increased prolactin - gynecomastia in men and glactorrhea-amenorrhea in women
  71. mscarinic blockage causes?
    blurred visoin, dry mouth, constipation, urinary difficulty
  72. alpha antagonism causes?
    orthostatic hypotension and failure to ejaculate
  73. examples of atypical antipsychotic drugs
    • clozapine (clozaril)
    • resperidone (risperdal)
    • quetiapine (seroquell)
    • olanzapine (zyprexa)
  74. few or no EPS sx and target the negative as well as the positive sx or schizoprenia; no motor side effects
    atypical antipsychotics
  75. adverse effects of lithium:

    nervous system and muscle
    • tremor, ataxia, confusion, convulsions
    • N/V/D
    • arrhythimias
    • polyuria, polydipsia, edema
    • goiter and hyperthyroidism
  76. antiepileptic drugs
    • carbamazepine (tegretol)
    • valproic acid/valproate (depakote)
    • clonazepam (klonopin)
  77. negative side effects of clozapine
    most dangerous

    most common

    • possibly fatal in 1-2% of pts b/c of potential to suppress bone marrow and induce agranulocytosis
    • potential for inducing convulsions in 3% of clients

    drowsiness, sedation, hypersalivation, tachycardia, and dizziness

    WBC's weekly
  78. negative side effects of risperidone
    motor difficulties, orthostatic hypotension, sedation
  79. negative side effects of quetiapine
    sedation and weight gain
  80. negative SE with valproic acid

    what test to monitor?
    hepatic failure, birth defects

    liver function tests
  81. typical/standard antidepressants - tricyclic antidepressants
    • amitriptyline (elavil)
    • imipramine (tofranil
    • nortriptyline (pamelor)
  82. negative side effects from TCA's
    blurred vision, dry mouth, tachycardia, constipation, sedation and drowsiness
  83. examples of selective serotonin reuptake inhibitors (SSRI's)
    • fluoxetine (prozac)
    • sertraline (zoloft)
    • paroxetine (paxil)
    • citalopram (celexa)
  84. MAOI's
    • Phenelzine (nardil)
    • tranylcypromine (parnate)
  85. foods containing tyramine
    aged cheeses, pickled or smoked fish and wine
  86. atypical/novel antidepressants examples
    • trazodone (desyrel)
    • nefazodone (serzone)
    • venlafaxine (effexor)
    • mirtazapine (remeron)
    • bupropion (wellbutrin)
  87. negative side effects of atypical/novel antidepresants
    • trazodone - orthostatic hypotension, priapism in males (painful continuous erectile state unrelated to sexual desires or activity)
    • venlafaxine - heightened anxiety, N/V and dizziness, abnormal ejaculation and impotence in males
    • mirtazapine - sedation, weight gain, dry mouth and constipation; antimuscarinic effects are not as strong with this
    • bupropion - headache, insomnia, nausea and restlessness and rarely causes sedation, weight gain, or sexual dysfunction
  88. antianxiety/anxiolytic drugs
    • benzodiazepines
    • buspirone (buspar)
  89. Benzodiazepines
    • diazepam (valium);
    • clonazepam (klonopin);
    • alparazolam (xanax);
    • flurazepam (dalmane);
    • triazolam (halcion);
    • lorazepam (ativan)
  90. side effects of benzodiazepines
    • flurazepam and triazolam - hypnotic (sleep inducing) effect
    • lorazepam and prazolam - not soporific (sleep producing)
  91. drugs that treat ADHD
    • methylphenidate (ritalin)
    • amphetamines (adderall)
  92. negative side effects with ADHD treatment
    agitation, exacerbation of psychotic thought processes, hypertension, long-term growth suppression and potential for abuse
  93. drugs to treat alzheimer's disease
    • tacrine (cognex)
    • donepezil (aricept)
  94. negative side effects of alzheimer's tx
    • tacrine - nausea, abdominal distress, tachycardia and hepatic toxicity
    • donepezil - nausea, diarrhea and sedation
  95. voluntary admission
    sought by the client or client's guardian trhough a written application to the facility
  96. ____________clients have the right to demand and obtain release
  97. voluntary admission clients may be required to sign a relase to the staff who re-evaluate the client's condition for possible conversion to ?
    involuntary status
  98. involuntary admission
    made without the client's consent
  99. involuntary admission is necessary when?
    the person is a danger to themselves or others, is in need of psychiatric treatment, or is unable to meet their own basic needs.
  100. necessary for involuntary admission
    specified number of physicians must certify that a person's mental health status justifies detention and treatment.
  101. three different commitment procedures
    judicial determination, administrative determination, and agency determination
  102. emergency involuntary hospitalization

    who authorizes this?
    1-10 days on avg; to prevent dangerous behavior that is likely to harm self or others.

    police officers, physicians, and MHP my be disignated by statute to authorize this.
  103. observational or temporary involuntary hospitalization


    who requests this?

    required for this type of admission
    civil commitment for observational or temporary involuntary hospitalization is of longer duration than emergency hospitalization.

    observatio, diagnosis, and treatment of persons who suffer from mental illness or pose a danger to themselves or others.

    guardian, family member, physician or other public health officer

    medical certification by two or more physicians that a person is mentally ill and in need of treatment
  104. long-term or formal commitment


    if the state does not require a judicial hearing before commitment they often provide?

    extened care and treatment of the mentally ill

    solely through judicial or administrative action or medical certification

    a judicial review after commitment procedures

    generally 60-180 days; may be for an indeterminate period
  105. clients who are involuntarily committed do not lose their right of
    informed consent
  106. conditional release
    requires outpatient treatment for a specified period to determine the client's compliance with med protocols, ability to meet basic needs and ability to reintegrate into the community
  107. an involuntary client who is conditionally released may be
    re-institutionalized withle the commitment is still in effect without recommencement of formal admission procedures
  108. discharge - unconditional release
    termination of a client-institution relationship; may be court ordered or administratively ordered by the institution's officials
  109. clients must be considered legally competent until
    they have been declared incompetent through a legal proceeding
  110. a voluntary client who is conditionally released cannot be re-institutionalized without
    consent unless the institution complies with the procedures for involuntary hospitalization
  111. who has discretionto discharge clients
    administrative officer of an institution
  112. release from the hospital depends on
    client's admission status
  113. social worker

    assist the client to prepare a support system that will promote mental health on discharge; including contact with day tx, employers, sources of finacial aid and landlords

    licensed and repared in individual, family and group therapies, often as PCP's
  114. counselor
    prepared in disciplines such as psychology, rehab counseling, and addiction counseling, may augment the tx plan by co-leading groups, providing basic supportive counseling or assisting in psychoeducational and recreational activities
  115. psychologists
    according to their amster's or doctoral degree prep, they conduct psychological testing, porvide consultation for the team, and offer direct services such as specialized individual, family or marital therapies
  116. occupational, recreational, art, music and dance therapists
    on the basis , of their specialist preparations they assist the clients to gain skills that help them cope more effectively, to gain or retain employment, to use leisure time to the benefit of their mental health, and to express themselves in healthy ways
  117. psychiatrist

    employed where?
    may provide in-depth psychotherapy or medication therapy or head a team of mental health providersfunctioning as a private service based in the community.

    as physicians they may be employed by the hospital or may hold practice privileges in the facility
  118. medical physicians
    provide on a consultation basis, medical diagnosis and tx. occasionally, prepared as an addictionologist may served in a more direct role on the unit that offers tx for addictive disease
  119. mental health workers
    like nursing assistants they function under the direction and supervision of RN's. provide assistance to clients in meeting basic needs anbd also help the community to remain supportive, safe and healthy
  120. pharmacist
    offers a valuable safeguard. physicians and nurses collaborate with them regarding new meds, wihch are proliferating at a steady rate
  121. interventions made by the psychiatirc mental health nurse - basic level
    • case management
    • counseling
    • health promotion and health maintenance
    • milieu therapy
    • psychobiological intervention
    • self-care activities
    • promotion of self care activities
  122. in an inpatient and outpatient setting the Psych mental health nurse (basic level) will:
    • coordinate health and human services
    • design and evaluate the use of culturally appropriate services
  123. the psych mental health nurse (basic level) will use what types of skills
    communication, interviewing, problem-solving, crisis intervention, stress management, assertiveness training, and behavior modification
  124. some examples of skills a psych nurse (basic level) should have are:
    • coduct health assessments
    • target at risk situations
    • initial interventions (assertiveness training, stress mgt, parenting classes, health teaching)
    • use of internet for communication and teaching pruposes with client and family
    • targets potential complications related to symptoms or treatment
  125. psych mental health nurse (basic level) should know formal and informal info regarding:
    coping, interpersonal relationships, mental health problems, mental disorders, tx and their effects on ADL's, developmental needs, and more; information is given in gender developmental, cultural, and educational appropriate levels
  126. the psych mental health nurse should provide a therapeutic environment by:
    focusing on a wide range of factors such as physical environment, social structures, interactions, and cultural setting
  127. psych mental health nurse should administer and monitor responses to:
    medications as well as emergency procedures, relaxation techniques, nutrition, and diet regulations, exercise and rest schedules and other somatic treatment
  128. the advance level psych nurse should possess all the abilities of a basic level psych nurse in addition to:
    • consultation
    • prescription authority and tx
    • psychotherapy
  129. the advanced level psych nurse should encourage highest level of independent functioning in areas such as:
    personal hygiene, feeding, recreational activities, practical skills (shopping, using public transportation)
  130. the advanced practice nurse should provide consultation to:
    health care providers and others as well as supervisino to other mental health care providers and trainers
  131. the advanced practice psych nurse may prescribe meds and ?
    order and interpret labs
  132. the advanced practiced nurse performs?
    individual, group, family, child and adolescent psychotherapy
  133. uses complimentary therapies, performs clinical supervisory activities, and has an expanded advocacy role
    advanced practice psych nurse
  134. possible community mental health practice sites
    • community mental health centers
    • youth centers
    • private practice offices
    • crisis centers
    • shelters (homeless, battered women, adolescent)
    • correction facilities, local jails, courts
    • primary care offices
    • chemical dependency program offices
    • client's home
    • schools and day care centers
    • nrusing homes
    • day hospital facilities
    • group homes and adult foster homes or day care centers
    • work release housing
    • industry and business
    • ER depts of community hospitals
    • outreach to multiple locations, including restaurants, shopping malls
    • chruches, temples, synagogues, mosques
    • ethnic cultural centers
    • hospices and AIDS supportiving living programs
    • client's worksite
  135. accultruation
    nurse must revisit beliefs that there is a single definition of health or that professionals can or should control client behavior
  136. community psychiatric mental health nurse attributes
    • awareness of self; personal and cultural values
    • nonjudgmental
    • flexible
    • problem-solving skills
    • ability to cross service systems (schools, corrections, shelters, HCP, employers)
    • knowledge of community resources
    • excellent psychosocial and health assessment skills
    • excellent communications skills
    • knowledge of psychoparmacology
    • ability to recognize need for consultation
    • calm external manner
    • ability to see strength and ability in severly ill
    • willingness to work with the family or significant others identfied by the client as support people
    • understanding of the social, cultural and political issues that affect mental health and illness
    • knowledge of political activism
  137. multidisciplinary tx team list
    • client
    • peer counselors
    • family members
    • employers
    • landlord
    • spiritual counselor
    • case manager
    • chemical dependency counselor
    • psychiatric nurse
    • psychiatric nurse practitioner
    • psychiatrist
    • psychiatric social worker
    • psychologist
    • occupational terapist
    • chiropractor
    • voc rehab therapist
    • nutitionist
    • PCP
    • recreation therapist
    • PT
  138. community resources for mental health
    • community mental health centers
    • homeless shelters
    • mobile mental health care units
    • forensic setting
    • private practice setting
    • outpatient chem dependency facilities
    • home psychiatric mental helath care

  139. ethnocentrism
    the assumption that one's own beliefs and practices are the best, preferred, or only way of being
  140. explanatory models
    documents the kinds of factors or events that people understand to cause distress
  141. idioms of distress
    forms of experience and expression that distress takes - understood only in their cultural context
  142. DSM-IV-TR cultural foundation of psychiatric dx
    cultural formulation:
    1. cutlural identity
    2. cultural explanation of illness
    3. cultural factors related to psychosocial environment and levels of functioning
    • 1. cultural reference group, language, involvement i culture of origin, involvement in host culture
    • 2. predominant idioms of distress, meaning and severity of sx in relation to cultural norms, perceived causes and explanatory models, help-seeking experiences and plans
    • 3. social stressors, social supports, levels of functioning and disability
  143. cultural ideology or world view
    beliefs and values held by people withing a given culture about what is good, right and normal
  144. rationale for sample assessment questions r/t beliefs and values
    1. what does someone in your community (culture, religion) call this illness?
    2. what do people believe caused this illness?
    3. do people shun or avoid someone who has this illness?
    4. what does a mature person act like - how do they conduct themselves?
    • 1. recognize self as cultural being
    • 2. recognize practice as based in western beliefs and practices
    • 3. collaborate with cultural translator to assess explanatory models
    • 4. determine meaning of illness to person and family/ community
  145. rationale for sample assessment questions r/t political/economic:
    1. what are the social classes, ethnic or racial categories used by the people?
    2. how odes being a woman or a man affect someone with this illness?
    3. who makes decisions about what needs to be done for the ill person?
    4. source and availability of income
    5. familiarity with technology
    6 accessibility of preferred type of health care and of dominant health care
    7. language spoken. language of dominant health care. language barriers to access to health care
    8. transportation and infrastructure
    • 1-3 match translator with region, ethnicity, social class, and gender whenever possible
    • - combat and eliminate racism and oppression
    • 4-7 remove environmental aspects that cause illness
    • 8. minimize language and environmental barriers
  146. rationale for sample assessment questions r/t practice

    1. how do people communicate with each other (space, gestures, mannerisms, voice tone)?
    2. what is done for the sick, and by whome
    3. what dietary practices or restrictions are used when one has this illness
    4. are there any ceremonies, special prayers, or other protections used to treat this illness, or protect people from it? who performs these? have they been seen? result?
    • 1. assess idioms of distress and their meanings and expression
    • 2. determine preferred or commonly used healing methods
    • 3. determine caregiver strategies and roles: work with appt members of family
    • 4. community based health promotion
  147. factors that healing systems have in common
    • 1. healing integrates the physical sx with the symbolic system of the culture
    • 2. the explanatory models of the client and the healer are congruent
    • 3. the healer has characteristics of charisma and confidence
    • 4. both the healer and the client conceptualize the illness in cultrual terms
    • 5. there are elements of confession or moral witnessing especially in an emotianlly charged or cathartic way
    • 6. there is emotional arousal and faith in the healing method both within the client and within the community
    • 7. the healer, the family and the community use social persuasion
    • 8. healing techniques are rhetorical devices such as irony and paradox.
  148. culturally competent clinical services include
    • bicultural staffing
    • coverage for all encountered languages
    • family involvement
    • cultural formulation included in assessment
    • use cultural interpreters, designated fmaily members, and community liasion work
    • biological response to meds
    • stigma related to psychiatric dx
    • community linkages with predominant non-western and non-white american populations
    • get your primary materials translated
    • relevant symbols
  149. aspects of the patients bill of rights
    • civil rights
    • client consent
    • communication
    • freedom from harm
    • dignity and respect
    • confidentiality
    • participation in their plan of care
  150. client's rights under the law
    • right to treatment
    • right to refuse treatment
    • right to informed consent
    • rights regarding seclusion and restraint
  151. civil rights to be maintained
    • right to vote
    • right civil service ranking
    • rights related to granting, forfeit, or denial of license
    • right to make purchases and to enter contractual relationsips (unless the client has lost legal capacity)
    • right to humane care and tx
    • right to religious freedom and practice
    • right to socially interact
    • right to exercise and recreational opportunities
  152. aspects of client consent:

    must have proper orders and client consent for certain tx such as

    must be documented where?
    surgery, ECT, use of experimental drugs or procedures

    in the chart
  153. communication rights
    right to communicate fully and privately with those outside the facility; have visitors; reasonable access to phones, mail and send and receive unopened correspondence; may seek other opinions (at their own expense); will not be forced to work for the hospital; explain rules and regs to clients
  154. freedom from harm
    unnecessary or excessive physical restraint, isolation, medication, abuse, or neglect - use of meds for punishment is prohibited
  155. dignity and respect
    legally protected right to be free from discrimination on the basis of ethnic origin, gender, age, disability, or religion
  156. confidentiality
    records, no photo's without consent; only discuss client with those who have a right to know; discussing client in public is prohibited and they must give consent to discuss person who are not directly involved with their care
  157. participation in their plan of care
    review written care plan regularly; involve client in decisions; entitled to a discharge plan that includes follow-up care; tx should provide the lease restrictive environment possible; inform client of med SE
  158. assault
    threat of harm or putting a person in a state of apprehension
  159. battery
    actual contact with the person
  160. tx must meet this criteria
    • environment must be humane
    • staff must be qualified and sufficient to provide adequate tx
    • plan of care must be individualized
  161. behavioral restraint and seclusion are authorized as an intervention when:
    • the behavior is physically harming the client or third party
    • disruptive behavior presents a danger to the facility
    • alternative or less restrictive measures are insufficient in protecting the client or others from harm
    • when a decrease in sensory overstimulation (seclusion only) is needed
    • the client anticipates that a controlled environment would be helpful and requests seclusion
  162. the use of seclusion and restraint is permitted only:
    • on the written order of a physician
    • when orders are confined to specific time-limited periods (every 2-4 hrs)
    • when the lcient's condition is reviewed and documented correctly (every 15 min)
    • when the original order is extended after review and reauthorization (every 24 hrs) and specifies the type of restraint
  163. contraindications to seclusion and restraints
    • extremely unstable medical and psychiatric conditions
    • delirious or demented patients unable to tolerate decreased stimulation
    • overly suicidal patients
    • patients with severe drug reactions or overdoses or those patients requireing close monitoring of drug dosages
    • (all above unless close supervision and direct observation is provided)
    • punishment or convenience of staff
  164. common liability issues
    • protecting clients
    • defamation of character
    • supervisory liability
    • short-staffing issues
  165. protecting clients (example)
    not leaving a suicidal pt alone with items to harm themself; medication errors; sexual misconduct
  166. defamation of character
    either written or oral can be brought if confidential info regarding clients is divulged that harms their reputation
  167. supervisory liability
    may be incurred if nursing duties are delegated to persons who cannot safely perform these duties.
  168. guidlines to avoiding liability:
    • always put client's rights and wefare first
    • observe the hospital's policy manual
    • practice withing scope of nurse practice act
    • maintain current understanding of established practice standards
    • keep accurate concise and timely nursing records
  169. do's of charting
    • chart in a timely manner - all factual info
    • be familiar with company policy
    • chart legibly in ink
    • facts fully, descriptively, and accurately
    • what you see hear feel and smell
    • total pt assessment on admission, discharge and transfer and in between when pertinent
    • psychosocial observations, physical sx; behavior
    • follow-up care
    • fully the facts surrounding unusual occurances or incidents (do not indicate an incident report was filed)
    • all nursing interventions, tx, and outocmes
    • expressed subjective feelings
    • each time you notify MD
    • MD visits and tx
    • discharge meds and instructions given and teaching
  170. don'ts of charting
    • opinions not supported by fact
    • defame client by calling names or making derrogatory statements
    • before an event occurs
    • generalizations, suppositions or pat phrases (client in good spirits)
    • obliterate, earse, alter, or destroy a record
    • leave blank spaces for chronological notes ("late entry")
  171. intentional torts
    • assault
    • battery
    • false imprisonment
  172. unintentional torts
    • negligence
    • malpractice
    • duty
    • breach of duty
    • cause in fact
    • proximate cause
    • damages
  173. nursing process in psych mental health nursing
    • 1. assessment
    • 2. nursing dx
    • 3. outcome identification
    • 4. planning
    • 5. implementation
    • 6. evaluation
  174. considerations regarding the psychiatric nursing assessment

    1. primary
    2. secondary
    3. tertiary
    • 1. preventative, fostering mental health
    • 2. treating illness
    • 3. rehabilitative
  175. assessment should include
    • MSE
    • construction of database - observation, interviews, hx taking physical exam, standardized rating scales
    • verify data
  176. Nursing dx should include
    • identify problem and etiology
    • make nursing dx and problem list
    • prioritize nursing dx
  177. outcome identification
    set goals
  178. planning
    plan nursing care
  179. care plan implementation:

    basic level intervention

    advanced practice
    counseling, millieu, self-care, psychological intervention, case mgt, health promotion and maintenance, health teaching

    psychotherapy, prescription of meds, consultation
  180. outcom evaluation
    • outcome/goals have/have not been met
    • additional data gathering, reassessement, revise plane
  181. standards of professional performance
    • quality of care
    • performance appraisal
    • CE
    • collegiality
    • ethics of care
    • interdisciplinary collaboration
    • research
    • use of community health systems
    • resource utilization
  182. when establishing a rapport consider
    • personal considerations
    • age considerations
    • developmental stages, child/adult/geriatric, observe children playing
  183. components of an MSE
    personal info, appearance, behavior, speech, affect and mood, thought process, perceptual disturbances, cognition, insight, judgment
  184. outcome criteria should be
    realistic, achievable, measurable, NOC, grounded in clinical practice and research, standardized
  185. planning (interventions) should be
    NIC, safe, appropriate, individualized, EBP, match defining data
  186. bower's basic nursing action
    • right to decide own destinies and be involved in decisions
    • help individuals meet their own needs or to solve their own probs
    • assist individuals in maximizing their independent level of funtioning
  187. nontherapeutic relationship with client
    • social - friendship/ no structure or set boundaries
    • initmate - sexual
  188. goals in a therapeutic relationship
    • facilitating - communication of distressing thoughts and feeelings
    • assisting - client with problem solving to help ADL's
    • helping - examine self-defeating behaviors and test alternatives
    • promoting - self-care and independence
  189. therapeutic relationship

    focuses on
    the nruse maximizing inner commuication skills, understanding of human behaviors and personal strengths to enhance the client's growth

    client's ideas, experiences and feelings, personal issues - CLIENT'S NEEDS ONLY
  190. factors that enhance growth in others
    • genuineness
    • empathy
    • positive regard
  191. beneficial behaviors of nurse-client relationship
    • consistency
    • pacing
    • listening
    • initial impression
    • comfort and control
    • client factors
  192. hampered behaviors of nurse-client relationship
    • inconsistency
    • unavailability
    • lack of self-awareness
    • negative feelings
    • inconsiderate of client's needs
  193. goals of nurse are to help the client:
    • identify and explore problems relating to tohers
    • discover healthy ways of meeting emotional needs
    • experience satisfying interpersonal relationships
    • feel understood and comfortable
  194. in communicating therapeutically the nurse should:
    • ask open ended questions (some closed may be necessary)
    • use clarifying techniques - paraphrasing, restating, reflecting, exploring (tell me more aobut...)
    • use of silence
    • active listening
  195. no therapeutic communication consist of:
    • asking excessive questions
    • giving approval/disapproval
    • advising
    • why questions
    • premature advice
    • minimize client feelings
    • false reassurance
    • nonverbal signs of boredome
    • value judgments
    • change subject
  196. common defense mechanisms
    • repression
    • denial
    • projection
    • reaction-formation
    • regression
    • rationalization
    • identification
    • introjection
    • displacement
    • sublimation
  197. freud's psychosexual stages of development
    • oral (0-1y/o)
    • anal (1-3 y/o)
    • phallic (3-6 y/o)
    • latency (6-12 y/o)
    • genital (12 yrs and older)
  198. erikson's eight stages of development
    • trust vs mistrust (0-1 1/2 yrs)
    • autonomy vs shame and doubt (1 1/2 - 3 yrs)
    • initiative vs guilt (3-6 yrs)
    • industry vs inferiority (6-12 yrs)
    • identity vs role confusion (12-20 yrs)
    • intimacy vs isolation (20-35)
    • generativity vs self - absorption (35-65)
    • integrity vs despair (65- death)
Card Set
Psych test 1