Glossary of Psych Nursing
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- Axis I
- Clinical Disorders (Major depression
- Axis II
- Personality disorders/mental retardation
- Axis III
- General medical condition
- Axis IV
- Psychosocial and Environmental Problems
- Axis V
- Global Assessment of Functioning
- Freud Stages of Personality Development
- Oral, Anal, Phallic, Latency, Genital
- birth to 18 months Relief from anxiety through oral gratification
- 18 months - 3 years Learning independence and control w/focus on the excretory function
- 3-6 years Identification with parent of same sex, development of sexual identity
- 13-20 yrs Libido reawakened as gental organs mature, focus on relationships
- Locus of instinctual drives-"pleasure principle" Impulsive and irrational
- Rational self. Mediator between external world, Id, and the superego
- "perfection principle" Internalizes values and morals
- Disturbance of 4 body fluids and its disruption. Hot, cold, dry & moisture. Yellow bile, Black Bile, Blood, Phlegm
- Mind and heart
- Breathing bad air. Tx place in temple w/ fresh air, sunshine, pure H20 and listening to waterfall
- Mentally ill could not enter into any contracts
- Middle Ages
- Alientation, Seclusion & Confinement Tx-starvation, torture, blood letting, beheadings, hanging, burning & exorcism
- Still being tortured & executed for mentally ill
- Bethlehem Royal Hospital
- 1st hospital. Patients tortured in public. Spectators paid admission to watch.
- Dorthea Dix
- Crusade for humane care of mentally ill
- McLean Hospital, Massachusetts
- 1882, First psychiatric training school for nurses
- Clifford Beers
- 1908, wrote book describing his years as psych patient, increased public awareness
- Linda Richards
- 1915, First graduate psychiatric nurse in the U.S.
"First Psychiatric Nurse"
- Battle Fatigue
- WW2..sleeplessness, battle dreams, anxiety, tremors, loss of appetite. Increased public awareness of mental illness
- "Open Door Policy"
- Phenothiazine therapy led to less violent, more responsive patients..released out of hospitals and treated outpatient.
- Community Mental Health Centers Act of 1963
- "deinstitutionalization movement" Out of huge rural state mental hospitals and into community centers/support services
- Protection and Advocacy Bill for Mentally Ill Individuals Act of 1981
- Bill of Rights for Psychiatric Patients
- Mental Illness
- clinically significant behavioralor psychological syndrome or pattern that occurs in a person and that is associated with present distress or diability. Abnormal response to stressors.
- Nursing Malpractice-Negligence
- 1. Failure to act in acceptable way.
2. Failure to conform to standards of care.
3. Approximate causes
4. Actual damage occurs
- Informed Consent
- Supports client's right to autonomy and self determination
- Involuntary admission
- Read rights, file petition. Right to court hearing within 72 hours.
- Orders must be reissued:
<9 yo. q hour
9-17 yo q 2h
>18 yo q 4h
- Conditions Essential to Development of a Therapeutic Relationship
- Rapport, Trust, Respect, Genuineness, Empathy
- Phases of a Therapeutic Nurse-Client Relationship
- Pre-interaction: Obtain information
- Nurse reminds client of something or someone
- Client reminds nurse of something or someone
- S-sit squarely facing client
O-Observe an open posture
L-Lean forward toward client
E-Establish eye contact
- Interpersonal Theory
Infancy, childhood, juvenile, preadolescence, Early adolescence, late adolescence
- Trust vs Mistrust
- birth to 18 months
- Autonomy vs shame and doubt
- 18 months to 3 years
- Initiative vs guilt
- 3-6 years
- Industry vs inferiority
- 6-12 years
- Identity vs role confusion
- 12-20 years
- Intimacy vs isolation
- 20-30 years
- Generativity vs stagnation
- 30-65 years
- Ego integrity vs despair
- 65 years - death
- Theory of object relations
- Phase I: Austic phase
Phase II: Symbiotic phase
Phase III: Seperation-individuation
- Peplau Nursing Model Roles
- Resource person
- Peplau Four stages of development
- Stage 1: Learning to count on others
Stage 2: Learning to delay satisfaction
Stage 3: Identifying oneself
Stage 4: Developing skills in participation
- Limbic system
- "emotional brain" associated with fear and anxiety; anger and aggression; love, joy and hope; sexuality and social behavior
- Acetylcholine Functions
- Implicated in sleep, arousal, pain perception, coordination of movement, memory acquisition and retention
- Possible implications of acetylcholine for Mental Illness
- Role in disorders of motor behavior and memory (Parkinson's, Huntington's, Alzheimer's) Increased levels associated with depression
- Norepinepherine (monoamine)Functions
- Role in regulation of mood, in cognition and perception, cardiovascular functioning and in sleep and arousal
- Possible implications of Norepinepherine for Mental Illness
- Implicated in mood disorders such as depression and mania, anxiety states, schizophrenia. Increased levels lead to mania, anxiety states and schizophrenia. Decreased in depression
- Dopamine functions
- Regulation of movements and coordination, emotionsand voluntary decision making ability
- Possible implications of Dopamine for mental illness
- Decreased levels implicated in Parkinson's and depression. Increased are associated with mania and schizophrenia
- Serotonin functions
- Play role in sleep and arousal, libido, appetite, mood, aggression and pain perception
- Possible implications of Serotonin for mental illness
- Increased levels implicated in schizophrenia and anxiety states. Decreased levels have been associated with depression
- Milieu Therapy
- Manipulate the environment so that all aspects of the client's hospital experience are considered therapeutic.
- Leader of Interdisciplinary team. Responsible for dx and tx of mental disorders. Performs psychotherapy, prescribes medication.
- Clinical psychologist
- Conducts individual, group and family therapy. Administers, interprets and evaluates psychological tests that assist in the diagnostic process.
- Psychiatric Clinical Nurse Specialist
- Conducts individual, group, and family therapy. Presents educational programs for nursing staff
- Psychiatric nurse
- Provides ongoing assessment of client condition, both mentally and physcially. Manages the therapeutic milieu on a 24-hour basis. Adminsters meds. Focus on one-one relationship development
- Mental health technician/psychiatric aide
- Functions under supervision of psych nurse. Provides assistance to clients to fulfill ADLs.
- Psychiatric Social Worker
- Conducts individual, group, and family therapy. Concerned with client's social needs such as placement, financial support and community requirements. Works with family, client to ensure discharge requirements are fulfilled.
- Occupational therapist
- Works with client to develop or redevelop independence in performing ADL
- Recreational therapist
- Use recreational activities to promote clients to redirect their thinking or to rechannel destructive energy in an appropriate manner.
- Music therapist
- Encourages clients in self expression through music.
- Plans nutritious meals for all clients. Works on consulting basis for clients with specific eatcing disorders.
- Assesses, identifies, and attends to the spiritual needs of clients and their family members. Provides spiritual support and comfort.
- General Adaptation Syndrome
- Physiologic response of a biological system to a change imposted on it.
- G.A.S.-Alarm Reaction Stage
- Fight or flight. Increased HR, BP, R; decreased GI motility, pupil dilation, diaphoresis
- G.A.S.-Resistance Stage
- Adapt to stressors. Ability to adapt dependent on your physical functioning, coping ability of stressors.
- G.A.S.-Exhaustion Stage
- Adaptive ability is exhausted after prolonged exposure to stressors.
- Clear sends of personal values/goals, Increased interaction with environment, sense of meaningfulness, internal locus of control
- Sense of Coherence
- Enduring tendency to see one's live as ordered, predictable and manageable.
- Reticular Activating System
- network of neurons involved with arousal & consciousness. Functions to maintain wakefulness and alertness.
- Levels of Anxiety
- 1. Mild
- Mild Anxiety
- Prepares people for action, sharpens senses, increases motivation for productivity, increases perceptual field, heightened awareness.
- Moderate Anxiety
- Perceptual field diminishes, less alert, attention span and ability to concentrate decreases.
- Severe Anxiety
- Concentration is able to focus on one particular detail only or many extraneous details. Attention span extremely limited. Multiple physical symptoms (headaches, palpitations, insomnia)
- Panic Anxiety
- Most intense state of anxiety. Misperceptions are common, loss of contact with reality may occur. May experience hallucinations or delustions.
- Ego Defense Mechanisms
- Mechanisms employed by the ego to relieve anxiety such as: compensation, denial, displacement, identification, intellectualization, introjection, etc.
- Covering up a real or perceived weakness by emphasizing a traint one considers more desireable. Ex. handicapped boy can't play football, compensates by becoming a great scholar
- Refusing to acknowledge the existence of a real situation or the feelings associated with it. Ex. Women drinks alcohol daily, can't stop, refuses to acknowledge there is a problem.
- Transfer of feelings from one target to another that is considered less threatening or that is neutral. Ex. Client angry at doctor, does not express it, yells at nurse instead.
- Involuntary blocking unpleasant feelings and experiences from one's awareness. Ex. Accident victim can't remember anything about the accident.
- Voluntary blockage of unpleasant feelings and experiences from one's awareness. Ex. Don't want to think about it, I'll think about it tomorrow.
- Integrating the beliefs and values of another individual into one's own ego structure. Ex. Children integrate parent's value system to their own.
- Symbolically negating or canceling out an experience that ones find intolerable. Ex. Abusive husband buys flowers for wife.
- Attributing feelings or impulses unacceptable to one's self to another person. Ex. Feels attraction to someone but says "they're coming on to me"
- Converts stress to a physical ailment.
- Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors. Ex. I drink because I have a bad job.
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