Glossary of Psychiatric Mental Health Nursing
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- What is the goal of treatment in mental health?
- To treat in the least restrictictive environment.
- What are some sites of mental health care?
- Hospital, crisis stabilization unit, outpatient setting, home, free standing psych hospitals.
- Name the members of the interdisciplinary team.
- Patient, Nurse, Psychiatrist (physician), Social Worker, Clinical Psychologist, Pastoral Counselor, Occupational Therapist, Physical Therapist.
- What does the case manager do?
- Makes sure the patient shows up for appointments, takes meds, etc.
- What is a community mental health agency?
- Where people go who are medicated but not hospitalized. Counseling is available, job training, alcohol/drug rehab.
- What are 3 patient hospitalization goals?
- Stabilize behavior
- What is the role of the physician in the interdisciplinary team?
- Serves as leader of the team. Responsible for diagnosis and treatment of mental disorders. Performs psychotherapy, prescribes medication.
- What is the role of the nurse in the interdisciplinary team?
- Provides ongoing assessment of clients condition, mental & physical. Manages the therapeutic milieu. Administers meds. Assists clients w/ therapeutic activities as required.
- What is the role of the social worker in the interdisciplinary team?
- Conducts therapy. Concerned w/ client's social needs, such as placement, financial support, community requirements. Works with client and family to meet discharge needs.
- What is the role of the clinical psychologist in the interdisciplinary team?
- Conducts individual, group and family therapy. Administers, interprets & evaluates psychological tests.
- Steps in the Interdisciplinary Treatment Plan.
- Initial assessment is made by the admitting psychiatrist, nurse, ets. A treatment plan is initiated in the first 8 hours. The IDT Plan is reviewed w/in 24 hours.
- What is the number one priority for the nurse managing the milieu?
- Some properties of a social relationship.
- Some properties of an intimate relationship.
- More involved
- Some properties of a therapeutic relationship.
- The basis of all therapeutic relationships
- Elements of the Jaharia window
- Know yourself, Others know you, Things hidden from others, Things hidden from self
- What is rapport?
- Establishing a comfortable relationship with the client. Sharing, talking.
- What is trust?
- People willing to expose themselves to others. Information is confidential.
- What is respect?
- Unconditional regard for the person regardless of their behavior or inappropriate ways of dealing with life.
- What is genuineness?
- Truthfulness, not fake.
- What is empathy?
- The ability to walk in someone else's shoes and know where they're coming from.
- What are some types of boundaries?
- Flexible, rigid, diffuse, loose, enmeshed,
- 4 Stages of a therapeutic encounter.
- What is transference?
- When a current relationship triggers an old relationship memory. (You remind the client of someone)
- What is countertransference?
- When the patient reminds the nurse of someone.
- What are the 2 components of communication?
- The sender and the receiver contribute.
- 3 types of communication
- Verbal (speech)
Non-verbal (body language)
Paralanguage (tone of voice, etc.)
- Name 6 listening skills
- Be on same level (sit with client)
Maintain good eye contact
Maintain proper distance
Sit open to the client
Don't use a table
Keep non-judgmental face
- Technique - Reflecting content and feeling
- Is there something you'd like to talk about?
Share with me how your pass went.
Where would you like to begin?
- Technique - Exploring
- And then?
Tell me about it?
- Technique - observe feelings
- You sound very upset with this situation. You appear tense.
- Technique - using silence
- Encourage a person to speak by waiting.
- Technique - offering self
- I'll stay with you a little while
I would like to sit with you for a while.
- Technique - Restating
- C: I have so much to do. I take care of the house and 3 kids. I work part-time. How can you expect me to fit in 30 minutes for relaxation exercises?
N: It's hard for you to see how you could fit one more activity into your busy day.
- Technique - giving information
- May name is...
Visiting hours are...
My purpose in being here is...
I'm taking you to the...
- Technique - Clarifying
- I'm not sure that I follow.
What would you say is the main point of what you said?
- Technique - Presenting reality
- I see no one else in this room.
That sound was a car backfiring.
I don't hear any voices other than yours and mine.
- Technique - summarizing
- Have I got this straight?
You've said that...
During the past hour you and I have discussed...
- Technique - Making observations
- Good morning, Mr. Jones.
I see you showered this morning.
- Technique - Encouraging continuation
I follow what you said.
- What is an assessment?
- A collection/interpretation of data.
- How often is a mental status exam done?
- Every shift
- Words that can be used for appearance.
- clean, showered, dirty, odor, slumped, upright, dressed gaudy, etc.
- Motor activity assessment.
- Observe gait
Lithium gives ataxic gait (unbalanced)
observe body activity (tremors, calm)
- Speech assessment
- Observe how thought processes are coming together. Observe quantity and quality.
- Poverty of speech
- Client talks very little.
- Pressured speech
- Client talks very fast, under force. Seen in manic depressive people.
- Retarded speech
- Very slow speech. Seen in depressed people.
- Hesitant speech
- Client speaks slowly and stops occasionally.
- Client stops in mid-sentence. Loses train of thought. May indicate problems in thought process.
- Sustained emotion over time
- Facial expression
- Mood and affect match
- Mood and affect don't match.
- Labile mood
- Mood changes frequently
- Behavior style
- cooperative, hostile, suspicious, guarded, friendly.
- Degree of interaction
- Withdrawn, quiet, talkative, seclusiveness, inwardly focused. Pay attention to who they interact with.
- Thought processes
Loose - disorganized thoughts
Word salad - sentences mixed up
Tangential thinking - change topics
- Flow of thought
- Normal, rapid (zooming), Racing thoughts - common in hypo manic or manic patients.
- Flight of ideas
- Many thoughts being said rapidly. Disorganized thoughts.
- Compare what the client says to reality. Reality is fluid - dependes on culture.
- A fixed belief that is not grounded in reality.
- How do we judge reality?
- Against common beliefs
- Religious Grandiosity
- Client believes they're God
- Somatic delusions
- Delusions of the body
(bugs inside, empty inside)
- 3 main types of mental illness
- Data is interpreted incorrectly (magic)
- Brain gets data that isn't there.
- Dementia quality
- Common to have visual hallucinations.
- Delirium quality
- Very common to have visual hallucinations.
- Schizophrenia quality
- Common to have auditory hallucinations.
- Serious psychiatric disturbances characterized by the presence of delusions or hallucinations and the impairment of interpersonal functioning and relationship to the external world.
- Test for long term memory
- Who was the last president?
- What type of memory is lost in dementia?
- Short term memory is lost. Long term memory may remain intact.
- Concrete thinking
- Taking info. exactly how it is said. (Stole a base)
- Abstract thinking
- Take words and infer from them. Occurs at around age 8 or 9.
- Test for judgement.
- Letter under mailbox. What would you do if you won the lottery?
- What are some vegetative symptoms?
- Physical functions such as sleep, appetite, libido, excretory functions.
- 6 factors that increase risk of suicide.
- Suicidal ideations
No support system
Own a gun
- Self concept
- Overall feeling of self. Body image, self esteem, personal identity.
- Spiritual life
- What gives meaning to your life. What helps you through trouble?
- An organized group who share common beliefs.
- Aftercare Plans
- Where will the client go after they leave? Transportation, finances?
- Medical category Axis I
- Clinical psychiatric disorders. Include drug/alcohol problems - dual diagnosis.
- Medical Category Axis II
- Personality disorder and mental retardation.
- Medical category Axis III
- Significant medical conditions that impact recovery (diabetes, hypertension)
- Medical Category Axis IV
- Psychosocial/environmental problems.
Stressors - homelessness, divorce, children leaving home, etc.
- Medical Category Axis V
- Global Assessment of Functioning GAF Scale of 1-100
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