Review Exam #1 - Psych mental health exam 1 notes PDF

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Psych mental health exam 1 notes...

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Psych Review Exam #1

Rights of the Patient with Mental Illness 1. Patients have the right to refuse medication unless they pose a danger to themselves or others 2. The right to the least restrictive treatment (seclusion  restricted to an area even if the doors are open. If isolated for more than 30mins is considered seclusion) 3. The right to be released/discharged if not dangerous to self or others  If the patient wants to leave the facility (self-discharge), as a nurse, you first need to talk to the patient to find out why they want to leave the facility (you need to assess objective and subjective data). Then, you call the Dr. to report what the patient wants and to inform him about your observation of the patient current mental status as well as the reason why the patient wants to leave (you need to collect the info first). As an RN, you cannot let the patient go even if it is their will because the person may be dangerous to himself and/or others (i. e; may commit suicide) 

Legally, the person can request to be discharged (they need to have been voluntarily admitted); however, if the person has a court order (Baker acted), they have to stay in the hospital and will not be allowed to leave under any circumstances unless capable to

Ethical Dilemmas When faced with ethical dilemmas there is no right or wrong answer. It is important to have some sense of your own believes, values, moral, attitudes to come out with a solution. Gather subjective and objective information to help you make an ethical decision Ex. A 95 y/o pt is very ill and wants to see his son who has not seen for 30 years before he dies. You call the son who refuses to see his father, what would you say to the patient? TAKING NO ACTION IS CONSIDERED AN ACTION TAKEN Ethics: the science that deals with the rightness and wrongness of actions Values: ideals or concepts that give meaning to the individual’s life Moral Behavior: conduct that result from serious critical thinking about how individuals ought to treat others (moral behaviors are based on values) Model for Making Ethical Decisions 1. 2. 3. 4. 5.

Assessment (Before making a decision, you need to gather data (subjective & objective) Problem Identification Plan Implementation Evaluation

Stress – Symptoms, Responses, Adaptive/Maladaptive Behavior

Anxiety and Grief have been described as the two major, primary psychological response patterns to Stress Adaptation is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual’s functioning Bad behaviors related to the thoughts and feelings in not socially accepted, but if the feelings and thoughts are put into words, it is accepted as a good behavior Anxiety: is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. Very common in our society Adaptive Behavior  Exercise  Breathing Techniques  Relaxation (music, read)

Maladaptive Behavior  Smoking, Overeating  Sleeping too Much or too Little  Drinking

Anxiety – Symptoms at Mild, Moderate, Severe and Panic Levels Peplau’s Four Level of Anxiety 1. Mild It is good because it motivates, rarely a psychological or physical problem. Learning is enhanced. It is adaptive  Restlessness, irritability  May remain superficial with others  Rarely experienced as distressful  Motivation is increased 2. Moderate  Your perceptual field diminishes. Learning still occurs, but not at optimal ability. Decreased attention span. Decreased ability to concentrate, part of the room may not be noticed  Increased restlessness  Increased heart rate, respiration rate and perspiration  Gastric discomfort, increased muscular tension  Increase in speech rate, volume and pitch  A feeling of discontent, someone talking may not be heard 3. Severe  Your perceptual field is greatly diminished that only extraneous details are perceived or fixation on a single detail may occur. May notice an event when attention is directed by another  Extremely limited attention span  Unable to concentrate or problem solve  Effective learning cannot occur  Headaches, dizziness, nausea, trembling, insomnia, palpitations, tachycardia, hyperventilation, urinary frequency, diarrhea  Feelings of dread, loathing and horror 4. Panic  Unable to focus on even one detail within the environment. Misperception of the environment, common perceived detail may be elaborated and out of proportion

 Learning cannot occur, unable to concentrate  Unable to comprehend even simple directions  Dilated pupils, labored breathing, severe trembling, sleeplessness, palpitations, diaphoresis and pallor, muscular incoordination, immobility or purposeless hyperactivity, incoherence or inability to verbalize  Terror, bizarre behavior, including shouting, screaming, running about wildly, clinging to anyone or anything from which a sense of safety and security is derived. Hallucinations, delusions, extreme withdrawal into self Grief: is the subjective state of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived Elisabeth Kubler-Ross Five Stages of Grief 1. 2. 3. 4. 5.

Denial Anger Bargaining Depression Acceptance

Defense Mechanisms At the mild to moderate level, the Ego calls on defense mechanisms for protection, such as… 

Compensation is the covering up of a real or perceived weakness by emphasizing a trait one considers more desirable Ex. A handicapped boy who is unable to participate in sports compensates by becoming a great scholar  Denial  is the refusal to acknowledge the existence of a real situation or the feelings associated with it  Displacement  is the transferring of feelings from one target to another that is considered less threatening or neutral Ex. A boy who is teased and hit by the class bully on the playground comes home after school and kicks his dog  Identification  is an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires Ex. The young son of a famous civil rights worker adopts his father’s attitudes and behaviors with the intent of pursuing similar aspirations  Intellectualization  is an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis Ex. A man whose brother is in ICU spends his visiting hours discussing with the RN tests results, and making reasonable determination about what might have caused his brother to end up in ICU  Introjection  is the internalization of the beliefs and values of another individual such that they symbolically become a part of the self to the extent that the feeling of separateness or distinctiveness is lost

Ex. A psychiatric client claims to be the Son of God, drapes himself in sheet and blanket, “performs miracles” on other clients, and refuses to respond unless addressed as Jesus Christ  Isolation  is the separation of a thought or a memory from the feeling tone or emotions associated with it (sometimes called emotional isolation) Ex. A young woman describes being attacked and raped by a street gang. She displays an apathetic expression and no emotional tone  Projection  projecting your feelings onto someone else, placing blame on others Ex. A businessperson who values punctuality is late and blames the secretary for not reminding him  Rationalization  having an excuse, explanation to justify an unacceptable feeling or behavior Ex. A woman is turned down for a secretarial job after a poor performance on a typing test. She claims, “I’m sure I could have done a better job on a word processor hardly anyone uses electric type writers anymore”  Reaction Formation  is the prevention of unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behavior Ex. A person that does not like kids and becomes a pre-k teacher  Regression  going back to a previous time Ex. Toilet trained toddler, after a new sibling begins to wet the bed  Repression  is the involuntary blocking of unpleasant feelings and experiences from ones awareness Ex. A woman cannot remember being sexually assaulted when she was 15 years old  Sublimation  take a potentially negative situation and turn it into something positive, productive Ex. Angry at boss and want to hit him in the face, but instead goes home and hit a tennis ball  Suppression  is the voluntary blocking of unpleasant feelings and experiences from one’s awareness Ex. A young woman who is depressed about getting divorce tells you “I just don’t want to talk about it, there’s nothing I can do anyways”  Undoing  believing that by doing something right it will undo the wrong already done Stages of Development / Personality Development – Freud, Erickson, Piaget, Maslow Psychoanalytic Theory – Freud Freud believed that basic character was formed by age 5 years. He organized the structure of the personality into three major components  Id  pleasure seeker at the expense of anyone or anything, instant gratification, is what I want and I want it now, low tolerance level. Id-driven behaviors are impulsive and may be irrational. Social and cultural acceptability are not considered, “if it feels good, do it”  Ego  rational, balance, mediator between the id and the superego. An effort is made to delay gratification and to satisfy societal expectations  Superego  conscience, feeling guilty, the perfection principle. Behaviors are uncompromising and rigid. They are based on morality and society’s values. Behaviors

strive for perfection. Violation of the superego’s standards generates guilt and anxiety in an individual who has a strong superego.

Development of Personality by Freud  Oral Stage (birth to 18 months)  Behavior is directed by the id, and the goal is immediate gratification of needs. The focus of energy is the mouth, with behaviors that include sucking, chewing, and biting. The infant feels a sense of attachment and is unable to differentiate the self from the person who is providing the mothering. Relief from anxiety through oral gratification needs  Anal Stage (18 months to 3 years)  The major task is gaining independence and control, with particular focus on the excretory function. When toilet training is strict and rigid, the child may choose to retain the feces, becoming constipated. Toilet training that is more permissive and accepting attaches the feeling of importance and desirability to feces production. The child becomes extroverted, productive, and altruistic  Phallic Stage (3 to 6 years)  The focus of energy shifts to the genital area. Discovering the differences between genders results in a heightened interest in the sexuality of self and others. The interest may be manifested in sexual self exploratory or groupexploratory play. Identification with parent of same sex, development of sexual identity, focus on genital organs  Latency Stage (6 to 12 years)  The focus now is shifted from egocentrism to more interest in group activities, learning, and socialization with peers. The preference is for the same-sex relationships, even rejecting members of the opposite sex  Genital Stage (13 to 20 years)  The maturing of the genital organs results in a reawakening of the libidinal drive. The focus is on relationships with members of the opposite sex and preparations for selecting a mate Theory of Psychosocial Development – Erikson Is based on the influence of social processes on the development of the personality Stages of Development  Trust vs Mistrust (birth to 18 months)  The major task is to develop a basic trust in the mothering figure and learn to generalize that to others. The infant learns to trust when basic needs are met consistently  Autonomy vs Shame and Doubt (18 months to 3 years)  The major task is to gain selfcontrol and independence within the environment. Autonomy is achieved when parents encourage and provide opportunities for independent activities  Initiative vs Guilt (3 to 6 years)  The goal is to develop a sense of purpose and the ability to initiate and direct one’s own activities. Initiative is achieved when creativity is encouraged and performance is recognized and positively reinforced  Industry vs Inferiority (6 to 12 years)  The major task is to achieve a level of selfconfidence by learning, competing, performing successfully, and receiving recognition from significant others, peers, and acquaintances. Achievement of the task results in a

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sense of satisfaction and pleasure in the interaction and involvement with others. Industry is achieved when encouragement is given to activities and responsibilities in the school and community, as well as those within the home, and recognition is given for accomplishment Identity vs Role Confusion (12 to 20 years)  The goal is to integrate the tasks mastered in the previous stages into a secure sense of self. Parents should be available to offer support when needed but should gradually relinquish control to the maturing individual in an effort to encourage the development of an independent sense of self Intimacy vs Isolation (20 to 30 years)  The objective is to form an intense, lasting relationship or a commitment to another person, a cause, an institution, or a creative effort. The intimacy goes far beyond the sexual contact between two people. It describes a commitment in which personal sacrifices are made for another, whether it be another person or, if one chooses a career or other type of cause to which the individual elects to devote his or her life Generativity vs Stagnation (30 to 65 years)  The major task is to achieve the life goals established for oneself while also considering the welfare of future generations. Generativity is achieved when the individual expresses satisfaction with this stage in life and demonstrates responsibility for leaving the world a better place on which to live Ego Integrity vs Despair (65 years to death)  The goal is to review one’s life and derive meaning from positive and negative events, while achieving a positive sense of self

Cognitive Development – Piaget Is based on the premise that human intelligence is an extension of biological adaptation, or one’s ability for psychological adaptation to the environment He identifies four stages of development that are related to age, demonstrating at each successive stage a higher level of logical organization than at the previous stage  Sensorimotor (birth to 2 years)  With increased mobility and awareness, development of a sense of self as separate from the external environment, the concept of object permanence emerges as the ability to form mental images evolves  Preoperational (2 to 6 years)  Learning to express self with language, development of understanding of symbolic gestures, achievement of object permanence  Concrete Operations (6 to 12 years)  Learning to apply logic to thinking, development of understanding of reversibility and spatiality, learning to differentiate and classify, increased socialization and application of rules  Formal Operations (12 to 15+ years)  Learning to think and reason in abstract terms, making and testing hypotheses, capability of logical thinking and reasoning expand and are defined, cognitive maturity achieved

Maslow’s Hierarchy of Needs

Maslow emphasized and individual’s motivation in the continuous quest for self-actualization. An individual’s position within the hierarchy may reverse from a higher level to a lower level based on life circumstances Maslow describes self-actualization as being “psychologically healthy, fully human, highly evolved, and fully mature”. 1. Self-Actualization: the individual possesses a feeling of self fulfillment and the realization of his or her highest potential 2. Self-Esteem/Esteem of Others: the individual seeks self-respect and respect from others, works to achieve success and recognition in work, and desires prestige from accomplishment 3. Love and Belonging: needs are for giving and receiving of affection, companionship, satisfactory interpersonal relationships, and identification with a group 4. Safety and Security: needs at this level are for avoiding harm, maintaining comfort, order, structure, physical safety, freedom from fear, and protection 5. Physiological Needs: basic fundamental needs include food, water, air, sleep, exercise, elimination, shelter, and sexual expression Role of the Psychiatric Nurse vs an ARNP Nurses: can do counseling, teaching, advocating ARNP: can provide psychotherapy, admits and discharges pts, able to prescribe meds Therapeutic Communication (Feedback, Silence, Empathy) vs Non Therapeutic Communication Techniques Therapeutic Communication Techniques  Using Silence: it allows the client to take control of the discussion, if he or she desires. The nurse can be silent, or the patient or both  Accepting: conveys positive regard  Giving Recognition: acknowledging, indicating awareness  Offering Self: making oneself available  Giving Broad Openings: allows client to select the topic of conversation  Offering General Leads: encourages client to continue  Placing the Event in Time or Sequence: clarifies the relationship of events in time  Making Observations: verbalizing what is observed or perceived  Encouraging Description of Perceptions: asking client to verbalize what is being perceived  Encouraging Comparison: asking the client to compare similarities and differences in ideas, experiences, or interpersonal relationships  Restating: lets client know whether an expressed statement has or has not been understood  Reflecting: directs questions or feelings back to client so that they may be recognized and accepted

 Focusing: taking notice of a single idea or even a single word  Exploring: delving further into a subject, idea, experience, or relationship  Seeking Clarification and Validation: striving to explain what is vague and searching for mutual understanding  Presenting Reality: clarifying misconceptions that client may be expressing  Voicing Doubt: expressing uncertainty as to the reality of client’s perception  Verbalizing the Implied: putting into words the feelings the client has expressed only indirectly  Formulating a Plan of Action: striving to prevent anger or anxiety from escalating to an unmanageable level the next time the stressor occurs  Empathy: Ex. I see you may be having a difficult time (don’t feel bad for the person, don’t show sympathy)  Feedback: it is based on perception of the other person’s behavior or action, it is not evaluative, and it is therapeutic  Feedback is useful when is descriptive rather than evaluative and focused on the behavior rather than on the client  It’s specific rather than general  It’s directed towards behavior that the client has the capacity to modify  Imparts information rather than offers advice  It’s well timed  Another therapeutic technique is to help the person put their thoughts/experiences into feeling as oppose to telling them what to do Nontherapeutic Communication Techniques  Giving Reassurance: may discourage clients from further expression of feelings if client believes the feelings will only be belittled  Rejecting: refusing to consider client’s ideas or behavior  Giving Approval or Disapproval: implies that the nurse has the right to pass judgment on the “goodness” or “badness” of client’s behavior  Agreeing/Disagreeing: implies that the nurse has the right to pass judgment on whether client’s ideas or opinions are “right” or “wrong”  Giving Advice: implies that the nurse knows what is best for client and that client is incapable of any self-direction  Probing: pushing for answers to issues the client does not wish to discuss causes client to feel used and valued only for what is shared with the nurse  Belittling Feelings Expressed: causes the client to feel insignificant or unimportant  Making Stereotyped Comments, Clichés, and Trite Expressions: these are meaningless in a nurse-client relationship  Using Denial: blocks discussion with the client and avo...