Foundational Concepts & Legal/Ethical Considerations
1. Define capacity
2. Define competency
1. A client's ability to comprehend information, use rational thought processing, communicate their wishes, and understand consequences. Determined by medical provider.
2. A legal term (determined by judge). Client unable to make decisions or provide informed consent.
What does holistic nursing care mean?
Treating the client as a whole (physical, emotional, social, spiritual)
What is therapeutic communication?
A purposeful, patient-centered way of communication that helps build trust, supports emotional expression, and promotes healing, insight, and problem-solving.
What is neuroplasticity? How does this pertain antidepressants and other MH medications?
It is the brain's ability to adapt synaptic connections but it takes a while to see a functional change.
May take up to 6 weeks to see full effect of medication.
When determining which nursing action should be performed first, what takes priority in mental health nursing?
Safety
What is the purpose of 1:1 observation in mental health care?
To maintain continuous observation and safety when a patient requires the highest level of monitoring.
What is a trauma-informed approach to care?
Assumes that a person may have had a trauma history even if we don't know about it.
Provides safety, compassion, trustworthiness, support/collaboration, and empowerment.
Briefly define:
1. beneficence
2. autonomy
3. nonmaleficence
4. justice
5. fidelity
1. doing good
2. clients' ability to make decisions about their care
3. preventing harm
4. fair and equitable care
5. being trustworthy
1. What is the most important dietary teaching for a patient taking an MAOI and why.
2. Give one example of a food/beverage they should avoid.
1. Avoid foods high in tyramine because it can build up and cause a hypertensive crisis
2. aged/strong cheese, dried or overripe fruit (raisins, prunes, avocado, bananas, wine), certain sauces (soy, fish, teriyaki), cured or processed meats
Define and provide an example of each:
1. eustress
2. distress
1. Beneficial stress. It helps you adapt, learn, and grow. Exs: birth of child, marriage, buying home, vacation, graduating, etc.
2. Negative stress. Can contribute to energy depletion. Exs: death of loved one, divorce, injury, financial burdens, etc.
What is milieu therapy and name 2 ways to create one.
A form of psychotherapeutic treatment that is focused on modifying or controlling the environment.
Ways: establish therapeutic relationship, trauma-informed approach, ensure safe environment, encourage expression of feelings, provide support, develop trust, rebuild self-efficacy
What are transference and countertransference?
Transference: When the client develops feelings toward the therapist/health care worker in a relation similar to someone who was significant in their childhood
Countertransference: When the therapist/health care worker unconsciously has feelings toward the client that reminds them of an individual in their past.
Define the following:
1. delusions
2. hallucinations
1. fixed false beliefs
2. sensory perceptions without an external stimulus
What are two important safety teachings for a patient taking a benzodiazepine?
Do not abruptly discontinue, do not drink alcohol, don't drive/operate heavy machinery until you know how the med affects you, fall risk.
How can journaling help a person manage stress?
It can help identify stressors/triggers and recognize patterns in how they respond to stress.
When documenting a client incident, name two things that help keep the documentation accurate and legally appropriate?
Document objectively, use the client's own words/quotations when appropriate, include an assessment, describe care provided and response, who you notified, if plan changed and a reassessment of client condition.
What is the name of the assessment used with every mental health client to establish a baseline of the patient's functioning?
Hint: it is the psychiatric version of a physical assessment.
Mental Status Exam (MSE)
Define the following therapeutic communication techniques:
1. affirmations
2. reflections
1. convey support/encouragement
2. reflect meaning and/or feelings to confirm understanding (clarify)
1. What is clozapine used to treat?
2. What special monitoring needs to be done?
1. schizophrenia (it is an antipsychotic)
2. Monitor for agranulocytosis (monitor for flu-like symptoms, ANC)
When planning a behavioral change, how should the desired outcome be written?
In specific, objective/measurable terms with a defined time frame. (SMART)
1. Place the following in order based on the mental health continuum: Thriving, Crisis, Struggling, Surviving, Excelling.
2. Describe one of the zones in detail.
Excelling: Doing well overall; functioning well, managing stress, maintaining relationships, and working toward goals.
Thriving: Experiencing normal stressors but coping effectively; stress is not significantly interfering with daily functioning.
Surviving: Beginning to struggle; may experience irritability, nervousness, distraction, withdrawal, or other concerns that need attention.
Struggling: Distress is noticeably affecting functioning, such as sleep, appetite, school/work performance, mood, or ability to cope.
Crisis: Severe symptoms are significantly disrupting functioning, and the person needs assistance.
1.What does ACE stand for?
2. What does a higher score indicate?
1. Adverse Childhood Events/Experiences
2. An increased risk for later mental, substance-related, and physical health problems.
Define the following defense mechanisms:
1. denial
2. rationalization
3. displacement
1. dismissing the situation as untrue
2. using reasoning or logic to explain a stressor/behavior and avoid the emotions
3. redirecting feelings or thoughts to a less threatening target
Define 2 of the 4 extrapyramidal symptoms (EPS)
1. acute dystonia
2. akathisia
3. pseudoparkinsonism
4. tardive dyskinesia
1. muscle rigidity/spasms
2. severe feelings of restlessness
3. looks like PD (slumped posture, shuffling gait, tremors, drooling, pill-rolling)
4. involuntary movements of the face, tongue, neck, and extremities.
Name 3 manifestations of a stress response.
Increased HR, blood pressure, dilated pupils, increased respiratory rate, increased blood glucose, sweating