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Psych - Unit 1 A

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olanjones's version from 2017-01-20 00:19

Mental Health/Illness

Question Answer
Mental healththe successful adaptation to stressors from the internal/external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms
Johoda 6 indicators of mental health1. Positive attitude towards self 2. Growth, development, & ability to achieve self-actualization 3. Integration 4. Autonomy 5. Perception of reality 6. Environmental mastery
Mental illnessmaladaptive responses to stressors from internal/external environment, evidenced by thoughts, feelings, & behaviors that are incongruent with local & cultural norms, and that interfere with individual's social, occupational, and/or physical functioning
3 effects presented in mental illnessDistress (can't function socially/emotionally in life - everything is altered: self-care, social life, etc)
Defiance (behaviors effects others, not themselves - they function ok but make other miserable)
Dysfunction (bringing harm to self or others)
Neurosispsychiatric disturbances (anxiety, depression - everything r/t brain) expressed directly or altered through defense mechanisms
Characteristics of neuroses-Are aware they are experiencing distress
-Are aware that their behaviors are maladaptive
-Are unaware of any possible psychological causes of distress
-Feel helpless to change their situation
-Experience no loss of contact with reality
Characteristics of psychoses-Exhibit minimal distress (emotional tone is flat, bland, or inappropriate)
-Are unaware that their behavior is maladaptive
-Are unaware of any psychological problems
-Are exhibiting a flight from reality into a less stressful world or into one in which they are attempting to adapt
Psychosissevere mental disorder characterized by gross impairment in reality testing (delusions, hallucinations)
Dementiaprogressive duration of ability to function
Influences that affect mental healthStress (internal/external), Anxiety, Grief
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Maslow & Multi-Axial Diagnosis

Question Answer
Maslow's hierarchy of needsPhysiological needs; Safety & Security; Love/belonging; Self-esteem (ID strengths to boost self-esteem); Self-Actualization (long/short term goals).
Self-actualizationpsychologically healthy, fully human, highly evolved and fully mature
Characteristics of self-actualization -Perception of reality; Ability to accept oneself, others & human nature
-Spontaneous; Can focus on problem solving
-Need for detachment/privacy; Independence, Autonomy & resistance to enculturation
-Intensity of emot’l rxn; Frequent “peak” experiences that validates worthwhileness, richness & beauty of life; ID’s with humankind
-Achieves satisfactory interpersonal relationships; Democratic structure & Strong sense of ethics
-Creativeness; A degree of nonconformance.
Axis IMood disorders, anxiety disorders, dissociative, substance, szhizo, dementia, delirium…
Axis IIMental retardation and personality disorders
Axis IIIGeneral Medical Conditions/Diagnoses
Axis IVPsychosocial & Env’tl problems such as job, marriage, education, support group…
Axis VGAF Scale (Global Assessment of Functioning Scale)
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Groups & Milieu

Question Answer
What groups might a RN lead?-Task groups: accomplish a specific outcome/task/solve problems/make decisions. Usually has a deadline & usually needs to have a satisfactory outcome.
-Teaching Groups: exist to convey knowledge & info. to a number of individuals. Nurses-med edu/child-birth/BRE/parenting. Usually have a timeframe or set # of meetings and objective is verbal or demo by learner of material by a specific time.
-Supportive/Therapeutic Groups: goal is to prevent future upsets by teaching memebers effective ways of dealing with emot’l stress arising from situational or developmental crises.
How does group therapy differ from therapeutic groups?group therapy - needs to have advanced edu in psychotherapy, social work, nursing or medicine and usually have additional training and supervision while therapeutic groups - anyone can lead, but needs to understand group process & content
Influences of group dynamicsSeating (open circle is better), Size (7-8 members so everyone has a chance to be heard), Membership (open = can join/leave at will; closed = predetermined & fixed time frame)
Yalom & Leszcz's Curative FactorsInstillation of Hope; Universality; Altruism
Imparting of Information
Corrective recapitulation of Primary Family Group; Imitative behavior; Interpersonal learning
Catharsis (express feelings +/-); Existential Factors (group is able to help members take control of their own lives)
Milieu: Basic assumptions1. The health in each indiv. is to be realized & encouraged to grow 2. Every interaction is an opportunity for therapeutic intervention 3. Client owns his/her own env’t (client/group make joint decisions) 4. Client owns his/her own behavior 5. Peer pressure is useful & powerful tool 6. Inappropriate behaviors are dealt with as they occur 7. Restrictions & punishment are to be avoided.
Conditions that promote Therapeutic community1. Basic physio needs are met 2. Physical facilities are conducive to achieving therapy goals 3. Democratic form of self-gov't 4. Responsibilities are assigned by capability 5. Structured program of social and work-related activities as part of tx 6. Community/Family are included in the program of therapy in an effort to facilitate discharge from treatment
Importance of Therapeutic communityIt ensures that the environment is one that keeps the client safe & allows the client to use new mechanisms so they can utilize what they have learned when they go home, helping with the transition
Members of Mental health tx teamMusic, Art, Psychiatrist, Nurse, Social Worker, Mental Health Specialist, dietetics, chaplain, rec
Role of RNProvide holistic care: advocate for client to make sure needs are met; ongoing physical assessment; med administration; detoxification; case mgmt.; consultations; maintain therapeutic env’t on a 24-hour basis; evaluation, help to manage mileu; educator; therapeutic one-one relationship
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Recovery

Question Answer
Describe Recoveryprocess of change through which individuals improve their health & wellness, live in a self-directed life & strive to reach their full potential.
Basic conceptsHealth, Home, Purpose, Community (must all be supported to aid a life in recovery and allow for client empowerment)
Principles of RecoveryEmerges from hope; Is based on respect
Is person-driven; Occurs via many pathways; Is holistic; Is culturally-based & influenced
Supported by peers/allies; through relationship/social networks; Supported by addressing trauma
Involves individual/family/community strengths and responsibilities
Goal of All Recovery ModelsEmpower patient to be independent so that when triggers come, they are able to get help and manage their disease
Tidal ModelValue the voice; respect the language; develop genuine curiosity; become the apprentice; use the available toolkit (what has worked for the client before?); craft the step beyond; give the gift of time; reveal personal wisdom (Id strengths & witnesses); know that change is constant; be transparent.
WRAP Wellness Recovery Action Plan) Modelstep-wise process that one can monitor and manage distressing symptoms that occur in daily life, others can be included in the process to assist, but indiv. empowerment comes from self-administration of the plan. One of the best models to help prevent relapse when people go home. Helps them to ID triggers in life so they know how to put barriers on these triggers. Giving them a lot of places to go to get help.
Steps of WRAP1. Develop a wellness toolbox 2. Daily maintenance list 3. Triggers 4. Early warning signs 5. Things are breaking down or getting worse 6. Crisis planning
Psychosocial Recovery ModelHope, Responsibility, Self Identity, Meaning and Purpose.
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Psychosocial Development

Question Answer
Freud’s Psychoanalytic Theory-Id-animal parts, get angry, unbalanced (this is where ego comes in to balance it)
-Ego-balance of personality, think before you do something
-Superego-self-conscious, perfectionist side, always having to do the right thing (ego helps to balance this strong ego)
PeplauInterpersonal Development theory to the nurse-client relationship development. Correlates the stages of personality development in childhood to stages through which clients advance during progression of an illness.
Peplau's nursing rolesstranger, resource person, counselor, teacher, leader, technical expert, surrogate
4 Stages of personality development1) Learning to count on others 2) Learning to delay gratification 3) Identifying oneself 4) developing skills in participation
Erikson's Stages of Development-Trust versus mistrust (birth to 18 months): relief from anxiety through oral gratification of needs
-Autonomy vs shame and doubt (18m-3y): basic trust in mother figure & learn to generalize it to others
-Initiative versus guilt (3 to 6 years): gain some self-control & independence w/in env’t
-Industry versus inferiority (6 to 12 years): self-confidence via learning, competing, performing & getting recognition from significant others, peers, and acquaintances
-Identity versus role confusion (12 to 20 years): integrate tasks mastered in the previous stages into a secure sense of self.
-Intimacy versus isolation (20 to 30 years): form an intense, lasting relationship or a commitment to another person, cause, institution or creative effort
-Generativity versus stagnation (30 to 65 years): achieve life goals established for oneself, while also considering welfare of future generations.
-Ego integrity versus despair (65 years to death): review one’s life and derive meaning from both positive and negative events, while achieving a positive sense of self-worth.
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Neurotransmitters

Question Answer
CholinergicsAcetylcholine
MonoaminesNorepinephrine (NE), Dopamine (DA), Serotonin (SE), Histamine
Amino AcidsGABA, Glycine, Gluamate & Aspartate
NeuropeptidesEndorphines & Enkephalines, Substance P (both work with pain modulation)
Use in antidepressant txserotonin, norepinephrine, glutamate, dopamine
Use in anti-psychotic txserotonin, dopamine
Use in anti-anxiety txserotonin, GABA, glutamate
Use in mood stabilizer txglutamate, dopamine
Action: DopamineModerate-high energizer, motivator; Frontal cortex, limbic, basal ganglia, thalamus, posterior pituitary, spinal cord
Action: GlutamateFast energizer, raw energy; Pyramidal cells of cortex, cerebellum, primary sensory afferent systems, hippocampus, thalamus, hypothalamus, spinal cord
Action: GABASoother, calming; Hypothalamus, hippocampus, cortex, cerebellum, basal ganglia, spinal core, retina
Action: NorepinephrineModerate mood booster, energizer, motivator; ANS (SNS postsynaptic nerve terminals) CNS (Thalamus, hypothalamus, limbic system, hippocampus, cerebellum, cerebral cortex)
Action: SerotoninSlow mood booster; Hypothalamus, thalamus, limbic, cerebral cortex, cerebellum, spinal cord
Action: AcetylcholineANS (SNS & PSNS presynaptic nerve terminals; PSNS post synaptic nerve terminals) CNS (cerebral cortex, hippocampus, limbic structures, basal ganglia)
Action: HistamineHypothalamus
Function: DopamineMovement & coordination, emotions, voluntary judgement, release of prolactin; ↓ levels = poor executive function, low mood, depression & Parkinson’s; ↑ levels = psychosis, mania, & schizo
Function: GlutamateRelay of sensory information & regulation of various motor & spinal reflexes; ↓ = apathy, low energy, schizo; ↑ = aggression, Huntington’s, temporal lobe epilepsy, spinal cerebellar degeneration, anxiety, depressive disorders
Function: GABASlowdown of body activity; ↓ = Huntington’s, anxiety, schizo, various forms of epilepsy; ↑ = sedation, confusion
Function: NorepinephrieMood, cognition, perception, locomotion, CV function, sleep & arousal; ↓ = depression; ↑ = hyperreactive, anxiety, mania, schizo
Function: SerotoninSleep & arousal, libido, appetite, mood, aggression, pain perception, coordination, judgment; ↓ = depression; ↑ = anxiety states, serotonin syndrome
Function: AcetylcholineSleep, arousal, pain perception, movement, memory; ↓ Alzheimers, Huntington’s, Parkinsons; ↑= depression
Function: HistamineWakefulness; pain sensation & inflammatory response; ↓ = depression
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Ethics & Legal Issues

Question Answer
Ethical issues in nursingRight to refuse medications/treatment; Right to Least-restrictive Treatment Alternative (unless a harm to self/others); Right to informed consent (to perform tx/procedure. Psychosis does not prevent this right)
Utilitarianismtheory that promotes action based on the end result producing the most happiness for the most people
Kantianismdecisions & actions are bound by sense of duty- right/wrong derived from motivation not outcome
Natural law theoriesdecisions about right/wrong self-evident & determined by human nature & intrinsic knowledge of the difference between good and evil
Patient confidentialityA right of ALL patients (is in ANA code of ethics for nurses); HIPAA-health info. cannot be released w/o pt’s consent (exceptions: tx team, duty to warn, protect third parties)
Tortviolation in civil law in which an individual has been wronged (can be: Defamation of character, Assault, Battery/False imprisonment)
Negligencefailure to exercise the standard of care that a reasonably prudent person would exercised in a similar situation
Malpracticeact or an omission to act that breaches the duty of care & results in or is responsible for a person’s injuries. Elements to prove Malpractice: Duty, Breach of duty, Injury to client, Proximate cause (injury was directly caused by breach)
Abandonmentlegal concept can arise when nurse does not leave pt. safely back in hands of another health care professional before discontinuing tx
Actions to avoid malpracticerespond to client; educate client; comply with standard of care; supervise care; adhere to nursing process; document carefully; follow up and evaluate; maintain a good interpersonal r/t with client and family
Admission typesVoluntary- individual makes direct application, may sign out unless risk of harm to self/others (status may be changed to involuntary)
Involuntary- commitment against client's will for specified period of time - includes ex parte
Involuntary admit typesEmergency situation: immediate risk of harm to self/others
Mentally ill person in need of tx: observation & tx (unable to take care of basic needs, likely to cause harm)
Involuntary outpatient: hx of repeated decompensation, existence of tx plan likely to be effective
Gravely Disabled: inability to make use of resources (d/t mental illness) resulting in inability to provide for basic needs
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