Psychiatric Nursing

92 flashcards by MentisLibrary

Mental health nursing for students and new nurses: therapeutic communication, mood and anxiety disorders, psychosis, substance use, personality disorders, trauma and crisis care, psychiatric medications, and the safety and legal rules of inpatient care.

How does a therapeutic relationship differ from a social one?
It exists for the patient's benefit, has defined goals and boundaries, and the nurse does not seek to have their own needs met in it.
What are the phases of the nurse and patient relationship?
Orientation, where trust and the contract are established, the working phase, where problems are explored and behavior changes, and termination, where gains are reviewed and the ending is prepared for.
Why is silence a therapeutic technique?
It gives the patient time to think and to decide what to say, and it communicates that the nurse is willing to wait rather than to fill the space.
What makes a question open ended and why does it matter?
It cannot be answered with yes or no, so it invites the patient to describe their experience in their own words.
What is reflection as a communication technique?
Directing the patient's own question or feeling back to them so they explore their own thoughts rather than receiving the nurse's opinion.
Why is false reassurance nontherapeutic?
Telling a patient that everything will be fine dismisses their feelings, may be untrue, and ends the conversation instead of opening it.
Why are why questions avoided?
They demand justification, tend to feel accusatory, and often produce defensiveness rather than information.
Why is giving advice or approval nontherapeutic?
Advice makes the nurse responsible for the decision and undermines the patient's autonomy, and approval ties the patient's worth to pleasing the nurse.
How should a nurse respond to a patient who is actively hallucinating?
Do not argue with or agree with the hallucination; acknowledge that the experience feels real, state calmly that you do not hear or see it, and focus on the feelings it causes.
How should a nurse respond to a fixed delusion?
Avoid debating the belief or pretending to share it; acknowledge the feeling behind it, present reality briefly without arguing, and redirect to concrete topics and activities.
What are the rules about self disclosure by a nurse?
Brief, purposeful disclosure that serves the patient's goals may occasionally help, while ongoing personal sharing shifts the focus to the nurse and blurs the boundary.
Empathy vs sympathy
Empathy is understanding and communicating the patient's feelings while remaining objective enough to help; sympathy shares the feeling and shifts the focus to the nurse's own emotion.
What defines a major depressive episode?
At least two weeks of depressed mood or loss of interest, with additional symptoms such as changes in sleep, appetite, energy, concentration, psychomotor activity, feelings of worthlessness and thoughts of death.
Why is the period when depression begins to lift a high risk time for suicide?
Energy and initiative return before mood improves, so a patient who had no ability to act on suicidal thoughts may now be able to.
What are the vegetative signs of depression?
Changes in the body's basic functions: sleep disturbance, appetite and weight change, reduced energy, psychomotor slowing or agitation, and loss of libido.
What characterizes an episode of mania?
A distinct period of elevated, expansive or irritable mood with increased energy, inflated self esteem, decreased need for sleep, pressured speech, racing thoughts, distractibility and risky goal directed activity.
What are the nursing priorities during acute mania?
Physical safety, nutrition and hydration, sleep, and a low stimulation environment with consistent limits.
What is the therapeutic serum range for lithium and when does toxicity begin?
Maintenance levels are generally about 0.6 to 1.2 milliequivalents per liter, with toxicity becoming likely above about 1.5.
What must a patient taking lithium be taught about sodium and fluid?
Keep sodium and fluid intake consistent, since dehydration or a low sodium intake raises the lithium level, and avoid nonsteroidal anti-inflammatory drugs and many diuretics without advice.
Which mood stabilizer carries a warning about a serious rash?
Lamotrigine, which requires slow dose titration because of the risk of a severe and potentially life threatening rash.
How long do antidepressants take to work?
Some improvement in sleep, appetite and energy may appear within a week or two, but full mood benefit usually takes about 4 to 6 weeks.
What is serotonin syndrome?
A potentially life threatening reaction to excess serotonergic activity, causing agitation, confusion, hyperthermia, diaphoresis, tremor, hyperreflexia, clonus and diarrhea.
What dietary restriction accompanies a monoamine oxidase inhibitor?
Tyramine containing foods must be avoided, because they can precipitate a hypertensive crisis.
What is the nursing care surrounding electroconvulsive therapy?
Preprocedure consent, nothing by mouth, and removal of dentures and jewelry, then postprocedure airway monitoring, orientation and safety while confusion resolves.
What is persistent depressive disorder?
A chronically depressed mood lasting at least two years in adults, generally less severe than a major episode but longer lasting and often untreated for years.
Why is a patient with bipolar disorder monitored when an antidepressant is started?
An antidepressant without a mood stabilizer can precipitate a switch into mania or a mixed state.
What are the four levels of anxiety and how do they affect learning?
Mild anxiety sharpens attention and is the best state for learning, moderate anxiety narrows the perceptual field, severe anxiety greatly reduces perception, and panic produces disorganized behavior and loss of rational thought.
What is the nursing care during a panic attack?
Stay with the patient, remain calm, use short simple directions, reduce stimulation, and guide slow breathing until the attack subsides.
What defines generalized anxiety disorder?
Excessive worry about multiple areas of life for at least six months, difficult to control, with symptoms such as restlessness, fatigue, poor concentration, irritability, muscle tension and disturbed sleep.
How are phobias treated?
With graded exposure, in which the patient approaches the feared object or situation in steps while learning that the anxiety subsides without avoidance.