- Information
- AI Chat
Study Guide Exam 2 Mental Health Nursing Summer 2019 1
Pharmacology (NUR 3145)
Santa Fe College
Recommended for you
Preview text
Chapter 8 – Assessment
What are some factors that may influence patient assessment? a. Client Participation/Feedback i. the client who is extremely depressed may not have the energy to answer questions or complete the assessment. Clients exhibiting psychotic thought processes or impaired cognition may have an insufficient attention span or may be unable to comprehend the questions being asked. b. Client’s Health Status i. If the client is anxious, tired, or in pain, the nurse may have difficulty eliciting the client’s full participation in the assessment. The information that the nurse obtains may reflect the client’s pain or anxiety rather than an accurate assessment of the client’s situation. c. Client’s Previous Experiences/Misconceptions About Health Care i. If the client is reluctant to seek treatment or has had previous unsatisfactory experiences with the health care system, he or she may have difficulty answering questions directly. The client may minimize or maximize symptoms or problems or may refuse to provide information in some areas. d. Client’s Ability to Understand i. If the client’s primary language differs from that of the nurse, the client may misunderstand or misinterpret what the nurse is asking, which results in inaccurate information. A client with impaired hearing also may fail to understand what the nurse is asking. e. Nurse’s Attitude and Approach i. If the client perceives the nurse’s questions to be short and curt or feels rushed or pressured to complete the assessment, he or she may provide only superficial information or omit discussing problems in some areas altogether. The client also may refrain from providing sensitive information if he or she perceives the nurse as nonaccepting, defensive, or judgmental.
Define and give examples of common terms used in assessing affect. a. Affect is the outward expression of the client’s emotional state. b. Common terms used in assessing affect: i. Blunted affect: showing little or a slow-to-respond facial expression ii. Broad affect: displaying a full range of emotional expressions iii. Flat affect: showing no facial expression iv. Inappropriate affect: displaying a facial expression that is incongruent with mood or situation: often silly or giddy regardless of circumstances
Define the terms guardianship and conservatorship. a. Guardianship i. a legal guardian who assumes many responsibilities for the person, such as giving informed consent, writing checks, and entering contracts. The client with a guardian loses the right to enter into legal contracts or agreements that require a signature (e., marriage or mortgage). This affects many daily activities that are usually taken for granted. Because guardians speak for clients, the nurse must obtain consent or permission from the guardian. b. Conservatorship
i. the term conservator refers to a person assigned by the court to manage all financial affairs of the client. This can include receiving the client’s disability check, paying bills, making purchases, and providing the client with spending money. Some states include the management of the client’s financial affairs under legal guardianship. c. Some states distinguish between conservator of the person (synonymous with legal guardian) and conservator of financial affairs only—also known as power of attorney for financial matters. 4. What is meant by the term least restrictive environment? a. Treatment appropriate to meet the client’s needs with only necessary or required restrictions b. It means that a client does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. It also means that the client must be free of restraint or seclusion unless it is necessary. The Joint Commission (JTC) develops and updates standards for Restraint and Seclusion as part of their accreditation procedures. 5. Define seclusion and related patient care requirements and nursing responsibilities. a. Seclusion i. the involuntary confinement of a person in a specially constructed, locked room equipped with a security window or camera for direct visual monitoring. ii. For safety, the room often has a bed bolted to the floor and a mattress. Any sharp or potentially dangerous objects, such as pens, glasses, belts, and matches, are removed from the client as a safety precaution. Seclusion decreases stimulation, protects others from the client, prevents property destruction, and provides privacy for the client. iii. The goal is to give the client the opportunity to regain physical and emotional self-control. 6. What decisions must be made in regards to the duty to warn third parties? a. One exception to the client’s right to confidentiality is the duty to warn, based on the California Supreme Court decision in Tarasoff vs. Regents of the University of California(Box 9). As a result of this decision, mental health clinicians may have a duty to warn identifiable third parties of threats made by clients, even if
- What is required for a client to be awarded the insanity defense? a. The argument that a person accused of a crime is not guilty because that person cannot control his or her actions or cannot understand the wrongfulness of the act is known as the M’Naghten Rule. b. The public perception of the insanity defense is that it is used frequently and that it is usually successful; that is, the person accused of the crime “gets off” and is free immediately. In actuality, this defense can be used only when the person meets the criteria for an insanity defense. So it is used infrequently, and is not usually successful. However, when the insanity defense is successful, it is widely publicized, leading to the perception that it is commonplace.
- Define the following: a. Tort (intentional and unintentional) i. A wrongful act that results in injury, loss, or damage. May be intentional or unintentional. b. Negligence i. an unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similar circumstances. c. Malpractice i. a type of negligence that refers specifically to professionals such as nurses and physicians
- What are the requirements for malpractice suits? a. For a malpractice suit to be successful, that is, for the nurse, physician, or hospital or agency to be liable, the client or family needs to prove the following four elements: i. Duty: A legally recognized relationship (i., physician to client, nurse to client) existed. The nurse had a duty to the client, meaning that the nurse was acting in the capacity of a nurse. ii. Breach of duty: The nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances. iii. Injury or damage: The client suffered some type of loss, damage, or injury.
iv. Causation: The breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner. 10. What is required to prove liability for intentional torts?
a. Proving liability for an intentional tort involves 3 elements i. The act was willful and voluntary on the part of the defendant (nurse). ii. The nurse intended to bring about consequences or injury to the person (client). iii. The act was a substantial factor in causing injury or consequences. 11. What are some ways to prevent liability? a. Practice within the scope of state laws and nurse practice act b. Collaborate with colleagues to determine the best course of action
involuntarily committed to a hospital, even though some may argue that this action violates his or her right to autonomy. In this example, the utilitarian theory of doing the greatest good for the greatest number (involuntary commitment) overrides the individual client’s autonomy (right to refuse treatment). c. Ethical dilemmas are often complicated and charged with emotion, making it difficult to arrive at fair or “right” decisions.
Chapter 10 – Grief and Loss
- What are the losses people may grieve?
a. Physiologic loss: Examples include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility. b. Safety loss: Loss of a safe environment is evident in domestic violence, child abuse, or public violence. A person’s home should be a safe haven with trust that family members will provide protection, not harm or violence. Some public institutions, such as schools and churches, are often associated with safety as well. That feeling of safety is shattered when public violence occurs on campus or in a holy place. c. Loss of security and a sense of belonging: The loss of a loved one affects the need to love and the feeling of being loved. Loss accompanies changes in relationships, such as birth, marriage, divorce, illness, and death; as the meaning of a relationship changes, a person may lose roles within a family or group. d. Loss of self-esteem: Any change in how a person is valued at work or in relationships or by himself or herself can threaten self-esteem. It may be an actual change or the person’s perception of a change in value. Death of a loved one, a broken relationship, loss of a job, and retirement are examples of change that represent loss and can result in a threat to self-esteem. e. Loss related to self-actualization: An external or internal crisis that blocks or inhibits strivings toward fulfillment may threaten personal goals and individual potential. A person who wanted to go to college, write books, and teach at a university reaches a point in life when it becomes evident that those plans will never materialize. Or a person loses hope that he or she will find a mate and have children. These are losses that the person will grieve. 2. What is the role of the nurse during the grieving process? a. To support and care for the grieving client/offer support and teach coping skills to clients b. 3. What are Kubler-Ross’s Stages of Grieving? a. Denial – shock and disbelief regarding the loss b. Anger – may be expressed toward God, relatives, friends, or HCPs c. Bargaining – when the person asks God or fate for more time to delay the inevitable loss d. Depression – when awareness of the loss becomes acute e. Acceptance – when the person shows evidence of coming to terms with death
b. Spiritual i. During loss, it is within the spiritual dimension of human experience that a person may be most comforted, challenged, or devastated. The grieving person may become disillusioned and angry with God or other religious figures or members of the clergy. The anguish of abandonment, loss of hope, or loss of meaning can cause deep spiritual suffering. c. Behavioral i. The grieving person may function “automatically” or routinely without much thought, indicating that the person is numb—the reality of the loss has not set in. Tearfully sobbing, crying uncontrollably, showing great restlessness, and searching are evidence of the outcry of emotions. ii. Drug or alcohol abuse indicates a maladaptive behavioral response to the emotional and spiritual despair. Suicide and homicide attempts may be extreme responses if the bereaved person cannot move through the grieving process. 5. What are some cultural factors and specific rituals that are a part of the grieving process? a. In the United States, various mourning rituals and practices exist. A few of the major ones are summarized next: i. African Americans
- Typically, the deceased is viewed in church before being buried in a cemetery. Mourning also may be expressed through public prayers, black clothing, and decreased social activities. The mourning period may last a few weeks to several years. ii. Muslim Americans
- Islam does not permit cremation. It is important to follow the five steps of the burial procedure, which specify washing, dressing, and positioning of the body. The first step is traditional washing of the body by a Muslim of the same gender iii. Haitian Americans
- Some Haitian Americans practice vodun (voodoo), also called “root medicine.” Derived from Roman Catholic rituals and cultural practices of western Africa (Benin and Togo) and Sudan, vodun is the practice of calling on a group of spirits with whom one periodically makes peace during specific events in life.
iv. Chinese Americans 1. the Chinese have strict norms for announcing death, preparing the body, arranging the funeral and burial, and mourning after burial. Burning incense and reading scripture are ways to assist the spirit of the deceased in the afterlife journey. v. Japanese Americans
- Close family members may bathe the deceased with warm water and dress the body in a white kimono after purification rites. For 2
essential not only for the soul of the deceased but also for the protection of community members. x. Orthodox Jewish Americans
- An Orthodox Jewish custom is for a relative to stay with a dying person so that the soul does not leave the body while the person is alone. To leave the body alone after death is disrespectful. The family of the deceased may request to cover the body with a sheet. The eyes of the deceased should be closed, and the body should
remain covered and untouched until family, a rabbi, or a Jewish undertaker can begin rites. 6. List circumstances that can result in disenfranchised grieving. a. A relationship that has no legitimacy. b. The loss itself is not recognized. c. The griever is not recognized. d. The loss involves social stigma. 7. What are factors that may complicate grieving? a. Low self-esteem b. Low trust in others c. A previous psychiatric disorder d. Previous suicide threats or attempts e. Absent or unhelpful family members f. An ambivalent, dependent, or insecure attachment to the deceased person. i. In an ambivalent attachment, at least one partner is unclear about how the couple loves or does not love each other. For example, when a woman is uncertain about and feels pressure from others to have an abortion, she is experiencing ambivalence about her unborn child. ii. In a dependent attachment, one partner relies on the other to provide for his or her needs without necessarily meeting the partner’s needs. iii. An insecure attachment usually forms during childhood, especially if a child has learned fear and helplessness (i., through intimidation, abuse, or control by parents).
Chapter 11: Anger Hostility, and Aggression
- Onset and clinical course of anger a. anger can be a normal and healthy reaction when situations or circumstances are unfair or unjust, personal rights are not respected, or realistic expectations are not met. If the person can express his or her anger assertively, problem solving or conflict resolution is possible. Anger becomes negative when the person denies it, suppresses it, or expresses it inappropriately.
- What is meant by the term “catharsis”
norepinephrine in the brain is associated with increased impulsively violent behavior b. Psychosocial i. As a child matures, he or she is expected to develop impulse control (the ability to delay gratification) and socially appropriate behavior. Positive relationships with parents, teachers, and peers; success in school; and the ability to be responsible for oneself foster development of these qualities. Children in dysfunctional families with poor parenting, children who receive inconsistent responses to their behavior, and children whose families are of lower socioeconomic status are at increased risk for failing to develop socially appropriate behavior. 4. Cultural considerations related to anger hostility and aggression
a. What a culture considers acceptable strongly influences the expression of anger. b. Some cultures, such as Asian and Native American, see expressing anger as rude or disrespectful and avoid it at all costs. In these cultures, trying to help a client express anger verbally to an authority figure would be unacceptable. c. Patients with dark skin, regardless of race, are sometimes perceived as more dangerous than light-skinned patients, and therefore more likely to experience compulsory hospitalizations, increased use of restraints, higher doses of medication, and so forth. d. Hwa-Byung or hwabyeong is a culture-bound syndrome that literally translates as anger syndrome or fire illness, attributed to the suppression of anger (Kim et al., 2014 ). It is seen in Korea, predominately in women, and is characterized by sighing, abdominal pain, insomnia, irritability, anxiety, and depression. Western psychiatrists would be likely to diagnose it as depression or somatization disorder. e. Two culture-bound syndromes involve aggressive behavior. Bouffée délirante, a condition observed in West Africa and Haiti, is characterized by a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. These episodes may include visual and auditory hallucinations and paranoid ideation that resemble brief psychotic episodes. Amok is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at other people and objects
- Intervention and treatment for aggressive clients a. The treatment of aggressive clients often focuses on treating the underlying or comorbid psychiatric diagnosis such as schizophrenia or bipolar disorder. b. Haloperidol (Haldol) and lorazepam (Ativan) are commonly used in combination to decrease agitation or aggression and psychotic symptoms. Patients who are agitated and aggressive but not psychotic benefit most from lorazepam, which can be given in 2-mg doses, every 45 to 60 minutes. Atypical antipsychotics are more effective than conventional antipsychotics for aggressive, psychotic clients c. Although not a treatment per se, the short-term use of seclusion or restraint may be required during the crisis phase of the aggression cycle to protect the client and
Study Guide Exam 2 Mental Health Nursing Summer 2019 1
Course: Pharmacology (NUR 3145)
University: Santa Fe College
- Discover more from:
