NR 326 Exam 1
What is needed for involuntary admission to a psychiatric inpatient unit?
1. Petition needed.
2. The RN will assess the pt for lethality; assess the inability of client to care for self; assess judgment and thought.
3. At first, clinical certification is needed from a clinical eval done by physician or psychologist.
4. A second clinical cert from a clinical eval by a psychiatrist is needed within 24 hrs after initial cert.
Examples of non-therapeutic communication techniques
-Offering false reassurance
-Giving opinions
-Asking "why" questions
-Asking too many questions without first establishing rapport or allowing pt to verbalize judgement; interrupting
-Focusing on the person's character weaknesses vs. strengths, opportunities for improvement, and behavioral motivation
Therapeutic communication techniques
-Active listening skills
-Redirecting patient to healthy ways of coping and interacting
-Providing dignity and respect
-Observing and relating the person's strengths to 1:1 and group interactions
-Identify and focus on the person's strengths, motivations
What are active listening techniques?
Clarifying, reflecting, summarizing, emotional labeling, silence, offering self, exploring (possible options and previous coping that has worked)
Nursing interventions for a pt exhibiting threatening behavior and violence
-Have staff nearby
-One person talks to the pt with a calm, non-threatening voice
-De-escalation skills
-Redirect pt (let's walk, I have time to listen, let's solve this together)
What are your priority actions during a situational crisis?
-Determine if the client has psychotic thinking
(Clients experiencing a situational crisis are at greatest risk for injury to themselves or others)
What do you do for a pt exhibiting panic level anxiety?
Remain with the pt for awhile (the nurse should not leave a pt who has severe anxiety alone. The nurse's priority is to use the least restrictive intervention, such as staying with the pt and calmly encouraging them to express their feelings)
Repression
A patient who just got assaulted and can't remember circumstances of the event
Denial
A nurse manager expects the nurse abusing alcohol to demonstrate the defense mechanism of denial. Denial is the most common defense mechanism, especially used by people dealing with the problems and missed responsibilities associated with substance abuse behavior. Rationalization
A pt states they have to drink a bottle of alcohol daily to relax due to a veery high stress job. Rationalization is when a person creates reasonable and acceptable explanations for unacceptable behavior.
Somatization
A pt indicates they keep feelings nauseated and sick to their stomach, chest pains, and a headache, every time they are asked to go to art therapy and be with other people (Somatization is developing physical symptoms in place of anxiety)
Reaction formation
A pt dislikes his roommate and speaks ill of him to everyone who will listen; but, when the roommate returns, he offers the roommate a cookie and a snack (Reaction formation is overcompensating or demonstrating the opposite behavior of what the person feels)
Displacement
A pt kicks a chair after emotionally yelling and screaming at a psychiatrist for prescribing
a med (displacement is shifting feelings r/t an object, person, or situation to another less
threatening object, person, or situation)
Regression
A pt is describing what he does to cope with things not working out the way he expects (Regression is reverting to an earlier, more primitive and child-like pattern of behavior)
What does a crisis situation contain?
A crisis situation contains the potential for psychological growth or deterioration
What may be prescribed for a pt experiencing anxiety?
Paroxetine and Lorazepam (benzo)
Nursing interventions for a pt experiencing a crisis r/t anxiety
-Establish rapport with the pt
-Identify the cause of the anxiety
-Validate the client's feelings
What are usual findings for panic level anxiety?
Increased pulse rate, respirations, and blood pressure.
*Elevated temp and decreased CO2 are not usual findings
What does a nurse do if a pt verbalizes that they are better off dead than alive?
The nurse needs to do a lethality assessment.
"Do you have a plan to harm yourself?" (When a pt expresses suicidal intent, it is the nurse's priority to determine the seriousness of the content and the lethality of the means.
What is the nurse's priority if the pt has hallucinations, is responding to internal stimuli, and is delusional and/or paranoid?
The nurse's priority is to place the pt on suicide precautions, monitoring within line of sight, or 1:1 supervision/monitoring
*Assess TMAPI: thoughts, means, ability, plan, and intent
Nursing interventions for pts who have a history of panic level anxiety
Provide continuity of care by assigning the same staff (consistent interactions are important in any care setting, but especially in mental health. This will help pts establish trust and a sense of seecurity)
What should the nurse do if a pt gets angry and throws a chair? The first action the nurse should take using the safety/risk reduction priority-setting framework is to attempt to de-escalate the pt's anger and aggression by talking the pt down in a calm, nonthreatening manner.
Give examples of patient rights
•Dignity and Respect
•Freedom from Abuse/Neglect
•Confidentiality
•Access to Record
•Environmental Rights
•Civil Rights
•Treatment and Support
•Person-Centered Planning
Voluntarily denying unpleasant thoughts and feelings
•Adaptive use: A student stops thinking about an argument he had earlier with a family member so he can focus on the test
•Maladaptive use : A person who has lost his job states he will worry about paying his bills next month.
Suppression
•Unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness
•Adaptive use: A Clinical Director preparing to give a speech unconsciously forgets the time when she was in high school and kids laughed at her while on stage
•Maladaptive use : A nursing student who has a fear of dentists consciously forgets to go to his dental appointments
Repression
Sudden use of childlike or primitive behaviors that don't correlate with the person's current developmental level.
•Adaptive use: A school age child temporarily wets the bed when she learns that her pet
died
•Maladaptive use: A nurse manager who has a nasty disagreement with a staff nurse starts throwing things around in her office
Regression
Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation.
•Adaptive use: A high school football player angrily punches a punching bag after losing
a game
•Maladaptive use: A dad who is angry about his wife divorcing him destroys his child's favorite toy
Displacement
Performing an act to make up for prior behavior.
•Adaptive use: A adolescent does his chores daily without being prompted after arguing with his parent
•Maladaptive use : A man brings his wife flowers and gifts every time he visits in the hospital following repeated incidences of physical and mental abuse
Undoing
Dealing with impulses and unfavorable feelings and substituting acceptable forms of expression. •Adaptive use: A person feeling anger and hostility to ward his supervisor at work sublimates these feelings by working out for a long time at the gym during his lunch period
•Maladaptive use : n/a
Sublimation
Overcompensating or demonstrating the opposite behavior of what is felt.
•Adaptive use: A Nurse who is currently trying to stop smoking repeatedly talks daily to adolescents on the unit about dangers of nicotine
•Maladaptive use : A neighbor you know who greatly dislikes the neighbor who is unpopular in your neighborhood continually tells others what a great neighbor he is
Reaction formation
Creating reasonable and acceptable explanations for unacceptable behavior.
•Adaptive use: An RN says, "that nurse must have had a bad day at home"
•Maladaptive use: A young adult tells the nurse he had to drive home for a party after drinking alcohol because he had to feed his dog
Rationalization
Pretending the truth is not reality to manage the anxiety felt of acknowledging what is real.
•Adaptive use: A relative initially saying, "No, that can't be true," when they are told they have cancer
•Maladaptive use: A parent informed his son was killed in combat tells everyone one month later that he is coming home for the holidays
Denial
Emphasizing strengths to make up for weaknesses.
•Adaptive use: An adolescent physically unable to play contact sports excels in academics
•Maladaptive use : A person introverted and overwhelmed around people works at computer skills to avoid socialization
Compensation
Conscious or unconscious assumption of the characteristics of another individual or group.
•Adaptive use: A little girl with chronic illness pretends to be a nurse for her dolls
•Maladaptive use : A child daily observing his dad abuse his mom becomes a bully at school
Identification
Separating emotions and logical facts when analyzing or coping with a situation or event.
•Adaptive use: A law enforcement officer blocks out the emotional aspect of a crime so he can objectively focus on the investigation
•Maladaptive use : A person who learns he has a terminal illness focuses on creating a will and organizing financial affairs, rather than acknowledging his grief
intellectualization
Responding to stress by unconsciously developing physical manifestation not caused by a physical illness.
•Adaptive use: n/a
