NUR 2488 Mental Health Exam 1 Study Guide

M e n t a l H e al t h E x a m 1 Theorists:  Freud  Id: The primitive, pleasure-seeking part of our personalities that lurks in the unconscious mind.  Ego: Our sense of self. Acts as an intermediary between the I ...

M e n t a l H e al t h E x a m 1 Theorists:  Freud  Id: The primitive, pleasure-seeking part of our personalities that lurks in the unconscious mind.  Ego: Our sense of self. Acts as an intermediary between the Id and the world by using ego defense mechanisms, such as repression, denial, and rationalization. Engages in secondary process thinking, which is rational, realistic, and orientated towards problem solving.  Superego: Assigned to those processes that Freud referred to as our conscience and is greatly influenced by our parents' or caregivers' morals and ethical stances.  Maslow’s Hierarchy of Needs  1. Physiological- food, water, oxygen, elimination, rest, sex  2. Safety- protection, security, stability, order, structure, limits  3. Love and Belonging Needs- affiliation, affection, lover  4. Esteem- competency, achievement, esteem from others  5. Self Actualization- becoming everything one is capable of  Erikson’s Stages of Development  Infant: Birth - 1.5 yrs old o Trust vs. Mistrust o Task: develop a basic sense of trust and comfort and minimal fear and uncertainty.  Early childhood (toddler) - 1.5-3 yrs old o Autonomy vs. Shame/doubt o Task: gain self-control and independence  Preschooler 3-6 yrs old o Initiative vs. Guilt o Task: achieve sense of purpose and task mastery  School age 6-12 yrs old o Industry vs. Inferiority o Task: self-confidence thru learning and competition  Adolescent 12-20 yrs old o Identity vs. Role confusion o Task: differentiation from parents leads to fidelity, integrate all the above for sense of self  Young adult 20-30 yrs old o Intimacy vs. isolation o Task: form intense long term relationships  Adult 30-65 yrs old o Generativity vs. Self-absorption o Task: achieve life goals and obtain concern for future generation  Older adult 65+ o Integrity vs. Despair o Task: derive meaning from life and sense of self worth Page 2 Role of neurotransmitters as related disorders:  Dopamine  Increase: o Schizophrenia o Mania  Decrease: o Parkinson's disease o Depression  Functions: o Fine muscle movement o Integration of emotions and thoughts o Decision making o Stimulates hypothalamus to release hormones (sex, thyroid, adrenal)  Serotonin  Increase: o Anxiety states  Decrease: o Depression  Functions: o Mood o Sleep regulation o Hunger o Pain perception o Aggression and libido o Hormonal activity  Norepinephrine  Increase: o Mania o Anxiety o Schizophrenia  Decrease: o Depression  Functions: o Mood o Attention and arousal o Stimulates sympathetic branch of autonomic nervous system for "fight or flight" in response to stress  GABA  Increase: o Reduction of anxiety o Schizophrenia o Mania  Decrease: o Mania o Anxiety o Schizophrenia Page 3 o Huntington chorea (Huntington's disease)  Functions: o Inhibitory neurotransmitter: o Reduces anxiety, excitation, aggression o May play a role in pain perception o Anticonvulsant and muscle-relaxing properties o May impair cognition and psycho motor functioning Nurse-Client Relationship:  Orientation  Can last for a few meetings or long period of time, the first time the nurse and patient meet. o An atmosphere is established in which rapport can grow. o The nurse's role is clarified, and the responsibilities of both the patient and the nurse are defined. o The contract containing the time, place, date, and duration of the meetings is discussed. o Confidentiality is discussed and assumed. o The terms of termination are introduced. o The nurse becomes aware of transference and countertransference issues. o Patient problems are articulated, and mutually agreed goals are established.  Working  Allows for the patient to experience increased levels of anxiety and demonstrate dysfunctional behaviors in a safe setting while experimenting with new and more adaptive coping behaviors. o Maintain the relationship o Gather further data o Promote the patient's problem-solving skills, self-esteem, and use of language o Facilitate behavioral change o Overcome resistance behaviors o Evaluate problems and goals, and redefine them as necessary o Promote practice and expression of alternative adaptive behaviors  Termination phase  The final, integral phase of the nurse-patient relationship. Termination is discussed during the first interview, and again during the working stage at appropriate times. Termination may occur when the patient is discharged or when the student's clinical rotation ends. o Summarizing the goals and objectives achieved in the relationship o Discussing ways for the patient to incorporate into daily life any new coping strategies learned during the time spent with the nurse Page 4 o Reviewing situations that occurred during the time spent together o Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship  Nurse-client vs social relationship  The therapeutic relationship between nurse and patient differs from both a social and an intimate relationship in that the nurse maximizes his or her communication skills, understanding of human behavior, and personal strengths to enhance the patient's growth. Patients more easily engage in the relationship when the clinician's interactions address their concerns, respect the patient as a partner in decision making, and use language that is straightforward.  Boundaries with clients  Patient needs separated from nurses needs  Warning signs: over helping, controlling, narcissism  Relationship is no longer helpful if boundaries are broken.  Role of psych RN Nursing process:  Developing plan of care  Developing a goal/outcome  Mental health vs mental illness