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| controls are exerted over access, use, quality, and effectiveness of health services. (Dominant form of healthcare in the U.S)Nurse must quickly identify patient's needs, establish realistic plan of care, implement interventions, and evaluate outcomes within a predetermined length of time. |
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- autonomy
- informed consent
- treatment w/ dignity and respect
- confidentiality |
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| individual's personal judgement of his or her own worth. Roots are in early parental and social relationships as well as in the person's perception of goal attainment and his or her own idea. |
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| any situation in which something a person values is rendered or threatened to be rendered inaccessible. |
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| protect the individual from threats, feelings of inadequacy, and unacceptable feelings or thoughts. THey are unconscious mental processes used to reduce anxiety and conflict by modifying, distorting, and rejecting reality. |
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| usually conscious methods that the individual uses to overcome a problem or stressor. They are learned adaptive or maladaptive responses to anxiety based on problem-solving, and they may lead to changed behavior. |
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| an attempt to remove an experience or a feeling from consciousness |
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| the belief that one would be in great danger if true feelings about someone were known to that person, which causes the individual to discharge or displace feelings onto a third person or object. |
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| Accepting the other person's circumstances as though they were one's own |
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| Separating emotion from an idea or thought because emotionally it is too painful (ex: pt discusses the physiology of his leukemia at length without any emotional reaction) |
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| Blocking out feelings associated with an unpleasant or threatening situation or thought |
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| Transferring or blaming others for one's own unacceptable ideas, impulses, wishes, or feelings |
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| Substituting acceptable reasons for the true reasons for personal behavior because admitting true reasons is too threatening. (ex: smoker continues to smoke despite physicians warning because he knows many people who smoke and have no ill effects. |
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| Actions that are opposite of the true, unacceptable feelings that the person is experiencing (ex: a woman has negative feelings about her pregnancy but lavishes constant attention on her newborn) |
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| Reverting to earlier patterns of development as a way to reduce anxiety and demands on one's self. (ex: during serious illness, a patient exhibits behavior more appropriate for a younger developmental age, such as excessive dependency. |
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| Forcibly dismissing unacceptable thoughts, feelings, impulses, or memories from consciousness (ex: a person is unable to recall feelings of hostility toward a sibling or specific memories from childhood. |
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| expressing repressed urges or desires in socially acceptable ways (ex: an angry person writes a poem about his reactions to his feelings.) |
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| What should be included in a psychosocial assessment |
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| lifestyle information, normal coping patterns, understanding of current illness, personality style, history of psychiatric disorder, recent lifestyle changes or stressors, spirituality, major issues raised by current illness, and mental status examination |
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| Mental status examination |
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Definition
| used to determine whether or not there are abnormalities in the patient's thinking and reasoning ability, feelings, or behavior. |
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| remaining totally immobile |
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| insistent, repetitive unwanted actions |
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| mechanical, repetition or words, thoughts |
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| high accelerated rapid speech |
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| absence of logical connections between thoughts |
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| rapidly jumping from one thought to another with minimal links |
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| talking around main point |
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| making up new words only speaker understands |
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| emotions that change quickly and unpredictably |
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| loss of energy, depression, confusion, lethargy (hyperparathyroidism; bone metastasis) |
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| reduced concentration and intellectual function; emotional lability, depression, psychosis, irritability, seizures (hypoparathyroidism) |
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| irritability, hallucinations, hyperactive intellectual function, stupor (dehydration, restricted fluid intake, diabetes insipidus) |
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| depression, lethargy, withdrawal, anorexia (severe dietary restriction, excessive water intake, Syndrome inappropriate anti-diuretic hormone SIADH) |
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| apprehension, irritability, numbness, stupor (gram - septicemia, alcohol withdrawal, low dietary intake, intravenous hyperalimentation) |
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| weakness, dysphagia (renal disease, potassium-sparing diuretics, increased IV intake) |
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| mood and personality changes, tearfulness, hopeless, helplessness, fatigue (renal disease, cushings syndrome, potassium-wasting diuretics, vomiting, diarrhea) |
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| decreased intellectual function, drowsiness, confusion, delirium (prolonged vomiting, status asthmaticus, renal failure, diabetes mellitus with ketosis) |
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| crisis in repsonse to facing a new developmental phase (ex: young adult leaving home for the first time, birth of a child) |
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| an unanticipated, external event triggers a strong response (loss of a job, death of a loved one.) |
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| crisis of disaster (ex: natural disaster, terrorism) |
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- perception of the event
- situational support
- adequate coping mechanisms |
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| three factors that determine the development of a crisis |
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| Generalized anxiety disorder (GAD |
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Definition
| this lasts at least 6 months, they will say everything makes them feel anxious, nothing in particular that makes them feel anxious. |
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| sometimes they get over it, sometimes they don’t, and the most extreme version of it is anxiety (they will say their chest hurts or they have chest pain) |
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| Post Traumatic Stress Disorder (PTSD) |
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| something someone that goes through that is out of the ordinary (not a test, but something like a war) sometimes because of a single event. A stressful event that is out of the realm of ordinary. This is a lot of times to do with a sexual event. |
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| These people are anxious about going out in to the public, so they stay in their house or their rooms ect. |
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| anxiety was caused by a conflict in the ego-state |
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anxiety comes from our interpersonal relationships with other people
Behavioral |
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| the perception of the event that causes the anxiety… not the event itself. |
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Medications: benzodiazepines, (short term use only, they have high addiction potential and high tolerance potential) nonbenzodiazepines (ph. 458) , some SSRIs [selective serotonin…] increase level of serotonin (antidepressants)
Beta-blockers (people who have performance anxiety), Kava and Valerian (over the counter drugs) |
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