NCLEX-PN Psychosocial Integrity

1. NCLEX-PNPsychosocial Integrity Concorde Career College Garden Grove

2. Effective Communication Techniques • Listen • Acknowledge • Give feedback • Be congruent • Clarify • Focus or defocus client • Validate • Reflect • Ask open-ended questions

3. Effective Communication Techniques (continued) • Encourage in nonverbal way • Restate • Paraphrase • Respond in neutral way • Use incomplete sentences • Minimize verbalization • Initiate broad statements • Use translator as needed

4. Blocks to Effective Communication • Make assumptions • Give advice • Change the subject • Use of social responses • Invalidate client • Use of false reassurances • Overload/underload conversation • Use of incongruent messages • Make value judgments

5. Mental Health Assessment • General appearance • Orientation • Affect, mood • Body movements • Speech • Thought processes – delusions • Perceptions – illusions, hallucinations • Memory • Religion, education, etc. • Judgment and potential for injury

6. Mental Health Assessment • Personality • Attitude and behavior • Patterns of adjustment • Stress • Learned or conditioned behavior • Anxiety • Perceived threat to self • Response to stress

7. Defense Mechanisms • Compensation • Conversion reaction • Denial • Displacement • Dissociation • Fantasy • Identification • Isolation • Projection

8. Defense Mechanisms (contin.) • Projection (scapegoating) • Rationalization • Reaction-formation • Regression • Repression • Restitution (undoing) • Sublimation

9. Crisis Intervention • Behaviors seen: • Denial • Anxiety • Shock • Anger • Withdrawal • Phases of crises: • Increased anxiety and tension • Normal coping ineffective • Panic state • Personality changes • Resolution

10. Care in Crisis Intervention • Try to understand feelings • Maintain safety • Enlist aid of others • Collaborate with health team members • Use non-verbal communication • Offer concrete assistance • Monitor progress and provide follow up

11. Treatment for Crisis Intervention • Group therapy • Family therapy • Environmental therapies • Psychotherapy • Somatic therapy • Electroconvulsive therapy • Phototherapy (esp. Seasonal Affective Disorder)

12. Grief and Loss • Stages of Grieving • Denial and isolation • Anger • Bargaining • Depression • Acceptance • Assessment • Previous coping mechanisms • Potential for violence • Changes in self • Changes in health maintenance

13. Grief and Loss Intervention • Provide support • Be aware of own feelings • Assess religious/spiritual beliefs • Assist client in saying goodbye • Provide medications as ordered

14. Post-Traumatic Stress Disorder • Symptoms • Introverted • Social withdrawal • Guilt and unfocused anger • Irritable and hostile • Low self-esteem • Sleep disturbances (insomnia, nightmares, etc.) • Depression • Substance abuse • Impaired relationships

15. Post-Traumatic Stress Disorder • Interventions • Educate about disorder • Non-stimulating/non-threatening environment • Provide support and protection • Encourage discussion of feelings • Set limits on behavior • Redirect aggressive or hostile behavior • Antianxiety medication

16. Somatoform Disorders • Characterized by reported physical symptoms with no organic cause • Manifestations • Sensory • Motor • Visceral • Nursing- • Redirect from manifestation • Encourage discussion of symptoms • Reinforce relaxation and stress reduction techniques • Schedule daily activities

17. Somatoform Disorders • Treatment • Antidepressants/antianxiety • Antipsychotic prn

18. Hypochondriasis • Preoccupied with health without organic cause • Seeks treatment from multiple providers • Nursing: • Set limits and do not support manifestations • Help client express feelings • Administer SSRI’s, tricyclics, etc. as ordered • Cognitive behavioral therapy

19. Cognitive Mental Disorders • Causes • Kidney or thyroid disease • Nutritional deficiencies • Meningitis • Syphilis • Benign trauma/tumor • Dementia • Slow and progressive • Delirium • Rapid change in consciousness

20. Alzheimer’s Disease • Non-reversible cognitive disorder • Progressive • Symptoms • Sensory aphasia • Echolalia or palilalia • Behavior and motor function changes • Changes worsen with disease

21. Cognitive Disorders: Nursing Care • Assess memory loss and level of consciousness • Help client remain independent as much as possible • Treat symptoms • Daily routine • Medications as ordered • Assess for side effects

22. Thought Process Disorders • Delusions: false, fixed beliefs • Types • Grandeur • Ideas of reference • Persecution • Somatic delusions • Thought broadcasting • Thought insertion • Thought withdrawal • Hallucinations: sensory disturbance

23. Thought Process Disorders • Schizophrenia • Symptoms • Cognitive impairment • Perceptual changes • Affective changes • Behavioral changes • Social changes • Assessment • Mental functioning • Ability to function in society • Ability to care for self • Safety

24. Thought Process Disorders • Schizophrenia • Interventions • Self-care activities • Counseling • Education • Neuroleptics/antipsychotics

25. Depression • Symptoms • Psychologically depressed mood • Appetite disturbance • Psychomotor retardation • Anxiety • Decreased self-esteem • Somatic complaints • Decreased or lack of interest in activities • Suicidal thoughts • Poor personal hygiene, posture, clothes

26. Depression (continued) • Interventions • Monitor physical activities • Thought processes – slowed, ruminative, blocking • Warm, supportive, repeated attention • Suicide precautions • Antidepressants • ECT • Psychotherapy • Requires long-term follow up

27. Bipolar Disorder • Symptoms (mania) • Flight of ideas • Elated, grandiose mood • Psychomotor excitement • Short attention span • Lack of attention to detail • Exaggerated response to stimuli • Restlessness

28. Bipolar Disorder (continued) • Interventions • Maintain physical status • Assess and assist with stabilization of thought processes • Decrease complications/hazards of abnormally inflated self-esteem • Prevention of painful consequences • Adjunct therapy • Lithium

29. Anxiety • Symptoms • Muscle aches • Shakes • Palpitations • Dry mouth • Nausea/vomiting • Hot flashes • Chills • Polyuria • Difficulty swallowing

30. Anxiety (continued) • Counseling • Apply coping skills • Improve self-care • Milieu therapy • Antianxiety medications

31. Panic Attack and Phobias • Panic attack • Phobias • Acrophophia • Agorophobia • Hematophobia • Mysophobia • Social phobias • Simple phobias • Claustrophobia

32. Panic Attack and Phobias • Interventions • Maintain calm milieu • Assurance staff will not belittle • Constructive activities • Promote safety • Promote social interaction • Do not attempt to interpret behavior • Monitor for panic attacks • Assess for suicidal thoughts • Document behavior changes

33. Obsessive Compulsive Disorder • Interventions • Provide time for ritual • Help problem solve • Role model appropriate behavior • Suicide precautions • Provide supportive environment with few changes • Monitor physical needs • Provide anti-anxiety meds and antidepressants • Document behavior changes

34. Personality Disorders • Borderline • Antisocial

35. Suicide • Symptoms • Improvement in mood and affect • Feelings hopelessness, helplessness, guilt, aggression • Gives away personal items • Progressive inability to cope • Usually follows series of “small” stressors • Talk about death and suicide • Difficulty sleeping

36. Suicide (continued) • Danger signs • Previous attempts • Change in personality • Change in mood • Giving away valued possessions • Getting things in order • Direct verbalizations • Long-term chronic illness • Alcoholism or drug abuse • Recurrent surgeries • Suicide note

37. Suicide (continued) • Interventions • Assessment extent of intent • Thinking about it? • Plan? • Means? • Suicide precautions • Offer support, safety • Treat underlying depression

38. Eating Disorders: Anorexia • Symptoms • Refusal to maintain body weight • Fear of becoming fat • Consumption of 200-400 calories/day • Denial of seriousness of low body weight • Absence of menarche • Excessive thoughts (i.e. exercise) • Sleep very little (2-3 hours/night)

39. Eating Disorders: Anorexia • Interventions • Education • Assess medications • Psychotherapy • Promote • Positive self-concept • Healthy coping skills • Adequate nutrition

40. Eating Disorders: Bulimia • Symptoms • Binge eating with or without purging • Loss of control during eating • Recurrent inappropriate actions to avoid weight gain and purging of calories • Fasting after binges • Excessive exercise for weight control • Self-esteem controlled by body shape/weight • Impulsiveness

41. Eating Disorders: Bulimia • Interventions • Promote healthy coping • Proper nutrition • Education: nutrition, exercise, sexuality • Assess medication • Psychotherapy

42. Substance Related Disorders: Terms • Substance abuse-> repeated use leading to significant impairment over 12 months • Substance dependence-> tolerance, withdrawal, taken greater than prescribed, desire to control use, continued use despite problems caused • Non-substance-related dependency-> dependence on behavior such as gambling or shopping • Addiction-> loss of control despite continued problems

43. Substance Use Disorders • Risk factors • Culture • Family dysfunction • Personality disorder • Poverty and deprivation • Genetic predisposition • Excessive drug use • Presence of psychological conflict • Diagnosis • Abuse of at least 1 month duration • Social complication • Dependence

44. Substance Use: Systemic Effects • Stress • Sleep problems • Attempts to decrease use • CNS symptoms progress • Neurological system • Cardiopulmonary • GI • GU • Skin

45. Substance Use Disorders (contin.) • Interventions • Individual and group counseling • Support groups • Relationship skills • Self-care activities • Special care for dual diagnoses • Health promotion • Pharmacologic intervention • Delirium tremens management • Safety

46. Substances • Heroine • Narcotics • Cocaine • Methamphetamines

47. Abuse • Causes • Tend to have low self-esteem • History of abuse • Abusers have personality disorders/poor relationships • Multiple stressors Types • Physical • Emotional • Sexual • Neglect • Social isolation • Economic

48. Abuse (continued) • History • Delay in seeking care • Discrepancies in history • Multiple ER visits • Story vague and contradictory • Sudden change in behavior • Caregiver refuses visitors when client alone • Significant other or parent answers all questions • Dependent or co-dependent personality • Reliance on abuser

49. Abuse (continued) • Physical Examination • Multiple bruises in various stages healing • Suspicious burns • Apathetic child or adult • Poorly nourished child • Child who does not turn to parent for comfort • Unexplained vaginal/genital bruising or bleeding

50. Abuse (continued) • Treatment/Nursing care • Notify abuse hotline when suspected • Make adult feel safe to discuss concerns • Provide information about abuse and where to go for help • Ensure safety • Know your own thoughts/feelings about abuse • Remain nonjudgmental/show empathy • Know agency policy