NCLEX-RN Flashcards: Mental Health Nursing, Therapeutic Communication, Crisis

Therapeutic communication is purposeful, goal-directed interaction that promotes the patient's wellbeing and establishes trust. Key techniques include open-ended questions that invite the patient to elaborate, reflection that mirrors the patient's feelings back to them, active listening demonstrated through eye contact and body language, silence that gives the patient time to collect thoughts, focusing to keep the conversation on topic, and summarizing to verify understanding.

When a patient expresses suicidal thoughts, the nurse should take it seriously and not dismiss or minimize the statement. Ask directly about the plan: "Are you thinking of hurting yourself? Do you have a plan?" A specific plan with access to means indicates higher risk. Ensure patient safety by removing dangerous items, placing the patient on one-to-one observation, and maintaining a calm, non-judgmental therapeutic presence. Notify the healthcare provider immediately. Document the patient's exact words, the assessment findings, interventions taken, and the provider notification.

Alcohol withdrawal symptoms begin 6 to 24 hours after the last drink and progress in severity. Early symptoms include anxiety, tremors, insomnia, nausea, diaphoresis, and tachycardia. Within 12 to 48 hours, hallucinations and seizures may occur. Delirium tremens, the most severe form, typically occurs 48 to 72 hours after cessation and presents with severe confusion, agitation, hallucinations, fever, hypertension, and tachycardia, with a mortality rate of 5 to 15 percent if untreated. The CIWA-Ar scale quantifies withdrawal severity and guides benzodiazepine dosing.

Anxiety has four levels. Mild anxiety sharpens awareness and enhances learning and perception, making it ideal for patient education. Moderate anxiety narrows the perceptual field, and the patient can still learn but may need redirection to focus. Severe anxiety greatly narrows perception, and the patient cannot problem-solve or learn new information, focusing only on small details or fragments. Panic level involves complete disorganization with possible loss of rational thought, distorted perceptions, and inability to function.

The priority is maintaining patient safety and dignity while using the least restrictive intervention for the shortest time possible. Restraints require a face-to-face provider assessment within one hour and must be reordered every four hours for adults. The nurse must assess the patient at least every two hours for circulation, sensation, movement, skin integrity, vital signs, hydration, nutrition, toileting, and emotional status. Document the behavior necessitating restraint, alternatives tried first, the type of restraint, times of assessment, and the patient's response.

Defense mechanisms are unconscious psychological strategies used to reduce anxiety. Common mechanisms include denial, refusing to accept reality; projection, attributing one's own feelings to another; rationalization, creating logical explanations for unacceptable behavior; displacement, redirecting emotions to a safer target; regression, reverting to behaviors from an earlier developmental stage; repression, unconsciously blocking threatening memories; and sublimation, channeling unacceptable impulses into socially acceptable activities. ---