Psychosocial Glossary - Key NCLEX Terms

Psychosocial Integrity - Key Nursing Terms

Therapeutic Communication: Purposeful, goal-directed communication techniques used to promote patient well-being and establish a helping relationship. Techniques include active listening, open-ended questions, reflection, restating, clarification, silence, and summarizing. Non-therapeutic techniques to avoid include giving advice, false reassurance, changing the subject, and asking "why" questions.
Defense Mechanisms: Unconscious psychological strategies used by the ego to manage anxiety and protect the individual from perceived threats. They operate outside conscious awareness. When used excessively or rigidly, defense mechanisms become maladaptive and may interfere with reality testing and interpersonal relationships.
Denial: A defense mechanism in which a person refuses to acknowledge a painful reality, thought, or feeling. Considered the most primitive defense mechanism. Example: a patient with a confirmed cancer diagnosis stating, "The lab must have made a mistake." Often the first response to distressing news.
Projection: A defense mechanism in which unacceptable thoughts, feelings, or impulses are attributed to another person. Example: a patient who is angry with the nurse accuses the nurse of being hostile. Reduces anxiety by allowing the expression of undesirable feelings without conscious recognition.
Rationalization: A defense mechanism involving the use of logical-sounding explanations to justify behaviors or feelings that are actually motivated by unconscious desires. Example: a student who fails an exam stating, "The test was unfair and poorly written." Makes unacceptable behavior appear reasonable.
Displacement: A defense mechanism in which emotions directed at one person or situation are redirected toward a less threatening target. Example: a patient yells at the nurse after receiving a poor prognosis from the physician. The substitute target is perceived as safer for emotional expression.
Sublimation: A mature defense mechanism in which unacceptable impulses are channeled into socially acceptable activities. Example: a person with aggressive impulses becomes a surgeon or athlete. Considered one of the most adaptive and healthy defense mechanisms.
Regression: A defense mechanism in which an individual returns to behaviors characteristic of an earlier developmental stage in response to stress or anxiety. Example: a hospitalized 6-year-old who is toilet-trained begins wetting the bed. Common in children and may occur in adults under extreme stress.
Crisis Intervention: A short-term, focused therapeutic approach used when an individual is unable to cope with a situation using their usual coping mechanisms. The goal is to return the person to their pre-crisis level of functioning. Phases include assessment, planning, intervention, and resolution. Typically limited to 4-6 weeks.
Kubler-Ross Stages of Grief: A model describing five stages of grief experienced by individuals facing death or significant loss: denial, anger, bargaining, depression, and acceptance. Stages are not necessarily sequential, may overlap, and not all individuals experience every stage. The model provides a framework for understanding grief responses.
Complicated Grief: A prolonged, intense grief response that significantly impairs daily functioning beyond the expected duration. Characterized by persistent yearning, preoccupation with the deceased, difficulty accepting the loss, bitterness, and inability to engage in meaningful activities. May require psychotherapy and/or pharmacotherapy.
Substance Use Disorder: A chronic, relapsing condition characterized by compulsive substance seeking and use despite harmful consequences. Diagnostic criteria include impaired control, social impairment, risky use, and pharmacological indicators (tolerance and withdrawal). Treatment approaches include detoxification, behavioral therapy, medications, and support groups.
Alcohol Withdrawal: A potentially life-threatening syndrome occurring when a person who has been drinking heavily suddenly stops or significantly reduces alcohol intake. Symptoms progress from anxiety, tremors, diaphoresis, and nausea (6-24 hours) to hallucinations (12-48 hours) to seizures (24-48 hours) to delirium tremens (48-96 hours). Benzodiazepines are the primary pharmacological treatment.
Delirium Tremens (DTs): The most severe form of alcohol withdrawal, occurring 48-96 hours after the last drink. Characterized by severe agitation, global confusion, hallucinations (visual, tactile, auditory), diaphoresis, tachycardia, hypertension, and hyperthermia. A medical emergency with significant mortality if untreated. Requires intensive monitoring and IV benzodiazepine administration.
Milieu Therapy: A therapeutic approach in psychiatric settings that uses the total environment as a treatment tool. The milieu (therapeutic community) provides a safe, structured setting with clear expectations, consistent limits, and opportunities for social interaction. Promotes patient autonomy, responsibility, and interpersonal skill development.
Therapeutic Relationship: A purposeful, goal-directed relationship between a healthcare provider and patient. Progresses through four phases: pre-interaction (reviewing patient data), orientation (establishing trust, defining boundaries), working (identifying problems, promoting change), and termination (evaluating goals, planning for continued growth). Boundaries are maintained by the nurse.
Suicide Assessment: A systematic evaluation of risk factors, warning signs, and lethality of a patient's suicidal ideation. Key assessments include presence of a plan, availability of means, prior attempts, hopelessness, substance use, social isolation, and recent losses. Direct questioning about suicidal thoughts does not increase risk. Patients with a specific plan, available means, and intent are at highest risk.
Anxiety Levels: Four progressive levels of anxiety: mild (increased alertness, enhanced learning), moderate (narrowed perceptual field, selective attention), severe (greatly reduced perceptual field, difficulty problem-solving), and panic (distorted perception, loss of rational thought, possible dissociation). Nursing interventions are tailored to the level present.
Major Depressive Disorder: A mood disorder characterized by persistent sadness, loss of interest or pleasure (anhedonia), changes in appetite and sleep, fatigue, difficulty concentrating, feelings of worthlessness or guilt, and recurrent thoughts of death. Symptoms persist for at least 2 weeks and cause significant functional impairment. Treated with antidepressants, psychotherapy, and in severe cases, electroconvulsive therapy (ECT).
Bipolar Disorder: A mood disorder characterized by episodes of mania (or hypomania) alternating with episodes of depression. Manic episodes feature elevated or irritable mood, grandiosity, decreased sleep need, pressured speech, racing thoughts, distractibility, and impulsive behavior. Lithium is the gold-standard mood stabilizer; therapeutic serum level is 0.6-1.2 mEq/L.
Schizophrenia: A chronic psychiatric disorder characterized by positive symptoms (hallucinations, delusions, disorganized speech and behavior) and negative symptoms (flat affect, alogia, avolition, anhedonia, social withdrawal). Onset typically occurs in late adolescence to early adulthood. Treated with antipsychotic medications. Second-generation (atypical) antipsychotics are generally first-line.
Hallucinations: Sensory perceptions that occur without external stimuli. Types include auditory (most common in schizophrenia), visual (common in delirium and substance withdrawal), tactile, olfactory, and gustatory. Nursing interventions include reality orientation, presenting reality without arguing, ensuring safety, and administering prescribed antipsychotic medications.
Delusions: Fixed, false beliefs that are not consistent with cultural or religious norms and persist despite contradictory evidence. Types include persecutory (being targeted or harmed), grandiose (inflated self-importance), referential (events directed at oneself), somatic (body dysfunction), and erotomanic (another person is in love with the patient). Nurses should not argue with or reinforce delusions.
Electroconvulsive Therapy (ECT): A procedure in which electric currents are passed through the brain to induce brief, controlled seizures, used primarily for treatment-resistant depression, acute suicidality, and catatonia. Pre-procedure care includes NPO status and removal of dentures. Common side effects include short-term memory loss, confusion, headache, and muscle soreness. Consent is required.
Selective Serotonin Reuptake Inhibitors (SSRIs): A class of antidepressant medications that block the reuptake of serotonin in the synaptic cleft, increasing serotonin availability. Examples include fluoxetine, sertraline, paroxetine, citalopram, and escitalopram. Therapeutic effects may take 2-4 weeks. Side effects include sexual dysfunction, GI disturbance, and insomnia. Risk of serotonin syndrome with concurrent serotonergic agents.
Serotonin Syndrome: A potentially life-threatening condition resulting from excessive serotonergic activity, often caused by drug interactions (SSRIs with MAOIs, tramadol, or triptans). Symptoms include mental status changes (agitation, confusion), autonomic instability (hyperthermia, diaphoresis, tachycardia), and neuromuscular abnormalities (clonus, hyperreflexia, rigidity). Requires immediate discontinuation of offending agents.
Neuroleptic Malignant Syndrome (NMS): A rare, life-threatening reaction to antipsychotic medications characterized by high fever, severe muscle rigidity ("lead pipe"), altered mental status, autonomic dysfunction (tachycardia, labile blood pressure, diaphoresis), and elevated creatine kinase (CK). Requires immediate discontinuation of the antipsychotic and supportive care. Dantrolene may be administered.
Tardive Dyskinesia: A potentially irreversible movement disorder caused by prolonged use of dopamine receptor-blocking agents (typical antipsychotics). Characterized by involuntary, repetitive movements, especially of the face, tongue, and jaw (lip smacking, tongue protrusion, grimacing). Monitored using the Abnormal Involuntary Movement Scale (AIMS). Prevention includes using the lowest effective dose.
Cognitive Behavioral Therapy (CBT): A structured, time-limited psychotherapeutic approach that focuses on identifying and modifying distorted thought patterns and maladaptive behaviors. Based on the premise that thoughts influence emotions and behaviors. Effective for depression, anxiety disorders, PTSD, OCD, eating disorders, and substance use disorders.
Post-Traumatic Stress Disorder (PTSD): A psychiatric disorder that develops after exposure to a traumatic event. Characterized by intrusive re-experiencing (flashbacks, nightmares), avoidance of trauma-related stimuli, negative alterations in cognition and mood, and hyperarousal (exaggerated startle response, hypervigilance, insomnia). Symptoms persist for more than one month. Treatment includes trauma-focused CBT and EMDR.
Eating Disorders: Psychiatric conditions characterized by persistent disturbances in eating behavior. Anorexia nervosa involves restriction of intake leading to significantly low body weight with intense fear of gaining weight. Bulimia nervosa involves recurrent binge eating followed by compensatory behaviors (purging, fasting, excessive exercise). Medical complications include electrolyte imbalances, cardiac arrhythmias, and esophageal tears.
Autism Spectrum Disorder (ASD): A neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, along with restricted and repetitive patterns of behavior, interests, or activities. Symptoms present in early childhood and range from mild to severe. Early intervention, behavioral therapy, and structured environments improve outcomes.
Attention-Deficit/Hyperactivity Disorder (ADHD): A neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning and development. Treatment includes behavioral interventions, parent education, and stimulant medications (methylphenidate, amphetamine salts). Monitor for decreased appetite, insomnia, and growth suppression with stimulant use.
Abuse Assessment: A systematic evaluation for signs of physical, emotional, sexual, or financial abuse or neglect. Key indicators include unexplained injuries in various stages of healing, inconsistent explanations, withdrawal, fearfulness around certain individuals, and delay in seeking treatment. Nurses are mandatory reporters and must document findings objectively using the patient's own words when possible.
Cultural Competence: The ability of healthcare providers to understand and effectively interact with patients from diverse cultural backgrounds. Involves cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. Nurses must assess and respect patients' cultural beliefs, values, and practices regarding health, illness, and treatment.