Ch 9: Mental health, violence, drug abuse Flashcards
What is not uncommon for people with mental health and how do they cope
It’s not uncommon for a person with mental health to not realize that they’ve had a problem for such a long time
The people tend to self medicate with alcohol and substances to cope
What is the world health organizations definition of mental health
Mental health is a state of wellness, realization of own abilities to go with stressors of life and how they contribute to the community
What is the relationship between Culture and health/ mental wellness (determines what)
What keeps many people from being treated for mental health
Culture determines the acceptable behaviors to mental health issues
Many people because of the negative stigma in terms associate with mental health do not seek treatment
What are common mental health disorders
4
- Depression
- schizophrenia
- PTSD
- substance abuse
When do you notice mental health issues when speaking to patients and what is vital to do after you notice the health issues
When doing the general survey (Hx) this is where you notice mental health issues
Once you determine a mental health issue you now need to guide your assessment and screen for the mental health
Give two mental health screening considerations
(especially for women) 
 why are these two considerations so important
- Culture/country
- Violence screening
-these two considerations determine for the patient what is acceptable cultural behavior

What is a Vital teaching two women about acceptable cultural behavior and how it relates to the United States
We must teach female patients that it is not acceptable in the US to have violence against women and the men can go to jail
When asking the patient questions what is a big red flag Upon their answers
After asking questions if patients are leaving information out or giving you different stories it’s a big red flag
What are vital components to the mental health assessment
(Bare components)
What do you want to do in response to patient behavior and answers
Mental health assessment components: -all questions -all responses and behaviors by patient   read patient behaviors and look into answers
What are signs when assessing for violence from a patient or family member that indicate anger
(give mnemonic)
What is your job when a patient or family member begins to become angry And what do you do if you cannot control the patient
Violence in patient/family members,
Assess with:
S-taring Tone: loud Anxious Mumbling (due to anger) P-acing \+ pounding
- When patient Or family becomes angry try to de-escalate the situation
- If you cannot de-escalate the situation get out and get help
What are dos and don’ts with an angry patient
Do: State the patient’s name
Don’t: raise voice or become defensive
 when are you most likely to notice types of violence or abuse as a nurse in a hospital setting
What is the issue with human violence in women

During labor and delivery it’s most common to see violence or abuse
Human violence and women often goes unreported due to fear
What are signs of an abusive husband or partner in labor and delivery
What is vital for you to do in efforts to ask the patient if they are being abused
What do you do if your highly suspicious of abuse
- The husband tries to control the entire conversation with the wife and nurse
- does not let the wife answer
- does not leave the wife’s side
- often the abusee Will not look up and make Eyecontact
It’s vital to get the husband out of the room to ask the patient if they are being abused
-if highly suspicious of abuse you MUST Report

What are three ways to get an abusive husband out of the room to ask the patient if they are in danger or being abused
Ways to get a piece of has been out of room:
• tell husband to get wife some thing
• say you’ll be performing an assessment
• “take a break”

Why does child maltreatment occur
Why does sibling violence occur
- what is the effect on the abusee
- what must parents do
Give an example of intimate partner violence (IVP)
-what is the type of abuse in IVP
Child maltreatment :occurs because of
Low parent impulse control
-parents first reaction is to hit don’t even think about it
Sibling violence: occurs because abuse is often not taken seriously by parent
- effects of abuse will be traumatic on abusee
- parents need to pay attention especially to rivalry, roughhousing, competition
Intimate partner violence (IVP): L & D couple with husband being abuser -other than physical, threats or coercion Are taken on by abuser  
What is the percentage of women who report rape, assault or stalking to be from who
2/3 A woman who report rape, salt, stocking or victimized by current or former partner’s
Give an example of Intimate partner violence (IVP) Within immigrants/refugees.
What are tactics used by abuser with immigrant and what does it result in for the immigrant
 IVP among immigrants/refugees:
-wife may be illegal and husband has total control
Abusive Husband may:
• threatened deportation
• threaten to leave patient with nothing (food, money, shelter ) 
-The abuse results in immigrant feeling trapped
Give types of elder abuse
Give elder abuse patterns
(presentations on older person) 
What type of older presentation do you specially look for abuse in
Elder abuse types:
-physical, neglect, financial exploitation, abandonment
Elder abuse patterns
- Kicking
- punching
- slapping
- burning
- locking in room
Especially if an elder looks cachexic evaluate for abuse
What is the most common elder abuse
How does This abuse occur
Malnutrition is the most common elder abuse
Malnutrition occurs by:
- taking money
- not Bryan groceries
- no one to care or cook for patient
What gender is at a greater risk of abuse in the collect
Older women or a greater risk for abuse and collect V older men
 what are the two types of violence against adults with disabilities
(cognitive issues)
Give an example of #2
- Intentional
- means to harm and hurt the patient - Unintentional
-caregiver burnout
: caregiver becomes burned out of having to do total care and takes it out on the patient
I.e: daughter burn out on mom
What is your action if you notice unintentional abuse of elder and describe it
If you notice an intentional abusive elder give caregiver:
RESPITE CARE:
-placing love one in a long-term care facility for about a week until the caregiver gets rest and recovers
What do you do if the patient needs exceeds the caregivers ability
If patient needs exceed caregiver ability:
- give caregiver help
- help put patient in long-term care facility
Why is sexual assault exceptionally high in women with developmental disabilities
Women with developmental disabilities are easy perpetrator victims and end up pregnant but don’t remember how
Must report!!!
What are common youth in school violence Actions among children
What is vital to teach kids about youth in school violence
Hitting
humiliating
bullying/cyber
If children witness bullying/school violence teach to report
When doing a cultural assessment on a patient what is vital to remember regarding sexual violence (marital rape) especially if they are not of your culture
What do you want to teach patient who suffer from marital rape when coming to the US
When doing cultural assessment on others who are not of the same culture:
Remember marital rape is not a crime in all countries
It’s vital to teach patients that it is not acceptable in the US and is a crime
 How do abusers get children to commit sexual acts
Abusers likely course children by threatening child into completing sexual act
What is the most common emotional response in sexual assault victims
The most common emotional response in victims of sexual assault is guilt
-victim will blame themselves
If no treatment what will the victims of sexual abuse become
If not treatment children who have been sexually abused will often become sex offenders
What are the domains of hate crimes and why are they done
Domains of hate crimes include:
- race
- ethnicity
- gender
- sexuality
- religion
Hate crimes are done out of hate towards domains

 when should human trafficking be assessed
What are ways of human trafficking
Human trafficking should be assessed if family dynamic does not appear normal
Human trafficking businesses:
- recruitment
- Sex trade/ sexual exploitation
- forced marriage
- cheap labor
Give the definition of human trafficking
Human trafficking: recruitment, transportation, transfer, harboring or recipient of people through threats, force, coercion
What is another common name for war related violence
Why does war related violence occur
What is vital to do when assessing someone with war related violence
War related violence equals PTSD  PTSD occurs because: -witnessing/intentionally killing - injuring others being injured -potentially killed
What assessing someone with PTSD it is vital to find triggers
What are signs and symptoms of PTSD
S&S of PTSD:
-nightmares
-feeling of guilt
-Poor concentration
-reliving event
• especially with war movies! What Is the highest concern/aspect(Paramount) to assess in human violence victims
What does Trust and rapport allow within patients and nurses
In human violence victims physical and emotional safety is key to assess
Trust and rapport allows:
Talking, trust, sharing
 what must a nurse establish within patients to get them to communicate 
Patients must established trust and rapport with nurse to communicate effectively
When conducting patient interviews/mental health assessments
-how must they be completed
-what is the talk to listen ratio
what do you use this time for?
-how do you prepare a patient for questions
When doing interviews/mental health assessments:
-interview must be done private and patient data must be confidential
-you should listen more than talking
80% pt/20% nurse
Used time to gather information and reppatient
-prepare patient by prefacing sense of questions saying
“ i’m going to be asking some very close and personal questions”
During urgent assessments for mental health, violence, drug abuse what are the most important questions to ask
If a patient is suicidal what should be your next follow-up question
When hearing suicide plan what do you want to assess for
If patient is suicidal next follow up question is
“ do you have a suicide plan”
After hearing plan assess for means to do it
Urgent assessment:
What are signs of depression in the patient
What will a patient in a psychotic state Believe and do
Signs of depression:
- Poor eye contacts
- poor grooming
- slumped
Patients in psychotic states will believe they are being threatened and will attack
Give characteristics of dementia with in patients
Dementia
- gradual mental status change
- disoriented X2
- Irreversible
- Common confabulation
- patient cannot remember so they will make things up
Eventually leads to Alzheimer’s
What is common among your Alzheimer’s and dementia patients at the end of the day
Define sundowner syndrome
How will patient present With sundowners syndrome
At the end of the day sundowners syndrome occurs between your Alzheimer’s and dementia patients
Sundowner syndrome is a natural late day confusion and fatigue due to low light causing an imbalance
Patient will be:
Confused/agitated late in day
Give characteristics of delirium
What can Delirium be caused by + What does it lead to(how does a Present)
Delirium:
-sudden in onset
-disoriented X3
-reversible
Delirium causes include: -alcohol withdrawal  Leads to disorganized thoughts and increased risk of injury 
What statements do you subjective data include
3 things
 subjective data include
- statements to the nurse
- overheard patient reporting(to someone else)
-  family and friends reporting
What kind of questions do you wanna ask A patient during the mental health and violence assessment
How is the mental health and violence assessment in art and a science
 you want to ask patient open ended questions during mental health assessment
Mental health assessment is an art: -
-communicating and assessing patient accurately
Science:
-Accurate knowledge base of patient to screen in mental health
What must you have in relation to the questions being asked
You must have the ability to listen and be comfortable with questions being asked related to psychosis, suicide, plan any form of abuse
What are non-verbal actions you want to do when obtaining objective data for the mental Health assessment/violence
When obtaining objective data, follow
SOLER
S-it at eye level O-pen inviting demeanor L-ean forward to show interest E: ye contact the patients level R: relaxed position (do not cross arms)
In patients with mental health issues what do you want to be aware of In regards to getting subjective data  and what are strategies used
patients with mental health may use diversion strategies such as
• asking personal questions
• insulting nurse to stop questioning
-Do not take personal but address the issue
• drift off
What behavior will patients with psychotic disorders display

In a patient with a psychotic disorder what do you never want to do and why
Patients With psychotic disorders me laugh in appropriately or answer unlogically
Never laugh around a patient with a psychotic disorder as they may think you were laughing at them
What age population is most likely to be depressed
What do support systems in patients with mental health resultant
Your older population is most likely to have depression
In those with mental health who have support systems, they have better outcomes and decrease cases of depression
In assessment of risk factors what are
unchangeable factors
Environmental (changeable factors)
Metabolic issues/associated
physiological processes
Unchangeable: mental health family history, age, gender
Environmental (changeable factors)
- any changes in support system
- coping skills
- does patient have family involvement?
Metabolic issues (May cause mental H issues)  -Parkinson’s cancer HIV/AIDS 
If a woman presents with postpartum depression what do you want to ask her
In a woman with postpartum depression ask if she wants to harm self for a child
When assessing violence, alcohol, drug use:
How do you assess alcohol use
What can a patient say that raises a red flag for suicide
With drug use what do you want to assess for
Asses alcoholic use with CAGE
C-ut down drinking
A-nnoyance With drinking criticism
G-Guilty
E-Eye-opener
•1st drink is alcoholic drink
If a patient says they have no sense of hope it is a red flag for suicide
For drug use assessed for mixing of trucks causing interactions
Spiritually what do you want to assess for that will benefit the patient
Spiritually, assess for rituals that will help patient cope
When educating on violence what do you want to give the patient information on
When educating on violence once separating from abuser give information on shelters
Give the most common symptoms for altered mental status
Auditory, visual, olfactory, tactile hallucinations
Suicide ideation
-assess plan
homicide ideation/aggressive behavior
-Self mutilation what is causing this pain
Alter mood and affect
If a patient is experiencing auditory hallucinations what do you want to ask the patient
What is pertinent to AVOID for patients undergoing auditory hallucinations
If Patient experiencing auditory hallucinations ask
“ what are the voices telling”
NEVER!!! Say the name of the voice because it makes it real for the patient
Describe olfactory hallucinations
describe tactile hallucinations
Olfactory hallucinations: patient can smell fire even if it’s not there
Tactile hallucinations: unusual sensations
What is the lifespan consideration when you’re pregnant women in relation to psychiatric disorders
Pregnant women me relapse in psychiatric disorders because of hormones
How is being African-American/Hispanic a risk factor
-What are signs and symptoms
How does being of a lower socioeconomic status develop into a risk factor
African-Americans/Hispanics because of stigma with culture risk of not recognizing depression
S&S:
-Poor cognition
-decrease sleep/initiative

Lower socioeconomic status is do not have the money to seek help
When do you use the geriatric Depression scale and what is the points game
Geriatric depression scale use in your geriatric if suspected depression.
Score breakdown:
5: suggestive of depression
- needs further evaluation
10: indicative of depression
What is a suicide risk assessment commonly used
What is the point system
SAD PERSONAS Is a commonly used suicide risk assessment
Scoring: One point per category the higher the score the higher the risk of suicide
what kind of care is cultural care
When using an interpreter for patient Mental health assessment what do you want to ask
what can the interpreter not do
Cultural care equals holistic care
When using an interpreter ask them:
- did the patient make sense
- did they voice any practices or beliefs
- was the conversation flowing
Patient cannot give any information on the interview to family members or friends bound by confidentiality and patient knows
How do you document an interview using interpreter
When using an interpreter document intro his name plus what interpreter has said
Within different cultures and religions what are some acceptable practices
what is the percentage of the population that does not seek traditional care and why
Acceptable practices:
- Witchcraft
- voodoo
- homeopathic
- Christian science
About 1/3 of the population does not situational care because of its access, cost, poverty, language, no insurance
When doing comprehensive assessment what is objective data you want to obtain
Objective data do you want to team includes:
- observing the patient and the patient’s behavior
What may physical presentation be useful for
How is physical assessment assessed
Physical presentation may be the first indication of a mental health/violence issue
Physical assessment used based on ABCT
Describe your ABCT for physical assessment
A-ppearance
-Overall appearance, posture, hygiene, dress
B-ehavior
-LOC, eye Contact, speech
C-ognative function
-assess orientation, attention, memory
• ask patients to add or subtract
• ask patient do you have somewhere to stay
• ask patients if they can solve problems
 T- hought process and Perceptions -A&O x 3 -paying attention? -Following conversation
Give another name for MMSE.
Describe the mini mental state examination (MMSE)
Describe the MMSE scoring system
MMSE =Mini cog
Techniche:
- List 3 unrelated words
- Have patient draw a clock face and the time on the clock
- Repeat the beginning three words
Scores:
• no words: demented
• recall all: not demented
What are violence victims symptoms noticed during assessment
Easily triggered
isolation/ social withdrawal
shutting down feelings (numbing) spacing out
 what are major signs of abuse in children elders and women you want to note
- injury not consistent with story
- Sexual activity younger than 14
- Failure to seek timely medical care
- Multiple hospital visits and fractures + bruises in different healing stages
- Burn configurations (cigarettes)

in an abusee What nonverbal cues will alert you to abuse
If the patient opens up about being abused how must you document
Eye scanning
being very jumpy/clingy
guilt
If the patient tells you they are being abused document verbatim and a detailed and descriptive manner
Who are mandated reporters and what is the report made in
What are the two people you report to
Nurses/healthcare workers are mandated reporters
-Reports are made in good faith without malice
Report to:
-charge nurse
-CPS
When you call to report abuse to CPS what are the four things you must document about the call
- Reason for call
- Time of call
- Full name of who took the call
- Response of call taker (timeframe) 
For people with dementia who do you have to defer personal questions
How well does someone with dementia follow instructions
what does a conversation of someone with dementia look like

In a patient with dementia refer personal questions to family members as patient is poor historian
Those with dementia unintentionally fail to follow directions
Those are dementia have difficulty following conversations
Give nursing diagnosis related to mental health, violence, drug abuse
Risk for suicide
Altered mental status
Give nursing outcomes related to mental health, violence, drug abuse
Patient does not harm self
Demonstrate social interaction
Identifies personal strengths
Give nursing interventions related to the mental health, violence, drug abuse assessment
Assess for risk of harm to self, others
Provide safe environment by removing items that may cause harm
Identify support systems, involve them in care
