Chapter 9- Mental health

Question 1

Mental Health is defined as

Answer 1

State of well-being in which the individual realizes their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community

Question 2

What is the role of the nurse in mental health?

Answer 2

• Assessment of mental health consists of screening for preexisting/current mental health conditions for all age groups.
• The mental health assessment is based on observation of the patient/patient’s responses to your questions.
• Data inferred from answers to questions and behaviors.
• Must determine whether there is a need to investigate an area in more depth during general assessment

Question 3

In what groups are higher incidences of substance abuse, depression, anxiety and suicide?

Answer 3

• Lesbian, gay, bisexual, and transgender (LGBT)
• The chronic stress of secrecy of identity and increased incidence of violence related to LGBT gender identity may be contributing factors

Question 4

1/3 of the women in the world are victims of _____________.

Answer 4

violence

Question 5

What is deems a violent situation as “family violence”?

Answer 5

• If the victim is biologically related to the offender or is (or was) related to him or her through marriage, adoption, or legal guardianship.

Question 6

What is intimate partner violence?

Answer 6

• Behaviors between spouses or nonmarital partners involving threatened or actual physical or sexual violence, psychological/emotional abuse, and/or coercive tactics when prior physical or sexual violence took place.
• Nonmarital partners include those in adolescent and adult dating relationships and in long-term, committed, and intimate heterosexual or homosexual relationships.

Question 7

The poorer the household, the higher the rate of _________.

Answer 7

• Domestic violence

Question 8

Why is it more dangerous for U.S. immigrants to be victims of violence?

Answer 8

• U.S. immigrants who attempt to escape IPV may not have access to bilingual safety shelters, financial assistance, food, or other support services.
• Also unlikely to have assistance from certified interpreters during court proceedings, when reporting complaints to police, or even when acquiring information about their rights and the legal system. - Also perpetrators of IPV may use their partners’ immigration status as a tool of control and force women to remain in the relationship, making it difficult for victims to escape the violence.

Question 9

Why is IPV a serious and widespread problem?

Answer 9

• Of women abused during pregnancy, more than half also experienced IPV before pregnancy.
• An assessment for violence in the prenatal, intrapartum, and postpartum periods is essential in high-risk groups

Question 10

What is sexual violence and what situations does it include?

Answer 10

• Sexual violence includes forced sex in dating and marital relationships, gang rape, sexual harassment, inappropriate touching, molestation, sex with a patient, forced prostitution, and forced exposure to sexually explicit behavior.

Question 11

What minority groups are at high risk of domestic violence and rape?
What ages of women are most likely to experience rape/attempted rape?

Answer 11

• Young women, low-income women, and some minorities
• Women aged 20-24 are at greatest risk of domestic violence
• Women aged 24 and under suffer from the highest rates of rape.
• One in five women will experience rape/attempted rape during their college years, and less than 5% of these rapes will be reported

Question 12

What is most likely to cause sex trafficking?

Answer 12

• Misleading or false advertising (e.g., offers of good wages and “legitimate” work abroad), sexual exploitation, forced marriage, and cheap labor for domestic or commercial purposes.

Question 13

hate crimes

Answer 13

perpetrator chooses a victim because of a characteristic, provides evidence that hate motivated the crime
-race, ethnicity, religion, gender, sexuality

Question 14

War-related violence

Answer 14

War-related fighting can involve:
-witnessing killing intentionally killing, injuring other humans, being intentionally injured, potentially killed
Victims: veterans, families or veterans, refugees
-higher rates of IPV perpetration, veterans with PTSD R/T combat exposure

Question 15

Drug and alcohol addiction

Answer 15

common substances
-alscohol and drug abuse cross boundaries of age, gender, and race

Question 16

Patient interviews

Answer 16

-Paramount: patient physical, emotional safety
-Completed in private: pt data is confidential
-Listen>Talk (80% pt and 20% nurse)
-generalized strategies
-preface sensitive questions to prepare its
Assess daily routine
-inculde questions about adverse childhood, family events

Question 17

Urgent assessment

Answer 17

Questions: violence, harm to self/ others
Situation includes risk for injury due to:
-psychotic states, depression
-dementia, delirium (they interfere with reliability)
Ask Safety questions FIRST; leaving presenting situation for last
-prevents forgetting to ask about safety
-allows more time to focus on presenting situation (may run out of time)

Question 18

Urgent assessment includes

Answer 18

INCLUDES:
-statements to the nurse
-over-heard patient reporting (to someone else)
-family and friends report, validation of patient’s data
Ask open ended questions
Assessment: art as well as a science
-assimilating verbal and nonverbal data
Establish RAPPOR FIRST
Be aware: patient divergent strategies; motivation for tactics
BE SURE TO REASSURE THAT YOU ASK EVERYONE THESE QUESTIONs

Question 19

3 types of risk factors

Answer 19

1. unchangeable factors
2. environmental (changeable) factors
3. metabolic issues/ associated physiological processes

Question 20

unchangeable factors

Answer 20

family history, age, gender

Question 21

environmental (changeable) factors:

Answer 21

support systems, housing, health care accessibility, literacy

Question 22

metabolic issues/associated physiological processes

Answer 22

parkinson disease, cancer, HIV/AIDS, other chronic conditions

Question 23

History and Risk Factors

Answer 23

-personal history: violence, alcohol, and drug use
-Psychosocial history: support network, substance used, spirituality
-Medications
-family history: their alcohol, drug, etc use

Question 24

Important patient education topics

Answer 24

-alterations in interest: life, motivation, energy, sleep, appetite, sexual behavior
-current stressors: coping, violence
-physical, sexual abuse, altered mood, affect
-pervasive worry, anxiety, substance use
-changes behavior, self-harm, suicidal thoughts
-Memory, concentration, problem-solving abilities
Health People: health promotion goals (such as decrease bullying and violence)

Question 25

common symptoms of altered mental health

Answer 25

Suicide ideation (thought or plan)
Homicide ideation and aggressive behavior
Altered mood and affect
Auditory hallucinations
Visual hallucinations

Question 26

GERIATRIC DEPRESSION SCALE

Answer 26

-score of 5-10 suggests depression
-score of >10 almost always indicated depression

Question 26

Cultural considerations

Answer 26

Using an interpreter for a pt with a mental health condition
-interpreter signs HIPAA/Confidentiality agreement
-discusses communication with appropriate health care providers only
-interpreter cannot divulge any info to pt family members or friends
-post interview: may ask interpreter regarding cultural beliefs which could impact treatment
-include interpreters name in Documentation

Question 27

Lifespan Considerations: Older Adults

Answer 27

Risk factors to assess:
-Female gender
-african american or hispanic (greater risk)
-social isolation, widowed, divorced, separated
-lower socioeconomic status, insomnia
-comorbid medical conditions, uncontrolled pain
-functional or cognitive impairment

Question 28

The CAGE tool is used to asses _______ abuse risk.

Answer 28

Alcohol abuse. Cut down, Annoyed, Guilty, and Eye-opener.

Question 28

What method(s) are used when collecting objective data for the the mental health assessment?

Answer 28

• ABCT
• A (appearance), B (behavior), C (cognitive function), and T (thought process)
• Plus the Mini-Mental State Examination (MMSE); a scoring tactic that is based on memorization

Question 29

delirium

Answer 29

generally has an underlying medical cause
-resolves after treatment of cause

Question 29

Critical thinking

Answer 29

Nursing diagnosis
Patient Outcomes: patient does not harm self, demonstrated appropriate social interaction, identifies personal strengths
Nursing interventions (partial list)
-assess for risk of harm to self, others
-provide safe environment by removing items which may cause harm
-identify support systems, involve them in care

Question 30

dementia

Answer 30

more common in older adults
-gradual process (years to months)
CLUES:
-seems disoriented, “poor historian”
-defers to family to answer questions
-repeatedly, unintentionally, fails to follow instructions
-word usage difficulties
-difficulty following conversations

Question 30

Mandated reporting

Answer 30

when child, elder, vulnerable-adult abuse or neglect is disclosed, assessed, or suspected
-must be done by nurses and other health care professional
Must call protective services hotline
Mandatory reporter is protected by the state: is report is made in good faith, without malice
Document call to protective services hotline: reason for call, time, Full name of who took call, response of call taker

Question 30

What conditions should the nurse look for that would indicate chronic alcohol and drug abuse?

Answer 30

-Poor balance and coordination, involuntary or abnormal eye movements and twitches, poor reflexes, changes in heart rate, muscle weakness, difficulty walking, confusion, and cognitive-processing difficulties.

Question 31

What is the objective data portion of the mental status examination?

Answer 31

• The nurse collects objective data by observing the patient’s behavior, how the patient communicates and responds to questions, and physical presentation.
• A patient’s physical presentation may be the first indication of toxicity, underlying medical problems, or psychosis.

Question 32

What mental health disorders are linked to drug and alcohol abuse?

Answer 32

Personality disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social phobias, specific phobias, major depression, manic depression, and schizophrenia.