Mental health Flashcards
1
Q
what kind of info is gained from a MSE & what sources
A
formal & informal interview, & Observation. Both objective & subjective data.
2
Q
What are the MSE Content areas
A
Appearance attitude/behaviour mood affect speech thought content thought process/form perception cognition insight & Judgement Socialization & interpersonal relationships
3
Q
Which parts of the MSE are observed
A
Appearance, attitude/behaviour, Mood ( mostly inquired but a little bit observed), Affect, speech, thought content, thought process& form, perception (if a pt. is reacting to hallucinations), insight/judgement, socialization & interpersonal relationships
4
Q
which parts of MSE can be inquired
A
mood, thought content, thought process, thought form, perception, cognition, insight & judgement, socialization & interpersonal relationships
5
Q
Adolescent MSE considerations
A
increased risk taking & abstract thought. Higher risk of intentional harm/ homicide. Half of diagnosable mental illness begin by age 14.
6
Q
who has higher risk of mental health problems (youth)
A
1) Aboriginal
2) Immigrant
3) Homeless
4) Sexual minority
7
Q
Mental health considerations for adult hood
A
- social isolation
- Dept incurred from education
- Vulnerable to distraction
- confidence & adaptability
- “caught in the middle feeling”
- work desmands
- biological changes (menopause, etc)
8
Q
Mental health considerations for older adult
A
- aging leaves mental health intact but things slow down
- loss of loved ones
- decrease in income
- changes in daily routines with retirement or loss
9
Q
What kind of questioning for Suicide Risk management assessment
A
1) Their intent
2) do they have a plan?
3) Do they have access to the means?
4) How lethal is the means?
5) Have the rehearsed it
10
Q
What is a part of ISPATHWARM
A
I= Ideation S= Substance issues P= Purposelessness A= Anxiety T= Trapped H= Hopelessness W= Withdrawl A= Anger R= Recklessnesss M= Mood changes
11
Q
What is suicidal ideation
A
- *ACUTE RISK**
1) Threaten to hurt or kill themselves or talking of wanting to kill themselves
2) Looking for ways to kill themselves by seeking access to firearms, pills or other means
3) Talking or writing about death, dying or suicide, when these actions are out of the ordinary
12
Q
What would indicate substance misuses
A
- excessively using alcohol or drugs
- or recently began using alcohol/drugs
13
Q
What would indicate purposelessness
A
- no reason for living
- no sense in purpose
- lost
14
Q
what would indication anxiety
A
- anxious
- aggitated
- unable to sleep or relax
- to much sleep
15
Q
What would indicate anger
A
- Rage
- uncontrolled anger
- Seeking revenge
16
Q
What would indicate feeling trapped
A
feeling like there’s no way out of current situation
- death may be preferable option to a pained life
- no other choices left
17
Q
what would indicate hopelessness
A
- negative sense of self, others or the future
- little chance for positive change in the future
18
Q
what would indicate withdrawal
A
- friends, fam, SO, society
- have they already begun? do they want to?
19
Q
what would indicate recklessness
A
- risky behaviour
- seemingly without thinking
- don’t think about consequences
20
Q
2 other considerations of ISPATHWARM
A
1) Crisis situations
(loss of relationship, housing, job, rejection, finance, bad news)
2) Change in behaviour &/or speech
(Reduced self care, unusual thoughts, no responding to phone class, messages, avoiding friends, not fulfilling responsibilities, giving away prized belonging)
21
Q
What is the SADPERSONS SCALE
A
S= Sex (Male)
A= Age 15-25 or 59+
D= Depression
P= Previous suicide attempt or psychiatric care
E= Ethanol abuse or drug (alcohol)
R=Rational thinking loss (psychotic or organic illness)
S=Social support lacking (single, widowed or divorced)
O= organized plan or serious attempt
N= no spouse/ social support
S= sickness (Chronic, debilitating disease) or stated future attempt
***ALL OF THESE THINGS PUT U AT RISK +1 FOR EACH ONE THAT APPLIES
22
Q
Explain sadpersons scoring
A
0-5 may be safe to discharge
6-8 needs psychiatric consultation
>8 hospital admission
(its out of 10)
23
Q
How long is the first stage of alcohol withdrawal
A
8 hr
24
Q
how long is the second stage of alcohol withdrawal
A
1-3 days
25
how long is the 3rd stage of alcohol withdrawal
weeks
26
what are the symptoms of the 1st stage of alcohol withdrawal
Anxiety, Insomnia, Nausea, & abdominal pain
27
what are the primary symptoms of the 2nd stage of alcohol withdrawal
High blood pressure, increased body temperature
28
what are the symptoms of the 3rd stage of alcohol withdrawal
hallucinations, fever, seizures, agitation
29
What is a comprehensive mental health assessment
- Complete health history & physical exam
- Psychological, Emotional, Social, Spiritual, ethnic & cultural dimensions of health
- Attends to health-illness experience
- focused on understanding the clients lived experience
- holistic
- baseline
- info from: Pt, Fam, HC providers, social services, educators, employers, records
- MAY TAKE DAYS OR WEEKS TO COMPLET
30
what is a focused mental health assessment
- specific info about a specific need, situation, or problem
- used in emergencies
- Evaluation of: medication effects, risk for self-harm/suicide, knowledge deficits, adequate support
- screen who are at high risk for particular problems
- may use specific tests: Glasgow coma scale, mini-mental health status, hamilton rating scale for depression
- FOR THE IMMEDIATE NEED OF THE PT. & SETTING
31
Factors the facilitate effective interviewing
1) Negotiate the terms of the interview with participants
2) The environment
3) Realistic time management
4) Attentive to your own nonverbal comm.
5) Avoid jargon
6) begin with a less sensitive topic & move toward sensitive issues as a rapport develops
7) Leave time at the end fo closure & future planning
32
Bio aspect of bio/psycho/social/spiritual/psychiatric mental health nursing assessment
1) Health status
2) Physical exam
3) Physical function
4) pharmacological
33
Psychological aspect of the bio/psycho/social/spiritual/psychiatric mental health nursing assessment
1) Responses to mental health problems
2) Mental status
3) Behaviour
4) Self-concept
5) Stress & coping
6) Risk assessment
34
Stress & coping patterns
- Everyone lives with some degree of stress
- For vulnerable individuals it may contribute to the development of mental health disorders
1) identify major stressors
2) Identify current stressors & coping strategies & evaluate the effectiveness
3) Highlight both problem areas & resources
35
Developmental considerations for mental health
1) Achievement of important developmental milestones or social & education difficulties may be indication of attentional or interpersonal deficits, behavioural problems, a chaotic family environment, brain injury or childhood mental problems)
2) Parental death or separation (may be associated with alterations in attachment * later relationship difficulties)
36
Briefly explain the components of a mental status exam
1) General observations (Appearance, Psychomotor behaviour, attitude toward interviewer)
2) Mood
3) Affect
4) Speech
5) Perception
6) Thought (content, process, form)
7) Sensorium (lvl of consciousness, orientation to person, place & time, Memory)
* Memory (immediate retention & recall, recent, short term, long term)
8) Insight
9) Judgement
37
What should be included in a general observation of appearance
1) Manner & appropriateness of dress
2) personal hygiene
3) Odours
4) Pupil size
5) Identifying characteristics (tattoos, piercings)
6) Skin ton
7) Nutrition status
8) Energy level
38
What should a general observation of Psychomotor behaviour include
1) Posture
2) Gait
3) Motor coordination
4) Facial expression
5) Mannerisms
6) Gestures
7) Activity
8) Clues to emotional state: Muscle tension, purposeless repetitive motion & restlessness
39
What should a general observation of attitude toward interviewer include
1) Accommodating
2) Cooperative
3) Open
4) Friendly
5) Apathetic
6) Bored
7) Guarded
8) Suspicious
9) Hostile
10) Evasive
40
What is mood
- A pervasive & sustained emotion & what the CLIENT REPORTS about his or her prevailing emotional state.
- tends to be stable over time & reflects the person disposition or world view
- "How have you been feeling over the last little while?"
- Euthymic, Euphoric, Dysphoric
41
what is Euthymic mood
normal
42
What is affect
- Immediately express or observed emotion that is INFERRED BY THE EXAMINER BY FACIAL EXPRESSION,VOCALIZATION & BEHAVIOUR.
- May change during the assessment
- Described by range, Appropriateness & stability
43
what is Affect range
Quantifies an affective response
| -Full, constricted, intensity, blunt, flattened
44
what is affect appropriateness
incongruent, or congruent to context
45
what is affect stability
mobile (normal to have changes) or labile (exaggerated changes)
46
What is Speech
- Provides clues about the client's thoughts, emotion & cognitive processes
- Conveys info about the clients understanding of the situation & ability to respond to social cues
- Described in terms of Quantity, Rate, Fluency of productions, & quality
- note speech impediments, response to latency, repetition, rhyming, or usual use of words
47
What is speech quality
Talkative, Verbose, Expansive or having paucity or poverty of speech
48
what is speech rate
slow, hesitant, fast or pressured (mania)
49
what is fluency of productions in terms of speech
aphasic ( impaired language due to neurological, cognitive or emotional origin)
50
what is quality of speech
Monotone, whispered, slurred, mumbled, staccato(broken) or loud
51
What is perception
- Complex series of mental events involved with taking in sensory info from the environment & processing of that info into mental representation
- includes hallucinations & illusions
52
what are hallucinations
false sensory perceptions that not associated with external stimuli & not shared by others
53
what are illusions
misperceptions or misrepresentations of real sensory stimuli (misidentifying the wind as a voice calling ones name or thinking that a label on clothes is an insect)
54
What is thought
Assessed through language in terms of its content and process/from
55
What is thought content
the subjective manner occupying a persons thoughts
| Delusions, paranoia, Phobia, reoccurring themes
56
what is thought process/form
Manner in which thoughts are formed & expressed (flight of ideas, thought blocking & word salad)
57
What Is level of consciousness
arousal or wakefulness.
If nonresponsive, apply increasing levels of stimulation to elicit a response (Verbal, Tactile, Painful)
-Glassgows coma scale
(Awake, alert, lethargic, somnolent, stuporous or comatose)
58
what is somnolent & stuporous
```
Somnolent = drowsy
Stuporous = slowed & sluggish
```
59
How should you ask questions about orientation
begin with specific questions about date, timer day, location & go more general if needed
60
Explain the 4 types of memory
1) Immediate retention & recall
- provide 3 unrelated words & ask client to repeat them immediately, 5 mins & 15 mins
2) Recent memory
- ask q about last few hr's or days
3) Short-term memory
- Ask question of the past weeks or months
4) Remote or long-term memory
- ask questions of events of years ago
61
How to ask about attention & concentration
ask the client to count backwards starting at 100 subtracting in increments of 7 or start at 20 and subtracting 3's
-spell simple word backwards
62
Explain comprehension & Abstract reasoning: Insight & judgement
involve the ability to examine ideas, conceptualize facts, solve problems & think abstractly
63
what is insight
describes a persons understanding of a set of circumstances & reflects awareness of his or her own thoughts & feelings and an ability to compare them with others
64
what is judgement
the ability to reach al logical decision about a situation & choose a reasonable course of action about examining & analyzing various possibilities.
provide a senario & ask best response
65
Assessing Risk, Protective & promotive factors
1) Risk factors - characteristics, conditions, situation & events that increase the individuals vulnerability to threats to safety/wellbeing
2) Protective Factors - attributes or conditions of individual or family that reduce, mitigate or eliminate risks
3) Promotive factors - conditions or attributes that actively enhances well being
* *TOGETHER THEY INCREASE THE PROBABILITY OF POSITIVE, ADAPTIVE & HEALTHY OUTCOMES
66
What should you know about assessing gender identity
- Gender exists on a continuum whose endpoints are anchored by man/male & female/woman
- Widespread discrimination & stigma leads to: *Disparities in health & disorders and risk behaviours * Negative social influence *poorer access to health care
67
Social assessment
1) family & relationship
2) Evaluation of functional status
3) information about the individuals ethnicity
68
Mental health increased risk
```
Low socioeconomic status
poor housing/living conditions
job stress
trauma or violence in family
parental mental illness
insecure attachement
malnutrition
low self esteem
psychoactive drug use
elder abuse
poverty
discrimination/bullying
bereavement
neightbourhood crime
poor civic amenities
```
69
What is addiction
Chronic, relapsing & treatable medical condition - Chronic disease
- LEAD PREVENTABLE DEATH, DISABILITY & DISEASE GLOBALLY
- Disease of the brain & not an expression of moral character
- can be neglected & under treated
70
What does CIWA-Ar stand for
Clinical institute withdrawal assessment of alcohol scale
71
How can addiction effect you
- negatively impact any or all body systems (disabling & irreversible)
- withdrawal symptoms can be life-threatening
72
when do withdrawal symptoms usually start
hours after last consumption
73
what are delirium tremors & when do they start
Can occur as early as 48 hours after last consumption & can involve profound confusion, autonomic hyperactivity (BP & HR) and seizures
74
Explain the opioid addiction
opioid prescribing in canada has lead to increase addiction & overdose
-Morphine, Codeine, oxycodone, methadone, fentanyl, tramadol & meperidine
75
What is the biologic theory of addition
Factor sushi as trauma, prenatal or postnatal stress, adverse childhood experience have to potential to change gene expression
76
what are the psychological theories of addiction
suggest that some individuals are born with certain temperaments & subsequently develop particular personality traits, vulnerabilities, or even personality disorder that make them more susceptible to addiction
77
what are the social theories of addiction
significant difference between countries and their prevalence of addition & accessibility. Culture is considered to effect addiction prevalence
78
What are the spiritual theories of addiction
Spirituality had a close relationship with the field of addiction treatment. Individuals who have recored from addiction often mention spiritual experiences or motivation as a major contributing factor to recovery
79
What is a delusion
3 essential qualities
1) Out of keeping with patients educational, cultural & social background
2) conviction & certainty
3) core feature of psychotic disorders
80
what is an obsession
an undesired, unpleasant, intrusive thought that cannot be suppressed through the patients volition. They are typically of violence, injury, dirt or sex or obsessive rumination on intellectual themes.
81
What is a mental health assessment assessing for
1) health status
2) Potential for wellness
3) health care deficits
4) risk to self & others
5) alterarations in thought, affect, behaviour
6) substance use
7) history of trauma/abuse
82
why do we do a physical assessment for mental health
- shorter life expectancy & chronic physical illnesses
- may disturb sleep/wake cycles, weight gain, cardiac arrhythmias
- medical conditions can mask or worsen psychiatric conditions
- psychiatric conditions can make it difficult to describe medical symptoms
83
Tasks during interview
1) build rapport
2) obtain facts
3) clarify perceptions
4) validate observations
84
What are the barriers to interviewing
1) lack of clarity of purpose doing interview
2) To many closed ended Q's
3) to many complex Q's
4) Assumptions
5) avoiding or ignoring expressions of emotion
85
Interprofesional collboration ...
- Decrease hospital stay
- Increase quality of care
- increases assess to care
- enhanced safety
- increased recuitment & retention
86
secondary sources:
Fam, HC providers, reports & records
87
different types of delusion
- Paranoid delusion - mistrust
- bizarre delusion - absurd
- somatic delusion- involve body
- depersonalization
- magical thinking
- Erotomania- think someones in love with them
- Hihilism - think they're dead
- obsession
- phobia
88
thought process abnormalities
Pressured speech
verigeration - meaningless repetition
-clang association - same sound but not associated
-preservation - response to stimulus after gone
-word said - incoherent mixture
-neologism- new words
89
neurobiology of addiction
addictive substances activate brain reward center (increased dopamine reinforces behaviour)
- changes within the brain that lead to no longer voluntary control
- not all who are exposed will become addicted (genetics, males)
90
symptom of alcohol addiction
poor nutrition and vitamin deficiencies
91
Explain mild withdrawal
6-12 hr. Resolves in 48-72hr
| -elevated temp, anxious, nausea, vomit, tremor, tachycardia, hypertension
92
explain intermediated withdraw
seizures, dysrhythmias, hallucinations
93
explain major withdraw
severe agitation, hyperactivity, global confusion, disorientation, occur within 5-6 days
94
Explain caffeine intoxication & withdrawal
Intoxication: Restless, nervous, excitement, insomnia, flushed face, diuresis, GI, twitch, rambling, tachycardia, arrhythmia, agitation *no long lasting consequences
Withdrawal: Headache, insomnia, abnormal dream, fatigue, difficulty concentrating, nausea
95
Cannabis related disorder
relax, distortion of senses, spatial misinterpretation, tachycardia, time standing still, cravings, decreased cognitives, impaired education, memory , recall, weight gain, psychosis/schizophrenia
* no treatment
96
Opioid related disorders
-CNS depression, sleep, analgesia, addictive, sweat, nausea, constipation, confusion, reduced respiration.
WithdrawL: flu, cravings, insomnia
97
Youth addiction special considerations
- vulnerable
- sensative to stress
- underdeveloped brain
- emotional
- livier, heard, impaired brain & organs
- need family involve for recovery
98
mental illness is not
moral weakness or a lifestyle choice
99
Parts to assess for CIWA
- Nausea.vomiting
- tremors
- anxiety
- agitiation
- paroxysmal sweats
- orientation
- tractile distrubances
- visual distrubances
- heacache
* Lorazepam for elderly or significant liver failure
* diazepam for all other
* the higher the score = worse
100
What is COWS assessment for
Clinical opiat withdrawal scale
101
what would you check for COWS assessment
1) Resting pulse
2) Sweating
3) Restlessness
4) Bone or joint aches
5) Running nose or tearing
6) GI UPSET
7) Tremor
8) Yawning
9) Anxiety or irritability
10) Gooseflesh skin/piloerection
severe = 36+
