Mental health exam 1 Flashcards
Asylum
a safe refuge or haven from the 1700s
Deinstituitionalization
a deliberate shift from the institutional care to community care
When and what were the early major milestones for MH?
psychopharmacology in the 1950s - development of psychotropic medications (thorazine and lithium) resulting in shorter stays, stabilization, and overall less chaotic stays in hospital settings
deinstitutionalization in 1960s - community MH centers construction act, shift from institutional care to community care, SSI income for disabled person, 1970s process for involuntary commitment made for difficult
Goals for Healthy People 2020
-reduce suicide rate
-reduce major depressive episode
—increase number of mental health facilities
-increase employment for people with mental illness
-increase treatment for dual diagnose
-increase care for the homeless with mental illness
What is DSM 5?
standard language for mental health that lists the defining characteristics of disorders and helped identify the underlying causes.
Diathesis + Stress =
Disorder
What is diathesis?
biological factors, social factors, and psychological factors that can lead to a predisposition for a disease/disorder.
Modern MH Nurses
advocate - fight stigma of mental health
standard of care - ethics
Phenomena of Concern of MH Nurse
self awareness
Mental health exists on a
continuum - both acuity and time
The contributing factors of mental illness is
Individual. Interpersonal, and Social/Cultural
Anhedonia is…
the inability to find joy in the things that they once did
Dysmorphic means
unhappy
psychosis
sensory or thought disturbances
What is ACE?
Adverse Childhood Experiences and Trauma Informed Care
The 3 types of ACEs?
abuse, neglect, household dysfunction
Protective Factors
Resilience - coping skills
Social and Economic Circumstances - environment/resources/accessibility
Perception of MH - hope/acceptance/support
Social Influences on MHC - positive change
Risk Factors
Biologic/genetic - vulnerabilities
Stressors - personal/financial/situational
Social and economic circumstances - environment/resources/accessibility
Perception of MH - stigma
Social Influences on MHC - policies/paternalism
Nurse’s Role
Educate
Advocacy
Self-Awareness
Compassionate care
Ethical Care
Political Involvement
Eradicate hurtful language (crazy)
Avoid laden and judgmental phrase (acting out)
Improve Documentation
Stigma
comes from history, polices, beliefs, past experiences, and media
involves beliefs of those involved with mental illness
How does stigma impact client experience?
feelings of isolation, discrimination, abuse, and violence
reflection
how we view our own experiences and beliefs
nonverbal communication
facial expression
eye contact
gestures
personal space
silence
sounds (sigh)
fidgety behavior
Therapeutic communication
active listening
observation
supportive touch
cultural considerations
identifying concerns
Implement interventions
Therapeutic Techniques
excepting
broad openings
VOICING DOUBT
clarification
silence
OPEN ENDED QUESTIONS
exploring
non-therapeutic techniques
advising, belittling, challenging, defending, disapproving, changing the topic
Empathy vs. Sympathy
In empathy, we understand the feelings and in sympathy, we feel the feeling.
Projective Questions
what if questions - beneficial for exploration
why not to ask why questions?
makes people defensive
looks for response that justifies feeling
create an imbalance of power
use tell me about that instead of why
clarity/brevity
short simple communication = best
timing/relevance
when would be the best time to have the conversation
pacing
using the right rate of speech
intonation
tone of voice conveys feelings
age related consideration
children - use simple terms
adolescences- consider importance of normal fear of telling the truth
older - assessing hearing ability and pace of speech (face the client)
Peplau’s Model
Orientation Phase - meet, establish roles/goals, and parameters
*important to know when the therapeutic relationship will end
Working Phase- problem identification and exploitation. Facilitating change
Termination - resolution, monitor for regression,
What is important before Peplau’s Model?
preparation and self awareness
Self awareness
allows us to see the perspective of others, practice self control, work creatively, and being able to monitor our stress, thoughts, emotions, and beliefs
Transference/Countertransference
transference-client unconsciously and inappropriately displaces feelings and behaviors onto the nurse
countertransference - nurse displaces feelings onto the patient
Decoding
exploring and investigating possible means for verbal communication
culture
all socially learned behavior, values, beliefs, traditions, and customs
these are transmitted down from generation to generation
How Culture might impact health care?
beliefs about to how to maintain health and what causes illnesses
Cultural Assessment Factors
communication
physical distance
time orientation
environmental control
biologic variations
Strategies for culturally competent care
Ask the patient:
how to be cared for?
what the expect from care?
any home remedies?
dietary preferences?
AVOID:
stereotyping and assumptions
missing cue
Campina-Bacote Model
Cultural:
Awareness
Skill
Knowledge
Encounters
Desires
cultural competence implies
endpoint - knowledge obtained is sufficient
cultural humility implies
ongoing process - room for improvement
Conflict (S/R)
disconnect from expectations
question (S/R)
“meaning of life and purpose”
hyper-religious (S/R)
ruminations and excessiveness
Hallucinations (S/R)
visions may occur (ex: voice of God, devil, demons, and angels
Impaired Judgement (S/R)
risky behavior, immortality
Delusions (S/R)
persecution, religious identity, and paranoia
Special Populations in MH care
homeless
incarcerated
immigrants
poverty
*might increase NEED but limits ACCESS
Values and Beliefs (self-awareness)
values - what is important to you
beliefs - an option you believe to be true
Implicit vs Explicit biases
implicit - unconscious
explicit - conscious
systematic desensitization
A type of counterconditioning that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli (ex: phobias)
Erikson’s stages of psychosocial development
- trust vs. mistrust (0-18 months)
- autonomy vs. shame and doubt (2-3)
- initiative vs. guilt (3-5)
- industry vs. inferiority (6-11)
- identity vs. role confusion (12-18)
- intimacy vs. isolation (19-40)
- generativity vs. stagnation (40-65)
- integrity vs. despair (65-death)
defense mechanisms
altruism - act to promote someone else’s welfare even at a risk to ourselves
sublimation - unconscious defense that reduces anxiety resulting from unacceptable urges or harmful stimuli
regression - return to a former or less developed state
denial - confrontation with a problem is avoided by denying that it exists
intellectualization - reason to block confrontation with an unconsciousness conflict associated with emotional stress
dialetical behavior therapy
mindfullness
distress tolerance- cope with strong emotions
emotion regulation - identify and deal with it
Interpersonal effectiveness - set boundaries
cognitive distortions
false and irrational - automatic thoughts
leads to false assumptions/misinterpretations
individual therapy
any background and style
relationship is KEY
can use different strategies
often HOMEWORK
termination can be challenging
Group Therapy
variety of types and styles
group development = ground rules
open or closed groups
family therapy
education
support
factors in dysfunctional families
blaming
manipulating
placating
distracting
generalizing
characters of behavior
passive - fails to express needs and feelings
assertive - direct expression of needs and feelings
aggressive - direct expression of needs and feelings to fault
light/phototherapy
1st line treatment for Seasonal Affective Disorder (SAD - a type of major depression)
-Exposure to light suppresses the nocturnal secretion of melatonin which helps people with SAD
-30-45 minutes daily - morning is best
ECT
electroconvulsive therapy
contraindications -hx of heart/stroke and can lead to memory loss
SAFE FOR PREGNANCY
CAM (complementary and alternative medicine)
-Herbal Therapy
-Meditation/Yoga
-Mindfulness
-Acupuncture
-Guided Imagery
-Relaxation Techniques (Be careful with progressive relaxation with somatic clients!)
-Spirituality (12 step groups are often based on spirituality)
-Diet, exercise, homeopathy, aromatherapy
-Music, Art, Pet Therapy
Least Restrictive Environment
clients have a right to get their treatment there
One exception to confidentiality is ______.
duty to warn
What can be claimed in a case involving restraint or forced medication?
assault
Treatment settings
inpatient/outpatient, partial hospitalization, day treatment, residential, long/short term, telehealth/webhealth
Milieu therapy
environment is apart of the therapy
safe is major concern
client centered
Multidisciplinary
*daily suicide assessments
*searches and environmental rounds
partial hospital programs
Transition from inpatient to living independently. Provides medication management, social support and socialization, and ongoing assessments. Client goes home at night with a responsible support person.
day treatment
offers daytime classes and support
ex: riverbed
assertive community treatment
case management - services to reduce rehospitlization
residential treatment settings
locked facilities with very strutted milieus
group homes (6-10 residents)
on-going support or care
Psychologist vs. Psychiatrist
Psychologists focus on using therapy to help their patients where as psychiatrists take a more medical approach to helping their patients ie. prescribing medication
Levels of Intervention
primary - promotes community health to prevent mental health crises (education)
secondary - early detection and intervention (crises management)
tertiary - rehabilitation, prevention of further problems, and reducing the impact of crises (support groups and care plans)
Dual Diagnosis
mental disorder and substance abuse
Case management
management of care on a case-by-case basis, represented an effort to provide necessary services while containing cost. The client is assigned to a case manager, a person who coordinates all types of care needed by the client.
Clubhouse model
evidence based recovery oriented program for adults living with mental health challenges - goal is to improve a person ability to function successfully in the community
provides members with many opportunities, including daytime work activities focused on the care, maintenance, and productivity
voluntary admission to MH facility
must meet admission criteria (risk to self or others)
clients sign themselves in
has right to apply for AMA
temporary emergency admissions to MH facility
patient is considered significantly unsafe, unable to make own decisions, legal hold of 24-96 hrs
involuntary admission to MH facility
admitted against will or for indefinite period, requires legal commitment, patients can still refuse treatment
*court hold up to 60 days
Safety Environment - Ligature Risk
doors open out rather than in
continuos hinges
anchored furniture
pull away curtains
boxed in plumbing
safety glass
non-looping shower head
platform beds
Beneficence
doing good
autonomy
clients rights to make own decisions
justice
fair and equal treatment for all
veracity
honesty, truthfulness
fidelity
loyalty, faithfulness to one’s duty
Non-maleficence
do no harm or wrong
Confidentiality
right to privacy and protection of PHI
informed consent
education prior to treatment and clients agreement to care
assault/battery
giving forced medication or treatment without consent
duty to warn
if client threatens others
duty to report
if a nurse suspects any abuse
seclusion
involuntary confinement
restraint
physical, mechanical, or chemical method to restrict physical movement
patients rights
right to consent treatment, right to refuse treatment, right to privacy, and right to least restrictive environment
seclusion and restraint
first try to avoid
offer medications
reduced stimulation
provide diversion
Seclusion and restraint time limits
under 9 : 1 hr
9-17 : 2 hr
18+ : 4 hr
must remain 1:1 the entire time and documentation must be detailed and accurate
ADPIE
Assessment
Diagnosis
Planning
Implementation/Intervention
Evaluation
Psychosocial Assessment
History
Appearance (hygiene, dress, posture)
Mood and Affect
Thought process (speech, flight of ideas, distortions)
Senorium/Intellectual- (Memory/Orientation/abstract thinking)
Abnormal sensory experiences
judgment/insight
sensory concept
roles and relationships
self care
C.A.G.E.
C: concern (knows there is a problem)
A: apparent (tells others about problem)
G: grave (guilty feelings)
E: evidence (dependence or tolerance)
Brief Psychiatric Rating Scale (BPRS)
Objective method of rating clinical symptoms that provides scores on 18 variables (e.g., somatic concern, anxiety, withdrawal, hostility, and bizarre thinking).
CIWA
Clinical Institute Withdrawal Assessment for Alcohol
AIMS
abnormal involuntary movement scale
Hamilton Rating Scale for Depression
A questionnaire used to rate depression severity (0-4) . The higher the score the more severely depressed. Score is as high as 66.
Columbia Suicide Severity Rating Scale
Suicide ideation definition and prompts that are answered with yes or no in the past month
SAD PERSONS scale
A simple and practical assessment tool to evaluate potentially suicidal patients.
Mini-Mental State Examination (MMSE)
A test that is used to measure cognitive ability, especially in late adulthood.
mood vs affect
Mood= persistent emotional state
Affect= external display of feelings
labile
easily altered; changing rapidly (emotions)
assessment: harm to self and others
ask directly
ask about plans
duty to warn
contract for safety
Hallucinations can be
auditory, visual, olfactory, gustatory, or tactile
assessment: self concept
self worth
emotional response
coping skills
body image
Judgement vs Insight
Judgement is behavior based
Insight is cognition based
Roles and life changes that can affect MH
History of Abuse
Divorce
Unemployment
New child
Recent move
New adult status
Importance of Family History :
abuse
substance abuse
mental illness
suicide
HEADSSS (teens)
Home environment
Education/employment
Activities
Drug and substance use
Sexuality
Suicide/depression
Safety
anergia
lack of energy
Avolition
lack of motivation
alogia
poverty of speech
affective blunting
minimal facial expressions
aphasia
inability to speak
Agnosia
the inability to recognize familiar objects.
Apraxia
loss of purposeful movement
anosognosia
denial of illness
apathy
withdrawal of activities / lack on interest
exit seeking vs wandering
exit seeking is more purposeful wandering
Hyperviligence
a heightened search for threats
what can cause or MIMIC mental illness?
UTI
Delirium
Drugs/Toxicity
Safety Assessment
suicide
homicidal
elopement (escape)
assault
falls (meds usually over 2 and presence of confusion)
Assessments help determine:
risk for infection
risk for self harm
complicated grieving
ineffective coping
hopelessness
fear
impaired social interaction
SMART goals
Specific - what we want to see accomplished
Measurable - number or something concrete to measure
Achievable - can the patient reasonably do this (short and long term goals)
Relevant - does this matter to the patient
Timed - when do we want this to achieved
Goals vs intervention
goals- what the patient is going to do
interventions - what the nurse will do to help the patient reach goals
document what is done and the clients response to the intervention
Main nursing intervention
educate
