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Mental health > Mental health exam 1 > Flashcards

Mental health exam 1 Flashcards

1
Q

Asylum

A

a safe refuge or haven from the 1700s

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2
Q

Deinstituitionalization

A

a deliberate shift from the institutional care to community care

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3
Q

When and what were the early major milestones for MH?

A

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

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4
Q

Goals for Healthy People 2020

A

-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

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5
Q

What is DSM 5?

A

standard language for mental health that lists the defining characteristics of disorders and helped identify the underlying causes.

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6
Q

Diathesis + Stress =

A

Disorder

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7
Q

What is diathesis?

A

biological factors, social factors, and psychological factors that can lead to a predisposition for a disease/disorder.

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8
Q

Modern MH Nurses

A

advocate - fight stigma of mental health

standard of care - ethics

Phenomena of Concern of MH Nurse

self awareness

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9
Q

Mental health exists on a

A

continuum - both acuity and time

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10
Q

The contributing factors of mental illness is

A

Individual. Interpersonal, and Social/Cultural

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11
Q

Anhedonia is…

A

the inability to find joy in the things that they once did

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12
Q

Dysmorphic means

A

unhappy

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13
Q

psychosis

A

sensory or thought disturbances

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14
Q

What is ACE?

A

Adverse Childhood Experiences and Trauma Informed Care

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15
Q

The 3 types of ACEs?

A

abuse, neglect, household dysfunction

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16
Q

Protective Factors

A

Resilience - coping skills

Social and Economic Circumstances - environment/resources/accessibility

Perception of MH - hope/acceptance/support

Social Influences on MHC - positive change

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17
Q

Risk Factors

A

Biologic/genetic - vulnerabilities

Stressors - personal/financial/situational

Social and economic circumstances - environment/resources/accessibility

Perception of MH - stigma

Social Influences on MHC - policies/paternalism

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18
Q

Nurse’s Role

A

Educate
Advocacy
Self-Awareness
Compassionate care
Ethical Care
Political Involvement
Eradicate hurtful language (crazy)
Avoid laden and judgmental phrase (acting out)
Improve Documentation

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19
Q

Stigma

A

comes from history, polices, beliefs, past experiences, and media

involves beliefs of those involved with mental illness

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20
Q

How does stigma impact client experience?

A

feelings of isolation, discrimination, abuse, and violence

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21
Q

reflection

A

how we view our own experiences and beliefs

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22
Q

nonverbal communication

A

facial expression
eye contact
gestures
personal space
silence
sounds (sigh)
fidgety behavior

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23
Q

Therapeutic communication

A

active listening
observation
supportive touch
cultural considerations
identifying concerns
Implement interventions

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24
Q

Therapeutic Techniques

A

excepting
broad openings
VOICING DOUBT
clarification
silence
OPEN ENDED QUESTIONS
exploring

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25
Q

non-therapeutic techniques

A

advising, belittling, challenging, defending, disapproving, changing the topic

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26
Q

Empathy vs. Sympathy

A

In empathy, we understand the feelings and in sympathy, we feel the feeling.

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27
Q

Projective Questions

A

what if questions - beneficial for exploration

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28
Q

why not to ask why questions?

A

makes people defensive
looks for response that justifies feeling
create an imbalance of power

use tell me about that instead of why

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29
Q

clarity/brevity

A

short simple communication = best

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30
Q

timing/relevance

A

when would be the best time to have the conversation

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31
Q

pacing

A

using the right rate of speech

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32
Q

intonation

A

tone of voice conveys feelings

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33
Q

age related consideration

A

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)

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34
Q

Peplau’s Model

A

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,

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35
Q

What is important before Peplau’s Model?

A

preparation and self awareness

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36
Q

Self awareness

A

allows us to see the perspective of others, practice self control, work creatively, and being able to monitor our stress, thoughts, emotions, and beliefs

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37
Q

Transference/Countertransference

A

transference-client unconsciously and inappropriately displaces feelings and behaviors onto the nurse

countertransference - nurse displaces feelings onto the patient

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38
Q

Decoding

A

exploring and investigating possible means for verbal communication

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39
Q

culture

A

all socially learned behavior, values, beliefs, traditions, and customs

these are transmitted down from generation to generation

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40
Q

How Culture might impact health care?

A

beliefs about to how to maintain health and what causes illnesses

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41
Q

Cultural Assessment Factors

A

communication
physical distance
time orientation
environmental control
biologic variations

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42
Q

Strategies for culturally competent care

A

Ask the patient:
how to be cared for?
what the expect from care?
any home remedies?
dietary preferences?

AVOID:
stereotyping and assumptions
missing cue

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43
Q

Campina-Bacote Model

A

Cultural:
Awareness
Skill
Knowledge
Encounters
Desires

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44
Q

cultural competence implies

A

endpoint - knowledge obtained is sufficient

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45
Q

cultural humility implies

A

ongoing process - room for improvement

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46
Q

Conflict (S/R)

A

disconnect from expectations

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47
Q

question (S/R)

A

“meaning of life and purpose”

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48
Q

hyper-religious (S/R)

A

ruminations and excessiveness

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49
Q

Hallucinations (S/R)

A

visions may occur (ex: voice of God, devil, demons, and angels

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50
Q

Impaired Judgement (S/R)

A

risky behavior, immortality

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51
Q

Delusions (S/R)

A

persecution, religious identity, and paranoia

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52
Q

Special Populations in MH care

A

homeless
incarcerated
immigrants
poverty

*might increase NEED but limits ACCESS

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53
Q

Values and Beliefs (self-awareness)

A

values - what is important to you
beliefs - an option you believe to be true

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54
Q

Implicit vs Explicit biases

A

implicit - unconscious
explicit - conscious

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55
Q

systematic desensitization

A

A type of counterconditioning that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli (ex: phobias)

56
Q

Erikson’s stages of psychosocial development

A
  1. trust vs. mistrust (0-18 months)
  2. autonomy vs. shame and doubt (2-3)
  3. initiative vs. guilt (3-5)
  4. industry vs. inferiority (6-11)
  5. identity vs. role confusion (12-18)
  6. intimacy vs. isolation (19-40)
  7. generativity vs. stagnation (40-65)
  8. integrity vs. despair (65-death)
57
Q

defense mechanisms

A

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

58
Q

dialetical behavior therapy

A

mindfullness
distress tolerance- cope with strong emotions
emotion regulation - identify and deal with it
Interpersonal effectiveness - set boundaries

59
Q

cognitive distortions

A

false and irrational - automatic thoughts
leads to false assumptions/misinterpretations

60
Q

individual therapy

A

any background and style
relationship is KEY
can use different strategies
often HOMEWORK
termination can be challenging

61
Q

Group Therapy

A

variety of types and styles
group development = ground rules
open or closed groups
family therapy
education
support

62
Q

factors in dysfunctional families

A

blaming
manipulating
placating
distracting
generalizing

63
Q

characters of behavior

A

passive - fails to express needs and feelings

assertive - direct expression of needs and feelings

aggressive - direct expression of needs and feelings to fault

64
Q

light/phototherapy

A

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

65
Q

ECT

A

electroconvulsive therapy

contraindications -hx of heart/stroke and can lead to memory loss

SAFE FOR PREGNANCY

66
Q

CAM (complementary and alternative medicine)

A

-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

67
Q

Least Restrictive Environment

A

clients have a right to get their treatment there

68
Q

One exception to confidentiality is ______.

A

duty to warn

69
Q

What can be claimed in a case involving restraint or forced medication?

A

assault

70
Q

Treatment settings

A

inpatient/outpatient, partial hospitalization, day treatment, residential, long/short term, telehealth/webhealth

71
Q

Milieu therapy

A

environment is apart of the therapy
safe is major concern
client centered
Multidisciplinary

*daily suicide assessments
*searches and environmental rounds

72
Q

partial hospital programs

A

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.

73
Q

day treatment

A

offers daytime classes and support
ex: riverbed

74
Q

assertive community treatment

A

case management - services to reduce rehospitlization

75
Q

residential treatment settings

A

locked facilities with very strutted milieus
group homes (6-10 residents)
on-going support or care

76
Q

Psychologist vs. Psychiatrist

A

Psychologists focus on using therapy to help their patients where as psychiatrists take a more medical approach to helping their patients ie. prescribing medication

77
Q

Levels of Intervention

A

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)

78
Q

Dual Diagnosis

A

mental disorder and substance abuse

79
Q

Case management

A

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.

80
Q

Clubhouse model

A

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

81
Q

voluntary admission to MH facility

A

must meet admission criteria (risk to self or others)
clients sign themselves in
has right to apply for AMA

82
Q

temporary emergency admissions to MH facility

A

patient is considered significantly unsafe, unable to make own decisions, legal hold of 24-96 hrs

83
Q

involuntary admission to MH facility

A

admitted against will or for indefinite period, requires legal commitment, patients can still refuse treatment

*court hold up to 60 days

84
Q

Safety Environment - Ligature Risk

A

doors open out rather than in
continuos hinges
anchored furniture
pull away curtains
boxed in plumbing
safety glass
non-looping shower head
platform beds

85
Q

Beneficence

A

doing good

86
Q

autonomy

A

clients rights to make own decisions

87
Q

justice

A

fair and equal treatment for all

88
Q

veracity

A

honesty, truthfulness

89
Q

fidelity

A

loyalty, faithfulness to one’s duty

90
Q

Non-maleficence

A

do no harm or wrong

91
Q

Confidentiality

A

right to privacy and protection of PHI

92
Q

informed consent

A

education prior to treatment and clients agreement to care

93
Q

assault/battery

A

giving forced medication or treatment without consent

94
Q

duty to warn

A

if client threatens others

95
Q

duty to report

A

if a nurse suspects any abuse

96
Q

seclusion

A

involuntary confinement

97
Q

restraint

A

physical, mechanical, or chemical method to restrict physical movement

98
Q

patients rights

A

right to consent treatment, right to refuse treatment, right to privacy, and right to least restrictive environment

99
Q

seclusion and restraint

A

first try to avoid
offer medications
reduced stimulation
provide diversion

100
Q

Seclusion and restraint time limits

A

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

101
Q

ADPIE

A

Assessment
Diagnosis
Planning
Implementation/Intervention
Evaluation

102
Q

Psychosocial Assessment

A

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

103
Q

C.A.G.E.

A

C: concern (knows there is a problem)
A: apparent (tells others about problem)
G: grave (guilty feelings)
E: evidence (dependence or tolerance)

104
Q

Brief Psychiatric Rating Scale (BPRS)

A

Objective method of rating clinical symptoms that provides scores on 18 variables (e.g., somatic concern, anxiety, withdrawal, hostility, and bizarre thinking).

105
Q

CIWA

A

Clinical Institute Withdrawal Assessment for Alcohol

106
Q

AIMS

A

abnormal involuntary movement scale

107
Q

Hamilton Rating Scale for Depression

A

A questionnaire used to rate depression severity (0-4) . The higher the score the more severely depressed. Score is as high as 66.

108
Q

Columbia Suicide Severity Rating Scale

A

Suicide ideation definition and prompts that are answered with yes or no in the past month

109
Q

SAD PERSONS scale

A

A simple and practical assessment tool to evaluate potentially suicidal patients.

110
Q

Mini-Mental State Examination (MMSE)

A

A test that is used to measure cognitive ability, especially in late adulthood.

111
Q

mood vs affect

A

Mood= persistent emotional state

Affect= external display of feelings

112
Q

labile

A

easily altered; changing rapidly (emotions)

113
Q

assessment: harm to self and others

A

ask directly
ask about plans
duty to warn
contract for safety

114
Q

Hallucinations can be

A

auditory, visual, olfactory, gustatory, or tactile

115
Q

assessment: self concept

A

self worth
emotional response
coping skills
body image

116
Q

Judgement vs Insight

A

Judgement is behavior based
Insight is cognition based

117
Q

Roles and life changes that can affect MH

A

History of Abuse
Divorce
Unemployment
New child
Recent move
New adult status

118
Q

Importance of Family History :

A

abuse
substance abuse
mental illness
suicide

119
Q

HEADSSS (teens)

A

Home environment
Education/employment
Activities
Drug and substance use
Sexuality
Suicide/depression
Safety

120
Q

anergia

A

lack of energy

121
Q

Avolition

A

lack of motivation

122
Q

alogia

A

poverty of speech

123
Q

affective blunting

A

minimal facial expressions

124
Q

aphasia

A

inability to speak

125
Q

Agnosia

A

the inability to recognize familiar objects.

126
Q

Apraxia

A

loss of purposeful movement

127
Q

anosognosia

A

denial of illness

128
Q

apathy

A

withdrawal of activities / lack on interest

129
Q

exit seeking vs wandering

A

exit seeking is more purposeful wandering

130
Q

Hyperviligence

A

a heightened search for threats

131
Q

what can cause or MIMIC mental illness?

A

UTI
Delirium
Drugs/Toxicity

132
Q

Safety Assessment

A

suicide
homicidal
elopement (escape)
assault
falls (meds usually over 2 and presence of confusion)

133
Q

Assessments help determine:

A

risk for infection
risk for self harm
complicated grieving
ineffective coping
hopelessness
fear
impaired social interaction

134
Q

SMART goals

A

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

135
Q

Goals vs intervention

A

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

136
Q

Main nursing intervention

A

educate

Mental health (3 decks)

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