Mental health exam 1 - 2nd Flashcards
Asylum
a safe refuge or haven - this term comes from the 1700s
Deinstitution
a deliberate shift from institutional care to community care
What were the 2 major milestones that happened in the mental health world?
Psychopharmacology - 1950s
- development of psychotropic medications such as (Thorazine & Lithium)
-this made hospital stays shorter, and helped people stabilise
Deinstitutionalization - 1960s
What are the goals for the Healthy People 2020
-reduce suicide rates
-reduce depression episodes
-increase number of MH facilities
-increase # of people with MI that are employed
-increase treatment for dual diagnosis
-increase care for MI homeless persons
What is the DSM 5?
-lists of defining characteristics of disorders
-basically this is used to best diagnose people with the illness that best fits their given characteristics
What does resilience mean?
ability to bounce- back or roll with the flow
What is addressed on the mental health continuum
time & acuity
time - is it episodic or chronic?
acuity - severity of symptoms?
Anhedonia
the inability to find joy in the things that once did
What is a dysphoric mood?
an unhappy mood
What is considered a mood swing?
the instability of a mood
What is Psychosis
sensory or thought disturbances
What does ACE stand for?
Adverse Childhood Experiences and trauma informed care
What are the 3 types of ACEs
-Abuse (physical, emotional, sexual)
-Neglect (physical, emotional)
-Household Dysfunction (divorce, substance abuse, etc.)
What are protective factors?
-Resilience - (coping skills)
-Social and economic circumstances (environmental, resources, accessibility)
-Perceptions of Mental Health/Mental Illness (hope, acceptance, support)
-Social influences on Mental Health Care (positive changes)
What are risk factors?
-Biologic/genetics (vulnerable)
-Stressors (personal, financial, situational?)
-Social and economic circumstances (environmental, resources, accessibility)
-Stigma
-Social influences on MHC ( paternalism- deciding what we as nurses think are best)
What is Stigma?
Biased opinions about someone
What is laden language
words like “acting out”
What does the Diathesis stress model help us understand?
a disorder
What is the Campina-Bacote Model?
cultural competency
What does Grief make someone feel?
sense of abandonment, anger, and hopeless
How does a question tie to a psychiatric symptom?
-“wouldn’t you be better off without me?”
What are the special populations that are more affected by Mental illness?
-homless
-incarcerated
-immigrants
-those living in poverty
** this increases their need for mental health help however it is limited to find
What are some examples of non verbal communication?
-facial expressions
-eye contact (eye rolls)
-gestures
-personal space
-silence
-sounds (sighs)
-Fidgety behavoir
What are some of the main therapeutic communication techniques
-accepting the pt
-being broad
-focus
-voicing doubt
-silence
-clarification
What are some NON therapeutic techniques?
-advising (telling them what they need to do)
-belitting (“at least”)
-Challenging
-defending something
-disapproving or giving approval
-interpreting for the client (let them tell their own story)
Empathy vs Sympathy
Empathy - understanding ones feelings
Sympathy- feelings ones feelings (crying when they cry)
What are projective questions?
What if questions
What should you refrain from asking your pt?
WHY
instead say “tell me about that”
What is Clarity/Brevity
shortest and simplest is usually the best
What is timing/relevance
“when would be the best time to have this conversation?”
What is pacing?
the rate of speech- hurried talking might convey “rushing” which can be negative
What is intonation?
tone of voice that conveys feelings
What are some reassuring tips for when you are talking to someone with anxiety?
-provide safety
-reassure
-be brief and calm
What are some reassuring tips when you are talking to someone with psychosis?
-provide safety
-decode (break it down)
-reduce anxiety
-be brief
-be calm
What are some reassuring tips when you are talking to someone with depression>
-complete suicide assessments
What are some reassuring tips when you are talking to someone with age considerations?
-be face to face
-use vocabulary that can be easily understood
What are some considerations to take into play when speaking with an adolescent?
-at this age, their is a fear for telling the truth, so be sure your pt knows the consequences.
-provide privacy
What are the 3 stages of Peplaus model?
-Orientation phase (meet and establish roles and goals)
-Working phase (identify problem)
-Termination phase (resolution, monitor for regression)
What is transference/countertransference
-Transference- patient unconsciously and inapproprialty displacing feelings and behaviors onto the nurse
Ex.) “you remind me of”
-Countertransference- nurse displaces feelings onto the patient
What to do if: Patient cries
-stay with pt, convey acceptance
-offer tissues
-allow time to recover, offer to stay, offer to leave
What to do if: Pt leaves session
-thank them
-offer to stay or be available later
What to do if: Pt does not want to talk?
-accept it
-offer to check back in later
What to do if: Pt threatens suicide
-assess and report
What to do if: Pt asks you to keep a secret
-you cannot make that promise
What to do if: a Pt asks you a personal question
-if appropriate and comfortable, the nurse may answer
-politely deflect, return focus to pt
What to do if: makes sexual advances
-set limits
-restate role
-leave if needed
Erikson’s psychological stages: Infancy (0-18mos)
trust vs mistrust
feeding/comfort
-Is my world safe?
Erikson’s psychological stages: Early Childhood (2 to 3)
-Autonomy vs shame and doubt
-toilet training/ dressing
-can I do things by myself or do I always rely on others?
Erikson’s psychological stages: Preschool (3 to 5)
-Initiative vs Guilt
- exploration/ play
-Am I good or bad?
Erikson’s psychological stages: School age (6 to 11)
-Industry vs Inferiority
-School/ Activities
-How can I be good?
Erikson’s psychological stages: Adolescent (12-18)
-Identity vs Role confusion
-Social relationships/ Identity
-Who am I? and Where am I going?
Erikson’s psychological stages: Young Adult (19-40)
-Intimacy vs Isolation
-intimate relationships
-Am I loved and wanted?
Erikson’s psychological stages: Middle Adulthood (40-65)
-Generative vs Stagnation
-Work and parenthood
-Will I provide something of real value?
Erikson’s psychological stages: Maturity (65-death)
-ego identity vs despair
-reflection on life
-Have a lived a full life?
What are some main defense mechanisms?
-Altruism
-Sublimation
-Regression
-Denial
-Intellectualization
What does the Peplau Therapuetic theory analyse
-phases of a relationship
-levels of anxiety
What does the Maslows Hierach of needs take care of?
-food, water, sleep, shelter
-safety
-self actualization
What is Carl Rogers client centred therapy?
-unconditional postive regards, genuine, empathetic understanding
What is Dialectical behaviour therapy?
-a type of cognitive behaviour therapy
-primary for self injurious behaviour
What are cognitive distortions
-Automatic thoughts
-THESE ARE FALSE AND IRRATIONAL
What are some characteristics of passivness?
-fails to express needs or feelings
-no eye contact
-low voice
-tense body movements
-depends on others for self care
What are some characteristics of Assertivness?
- direct expression of needs and feelings
-looks directly at others
-clear voice
-calm body postures
-uses “I” statements
-
What are some characteristics of aggresivness?
-uses intimidating eye contact
-speech is rapid
-tense body postures
-threatening to others
-blames others
Light/ phototherapy
-1st line treatment for seasonal affective disorder
-30-45 min daily - morning is best
Psychiatrists vs Psychologist
Psychiatrists - actual DR that can write meds
Psychologist- not a DR- typically outpatient and can do individual testing
What is the role of a social worker/case manager?
-leads the groups
What is the utilization review used for?
-reimbursment
Levels of intervention : Primary
-promotes community health to reduce FUTURE mental health crisis
-community education
-PREVENTS CRISIS
Levels of intervention: Secondary
-focuses on early detection
-screenings
Levels of intervention: Tertiary
-focus is on rehab and preventing further problems
-AA meetings
-damage control
What is a dual diagnosis?
-2 illnesses
What population is mental illness higher in?
-homeless
-veterans
-incarcerated
What is voluntary admission consist of?
-must meet admission requirements
-client signs themselves in
-client has the RIGHT to apply for AMA form, but Dr must approve write an order
-client has right to refuse treatment but Dr may override if needed
What is a temporary emergency admission?
-client considered to be SIGNIFICANTLY unsafe at this time
-unable to make own health decisions
-usually do not exceed 15 days
-temp legal hold- 24-96 hours
What does an involuntary admission consist of?
-admitted against will for a longer period of time
-requires legal commitment
-if client is competent, they can still refuse care
What is a therapeutic Milieu?
-the environment at the hospital
Benficence
doing good
autonomy
clients rights to make own decisions
Justice
fair and equal treatment
Fidelity
loyalty to ones duty, doing no harm
Veracity
honest
How long can an 18 and older be in restraints?
4 hours
How long can a 9-17 year old be in restraints?
2 hours
How long can a 9 and under year old be in restraints?
1 hour
What must happen if a pt is in restraints?
be 1:1
What does ADPIE stand for?
A- assessment
D-Diagnosis
P-Planning
I-interventions
E-Evaluations
What is the CAGE tool used for
substance abuse
What is the BECK tool used for?
Depression
What is the Hamilton A and D used for ?
Anxiety & depression
What is the AIMS tool used for ?
abnormal movements
What is the CIWA used for?
withdrawal
What is the GAF used for?
assessment of functions
benchmark of 1-100, 100 is good. below 40 is bad.
What is the Columbia Suicide Severity scale for?
most standard suicide rating scale
What is the SADPERSONS used for?
suicidal
What is the mini mental status exam
-VITAL signs for brain
-used for dementia
Word salad
words are in no order
Tangentail
-no reason
- like chasing rabbits.
Echolalia
repeat everything you say
Ruminations
going over something over and over
neologisms
-making up words
clanging
using words that rhyme
anergia
lack of energy
Anhedonia
inability to find pleasure in things that you used to enjoy
Avolition
lack of follow through / no motivation
Algoia
poverty of speech
Affective blunting
minimal facial expressions
Aphasia
can’t find the right word
Agnosia
don’t recognise familiar objects anymore
Apraxia
loss of purposeful movement - basic skills
Anosognosia
no knowledge of illness - denial
Apathy
loss of initiative - withdrawal from activites
