Mental Health Exam 2 Flashcards
6 Steps of Nursing Process
1-Assessment
2-Diagnosis
3-Outcome Identification
4-Planning
5-Implementation
6-Evaluation
HEADSSS Psychosocial Interview Technique
-H Home environment (e.g., relations with parents and siblings)
-E Education and employment (e.g., school performance)
-A Activities (e.g., sports participation, afterschool activities, peer relations)
-D Drug, alcohol, or tobacco use
-S Sexuality (e.g., whether the patient is sexually active, practices safe sex, uses contraception, or practices alternative sexual lifestyles)
-S Suicide risk or symptoms of depression or other mental disorder
-S “Savagery” (e.g., violence or abuse in home environment or in neighborhood)
Documentaion Formats
-Narrative Charting
-Charting by Exception (CBE)
-Problem Oriented Charting (SOAPIE)
-PIE- Problems, Interventions, Evaluations
-Focus (DAR)- Data, Action, Response.
SOAPIE
-S: Subjective data (patient statement)
-O: Objective data (nurse observations)
-A: Assessment (nurse interprets S and O and describes either a problem or a nursing diagnosis)
-P: Plan (proposed intervention)
-I: Interventions (nurse’s response to problem)
-E: Evaluation (patient outcome)
therapeutic communication/ Techniques
Therapeutic communication is the purposeful use of communication to build and maintain helping relationships with clients, families, and significant others.
(1) silence, (2) active listening, and (3) clarifying techniques.
Verbal communication
consists of all words a person speaks. We live in a society of symbols, and our supreme social symbols are words. Talking is our most common activity—our public link with one another, the primary instrument of instruction, a need, an art, and one of the most personal aspects of our private lives. 5% - 10% - of Communication
Nonverbal communication
Body gestures, such as facial expressions, body posture, and hand movements. The tone and pitch of a person’s voice and the way a person paces speech are also examples of nonverbal communication. It is important to keep in mind, however, that culture influences the pitch and the tone a person uses. 65% - 90% of Communication
Phases of the nurse- patient relationship
-Preorientation phase. thoughts and feelings going into first clinical session.
-Orientation phase - establishment of rapport
-Working Phase – When patient is able to experience anxiety and demonstrate dysfunctional behaviors in a safe setting while experimenting with new and more adaptive coping behaviors.
-Termination Phase - Summarize goals, discuss patient outcomes.
Empathy vs Sympathy
-In empathy, we understand the feelings of others.
-In sympathy, we feel the feelings of others.
When a helping person is feeling sympathy for another, objectivity is lost, and the ability to assist the patient in solving a personal problem ceases.
Symptoms of Mania – DIG FAST
- Distractibility
- Impulsivity
- Grandiosity
- Flight of ideas/racing thoughts
- Activity/energy increase
- Sleep needs diminish
- Talkative
Interventions for: hypomania, mania, delirious mania
- The overall goal during the acute manic phase is to prevent injury and maintain safety.
1. Decreasing excessive physical activity
2. Maintaining adequate food and fluid intake
3. Ensuring at least 4 to 6 hours of sleep per night
4. Alleviating any bowel or bladder problems
5. Intervening to ensure self-care needs are met
6. Providing careful medication management
Some patients may require close observation, seclusion, or ECT for severe symptoms.
Milieu Therapy
persons who are hyperactive and easily distracted need
-atmosphere with decreased stimulation. solitary or noncompetitive activities, such as writing, drawing, or pacing/walking. protect the patient from potentially embarrassing behaviors on the unit.
-A patient should be assigned a private room when possible and encouraged to return to the room when showing beginning signs of agitation.
Seclusion
defined as the involuntary, solitary confinement of an individual.
Restraint
any method, device, or equipment that immobilizes or reduces an individual’s ability to freely move the arms, legs, body, or head.
chemical restraint
sedating a person to control or overpower by giving medication that is not a standard treatment or dosage for the condition
Lithium indications
the first-line treatment used for bipolar disorder. Multiple studies have demonstrated effectiveness in the treatment of acute mania, acute bipolar depression, and the prevention of manic and depressive episodes.
Lithium Serum/Toxic Levels
- Therapeutic serum levels in treating acute mania are 0.5 to 1.2 mEq/L,
-Maintenance serum levels are 0.6 to1.0 mEq/L,
-Toxic concentrations are greater than 1.5 mEq/L.
-lithium toxicity with levels of 2 mEq/L or greater constitute a life-threatening emergency.
-Serum lithium levels are drawn at a trough level (10 to 12 hours after the last dose)
Lithium toxicity Symptoms
- Neurologic: coarse tremor, slurred speech, ataxia, seizures, stupor, coma
- Gastrointestinal (GI): severe nausea, vomiting, and diarrhea
- Cardiac: hypotension, bradycardia, electrocardiogram (ECG) abnormalities
- Renal: renal failure
Positive Schizophrenia Sympotoms
-Hallucinations
-Delusions
-Bizarre behavior
-Catatonia
-Formal thought disorder
Negative Schizophrenia Symptoms
-Apathy
-Lack of Motivation
-Anhedonia
-Flat or Blunt Affect
-Poverty of speech
-Social withdrawal
Cognitive Schizophrenia Symptoms
-Impaired Memory
-Disruption in Social Learning
-Inability to reason, solve problems, focus attention.
Mood Schizophrenia Symptoms
-Depression
-Anxiety
-Demoralization
-Suicidality
-Excitability
-Agitation
Alterations in thinking
-Delusions are defined as false fixed beliefs that cannot be correct by reasoning, even with evidence to the contrary.
-Concrete thinking is another alteration in thinking and refers to an overemphasis on specific details and literal interpretation of ideas. It is contrasted with abstract thinking. The answer is literal; the ability to use abstract reasoning is lessened or absent.
-Disorganized speech
Typically arise from alterations in thought processes or how thoughts are connected. Associations are the threads that tie one thought to another and one concept to another.
Alterations in perceptions
-Illusion -
Misperceptions or misinterpretations of a real object or experience
-A man sees his coat hanging on a coat rack and believes it to be a bear about to attack him.
Alterations in perceptions
-Depersonalization -
Feeling disconnected or detached from one’s body and thoughts
-“I feel like I am observing myself from outside my body” or “I am not connected to my arm.”
Alterations in perceptions
-Derealization -
Alteration in the perception or experience of the external world so that it seems unreal. -Sights and sounds may be described as muted, strange, or unreal.
