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Mental Health > Objective 2 > Flashcards

Objective 2 Flashcards

1
Q

what are the categories of psychiatric history?

A

current condition
previous diagnosis
previous interventions and treatments
family history

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2
Q

what are the categories of data?

A

complaint/reason for admin
present symptoms
previous hospitalizations and treatments
personal history
personality

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3
Q

what is the significance of psychiatric mental health nursing assessment?

A

Establish rapport
* Obtain understanding of current problem
* Review physical status and obtain baseline VS
* Assess risk factors associated with safety of patient or
others
* Perform a mental status assessment
* Assess psychosocial status
* Identify mutual goals for treatment
* Formulate a plan of care

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4
Q

Useful tools include storytelling, dolls, drawing, and
games to promote disclosure

A

assessment of children

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5
Q

Particularly concerned about confidentiality
 Threats of suicide or homicide, use of illegal drugs, or
issues of abuse cannot be kept confidential and must
be shared with other professionals and parents

A

assessment of adolescents

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6
Q

Be aware of physical limitations such as a sensory,
motor, or medical condition that could cause
increased anxiety, stress, or physical discomfort for
the patient
 Make accommodations at the beginning of the
interview when possible (hearing, sight)
 High pitch voice may increase anxiety
 Sit close but not to invade the pt’s personal space

A

assessment of older adults

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7
Q

steps of cultural competence during assessment

A
  1. Assess and clarify the client’s cultural values, beliefs,
    and norms
  2. Assess the client’s degree of cultural
    assimilation/acculturation
  3. Assess the client’s perspective regarding feelings and
    symptoms
  4. Elicit the client’s expectations and ask what is
    important for the health care provider to know
  5. Learn how to work with interpreters
  6. When using an interpreter, talk to the client rather
    than the
    interpreter (observe eyes/face for nonverbal)
  7. Seek collaboration with bilingual community
    resources (social
    worker in meeting)
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8
Q

Review of systems
 Laboratory data
 Mental status examination [MSE] (Box 6-3)
 Psychosocial assessment (Box 6-4)
 Spiritual/religious assessment
 Cultural and social assessment
Standardized nursing assessment tools facilitate the
assessment process (Table 6-2)

A

gathering data

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9
Q

(old medical records, family)

A

validate data

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10
Q

what do we assess during mental status assessment?

A

intelligence
thought processes
capacity for insight

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11
Q

Data related to client’s
 Biological
 Psychological
 Cultural
 Spiritual
 Social needs
* Completed in collaboration with other health
care professionals

A

comprehensive assessment

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12
Q

Collection of data regarding a particular
problem as determined by:
 Client
 Family member
 Crisis situation

A

focused assessment

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13
Q

Collection of predetermined data usually during initial
contact, to determine how client is functioning in various
areas
* Includes use of assessment or rating scales to evaluate
data regarding a specific problem (memory loss or
insomnia) or behavior (combativeness or impulsivity)

A

screening assessment

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14
Q

A type of screening assessment that can be used in
variety of settings to describe appearance, speech, mood,
thinking, perceptions, sensorium, insight and judgment

A

psychiatric mental status exam

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15
Q

Screens for cognitive impairment and dementia
 Used to estimate level of cognitive impairment
at a given point in time
 The maximum score is 30. A score of 23 or lower
is indicative of cognitive impairment
 Takes only 5-10 minutes to administer and is
therefore practical to use repeatedly and
routinely

A

Folstein’s mini mental state exam

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16
Q

what is the purpose of the mental status exam?

A

Gather objective data.
* Deal immediately with any
risk of violence or harm.
* The MSE can change from
day to day or hour to hour
* It is the description of the
patient’s appearance,
speech, actions, and
thoughts throughout the
interview.

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17
Q

Psychological equivalent of a physical exam that
describes the mental state and behaviors of the
person being seen including objective
observations and subjective descriptions
provided by the client
* Provides information for the diagnosis and
assessment of disorder and response to
treatment
* A mental status exam provides a snap shot at a
point in time

A

mental status exam

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18
Q

what are the steps in collection of data

A

appearance
affect or emotional state
behaviour, attitude, and coping patterns
communication and social skills
content of thought
orientation
memory
intellectual ability
insight regarding illness
spirituality
sexuality
neurovegetative changes

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19
Q

A form of nonverbal communication where
thoughts feelings and moods and conveyed

A

appearance

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20
Q

what do we observe during appearance?

A

Apparent age (relationship between appearance &
age)
* Peculiarity of dress
* Cleanliness (hygiene & grooming)
* Use of cosmetics
* Pupil dilation, facial expression
* Height, weight, nutritional status
* Present of scars, tattoos, body piercings

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21
Q

Body movements
Level of eye contact (be mindful of cultural
differences)

A

behaviour (observed)

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22
Q

Rate & tone
Volume
Disturbances
Cluttering

A

speech (observed)

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23
Q

what do we observe when assessing behavior attitude and oping patterns?

A

suicide
violence
substance abuse

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24
Q

Emotional experience over prolonged period of
time
 Tone (sad, euphoric, depressed)
 Degree (mild, moderate, extreme)
 Irritability (calm, irritable, explosive)
 Stability (rapid or delayed)

A

mood (inquired)

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25
Q

Immediate expressions of emotions
 Range
 Appropriateness & Stability

A

affect (observed)

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26
Q

An individual’s present emotional
responsiveness
 Temporary expression of feelings or state of
mind
 Nonverbal
 Facial expressions, gestures
 Differs from mood
 Are the two congruent?
 Affect can be incongruent from what one says or
does

A

affect or emotional state

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27
Q

Severe reduction or limitation in intensity of one’s
affective response to a situation

A

blunted

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28
Q

Absence or near absence of signs of affective
responses (immobile face, monotonous tone of voice)

A

flat

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29
Q

Discordance (lack of harmony) between one’s voice and
movements with one’s speech or verbalized thoughts

A

inappropriate

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30
Q

Abnormal fluctuation or variability of one’s expressions
(repeated, rapid or abrupt shifts)

A

labile

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31
Q

Reduction in one’s expressive range and intensity of affective responses

A

restricted or constricted

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32
Q

what are the factors to consider when assessing attitude?

A

Is behaviour strange, threatening, suicidal, self injurious
or violent?
* Is client trying to control emotions?
* Any unusual mannerisms or motor activity such as
grimacing, tremors, tics, impaired gait, psychomotor
retardation or agitation? Excessive pacing?
* Are they friendly, embarrassed, fearful, resentful,
angry, negativistic or impulsive?
* Attitude toward interviewer or others can facilitate or
impair the assessment process
* Is behaviour overactive or hyperactive? Is it purposeful,
disorganized, stereotyped?
* Are actions consistent?

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33
Q

what are the communication and social skills for impaired communication?

A

blocking
circumstantiality
clang association
echolalia
flight of ideas
looseness of association
mutism
neologism
perseveration
tangentiality
verbigeration
word salad

34
Q

Disorganized, coherent, flight of ideas,
neologisms, thought blocking, circumstantiality

A

thought process

35
Q

Delusions, jealousy, thought
control/withdrawal/insertions, obsessions or
preoccupations

A

thought content

36
Q

Fixed or false beliefs not true to fact & not ordinarily
accepted by other
 Occur in clients with various psychotic disorders

A

delusions

37
Q

what are the types of delusions frequently reported?

A

Delusion of reference or persecution
* Delusion of alien control
* Nihilistic delusion
* Delusion of poverty
* Delusion of grandeur
* Somatic delusion

38
Q

Feeling of unreality or strangeness concerning self, environment or
both
* Clients describe out of body experiences
* Common in schizophrenia, bipolar disorders, depersonalization
disorders

A

depersonalization

39
Q

what are the obsessions of content of thought?

A

Insistent thoughts, recognized as arising from self
* Seen in those with anxiety or obsessive compulsive disorder

40
Q

what are the compulsions associated with content of thought?

A

Insistent, repetitive, intrusive and unwanted urges to perform an
act contrary to one’s ordinary wishes or standards
* Repetitive urge to gamble although partner threatens divorce if
don’t stop playing poker
* If don’t engage in act, feel tension and anxiety
* Seen in those with anxiety, obsessive compulsive disorder or
personality body dysmorphic, eating or autism spectrum disorders

41
Q

Sensory perceptions in the absence of an actual
external stimulus

A

hallucinations

42
Q

what are the types of hallucinations?

A

auditory
visual
olfactory
gustatory
tactile

43
Q

Hears voices frequently telling client when to eat, dress and
go to bed each night

A

auditory

44
Q

Describes seeing spiders and snakes on ceiling of room

A

visual

45
Q

States “smells rotten garbage” but not evidence of any foul
smelling material

A

olfactory

46
Q

Complains of constant taste of salt water in mouth

A

gustatory

47
Q

Client going to alcohol withdrawal and delirium tremens

A

tactile

48
Q

Misperception of a real external stimulus such as, noise
or shadows
* Ex: dementia patients interpret rustling of leaves as
voices
* Also common in symptoms of withdrawal from
alcohol/other substances

A

illusions

49
Q

what are the common dissociations for illusions?

A

Feeling detached, surroundings not real

50
Q

what are the things to looks for when assessing cognition (inquired)?

A

Orientation (person, place, time)
 Level or consciousness (alert, confused, stuporous)
 Memory functioning (remote, recent, immediate)
 General Knowledge (compared to average person)
 Language (following instructions)
 Attention (performance on tests with #’s)
 Abstraction (performance on tests with similarities)
 Visual or special processing
 Insight (self-understanding)
 Judgement (problem-solving)

51
Q

what are the things to look for when you assess orientation?

A

1.Person
2.Place
3.Time
4.Level of orientation and consciousness
 Confusion
 Clouding of consciousness
 Stupor
 Delirium
 Coma

52
Q

Disorientation to person, place or time, characterized by
bewilderment and complexity

A

confusion

53
Q

Disturbance in perception or thought that is slight to moderate,
usually due to physical or chemical factors producing functional
impairment of the cerebrum

A

clouding of consciousness

54
Q

A state in which the client does not react to or is unaware of his
or her surroundings. May be motionless and mute but conscious

A

stupor

55
Q

Confusion accompanied by altered or fluctuating
consciousness. Moderate to severe disturbance in emotion,
thought and perception, usually associated with infections,
toxic states, head trauma, etc

A

delirium

56
Q

Ability to recall events in the immediate past and for up
to 2 weeks previously

A

recent memory

57
Q

Ability to recall remote past experiences such as the
date and place of birth, names of schools attended,
occupational history, chronologic data related to
previous illnesses

A

long-term memory

58
Q

what are some memory disorders?

A

hypermnesia
amnesia
paramnesia

59
Q

abnormally pronounced memory

A

hyperamnesia

60
Q

loss of memory

A

amnesia

61
Q

falsification of memory

A

paramnesia

62
Q

Ability to use facts comprehensively

A

intellectual ability

63
Q

what must u ask a pt when assessing intellectual ability?

A

 Names of persons or places (last three Prime
Ministers)
 Mathematical questions (calculate simple math
problems)
 Ability to form opinions (what would you do if you
found a wallet in front of your house?)

64
Q

Make distinctions between abstractions
 Interpret simple fables or proverbs

A

abstract thinking

65
Q

Self understanding or the extent of one’s
understanding about the:
 Origin
 Nature
 Mechanism of one’s attitudes or behaviour

A

insight

66
Q

Should determine
 Denomination
 Beliefs
 Spiritual practices
 Spiritual support system
 Are beliefs used as a coping mechanism?

A

spirituality

67
Q

Use non-gender-specific terms during interview
(eg: partner, them/they)
* Sexual identity
* Gender identity
* Sexual orientation
* Assess client’s comfort level when discussing
sexuality

A

sexuality

68
Q

what are neurovegetative changes?

A

sleep patterns’
eating patterns’
energy levels
sexual functioning
elimination patters

69
Q

Asking clients about their sleep patterns
and any problems with sleeping is an often-
neglected, but extremely important, area
to investigate:
* Insomnia
* Acute or primary insomnia
* Secondary insomnia

A

sleep patterns

70
Q

Difficulty initiating and maintaining sleep

A

insomnia

71
Q

Sleepiness and alertness that occur at an inappropriate
time of day relative to local time, occurring after repeated
travel across more than one time zone

A

jet lag

72
Q

Overwhelming sleepiness in which irresistible attacks of
refreshing sleep, cataplexy (loss of muscle tone) and/or
hallucination or sleep paralysis at beginning or end of
sleep episodes

A

narcolepsy

73
Q

Repeated awakenings from major sleep or naps with
detailed recall of extended or extremely frightening
dreams, usually involving threats to survival, security or
self esteem

A

nightmare disorder

74
Q

Characterized by insomnia associated with crawling
sensations in lower extremities, frequently associated
with medical conditions such as arthritis or pregnancy

A

restless leg syndrome

75
Q

Breathing related sleep disorder due to disrupted
ventilation or airway obstruction with lack of airflow.
Normal sleeping pattern completely disrupted several
times throughout night

A

sleep apnea

76
Q

Recurrent episodes of abrupt awakening from sleep
usually accompanied by panicky scream, intense fear,
tachycardia, rapid breathing and diaphoresis
* unresponsive to efforts of others to provide comfort
and no detailed dream recall

A

sleep terror disorder

77
Q

how do we assess for ideas of harming self or others?

A

Inquire about suicidal or homicidal thoughts
 Target (self or other)
 Frequency
 Intent
 Plan (Lethality of means, means or opportunity to
carry out the plan

78
Q

how do we assess pain?

A

Assess level of pain using pain intensity age-
appropriate rating scale
 Client self report of pain most reliable indicator
 If unable to verbally communicate look at
nonverbal

79
Q

Information is used to
plan treatment.
* Develop nursing diagnosis.
* Predict outcomes
* Set goals for client
behavior.
* Measure impact of
treatment
* Evaluate client response to
goal/treatment.

A

global assessment of functioning

80
Q

a handbook for mental
health professionals that lists different
categories of mental disorders and
the criteria for diagnosing them
The manual has been revised six
times since its inception
Organizes each psychiatric diagnosis
according to different aspects of a
specific disorder or disability

A

DSM-V

81
Q

informal supporters or caregivers are prone to:

A

depression
anxiety
grief
fatigue
changes in social relationships
other issues

82
Q

what do we document for assessment data?

A

Objective
* Descriptive
* Complete
* Legible
* Dated
* Logical
* Signed

Mental Health (13 decks)

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