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Psych Exam 1 > Psychosocial Assessment > Flashcards

Psychosocial Assessment Flashcards

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1
Q

Basic Interview Stages

A
  1. Opening/Introduction (sets the tone)
  2. Body/Development (patient responds to questions)
  3. Closing (termination of the interview)
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2
Q

Opening/Introduction

A
  • establish rapport
  • explain purpose and nature of interview

“MAY I SIT DOWN FOR ABOUT 10 MINUTES TO
TALK ABOUT WHAT BROUGHT YOU INTO THE HOSPITAL?”

“ FEEL FREE TO SAY IF THERE IS ANYTHING YOU DON’T WANT TO TALK ABOUT.”

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3
Q

Body/Development: Types of Interview Questions

A
  • Closed
  • Open-ended
  • neutral
  • leading
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4
Q

Closed Questions

A

answer is restricted to few words

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5
Q

Open-ended Questions

A

invitation to explore thoughts/feelings

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6
Q

Neutral Questions

A

freedom to answer without pressure

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7
Q

Leading Questions

A

limits accuracy of response

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8
Q

Body/Development Techniques

A
  • listen attentively
  • use simple language
  • clarify points not understood
  • question in logical sequence
  • ask one question at a time
  • do not impose own values
  • avoid using personal examples
  • convey respect and interest
  • be aware of body language
  • be aware of voice
  • sit at even level
  • use silence to allow patient to organize thoughts
  • use eye contact ad be unhurrried
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9
Q

Closing Techniques

A
  • offer to answer questions
  • offer clear conclusion
  • thank the patient
  • express concern for future welfare
  • plan for next meeting
  • provide a summary
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10
Q

Considerations

A
  • effective nurse communication
  • holistic approach
  • interview environment
  • patient’s developmental level
  • patient emotional factors
  • patient family factors
  • patient culture
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11
Q

Goal to the psychosocial assessment

A

to understand the patient

evaluates:
- mental health and illness
- social well-being
- perception of self
- ability to function in community
- multiple domains of mental status

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12
Q

Components of the Psychosocial Assessment

A
  • identify patient
  • chief complaint
  • history of present illness
  • psychiatric history
  • med/surg history
  • medication list
  • alcohol/drug use
  • family history
  • developmental history
  • social history
  • violence risk
  • mental status exam
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13
Q

Social History Components

A
  • social relationships
  • living situation
  • significant life events
  • employment
  • education
  • legal
  • spiritual
  • cultural
  • financial situation
  • coping skills
  • interests/hobbies
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14
Q

Obtaining Military History

A

General question: Would it be okay if I asked you about your military experience?

If yes,

  • how has military affected you?
  • did you see combat, enemy fire, or causalities?
  • were you or a buddy wounded, injured or hospitalized?
  • do you have a service-connected condition?
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15
Q

Mental Status Exam

A
  • analogous to the physical exam
  • assessment of brain fx (mental function, emotions, behaviors)
  • some aspects obtained by observation
  • some aspects obtained by direct questioning
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16
Q

Mental Status Exam Components

A
  • general apperance
  • motor activity
  • speech/communication
  • emotional state
  • thought content
  • thought processes
  • perceptual disturbances
  • cognition
  • abstract reasoning
  • insight and judgement
17
Q

General Apperance

A
  • apparent age
  • dress
  • hygiene/grooming
  • posture
  • facial expression
  • eye contact
  • pupils
  • general state of health/nutrition
  • acute distress
18
Q

motor activity

A
  • rate of movement
  • gait
  • unusual movements
19
Q

rate of movement

A
  • slowed=bradykinesia

- agitated=hyperkinesia

20
Q

Gait

A
  • freedom
  • pacing
  • posture
21
Q

Unusual movements

A
  • tics
  • tremors
  • jitteriness
  • hand wringling
  • muscle spasms
  • lip smacking
  • unable to remain still (akathisia)
22
Q

Communication

A

process of content being expressed

  • resistant
  • disorganized
  • negative
  • requires prompting
23
Q

Speech

A

how content is articulated

  • fluency
  • rate
  • amount
  • tone
  • volume
  • repetition
24
Q

Mood

A

subjective emotional state

  • sad
  • angry
  • guilty
  • anxious
25
Q

Affect

A

outward expression of emotional state

  • flat
  • blunted/constricted
  • tearful
  • euthymic
26
Q

Types of thoughts

A
  • phobias
  • hypochondriasis
  • ideas of reference
  • magical thinking
  • obsessions/preoccupations
  • thought insertion
  • thought broadcasting
  • suicidal ideation*
  • homicidal ideation*
  • delusions
27
Q

Types of Delusions

A
  • grandiose
  • persecutory
  • jealously
  • religious
  • somatic
  • ideas of reference
  • thought insertion
  • though broadcasting
28
Q

Thought Process

A

description of how thoughts are formulated, organized, and expressed

29
Q

Hallucinations

A
  • perceptions in the absence of stimuli to account for them
  • may involve any of 5 senses
  • auditory most common (command vs. non command)
  • do you hear voices when no one is around
30
Q

illusions

A

misperception of stimuli, mistaking wind for a voice

31
Q

depersonalization

A
  • feeling detachment from oneself

ex: looking down and seeing oneself

32
Q

derealization

A
  • feeling environment has changed

- ex: feeling a barrier between oneself and the world

33
Q

Cognition

A

-alertness
-orientation
-memory
-calculations
concentration/attention
-visuspatial ability
-abstract reasoning

34
Q

insight

A
  • patients understanding of: own feelings, how presenting and functioning, potential causes of psychiatric symptoms
  • reality testing with psychosis “I know there are not little men in my home, but I can see them and hear their voices”
35
Q

Judgment

A
  • capacity to make healthy decisions, also to act on healthy decisions
  • may or may not correlate with level of insight
  • can be tested with hypothetical examples
  • recommended to use real patient situations
36
Q

Functional Ability

A
  • self-care
  • socialization
  • appetite
  • sleep

Psych Exam 1 (5 decks)

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