W3: Mental health and Blood Pressure Flashcards
Define mental health/ mental illnesses
Mental Health: is the capacity of each us to think and act in ways to enhance our life. Balance in all life aspects.
Mental Disorder: constellations of occuring symptoms that alter state of thoughts, emotions , expereince.
Mental Health in Substance Use
Connected and involve inter personal violence, shown to relate to subtance use issues
Mental Health Nursing Assessment
- Essential to first build rapport between client and nurse.
- Comprehensive mental health nurse assessment where basic functions are assessed first such as behavior, language, and consciosuness.
Mental Health Stigma
Negative stereotypes potrayed towards a particular group. This can often hinder healthcare and seeking help to reasources.
Main Indications for Mental Health Screening
- Behavior changes such as depression, anxiety
- Stroke
- Aphasia damage
- Symptoms of pyschiatric illness
Main components to Mental Health Assessment
- Acute: asking the safety questions first, risk for injury, harm to self or others, depression
- Interview of health history
- Observations: apperance, behavior, cognititive abilities
- Physical Exam: Health examinaition
- Collaboration: risk assessment
Subjective data gathered
- Primary source of the pt what they are saying to the nurse, what is overheard, what family said
- Rapport first, focused questions
Objective data gathered
Objective data gathered from observing paitent and their behavior. In general survey, physical presenttaion may be indicator of medical issues or toxicity. Involves apperance, cogniitive, behavior, thoughts, body structure
Physcial apperance
- Posture: relaxed, erect
- Body movements: pacing, sitting still
- Dress: atire
- Hygine: clean, dirty
Behavior
Level of Consciousness AxO ( alert and oritented)
Facial expressions: appropiate changes
Mood and affect : appropiate mood and change
Speech: words
Cognitiion
Consciousness: awareness of thoughts
Orientation: awareness of world reltion to self
Immediate memory
Attention and concentration: impaired attention
Thought Processes
Perception: awareness , illusions
Thought Content: content with ideas and use of words
Thought Process: train of thoughts
Insight and judgment: awareness of reality
Judegment
Why cognitive screening
Detects cognitive impairments, need for future testing done
Delirum / Dementia
Assess for overall issues
Mini Mental State Examination MMSE
Done commonly for issues with memory or cognitiion and concern of impairment from family and friends. People with known demenitia , used to assess the severity. Series of questions and tests gather a score and test various aspects to mental abilities. Looks for potenital issues in future.
–> compliants cognitive issues from family suggest impairment. people with known demenita
–> Used by clinicans to assess dementia paitents.
Montreal Cognititive Assessment MoCA
Quick to adminster, best alternative screening test for mild cognitive impairments ( alzhheimers, dementia)
Brief 30 questiom test around 10-12 min to assess people for dementia. Assess oritentation, memory, lanuage, clock drawing, attention, recall etc.
Risks Management
- Sucidal Thoughts: assess for risk of self harm
- Assultive homidal ideation: inquries about past acts of harm, violence., do you have thoughts of hurting someone
- Elopement Risk: risk for injury
Charting
Apperance: posture erect, body movements, hygine
Behaviror: LOC, facial expressions, speech , affect and mood , speech
Congititive: oritented to time, person, self, memory, thoughts, oritentation
Thinking: perception, thought content, insight, judgement
What is trauma informed pratice
–> is a principle-based approach involving an understanding of trauma, its presentation, and its prevalence, to promote culture of safety, empowerment and healing.”
Trauma Principles
- Proxemics trust and safety
- View trauma through eyes of person
- Awareness of the adverse effects
- What trama can look like
-Surviors may learn to feel safe from trust, compassion
Realize, recognize, respond,
Examples of strength based language
” I am no longer the person I was “–> highlight what they can do , be positive. Humor, personality
What is functional Assessment ?
Person’s actual or intenitional ability to peform acitivties needed to live in society. older adults may have trouble being indepedent and living. This assessment focuses in on the effects of healh/illlnesss on clients quality of life. Clustering data looks like assessing their health dimensions in the enviornment.
What are Gordon’s 11 Functional health patterns ?
- Pattern of Health Perception / management
- Nutritional metabolic patten
- Pattern of elemination
- Pattern of activity and excerise
- Cognitive perceptual patterns
- Pattern of sleep/rest
- pattern self perception/ self concept
- Role relationship pattern
- Sexuality reproductive pattern
- Pattern coping and stress tolerance
- Pattern values/beleifs
Functional patterns ADL
Activities of daily living, are the activities usally performed in the course of a normal day and are nessary for self care. They include: eating, dresssing, washing, brushing teeth, toileting, housekeeping
Instrumental Activities of Daily Living
These are the functional abilities required for independent living
- Shopping, meal prep, banking, meds
