Mental Health Exam 1

what are the 6 steps of the nursing process?

assessment

diagnosis

outcomes

planning

implementation

evaluation

who is the primary source?

the patient

what is the purpose of a psychiatric nursing assessment?

to assess psychosocial status

identify mutual goals for treatment

formulate a plan of care for the immediate condition and needs

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what does a mental status exam evaulate?

the current cognitive processes

* it is more objective

what do you observe during a mental status exam?

appearance, nonverbal communication, speech patterns, mood and affect, thought processes, cognition, and insight and judgment

what is a psychosocial assessment?

it provides more information along the MSE to help with the plan of care

* more subjective

what does a psychosocial assessment consist of?

patient’s chief complaint (in their own words)

previous hospitalizations

educational/occupational background

social patterns

sexual patterns

interests

substance use/abuse

coping abilities

spirituality assessment

cultural assessment

what technique is used for a psychosocial assessment for adolescents?

HEADSSS:

home environment

education and employment

activities

drugs, alcohol, and tobacco

sexuality

suicide risk

“savagery”

what does a nursing diagnosis consist of?

the problem , the etiology, and the supporting data

what is the purpose of a risk diagnoses?

made to help prevent a potential unwanted or dangerous future event in an effort to ensure patient safety

* high probability of a future negative event for a vulnerable individual
* EX. risk for suicide

when are health promotion diagnoses used?

when clinical observations and/or patient (family, group, etc.) statements indicate a willingness and a wish to enhance specific health behaviors

what should outcomes identification reflect?

Reflect maximal patient health that can be realistically achieved through evidence-based interventions

how should goals be set up?

* measurable
* indicate the patients’ desired behavior
* include a set time for achievement
* short and specific

what should occur during the implementation step?

health teaching and promotion

* such as pharmacological, biological, and integrative therapies

what should occur during the evaluation?

include supporting data

enables revisions to diagnoses, outcomes, \n and interventions

* it is systematic, ongoing, and criterion-based

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what is the 7th nursing process step?

documentation

what is the SOAPIE format?

**S:** Subjective data (patient statement) \n **O**: Objective data (nurse observations) \n **A:** Assessment (nurse interprets S and O and describes \n either a problem or a nursing diagnosis) \n **P:** Plan (proposed intervention) \n **I:** Interventions (nurse’s response to problem

**E:** Evaluation (patient outcome)

what is evidence based practice?

* scientifically grounded methods
* research on biology and treatments

what is the recovery model’s principle?

believes that addicts can recover and lead on full lives

* social model of disability
* includes AA’s 12 steps

how does the recovery model help patients?

encouraging supportive relationships, engagement in community/social life, and a reduction of symptoms

what does trauma-informed care provide?

provides guidelines for integrating an understanding of how trauma affects patients into clinical programming

* change from “what is wrong with you?” to “what has happened to you?”
* avoid retraumatizing the patient

which level of evidence shows the strongest evidence?

level 1: systematic reviews or meta-analyses of randomized controlled studies and evidence-based clinical practice

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what is the weakest level of evidence?

level 7: expert committee reports, opinions, clinical experience, and descriptive studies

what are resources for clinical practice?

1. internet resources
2. clinical practice guidelines
3. clinical algorithms
4. clinical/critical pathways

what is a clinical algorithm?

step-by-step guidelines prepared in a flowchart or decision-tree format

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what are clinical/critical pathways?

serve as a “map” for specified treatments and interventions to occur within specific time frames that have been shown to improve clinical outcomes

* can include tests, health teaching, and medications
* EBP

what do clinical practice guidelines increase?

can increase the quality and consistency of care and facilitate outcome research

how do you integrate EBP into clinical practice?

1. ask a question
2. acquire the literature
3. appraise the literature
4. apply the evidence
5. assess the performance

* the 5 A’s

what is the research-practice gap?

the best evidence treatments and their effective translation into practice

what is the need for research-practice gap?

continued research on how best to apply the findings of clinically relevant issues

what are the 6 QSEN competencies?

* Patient-centered care
* Teamwork and \\n collaboration
* Evidence-based practice
* Quality improvement
* Safety
* Informatics

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what does the art of nursing consist of?

caring

attending

patient advocacy

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what does a caring nurse indicate?

a competent nurse

what does attending indicate?

being present

using therapeutic communication -verbal and non-verbal

what does advocating for a patient indicate?

* Providing informed consent, including refusal of treatment
* Respecting patient decisions
* Protecting against threats to well-being
* Being informed about best practices (accurate and current information)

why are mental illnesses and mental health NOT specific?

because they exist on a continuum

what percentage of people in the US will experience mental illnesses in their lifetime?

50%

what are some attributes to mental health?

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what is the diagnostic and statistical manual of mental disorders (DSM-5)?

the current official guidebook for categorizing and diagnosing psychiatric mental health disorders in the United States

does the DSM-5 identify the patient?

NO; classifies a disorder a patient has

what is resiliency?

the ability to recover from or adjust successfully to trauma or change

what is the mental health parity act(1996)?

requires insurers to offer mental health benefits at the same level provided for medical coverage

what are some factors that affect mental health?

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how does the “stigma” affect mentally ill patients?

stigma of mental illness affects how an individual is viewed

* affects housing, employment, and health services


* has harmful effects on the patient and family

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what is freud’s psychoanalytic theory?

most psychological disturbances are the result of early trauma or incidents that are often not remembered or recognized

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leads to the personality structure which includes: the id, ego, and superego

what is the id?

the primitive, pleasure-seeking, and impulsive part of our personalities that lurks in the unconscious mind

what is the ego?

problem solver and reality tester that navigates in the outside world

what is the superego?

represents the moral component of the personality that Freud referred to as our conscience (our sense of what is right or wrong)

* greatly influenced by parents or caregivers

what are the levels of awareness?

conscious, preconscious, and unconscious

what is the conscious level of awareness?

thoughts, beliefs, and feelings

what is the preconscious level of awareness?

information that is not currently the subject of our attention, but accessible

what is the unconscious level of awareness?

biggest chunk; seat of primitive feelings, drives, and memories, especially those that are unbearable and traumatic

what are the erogenous body zones?

parts of the body that excite sexual feelings when stimulated

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personality formation is associated with this

what erogenous zones does the id focus on?

the oral, anal, and phallic zones

what is transference?

occurs as the patient projects intense feelings onto the therapist related to unfinished work from previous relationships

ex. patient treats therapist differently because they remind them of their sister

what is countertransference?

redirection of a pscyhotherapist’s feelings onto a client

what is pavlov’s behavior theory?

classical conditioning-- pavlov’s dogs became accustomed to receiving food after a bell was rung

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associated being fed when the bell rung

what is watson’s behavior theory?

believed behavior is learned-- conditioned a 9 month old child to be terrified at the sight of white fur

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concluded that anyone can be trained to be anything

what is skinner’s behavior theory?

operant conditioning-- conditioned behaviors through positive and negative reinforcement

what is behavioral modification?

a technique used to correct or eliminate maladaptive behaviors by rewarding and reinforcing adaptive behavior

what is the systematic desensitization?

based on classical conditioning-- this theory attempts to reverse a learned response by promoting relaxation and then gradually facing an anxiety-provoking stimulus

what is the systematic desensitization usually used to treat?

extreme fears and phobias

what is aversion therapy?

therapy based on both operant and classical conditioning that is used to eradicate unwanted habits by associating unpleasant consequences with them

what is biofeedback?

a technique in which individuals learn to control physiological responses (breathing, HR, etc.)

* achieved by providing visual or auditory biofeedback of the physiological response and then using relaxation techniques such as slow, deep breathing or meditation

what are maslow’s hierarchy of needs?

classification of needs ascending from basic biological needs to more complex psychological motivations

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from most complex to basic:

self-actualization

self-esteem

love and belonging

safety and security

physiological needs

what is cognitive-behavioral therapy?

a therapeutic tool based on both cognitive and behavioral theories that seek to modify negative thoughts that lead to dysfunctional emotions and actions

what do biological theories suggest?

mental disorders are from physical causes

what are some examples of biological therapy?

medications, electroconvulsive therapy(ECT), and other brain stimulation therapies

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usually used in conjunction to talk therapies

what is piaget’s theory of cognitive development?

suggests that cognitive development is a progression from primitive awareness to complex thought and responses

what are the stages of cognitive development?

* sensorimotor: object permanence--birth to 2 years


* preoperational: language; egocentric thinking-- 2 to 7 years
* concrete operational: conservation, logic, abstract problem solving, patterns, and reversibility-- 7 to 11 years
* formal operational: conceptual reasoning-- 11 to adult

what is erikson’s stages of psychosocial development?

a theory that supports the continuation of our personality as we age

what stage of development would an infant be in?

trust v. mistrust-- birth to 1.5 years

what stage of development would an toddler be in?

autonomy v. shame/doubt-- 1.5 to 3 years

what stage of development would an preschooler be in?

initiative v. guilt-- 3 to 6 years

what stage of development would an school-age child be in?

industry v. inferiority-- 6 to 12

what stage of development would an adolescent be in?

identity v. role confusion -- 12 to 20

what stage of development would an young adult be in?

intimacy v. isolation --20 to 30 years

what stage of development would an middle-aged adult be in?

generativity v. self-absorption --30 to 65

what stage of development would an older adult be in?

integrity v. despair -- 65 to death

what does a therapeutic milieu refer to?

a healthy environment--people, setting, structure, and emotional climate are all important to healing

what did the affordable care act of 2010 do?

* allowed young adults to stay on parent’s health insurance up to age 26
* banned dollar limits
* mental health is no longer a pre-existing condition

what are some communication factors?

emotional and social factors

cultural and language factors

lifestyle differences

cognitive differences

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what are some cultural considerations for communication?

1. communication styles
2. use of eye contact
3. perception of touch
4. cultural filters

what is the function of acetylcholine?

enables muscle contraction for motor movement, learning, and memory

what is the function dopamine?

influences movement and attention; alertness

what is the function of endorphins?

controls pain, reduces stress, and promotes feelings’ of pleasure-- natural opiate

what is the function of GABA?

this is the brain’s major inhibitory neurotransmitter

what is the function of glutamate?

this is the brain’s major excitatory neurotransmitter; it creates a links between neurons that form basis of learning and long-term memory

what is the function of norepinephrine?

activates “fight or flight” -- alertness, elevates mood, and increases heart rate and circulation

what is the function of serotonin?

regulates mood, hunger, and sleep

what can a deficit in acetylcholine result in?

alzheimer’s disease, parkinson’s disease, and huntington chorea

what might an excess of acetylcholine result in?

depression

what might an excess of dopamine result in?

schizophrenia

what neurotransmitter deficits may result in parkinson’s disease?

acetylcholine and dopamine

what neurotransmitter deficit might potenitally be involved in addiction?

endorphins

what might a deficit in GABA result in?

seizures or insomnia

what might an excess of glutamate result in?

overstimulation of the brain--seizures

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avoid foods with glutamate (MSG)

which neurotransmitter deficits can result in a depressed mood?

norepinephrine and serotonin

what are the functions of the occipital lobe?

vision and color

what are the functions of the frontal lobe?

reasoning, thinking, planning, expressive language, emotions, judgment, motor function, movement, and short term memory