Psych exam 1 content

what is mental health

state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. — regarding mental health/ illness

Nurse is assessing the factors contributing to the well-being of a newly admitted client. Which of the following would the nurse identify as having a positive impact on the individual's mental health?

the ability to effectively manage stress

Which of the following statements about mental illness are true?

mental illnesses can cause significant distress, impaired functioning, individuals usually able to cope effectively with daily life, may experience dissatisfaction with relationship and self

Mental Disorders manifest as alterations in ?

thinking, mood, or behavior (alone or in combination) associated with distress and/or impaired functioning.

The dynamic continuum

mental health (successful function) on one end and mental illness (impaired function) on the other end.

A client grieving the recent loss of her husband asks if she is becoming mentally ill because she is so sad. The nurse's best response would be,?

you are not mentally ill, this is an expected reaction to the loss you have experienced

influences that effects mental/ illness

society, cultural beliefs and religious beliefs

behavior that effects mental health/illness

acceptable, appropriate

Massachusetts was first training nurses

1882

DSM IV-TR, DSM V

Provides a standardized language for all mental health professionals — serves as a guide for client assessment, Defines characteristics/ symptoms, Identifies underlying causes of disorders

nursing student would use DSM

to understand the reason for admission and nature of psychiatric illnesses

Circumstances to appoint a legal guardian

gravely disabled, mentally incompetent, unable to provide basic needs when resources exist

Positive Attitude Towards Self

clear about strengths and weaknesses strong sense of personal identity

Dorothea Dix (1802 – 1887)

reformer and activist for humane treatment of mentally ill; lobbied for the creation of hospitals for the mentally ill; advocated adequate shelter, nutritious foods, and warm clothing

Sigmund Freud

connected the mind to the behavior evident in the mentally ill psychosocial analysis— study of human behavior

Psychopharmacology

psychotropic drugs used to treat mental illness

chlorpromazine

the first antipsychotic used; tricyclic antidepressants used for mood disorders

chlordiazepoxide

the first benzodiazepine (anti-anxiety) introduced

haloperidol

FDA approved as an antipsychotic

if prescribes and refuses med?

accept the client’s decision

1963: Community Mental Health Act:

funding for construction of mental health centers; community based care

Goal of the community health act

deinstitutionalization state hospitals (on keri’s — deinstitutionalize = community)

Revolving Door Effect

Shorter LOS /Frequent admissions — escalating? keri’s

Linda richards

America’s first trained nurse; consulted with Florence Nightingale; pioneered nurses’ training; worked for training psychiatric nurses and humane treatment of psychiatric patients

if client depressed/ suicidal? who should sign consent?

the client

Hildegard Peplau

published Interpersonal Relations in Nursing — she described therapeutic nurse- client relationship

Voluntary admission

willing to seek treatment and agree to be hospitalized may sign out after a specified time provided they don’t represent danger to themselves/ others (48 to 72 hours) unless admission status changed

if voluntary but then makes comments of “ending it all”, wants to leave AMA, what is most appropriate action?

contacting the psychiatrist for initiation of commitment proceedings

Involuntary admission

person is danger to self or others — can leave when no longer pose danger to themselves or others

Involuntary admission reason

suicidal thoughts/tendecies, homicidal, gravely disabled (not able to make decisions)

An example of someone who needs to be involuntary admitted

unable to control rage and is assaulting everyone around him

The client is paranoid and upset and states, “No one can be trusted.” Which of the criteria for involuntary admission does this client meet?

DOES NOT meet any necessary criteria

If committed client is found to be incompetent

loses rights under Patient’s Bill of rights

During involuntary

Keep all rights except right to freedom

How long can someone be detained in psychiatric facility on an emergency basis until hearing is conducted?

48-72 hrs

Legally mandated/ assisted outpatient treatment

is the requirement the clients continue to participate in treatment

on involuntary basis after release from the hospital — 48 states

Individuals that are eligible for outpatient commitment:

has a mental illness that causes them to be a danger to self, others, or property, is noncompliant with needed treatment, **A client who is addicted to alcohol who had two DUI offenses

Confidentiality and right to privacy

HIPPA— law guarantees the privacy and protection of health information

if someone calls to ask about status of patient?

cannot confirm or deny the existence of any client

Disclosure of client info beyond interdisciplinary team without consent breach of?

confidentiality

involuntary confinement

require face to face evaluation by a licensed independent practitioner within 1 hour of restraint

When can you place restraints?

if client is aggressive, is imminently dangerous to himself/ others, all other means of calming the client has been unsuccessful

placing a client in restraints before using other methods violates right to

receive tx in least restrictive

Nurse can initiate restraints but ?

within an hour provider needs to come down and give an order

Medical Restraint

order good for 24 hours ex. confused patient pulling out IVs

Behavioral Restraint

good for 4 hours ex. protects patient from immediate harm to self/ others

nurse offers meds but refuses “any drugs” staff realizes that legally this client can?

refuse treatment

Duty to warn third parties

Exception to confidentiality, Based on California Supreme Court decision —Tarasoff vs. Regents of the University of California (1969), Mental Health Clinicians have duty to warn identified 3rd parties of threats made by clients

a jealous man states “ i am getting my gun and going to shoot my wife’s

lover” if threats are made to an identifiable third party

legal obligated to break confidentiality

Nurse tells patient, one more word and you’ll stay in the room the rest of the day?

inappropriate; room restriction is not treatment in the least restrictive environment

Deontology

theory that says decisions should be based on whether or not an action is morally right with no regard for the result or consequences

Ethics

branch of philosophy that deals with values of human conduct related to rightness/ wrongness of actions and the goodness/ badness of the motives and ends of such actions

Prevention of liability

Practice within the scope of state laws and nurse practice act.

Collaborate with colleagues to determine the best course of action.

Use established practice standards to guide decisions and actions.

Always put the client’s rights and welfare first.

Autonomy

right to self determination through patients right and informed consent — guide the decision on appropriate use of seclusion

Beneficence

advocating- doing good, working for another best interest

Non-maleficence

doing no harm — assuring that the restraints are not causing injury to the client, ex. practicing safe take-down techniques for aggressive patients

Justice

Fair and equal treatment for everyone

veracity

truthfulness and honesty

fidelity

obligation to honor commitments

ex. of dilemmas involving fidelity

when the nurse is unable to agree with the policies or common practices of an agency & when the nurse is faced with decision to violate a policy that is harmful to the client

Utilitarianism

if client very noisy and combative & others are worried, so you seclude patient

Ethical Dilemmas

situation in which ethical principles conflict or when there is no clear course of action in a given situation, A choice must be made between two equally unfavorable alternatives

Why are ethical dilemmas challenging to nurses?

Ethical dilemmas are often charged with emotion

Implied consent

going to the hospital and getting vitals taken butttt if getting scope done, its more invasive

If voluntary suicidal — 2 days committed and still suicidal & want to leave?

they cannot, they need to go into committed status

Involuntary Commitment - Individuals must be assessed by designed screening staff(individuals can be assessed at a screening center, emergency room, or acute care unit).

certified screener & 2 psychiatrists— judges makes decision

Legal Guardian

gravely disabled, mentally incompetent, unable to provide basic needs when resources exist

standards of care are developed from which?

Code of Ethics for Nurses with Interpretive, Statements,State Nurse Practice Acts, Agency job descriptions,Professional nursing organizations

if you suspect fellow nurse is taking drugs what to do?

Report to nurse manager

Battery

touching without consent, neither require harm or injury — ex. client

undergoing procedure before the nurse verifies the client’s signature on the consent form

False imprisonment

unjustifiable detention of client

During the rounds the client is discovered to completed a suicide attempt in the bathroom, which type of lawsuit could the clients family file?

malpractice

psychosocial assessment purpose?

assess current emotional state, mental capacity, behavioral function

during assessment describe problems to obtain info about ?

perception of the problem

General appearance & Motor Behavior

hygiene & grooming— dirty unkept, appropriate dress, posture, hunched over & looking on the ground , eye contact avoiding , unusual speech or mannerisms

Mood

sustained emotion — sad, depressed, anxious & affect — expression of emotion, facial expressions

neologism

invented word that have meaning only for the client

Delusions

false fixed beliefs; they are irrational — problem in thinking — “special powers”

example of a delusion

patient stating he is 14 trillion years old & “ I am president of the largest corporation in the world…

Loose association

disorganized thinking that jumps from one idea to another — no evident relation between thoughts

flat affect

showing no facial expression

tangentially

never gets to the point — ex. wandering off the topic and never answering the question

Circumstantiality

eventually gets to the point — only after excessive unnecessary detai

Which of the following are components of the assessment thought process and content?

what the client is thinking, how the client is thinking, clarity of ideas, self-harm or suicide agents

labile mood

if client has been laughing & euphoric, then angry and crying for no reasons

Suicidal / homicidal patients must be asked directly

“Are you having thoughts of killing yourself?”

Focus assessment

determines seriousness of the threat; existence of a plan; means to carry out the plan Look and listen for clues and warning signals

ideation

are you thinking of killing yourself

plan

do you have a plan to kill yourself

method

How do you plan to kill yourself

access

how would you carry out this plan

confusion or memory loss

verify , what did you do yesterday? ex. who is the current president

concentration

follow directions, nurse asks to list days of the week in reverse order

abstract thinking

if only concrete or literal then communication with patients is concrete

example of abstract thinking

a stitch in time saves nine and restate in own words & ex. what do I mean when I say, “don’t sweat the small stuff”

illusions

misperception of something real

hallucinations

involve the 5 senses — false sensory perception that do not really exist — seeing things & hearing things

judgment

affects safety

example of assessing judgement

if you find yourself downtown without money or care, how would you get home? & getting pulled over, what did you do next?

insight

understanding of a situation