Unit Four - Management of Mental Illness

What labs are used to assess for common physical causes?

Liver function tests, kidney labs

Urine drug screen

Hypo/hyperthyroidism

appearance section of MSE

grooming and dress

hygiene

pupils

facial expression

height, weight, nutritional status

piercings, tattoos, scars

relationship between appearance and age

behavior section of MSE

body movements (excessive or reduced)

peculiar movement (LOC, balance, gait, scanning environment, gestures)

abnormal movement (tremors, tardive dyskinesia)

level of eye contact

speech section of MSE

rate

volume

disturbances (articulation, slurring, stuttering, mumbling)

mood section of MSE

affect: flat, bland, animated, angry, withdrawn, appropriate to context

mood: sad, labile, euphoric

disorders of the form of thought section on MSE

thought processes (disorganized, coherent, flight of ideas, neologisms, thought blocking, circumstantiality)

thought content (delusions, obsessions)

perceptual disturbances MSE

hallucinations (auditory, visual)

illusions

cognition MSE

orientation

LOC

memory

fund of knowledge

attention

abstraction

insight

judgement

ideas of harming self or others MSE

suicidal or homicidal history and current thoughts

presence of a plan

means to carry out the plan

opportunity to carry out plan

What are the elements of the psychosocial assessment?

previous hospitalizations

educational background

occupational background

social patterns (family, friends, support system)

sexual patterns (activity, safety, orientation)

interests

substance use (prescriptions, OTC, recreational)

coping abilities

spiritual assessment (importance, relation to self-care, impact on stressful situations)

health behaviors

What are examples of nonverbal communication impacting the message?

body behaviors (posture, movement, gait)

facial expression (frown, smile, grimace)

eye expression and gaze

voice-related (tone, pitch, intensity, inflection)

autonomic responses (respirations, pupils)

personal appearance (grooming, dress, hygiene)

physical characteristics (height, weight, physique)

Role of an open-ended question

gives power to the patient to share. they decide the direction of the conversation

Role of a close-ended question

used to collect specific information. answered yes/no

Role of a projective question

allows patient to explore, articulate, and identify thoughts or feelings

Example of projective question

“what if you could go back to change a life event? what would you DO differently?

Purpose of the miracle question

goal identification and setting

Example of the miracle question

“what if a particular problem vanished - what would BE different?”

How does culture contribute to communication?

What is the nurse’s role in restraint management?

predictors of violence

hyperactivity (pacing, restlessness)

increasing tension or anxiety

verbal abuse

What can the nurse do to reduce the risk of violence?

Example of silence

encouraging a person to talk by waiting for the answers

Example of acceptance

“yes”

“I’m following”

“go on”

just indicates that the person has been understood - not necessarily agreed with

example of giving recognition

“Good morning, Mr. James”

“I noticed you went to group today”

“You’ve eaten your whole lunch”

is giving recognition good/bad or right/wrong?

no, it’s neutral

simple awareness of a personal effort

example of offering self

“I’ll stay here and sit with you for a while.”

“Can I listen?”

example of offering general leads

“Go on…”

“And then…”

“Tell me about it”

basically the same thing as acceptance

examples of giving broad openings

“Where would you like to start?”

“What are you thinking about?”

“What would you like to talk about?”

example of placing events in time or sequence

“What happened before this?”

“When did this happen?”

example of making observations

“You look tense”

“I notice that you’re biting your lip/tapping your foot/picking at your nails”

“You seem nervous whenever ___ enters the room”

examples of encouraging description of perception

“what are the voices saying?”

“what is happening now?”

“tell me when you feel anxious”

benefits of encouraging description of perception

talking about feelings and struggles can lessen the need to act them out inappropriately

examples of encouraging comparison

“has this ever happened before?”

“is this how you felt…”

“was it something like…”

restating

repeats main idea expressed

patient can clarify if message has been misunderstood

reflecting

directs questions, feelings, ideas back to the patient

“what do you think you should do?”

focusing

concentrates attention on a single point. useful if jumping from topic to topic

“you’ve mentioned a lot of things. let’s go back to your thinking of ending it all”

example of presenting reality

“Your mother is not here. I am a nurse”

“That was Dr. Todd, not a man from the Mafia”

summarizing

brings together important points when someone is going on and on

“have I got this straight?…”

“you said that…”

encouraging formulation or plan of action

“What could you do to let the anger out harmlessly?”

“The next time this comes up, how might you handle it?”

Alternative to giving premature advice

encourage problem solving

“what are the pros and cons of this situation?”

“what are some ways you’ve thought of meeting your goals?”

alternative to minimizing feelings

empathize and explore

“you must be feeling very upset. are you thinking of hurting yourself?”

alternative to falsely reassuring

clarifying the patients message

“what specifically are you worried about?”

“what do you think could go wrong"?”

alternative to making value judgements

making observations

“I notice you’re still smoking even though your wife has lung cancer. Is this a problem?”

alternative to asking “why” questions

ask OPEN ENDED questions and give a broad opening

“tell me some of the reasons that led up to you not taking your medication”

alternative to asking excessive questions

clarifying

“tell me about your eating habits since you’ve been depressed”

alternative to giving approval and agreeing

make observations and ask open ended questions

“I noticed that you applied for that job”

“What led to that decision?”

alternatives to disapproving and disagreeing

exploring

“what was going through your head when you decided not to come to group?”

“how did you arrive at that conclusion?”

alternatives to changing the subject

validating and exploring