NURS 222: Mental Health-Mental Health & Illness (Week 1)

Origins of mental health

Germs

&

Genetics

until 1952-Neurotransmitter imbalance

-chlorpromazine was discovered

>1st antipsychotic ever created: reduces dopamine

Decreases psychosis (caused by dopamine)

Diathesis

biological predisposition

-that someone is at risk for a illness

>possible genetic connect

Manage via modifiable risk factors

Stress

Enviorment

Trauma

-most expected explaination for mental illness

>can be modified

Adaptive & Maladaptive Coping

Adaptive-Good coping skills

>Music

>Hobby

Maladaptive-negative coping skills

>ETOH

>Drugs

>Smoking

>Cutting

>Agression

A mentally healthy person

Able to

Think rationally

Be resilient/cope w/ stress

Have a healthy self esteem

Foster meaningful relationships

Grow emotionally/psychosocially

DSM-5

Diagnostic and Statistical Manual of Mental Disorders 5th edition

Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders

IDs disorders based on criteria

Mental illness defined by

Psychologist

or

Psychiatrist

Mental health defined by the culture

Resilience

Being resilient does not mean being unaffected by stressors; it means recognizing the feelings, readily dealing w/ them, and learning from the experience rather than falling victim to negative emotions

Everyone is resilient to a degree, a degree that can be enhanced w/ help & practice, by identifying the problem, accepting what can't be changed, and focusing on what can be overcome

A person has a high level of resilience. Which characteristic would the nurse expect this person to have?

Nuse can expect this person to have an depressed effect

What assessment finding most clearly indicates that a patient may be experiencing a mental illness?

The patient reports a consistently sad, discouraged, and hopeless mood

Epidemiological studies

Incidents-how many cases in a time period

Prevalence-total cases (current+old) in a time range/period

We can see trends & risk factors that are associated w/ it

-by knowing this it can be treated, mitigated, or prevented

Freud-Levels of awareness

Three levels of psychological awareness

Conscious

Preconscious

Unconscious

Freud-Levels of awareness (Conscious)

Part of the mind that contains all the material a person is aware of at any one time including

-perceptions

-memories

-thoughts

-fantasies

&

-feelings

Freud-Levels of awareness (Preconscious)

contains material that can be retrieved rather easily through conscious effort

Freud-Levels of awareness (Unconscious)

All repressed memories, passions, and unacceptable urges lying deep below the surface

Memories and emotions associated w/ trauma may be stored here due to being too painful

Exerts an powerful/unseen effect

Usually can only be retrieved w/ a trained therapist

Freud-Personality structure

Three major and distinct but interactive systems of the personality

Id

Ego

Superego

Freud-Personality structure (Id)

Totally unconscious and impulsive (Brawn/Impulse)

-infants have this type of brain

Source of all drives, instincts, reflexes, and needs

Cannot tolerate frustration

Seeks to discharge tension

To return to a more comfortable level of injury

Lacks the ability to problem solve and is illogical

Freud-Personality structure (Ego)

1st few years of life ego develops (Brain)

Presides in all levels of awareness

Acts as the problem solver

-Attempts to navigate the world

Differentiate

-subjective experiences

-Memory images

-Objective reality

Freud-Personality structure (Superego)

Develops between the ages of 3-5

Moral component of personality

-resides in all levels of awareness

Consist of conscience morals (should nots)

-when situation is not ideal it can result in guilt

-if ideal it can result in pride

Freud-Transference

when a patient unconsciously and inappropriately displaces/transfers onto the nurses feelings and behaviors related to significant figures in the patients past

You remind me of my

-father

-mother

-sister

-brother

-etc

Freud-Countertransference

Transference in reverse

When a nurse unconsciously displaces feelings onto the patient

Maslow-Ethical Principles

The study of philosophical beliefs about wrong & right

Bioethics

-The study of specific ethical questions that arise in healthcare

Maslow-Ethical Principles (Beneficence)

They duty to act to benefit or promote the good of others

Ex. spending extra time to help calm an anxious patient

Maslow-Ethical Principles (Justice)

They duty to distribute resources or care equally, regardless of personal attributes

Ex. Treating a pt w/ a stroke & pt w/ suicidal idealizations equally

Maslow-Ethical Principles (Autonomy)

Respecting the rights of others to make their own decisions

Ex. patients right to refuse medicaiton

Maslow-Ethical Principles (Fidelity)

aka nonmaleficence

Maintaining loyalty and commitment to the patient & doing no wrong

Maslow-Ethical Principles (Veracity)

The duty to communicate truthfullly

-To educate the pt on all the informaiton/being truth full

Patient rights

Laws and regulatory standards require patients' rights be

Ex.

-Right to be treated w/ dignity

-Right to refuse treatment

-Right to keep personal belongings (unless dangerous)

-Right to informed consent

-ETC

Patient rights: Duty to warn

An obligation to warn third parties when they may be in danger from a patient

Duty to protect is the similar

-if a patient intends to harm a person a therapist may be required to call/warn the intended victim, family, or police

ACT (stands for)

Assertive Community Treatment team or ACT

Assertive Community Treatment team (ACT)

Intensive type of case management developed in the 1970s

In response to hard-to-engage, community-living needs of people with serious persistent psychiatric symptoms

ACT teams work in whatever environment and are available 24/7

Multidisciplinary & typically composed of psychiatric-mental health RNs, social workers, psychologist, advanced practice RNs

Cases can last years to stabilize the pt

or

ready to accept transfer to a more structured site

May require visits 3-5 times a week

Tort

Wrongful harm

Injury to person, property, or reputation

Types of Torts

Intentional

-assault

-battery

-false imprisonment

Unintentional

-negligence

-malpractice

Negligence

Failure to use ordinary care in any professional or personal situation, when you have the duty to

Not doing anything or being careless

Malpractice

professional negligence

Five elements

-Duty

-Breach of duty

-Cause in fact/Proximate cause

-Damages

Knowingly

Foreseeability of harm

-harm will happen but nothing is done

Elopment

leaving before being discharged

Levels of Prevention

Primary

-prevention

>immunization programs

>nutrition & fitness activities

>health education in schools

Secondary

-ID & Treating a illness

>Screening

>Treatment

Tertiary

-prevent long-term consequences of chronic ilness

>beings after injury/illness

>Support groups

>rehabilitation center

Inpatient Nursing Care (Level of Risk)

q15 min checks

1 to 1

-2 to 1

seclusion (locking pt in room w/ camera)

restraints

Must use least restrictive measures first

-can ween of or instantly DC

Seclusion & restraints will be DC when pt no longer needs it/safe

Criteria for 5150 hold

Dangerous/Harm to self (DTS)

Greatly disabled

Dangerous/Harm to others (DTO)

-can be voluntary

Last for 72 hours=3 days

Equal to ICU (most intensive)

-trying to stabilize the patient within the 72 hrs

5150 ends...

Psychiatrist can end or continue to 5250

-can do a hearing for the latter

Types of Hearing

Writ of habeas corpus

Riese hearing/medication capacity hearing

Conservatorship hearing

Writ of habeas corpus

hearing that judge decides if the patient stays or can be off the 5150

Riese hearing/medication capacity hearing

The judge decides to remove the patients right to refuse medication

Conservatorship hearing

The judge/court assigns guardianship to a person

-transfers the patients rights to a conservator

>final say/decision maker

intense process & person will be appointed to take the course that is best in mind for the patient

5250

The pt can be forced to stay an extended period of time in care

1 to 14 days

You are working with a patient who will be discharged into the community soon. What are some problems that may affect the success of treatment

Environmental factors

-neighborhood contains negative influences

-willingness to follow the treatment plan

Patients' Rights

Hospitalized patients retain their rights as citizens

-What is the main right being withheld

right to leave (freedom)

Patient's need for safety must be balanced against patients rights as a citizen

+dignity

+respect

+receiving care

+mail letter

+complaints

+vote

+visitors

personal items depends

-objects that can harm the patient are a no go

>belt

>shoe lace

> sharp or possible sharp objects

Inpatient Therapy (Types)

Cognitive-Behavioral Therapy

-Cognitive Therapy (Idea/Mind)

-Behavioral Therapy (Behavioral/habits)

Both need multiple sessions

Pharmacological Therapy (Medication)

Milieu Therapy (Environment)

Cognitive therapy

Idea/Mind

have the patient see "it" from a different perspective to replace the bad w/ good

Behavioral therapy

Behavioral/Habits

replacing how people do so change habits

use +positive coping skills/habits

Pharmacological Therapy

Use of medications to treat pts

Is after non-pharmacological therapy-Per ATI

Milieu therapy

Environment/Atmosphere

-People

-Area

-Presentaiton

Mental status exam (MSE-4 Main sections)

Levels of consciousness

Physical appearance

Behavior

Cognitive abilities

Mental status exam (Level of consciousness)

Alert= Awake

Lethargic= slightly/drowsy

-need of verbal stimuli

Stupor= greatly tired

-need of physical stimuli

Coma=Unconscious

Mental status exam (Physical appearance)

Appearance

-Skin

-Clothes

-Oder

-Nails

-Oral

-Shaven

Mental status exam (Behavior)

Mood & Affect

Fighting

Defensive

Aggressive

Depressed

Withdrawn

Mental status exam (Cognitive Abilites)

Memory

-Sematic (general knowledge)

-Episodic (past experience)

Judgment (if)

Abstract thinking (grass is greener on the other side)

Speech

-tone

-volume

Calculation

A&O

MSE: Mood

Subjective

-How the pt says he/she feels

MSE: Affect

Objective

-Observable; physical expressions caused by mood

MSE: Affect (Types)

Good

Blunted

Flat

MSE: Affect (Good)

Normal expression/response

MSE: Affect (Blunted)

Narrow expression/response

-Dull response

MSE: Affect (Flat)

Abnormal expression/response

-Unaffected

A nurse was the case manager for a client with a serious mental illness for 6 years. The client spouse asks "I always wondered if my spouse was a victim of sexual abuse in childhood. What can you tell me about that?" Can the nurse disclose information to the surviving spouse?

Yes

The patient can have her info transferred if the spouse was on the consent form

Social relationship vs Therapeutic relationship

Social relationship-Casual

-Primarily initiated for friendship, socialization, enjoyment, or accomplishment of a task

-Communicaiton is superficial

Intimate

-Emotional commitment to each other

Therapeutic relationship-Practice

-Focus of the relationship is on the patient's ideas, experiences, and feelings

-Nurse addressing issues introduced by the pt or from meetings

-ID areas in need of exploration and evaluate the degree of progress of the patient