Chapter 7: Mental Health Flashcards
What are some of the common questions asked during an initial patient admission history ?
- Have you ever been treated for mental health problems ?
- Have there been any recent changes in your life ? How have these changes affected your stress level ?
- How often do you drink alcohol, including beer, wine or liquor ? (standard for male is 2 and for female its 1) Further questions if more then this
- Some people use recreational drugs. Do you ever use recreational drugs ? or Do you use any drugs or medications that are not prescribed to you ?
- In the last year, how often did anyone Hurt your physically, Insult or talk down to you, Threaten you with physical harm, Scream or curse at you ?
- Avoid do you feel safe at home ? because its not specific enough to abuse
What are some risk factors of depression and suicide ?
- more women are diagnosed then men (may be because they are more likely to seek treatment)
- often begins in the teens-30s
- abuse or alcohol or illegal drugs contributes to depression
- children of parents who have depression are more likely to develop it (doubles if both parents affected)
- have a history of trauma, sexual & physical abuse, physical disability, or death of relative, divorce or financial problems
- low self esteem, being overly dependent or self critical, pessimistic, inability to acknowledge personal accomplishment, severe illness, few friends
What screening tools are used for depression ?
- PHQ-9
What are some questions asked related to depression and suicide ?
- In the past 2 weeks, have you often felt down, depressed or hopeless ?
- In the past month. have you often had little interest or pleasure in doing things ?
- Have you thought about hurting yourself or taking your own life ? Do you have a plan ? If yes- do you have a way to carry out the plan. Is there anything that would prevent you from carrying out the plan ?
What screening tools are used for alcohol abuse ?
- CAGE Questionnaire
- AUDIT (Alcohol Use Disorders Idenitification Test)
What questions do you follow-up for alcohol abuse if initial screening shows overuse ?
In the past 2 months, has your drinking caused or contributed to …..
- bodily harm- or risk of bodily harm ?
- relationship trouble ?
- role failure ?
- run ins with the law ?
What does the CAGE questionnaire ask ?
- Have you ever felt you should CUT down on your drinking ?
- Have people ANNOYED you by criticizing your drinking ?
- Have you ever felt GUILTY about your drinking ?
- Have you ever had a drink first thing in the morning ? (EYE OPENING)
How does the AUDIT test work ?
Alcohol Use Disorders Identification Test
- score >8 (out of 41) suggests problem drinking and indicates need for more in-depth assessment
- Cut off of 10 pts is recommended by some to provide greater specificity
- 5 pts if response is 10 or more drinks on a typical day
What questions do you follow-up on for drug abuse if initial screening is positive ?
- Ask about which drugs are being used, and how frequently
- Has a friend, relative or other person expressed concern about your drug use ?
- Have you ever tried to control, cut down, or stop ?
- Have you ever used any drug by injection for non-medical use ?
What kinds of questions are follow-up for interpersonal violence ?
“Many people are dealing with this problem, you may talk to me about it safely”
- Have you been physically hurt ot threatened ?
- Has your partner destroyed things that you value ?
- Do you feel afraid of a partner, friend or other person in your life ?
- Do you have guns where you live ?
What to do if the screening tool shows concern for these mental health issues ?
- notify the advanced practitioner (physician, NP, physician assistant) for follow up
- suicide precautions needed for any patient with suicidal thoughts (HIGH PRIORITY)
- Case manager and/or social worker can help assess and file report for interpersonal violence and direct patients for follow up care for addiction and mental health services
- hospital security or law enforcement may be needed in cases of interpersonal violence
- charge nurse should be notified and can help provide proper follow up for patient
What are some physical assessment findings found in depression ?
- neglect grooming, dressing and personal hygiene
- interruption of sleeping habits (insomnia); difficulty falling asleep and staying asleep
- appetite loss or gaining weight
- abnormal lack of energy
- avoid eye contact
- flat affect; monotone voice
- slumped posture and slow movements
- decreased respiratory rate
What are some physical assessment findings found in drug/alcohol abuse ?
Drug:
- abnormal movements like tremors
- increased pulse rate
- dilated or constricted pupils
- bloodshot or glazed eyes
- dental issues
Alcohol:
- changes in pupil size
- redness of sclera
- glazing of cornea
- watering eyes, drooping of eyelids
What are some physical assessment findings found in interpersonal violence ?
- bruises all over body at different levels of healing
- avoidance of eye contact
- signs of nervousness
Are all patients screened for interpersonal violence ?
yes
