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Psych > 1st week Chapter 1,3, and psychiatric setting > Flashcards

1st week Chapter 1,3, and psychiatric setting Flashcards

1
Q

mental health is ______________________

A

not the absence of sadness

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2
Q

traits of mental health

A

ability to

  • think rationally
  • communicate appropriately
  • learn
  • grow emotionally
  • be resilient
  • have a healthy self-esteem
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3
Q

Diathesis stress model

what is Diathesis?

what is stress?

  • combination of genetic vulnerability and negative environmental stressors.*
  • For example: if your mother had depression, you are more likely to have it too.*
A

Biological predisposition by nature

Environmental stress or trauma nurture

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4
Q

DSM-5

A

RN’S use DSM-5 to identify diagnosis and criteria, guide assessment, plan, implement and evaluate care

changed to 5 when we include cultural details

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5
Q

RNs in use of DSM-5

assessment

psychosocial history

culture and practices

A

perception of self-health, belief about illness. how patient passes time(leisure activities). substance use disorders and coping abilities.

stigma: less likely to reach for mental health support, spiritual and religious beliefs: for example, a catholic patient will hide any feelings of suicide to a friend.

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6
Q

NANDA - I

foundational to the care of mental health is the nursing process

what does it stand for?

what is it?

A

The North American Nursing Diagnosis Association International

describes a nursing diagnosis as a clinical judgment about individual, family, or community responses to actual or potential health problems and life processes.

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7
Q

Mental status examination (MSE)

level of consciousness

  • alert
  • lethargic
  • stuporous

physical appearance - cold outside but the patient is wearing summer clothes

behavior

  • voluntary and involuntary body movement
  • eye contact
  • mood (subjective)
  • affect (objective)
A

lethargic- sleepy but easy to arouse

stuporous- coma

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8
Q

standardized screening tools

Mini-mental state examination (MMSE)

what is it used for?

Glasgow coma scale

A

mini-mental

  1. to rule out cognitive function decline, such as senile dementia
  2. orientation to time and place
  3. attention span and ability to calculate by counting backward by seven
  4. registration and recalling objects
  5. ability to follow commands

Glasgow

a score of 15 indicates that the patient is awake and responding appropriately

a score of 7 or less indicates that the client is in a coma

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9
Q

standardized screening tools for children and adolescents

  1. H
  2. E
  3. A
  4. D
  5. S
  6. S
  7. S
A
  1. home environment (relationship with parents)
  2. education/ employment( performance)
  3. activities (interaction with peers), drug and substance use, sexuality and suicide/ depression (risk), savagery (abuse at home or violence in his neighborhood
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10
Q

standardized screening tools for the older adult population

  • geriatric depression scale (short term)
  • Michigan alcoholism screening test (geriatric version)
  • the McGill Pain questionnaire (MPQ)
  • patient health questionnaire (PHQ-9/PHQ-2)
  • general anxiety disorder (GAD-7)
A

the McGill Pain questionnaire (MPQ)

The McGill Pain Questionnaire (MPQ) measures the sensory, affective, evaluative, and miscellaneous components of pain

patient health questionnaire (PHQ-9)

diagnose depression

patient health questionnaire (PHQ-2)

provide a brief, initial screening for major depression.

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11
Q

patient self determination act

A

information about advance care documents should they become unable to make those decisions due to illness

questions on admission about having an advanced care document

information about rights to complete advance care documents

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12
Q

advance care directives in mental health

What’s durable power of attorney?

A

living will - a written statement detailing a person’s desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive.

continuing

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13
Q

what is competency?

A

the degree to which the client can understand and appreciate the information given during the consent process.

cognitive ability to process information at a specific time

different from rationality

competent client can refuse any aspect of the treatment plan

make sure the client is competent!!!!!!!!!!!!!!!

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14
Q

how can we assess competency?

A

communicate choices

understand relevant information

appreciate situation and consequences

use logical thought process to compare risks and benefits of treatment options

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15
Q

informed consent

A

legal procedure to ensure that client knows the benefits and costs of treatment

mandate of state laws

complicated in mental health treatment

  • competency necessary to give consent
  • decision- making ability often compromised in mental illness
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16
Q

least restrictive environment

can a person be restricted to an institution?

meds cannot be given unnecessarily

use of restraints last resort!!!!!!!!!!!!!!

A

no, person cannot be restricted to an institution when he or she can be successfully treated in the community

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17
Q

seclusion

what is it used for?

what does it have?

individual observed at all times

extremely negative client experience; many facilities have abandoned practice

outcomes may be worse if used

A

involuntary confinement in a room or area where the person is physically prevented from leaving

used for purposes of safety or behavioral management

contains mattress and blanket, usually padded walls, environmentally safe ( no hanging devices, electrical outlets, or accessible windows)

18
Q

restraints # 1

  • most restrictive safety intervention
  • any manual (physical or mechanical) method which immobilizes or reduces ability to move
  • must choose least restrictive type to keep client safe

what body areas to use?

A

wrist

walking or ankle

four-point

five-point

chemical

19
Q

restraints #2

  • last resort if client continues to be danger to self or others
  • documentation must reflect careful assessment and all previously tried unsuccessful interventions
  • promptly removed when client regains control over his or her behavior
  • requires continued close observation after removal
  • use can result in psychological harm and physical injury
A
20
Q

trauma-informed care

  • using restraints or seclusion can trigger and retraumatize client
  • nurse must recognize connection between earlier trauma and adult mental health problems
  • must follow medicare regulations if receiving medicare funding
  • patients rights condition of participation
A
21
Q

voluntary treatment

voluntary admission or commitment

  • person retains full civil rights
  • treatment strategies are recommended and agreed on by both provider and client
  • free to leave at any time, even against medical advice

​consider the DTO and DTS! always check the chart

A
22
Q

involuntary treatment

involuntary commitment: court-ordered ; without persons consent

three common elements

  • mentally disordered
  • dangerous to self or others
  • unable to provide for basic needs

right to receive treatment; possible right to refuse treatment

cannot leave against medical advice

A
23
Q

what is breach of confidentiality?

A

release of client information without the clients consent in the absence of legal compulsion or authorization

24
Q

mandates to inform

a legal obligation to breach of confidentiality

duty to warn

  • judgment that the client has harmed someone or is about to injure someone
  • based on tarasoff v. regents of the university of California
A
25
Q

lawsuits

very common in this field especially clients that are suicidal or violent

nurses usually included in lawsuit filed against agency

so we have to document !!!!!!!!!!!!!!

what is sentinal event?

A

when patient kill himself or herself in institution

26
Q

who is more important to watch over

manic

or

the alcoholic that is detoxing

A

alcoholic because he can die from detoxing

27
Q

nursing documentation

clients have access to their records

legal documents

A
28
Q

if the patient is suicidal or homicidal:

if that is the reason why he was admitted; PRN meds require separate entry to include the reason for administration, dosage, route, and response to medication

careful documentation!

A
29
Q

social influences on psychiatric care settings

traditional medical health care vs. psychiatric mental health care

why are psychiatric illness often hidden?

A

stigma- shame and being flawed is associated with illness

30
Q

outpatient psychiatric mental health care

specialty psychiatric care providers

patient-centered health/ medical homes

A

professionals who can prescribe meds, practice individual psychotherapy and or group therapy

the affordable care act ( health affairs 2010)

co-location of primary and specialty care in community based mental health settings

eliminates the stigma of seeking care for psychiatric disorders

31
Q

community mental health centers

  • created in the 1960’s
  • mainstay for those who have no access to private mental health care
  • provide emergency services, adult services, children services

treatments?

dual diagnosis treatment (meaning to the diagnosis)

A

treatments

medication administration

individual and group therapy

family therapy

32
Q

community- based mental health programs

assertive community treatment (ACT)

partial hospitalization programs

A
  • non traditional case management and treatment for clients who have severe mental illness and are noncompliant with traditional treatment
  • reserve to those with repeated hospitalizations with severe symptoms
  • ACT teams work intensively with patients in their homes, hospitals and clinics
  • creative problem solving and interventions are the hallmarks of care provided by mobile teams
  • intense short-term treatment for clients who are well enough to go home every night and who have a responsibility at home to provide a safe and supportive environment
  • programs 5-6 hrs/day utilizing individual and group psychotherapy treatment
  • primary goal

symptom improvement

safety

education on clinical condition and medication

coping strategies

33
Q

other outpatient venues for psychiatric care

A

telephone crisis counseling

telephone outreach

internet

telepsychiatry

34
Q

prevention in community care

primary

secondary

tertiary

A

occurs before any problem is manifested and seeks to reduce the incidence or rate of new cases (prevention) coping strategies and psychosocial support

reducing the prevalence of new and old cases at any point of time in psychiatric disorders. early identification, screening, prompt and effective treatment

treatment of disease with a focus on preventing the progression. encimpasses rehabilitation which aims to restore functional ability

35
Q

psychiatric nursing in outpatient and community settings

strong problem-solving and clinical skills

cultural competence

flexibility

knowledge of community resources

autonomy

A
36
Q

psychiatric nursing in outpatient and community settings continued…..

biopsychosocial assessment

case management

promoting continuation of treatment

teamwork and collaboration

A

nurse must have a comprehensive understanding of the patients ability to cope with the demands of living in the community

bridging the gap of all the patients medical and mental health needs

patient centered care

multidisciplinary treatment teams increase success, maybe a dietary because some meds require special diet

37
Q

emergency care and crisis stabilization

comprehensive emergency service model

hospital-based consultant model

mobile crisis team model

crisis stabilization/ observation units

A

full service emergency department

incorporating triage and stabilization

stabilization “in the field’/goal to stabilize without ED

rapid stabilization and short length stay/ observation for 1-3 days

38
Q

inpatient psychiatric care

admission reserved for individuals who are?

admission options

  • direct admission
  • hospital emergency department

criteria to justify admissions

  • danger to self or others or unable to fulfill basic needs

voluntary or involuntary

  • voluntary-agree to admission and treatment
  • involuntary-admitted against their will due to safety concerns
  • patient rights are maintained regardless of status
A

suicidal

homicidal

extremely disabled (unable to care for basic needs, gross impairment of judgement, and inability to protect oneself)

39
Q
A
40
Q

Therapeutic Milieu

surrounding and physical evironment

overall environment and interactions of environment

well managed milieu

  • promotes healing
  • inspires a sense of security
  • structure

activities

unit rules

reality orientation practice

practice communication and coping skills

preparation for return for the community

A
41
Q
A

Psych (5 decks)

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