1st week Chapter 1,3, and psychiatric setting

Question 1

mental health is ______________________

Answer 1

not the absence of sadness

Question 2

traits of mental health

Answer 2

ability to

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

Question 3

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.*

Answer 3

Biological predisposition by nature

Environmental stress or trauma nurture

Question 4

DSM-5

Answer 4

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

Question 5

RNs in use of DSM-5

assessment

psychosocial history

culture and practices

Answer 5

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.

Question 6

NANDA - I

foundational to the care of mental health is the nursing process

what does it stand for?

what is it?

Answer 6

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.

Question 7

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)

Answer 7

lethargic- sleepy but easy to arouse

stuporous- coma

Question 8

standardized screening tools

Mini-mental state examination (MMSE)

what is it used for?

Glasgow coma scale

Answer 8

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

Question 9

standardized screening tools for children and adolescents

1. H
2. E
3. A
4. D
5. S
6. S
7. S

Answer 9

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

Question 10

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)

Answer 10

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.

Question 11

patient self determination act

Answer 11

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

Question 12

advance care directives in mental health

What’s durable power of attorney?

Answer 12

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

Question 13

what is competency?

Answer 13

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!!!!!!!!!!!!!!!

Question 14

how can we assess competency?

Answer 14

communicate choices

understand relevant information

appreciate situation and consequences

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

Question 15

informed consent

Answer 15

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

Question 16

least restrictive environment

can a person be restricted to an institution?

meds cannot be given unnecessarily

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

Answer 16

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

Question 17

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

Answer 17

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)

Question 18

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?

Answer 18

wrist

walking or ankle

four-point

five-point

chemical

Question 19

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

Question 20

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

Question 21

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

Question 22

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

Question 23

what is breach of confidentiality?

Answer 23

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

Question 24

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

Question 25

**lawsuits** ## Footnote 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?

Answer 25

when patient kill himself or herself in institution

Question 26

who is more important to watch over manic or the alcoholic that is detoxing

Answer 26

alcoholic because he can die from detoxing

Question 27

nursing documentation **clients have access to their records** **legal documents**

Question 28

if the patient is suicidal or homicidal: ## Footnote **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!**

Question 29

**_social influences on psychiatric care settings_** traditional **medical health care** vs. **psychiatric mental health care** why are psychiatric illness often hidden?

Answer 29

stigma- shame and being flawed is associated with illness

Question 30

**outpatient psychiatric mental health care** ## Footnote specialty psychiatric care providers patient-centered health/ medical homes

Answer 30

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

Question 31

**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)

Answer 31

**treatments** medication administration individual and group therapy family therapy

Question 32

**community- based mental health programs** ## Footnote assertive community treatment (ACT) partial hospitalization programs

Answer 32

* 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

Question 33

**other outpatient venues for psychiatric care**

Answer 33

telephone crisis counseling telephone outreach internet telepsychiatry

Question 34

**prevention in community care** ## Footnote primary secondary tertiary

Answer 34

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

Question 35

**psychiatric nursing in outpatient and community settings** ## Footnote strong problem-solving and clinical skills cultural competence flexibility knowledge of community resources **autonomy**

Question 36

**psychiatric nursing in outpatient and community settings continued.....** ## Footnote biopsychosocial assessment case management promoting continuation of treatment teamwork and collaboration

Answer 36

## Footnote 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

Question 37

**emergency care and crisis stabilization** ## Footnote comprehensive emergency service model hospital-based consultant model mobile crisis team model crisis stabilization/ observation units

Answer 37

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

Question 38

**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

Answer 38

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

Question 40

**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