Ch 9: Mental health, violence, drug abuse

Question 1

What is not uncommon for people with mental health and how do they cope

Answer 1

It’s not uncommon for a person with mental health to not realize that they’ve had a problem for such a long time

The people tend to self medicate with alcohol and substances to cope

Question 2

What is the world health organizations definition of mental health

Answer 2

Mental health is a state of wellness, realization of own abilities to go with stressors of life and how they contribute to the community

Question 3

What is the relationship between Culture and health/ mental wellness (determines what)

What keeps many people from being treated for mental health

Answer 3

Culture determines the acceptable behaviors to mental health issues

Many people because of the negative stigma in terms associate with mental health do not seek treatment

Question 4

What are common mental health disorders

4

Answer 4

1. Depression
2. schizophrenia
3. PTSD
4. substance abuse

Question 5

When do you notice mental health issues when speaking to patients and what is vital to do after you notice the health issues

Answer 5

When doing the general survey (Hx) this is where you notice mental health issues

Once you determine a mental health issue you now need to guide your assessment and screen for the mental health

Question 6

Give two mental health screening considerations
(especially for women) 

 why are these two considerations so important

Answer 6

1. Culture/country
2. Violence screening

-these two considerations determine for the patient what is acceptable cultural behavior



Question 7

What is a Vital teaching two women about acceptable cultural behavior and how it relates to the United States

Answer 7

We must teach female patients that it is not acceptable in the US to have violence against women and the men can go to jail

Question 8

When asking the patient questions what is a big red flag Upon their answers

Answer 8

After asking questions if patients are leaving information out or giving you different stories it’s a big red flag

Question 9

What are vital components to the mental health assessment

(Bare components)

What do you want to do in response to patient behavior and answers

Answer 9

Mental health assessment components:
-all questions
-all responses and behaviors by patient

 read patient behaviors and look into answers

Question 10

What are signs when assessing for violence from a patient or family member that indicate anger
(give mnemonic)

What is your job when a patient or family member begins to become angry And what do you do if you cannot control the patient

Answer 10

Violence in patient/family members,
Assess with:

S-taring
Tone: loud
Anxious
Mumbling (due to anger)
P-acing
\+ pounding

• When patient Or family becomes angry try to de-escalate the situation
• If you cannot de-escalate the situation get out and get help

Question 11

What are dos and don’ts with an angry patient

Answer 11

Do: State the patient’s name

Don’t: raise voice or become defensive

Question 12

 when are you most likely to notice types of violence or abuse as a nurse in a hospital setting

What is the issue with human violence in women


Answer 12

During labor and delivery it’s most common to see violence or abuse

Human violence and women often goes unreported due to fear

Question 13

What are signs of an abusive husband or partner in labor and delivery

What is vital for you to do in efforts to ask the patient if they are being abused

What do you do if your highly suspicious of abuse

Answer 13

• The husband tries to control the entire conversation with the wife and nurse
• does not let the wife answer
• does not leave the wife’s side
• often the abusee Will not look up and make Eyecontact

It’s vital to get the husband out of the room to ask the patient if they are being abused

-if highly suspicious of abuse you MUST Report


Question 14

What are three ways to get an abusive husband out of the room to ask the patient if they are in danger or being abused

Answer 14

Ways to get a piece of has been out of room:

• tell husband to get wife some thing
• say you’ll be performing an assessment
• “take a break”


Question 15

Why does child maltreatment occur

Why does sibling violence occur

• what is the effect on the abusee
• what must parents do

Give an example of intimate partner violence (IVP)
-what is the type of abuse in IVP

Answer 15

Child maltreatment :occurs because of
Low parent impulse control
-parents first reaction is to hit don’t even think about it

Sibling violence: occurs because abuse is often not taken seriously by parent

• effects of abuse will be traumatic on abusee
• parents need to pay attention especially to rivalry, roughhousing, competition

Intimate partner violence (IVP):
L & D couple with husband being abuser
-other than physical, threats or coercion Are taken on by abuser



Question 16

What is the percentage of women who report rape, assault or stalking to be from who

Answer 16

2/3 A woman who report rape, salt, stocking or victimized by current or former partner’s

Question 17

Give an example of Intimate partner violence (IVP) Within immigrants/refugees.

What are tactics used by abuser with immigrant and what does it result in for the immigrant

Answer 17

 IVP among immigrants/refugees:
-wife may be illegal and husband has total control

Abusive Husband may:
• threatened deportation
• threaten to leave patient with nothing (food, money, shelter ) 

-The abuse results in immigrant feeling trapped

Question 18

Give types of elder abuse

Give elder abuse patterns
(presentations on older person) 

What type of older presentation do you specially look for abuse in

Answer 18

Elder abuse types:
-physical, neglect, financial exploitation, abandonment

Elder abuse patterns

• Kicking
• punching
• slapping
• burning
• locking in room

Especially if an elder looks cachexic evaluate for abuse

Question 19

What is the most common elder abuse

How does This abuse occur

Answer 19

Malnutrition is the most common elder abuse

Malnutrition occurs by:

• taking money
• not Bryan groceries
• no one to care or cook for patient

Question 20

What gender is at a greater risk of abuse in the collect

Answer 20

Older women or a greater risk for abuse and collect V older men

Question 21

 what are the two types of violence against adults with disabilities
(cognitive issues)

Give an example of #2

Answer 21

1. Intentional
   - means to harm and hurt the patient
2. Unintentional
   -caregiver burnout
   : caregiver becomes burned out of having to do total care and takes it out on the patient

I.e: daughter burn out on mom

Question 22

What is your action if you notice unintentional abuse of elder and describe it

Answer 22

If you notice an intentional abusive elder give caregiver:

RESPITE CARE:
-placing love one in a long-term care facility for about a week until the caregiver gets rest and recovers

Question 23

What do you do if the patient needs exceeds the caregivers ability

Answer 23

If patient needs exceed caregiver ability:

• give caregiver help
• help put patient in long-term care facility

Question 24

Why is sexual assault exceptionally high in women with developmental disabilities

Answer 24

Women with developmental disabilities are easy perpetrator victims and end up pregnant but don’t remember how

Must report!!!

Question 25

What are common youth in school violence Actions among children What is vital to teach kids about youth in school violence

Answer 25

Hitting humiliating bullying/cyber If children witness bullying/school violence teach to report

Question 26

When doing a cultural assessment on a patient what is vital to remember regarding sexual violence (marital rape) especially if they are not of your culture What do you want to teach patient who suffer from marital rape when coming to the US

Answer 26

When doing cultural assessment on others who are not of the same culture: Remember marital rape is not a crime in all countries It’s vital to teach patients that it is not acceptable in the US and is a crime

Question 27

 How do abusers get children to commit sexual acts

Answer 27

Abusers likely course children by threatening child into completing sexual act

Question 28

What is the most common emotional response in sexual assault victims

Answer 28

The most common emotional response in victims of sexual assault is guilt -victim will blame themselves

Question 29

If no treatment what will the victims of sexual abuse become

Answer 29

If not treatment children who have been sexually abused will often become sex offenders

Question 30

What are the domains of hate crimes and why are they done

Answer 30

Domains of hate crimes include: - race - ethnicity - gender - sexuality - religion Hate crimes are done out of hate towards domains 

Question 31

 when should human trafficking be assessed What are ways of human trafficking

Answer 31

Human trafficking should be assessed if family dynamic does not appear normal Human trafficking businesses: - recruitment - Sex trade/ sexual exploitation - forced marriage - cheap labor

Question 32

Give the definition of human trafficking

Answer 32

Human trafficking: recruitment, transportation, transfer, harboring or recipient of people through threats, force, coercion

Question 33

What is another common name for war related violence Why does war related violence occur What is vital to do when assessing someone with war related violence

Answer 33

``` War related violence equals PTSD  PTSD occurs because: -witnessing/intentionally killing - injuring others being injured -potentially killed ``` What assessing someone with PTSD it is vital to find triggers

Question 34

What are signs and symptoms of PTSD

Answer 34

``` S&S of PTSD: -nightmares -feeling of guilt -Poor concentration -reliving event • especially with war movies!  ```

Question 35

What Is the highest concern/aspect(Paramount) to assess in human violence victims What does Trust and rapport allow within patients and nurses

Answer 35

In human violence victims physical and emotional safety is key to assess Trust and rapport allows: Talking, trust, sharing

Question 36

 what must a nurse establish within patients to get them to communicate 

Answer 36

Patients must established trust and rapport with nurse to communicate effectively

Question 37

When conducting patient interviews/mental health assessments -how must they be completed -what is the talk to listen ratio what do you use this time for? -how do you prepare a patient for questions

Answer 37

When doing interviews/mental health assessments: -interview must be done private and patient data must be confidential -you should listen more than talking 80% pt/20% nurse Used time to gather information and reppatient -prepare patient by prefacing sense of questions saying “ i’m going to be asking some very close and personal questions”

Question 38

During urgent assessments for mental health, violence, drug abuse what are the most important questions to ask If a patient is suicidal what should be your next follow-up question When hearing suicide plan what do you want to assess for

Answer 38

During the urgent assessment ask questions of violence, self harm/others - If patient is suicidal next follow up question is “ do you have a suicide plan” After hearing plan assess for means to do it

Question 39

Urgent assessment: What are signs of depression in the patient What will a patient in a psychotic state Believe and do

Answer 39

Signs of depression: - Poor eye contacts - poor grooming - slumped Patients in psychotic states will believe they are being threatened and will attack

Question 40

Give characteristics of dementia with in patients

Answer 40

Dementia - gradual mental status change - disoriented X2 - Irreversible - Common confabulation - patient cannot remember so they will make things up Eventually leads to Alzheimer’s

Question 41

What is common among your Alzheimer’s and dementia patients at the end of the day Define sundowner syndrome How will patient present With sundowners syndrome

Answer 41

At the end of the day sundowners syndrome occurs between your Alzheimer’s and dementia patients Sundowner syndrome is a natural late day confusion and fatigue due to low light causing an imbalance Patient will be: Confused/agitated late in day

Question 42

Give characteristics of delirium What can Delirium be caused by + What does it lead to(how does a Present)

Answer 42

Delirium: -sudden in onset -disoriented X3 -reversible ``` Delirium causes include: -alcohol withdrawal  Leads to disorganized thoughts and increased risk of injury  ```

Question 43

What statements do you subjective data include | 3 things

Answer 43

 subjective data include 1. statements to the nurse 2. overheard patient reporting(to someone else) 3.  family and friends reporting

Question 44

What kind of questions do you wanna ask A patient during the mental health and violence assessment How is the mental health and violence assessment in art and a science

Answer 44

 you want to ask patient open ended questions during mental health assessment Mental health assessment is an art: - -communicating and assessing patient accurately Science: -Accurate knowledge base of patient to screen in mental health

Question 45

What must you have in relation to the questions being asked

Answer 45

You must have the ability to listen and be comfortable with questions being asked related to psychosis, suicide, plan any form of abuse

Question 46

What are non-verbal actions you want to do when obtaining objective data for the mental Health assessment/violence

Answer 46

When obtaining objective data, follow SOLER ``` S-it at eye level O-pen inviting demeanor L-ean forward to show interest E: ye contact the patients level R: relaxed position (do not cross arms) ```

Question 47

In patients with mental health issues what do you want to be aware of In regards to getting subjective data  and what are strategies used

Answer 47

patients with mental health may use diversion strategies such as • asking personal questions • insulting nurse to stop questioning -Do not take personal but address the issue • drift off

Question 48

What behavior will patients with psychotic disorders display  In a patient with a psychotic disorder what do you never want to do and why

Answer 48

Patients With psychotic disorders me laugh in appropriately or answer unlogically Never laugh around a patient with a psychotic disorder as they may think you were laughing at them

Question 49

What age population is most likely to be depressed What do support systems in patients with mental health resultant

Answer 49

Your older population is most likely to have depression In those with mental health who have support systems, they have better outcomes and decrease cases of depression

Question 50

In assessment of risk factors what are unchangeable factors Environmental (changeable factors) Metabolic issues/associated physiological processes

Answer 50

Unchangeable: mental health family history, age, gender Environmental (changeable factors) - any changes in support system - coping skills - does patient have family involvement? ``` Metabolic issues (May cause mental H issues)  -Parkinson’s cancer HIV/AIDS  ```

Question 51

If a woman presents with postpartum depression what do you want to ask her

Answer 51

In a woman with postpartum depression ask if she wants to harm self for a child

Question 52

When assessing violence, alcohol, drug use: How do you assess alcohol use What can a patient say that raises a red flag for suicide With drug use what do you want to assess for

Answer 52

Asses alcoholic use with CAGE ``` C-ut down drinking A-nnoyance With drinking criticism G-Guilty E-Eye-opener •1st drink is alcoholic drink ``` If a patient says they have no sense of hope it is a red flag for suicide For drug use assessed for mixing of trucks causing interactions

Question 53

Spiritually what do you want to assess for that will benefit the patient

Answer 53

Spiritually, assess for rituals that will help patient cope

Question 54

When educating on violence what do you want to give the patient information on

Answer 54

When educating on violence once separating from abuser give information on shelters

Question 55

Give the most common symptoms for altered mental status

Answer 55

Auditory, visual, olfactory, tactile hallucinations Suicide ideation -assess plan homicide ideation/aggressive behavior -Self mutilation what is causing this pain Alter mood and affect

Question 56

If a patient is experiencing auditory hallucinations what do you want to ask the patient What is pertinent to AVOID for patients undergoing auditory hallucinations

Answer 56

If Patient experiencing auditory hallucinations ask “ what are the voices telling” NEVER!!! Say the name of the voice because it makes it real for the patient

Question 57

Describe olfactory hallucinations describe tactile hallucinations

Answer 57

Olfactory hallucinations: patient can smell fire even if it’s not there Tactile hallucinations: unusual sensations

Question 58

What is the lifespan consideration when you’re pregnant women in relation to psychiatric disorders

Answer 58

Pregnant women me relapse in psychiatric disorders because of hormones

Question 59

How is being African-American/Hispanic a risk factor -What are signs and symptoms How does being of a lower socioeconomic status develop into a risk factor

Answer 59

African-Americans/Hispanics because of stigma with culture risk of not recognizing depression S&S: -Poor cognition -decrease sleep/initiative  Lower socioeconomic status is do not have the money to seek help

Question 60

When do you use the geriatric Depression scale and what is the points game

Answer 60

Geriatric depression scale use in your geriatric if suspected depression. Score breakdown: 5: suggestive of depression - needs further evaluation 10: indicative of depression

Question 61

What is a suicide risk assessment commonly used What is the point system

Answer 61

SAD PERSONAS Is a commonly used suicide risk assessment Scoring: One point per category the higher the score the higher the risk of suicide

Question 62

what kind of care is cultural care When using an interpreter for patient Mental health assessment what do you want to ask what can the interpreter not do

Answer 62

Cultural care equals holistic care When using an interpreter ask them: - did the patient make sense - did they voice any practices or beliefs - was the conversation flowing Patient cannot give any information on the interview to family members or friends bound by confidentiality and patient knows

Question 63

How do you document an interview using interpreter

Answer 63

When using an interpreter document intro his name plus what interpreter has said

Question 64

Within different cultures and religions what are some acceptable practices what is the percentage of the population that does not seek traditional care and why

Answer 64

Acceptable practices: - Witchcraft - voodoo - homeopathic - Christian science About 1/3 of the population does not situational care because of its access, cost, poverty, language, no insurance

Question 65

When doing comprehensive assessment what is objective data you want to obtain

Answer 65

Objective data do you want to team includes: | - observing the patient and the patient’s behavior

Question 66

What may physical presentation be useful for How is physical assessment assessed

Answer 66

Physical presentation may be the first indication of a mental health/violence issue Physical assessment used based on ABCT

Question 67

Describe your ABCT for physical assessment

Answer 67

A-ppearance -Overall appearance, posture, hygiene, dress B-ehavior -LOC, eye Contact, speech C-ognative function -assess orientation, attention, memory • ask patients to add or subtract • ask patient do you have somewhere to stay • ask patients if they can solve problems ```  T- hought process and Perceptions -A&O x 3 -paying attention? -Following conversation ```

Question 68

Give another name for MMSE. Describe the mini mental state examination (MMSE) Describe the MMSE scoring system

Answer 68

MMSE =Mini cog Techniche: - List 3 unrelated words - Have patient draw a clock face and the time on the clock - Repeat the beginning three words Scores: • no words: demented • recall all: not demented

Question 69

What are violence victims symptoms noticed during assessment

Answer 69

Easily triggered isolation/ social withdrawal shutting down feelings (numbing) spacing out

Question 70

 what are major signs of abuse in children elders and women you want to note

Answer 70

1. injury not consistent with story 2. Sexual activity younger than 14 3. Failure to seek timely medical care 4. Multiple hospital visits and fractures + bruises in different healing stages 5. Burn configurations (cigarettes) 

Question 71

in an abusee What nonverbal cues will alert you to abuse If the patient opens up about being abused how must you document

Answer 71

Eye scanning being very jumpy/clingy guilt If the patient tells you they are being abused document verbatim and a detailed and descriptive manner

Question 72

Who are mandated reporters and what is the report made in What are the two people you report to

Answer 72

Nurses/healthcare workers are mandated reporters -Reports are made in good faith without malice Report to: -charge nurse -CPS

Question 73

When you call to report abuse to CPS what are the four things you must document about the call

Answer 73

1. Reason for call 2. Time of call 3. Full name of who took the call 4. Response of call taker (timeframe) 

Question 74

For people with dementia who do you have to defer personal questions How well does someone with dementia follow instructions what does a conversation of someone with dementia look like 

Answer 74

In a patient with dementia refer personal questions to family members as patient is poor historian Those with dementia unintentionally fail to follow directions Those are dementia have difficulty following conversations

Question 75

Give nursing diagnosis related to mental health, violence, drug abuse

Answer 75

Risk for suicide Altered mental status

Question 76

Give nursing outcomes related to mental health, violence, drug abuse

Answer 76

Patient does not harm self Demonstrate social interaction Identifies personal strengths

Question 77

Give nursing interventions related to the mental health, violence, drug abuse assessment

Answer 77

Assess for risk of harm to self, others Provide safe environment by removing items that may cause harm Identify support systems, involve them in care