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BN5 > Mental Health > Flashcards

Mental Health Flashcards

1
Q

What is a mental health assessment?

A

It is the same as a mental state examination with more information. It can be considered a holistic approach to assessment.

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2
Q

What is a mental state examination?

A

A MSE (mental state examination) is a comprehensive assessment process. A large component of this assessment is observation based.

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3
Q

What does affect describe in a MSE?

A

Affect is what you observing in the clients face. It can include the person’s expressions which will show their internal thought.

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4
Q

What are the three ‘thought’s’ that might impact the objective data of an MSE?

A

Thought content - expressing any odd thinking.
Thought form - are they speaking logical.
Thought stream - the speed of their thought.

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5
Q

What is a BATOMMMI?

A

Initial mental state examination that includes:
B - behaviour
A - affect
T - thoughts
O - Orientation
M - mood
M - memory
M - motivation
I - Insight / judgement.

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6
Q

What is Catatonia?

A

Slowed to no movement.

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7
Q

What does insight mean and it’s 3 levels of insight?

A
  1. full
  2. partial
  3. no insight.
    this is the capacity to organise and understand the current situation.
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8
Q

What are some symptoms of anxiety and how are they different to Depression?

A

Anxiety and depression are similar. Anxiety can include, chest pain, paralysis, nausea, increase RR, widening of pupils, palpitations, increase HR and strength of heart.

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9
Q

What is GAD?

A

Generalised Anxiety disorder.

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10
Q

How is depression different to anxiety?

A

Comples and varied symptoms and the symptoms are different between each person.

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11
Q

What are some symptoms of depression? And how long does it need to occur in order to get to get a diagnosis?

A

Symptoms will occur for longer than two weeks. Some symptoms are:
- continuous low mood or sadness.
Low self esteem
Tearful or guild ridden.

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12
Q

What is a social symptom of depression?

A

Avoiding contact with friends and family and taking part in fewer social activities.

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13
Q

What are some screening tools for depression?

A

GAD - geriatric depression scale.
GAI - geriatric anxiety index.
EPNDS - Edinburgh post-natal depression scale.

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14
Q

Why might someone be considered for ECT?

A

major depressive disorder.
Catatonia
Mania
Schizoaffective disorder

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15
Q

What are some contraindications for ECT?

A

Recent MI or stroke - last 30days.
Increased cranial pressure.
Active bleeding - especially CNS.
Rentinal detachment
Cochlear implant.
Respiratory compromise.

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16
Q

Why do we use anaesthesia with ECT?

A

The motivation for Ect with anaesthesia is humanity - it would be intolerable otherwise.

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17
Q

One function of anaesthesia in ECT is to reduce muscle strength, making injury less likely. What are two others?

A
  1. Improves oxygenation - hypoxia less likely.
  2. Dampens the autonomic effects of ECT.
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18
Q

Neuroleptic malignant syndrome is a risk of ECT. What are two others?

A

Lithium interactions - this can prolong the paralysis resulting in patient waking and feeling like they can no breath.
Fractures

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19
Q

If the patient has DM, what will we need to implement and why?

A

We need to measure BGL before and after ECT treatment. ECT can cause hypoglycemia.
The brain is using more glucose due to the seizure.

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20
Q

Before ECT, what does the nursing process include?

A

Documentation and prescription.
Also, patient is NBM.

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21
Q

On the morning before the ECT, what does the RN need to consider before treatment?

A

BGLs
Medication
ECT checklist.

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22
Q

BP is one procedure the RN is required to complete during ECT. What are three other tasks for the RN?

A

BP
Lip balm
Support
Socks - will be taken off.

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23
Q

Ethical nursing is fundamental aspect in our nursing practice. What codes and guidelines guide our practice?

A

Code of conduct for nurses
Guidelines for professional boundaries
Guidelines for social media and electronic communication.

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24
Q

What is clinical reasoning?

A

Defined as practice-based disciplines as the application of critical thinking to the clinical situation.

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25
Q

Section 7A MH (CAT) Act 1992 ensures that clinicians consult whanau in all practice where reasonable. What type of care is this?
a. recovery orientated care.
b. whanau inclusive care.

A

Whanau inclusive care.

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26
Q

A mental health disorder or illness can include two types of disorders. One is mood, what is the other?

A

Cognitive - dementia, personality disorders.
Mood - bipolar, depression, anxiety.

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27
Q

There is a 5 stepped approach to assist a tangata whaiora in mental health. The first step is self-management. What are the next four?

A

Self-management
Low-intensity
Moderate
High-intensity
Acute and specialist community

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28
Q

Most people receiving treatment for mental illness comes under what Act?

A

The mental health Act 1992. They are either voluntary or informal.

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29
Q

Who is the mental health act design to cover?

A

It is designed to cover people or situations when it is considered that treatment for their mental illness is needed, but the person will not consent or agree to it.

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30
Q

What are the principles of the mental health act 1992 designed to cover for the person for the person being treated?

A

It defines the rights of the person subject to compulsory mental health assessment and treatment, and to provide better protection for those rights.

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31
Q

What is the legal definition of a mental disorder?

A

An abnormal state of mind shown by delusions or disorders of mood, perception, volition, or cognition.

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32
Q

Abnormal state of mind can mean the patient has one of two inabilities. One is the inability to care for one self. What is the other?

A

That there is danger to the persons health and safety, or the health and safety of another person.

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33
Q

Patient has 11 rights.
The right to:
1. information
2. respect for cultural identity.
3. right to an interpreter
4. right to treatment.
What are the 7 others?

A
  1. information
  2. respect for cultural identity.
  3. right to an interpreter
  4. right to treatment.
  5. right to be informed about treatment.
  6. right to refuse video recording.
  7. right to independent psychiatric advice.
  8. right to legal advice.
  9. right to company.
  10. right to have visitors and make telephone calls.
  11. right to send and receive mail.
34
Q

T or F. Section 62 of MHA preserves the legal right to administer treatment that ‘immediately necessary to save the patients’ life’ to prevent serious damage to the health of the patient, or to prevent the patient from causing serious injury to themselves or others.

A

True.

35
Q

What section of the MHA gives the power for the RN to detain someone in the compulsory assessment process who has been admitted to hospital or bought there and is suspected of a mental disorder.

A

It is Section 111, 2(a).

36
Q

Right 7(2) of HDC patient code of conduct presumes that patients are competent unless there are reasonable grounds to not. What are the two ways to determine competence?

A
  1. clinical assessment.
  2. Legal test - whether the person understands the nature, purpose, effects and likely consequences of the propose treatment or of refusing treatment.
37
Q

What is a comprehensive mental health assessment?

A

It is an assessment that is much like a specialist medical assessment. A way to gather more specific information on the tangata whaiora.

38
Q

A comprehensive mental health assessment includes 9 components. The first two are:
1. presenting complaint and history of presenting complaint.
2. Past psychiatric history.
What are the 7 others?

A
  1. presenting complaint and history of presenting complaint.
  2. Past psychiatric history.
  3. Past medical history.
  4. Medication.
  5. Family history
  6. Personal history
  7. Premorbid history.
  8. Goals for treatment.
  9. Mental state examination.
39
Q

When completing a CMHA, two types of examinations need to be completed. One is a physical examination, what is the other?

A

Baseline laboratory test - should included hyperthyroidism, low B12, anaemia and neurological conditions.
Physical examination - sometimes physical symptoms can present due to mental health and not always explored.

40
Q

When completing a CMHA, what three things do we need to know about their medication?

A
  1. What they are currently on.
  2. What medication have they been prescribed in the past.
  3. What medication has not worked for them in the past.
41
Q

T or F. We use the information from the premorbid history to help develop a safety plan.

A

T. This is where the tangata whaiora can let us know what they experience or feel like before becoming unwell. Commonly called warning signs.

42
Q

What is BATOMMMI?

A

Behaviour / appearance
Affect
Thoughts
Orientation
Mood
Memory
Motivation
Insight / judgement.

43
Q

What and who uses an mental state examination?

A

A mental health nurse uses this comprehensive assessment process. It mostly collects objective data and is based on direct supervision.

44
Q

What are the 3 T’s in MSE?

A

Thought content - odd thinking.
Thought form - speaking logical.
Thought stream - speed of thought.

45
Q

What is catationia?

A

Slowed to no movement - assessed in appearance and behaviour.

46
Q

Slower than normal speech can indicate depression. What can faster than normal speech indicate?

A

Disorganised thinking.

47
Q

Clinical terms associated with speech.
Euphoric =
Eurhythmic =
Dysphoric =
Dysthymic =
Labile =

A

Euphoric = high
Eurhythmic = normal
Dysphoric = low
Dysthymic = chronic low mood
Labile = fluctuates in presentation.

48
Q

Define what you might see during in congruent affect?

A

Expressions that are not matching the environment or stimuli around them.

49
Q

What is a WRAP and how do we use it?

A

Wellness Recovery Action Plan
It is a tool that looks at what wellness is for that person and strategies to reach it.
It also identifies how they might feel when they are becoming unwell and how to respond to those feelings.

50
Q

The principles of the WRAP are drawn from what model of care?

A

Recovery model of care.

51
Q

Nursing ethics is based on our obligation to protect and respect human life, what are three guides or codes that are formally recognised in NZ that assist us with this?

A

Code of conduct for RN.
Guidelines for professional boundaries.
Guidelines for social media and electronic communication.

52
Q

What is clinical reasoning in nursing practice?

A

It is defined in practice based disciplines as the application of critical thinking to the clinical situation.

53
Q

There are 8 steps in the clinical reasoning cycle. The first two are:
1. Consider patient situation.
2. Collect cues / information.
What are the final 6?

A
  1. Consider patient situation.
  2. Collect cues / information.
  3. Process information.
  4. Identify problems / issues.
  5. Establish goals.
  6. Take action.
  7. Evaluate outcomes.
  8. Reflect on process and new learning.
54
Q

How is a nursing diagnosis is different to a mental health impression?

A

Mental health is done by collecting information, through impression and formulations.

55
Q

What is a SMART Goal?

A

Specific
Measurable
Achievable
Realistic
Timed

56
Q

T or F. Stress is a transient phenomenon related to specific stressors.

A

True. It will generally subside when the stressor disappears or as the individual adapts to the stressor.

57
Q

Define Stress.

A

Is internal and external and usually something difficult to cope with.

58
Q

What is the difference between triggers and provocation?

A

Triggers are usually linked to past traumatic event or experience and provocation is a deliberate act or expression to illicit an reaction.

59
Q

De-escalation is a two step process. The first step is to identify when a person is experiencing distress. What is the second step?

A

Communication skills and other approaches to reduce level of distress.

60
Q

There is always a physiological hormone response to stress. What hormones are released into the blood stream during an immediate reaction?

A

Adrenaline and noradrenaline.

61
Q

There is always a physiological hormone response to stress. What hormones are released into the blood stream during an intermediate reaction?

A

Adrenocorticotropic hormone (ACTH)
Antidiuretic hormone (ADH)

62
Q

There is always a physiological hormone response to stress. What hormones are released into the blood stream during an prolonged response to stress?

A

Cortisol release is problematic to physical health and contributes to chronic illness and disease.

63
Q

T or F. Active listening, therapeutic communication and therapeutic relationships are integral for de-escalation in mental health nursing?

A

True

64
Q

What should be number one consideration when trying to de-escalate in mental health nursing?

A

Safety first - always. Do this through being aware of the situation, observing distress early before it becomes crisis.

65
Q

A member of the public asks to have a family member assess for the MHA. Who is the person who will assist with this?
a. Director of mental health.
b. director of area mental health services.
c. duly authorised officer.
d. district inspector.
e. responsible clinician.

A

Duly authorised officer can give advise on mental health services and how the Act works. They can also help with the assessment of proposed patients.

66
Q

A patient subject to the MHA has a complaint about their treatment. Who will investigate this complaint?
a. Director of mental health.
b. director of area mental health services.
c. duly authorised officer.
d. district inspector.
e. responsible clinician.

A

District inspector. They are lawyers with special responsibility for safe guarding the rights of people under the MHA.

67
Q

A patient subject to the MHA wants explanations about their treatment. Who will need to inform the patient of their treatment?
a. Director of mental health.
b. director of area mental health services.
c. duly authorised officer.
d. district inspector.
e. responsible clinician.

A

Responsible clinician. This can be a psychiatrist or nurse practitioner and can limit the rights of:
- company of others (seclusion).
- send and receive mail and telephone calls.
- visitors.
They may also grant leave from the hospital.

68
Q

True or False. An MSE is a observation process that looks at the mental state of an individual over a period of two weeks.

A

False. It looks at the mental state of an individual at a set point of time.

69
Q

What disorder is an impulse control disorder?
a. hoarding
b. OCD
c. body dysmorphic disorder
d. skin picking disorder

A

Skin picking disorder

70
Q

True or false. A dignosis of OCD needs to include both obsessions and compulsions?

A

True.

71
Q

What is the main treatment for OCD & eating disorder?

A

CBT

72
Q

What 3 symtpoms of anorexia nervosa that may lead to fatality?
a. amenorrhea
b. hypothermia
c. cardiac failure
d. suicide

A

hypothermia, cardiac failure, suicide

73
Q

T or F. Is serotonin depletion the main biological reason for OCD?

A

True.

74
Q

What tricyclic antidepressant is used to treat OCD?
a. Amitriptyline
b. Nortriptyline
c. Clomipramine

A

Clomipramine

75
Q

What are some risk factors of metabolic syndrome?

A

Hypertension
insulin resistance
dyslipidaemia
abdominal obesity

76
Q

There are 5 stages to the assault cycle, the first is the trigger stage, what are the next four?

A

Trigger stage - immediate response to stimuli
Escalation stage - behaviour changes due to increased emotions - de-escalation techniques are most useful.
Crisis stage - no longer in control.
Recover stage - returning to baseline behaviour - 90mins and high risk of being triggered again.
Post crisis depression - behaviours drop below baseline and potential for self harm

77
Q

What stage of the assault cycle would de-escalation techniques be most useful?
a. trigger stage
b. escalation stage
c. crisis stage
d. recovery stage.

A

Escalation stage - this is where the emotions are building resulting in behaviour changes. Once they are triggered, they are triggered, but you may potentially be able to manage the situation so that it does not escalate further.

78
Q

How long (approx) does someone remain in the recovery stage for?
a. 30mins
b. 20mins
c. 90mins
d. 60mins

A

90mins in the recovery stage, it is dependent on the person and during this stage they are at high risk of being triggered again.

79
Q

At what stage may you see restraints, seclusion or PRN IM be administered?
a.trigger stage
b. escalation stage
c. crisis stage
d. recovery stage.

A

Stage 3 - Crisis stage

80
Q

What are the three stages you might be able to de-escalate the patient?

A

Proactive - before the event
Dynamic - continuous process in a changing environment
Post incident - after to prevent its recurrence.

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