Mental health exam 1 Flashcards
(136 cards)
1
Q
Asylum
A
a safe refuge or haven from the 1700s
2
Q
Deinstituitionalization
A
a deliberate shift from the institutional care to community care
3
Q
When and what were the early major milestones for MH?
A
psychopharmacology in the 1950s - development of psychotropic medications (thorazine and lithium) resulting in shorter stays, stabilization, and overall less chaotic stays in hospital settings
deinstitutionalization in 1960s - community MH centers construction act, shift from institutional care to community care, SSI income for disabled person, 1970s process for involuntary commitment made for difficult
4
Q
Goals for Healthy People 2020
A
-reduce suicide rate
-reduce major depressive episode
—increase number of mental health facilities
-increase employment for people with mental illness
-increase treatment for dual diagnose
-increase care for the homeless with mental illness
5
Q
What is DSM 5?
A
standard language for mental health that lists the defining characteristics of disorders and helped identify the underlying causes.
6
Q
Diathesis + Stress =
A
Disorder
7
Q
What is diathesis?
A
biological factors, social factors, and psychological factors that can lead to a predisposition for a disease/disorder.
8
Q
Modern MH Nurses
A
advocate - fight stigma of mental health
standard of care - ethics
Phenomena of Concern of MH Nurse
self awareness
9
Q
Mental health exists on a
A
continuum - both acuity and time
10
Q
The contributing factors of mental illness is
A
Individual. Interpersonal, and Social/Cultural
11
Q
Anhedonia is…
A
the inability to find joy in the things that they once did
12
Q
Dysmorphic means
A
unhappy
13
Q
psychosis
A
sensory or thought disturbances
14
Q
What is ACE?
A
Adverse Childhood Experiences and Trauma Informed Care
15
Q
The 3 types of ACEs?
A
abuse, neglect, household dysfunction
16
Q
Protective Factors
A
Resilience - coping skills
Social and Economic Circumstances - environment/resources/accessibility
Perception of MH - hope/acceptance/support
Social Influences on MHC - positive change
17
Q
Risk Factors
A
Biologic/genetic - vulnerabilities
Stressors - personal/financial/situational
Social and economic circumstances - environment/resources/accessibility
Perception of MH - stigma
Social Influences on MHC - policies/paternalism
18
Q
Nurse’s Role
A
Educate
Advocacy
Self-Awareness
Compassionate care
Ethical Care
Political Involvement
Eradicate hurtful language (crazy)
Avoid laden and judgmental phrase (acting out)
Improve Documentation
19
Q
Stigma
A
comes from history, polices, beliefs, past experiences, and media
involves beliefs of those involved with mental illness
20
Q
How does stigma impact client experience?
A
feelings of isolation, discrimination, abuse, and violence
21
Q
reflection
A
how we view our own experiences and beliefs
22
Q
nonverbal communication
A
facial expression
eye contact
gestures
personal space
silence
sounds (sigh)
fidgety behavior
23
Q
Therapeutic communication
A
active listening
observation
supportive touch
cultural considerations
identifying concerns
Implement interventions
24
Q
Therapeutic Techniques
A
excepting
broad openings
VOICING DOUBT
clarification
silence
OPEN ENDED QUESTIONS
exploring
25
non-therapeutic techniques
advising, belittling, challenging, defending, disapproving, changing the topic
26
Empathy vs. Sympathy
In empathy, we understand the feelings and in sympathy, we feel the feeling.
27
Projective Questions
what if questions - beneficial for exploration
28
why not to ask why questions?
makes people defensive
looks for response that justifies feeling
create an imbalance of power
use tell me about that instead of why
29
clarity/brevity
short simple communication = best
30
timing/relevance
when would be the best time to have the conversation
31
pacing
using the right rate of speech
32
intonation
tone of voice conveys feelings
33
age related consideration
children - use simple terms
adolescences- consider importance of normal fear of telling the truth
older - assessing hearing ability and pace of speech (face the client)
34
Peplau's Model
Orientation Phase - meet, establish roles/goals, and parameters
*important to know when the therapeutic relationship will end
Working Phase- problem identification and exploitation. Facilitating change
Termination - resolution, monitor for regression,
35
What is important before Peplau's Model?
preparation and self awareness
36
Self awareness
allows us to see the perspective of others, practice self control, work creatively, and being able to monitor our stress, thoughts, emotions, and beliefs
37
Transference/Countertransference
transference-client unconsciously and inappropriately displaces feelings and behaviors onto the nurse
countertransference - nurse displaces feelings onto the patient
38
Decoding
exploring and investigating possible means for verbal communication
39
culture
all socially learned behavior, values, beliefs, traditions, and customs
these are transmitted down from generation to generation
40
How Culture might impact health care?
beliefs about to how to maintain health and what causes illnesses
41
Cultural Assessment Factors
communication
physical distance
time orientation
environmental control
biologic variations
42
Strategies for culturally competent care
Ask the patient:
how to be cared for?
what the expect from care?
any home remedies?
dietary preferences?
AVOID:
stereotyping and assumptions
missing cue
43
Campina-Bacote Model
Cultural:
Awareness
Skill
Knowledge
Encounters
Desires
44
cultural competence implies
endpoint - knowledge obtained is sufficient
45
cultural humility implies
ongoing process - room for improvement
46
Conflict (S/R)
disconnect from expectations
47
question (S/R)
"meaning of life and purpose"
48
hyper-religious (S/R)
ruminations and excessiveness
49
Hallucinations (S/R)
visions may occur (ex: voice of God, devil, demons, and angels
50
Impaired Judgement (S/R)
risky behavior, immortality
51
Delusions (S/R)
persecution, religious identity, and paranoia
52
Special Populations in MH care
homeless
incarcerated
immigrants
poverty
*might increase NEED but limits ACCESS
53
Values and Beliefs (self-awareness)
values - what is important to you
beliefs - an option you believe to be true
54
Implicit vs Explicit biases
implicit - unconscious
explicit - conscious
55
systematic desensitization
A type of counterconditioning that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli (ex: phobias)
56
Erikson's stages of psychosocial development
1. trust vs. mistrust (0-18 months)
2. autonomy vs. shame and doubt (2-3)
3. initiative vs. guilt (3-5)
4. industry vs. inferiority (6-11)
5. identity vs. role confusion (12-18)
6. intimacy vs. isolation (19-40)
7. generativity vs. stagnation (40-65)
8. integrity vs. despair (65-death)
57
defense mechanisms
altruism - act to promote someone else's welfare even at a risk to ourselves
sublimation - unconscious defense that reduces anxiety resulting from unacceptable urges or harmful stimuli
regression - return to a former or less developed state
denial - confrontation with a problem is avoided by denying that it exists
intellectualization - reason to block confrontation with an unconsciousness conflict associated with emotional stress
58
dialetical behavior therapy
mindfullness
distress tolerance- cope with strong emotions
emotion regulation - identify and deal with it
Interpersonal effectiveness - set boundaries
59
cognitive distortions
false and irrational - automatic thoughts
leads to false assumptions/misinterpretations
60
individual therapy
any background and style
relationship is KEY
can use different strategies
often HOMEWORK
termination can be challenging
61
Group Therapy
variety of types and styles
group development = ground rules
open or closed groups
family therapy
education
support
62
factors in dysfunctional families
blaming
manipulating
placating
distracting
generalizing
63
characters of behavior
passive - fails to express needs and feelings
assertive - direct expression of needs and feelings
aggressive - direct expression of needs and feelings to fault
64
light/phototherapy
1st line treatment for Seasonal Affective Disorder (SAD - a type of major depression)
-Exposure to light suppresses the nocturnal secretion of melatonin which helps people with SAD
-30-45 minutes daily - morning is best
65
ECT
electroconvulsive therapy
contraindications -hx of heart/stroke and can lead to memory loss
SAFE FOR PREGNANCY
66
CAM (complementary and alternative medicine)
-Herbal Therapy
-Meditation/Yoga
-Mindfulness
-Acupuncture
-Guided Imagery
-Relaxation Techniques (Be careful with progressive relaxation with somatic clients!)
-Spirituality (12 step groups are often based on spirituality)
-Diet, exercise, homeopathy, aromatherapy
-Music, Art, Pet Therapy
67
Least Restrictive Environment
clients have a right to get their treatment there
68
One exception to confidentiality is ______.
duty to warn
69
What can be claimed in a case involving restraint or forced medication?
assault
70
Treatment settings
inpatient/outpatient, partial hospitalization, day treatment, residential, long/short term, telehealth/webhealth
71
Milieu therapy
environment is apart of the therapy
safe is major concern
client centered
Multidisciplinary
*daily suicide assessments
*searches and environmental rounds
72
partial hospital programs
Transition from inpatient to living independently. Provides medication management, social support and socialization, and ongoing assessments. Client goes home at night with a responsible support person.
73
day treatment
offers daytime classes and support
ex: riverbed
74
assertive community treatment
case management - services to reduce rehospitlization
75
residential treatment settings
locked facilities with very strutted milieus
group homes (6-10 residents)
on-going support or care
76
Psychologist vs. Psychiatrist
Psychologists focus on using therapy to help their patients where as psychiatrists take a more medical approach to helping their patients ie. prescribing medication
77
Levels of Intervention
primary - promotes community health to prevent mental health crises (education)
secondary - early detection and intervention (crises management)
tertiary - rehabilitation, prevention of further problems, and reducing the impact of crises (support groups and care plans)
78
Dual Diagnosis
mental disorder and substance abuse
79
Case management
management of care on a case-by-case basis, represented an effort to provide necessary services while containing cost. The client is assigned to a case manager, a person who coordinates all types of care needed by the client.
80
Clubhouse model
evidence based recovery oriented program for adults living with mental health challenges - goal is to improve a person ability to function successfully in the community
provides members with many opportunities, including daytime work activities focused on the care, maintenance, and productivity
81
voluntary admission to MH facility
must meet admission criteria (risk to self or others)
clients sign themselves in
has right to apply for AMA
82
temporary emergency admissions to MH facility
patient is considered significantly unsafe, unable to make own decisions, legal hold of 24-96 hrs
83
involuntary admission to MH facility
admitted against will or for indefinite period, requires legal commitment, patients can still refuse treatment
*court hold up to 60 days
84
Safety Environment - Ligature Risk
doors open out rather than in
continuos hinges
anchored furniture
pull away curtains
boxed in plumbing
safety glass
non-looping shower head
platform beds
85
Beneficence
doing good
86
autonomy
clients rights to make own decisions
87
justice
fair and equal treatment for all
88
veracity
honesty, truthfulness
89
fidelity
loyalty, faithfulness to one's duty
90
Non-maleficence
do no harm or wrong
91
Confidentiality
right to privacy and protection of PHI
92
informed consent
education prior to treatment and clients agreement to care
93
assault/battery
giving forced medication or treatment without consent
94
duty to warn
if client threatens others
95
duty to report
if a nurse suspects any abuse
96
seclusion
involuntary confinement
97
restraint
physical, mechanical, or chemical method to restrict physical movement
98
patients rights
right to consent treatment, right to refuse treatment, right to privacy, and right to least restrictive environment
99
seclusion and restraint
first try to avoid
offer medications
reduced stimulation
provide diversion
100
Seclusion and restraint time limits
under 9 : 1 hr
9-17 : 2 hr
18+ : 4 hr
must remain 1:1 the entire time and documentation must be detailed and accurate
101
ADPIE
Assessment
Diagnosis
Planning
Implementation/Intervention
Evaluation
102
Psychosocial Assessment
History
Appearance (hygiene, dress, posture)
Mood and Affect
Thought process (speech, flight of ideas, distortions)
Senorium/Intellectual- (Memory/Orientation/abstract thinking)
Abnormal sensory experiences
judgment/insight
sensory concept
roles and relationships
self care
103
C.A.G.E.
C: concern (knows there is a problem)
A: apparent (tells others about problem)
G: grave (guilty feelings)
E: evidence (dependence or tolerance)
104
Brief Psychiatric Rating Scale (BPRS)
Objective method of rating clinical symptoms that provides scores on 18 variables (e.g., somatic concern, anxiety, withdrawal, hostility, and bizarre thinking).
105
CIWA
Clinical Institute Withdrawal Assessment for Alcohol
106
AIMS
abnormal involuntary movement scale
107
Hamilton Rating Scale for Depression
A questionnaire used to rate depression severity (0-4) . The higher the score the more severely depressed. Score is as high as 66.
108
Columbia Suicide Severity Rating Scale
Suicide ideation definition and prompts that are answered with yes or no in the past month
109
SAD PERSONS scale
A simple and practical assessment tool to evaluate potentially suicidal patients.
110
Mini-Mental State Examination (MMSE)
A test that is used to measure cognitive ability, especially in late adulthood.
111
mood vs affect
Mood= persistent emotional state
Affect= external display of feelings
112
labile
easily altered; changing rapidly (emotions)
113
assessment: harm to self and others
ask directly
ask about plans
duty to warn
contract for safety
114
Hallucinations can be
auditory, visual, olfactory, gustatory, or tactile
115
assessment: self concept
self worth
emotional response
coping skills
body image
116
Judgement vs Insight
Judgement is behavior based
Insight is cognition based
117
Roles and life changes that can affect MH
History of Abuse
Divorce
Unemployment
New child
Recent move
New adult status
118
Importance of Family History :
abuse
substance abuse
mental illness
suicide
119
HEADSSS (teens)
Home environment
Education/employment
Activities
Drug and substance use
Sexuality
Suicide/depression
Safety
120
anergia
lack of energy
121
Avolition
lack of motivation
122
alogia
poverty of speech
123
affective blunting
minimal facial expressions
124
aphasia
inability to speak
125
Agnosia
the inability to recognize familiar objects.
126
Apraxia
loss of purposeful movement
127
anosognosia
denial of illness
128
apathy
withdrawal of activities / lack on interest
129
exit seeking vs wandering
exit seeking is more purposeful wandering
130
Hyperviligence
a heightened search for threats
131
what can cause or MIMIC mental illness?
UTI
Delirium
Drugs/Toxicity
132
Safety Assessment
suicide
homicidal
elopement (escape)
assault
falls (meds usually over 2 and presence of confusion)
133
Assessments help determine:
risk for infection
risk for self harm
complicated grieving
ineffective coping
hopelessness
fear
impaired social interaction
134
SMART goals
Specific - what we want to see accomplished
Measurable - number or something concrete to measure
Achievable - can the patient reasonably do this (short and long term goals)
Relevant - does this matter to the patient
Timed - when do we want this to achieved
135
Goals vs intervention
goals- what the patient is going to do
interventions - what the nurse will do to help the patient reach goals
document what is done and the clients response to the intervention
136
Main nursing intervention
educate
