Psychiatric Mental Health Nursing

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What is the goal of treatment in mental health?: To treat in the least restrictictive environment.
What are some sites of mental health care?: Hospital, crisis stabilization unit, outpatient setting, home, free standing psych hospitals.
Name the members of the interdisciplinary team.: Patient, Nurse, Psychiatrist (physician), Social Worker, Clinical Psychologist, Pastoral Counselor, Occupational Therapist, Physical Therapist.
What does the case manager do?: Makes sure the patient shows up for appointments, takes meds, etc.
What is a community mental health agency?: Where people go who are medicated but not hospitalized. Counseling is available, job training, alcohol/drug rehab.
What are 3 patient hospitalization goals?: Stabilize behavior
What is the role of the physician in the interdisciplinary team?: Serves as leader of the team. Responsible for diagnosis and treatment of mental disorders. Performs psychotherapy, prescribes medication.
What is the role of the nurse in the interdisciplinary team?: Provides ongoing assessment of clients condition, mental & physical. Manages the therapeutic milieu. Administers meds. Assists clients w/ therapeutic activities as required.
What is the role of the social worker in the interdisciplinary team?: Conducts therapy. Concerned w/ client's social needs, such as placement, financial support, community requirements. Works with client and family to meet discharge needs.
What is the role of the clinical psychologist in the interdisciplinary team?: Conducts individual, group and family therapy. Administers, interprets & evaluates psychological tests.
Steps in the Interdisciplinary Treatment Plan.: Initial assessment is made by the admitting psychiatrist, nurse, ets. A treatment plan is initiated in the first 8 hours. The IDT Plan is reviewed w/in 24 hours.
What is the number one priority for the nurse managing the milieu?: Safety
Some properties of a social relationship.: Non-threatening
Some properties of an intimate relationship.: More involved
Some properties of a therapeutic relationship.: Nurse-client
The basis of all therapeutic relationships: Caring
Elements of the Jaharia window: Know yourself, Others know you, Things hidden from others, Things hidden from self
What is rapport?: Establishing a comfortable relationship with the client. Sharing, talking.
What is trust?: People willing to expose themselves to others. Information is confidential.
What is respect?: Unconditional regard for the person regardless of their behavior or inappropriate ways of dealing with life.
What is genuineness?: Truthfulness, not fake.
What is empathy?: The ability to walk in someone else's shoes and know where they're coming from.
What are some types of boundaries?: Flexible, rigid, diffuse, loose, enmeshed,
4 Stages of a therapeutic encounter.: Preinteraction
Orientation
Working
Termination
What is transference?: When a current relationship triggers an old relationship memory. (You remind the client of someone)
What is countertransference?: When the patient reminds the nurse of someone.
What are the 2 components of communication?: The sender and the receiver contribute.
3 types of communication: Verbal (speech)
Non-verbal (body language)
Paralanguage (tone of voice, etc.)
Name 6 listening skills: Be on same level (sit with client)
Maintain good eye contact
Maintain proper distance
Sit open to the client
Don't use a table
Keep non-judgmental face
Technique - Reflecting content and feeling: Is there something you'd like to talk about?
Share with me how your pass went.
Where would you like to begin?
Technique - Exploring: And then?
Tell me about it?
Technique - observe feelings: You sound very upset with this situation. You appear tense.
Technique - using silence: Encourage a person to speak by waiting.
Technique - offering self: I'll stay with you a little while
I would like to sit with you for a while.
Technique - Restating: C: I have so much to do. I take care of the house and 3 kids. I work part-time. How can you expect me to fit in 30 minutes for relaxation exercises?
N: It's hard for you to see how you could fit one more activity into your busy day.
Technique - giving information: May name is...
Visiting hours are...
My purpose in being here is...
I'm taking you to the...
Technique - Clarifying: I'm not sure that I follow.
What would you say is the main point of what you said?
Technique - Presenting reality: I see no one else in this room.
That sound was a car backfiring.
I don't hear any voices other than yours and mine.
Technique - summarizing: Have I got this straight?
You've said that...
During the past hour you and I have discussed...
Technique - Making observations: Good morning, Mr. Jones.
I see you showered this morning.
Technique - Encouraging continuation: Yes.
Uh Hum.
I follow what you said.
Nodding.
What is an assessment?: A collection/interpretation of data.
How often is a mental status exam done?: Every shift
Words that can be used for appearance.: clean, showered, dirty, odor, slumped, upright, dressed gaudy, etc.
Motor activity assessment.: Observe gait
Lithium gives ataxic gait (unbalanced)
observe body activity (tremors, calm)
Speech assessment: Observe how thought processes are coming together. Observe quantity and quality.
Poverty of speech: Client talks very little.
Pressured speech: Client talks very fast, under force. Seen in manic depressive people.
Retarded speech: Very slow speech. Seen in depressed people.
Hesitant speech: Client speaks slowly and stops occasionally.
Blocking: Client stops in mid-sentence. Loses train of thought. May indicate problems in thought process.
Mood: Sustained emotion over time
Affect: Facial expression
Congruence: Mood and affect match
Incongruence: Mood and affect don't match.
Labile mood: Mood changes frequently
Behavior style: cooperative, hostile, suspicious, guarded, friendly.
Degree of interaction: Withdrawn, quiet, talkative, seclusiveness, inwardly focused. Pay attention to who they interact with.
Thought processes: Organized
Loose - disorganized thoughts
Word salad - sentences mixed up
Tangential thinking - change topics
Flow of thought: Normal, rapid (zooming), Racing thoughts - common in hypo manic or manic patients.
Flight of ideas: Many thoughts being said rapidly. Disorganized thoughts.
Content: Compare what the client says to reality. Reality is fluid - dependes on culture.
Delusion: A fixed belief that is not grounded in reality.
How do we judge reality?: Against common beliefs
Religious Grandiosity: Client believes they're God
Somatic delusions: Delusions of the body
(bugs inside, empty inside)
3 main types of mental illness: Depression
Schizophrenia
Mania
Illusion: Data is interpreted incorrectly (magic)
Hallucination: Brain gets data that isn't there.
Dementia quality: Common to have visual hallucinations.
Delirium quality: Very common to have visual hallucinations.
Schizophrenia quality: Common to have auditory hallucinations.
Psychosis: Serious psychiatric disturbances characterized by the presence of delusions or hallucinations and the impairment of interpersonal functioning and relationship to the external world.
Test for long term memory: Who was the last president?
What type of memory is lost in dementia?: Short term memory is lost. Long term memory may remain intact.
Concrete thinking: Taking info. exactly how it is said. (Stole a base)
Abstract thinking: Take words and infer from them. Occurs at around age 8 or 9.
Test for judgement.: Letter under mailbox. What would you do if you won the lottery?
What are some vegetative symptoms?: Physical functions such as sleep, appetite, libido, excretory functions.
6 factors that increase risk of suicide.: Suicidal ideations
Suicidal gestures
Family history
Drugs/alcohol
No support system
Own a gun
Self concept: Overall feeling of self. Body image, self esteem, personal identity.
Spiritual life: What gives meaning to your life. What helps you through trouble?
Religion: An organized group who share common beliefs.
Aftercare Plans: Where will the client go after they leave? Transportation, finances?
Medical category Axis I: Clinical psychiatric disorders. Include drug/alcohol problems - dual diagnosis.
Medical Category Axis II: Personality disorder and mental retardation.
Medical category Axis III: Significant medical conditions that impact recovery (diabetes, hypertension)
Medical Category Axis IV: Psychosocial/environmental problems.
Stressors - homelessness, divorce, children leaving home, etc.
Medical Category Axis V: Global Assessment of Functioning GAF Scale of 1-100

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