ATI Mental Health Final Review PDF

Preview

Summary

Download ATI Mental Health Final Review PDF

Description

ATI Mental Health Final Review Chapter 1- Basic Mental Health Concepts -

Assessment o Psychosocial History— assess the patients’ perception of health, beliefs, illness, wellness, leisure activities, history of substance abuse, stress level, coping abilities, and support systems. o Cultural beliefs and practices— cultural health care beliefs, practices, values, cultural factors. o Spiritual and religious beliefs— affect the way the patient finds meaning, hope, purpose, and a sense of peace. Assess the patient’s support systems and assist them in identifying support persons and resources. o Mental Status Examination (MSE)— standardized method of evaluating the mental status of a patient.

Components Evaluation Appearance Grooming, hygiene, clothing. Behavior Distressed, cooperative, agitated? Motor Activity Posture, voluntary and involuntary movements. Speech Amount on verbalization, rate, tone of speaking, slurred speech. Mood/Affect Compare patient’s mood to patient’s affect (expressions). Thought Process/Content Are they thinking linear, organized or are they delusional, homicidal, or suicidal? Perception Is the patient having hallucinations? Cognition Alert and oriented? Ability to stay focused, short, and long-term memory Insight Is patient understanding of their own illness Judgement Is the patient able to make good decisions? - Considerations Across the Lifespan o Children and adolescents  Assessment includes temperament, social and environmental factors, cultural and religious concerns, and developmental level. o Older adults  Assess the older adults’ functional ability, economic and social status, environmental factors.  Interview should be held in a quiet space with adequate lighting to accommodate for impaired vision and hearing. o Mental Health Diagnosis  The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)  DSM-5 establishes diagnostic criteria, assists nurses in planning care, and indicates expected assessment findings of mental health disorders. Chapter 2- Legal and Ethical Issues -

Patient Rights o Patient Confidentiality- HIPAA law protects the patient’s right to privacy.  Exception- if the nurse determines the patient poses a serious threat to another person, the nurse must protect the third party.

Right to Refuse Treatment- they have the right to refuse medications and therapies even when admitted involuntarily (except in an emergency). o Right to Least Restrictive Environment- restraints and seclusions should only be used as a last resort and for the shortest duration of time. Informed Consent o Provider’s Role- explain the procedure including risks, benefits, alternatives, and assess the patient’s understanding of the information. o Nurse’s Role- sign consent form as a witness, confirm the patient received and understands the information provided, and ensure the patient is competent and gave consent voluntarily. o Documentation- informed consent must be documented on a form or in the patient’s EMR. Ethical Principles o Autonomy- the patient’s right to make their own healthcare decisions.  Example- respect the patient’s right to refuse their medication. o Beneficence- to promote good  Example- provide a quiet space and remain with an anxious patient. o Nonmaleficence- to avoid causing harm  Example- perform multiple checks to avoid medication error. o Justice- to treat fairly and equally  Example- distribute care equitably among assigned patients. o Fidelity- being faithful/loyal.  Example- keeping promises made to a patient. o Advocacy- to promote/protect the patient’s right, health, and safety.  Example- notify the provider of concerning change in patient’s condition. o Veracity- to tell the truth.  Example- be honest with a patient about possible side effects of a medication. Restraints and Seclusion o Indications- patient poses an imminent danger to self or others. o Types  Physical- hand mitts, limb restraints, belts, vests.  Chemical- benzodiazepines, antipsychotics. o Nursing Care  Always try to deescalate before using restraints; using nonthreatening language, set clear boundaries, decrease stimuli, provide diversion, offer PRN medications.  In an emergency, the nurse can apply restraints but an order needs to be obtained by the provider ASAP.  Assess patient every 15 minutes; vital signs, ROM exercises, offer fluids and toileting every 2 hours.  Once the patient is no longer a danger to themselves or others, restraints can be removed. o Order Requirements  Provider must assess the patient physically within 24 hours of initiation of restraints or seclusion.  Orders must be renewed within the following time frames  ≤ 4 hours for adults (≥ 18 years) o

-

-

-

o

 ≤ 2 hours for older children and adolescents (9 to 17 years)  ≤ 1 hour for younger children ( < 9 years old)  PRN medications cannot be given.  A new order is required every 24 hours if restraints are still needed. Nursing Documentation  Rationale for restraints/seclusion, time, assessment findings, patient care offered and provided.

Chapter 3- Effective Communication -

-

-

-

-

Basic Communication o Levels of communication include:  Intrapersonal communication- occurs within an individual; “self-talk”.  Interpersonal communication- occurs one-on-one with another individual.  Small-group communication- occurs between two or more people in a small group.  Public Communication- occurs within large groups or people. Verbal Communication: o Vocabulary- words used to communicate either a written or spoken language. o Denotative/Connotative meaning- words have multiple meaning and can cause miscommunication. o Clarity-brevity- the shortest, simplest communication is usually the most effective. o Timing/relevance- knowing when to communicate allows the receiver to be more attentive to the message. o Pacing- rate of speech can communicate a meaning to the receiver. o Intonation- tone of voice can communicate a variety of feelings. Nonverbal communication o Appearance, posture, gait, facial expressions, eye contact, gestures, sounds, territoriality, personal space, silence. Therapeutic Communication o Use of communication to build and maintain helping relationships with patients, families, and significant others. o Essential when caring for a patient who has a mental disorder because of the emotional as well as the physical effects of the disorder on the patient. o Nurse’s use therapeutic communication to: o Attend to patient’s thoughts, feelings, concerns, and needs. o Express empathy o Obtain information and give feedback o Intervene to promote functional behavior and effective interpersonal relationships o Evaluate patient’s progress towards goals and outcomes. Essential Components o Time- plan for and allow adequate time to communicate. o Attending behaviors or active listening- nonverbal means of conveying interest; eye contact, posture, body language. o Caring attitude- concern and facilitate an emotional connection with the patient. o Honest- be open, direct, truthful, and sincere.

Empathy- objective awareness and understanding of the feelings, emotions, and behaviors of others. o Nonjudgmental attitude- acceptance that will encourage open, honest communication. Effective Communication Skills and Techniques o Silence o Active listening o Questions  Open-ended questions- facilitates spontaneous responses and interactive discussion.  Closed-ended questions- helpful if used sparingly during the initial interaction to obtain specific data.  Projective questions- uses “what if” or similar questions to assist patient in exploring feelings.  Presupposition questions- explores patient’s life goals or motivations by presenting hypothetical situation in which the patient no longer has the mental health disorder. o Clarifying techniques  Restating- using patient’s exact words.  Reflecting- directs the focus back to the patient for the patient to examine his feelings.  Paraphrasing- restates the patient’s feelings and thoughts for the patient to confirm what has been communicated.  Exploring- allows the nurse to gather more information regarding important topics mentioned by patient. o Offering general leads, broad opening statements- encourages patient to determine where the communication can start and to continue talking o Showing acceptance and recognition- acknowledges the nurse’s interest and nonjudgmental attitude. o Focusing- helps patient to concentrate on what is important o Giving information- provides details that the patient may need for decision making o Presenting reality- helps the patient focus on what is happening and to dispel delusions, hallucinations, or faulty beliefs. o Summarizing- emphasizes important points and reviews what has been discussed. o Offering self- willingness to spend time with the patient. o Touch- if appropriate, therapeutic touch communicates caring and can provide comfort to the patient. Barriers to Effective Communication o Asking irrelevant personal questions o Offering personal opinions o Giving advice o Giving false reassurance o Minimizing feelings o Changing the topic o Asking “why” questions o Offering value judgments o

-

-

-

o Excessive questioning o Giving approval or disapproval Nurse/Patient Relationship o Pre-orientation  Prepare to meet the patient, review chart and examine your own feelings about working with the patient. o Orientation Phase  Perform introductions, establish rapport, set mutually agreeable goals and plan of action, and establish boundaries.  Discuss confidentiality. o Working Phase  Gather data, identify and practice problem-solving and coping skills, provide education, evaluate progress towards goals. o Termination Phase  Summarize goals, discuss incorporation of new coping skills and discharge plans.  Allow patient to share feelings regarding termination of the relationship. May elicit a sense of grief from the patient.

Chapter 4- Stress and Defense Mechanisms -

Defense Mechanisms o Altruism- dealing with anxiety by reaching out to others.  Adaptive Use- a nurse who lost a family member in a fire is a volunteer firefighter. o Sublimation- dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms or expression.  Adaptive Use- a person who is angry will go work out vigorously. o Suppression- voluntarily denying unpleasant thought and feelings.  Adaptive Use- a student puts off thinking about a fight she had with her friend so she can study for her final exam.  Maladaptive- a person who has lost their job states they will worry about paying bills next week. o Repression- unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness.  Adaptive- a person preparing a speech unconsciously forgets that when they were little kids laughed at them while on stage.  Maladaptive- a person who has a fear of the dentist continuously forgets to go to their dental appointments. o Regression- sudden use of childlike or primitive behaviors that do not correlate with the person’s current developmental level.  A young child temporarily wets their bed when they learn their parents are getting a divorce.  Maladaptive use- a person who has a disagreement with a coworker slams the door and throws things. o Displacement- shifting feelings related to an object, person, or situation to another less threatening object, person, or situation.

Adaptive- an adolescent angrily punches a punching bag after losing a game. Maladaptive- a person who is angry about losing their job destroys their child’s favorite toy. Reaction formation- unacceptable feelings or behaviors are controlled or kept out of awareness by overcompensating or demonstrating. Overcompensating or demonstrating the opposite behavior of what is felt.  Adaptive- a person who is trying to quit smoking repeatedly talks to adolescents about the dangers of nicotine.  Maladaptive- a person who resents having to care for an aging parent becomes overprotective and restricts their freedoms. Undoing- performing an act to make up for prior behavior (most seen in children).  Adaptive- an adolescent completes chores after arguing with their parent.  Maladaptive- a person buys their partner flowers after an incident of partner abuse. Rationalization- creating reasonable and acceptable explanations for unacceptable behavior.  Adaptive- an adolescent says, “They must have a boyfriend” when rejected by another adolescent.  Maladaptive- an adult says they had to drive home from a party after drinking because they had to feed their dog. Disassociation- a disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalization of uncomfortable or unpleasant aspects of oneself.  Adaptive- a parent blocks out the distracting noise of their children to focus while driving in traffic.  Maladaptive- a person forgets who they are following a sexual assault. Denial- pretending the truth is not reality to manage unpleasant, anxiety-causing thoughts or feelings.  Adaptive- a person initially says, “No that can’t be true” when they find out they have cancer.  Maladaptive- a parent who was informed that their child was killed in combat, states he is coming home for the holidays. Compensation- emphasizing strengths to make up for weaknesses.  Adaptive- a child who is unable to play sports excels academically.  Maladaptive- a person who is shy learns computer skills to avoid socialization. Identification- conscious or unconscious assumption of the characteristics of another individual or group.  Adaptive- a child who has an illness pretends to be a nurse for their dolls.  Maladaptive- a child sees their parents abuse each other and becomes a bully at school. Intellectualization- separation of emotions and logical facts when analyzing or coping with a situation or event.  Adaptive- a police officer blocks out the emotional aspect of a crime in order to focus on the investigation.  Maladaptive- a person learns they have a terminal illness and focus on creating a will rather than acknowledging their grief.  

o

o

o

o

o

o

o

o

o

o

o

-

Conversion- responding to stress through the unconscious development of physical manifestations not caused by a physical illness.  Maladaptive- a person experiences deafness after their partner tells them they want a divorce. Splitting- demonstrating an inability to reconcile negative and positive attributes of self or others into a cohesive image.  Maladaptive- A patient tells the nurse that the nurse is the only one who cares about him, yet the following day, the patient refuses to talk to that nurse. Projection- attributing one’s unacceptable thoughts and feelings onto another who does not have them.  A married patient who is attracted to another person accuses their partner of having an affair.

Anxiety o Mild Anxiety  Characteristics- normal, expected response to daily events. Heightens awareness, increased perceptual field, allows for optimal functioning. Beneficial for learning.  Symptoms- restlessness, irritability, increased motivation. o Moderate Anxiety  Characteristics- decreased concentration, attention span, and perceptual field. May hinder problem solving.  Symptoms- increase heart rate and respirations, GI discomfort, and muscle tension. o Mild to Moderate Anxiety Nursing Care  Help patient with problem-solving, coping mechanisms the patient has successfully used in the past, provide outlet to relieve tension (i.e., exercise). o Severe Anxiety  Characteristics- greatly decreased perceptual field, difficulty completing a simple task. Effective learning is not possible.  Symptoms- feeling of dread, headache, nausea diarrhea, insomnia, palpitations, hyperventilation. o Panic Anxiety  Characteristics- loss of contact with reality, functioning and communication ineffective, learning is not possible, can be life-threatening.  Symptoms- feeling of terror or impending doom, hallucinations or delusions, dilated pupils, severe trembling, diaphoresis. o Severe and Panic Level Anxiety Nursing Care  Move patient to a quiet setting, remain with patient.  Speak slowly and clearly.  Provide for the patient’s physical needs (i.e., food and rest) and safety needs.

Chapter 5- Creating and Maintaining a Therapeutic and Safe Environment -

Therapeutic Relationship o The therapeutic nurse-client relationship is foundational to mental health nursing care.  Purposeful and goal directed.  Well-defined with clear boundaries

  -

-

Structured to meet the client’s needs. Characterized by an interpersonal process that is safe, confidential, reliable, and consistent.

Milieu Therapy o Creates an environment that is supportive, therapeutic, and safe. Can also be called therapeutic community or therapeutic environment.  Management of the milieu refers to the management of the total environment of the mental health unit to provide the least amount of stress, while promoting the greatest benefit for all the clients.  Goal includes- the patient will learn the tools necessary to cope adaptively, interact more effectively and appropriately, and strengthen relationship skills.  Nurse is responsible for structuring and implementing aspects of the therapeutic milieu within the mental health facility.  One structure is regular community meetings, which include both the patients and the nursing staff. Therapeutic Nurse-Client Relationship o Roles of the Nurse  Focus on patient’s ideas, experiences, and feelings.  Identify and explore needs and problems.  Discuss problem solving alternatives.  Develop patient strengths and coping skills.  Encourage positive behavior change.  Assist patient in developing a sense of autonomy and self-reliance.  Portray empathy and a positive regard toward patient. o Benefits of the Therapeutic Relationship  Contribute to the well-being of those who have a mental illness.  Therapeutic relationships have a positive impact on the success of treatment.  Nursing factors include:  Consistent approach to interaction  Adjustment of pace to client’s needs  Attentive listening  Positive initial impressions  Comfort level during the relationship  Self-awareness of own thoughts and feelings  Consistent availability o Client Factors  Trusting attitude  Willingness to talk  Active participation  Consistent availability o Boundaries of the Therapeutic Relationship  Boundaries must be established to maintain a safe and professional nurse-client relationship.  Blurred boundaries occur if the relationship begins to meet the needs of the nurse rather than those of the client, or if the relationship becomes social rather than therapeutic.

Social relationships- primary purpose is for socialization or friendship with a focus on the mutual needs of the individuals involved in the relationship.  Therapeutic relationships- primary purpose is to identify the client’s problems or needs and then focus on assisting the client in meeting or resolving those issues. Nurses must maintain constant level of involvement with patient so they can reflect on boundary issues.  Transference- patient views a member of the health care team as having characteristics of another person that is significant to their personal life.  Behaviors include: o Patient might expect exclusive services from nurse. o Patient may become jealous of nurse’s time or attention o Patient compares nurse to a former authority figure.  Nursing implications o nurse should be aware that transference by a patient is more likely to occur with a person in authority.  Countertransference- occurs when a health care team member, displaces characteristics of people in their past onto a client.  Behaviors include: o Nurse overly identifies with patient o Nurse competes with patient o Nurse argues with patient  Nursing implications: o Nurse should be aware that patients who induce strong...