LAB2 Mental Health NSG3137 PDF

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Summary

Care of individuals with mental health issues. The practice and application of therapeutic interaction/communication, relationship skills, family assessment and support in simulation environments and health care settings. ...

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Caring for the person experiencing Mania Introduction to Mental Status Examination (MSE) Learning Objective: 1. Demonstrate knowledge of therapeutic communication techniques appropriate to a mental health situation 2. Demonstrate an understanding of nursing care related to Bipolar Disorder 3. Reflect on therapeutic communication of self before, during, and after the patient encounter. 4. Provide constructive feedback to a peer related to therapeutic communication. 5. Explore personal feelings about psychiatric nursing roles and patients one might interact with 6. Share concerns and fears about beginning mental health clinical 7. Demonstrate knowledge of mental status exam components and apply effectively 8. Understand the role of stigma in provider care

Mental Status Examination RNAO iaBPG, nursing best practice guideline- Outline mental status assessment http://pda.rnao.ca/content/outline-mental-status-assessment (not a reading) Jarvis (2014) Physical examination and health assessment Toronto: Elsevier Canada, Chapter 6, p,82-103

Halter (2014). Canadian Psychiatric Mental Health Nursing. First Canadian edition.Application of the Nursing Process-About Assessment -p. 138, 592-593 Assessment Data

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Developmental Assessment ○ The developmental assessment provides info about the child or adolescent’s maturational level ○ Abnormal finding in the developmental and mental status assessments may be related to stress and adjustment problems or to more serious disorders ○ As young people develop maladaptive coping behaviours and use these behaviours over time more at risk for developing mental health disorders Mental Status Examination ○ Provides info about the mental state at the time of the examination and identifies problems with thinking, feeling, and behaving ○ Risk (for suicide) Assessment ■ Past and current suicidal thoughts, threats, or attempts ■ Existence of a plan, lethality of the plan, and accessibility of any necessities for carrying out the plan ■ Feeling of hopelessness; changes in level of energy ■ Circumstances, state of mind, and motivation ■ Viewpoints about suicide and death ■ Depression and other moods or feelings ■ History of impulsivity, poor judgement, or decreased decision making ■ Drug or alcohol use ■ Prescribed medications and any recent adherence issues Cultural Factors ○ The DSM-5 i dentifies culture-bound syndromes of mental illness that are not diag- nostic categories in Western medicine ○ Sensitivity to cultural influences in mental illness is a necessity to show respect for cultural preferences in providing individualized care ○ The use of “nonstandard” english dialects can make speech difficult to assess and can contribute to stereotyping

__________________________________ Mania Halter (2019). Canadian Psychiatric Mental Health Nursing. First Canadian edition. Application of the Nursing Process-p. 264-268 (OR 281 - 285) ASSESSMENT General Assessment ● Mood ○ Euphoric mood - associated with mania is unstable ○ Patients may state they are experiencing an intense feeling of well-being, is “cheerful in a beautiful world” or is becoming “one with God” ○ People experiencing a manic state may laugh, joke, and talk in a continuous stream, with uninhibited familiarity. ○ ○ ○ ○ ○ ● Behaviour ● Thought Processes and Speech Patterns ● Cognitive Function Self-Assessment ● Person experiencing mania (out of control and resists being controlled)

What is mania? ● Mania is a state of extreme physical and emotional elation. Symptoms and types of mania ● A person experiencing mania or a manic episode may present with the following symptoms: ● Elevated mood. The person feels extremely ‘high’, happy and full of energy; he or she may describe the experience as feeling on top of the world and invincible. The person may shift rapidly from an elevated, happy mood to being angry and irritable if they perceive they have been obstructed. ● Increased energy and overactivity. The person may have great difficulty remaining still. u Reduced need for sleep or food. The person may be too active to eat or sleep. u Irritability. The person may become angry and irritated with those who disagree with or dismiss his or her sometimes unrealistic plans or ideas. ● Rapid thinking and speech. The person’s thoughts and speech are more rapid than usual. ● Grandiose plans and beliefs. It is quite common for a person in a hypomanic or manic state to believe that he or she is unusually talented or Page 49 Page 50 Mania gifted or has special friends in power. For example, the person may believe that he or she is on a special mission from God. ● Lack of insight. A person in a hypomanic or manic state may understand that other people see his or her ideas and actions as inappropriate, reckless or irrational. However, he or she is unlikely to personally accept that the behaviour is inappropriate, due to a lack of insight. ● Distractibility. The person has difficulty maintaining attention and may not be able to filter out external stimuli. ● Episodes that are characterised by the above, but are not associated with marked social or occupational disturbance, a need for hospitalisation or psychotic features are called hypomanic episodes. ● Causes, onset and course of mania ○ A person may experience mania as a result of a range of factors, including: ■ stressful events ■ genetic factors ■ biochemical factors (neurotransmitter abnormalities or imbalances) ■ seasonal influences ■ bipolar affective disorder (BPAD). ○ For individuals living with bipolar affective disorder (also called bipolar disorder and formerly called manic depressive psychosis) they will experience recurrent episodes of depression and mania, of which the symptoms are not due to substance use or other general medical conditions. The manic or depressive episodes are usually separated by lengthy periods where the person is well. ○ The average age for the first manic episode is in the early twenties; however, for some, episodes begin in adolescence. The first episode rarely occurs after the age of 50. Manic episodes in adolescence are more likely to include psychotic features and may be associated with school truancy, antisocial behaviour, school failure or substance abuse. Lifetime prevalence is about one per cent. Manic episodes begin suddenly and with a rapid escalation of symptoms over a few days. They may follow psychosocial stressors or a major depressive episode.

Respond to the questions and send your responses to your instructor at least 1 hr prior to your lab. 1. What is the purpose of the MSE? The purpose of the MSE is to assess and evaluate an individual’s current cognitive, affective (emotional), and behavioural functioning. It includes both objective observations of the clinician and subjective descriptions given by the patient. 2. When should a MSE be conducted? MSEs are often administered every day for acutely disturbed patients. They should be conducted every shift. 3. 1.

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What are the eight components/elements of the MSE? (BESTPICK) Behaviour and general appearance - age, sex, gender, cultural background, posture, dress/ grooming, manner, alertness, as well as agitation, hyperactivity, psychomotor retardation, unusual movements, catatonia, etc. Emotions: mood and state, emotional state and visible expression (state) including description and variability. Speech—rate, amount, style and tone of speech. Thought content and processes—abnormalities, obsessions, delusions and suicidal and homicidal thoughts and thought process as well as loose associations, tangential thinking, word salad, and neologisms, circumstantial thought, and concrete versus abstract thought. Perceptual disturbances—illusions and hallucinations. Impulse control—ability to delay, modulate or inhibit expressions or behaviours. Cognition—consciousness, orientation, concentration and memory. Knowledge, insights and judgment—the capacity to identify possible courses of action, anticipate consequences, and choose appropriate behaviour, and extent of awareness of illness and maladaptive behaviours.

4. What are the benefits and challenges of conducting a MSE? Benefits of conducting a MSE include providing information for practitioners to diagnose and assess the disorder and response to treatment. Additionally, if another practitioner sees the patient, it allows them to determine if their mental status and changes without previously assessing the patient. Challenges in carrying out an MSE include if the patient has limited language or has other impairments. The MSE is a tick sheet and may not describe everything that is going on with the patient. There are also cultural differences around mental health. 5.

What would a nurse notice about a person’s speech language if a person had decreased reciprocal flow? If a person had a decreased reciprocal flow, they would show a reduced effort in maintaining the conversation by responding in short answers. 6.

It is very common for student nurses to confuse thought process and thought content. In your own words define thought process and what you would notice if a person is experiencing a loosening of associations. Thought process is how someone thinks. If a person is experiencing loosening of associations, I would notice that conversations with the person can shift from one topic to another in a completely unrelated manner, making it confusing and difficult to follow. Their speech would be d isconnected and fragmented, with the individual jumping from one idea to another unrelated or indirectly related idea. 7. Define Thought content and what you would notice if a person is experiencing ideas of reference Thought content is what the person is thinking. If a person is experiencing ideas of reference, they would believe that unrelated/random objects, people, places or events are specifically directed to them . 8.

Describe the five categories of hallucinations that person may experience

Auditory = Hearing voices/sounds that do not exist in the environment but are misperceptions of inner thoughts/feelings Visual = Seeing a person, object, animal, colours, or visual patterns that do not exist in the environment Olfactory = Smelling odours that do not exist Gustatory = Tasting sensations that do not exist Tactile = Feeling strange sensations on the skin where no external objects stimulate such feelings 9.

Our ability to make judgements is often considered a function of the frontal lobe. Define what is meant by judgement and insight when you are conducting an MSE. When conducting an MSE, judgement is assessed based on the person's ability to make logical decisions and choose the correct action after analyzing the pros and cons of each possibility. Insight is evaluated based on the person's ability to comprehend their illness and the awareness of themselves compared to others....