Mental Health Exam 1 notes PDF

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Mental Health Exam 1 notes Chapter 2 mental health/ mental illness 

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Mental health - is a successful performance of mental functions such as adapting to change, coping with stressors, fulfilling relationships with others, and accomplishing productive activities. (Basically, a normal person) Mental illness – Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and that interfere with the individual’s social, occupational, and/or physical functioning. (This is like maybe a special ed person)  Behaviors that is considered “normal” and abnormal is defined by ones cultural or societal norms. Your culture defines what is normal or not normal.

Six indicators that are a reflection of mental health p.14-15  Positive attitude toward self 

Growth, development, and the ability to achieve self-actualization

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Integration

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Autonomy

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Perception of reality Environmental mastery

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Anxiety

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Mild Anxiety: associated with the tension experienced in response to the events of day to day life. (We actually need this to be productive)  prepares people for action  sharpens senses, increases motivation for productivity, inc. perceptual field, heightened awareness of the environment  learning is enhanced, individual is able to function at optimal levels, restlessness, irritability. Moderate anxiety: individual is less alert to events occurring in the environment.  attention span and ability to concentrate decreases. but may still attend to needs with direction.  assistance with problem solving may be required, increased muscular tension and restlessness.  increased restlessness, HR and RR, perspiration, muscular tension, speech rate, volume and pitch. Severe anxiety: concentration centers on one particular detail only or on many extraneous details.  attention span is extremely limited, difficulty completing task. HAS PHYSICAL SYMPTOMS.

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symptoms: headaches, palpitations, insomnia, confusion, dread, horror, dizziness, nausea, trembling, palpitations, tachycardia, hyperventilation, diarrhea. Panic anxiety: most intense state of anxiety, unable to focus on any detail in the environment, loss of contact with reality may occur.  hallucinations or delusions, wild and desperate actions, extreme withdrawal, misperceptions of environment.  human functioning and communication with others is ineffective(Due to hallucinations)  fear of going crazy, losing control, dilated pupils, palpitations, sleeplessness, bizarre behavior, diaphoresis and pallor, severe trembling terror. Stages of Grief (DAB DA) (why cry when you can DAB)  Stage 1: Denial  Stage 2: Anger  Stage 3: Bargaining  Stage 4: Depression  Stage 5: Acceptance Maladaptive grief responses:  prolonged response-disorganization of function, in denial or anger stage  delayed or inhibited response-fixed in the denial stage, anxiety disorders may be evident. They can even remain in denial stage for many years.  distorted response: fixed in the anger stage, the normal behaviors associated with grieving are exaggerated, they are unable to function.  anxiety and grief are the common two major primary response to stress.  anticipatory grief: when the mourning process is completed prematurely, can cause the individual to distance themselves from the patient before they are gone.  ego defense mechanisms  pg 19

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neurosis: the patient knows they are experiencing distress, that they are having problems. psychosis: the patient is unaware of their behavior or any psychological problems they have

Chapter 5 ethics 

Don’t use physical restraint until you have used (exhausted) all other restraint measures like medication or chemical restraint.

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You can discharge the patient if he doesn’t seem like a danger to himself or other people.

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Discharge must be completed within 24 hours. KNOW: Beneficence, nonmaleficence and Justice. Box 5-3

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Mental health uses alert and oriented times 10

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Ethics: is a branch of philosophy that deals with systematic approaches to distinguishing right from wrong behavior. Values: Are personal beliefs about what is important and desirable. Right: is a valid legally recognized claim or entitlement, showing both freedom from government. Ethical considerations  Utilitarianism: Actions promote HAPPINESS (Happiness is the utility bills are paid)  Kantianism: it suggests that our actions are bound by sense of duty. (I “kant” leave because it is my duty).  Christian ethics: All decisions about right or wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated. (Do to others as you would have them do unto you).  Natural Law Theory: this theory is that as rational human beings, we inherently know the difference between good and evil. (Given by God)  Ethical egoism: is when an individual makes actions that will only benefit them.  Ethical dilemmas: in nursing is a situation that requires the nurse to make a choice between two equally unfavorable alternatives. Voluntary admission: when the patient is admitted by their own choice involuntary admission: when the patient is admitted on court order

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if a patient is not able to make decisions on their own, a proxy or surrogate can be assigned to help the patient. why involuntary admission? danger to themselves and others (public), not able to focus, not able to care for themselves (ex. Bipolar patient in mania phase or schizophrenia patient in acute phase).  MUST have a court order for them to be taken to the hospital for admission. rules and regulation governing voluntary/involuntary admission:  in a period of 72hrs, if they are stable and nothing has happened, able to complete tasks etc. the patient can be discharged -voluntary and involuntary.  depending on the needs and how they were admitted: if they agree to stay or if they have behavior that has not improved, they must get another court order for involuntary, and voluntary they will be able to stay if they agree, if not then a court order is needed.  if a client is stable, they shall be released or sign in voluntarily  if client is a threat to self or others, petition for involuntary placement order/certificate shall be filed in the appropriate court.  right to release: habeas corpus  voluntary client or involuntary client who converted to voluntary status  his/her right to request discharge within 12 hours.  discharge must be completed within 24 hours.

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If client reverse to involuntary status, a court order for involuntary placement must be initiated

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Client must meet requirement for involuntary admission to initiate such petition

Ethical principles 

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Autonomy: This means that individuals are always capable of making their own independent choices.  (Unless they are children, coma patient and mental illness patient who cant make a choice of their own, then you’d get a representative for them)  beneficence: to do good to others.  Advocacy: means acting in another’s behalf as a supporter or defender. Basically, protecting your client as a nurse is your right.  non-maleficence: to do no harm  justice: fairness, individuals being treated equally.  veracity: to tell the truth. Ethical issues  right to refuse medication: they have the right unless immediate intervention is required to prevent death or serious harm to patient or another person.  right to the least restrictive treatment alternative: restrictive measures should be used first before resulting to medication or restraints.  the team must determine 3 criteria before a client can be forced to receive treatment.

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Exhibit dangerous behavior to self or others Medication must have a reasonable change of providing help to the client The treatment in question must be evaluated based on the clients incompetency.

Types of Law  Statutory Law: law that has been enacted by a legislative body(Congress), ex: nurse practice acts.  common law: based on decisions from previous cases.  arises from court decisions on variety of controversial cases  the law may be different from state to state.  (Because of issues in the past, they formulate laws because of it)  Civil Law : protects the private and property rights of individuals and businesses.  Torts : violation of a civil law in which an individual has been wronged  intentional: medical treatment without the individual consent  unintentional: malpractice, negligence.  (Torturing a patient and they don’t like it)  contracts: one party asserts that the other party, in failing to fulfil an obligation, has breached the contract, and either compensation or performance of the obligation is sought as remedy. (Breaking a contract)  criminal laws: provides protection for conducts deemed injurious to the public welfare  ex: of violation is theft by hospital employee of supplies or drugs confidentially and right to privacy HIPPA(Health Insurance Probability and Accountability Act) – privacy rule. privileged communication – grants professionals privileges under which they may refuse to reveal information about and communication with clients. a duty to warn-protection of 3rd party: under certain circumstances a therapist might be required to warn an individual, notify police, etc, to protect the intended victim from harm. (This is just circumstances when a psychiatrist or whoever is talking to a client can report confidential information to the police).  assessment of a threat or violence by a citing toward another individual.  identification of the intended victim.  ability to intervene in a feasible, meaningful way too protect the intended victim. informed consent: the patient must be of sound body and mind and understand the terms of the treatment in order to sign informed consent, three major elements: knowledge, competency, free will. (Patient must be knowledgeable before they sign)  exceptions for informed consent  mentally incompetent, refusing treatment endangers life of others, emergency, child, therapeutic privilege.  Informed consent is permission granted by a client for a physician to perform a therapeutic procedure. restraints and seclusion  orders must be renewed every 4 hours for adults 18 and up, 2 hours for children 9-17, and every hour for under 9.  Orders may be renewed according to these time frames for a max of 24 hours, monitor client closely and frequently.

 Written order 24 hours An in person evaluation must be conducted within one hour of initiating restraint or seclusion. the nurse practice act: defines the legal parameters of professional and practical nursing case of tarsoff vs Regents: put into place the duty to warn due to a patient telling his therapist he would kill someone and the patient carried out the plan, tarsoff was killed by a fellow university student.. suspected child and elderly abuse: it must be reported if you suspect any type of abuse. therapeutic privilege: info may be withheld if disclosing would be a hindrance to consent/treatment Negligence: The failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation. They fail to protect others against unreasonable risk of harm. Malpractice: an instance of negligence or incompetence on the part of a professional. (bad practice and don’t know what you doing and client got injured) Libel: when information is written. Like written in the clients medical record. (Librebook) Slander: oral defamation. Defamation of character involves communication that is malicious and false. (Saying wrong things about a person). assault: fear that they will be touched, making threats. battery: physically touching the patient 

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Chapter 7 therapeutic relationship 

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Therapeutic relationship: An interaction between two people (Usually a caregiver and a care receiver) in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention. Orientation phase: Working phase:?  Maintain trust and rapport  Promote clients insight and perception of reality  Problem-solve using the model  Overcome resistance behaviors  Continuously evaluate progress toward goal attainment (Just checking your progress as you work) Termination phase: ….. Role of the psychiatric nurse: Stranger, resource person, teacher, leader, surrogate, technical expert and counselor. Notes begin therapeutic relationship: an interaction that leads to an environment of healing, growth promotion, and illness prevention.  they are goal oriented!!!  nursing process in psychiatric care  pre interaction: data: preparation for the first encounter with the client, gather the needed information.

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orientation: trust and plan: introducing yourself to the client, nurse and patient become aquatinted, formulating nursing diagnosis, set goals, develop plan of action, explore feelings of the client.  working: goal attainment: work is accomplished during this phase, problem solving, maintain trust and rapport, evaluating progress toward goals.  termination: goal accomplished: the goals have been met and the client may be discharged from the hospital. role of the psychiatric nurse  stranger  Resource person: Can provide specific answers to questions usually formulated with relation to a larger problem.  teacher  leader  surrogate – When patient view a nurse as a mother figure. ((Sur, go care for your mum) (when helping ill patients).  technical expert:  counselor: most important: counseling the patient and assist clients in adapting to difficulties or changes in life experience. goals are often achieved through the use of the problem-solving model  identify the patients problem  promote discussion of desired changes  discuss aspects that cannot realistically be changed and ways too cope with them more appropriately.  discuss alternative strategies for creating changes the client desires to make therapeutic use of self: the ability to use ones personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention. (means: having self-awareness and self understanding and using it to help others.) self awareness: when you learn to accept what you value and learn to accept the uniqueness and differences of others. Beliefs: Is an idea that one holds true.  Rational beliefs – is just when there is something for them to see, in order for it to be true.  Irrational beliefs – is when an individual believe something to be true despite there being evidence to show it is NOT true. (Irrational thinker)  Faith – is a belief is something or someone that doesn’t require proof.  Stereotype – is a socially shared belief that describes a concept. Attitudes: a way an individual views his or her world. Values: An individual’s positive or negative ideal goals. transference: when the patient projects feelings for another person to the nurse, they do it unconsciously.  Transference can also take the form of overwhelming affection for or excessive dependency on the nurse. Then the client forms an unrealistic expectation of the nurse. countertransference: when the nurse transfers feelings for another person onto the patient. professional boundaries  self-disclosure: only when the information will benefit the patient

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 gift giving can be accepted on certain circumstances  touch: make sure it is appropriate, supportive and welcomed  friendship and romantic association: not allowed between nurse and patient. Warning signs that indicate that professional boundaries of the nurse client relationship may be in jeopardy: favoring a clients care over another, keeping secrets with the client, changing dress style for working with a particular client, sharing personal information or work concerns with the client, receiving of gifts or continued contact/communication with the client after discharge, shaping client assignments to care for a particular client, giving special attention or treatment to one client over others, spending free time with a client, frequently thinking about the client when away from work. Essential to therapeutic relationship  rapport: primary task in relationship development, getting aquatinted. (Rapport is the ability to relate to others in a way that creates a level of trust and understanding)  trust: feeling confident in the person presence, reliability, integrity, veracity, and sincere desire to provide assistance when needed.  respect: believe in divinity and worth of an individual regardless of their unacceptable behavior.  empathy: ability to see beyond outward behavior and understand the situation from the client’s point of view.  genuineness: nurses ability to be open, honest and real in interactions with the client, congruence between what is felt and what is expressed.

Chapter 8 Therapeutic Communication 

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Soler –  S-sit squarely facing the client  O- Observe and open posture:  L - Lean forward:  E - eye contact:  R – relax Read page 152-156 therapeutic communication techniques. Communication: Is an interactive process of transmitting information between two or more entities. Culture and religion: Communication has its roots in culture. Culture mores, norms, ideas, and customs provides the basis for our way of thinking. Cultural values are learned and differ from society to society. Social status: Studies of nonverbal indicators of social status or power have suggested that high-status persons are associated with gestures that communicate their higher-power position. Gender: Gender influences the manner in which individuals communicate. Most cultures have gender signals that are recognized as either masculine or feminine and provide a basis for distinguishing between members of each gender. Examples includes differences in posture, both standing and sitting between men and women in the united states. Men usually stand with thighs 10 to 15 degrees apart, the pelvis rolled back. Territoriality, density, and distance: are aspects of environment that communicate message.

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Territoriality – is the inmate tendency to own space. Individuals lay claim to area around them as their own. Density – refers to the number of people within a given environmental space. (Its so dense in here and packed!) Distance – is the means by which various cultures use space to communicate. (Have distance when you talk to me)  Intimate distance is the closest distance that individuals

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will allow between themselves and others.  In mainstream American culture, this distance, which is restricted to interactions of an intimate nature, is 0 to 18 inches. Personal distance is approximately 18 to 40 inches and reserved for interactions that are personal in nature, such as close conversations with friends or colleagues. Social distance is about 4 to 12 feet away from the body.  Interactions at this distance include conversations with strangers or acquaintances, such as at a cocktail party or in a public building. A public distance is one that exceeds 12 feet.  Examples include speaking in public or yelling to someone some distance away. This distance is considered public space, and communicants are free to...