CHAPTER 1: MENTAL HEALTH AND MENTAL ILLNESSES
Mental health
a state of well-being in which each individual is able to realize his or her own potential, cope with normal stressors of life, work productively, and make a contribution to the community.
Mental health continuum
points between health and illness Health = Well-being: occasional stress to mild distress. No impairment Mental Health Problems = Emotional problems or concerns: mild to moderate distress. Mild or temporary impairment Mental Health Problems = Mental illness: Marked distress. Moderate to disabling or chronic impairment
Resilience
the ability and capacity for people to secure the resources they need to support their well-being. Found in young children of poverty and abuse who seek out trusted adults
A nurse, active in local consumer mental health groups and in local and state mental health associations, keeps aware of state and national legislation affecting mental illness treatment. How can this nurse positively affect the climate for effective, mental health treatment? "By becoming active in politics leading to a potential political career." "By educating the public on the effects that stigmatizing has on mental health clients." "Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons." "Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions."
"By becoming active in politics leading to a potential political career." "By educating the public on the effects that stigmatizing has on mental health clients." "Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons." "Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions." Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. The other options are undesirable outcomes
A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" Keeping in mind the diagnosis of the patient, how should the nurse respond to this question? "Don't be afraid; it means I'm here to help, not hurt, you." "Psychiatric mental health nurses care for people with mental illnesses." "We have the specialized skills needed to care for those with mental illnesses." "The nurses who work in mental health facilities have that title."
"Don't be afraid; it means I'm here to help, not hurt, you." "Psychiatric mental health nurses care for people with mental illnesses." "We have the specialized skills needed to care for those with mental illnesses." "The nurses who work in mental health facilities have that title." A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client's question or assume that the question is the result of the client's paranoia.
A 29-year-old patient has been admitted following a suicide attempt. Which nursing statement illustrates the concept of patient advocacy? "Dr. Raye, I notice you ordered fluoxetine for this patient. During the admission interview, the client stated they will refuse the medication because of adverse effects they experienced previously." "Dr. Raye, during the admissions interview the patient stated that there is a family history of three other suicide attempts in the past." "I'd like you tell me more about your depression and your suicide attempt?" "I will take you on a tour of the unit and orient you to the rules so you can get adjusted here."
"Dr. Raye, I notice you ordered fluoxetine for this patient. During the admission interview, the client stated they will refuse the medication because of adverse effects they experienced previously." "Dr. Raye, during the admissions interview the patient stated that there is a family history of three other suicide attempts in the past." "I'd like you tell me more about your depression and your suicide attempt?" "I will take you on a tour of the unit and orient you to the rules so you can get adjusted here." By letting the provider know that the patient does not want the treatment the provider is prescribing, you have advocated for the patient and her right to make decisions regarding her treatment. The other selections do not describe patient advocacy since they do not represent actions by the nurse that the patient is incapable of on their own.
Resilience is characteristic of mental health that allows people to adapt to tragedies, trauma, and loss. Which client behavior demonstrates this characteristic? "My mother made decisions about my husband's funeral when I just couldn't do that." "Losing my job was hard but my skills will help me get another one." "In spite of all the treatment, I know I'll never be really healthy." "My kids, happiness is worth any sacrifice I have to make."
"My mother made decisions about my husband's funeral when I just couldn't do that." "Losing my job was hard but my skills will help me get another one." "In spite of all the treatment, I know I'll never be really healthy." "My kids, happiness is worth any sacrifice I have to make." Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as relying on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.
A new nurse has accepted a position as staff nurse on a psychiatric unit. Which statement made by the new nurse requires additional instructions regarding the therapies provided on the unit? "You will participate in unit activities and groups daily." "You will be given a schedule daily of the groups we would like you to attend." "You will attend a psychotherapy group that I lead that will help you care for yourself." "You will see your provider daily in a one-to-one session."
"You will participate in unit activities and groups daily." "You will be given a schedule daily of the groups we would like you to attend." "You will attend a psychotherapy group that I lead that will help you care for yourself." "You will see your provider daily in a one-to-one session." Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.
Which severe mental illness is recognized across cultures? Antisocial disorder Schizophrenia Anorexia nervosa Social phobia Bipolar disorder Borderline personality disorder
Antisocial disorder Schizophrenia Anorexia nervosa Social phobia Bipolar disorder Borderline personality disorder Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.
According to current information what factor is associated with the most disabling mental disorders? Biological influences Psychological trauma Learned ways of behaving Faulty patterns of early nurturance
Biological influences Psychological trauma Learned ways of behaving Faulty patterns of early nurturance Biological and genetic factors influence mental health. The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, post-traumatic stress disorder, and autism. Therefore many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders.
Brian, a college sophomore with a grade point average of 3.4, is brought to the emergency department after a suicide attempt. He has been extremely despondent since the death of his girlfriend 5 months previously, when the car he was driving crashed. His parents are devastated by the suicide attempt. They believe that taking one's own life prevents a person from going to heaven. Brian has epilepsy and has had more seizures since the auto accident. He says he should be punished for his carelessness and does not care what happens to him. He has stopped going to classes and no longer shows up for his part-time job of tutoring young children in reading. What is a possible DSM-V Diagnosis? Before you plan your care, what are some other factors you would like to assess regarding aspects of Brian's overall health and other influences that can affect his mental health? If an antidepressant medication could help Brian's depression, explain why this alone would not meet his multiple needs. What issues do you think have to be addressed if Brian is to receive a holistic approach to care? Formulate at least two potential nursing diagnoses for Brian. Would Brian's parents' religious beliefs factor into your plan of care? If so, how?
Brian would be likely to receive a diagnosis of major depressive disorder given the symptoms of melancholy, hopelessness, and lack of functioning. Coping skills should be assessed in any crisis: How has Brian dealt with issues of loss in the past? Brian's epilepsy and the fact he has had increased seizure activity is important. Support systems should also be assessed: His parents' religious beliefs related to suicide may affect his prognosis if he thinks he doesn't have their support (and he already doesn't care if he lives or dies). Brian's own religious beliefs should also be assessed. Are his views similar to those of his parents? What is his perception regarding suicide and going to heaven? An antidepressant would help relieve the pathological depressive feelings he is experiencing. However, no medication will help him through the grieving process. Grief counseling would be most appropriate to assist him with those feelings. We must remember that it has been only 5 months since the death of his girlfriend, so we should expect him to be grieving. Brian will also need a tremendous amount of support from his family and friends to help him through this period. A support group would also be recommended. Potential for self-injury related to death of girlfriend, as evidenced by suicide attempts. Ineffective coping related to death of girlfriend, as evidenced by feeling the need to be punished and not caring for what happens to him. Their views are important and should be respected. However, we must carefully observe interactions between Brian and his parents to ascertain that their belief system is not detrimental to his care and prognosis, that is, making him feel guilty for being suicidal, which could potentially compound the problem.
Summarize the social influences of mental health care in the United States
Consumer and recovery movement National Alliance on Mental Illness (NAMI)
Compare and contrast a DSM-5 medical diagnosis with a nursing diagnosis
DSM-5 is a manual for assessment and diagnosis of mental disorders and does not include information or guidelines for treatment of any disorder. That said, determining an accurate diagnosis is the first step toward being able to appropriately treat any medical condition, and mental disorders are no exception. DSM-5 will also be helpful in measuring the effectiveness of treatment, as dimensional assessments will assist clinicians in assessing changes in severity levels as a response to treatment.
nature/nurture origins of psychiatric disorders
Environmental, individual attributes, social and economic circumstances
The nurse planning care for a mentally ill client bases interventions on which concept? Every client has a certain degree of resilience. It is a client right to be treated respectfully. Every client comes with experiences that contribute to their problem. There are universal fears that are shared by all mentally healthy individuals.
Every client has a certain degree of resilience. It is a client right to be treated respectfully. Every client comes with experiences that contribute to their problem. There are universal fears that are shared by all mentally healthy individuals. Nurses are expected to evaluate clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged. Resilience is the ability and capacity for people to secure the resources they need to support their well-being. None of the remaining options describe concepts that are the foundation for the actual creation of individualized care plans.
Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? Experimental Descriptive Clinical Analytic
Experimental Descriptive Clinical Analytic Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms. None of the other options accurately identify the field that is associated with clinical practice.
According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder? Select all that apply. I've been really anxious for at least 2 years now. My anxiety has to be genetic; my mom was a terrible worrier too. My marriage is in trouble because I'm always so irritable. I've had a good physical and my health care provider says I'm in good health. Its hard falling asleep and even harder staying asleep; I'm restless all night.
I've been really anxious for at least 2 years now. My anxiety has to be genetic; my mom was a terrible worrier too. My marriage is in trouble because I'm always so irritable. I've had a good physical and my health care provider says I'm in good health. Its hard falling asleep and even harder staying asleep; I'm restless all night. The DSM-V criteria for generalized anxiety disorder include excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months; sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) and irritability; the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; the disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Family history is not a recognized criterion for generalized anxiety disorder.
A nursing diagnosis for a client with a psychiatric disorder serves what purpose with considering the plan of care? Justifying the use of certain psychotropic medication. Providing data essential for insurance reimbursement. Establishing a framework for selecting appropriate interventions. Completing the medical diagnostic statement.
Justifying the use of certain psychotropic medication. Providing data essential for insurance reimbursement. Establishing a framework for selecting appropriate interventions. Completing the medical diagnostic statement. Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing. While the nursing diagnosis may contribute to the other options, none describe the purpose of the nursing diagnosis.
Identify how the Diagnostic and Statistical Manual, fifth edition (DSM-5), is used for diagnosing psychiatric conditions.
List of criteria MEDICAL diagnosis
Mental illness
a collective term for all diagnosable mental disorders
Stigma
belief that the overall person is flawed, is characterized by social shunning, disgrace and shame
Diathesis-stress model
explanation for mental illness that diathesis = biological predisposition stress = environmental stress or trauma Combination of genetic vulnerability and negative environmental stressors
What term is used to identify the quantitative study of the distribution of mental disorders in human populations? mortality prevalence epidemiology clinical epidemiology
mortality prevalence epidemiology clinical epidemiology Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population with a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by providers of care.