Mental Health Exam One

Rights regarding psychiatric directives

1-designation to preferred physician/therapist 2-appointment of someone to make mental health treatment decisions 3-preferences regarding medications to take or not take 4-consent or lack of consent for ECT 5-consent or lack of consent for admission to psychiatric facility 6-preferred facilities and unacceptable facilities individuals who should not visit

Involuntary Commitment

A court-ordered admission to a facility without the patient's consent The criteria for commitment are the legal standards under which admission may be necessary, these standards include a person who is: mentally ill, posing a danger to self/others, gravely disabled, and in need of treatment Generally involuntary commitment begins with someone who is familiar with teh individual and believes that treatment is necessary Patients have the right to access a legal counsel and the right to take their case before a judge who may order a release A patient who believes that he/she is being held without just cause can file a patient for writ of habeous corpus Patients can also challenge the hospitalization based on the least restrictive alternative doctrine - mandates providers to take the least drastic option to achieve a specific person

Physical disorders can cause mental illness / importance of physical exam in mental health (Maslow - physical needs before psychosocial needs).

Always focus on the physical symptoms first; as the mental health issue could simply be from the physical issue Also if in the psych unit and has a medical emergency, is sent out to a med-surg floor with a sitter and once stabilized sent back to the psych unit Always remember: Ex. bizzare complaint, demons are hitting my head and i have a headache -- address the headache first & figure out if there is a physiological cause for the headache & then look at the mental health issues

Signs of mental illness in children/adolescents

Assessment of mental status of children and adolescents is similar to that of adults. The main difference is that assessment is adapted to be appropriate for the child's developmental stage, cognitive capabilities, and verbal skills. It provides information about the mental state at the time of the examination and identifies problems with thinking, feeling, and behaving Adolescents are especially concerned with confidentiality and may fear that you will repeat what they say to their parents. This is a difficult area. In the eyes of the law, parents must give consent for treatment and therefore have a right to know how their child will be treated

Nursing process applied to mental health nursing

Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, Evaluation Always be sure there have been sufficient assessments before implementations

Identify components of nursing process and standards of care for psychiatric patient

Assessment: -Construct database, MSE, Psychosocial assessment, Physical examination, History taking, Interviews, Standardized rating scales, Verify the data Diagnosis: Identify problem and etiology, Construct nursing diagnoses and problem list, Prioritize nursing diagnosis Outcomes Identification: Identify attainable and culturally expected outcomes; Document expected outcomes as measurable goals; Include time estimate for expected outcomes Planning Identify safe, pertinent, evidence-based actions. Strive to use interventions that are culturally relevant and compatible with health beliefs and practices;Document plan using recognized terminology Implementation Basic Level Interventions: Coordination of care Health teaching and health promotion Milieu therapy Pharmacological, biological, and integrative therapies Advanced Practice Interventions: Prescriptive authority and treatment Psychotherapy Consultation Evaluation Document results of evaluation If outcomes have not been achieved at desired level: Additional data gathering Reassessment Revision of plan

Wind illness

Chinese, Vietnamese. Characterized by a fear of cold, wind, or drafts. Derived from the belief that yin-yang and hot-cold elements must be in balance in the body or illness occurs. Treated by keeping warm and avoiding foods, drinks, and herbs that are cold or considered to have a cold quality, as well as cold colors, emotions, and activities. Also treated by pulling the "cold wind" out of the patient by coining (vigorously rubbing a coin over the body) or cupping (applying a heated cup to the skin, creating a vacuum).

Neurasthenia

Chinese. Characterized by somatic symptoms of depression such as anorexia, weight loss, fatigue, weakness, trouble concentrating, and insomnia. Feelings of sadness or depression are denied. Thought to be related to a lack of yin-yang balance. Traditional treatment includes eating healthier, exercise, massage, rest, and lifestyle adjustment. Antidepressant therapy is now common.

Social influences on mental health care in the United States

Consumer/recovery movement National Alliance on Mental Illness (NAMI) Decade of the brain: In the 1990s George H.W. Bush designated the last part of the 1900s to make legislators and the public aware of the advances that had been made in neuroscience and brain research. New Freedom Commission on Mental Health Mental Health Parity Act MEDIA

Assisted outpatient treatment

Court-ordered outpatient treatment Assisted outpatient treatment can be a preventative measure, allowing a court order before the onset of a psychiatric crisis that would result in an inpatient admission The order for involuntary outpatient care is usually tied to receipt of goods and services provided by social welfare agencies including disability benefits and housing

The HEADSSS Psychosocial Interview Technique

H Home environment (e.g., relations with parents and siblings) E Education and employment (e.g., school performance) A Activities (e.g., sports participation, after-school activities, peer relations) D Drug, alcohol, or tobacco use S Sexuality (e.g., whether the patient is sexually active, practices safe sex, or uses contraception) S Suicide risk or symptoms of depression or other mental disorder S Safety (e.g., how safe does the patient feel at home and school, wear a safety belt, or engage in dangerous or risky activities)

Populations at risk for mental illness and inadequate care

Homeless are at high risk for inadequate care elderly people who went through a traumatic event-war, childhood abuse people who have a first order relative with a mental disorder substance abuse: drugs/alcohol minority groups for inadequate care Chronic illness People with disabilities

Assessment of older adults

Important: do not stereotype older adults and expect them to be physically/ mentally deficient Nurse needs to be aware of any physical limitations: sensory - difficulty hearing/seeing motor - difficulty walking or maintaining balance medical - back pain, cardiac or pulmonary deficits identify any physical deficits at the beginning of the assessment and make accommodations for them

Release against medical advice (AMA)

In cases in which treatment seems beneficial but there is no compelling reason (ex. danger to self/others) to seek involuntary continuance of stay, patients may leave against medical advice

NIC (Nursing Intervention Classification)

Is a book used to standardize, define, and measure nursing care. This includes direct or indirect care that the patient receives. The seven domains of the NIC include basic physiological, complex physiological, behavioral, safety, family, health system, and community.

Clients right to refuse treatment

Just as patients have the right to receive treatment, they also have the right to refuse it. Patients may withhold consent or withdraw consent at any time, even if they are involuntarily committed. Patients can also retract consent previously given, and care providers must respect this whether it is a verbal or written retraction. However, the patient's right to refuse treatment with psychotropic drugs has been debated in the courts. Patients have the right to quality treatment, the right to refuse treatment (even if involuntary commitment) and the right to informed consent (i.e., knowing their treatment options and voluntarily accepting treatment). In an emergency to prevent a person from causing serious and imminent harm to self or others, institutions can medicate a person without a court hearing. After a court hearing, a person can be medicated if all of the following criteria are met 1. The person has a serious mental illness 2. The person's ability to function is deteriorating or he or she is suffering or exhibiting threatening behavior 3. The benefits of treatment outweigh the harm 4. The person lacks the capacity to make a reasoned decision about the treatment 5. Less-restrictive services have been found inappropriate

Hwa-byung

Korean. Characterized by epigastric pain, anorexia, palpitations, dyspnea, and muscle aches and pains. Thought to be caused by a lack of harmony in the body or in interpersonal relationships. Treated by reestablishing harmony. Some researchers feel that it is closely related to depression.

Susto

Latin American. Characterized by a broad range of somatic and psychological symptoms similar to posttraumatic stress disorder. Precipitated by a traumatic incident or fright that caused the patient's soul to leave the body. Treated by an espiritista (spiritual healer).

Ataque de nervios:

Latin American. Characterized by a sudden attack of trembling, palpitations, dyspnea, dizziness, and loss of consciousness. Thought to be caused by an evil spirit and related to intolerable stress. Treated by an espiritista (spiritual healer) and by the support of the family and community who provide aid to the patient and consider the patient to be calling for help in a culturally acceptable way.

Specialty of psychiatric mental health nursing (RN and advanced practice - APRN - Nurse practitioner) vs social worker vs psychiatrist vs psychologist / who can provide psychotherapy? / who can prescribe medications?

Mental health nursing is a specialty: Major players or professionals that work in mental health and what they can and cannot do legally Ex. RN CAN: Give meds, treatments, vitals, assessments, teaching, injections. -RN CAN'T DO: psychotherapy, -APRN, NP, and APMHN ( all the same thing) -CAN: psychotherapy, prescribe medications -Social worker: CAN do psychotherapy, NO medication prescription -Psychiatrist: MD, but specialize in mental health -Psychologist: Psychotherapy yes, CANNOT prescribe

Health Care Traditions

More expensive to care for inpatients than outpatients so trends are going towards more outpatient treatment settings Mental health is moving towards more community settings Those admitted must be a risk of harming themselves or others or cannot care for themselves due to their condition Regular depression is treated in outpatient settings Actively suicidal is treated in inpatient settings Shorter time for inpatient stays Better medications available for treatments

NANDA-1

NANDA-1 diagnosis are nursing diagnosis. A nursing diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or vulnerability for that response by an individual, family, group, or community nursing diagnoses focus on interventions to improve client outcomes and focus less on the specific diagnosis and more about patient centered interventions that could improve the patient's ability in society

Ghost sickness

Navajo. Characterized by "being out of one's mind," dyspnea, weakness, and bad dreams. Thought to be caused by an evil spirit. Treated by overcoming the evil spirit with a stronger spiritual force the healer, a "singer," calls forth through a powerful healing ritual.

Rights regarding restraints and seclusion

Nurses should consider the following before using seclusion and restraint: 1-verbally intervening 2-reducing stimulation 3-actively listening 4-providing diversion 5-offering PRN medications In an emergency, a nurse may place a patient in seclusion or restraint but must obtain a written/verbal order as soon as possible Orders for a restraint must be renewed for a total of 24 hours with limits depending upon the patient age after the physician personally assesses the patient The nurse must assess the patient at frequent intervals for physical needs, safety, and comfort and should document thoroughly

MH (Mental Health) self-care

Nurses should model good self-care because daily exposure to grief and dying can lead to increased vulnerability to emotional attachments and compassion fatigue. Nurses often grow attached to some patients and may experience both anticipatory grieving and bereavement. To maintain emotional balance and health, it is essential to rely on the support of others and practice good self-care. -- As health care providers how do we take care of ourselves & our mental health -- Ex. Dr. Anema had a mentor that they could talk to about their patients as a sort of therapy for themselves. -- Let your faculty know if you are in clinical if you are having a tough time.

Signs of mental illness in older adults

Older adults who develop late-life mental illness are less likely than young adults to be accurately diagnosed and receive mental health treatment. Psychiatric issues such as depression, cognitive deficits, and prolonged grieving are not a normal part of aging. Diagnosing and treating psychiatric disorders prolongs the individual's ability to remain independent and increases the ability to take the lead in personal choices -Depression is quite common after cardiac events and strokes, but care providers can confuse it with dementia or delirium. A careful systematic assessment is necessary to properly distinguish among the three -Neurocognitive Disorders: The most common neurocognitive disorders are Alzheimer's disease and vascular disease. Both are characterized by a functional decline, aphasia (difficulty finding words), apraxia (difficulty carrying out motor functions), agnosia (failure to recognize objects), and disturbances in executive functioning (organizing, planning, abstracting, insight, judgment). -Anxiety problems in older adults can manifest as a fear of falling, greatly influencing an older adult's personal freedom -Mental Status Exam: Assessment of the cognitive, behavioral, and emotional status of the older adult is important in managing the nursing care of the patient. The periodic repetition of screening tools serves to evaluate the effectiveness of interventions targeting mood problems. >Geriatric Depression Scale >Cornell Scale for Depression and Dementia

Safety / Milieu / environment

One way patients are kept safe is proper assessments done on every shift; 15 minute checks on all patients-to know where the patient is and how they are acting, such as calm or sleeping; all staff members on the floor go through crisis training and prevention; staff also learn how to deescalate a patient as well; Patients may have to wear scrubs until allowed street clothes again; all sharp objects and strings/belts are taken if allowed street clothes; no access to other sharp items such as scissors or razors; utensils are counted before and after meals so none are taken by patients; Doors can have sensors on top of them; platform beds instead of hospital beds; furniture bolted to the floor except for chair; doors that swing out so patients cant block them; handles and hangers that break away when too much weight is applied to them; plumbing fixtures blocked in; monitored visitation-staff should check bags and purses for unsafe items and no patient intimacy allowed Milieu: Inpatient common area, entire environment in which clients live in when they are impaired. Milieu therapy: patients getting to learn how to live with other people and the situations in life through their environment. How do we keep them safe? From self & environment, go through all their belongings & take out the stuff they could harm themselves with & lock it up. Ex. nail files, clippers, mouthwash, belts. Housekeeping has to be very careful with leaving equipment around. Blinds in between two walls of glass, or without cords. Cordless electric razors are FINE

Outpatient Care

Outpatient means they are not a threat to themselves or others; only need intermittent supervision such as with therapy or in-home visits -May have thoughts of suicide, but no plan set in place -Suicidal ideations -Risk of carrying out today or tomorrow are minimal

Right to refuse treatment

Patient has the right to refuse treatment Exceptions in an emergency: 1-the person has a serious mental illness 2-the person's ability to function is deteriorating or he or she is suffering or exhibiting threatening behavior 3-the benefits of treatment outweigh the harm 4-the person lacks the capacity to make reasoned decision about the treatment 5-less-restrictive services have been found inappropriate

Levels of Care

Primary- ex: psychosocial support and coping strategies for young adolescents to prevent mood disorders Secondary- ex: reducing prevalence of the disorder; early identification, screening, and prompt treatment; use to DELAY or AVERT progression Tertiary-prevent progression to severe course, disability, or death; ex: in major depression the aim is to avoid loss of job, reduce family disruption, and prevent suicide

Role of resilience in mental health and mental illness

Resilience is the ability and capacity for people to secure the resources they need to support their well-being. Resilience leads to an overall better ability to adapt to tragedy, loss, trauma, and severe stress.

Principles RN follows in planning nursing actions / ethics

Safe: Interventions must be safe for the patient, as well as for other patients, staff, and family. Compatible and appropriate: Interventions must be compatible with other therapies and with the patient's personal goals and cultural values, as well as with institutional rules. Realistic and individualized: Interventions should be (1) within the patient's capabilities, given the patient's age, physical strength, condition, and willingness to change; (2) based on the number of staff available; (3) reflective of the actual available community resources; and (4) within the student's or nurse's capabilities. Evidence-based: Interventions should be based on scientific evidence and principles when available.

Transitional Care Unit

Similar to assistive living psych patients that may have other illnesses can go to a TCU and have a continued care of their mental disorder while being treated for the physical illness or injury.

Jin" possession

Somalian. Symptoms of psychological distress and anxiety. Thought to be caused by possession by a Jin, an invisible being that is angry with the human. Intermittent, involuntary, abnormal body movements occur along with the psychological distress. Treatment consists of an exorcism by a religious leader, such as an Imam, who will ask the Jin what the person has done to anger it so that the person can apologize and make amends

Spirituality

Spirituality is one's connectedness to the world around them, and where they find peace Someone can be spiritual but NOT have a specific religion.

Emergency Commitment

Temporary admission Used for: 1-people who are so confused they cannot make decisions on their own 2-for people who are so ill they need emergency admission Generally a psychiatrist employed by the facility needs to confirm the need for hospitlization The primary purpose of this observation is for observation, diagnoseis, and treatmetn of those who have a mental illness or pose a danger to themselves/others Admission typically ranges from 24-96 hours

DSM-5

The DSM-5 identifies disorders based on specific criteria. It is used in inpatient, outpatient, partial hospitalization, consultation-liaison, clinics, private practice, primary care, and community settings. It also serves as a tool to collect epidemiological statistics about psychiatric disorders. The DSM-5 are the medical diagnosis. Help with diagnosing, medically guided. MEDICAL DIAGNOSIS DSM 5 is the medical diagnosis- symptoms, onset, alterations, medications and therapies used to treat the disorder

Mental Status Exam (MSE)

The MSE is apart of our clinical packet for MH The purpose is to evaluate an individual's current cognitive processes. It aids in collecting and organizing objective information. Objective data refers to all things that nurses observe about the patient with five senses. The nurse observes the patient's physical behavior, nonverbal communication, appearance, speech patterns, mood and affect, thought content, perceptions, cognitive ability, and insight and judgment Objective data also includes all measurable information such as body weight, blood pressure, and oxygen saturation. Figure 7.4 is an example!

Unconditional release

The termination of the patient-institution relationship

Advocacy

Through direct care and indirect action, nurses advocate for the psychiatric patient. As a patient advocate, the nurse reports incidents of abuse or neglect to the appropriate authorities for immediate action. The nurse also upholds patient confidentiality, which has become more of a challenge as the use of electronic medical records increases. Another form of nursing advocacy is supporting the patient's right to make decisions regarding treatment.

Cultural Competency / Cultural Barriers to mental health services

Understanding and respecting the culture of others Cultural barriers: communication, stigma, misdiagnosis, cultural concepts of distress, genetic variations in drug responses

NOC (Nursing Outcomes Classification)

a comprehensive source for standardized outcomes and definitions of these outcomes. A five-point Likert scale is used, with 5 being the best rating and 1 being the worst rating. The seven domains of NOC include functional health, physiological health, psychosocial health, health knowledge and behavior, perceived health, family health, and community health.

Malpractice

a special type of professional negligence. The five elements required to prove malpractice are: 1-duty 2-breach of duty 3-cause in fact 4-proximate cause 5-damages

Which statement made by a patient demonstrates a healthy degree of resilience? Select all that apply. a. "I try to remember not to take other people's bad moods personally." b. "I know that if I get really mad I'll end up being depressed." c. "I really feel that sometimes bad things are meant to happen." d. "I've learned to calm down before trying to defend my opinions." e. "I know that discussing issues with my boss would help me get my point across."

a. "I try to remember not to take other people's bad moods personally." d. "I've learned to calm down before trying to defend my opinions." e. "I know that discussing issues with my boss would help me get my point across."

The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply. a. "Is the patient expressing suicidal thoughts?" b. "Does the patient have intact judgment and insight into his situation?" c. "Does the patient have experiences with either community or inpatient mental healthcare facilities?" d. "Does the patient require a therapeutic environment to support the management of psychotic symptoms?" e. "Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?"

a. "Is the patient expressing suicidal thoughts?" b. "Does the patient have intact judgment and insight into his situation?" d. "Does the patient require a therapeutic environment to support the management of psychotic symptoms?" e. "Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?"

The nurse frequently includes daily sessions involving relaxation techniques. Which assessment data would most indicate a need for this intervention to be included in the initial plan of care for a patient? a. Family history of anxiety and symptoms of anxiety b. Significant other has a chronic health issue c. Hopes to retire in 6 months d. Recently adopted infant twins

a. Family history of anxiety and symptoms of anxiety

According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder? a. I've been really anxious for at least 2 years now. b.My anxiety has to be genetic; my mom was a terrible worrier too c.My marriage is in trouble because I'm always so irritable. d. I've had a good physical and my health care provider says I'm in good health. e.Its hard falling asleep and even harder staying asleep; I'm restless all night

a. I've been really anxious for at least 2 years now. c.My marriage is in trouble because I'm always so irritable. d. I've had a good physical and my health care provider says I'm in good health. e.Its hard falling asleep and even harder staying asleep; I'm restless all night

Which intervention demonstrates an attempt by nursing staff to meet the goals identified by the Joint Commission as National Patient Safety Goals? Select all that apply. a. Identifying patients using both name and date of birth before drawing blood. b. Sitting with the patient diagnosed with an eating disorder during meals. c. Administering the Beck Scale on each patient at the time of admission. d. Performing a medication history assessment on each new patient. e. Using appropriate hand washing technique at all times.

a. Identifying patients using both name and date of birth before drawing blood. c. Administering the Beck Scale on each patient at the time of admission. d. Performing a medication history assessment on each new patient. e. Using appropriate hand washing technique at all times.

Emma is a 40-year-old married female who has found it increasingly difficult to leave her home due to agoraphobia. Emma's family is appropriately concerned and suggests that she seek psychiatric care. After investigating her options, Emma decides to try: a. Telepsychiatry b. Assertive community treatment c. Psychiatric home care d. Outpatient psychiatric care

a. Telepsychiatry

A 29-year-old patient has been admitted following a suicide attempt. Which nursing statement illustrates the concept of patient advocacy? a."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." b."Dr. Raye, during the admissions interview the patient stated that there is a family history of three other suicide attempts in the past." c. "I'd like you tell me more about your depression and your suicide attempt?" d."I will take you on a tour of the unit and orient you to the rules so you can get adjusted here."

a."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."

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? a.Break-away closet bars to prevent hanging b.Bedroom and dining areas with locked windows to prevent jumping c.Double-locked doors to prevent escaping from the unit d.Platform beds to prevent crush injuries

a.Break-away closet bars to prevent hanging

Assessment of adolescents

adolescents are often concerned with confidentiality and fear what information will be shared with their parents the adolescent and their family should be provided with an overview of how information sharing will work, what information will be shared, with whom, and when. threats of suicide, homicide, sexual abuse or behaviors that put the patient or others at risk should be shared with other professionals and the patients identifying risk factors is one of the key objectives when assessing adolescents. HEADSS interview technique -Home environment -Education and employment -Activities -Drug, alcohol, or tobacco use -Sexuality -Suicide -Safety

Right to confidentiality

an ethical responsibility of healthcare professionals that prohibits the disclosure of privileged information without the patient's consent 1-HIPAA 2-confidentiality and social media 3-confidentiality after death - do not divulge information after death that you could not legally prior to death 4-confidentiality of professional communications EXCEPTIONS: 1-duty to warn and protect third parties 2-reporting child/elder abuse

Diathesis-stress model

an interaction between a predisposition vulnerability and a stress caused by life experiences causing mental illness. A diathesis-stress model—in which diathesis represents biological predisposition and stress represents environmental stress or trauma—is the most accepted explanation for mental illness. (Nature + Nurture). This explains why two persons exposed to relatively similar events may respond differently (one person may demonstrate resilience and another may develop depression)

unintentional torts

are unintended acts against another person that produce injury or harm negligence and malpractice

Recognizing the frequency of depression among the American population, the nurse should advocate for which mental health promotion event? a-including discussions on depression as part of school health classes b-providing regular depression screening for adolescent and teenage students c-increasing the number of community-based depression hotlines available to the public d-encouraging senior centers to provide information on accessing community depression resources

b-providing regular depression screening for adolescent and teenage students

When considering stigmatization, which statement made by the nurse demonstrates a need for immediate intervention by the nurse manager? a. "Depression seems to be a real problem among the teenage population." b. "My experience has been that the Irish have a problem with alcohol use." c. "Women are at greater risk for developing suicidal thoughts then acting on them." d. "We've admitted several military veterans with posttraumatic stress disorder this month."

b. "My experience has been that the Irish have a problem with alcohol use."

A patient needs supportive care for the maintenance treatment of bipolar disorder. The new nurse demonstrates an understanding of the services provided by the various members of the patient's mental healthcare team when he makes which statement: a. "Your social worker will help you learn to budget your money effectively." b. "Your counselor asked me to remind you of the group session on critical thinking at 2:00 today." c. "The mental health technician on staff today will administer the medication that you require." d. "Remember to ask the occupational therapist about sources of financial help that you are qualified for."

b. "Your counselor asked me to remind you of the group session on critical thinking at 2:00 today."

A Gulf War veteran has been homeless since being discharged from military service. He is now diagnosed with schizophrenia. The nurse practitioner recognizes that assertive community treatment (ACT) is a good option for this patient since ACT provides: a. Psychiatric home care b. Care for hard-to-engage, seriously ill patients c. Outpatient community mental health center care d. A comprehensive emergency service model

b. Care for hard-to-engage, seriously ill patients

Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply. a. Intermittent supervision is available in inpatient settings. b. He requires stabilization of multiple symptoms. c. He has nutritional and self-care needs. d. Medication adherence will be mandated. e. He is in imminent danger of harming himself.

b. He requires stabilization of multiple symptoms. c. He has nutritional and self-care needs. e. He is in imminent danger of harming himself.

Epidemiological studies contribute to improvements in care for individuals with mental disorders by: a. Providing information about effective nursing techniques. b. Identifying risk factors that contribute to the development of a disorder. c. Identifying individuals in the general population who will develop a specific disorder. d. Identifying which individuals will respond favorably to a specific treatment.

b. Identifying risk factors that contribute to the development of a disorder. d. Identifying which individuals will respond favorably to a specific treatment.

The World Health Organization describes health as "a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity." Which statement is true in regards to overall health? Select all that apply. a. There is no relationship between physical and mental health. b. Poor physical health can lead to mental distress and disorders. c. Poor mental health does not lead to physical illness. d. There is a strong relationship between physical health and mental health. e. Mental health needs take precedence over physical health needs.

b. Poor physical health can lead to mental distress and disorders. d. There is a strong relationship between physical health and mental health.

Which of the following activities would be considered nursing care and appropriate to be performed by a basic level nurse for a patient suffering from mental illness? a. Treating major depression b. Teaching coping skills for a specific family dynamic c. Conducting psychotherapy d. Prescribing antidepressant medication

b. Teaching coping skills for a specific family dynamic

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? a."By becoming active in politics leading to a potential political career." b."By educating the public on the effects that stigmatizing has on mental health clients." c."Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons." d."Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions."

b."By educating the public on the effects that stigmatizing has on mental health clients."

Resilience is characteristic of mental health that allows people to adapt to tragedies, trauma, and loss. Which client behavior demonstrates this characteristic? a."My mother made decisions about my husband's funeral when I just couldn't do that." b."Losing my job was hard but my skills will help me get another one." c."In spite of all the treatment, I know I'll never be really healthy." d."My kids, happiness is worth any sacrifice I have to make."

b."Losing my job was hard but my skills will help me get another one."

Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? a.A depressed patient with a suicidal plan b.A patient being discharged from an inpatient alcohol rehabilitation unit c.A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs d.Jeff, who has mild depression symptoms and is starting outpatient therapy

b.A patient being discharged from an inpatient alcohol rehabilitation unit

invasion of privacy

breaking a persons confidences or taking photographs without explicit permission

Which statement demonstrates the nurse's understanding of the effect of environmental factors on a patient's mental health? a. "I'll need to assess how the patient's family views mental illness." b. "There is a history of depression in the patient's extended family." c. "I'm not familiar with the patient's Japanese's cultural view on suicide." d. "The patient's ability to pay for mental health services needs to be assessed."

c. "I'm not familiar with the patient's Japanese's cultural view on suicide."

Which statement about mental illness is true? a. Mental illness is a matter of individual nonconformity with societal norms. b. Mental illness is present when irrational and illogical behavior occurs. c. Mental illness changes with culture, time in history, political systems, and the groups defining it. d. Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality.

c. Mental illness changes with culture, time in history, political systems, and the groups defining it.

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? a.You will participate in unit activities and groups daily." b."You will be given a schedule daily of the groups we would like you to attend." c."You will attend a psychotherapy group that I lead that will help you care for yourself." d."You will see your provider daily in a one-to-one session."

c."You will attend a psychotherapy group that I lead that will help you care for yourself."

Day Programs

can be partial hospitalization or intensive outpatient care -Partial hospitalization means going into the hospital for a certain amount of time, days a week, and number of weeks, usually used for first time treatment and transitions back to work/home, example is 5 hours a day 5 days a week for 2-3 weeks -IOC is slightly less intense than PH, can be for newly diagnosed or increased symptoms in prolonged disease, the number of weeks is not specified and can change from patient to patient, however an example of time commitment is 3 hours a day 3 days a week;

Homeless shelters

can have certain rooms that allow for discharged patients to stay for 30 days to get on their feet or find a permanent location to go to. These are private rooms

Assessment of Children

caregivers often can best describe the behavior, performance, and conduct of the child and are also helpful in interpreting the child's words or responses -separate interview may be necessary if the patient reluctant to speak consider developmental levels of the child - children with psychiatric decisions have the tendency to regress assess children through the combination of observation and interview -watching them play provides important clues for their functioning

A patient has been voluntarily admitted to a mental health facility after an unsuccessful attempt to harm himself. Which statement demonstrates a need to better educate the patient on his patient's rights? a. "I understand why I was restrained when I was out of control." b. "You can't tell my boss about the suicide attempt without my permission." c. "I have a right to know what all of you are planning to do to me." d. "I can hurt myself if I want too. It's none of your business."

d. "I can hurt myself if I want too. It's none of your business."

An adolescent female is readmitted for inpatient care after a suicide attempt. What is the most important nursing intervention to accomplish upon admission? a. Allowing the patient to return to her previous room so that she will feel safe b. Orienting the patient to the unit and introduce her to patients and staff c. Building trust through therapeutic communication d. Checking the patient's belongings for dangerous items

d. Checking the patient's belongings for dangerous items

A nursing student new to psychiatric-mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be: a. Nursing Interventions Classification (NIC) b. Nursing Outcomes Classification (NOC) c. NANDA-I nursing diagnoses d. DSM-5

d. DSM-5

A newly divorced 36-year-old mother of three has difficulty sleeping. When she shares this information to her gynecologist, she suggests which of the following services as appropriate for her patient's needs? a. Assertive community treatment b. Patients-centered medical home c. Psychiatric home care d. Primary Care Provider

d. Primary Care Provider

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? a.A client and family members attend counseling sessions together at a neighborhood clinic b.Implementation of a more flexible work schedule for staff c.Improved reimbursement for services provided in the community d.A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

d.A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

When providing respectful, appropriate nursing care, how should the nurse identify the patient and his or her observable characteristics? a. the manic patient in 234 b. the patient in 234 is manic c.the patient is room 234 is possible manic d.the patient in room 234 is displaying manic behavior

d.the patient in room 234 is displaying manic behavior

In-patient Care

homicidal attempt or ideation with a plan; suicidal attempt or ideation with a plan; 24-hour supervision with 15 minutes checks -DANGER TO SELF OR OTHERS RIGHT NOW -Currently suicidal: Plan, ability, stating it. The only reason a client is admitted to inpatient care is: at danger to self or others or unable to care for self-due to a mental illness. If clients have thoughts about suicide, but not really actively suicidal, they can be treated outpatient. If they have a plan of suicide and the ability, they need to be treated inpatient.

assault

intentional threat designed to make another person fearful that you will cause harm to them -verbal threats or pretending to hit a patient

Assistive Living

like Estates, where the population might have might homeless before and need to stay on medications so they go to an assisted living this could also be at a nursing home where certain halls may have more acute psych disorders present- such as a dementia hall with locked doors

Voluntary admission

occur when a patient applies in writing for admission into a facility the person must understand the need for treatment and willing to be admitted if the patient is under 16 - parent/guardian/next of kin can apply on behalf of the patient voluntarily admitted patients have the right to request and obtain release -reevaluation may be necessary -reevaluation may result in the care provider to initiate an involuntary commitment according to state criteria

Right to informed consent

patient has been provided with basic information regarding risks, benefits, and alternatives of treatment consent must be secured for: 1-surgery 2-ECT 3-use of experimental drugs/procedures Patients must be informed of the following events: 1-the nature of the problem/condition 2-the nature/purpose of a proposed treatment risks and benefits of treatment 3-the alternative treatment options probability that the proposed treatment will be successful 4-the risks of not consenting to treatment

Right to treatment

patients have the right to quality care. 1-the right to be free from excessive or unnecessary medication 2-the right to privacy and dignity 3-the right to the least restrictive environment 4-the right to an attorney, clergy, and private care providers 5-the right to not be subjected to lobotomies, ECTs, and other treatments without fully informed consent

Other mental health care settings examples

psychiatric home care, community mental health centers, primary care providers and specialized psych care providers.

Conditional Release

requires outpatient treatment for a specified period to determine if the patient follows the medication regimen, can meet basic needs, and is able to reintegrate into the community

Continuum of mental health and mental illness

sliding scale on one end, mental well being where there is no impairment and occasional to mild stress; the other end has mental health problems which is split into two parts-emotional problems and mental illness; emotional problems has mild to moderate stress and mild or temporary impairment, they can have mild depression, generalized anxiety, or ADD; mental illness is marked distress and moderate to disabling/chronic impairment, such as major depressive disorder or schizophrenia.

battery

the actual harmful or offensive touching of another person

Negligence

the failure to use ordinary care in any professional or personal situation when you have the duty to do say Ex: failure to question a physician's order, failure to protect a patient from self-harm, and failure to provide patient teaching

Informal admission

the least restrictive of all admissions there is no formal application the patient does not pose a substantial threat of harm to self/others the normal care-giver patient still exists the patient is free to stay or leave, even against medical advice

Ethocentrism

the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way

Patient-Centered Medical Home

this is a care model where the patient is the focus and all care is coordinated by the patient's personal/primary physician. This means that physician provides the care, such as preventative care, or refers to other providers.

Daycare

used to help patients return to normal life or reduce strain on family usually for the time of a normal work shift could allow family to go back to work and not worry as much about family member also used of patient is not ready for complete reduction of supervision.

Halfway House

used to provide temporary housing when looking for a more permanent housing similar to homeless shelter however may allow for a longer period of time in MN it is around 90 days -May have house mother -May have job, sign out in the morning sign out at night -Some supervision but not like in the hospital, not a lot of programs -Place to live with minimal supervision

Epidemiological study impact on mental health

used to study the distribution of mental health disorders among populations helps identify high risk groups also risk factors for onset, duration, and recurrence helps track incidence and prevalence in populations Example: Areas lacking sunshine, higher depression rates i.e. less depression in florida.

assertive community treatment

used when the patient is unwilling or unable to do traditional treatment forms can come to the home or other agencies as well, such as the hospital works with the patient until stable or ready to transfer to a more structured care site psych team is on call 24 hours a day treatment can last for years

false imprisonment

when a patient is confined in a limited area or within an institution ex: may be made when a person is placed in restraints, seclusion, and the use of a chemical restraint

defamation of character

when a provider makes a false statement that causes some degree of harm, usually to the reputation of the patient

Intentional Torts

willful or intentional acts that violate another person's rights or property assault, battery, false imprisonment, invasion of privacy, and defamation of character