Study Guide for Mental Health Exam 1.docx

Study Guide for Mental Health *Exam 1 will consist of 47 multiple choice questions & 3 fill-in-the-blank dosage calculation questions.* **Ch 1 -- 3 questions** - Mental Health state of well-being in which individuals reach their own potential cope with the normal stresses of life, work...

Study Guide for Mental Health *Exam 1 will consist of 47 multiple choice questions & 3 fill-in-the-blank dosage calculation questions.* **Ch 1 -- 3 questions** - Mental Health state of well-being in which individuals reach their own potential cope with the normal stresses of life, work productively, and contribute to the community. - Traits of Mental Health capacity for - Rational thinking - Communication skills - Learning - Emotional growth - Resilience - Self-esteem - Societal Norms of Mental Health - This is what society sanctions as normal, what we are all supposed to be able to do in order for us to be considered mentally healthy. - Rational thinking - Effective coping - Resiliency - Self-control - Self-awareness - Developmentally on task - Spiritual satisfaction - Happiness and joy - Self-care - Positive self-concept - Learning and productivity - Effective communication - Meaningful relationship - Mental Illness - Society's definition of mental illness evolves over time. It is a definition shaped by the prevailing culture and societal values, and it reflects changes in cultural norms, social expectations, political climates, and even reimbursement criteria by third-party payers. - Psychiatric disorders with definable diagnoses - Significant dysfunction in mental functioning related to - Developmental - Biological - Physiological disturbances - Culturally defined - Mental Health Continuum - Well-being - Excelling - Thriving - Surviving - Struggling - Crisis - Mental Illness - Individual Attributes and Behaviors - Resilience - Ability and capacity to secure resources needed to support well-being - Characterized by: - Ability to secure needed resources - Capacity for regulating one's own emotions and overcoming negative, self-defeating thoughts - Essential to recovery - Risk and Protective Factors - Social and Economic Circumstances - Family - School and peer groups - Socioeconomic status - Educational advancement - Environmental Factors - Political climate & cultural considerations - Social & economic policies - Classification of Mental Disorders - The Diagnostic and Statistical Manual of Mental Disorders, 5^th^ edition (DSM5) - Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders - Based on specific criteria influenced by multi-professional clinical field trials. **Ch 2 -- 6 questions** - Psychoanalytic Theories and Therapies - Dr. Sigmund Freud: The father of psychoanalytic - Psychoanalytic Theory - Freud's Level of Awareness - Conscious: contains all the material a person is aware of at any one time. (aware of right now) - Preconscious: contains material that can be retrieved rather easily through conscious effort. (not thinking about it at the moment but knows the answer if think about it) - Unconscious: includes all repressed memories, passions, and unacceptable urges lying deep below the surface. (don't remember, buried, someone needs to work with you therapeutically to retrieved, repressed memories) - Personality Structure - Id: "I need" - Pleasure principle - Reflex action - Primary process - The Id is totally unconscious and impulsive. It cannot tolerate frustration and seeks to discharge tension and return to a more comfortable level of energy. The Id lacks the ability to problem solve and illogical. - Ego: "I want" - Problem solver - Reality tester - Within the first few years of life as the child begins to interact with others the ego develops. The ego resides in the conscious, preconscious, and unconscious levels of awareness. The problem solver and reality tester, the ego attempts to navigate the outside world. It is able to differentiate subjective experiences, memory images, and objective reality. - Superego: "I should" - Moral component - Develops between the ages 3 and 5, represents the moral component of personality. The superego resides in the conscious, preconscious, and unconscious level of awareness. The superego consists of the conscience (all the "should nots" internalized from parents and society) and the ego ideal (all the "should" internalized from parents and society). It seeks perfection and when it falls short, it may induce feeling of guilt. - Defense Mechanisms and Anxiety - Operate on unconscious level - Deny, falsify, or distort reality to make it less threatening - Ward off anxiety by preventing conscious awareness of threatening feelings. - Denial: Involves escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence. - Displacement: is the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation. - Dissociation: is a disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalizing uncomfortable or unpleasant aspects of oneself. - Projection: refers to the unconscious rejection of emotionally unacceptable features and attributing them to others. - Rationalization: consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener. - Reaction Formation: is when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior. - Repression: is the unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. - Undoing: is when a person makes up for a regrettable act or communication. - Classical Psychoanalysis - Seldom used today - Valid tools and concepts - Transference: which includes feeling that the client has developed toward the therapist in relation to similar feelings toward significant persons in the client's early childhood. - Countertransference: the unconscious feeling that the healthcare worker has toward the clint. The clint can remind them of a person from their past in a positive or negative manner. - Implications of Interpersonal Theory to nursing - Foundations: Hildegard Peplau - Nurse as both participant & observer. - Self-awareness helps keep focus on patient. - Application of Sullivan's theory of anxiety to nursing practices. - Lowering patient's anxiety improves ability to think and function. - Cognitive Theory and Therapies - Dynamic interplay between individuals and the environment. - Thoughts come before feelings and actions. - Thoughts about the world and our place in it are based on our own unique perspectives, which may or may not be based on reality.; - Maslow's Hierarchy of Needs - Human beings are active participants in life, striving for self-actualization. - When lower needs are met, higher needs are able to emerge. - Self-actualization: (highest needs) - Esteem needs - Belonging and love needs - Safety - Physiological needs: (lowest needs) - The Biological Model - Focus on: - Neurological - Chemical - Biological - Genetic - How the body and brain interact to create: - Emotions - Memories - Perceptual experiences - Developmental Theories - Theory of psychosocial development (Erikson) - 8 stages of development personality continues to develop through old age. - Trust vs. Mistrust: age 0-1.5 yrs. - Autonomy vs. Shame-doubt: age 1.5-3 yrs. - Initiative vs. Guilt: age 3-6 yrs. - Industry vs. Inferiority: age 6-12 yrs. - Identity vs. Role Confusion: age 12-20 yrs. - Intimacy vs. Isolation: age 20-35 yrs. - Generativity vs. Self-Absorption: age 35-65 yrs. - Integrity vs. Despair: age 65+ yrs. **Ch 3 -- 9 questions** - Common Mental Health Disorders Diagnosed in **Children & Adolescence** - Mood Disorder - Eating Disorders - Conduct Disorders - Attention Deficit Hyperactivity Disorders (ADHD) - Pervasive Developmental Disorders - Substance Use Disorders - Trauma & Stressor- Related Disorders - Anxiety Disorders - Common Mental Health Disorders Diagnosed in **Adulthood** - Mood Disorders - Personality Disorders - Anxiety Disorders - Psychotic Disorders - Substance use Disorders - Trauma & Stressor Related Disorders - Common Mental Health Disorders Diagnosed in **Older Adulthood** - Depression - Dementia - Delirium - Composition of the Human Brain - Brainstem = Midbrain, Pons, Medulla Oblongata - Present in all animals - Connects directly to the spinal cord - Controls bodily functions essential for survival - Heart rate - Respirations - Digestion - sleep - Limbic System - Governs psychological functions & emotions - Utilizes norepinephrine, serotonin & dopamine - Hypothalamus - Controls hunger, thirst, sex drives & homeostasis with the body - Cerebrum - The human brain contain the largest and most developed cerebral cortex of all animals. - Consists of four lobes, not including the pre-frontal cortex - Frontal lobe: Formulate or select goals Initiate, plan, terminate actions, Decision making Insight, Motivation, Social judgment, Voluntary motor ability starts in frontal lobe - Parietal lobe: Receive and identify sensory information, Concept formation and abstraction, Proprioception and body awareness, Reading, mathematics, Right and left orientation (prefrontal cortex helps stimulate the babies and it help them develop attachment between baby and parent. This is also the emotional part that help when you don't have a good feeling or vibe about something) - Temporal lobe: Language comprehension, Stores sounds into memory (language, speech), Connects with limbic system, "the emotional brain," to allow expression of emotions (sexual, aggressive, fear, etc.) - Occipital lobe: Interprets visual images, Visual association, Visual memories, Involved with language formation - Functions as a control center for conscious thought, sensory function, memory, language, communication, executive functions, and other uniquely "human processes) - Cerebellum - Controls coordination of skeletal musculature - Maintains balances and equilibrium - Neurotransmitters - Dopamine - Thought processes - Decision-making - Reward seeking behaviors - Fine muscle movements - Integration of thoughts and emotions - Stimulates the hypothalamus to secrete hormones - [Effect of excess] - **Mild** - Enhances creativity & problem solving - Improves spatial awareness & thought processes - **Severe** - Disorganized thought & speech processes - Disabling compulsions - Stereotypic behaviors - Mania, schizophrenia - [Effects of deficit] - **Mild** - Impaired impulse control &spatial awareness - Depressive symptoms - ADHD - **Severe** - Movement disorders - Parkinson's disease - Norepinephrine - Ability to focus attention & learn - Ability to be oriented & maintain alertness - Enhances the senses & memory - Impacts mood - Primes & stimulates the SNS - [Effects of excess] - Hyper-alert - Paranoia - Appetite loss - Anxiety - Mania - Schizophrenia - [Effect of deficit] - Dull - Low energy - Depression - ADHD - Serotonin: Regulates - Mood - Sleep cycle - Body temperature - Pain perception - Reduces aggression, play, sexual, and eating activity. - [Effect of excess] - Sedation - Serotonin syndrome: is fatal - Sign & symptoms: - Skin looks reddish tinge - Sweating profusely - Muscle super rigidity - Mild calmness of the muscles - [Effect of deficit] - Sleep disturbance - Depression - Suicidality - GABA - Reduces aggression and agitation - Decreases anxiety and excitation - Relaxes muscle - Anticonvulsant properties - [Effect of excess] - Decreased anxiety symptoms - [Effect of deficit] - Anxiety - Mania - Schizophrenia - Huntington's Disease - Psychotherapy: - Drug Class - Stimulants - Drug Types - IR: tablets no coating will kick in 15-20 mins last 4-6 hrs. - ER: capsules has beads inside that are IR AND ER that last 8-12 hrs. get released throughout the day. - Methylphenidate IR - Ritalin - Methylphenidate ER - Ritalin LA - Concerta - Daytrana (patch) - Quillivant XR (liquid) - Quillichew ER (chewable) - Amphetamines IR - Adderall - Focalin - Dexedrine - Amphetamines ER - Adderall XR - Focalin XR - Vyvanse - Indication - **ADHD** - Narcolepsy - Bing-eating disorder - Side Effects - Decreased appetite - Increased HR/BP - Cardiac arrhythmias - Insomnia - Irritability (drinking coffee after they've taken their stimulant will amplifying that not great for the heart) **Ch 4 -- 6 questions** - Background - Related to the shift from hospital to community care were the pharmacological breakthroughs in the mid-20^th^ century that resulted in dramatic changes in the provision of psychiatric care, starting with the introduction of chlorpromazine (Thorazine), the first antipsychotic medication, in the early 1950s, which contributed to hospital discharges. - Current system: Outpatient and inpatient setting along a **continuum of care** - Outpatient Care Setting - Primary care providers - Specialized psychiatric care providers - Patient-centered medical homes (PCMH) = group home - Patient-centered - Comprehensive care - Coordination care - Improved access - System approach - Outpatient Psychiatric Mental Health Care - Community mental health centers - Psychiatric home care (homebound) - Assertive community treatment (ACT) - Intensive outpatient programs (to help prevent hospitalization) - Partial hospitalization (not staying/living in the hospital, but has to report more times a week) - Other outpatient venues for psychiatric care - Telepsychiatry - Mobile mental health units - Emergency Care - Comprehensive Emergency Service Model - Dedicated psychiatric space & staff, often affiliated with a full-service emergency department (ED) in a hospital or medical center. - Hospital-Based Consultant Model - No dedicated space or separate staffing; psychiatric staff on-site or on-call for ED. - Mobile Crisis Team Model - Stabilization in the field to assess and de-escalate. - The primary goal **in emergency services** is to preform **triage** and **stabilization** - Triage: refers to determining the severity of the problem and the urgency of a response. - Stabilization: is the resolution of the immediate crisis. - Outpatient Psychiatric Nursing - Strong problem-solving and clinical skills - Cultural competence - Flexibility - Knowledge of community resources - Autonomy - Promoting recovery and continuation of treatment - Inpatient Care Setting - Crisis Stabilization/ Observational Units - General Hospitals (Jacob, St. Barnabas) and Private Hospitals (Fourwinds) - State Psychiatric Hospitals (Rockland) - Entry to Acute Inpatient Care - Direct admission on referral - Emergency department or crisis service - Voluntary or involuntary - Right of the Hospitalized Patient - Hospitalized patients retain their rights as citizens. - Patient's need for safety must be balanced against patient's rights as a citizen. - Mental health facilities have written statements of patients' rights and applicable state laws. - Therapeutic Milieu - Surroundings and physical environment - Managing behavioral crises - Safety - Unit design - Goals of unit design - Promote an environment of safety and empower patients to partner with clinical staff and take ownership of their own health and safety. - Teamwork and Collaboration - Members of each discipline are responsible for gathering data and participating in the planning of care. - Treatment plan or clinical pathway provides a guideline for patient's care during hospital stay. - Nurse's role is often to lead planning meetings - For standardization in treatment and improved outcomes, inpatient units use clinical pathways. - **Clinical pathways**: also known as **care pathway** and **integrated pathways,** detail the essential steps in the care of patients with specific clinical problems based on the usual and expected clinical course. These tools provide an essential link between evidence-based knowledge and clinical practice. **Ch 6 -- 8 questions** - Ethical Concepts - Ethics: the study of philosophical beliefs about what is considered right or wrong in society. - Bioethics: used in relation to ethical dilemmas surrounding health care. - Ethical Dilemma: conflict between two or more courses of action, each with favorable and unfavorable consequences. - Six Principle of Bioethics - Autonomy: respecting the rights of others to make their own decisions. - Beneficence: the duty to promote good. - Nonmaleficence: doing no harm to patient. - Justice**:** distribute resources or care equally. - Fidelity: maintaining loyalty and commitment; doing no wrong to a patient. - One's duty to always communicate truthfully. - Hospital Procedures - Voluntary Admission - Sought by patient or guardian (can sign yourself into the hospital or if under the age of 18 yrs. a guardian can sign into the hospital). - Involuntary Commitment - Without patient's consent - Mentally ill - Danger to self or others - Gravely disabled - In need of treatment & illness prevents voluntary help seeking. - Emergency commitment (temporary admission) - Person confused or demented; emergency admission - Used for observation, diagnosis and treatment - Generally for 24 to 96 hours - Court hearing before discharge or next admission - Due Process in Involuntary Commitment - Writ of habeas corpus - Used when patients believe they have been held without just cause. - Challenges unlawful detention (which means a "formal written order" to "free the person." Patients who believe they are being held without just cause can file a petition for a **writ of habeas corpus**, which means a formal written order to free the person. The writ of habeas corpus is the procedural mechanism used to challenge unlawful detention by the government.) - Least restrictive alternative doctrine - Taking the least drastic or restrictive action ( the least restrictive alternative doctrine mandates that care providers take the least drastic action to achieve a specific purpose. For example, if you can treat someone safely for depression on an outpatient basis, hospitalization would be too restrictive and unnecessarily disruptive. In this case, however , "assisted outpatient treatment" could be legally mandated in certain cases.) - Discharge Procedures - Unconditional release - Termination of the legal patient-institution relationship - Release against medical advice (AMA) - May present an ethical dilemma for clinicians. On the one hand, patient autonomy and the right to refuse treatment support the patient's wishes for discharge. On the other , the clinician beneficence could support benefiting and promoting good, which includes protecting the patient. - Conditional release - Usually requires outpatient treatment for a specified period of time with follow-through evaluation. - Assisted outpatient treatment - Similar to conditional release but court-ordered - Patient's Rights under the Law - Right to treatment - Right to refuse treatment - Right to refuse treatment does not apply when they are hurting themselves or someone else or with a court order as well. - Right to informed consent - Patient is informed of risks, benefits, and alternatives - Person must voluntarily accept treatment - Implied consent - A patient is approached with a medication in hand, and the patient indicates a willingness to receive the medication: implied consent has occurred. - Capacity & competency - Capacity: is a person's ability to make an informed decision. - Competency: is a legal term related to the degree of mental soundness a person has to make decisions or to carry out specific acts. - Rights regarding psychiatric advance directives - Rights regarding restraint and seclusion - Orders and documentation - In an emergency, a nurse may place a patient in seclusion or restraint but obtains a written or verbal order as soon as possible thereafter. - Orders for restraint or seclusion are never written as an as needed or as a standing order. - **Chemical Restraints**: are medications or doses of medication that are not being used for the patient's condition. Chemical interventions are usually less restrictive than physical or mechanical interventions. - **Considerations:** nurses should consider the following before using seclusion and restraint: - verbally intervening (e.g., asking the patient for cooperation) - reducing stimulation - actively listening - providing diversion - offering as needed (PRN) medications - Rights regarding confidentiality - Health Insurance Portability and Accountability Act (HIPAA) privacy rule - confidentiality and social media - confidentiality after death - confidentiality of professional communications - Patient Confidentiality - Is an ethical responsibility of healthcare professionals that prohibits the disclosure of privileged information without the patient's consent. - Exceptions to the rule - Duty to warn and protect third parties: usually includes the following: - Assessing and predicting the patient's danger of violence toward another - Identifying the specific persons being threatened - Taking appropriate action to protect the identified victims - Statutes for reporting child and older adult abuse - Failure to protect patients **Ch 7 -- 1 question** - Psychiatric Mental Health Nursing Assessment - Goals - Establish rapport - Understand current problem - Review physical baseline status - Identify risk factors - Perform MSE - Assess psychosocial status - Identify mutual treatment goals - Formulate plan of care - Document data in retrievable format - Gathering Data - Review of systems - Laboratory data - MSE - Psychosocial assessment - Spiritual/religious assessment - Cultural and social assessment - Validating the assessment - Using rating scales **Ch 8 -- 6 questions** - Concepts Central to the Nurse-Patient Relationship - Patient-centered care - Dignity and respect - Information sharing - Patient and family participation - Collaboration in policy and program development - Clear and appropriate boundaries - Therapeutic Use of Self - Safe, confidential, reliable, and consistent - Use personality consciously and in full awareness - Attempt to establish relatedness - Structure nursing interventions - Important of Talk Therapy - Advanced practice registered nurses - Based on psychotherapy - Changes brain chemistry in much the same way as medication. - Best treatment for most psychiatric problems: a combination of medication and psychotherapy - Personal Relationship - Initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task - Mutual needs are met - Communication to give advice, give, or ask for help - Content of communication superficial - Therapeutic Relationship - Needs of patient identified and explored - Clear boundaries established - Problem-solving approaches taken - New coping skills developed - Behavioral change encouraged - Relationship Boundaries & Roles - Boundaries - The expected and accepted legal, ethical, and professional standards that separate nurses from patient - Professional and Ethical Boundaries: maintaining a professional role helping meet goals and never personal goals of the nurse. - Legal Boundaries: patient's right to confidentiality. Breach of confidentiality is a common law tort, which is a civil wrong. (this wrong can result in a lawsuit resulting in monetary damages). Sexual misconduct (this violates all three standards) - Provide a safe space for the patient - A Focus on Self-Awareness - Nurse's Values and Beliefs - It is helpful to realize that our values and beliefs - Reflect our own culture or subculture - Derived from a range of choices - Are those we have chosen for ourselves from a variety of influences and role models. (these chosen values stem from religious, cultural, and societal forces. Our values guide us in making decisions and taking actions that we hope will make our lives meaningful, rewarding, and fulfilled. Being self-aware helps us to accept the uniqueness and differences in others. - Factors that Promote Patient Growth - Genuineness - Empathy (not sympathy) - Positive regard - Attitudes - Actions - Attending: is a special kind of listening that refers to an intensity of presence or being with the patient. At times, simply being with another person during a painful time can make a difference. Posture, eye contact, and body language are nonverbal behaviors that reflect the degree of attending and are highly culturally influenced. **Ch 9 -- 8 questions** - Introduction - Therapeutic communication: is crucial to the formation of patient-centered therapeutic relationship. - Patient-centered: refers to the patient as a full partner in care whose values, preferences, and needs are respected. - Goal-directed - Scientifically based - Saying the wrong thing - Making mistakes helps us to find more useful and effective way of helping individuals reach their goals. - Therapeutic Communication - Benefits to the patient - Feeling safer and protected - More satisfied with care - Increased recovery rates - Improved adherence to treatment (Worried **wells**: which is individuals who are on that pretty high functioning. They go to work. They might go to school, they have families, they have kids. They might live alone whatever. But they pay their bills. They\'re functioning. They have social lives like they\'re doing life. They\'re doing the best they can. They\'re on that like they\'re able to function, but they\'ve got a lot of things like stressing them out, weighing them down, affecting their mood. There's typically going to be no psychosis, no mania any, no type of major mental illness. So that\'s why, when they talk about these therapeutic relationships.) - Factors that Affect Communication - Personal factors - Depression - Cognition - Language/cultural barriers - Environmental factors - The setting - Relationship factors - Level of equality within the relationship - Verbal Communication - All words a person speaks - Communicates - Beliefs and values - Perceptions and meaning - Can convey - Interest and understanding - Insult and judgement - Clear or conflicting messages - Honest or distorted feelings - Nonverbal Communication - Tone of voice - Emphasis on certain words - Physical appearance - Facial expressions - Body posture - Amount of eye contact - Hand gestures - Interaction of Verbal and Nonverbal Communication - Messages can appear to be one thing when in fact they are another. - People are often less aware of their nonverbal messages and behaviors. - Verbal message can be called the content, while the nonverbal behavior is the process. - Double-bind messages: mutually contradictory messages, usually given by a person in power. - Therapeutic Communication Techniques - Silence - Active listening: nurses focus, respond, and remember what the patient is saying verbally and nonverbally. - Clarifying techniques: include paraphrasing, restating, reflecting, and exploring. - Questions - Opened-ended: encourage patients to share information about experiences, perceptions, or responses to a situation. - Closed-ended: ("yes" or "no") when used sparingly, can give you specific and needed information. Closed-ended questions are most useful during an initial assessment or intake interview or to determine specific results. - Projective: usually start with a "what if" to help people articulate, explore, and identify thoughts and feelings. - The miracle question: is a goal-setting question that helps patients to see what the future would look like if a particular problem were to vanish. - Nontherapeutic Communication Techniques - Excessive questioning - Giving approval or disapproval - Giving advice - Asking "why" questions - Cultural Considerations - Communication style: in some cultures, expression of positive or negative emotions is a private affair, and open expression of them is considered to be in bad taste and possibly a weakness. - Use of eye contact: cultural norms dictate a person's comfort or lack of comfort with direct eye contact. Therefore, do not use the amount of eye contact to assess attentiveness, judge truthfulness, or make assumptions on the degree of engagement one has with a patient. - Perception of touch: may be seen as healing and supportive, but it may be experienced as patronizing, intrusive, aggressive, or sexually inviting in other cultures. - Cultural filters -- from of bias or prejudice - Preparing for the Clinical Patient Interview - Pace - Setting - Seating - Seating arrangements can be face-to-face with a table in between, face-to-face with no table, at an angle with a table in between, or at an angle with no table. Some people believe that face-to-face with a table suggest a power differential and that the desk serves as a barrier. However, face-to-face discussion does facilitate the best reading of nonverbals. - Introductions - Initiating the interview - Tactics to Avoid - Arguing, minimizing, or challenging the patient - Giving false reassurance - Interpreting or speculating - Probing into sensitive areas the patient doesn't want to discuss - Trying to "sell" the patient on accepting treatment - Joining in attacks patients launch on others - Participation in criticizing other staff members **Dosage Calculation -- 3 questions**