ATI Mental Health Basics Study Guide. High score Guide (NEW)

Mental Health Basics  Levels of Consciousness (alphabetic until C) o Alert : patient is responsive, opening eyes spontaneously, respond to question appropriately o Lethargic: falls asleep easil y, opens eyes, responsive o Obtunded: respond to light shaking, confused, slow to respond o Stuporous: patient barely responds to painful stimuli (ex: rubbing sternum) o Comatose: unresponsive and abnormal posturing may be present  1 . decorticate: arms are flexed and internally rotated towards core, legs extends and internally rotated  2. Decerebrate: both arms and legs extended, head arched back  Nursing Ethics o Autonomy: patient has right to make own decision, even if it’s not in their best interest o Beneficence: doing what is best for patient o Fidelity: loyal, keeping promises o Justice: provide fairness in care and allocation in resources across patients o Non-maleficence: doing no harm o Veracity: telling the truth, being honest  Patient rights o Right to refuse treatment – applies to patients who are involuntary admitted o Confidentiality: patients medical information is protected by HIPPA and cannot be released unless permission given o Mandatory reporting: nurses are required to report suspicion of abuse, and to warn/protect third parties who are at risk for harm.  Informed Consent: o Provider Responsibilities:  Communicates purpose of procedure, and complete description of procedure in the patient’s primary language  Explain risks vs. benefits  Describe other options to treat condition o RN  Make sure provider gave the patient the above information  Ensure the patient is competent to give informed consent (i.e. patient is an adult or emancipated minor, not impaired)  Have patient sign consent document  Notify provider if patient has more questions or doesn’t understand any information  Restraints: o Always have alternatives before restraints. o Can do restraint in emergency BUT need written prescription from provider quickly after (1hr) 1 ATI MENTAL o Provider will need to re-write prescription every 24 hours, no PRN prescription o Best Practice:  Wrist – two fingers  Quick release knot (slip knot, NOT SQURE)  Use a movable part of the bed frame so if you move the bed the restraints move with them o Types of restraints: physical (vest, belt, mitten) or chemical (sedative or antipsychotic medication) o Alternatives: provide verbal interventions, diversions, calm/quiet environment o Prescription:  Prescription must be in writing  If need for constraints continue, provider must re-write prescription every 24 hours  In an emergency situation, a nurse can use restraints but must obtain a written prescription per facility policy (15-30 minutes) o Time limits:  Adults: 4 hours  9-17: 2 hours  8: 1 hour o Documentation:  Complete every 15 -30 minutes  Include: precipitating event, alternative interventions attempted, time treatment began, medication administered, patient assessment (current behavior, VS, pain), patient are provided (food, toileting) o DC: restraints can be discontinued when patient can follow the nurses’ direction  Torts o Unintentional Torts  Negligence: forgetting to set bed alarm for a patient at risk for falls  Malpractice: medication error that harms patient o Intentional torts:  Assault: nurse threatens patient  Battery: nurse hits patients or administer medication against patients will  False imprisonment: nurse inappropriately restrains a patient or administers a chemical restraint such as a sedative  Communication o Intrapersonal communication: “self-talk”, thinking thoughts, but not verbalizing them o Interpersonal communication: one-on-one communication with another person o Open-ended questions: promotes interactive discussions o Closed-ended questions: used to obtain, specific data. Use sparingly as it can block further communication.  Communication techniques 2 ATI MENTAL o Restating: repeat the patients exact words o Reflecting: return focus back to patient o Paraphrasing: restate patient’s feelings to confirm understanding of what patient is saying o Exploring: gathering more information about something patient has mentioned o General leads: allows patient to guide discussion o Presenting reality: communicate what is actually happening; dispel hallucinations, delusions, false beliefs. o Offering self: limited self-disclosure by nurse. Return focus to patient as soon as possible.  Therapeutic communication o WRONG  Asking why  Offering your opinion  Giving false reassurance  Giving advice  Changing the subject  Minimizing the patients feelings o RIGHT  Asking open-ended questions  Maintaining eye contact  Sitting/standing at eye level  Therapeutic tough to convey caring and provide comfort o Older adults:  Minimize distractions, discuss health in private settings  Face the patient when speaking  Use a lower pitch voice  Begin the interview by asking the patient to identify his/her needs and concerns  Limit the number of items on a questionnaire when gathering data  Allow plenty of time for the patient to respond to questions.  Defense Mechanisms o Altruism: dealing w/ stress/anxiety by helping others o Sublimation: substitute negative impulses into acceptable forms of expression (ex: working out hard at the gm) o Suppression: voluntary denial of unpleasant thoughts or feelings o Repression: unconscious denial of unpleasant thoughts or feelings o Regression: reverting back to childlike behaviors that are inappropriate for the patient’s current development level o Displacement: redirecting feelings about a person or situation towards a less threatening object/person (ex: dad loses his job, destroys his childs toy) o Reaction formation: demonstrating the opposite behavior vs what is actually felt (I love nursing exams) 3 ATI MENTAL o Undoing: performing an act to make up for a previous behavior o Rationalization: creating an acceptable excuse for unacceptable behavior o Dissociation: temporary compartmentalization of feelings/thoughts (forgettin who you are during sexual assault) o Denial: pretending truth is not reality o Compensation: emphasizing strengths to make up for weaknesses  Anxiety o Levels of anxiety  Mild: enhances an individuals perception. Normal experience.  Symptoms: restlessness, irritability, fidgeting, foot-tapping  Moderate: slightly reduced perception and ability to think  Symptoms: pacing, difficulty concentrating; increased RR, HR,  Severe: perception greatly reduced; no ability to problem-solve  Symptoms: feelings of “doom”, tachycardia, hyperventilation, rapid speech  Panic level: individual loses touch with reality disturbed behaviors  Symptoms: dilated pupils, hallucinations, severe withdrawal, severe shakiness o Nursing interventions  Mild/moderate anxiety: active listening, evaluate patients past coping mechanisms, assist patient w/ problem solving, teach relaxation techniques (ex: abdominal breathing exercises), encourage exercise to reduce anxiety  Severe/panic-level anxiety: provide a quiet environment w/ minimal stimulation, remain with patient, set limits with short/simple statements, help patient to focus on reality. Problem solving is NOT realistic at this level of anxiety.  Therapeutic Relationship o Orientation: introduce self, discuss confidentiality, establish expectations and boundaries/parameters, identify patients needs and set goals. o Working: perform on-going assessments, assist patient with problem solving and behavior changes, evaluate coping strategies used by patient in the past, introduce patient to others on the unit, revise goals and plans as needed, support patients use of new coping skills. o Termination: summarize goals and achievements, allow patient to share feelings about termination of relationship, discuss ways for patient to incorporate new healthy behaviors into his/her life.  Transference and Countertransference o Transference: occurs when a patient views the nurse as being similar to an important person in his/her life (often a person of authority). Can result in patient treating nurse like this individual. 4 ATI MENTAL o Countertransference: occurs when the patient reminds the nurse of someone in his/her life, which induces strong personal feelings and may cause the nurse to treat the patient differently.  Prevention o Primary: focus on prevention of MH problems (community education, programs) o Secondary: focus on early detection and screening for mental illness (screening for depression in older adults) o Tertiary: focus on rehabilitation and prevention of complications in patients who have already been diagnosed w/ mental illness (support group for those w/ substance abuse disorder) Non-pharmacological Therapies  Psychoanalysis: assesses unconscious thoughts and feelings. Based on belief that internal conflicts stem from early childhood experiences. Focuses on past relationships.  Cognitive reframing: identifies negative thoughts, examines the cause, and replaces negative self-talk with healthier and more constructive thinking (i.e. positive self statements) o Includes: priority restructuring, journal keeping, assertiveness training, monitoring thoughts  Behavioral therapies o Modeling: therapist serves as a role model for patient. Demonstrates appropriate behavior. o Operant conditioning: provides positive rewards for desired behavior. o Systemic desensitization: progressive exposure to anxiety causing stimuli while using relaxation therapies. o Aversion therapy: punishment for maladaptive behavior (ex: bitter taste, mild shock) to promote behavior change. o Others: guided imagery, biofeedback, thought stopping, muscle relaxation.  Group therapy: o Goals: allows members to share common feelings and experiences, learn alternative ways to solve problems.  Silent member: divide group into pairs to discuss topic, then summarizes discussion to group  Member constantly talking: ask group to discuss their feelings regarding the member’s monopolizing behavior  Angry/agitated member: move group members away from member to prevent injury.  Electroconvulsive therapy (ECT) o ECT: use of electrical activity to induce a seizure, which may enhance the effects of NT in the brain o Performed 2-3 times a week for a total of 6-12 treatments. o Indications: major depressive disorder (used in conjunction with antidepressants, does not replace medication therapy). Schizophrenia, acute manic episodes o Medications: