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Ch 56 mental Heath function, assessment
Terms in this set (110)
Mental health has been defined in many ways including the ability to do the following:
• be flexible ♂️
• take responsibility for own actions👇
• form close relationships👩❤️👨
• make appropriate judgments
• solve problems💡
• cope with daily stress♂️
•Have a positive sense of self🙋♀️
Where is acetylcholine found?
Found in the ANS
Found in CNS: Cerebral cortex, hippo campus, Olympic structures, basal ganglia
What is the function of acetylcholine?
Sleep, arousal, pain perception, movement and memory
What happens when you have decreased levels of acetylcholine?
Alzheimer's disease, Huntington disease, Parkinson disease
What happens when you have increased levels of acetylcholine?
Where is norepinephrine found?
CNS: thalamus, hypothalamus, limbic system, hippocampus, cerebellum, cerebral cortex
What is the functions of norepinephrine?
Mood, cognition, perception, locomotion, cardiovascular functioning, sleeping arousal
What happens if you have increased levels of Norepinephrine?
Mania, anxiety states, schizophrenia
What happens when you have decreased levels of norepinephrine?
Where is dopamine found?
Frontal cortex, limbic system, basal ganglia, thalamus, Posterior pituitary, spinal cord
What are the functions of dopamine?
Movement and coordination, emotions, voluntary judgment, release of Prolactin
What happens when you have decreased levels of dopamine?
Parkinson's disease, depression
What happens when you have increased levels of dopamine?
Where is serotonin found?
Hypothalamus, thalamus, limbic system, cerebral cortex, cerebellum, spinal cord
What are the functions of serotonin?
Sleeping arousal, libido, appetite, mood, aggression, pain perception, coordination, judgment
What happens when you have decreased levels of serotonin?
What happens when you have increased levels of serotonin?
Where is histamine found?
In the hypothalamus
What happens when you have decreased levels of histamine?
Where is the amino acids, gamma-Aminobutyric Acid?
Hypothalamus, hippocampus, cortex, cerebellum, basal ganglia, spinal cord, retina
What is the function of GAPA?
Slow down a body activity
What happens when you have decreased function of GABA?
Huntington disease, anxiety disorders, schizophrenia, various forms of epilepsy
Where is The amino acid glycine found?
Spinal cord and brain stem
What is the function of Glycine?
Recurrent inhibition of motor neurons
What happens when you have toxic levels of glycine?
Glycine encephalopathy decreased levels are correlated with spastic motor movement
Where are the amino acids Glutamate and Aspartate?
Pyramid of cells of this cortex, Cerebellum and primary since reference systems like the hippocampus thalamus hypothalamus and spinal cord
What happens when you have increased levels of glutamate and asparatate?
Huntington disease, temporal lobe epilepsy, Spinal cerebellar degeneration
Mental illness can be defined as experiencing the following:
• impaired ability to think
• impaired ability to feel
• impaired ability to make sound judgment
• impaired ability to adapt
• difficulty coping or inability to cope with reality
• difficulty in forming or inability to form strong personal relationships
What are the questions and observations evaluated during the mental status examination?
1) appearance and behavior
2)Level of awareness and reality orientation
3) thinking/content of thought
5) speech in ability to communicate
6) Mood and affect
1) appearance and behavior
2)Level of awareness and reality orientation
3) thinking/content of thought
5) speech in ability to communicate
6) Mood and affect
What is coping?
is the way one adapts psychologically, physically, and behaviorally to a stressor.
What influences a persons response to stress?
-individual belief system
What are some ways individuals may cope with stress?
What is adaptation?
process of effective coping
What are some helpful roles you can perform?
-active listening to the patients thoughts and feelings
-assisting with identifying precipitating factors and patterns to stress
-encouraging the patient to problem-solve
-help develop alternative solutions to a problem
Speech and ability are assessed to determine mental status, what signs and assessments would indicate a psychological problem?
*Limited speech production. Rate of speech is inconsistent with other psychomotor activity
*Volume is not appropriate to situation (speaks louder or softer than appropriate
* Presence of stuttering, word repetition, or neologisms may indicate physical or psychological illness
Mood and affect are assessed to determine mental status, what are signs that indicate altered mental status?
Mood and affect do not match. Facial expression does not appear sad while the patient is expressing feelings of sadness
Judgement is assessed to determine mental status. What would indicate and altered mental status?
Patient cannot interpret the saying or complete problem-solving questions appropriately. The patient may say " Dogs can't learn anything new when they get old"
Perception is assessed to determine mental status, what would indicate an altered mental status?
-Hallucination (false sensory perceptions) may occur with schizophrenia. Illusions are misperceptions of reality
-The patient is unable to state understanding of the origin of the illness; associated behaviors are inappropriate
- Many people with schizophrenia or mania have poor insight because of impairment of prefrontal cortex function during psychosis.
Appearance is assessed to determine mental status, which would indicate an altered mental status?
*Displays apathy or unconcern about appearance
*Displays hostile and uncooperative behavior or suspicious behavior toward health care personnel.
Alertness is assessed to determine mental status, what is considered abnormal?
* difficult to arouse
*difficulty remaining calm
*inability to correctly answer questions or inability to answer commonly known questions such as "who is the president?"
Thinking/ Content of thought are used to assess the patients mental status. What is considered abnormal?
*abnormal behaviors include flight of ideas, loose associations, phobias, delusions and obsessions.
Memory is used to assess mental status of patient. What is considered abnormal?
*Inability to accurately perform recent or remote exercises like recalling events that are within two weeks of the assessment like recent events or news. Nurse may ask the patient what they had for breakfast. Remote memory would include recalling events that happened past beyond two weeks like where the patient was born or what grade school they went to.
What are ego defense mechanisms?
When conscious techniques are not successful, people may unconsciously fall into old habits that give the illusion of coping. Ego defense mechanisms act as mental pressure valves. Their purpose is to reduce or eliminate anxiety.
When are coping mechanisms learned?
By age 10
Describe the defense mechanism denial and give an example.
usually the first line of defense learned and used. Unconscious refusal to see reality; not conscious lying.
Example: the alcoholic states "I can quit whenever I want to"
Describe the DM of repression (stuffing) and give an example.
An unconscious "burying" or "forgetting" mechanism. Excludes or withholds from consciousness events or situations that are unbearable.
Example: A step deeper than "denial". A patient may "forget" about an appointment he or she does not want to keep
Describe the defense mechanisms of rationalization and give an example.
Using logical-sounding excuse to cover up true thoughts and feelings. The most frequently used defense mechanism
Ex: "I made a medication error because the doctor's order was confusing.
"I failed the test because the teacher wasn't clear about what would be on it"
Describe the defense mechanism compensation and give an example.
Making up for something perceived as an inadequacy by developing some other desirable trait.
Ex: the small boy who wants to be a basketball center instead becomes an honor roll student
Ex: the physically unattractive person who wants to be a model instead becomes a famous designer
Describe the defense mechanism of reaction formation (overcompensation)
Similar to compensation, except the person usually develops the exact opposite trait.
Ex: The small boy who wants to be a basketball center becomes a political voice to decrease the emphasis on sports in the elementary grades. Basically you become a hater fam lol.
Ex: The physically unattractive person who wants to be a model speaks out about eliminating beauty pageants.
Describe the defense mechanism of Regression and give an example.
Emotionally returning to an earlier time in life when the patient experienced far less stress. Commonly seen in patients while hospitalized.
Ex: Children who are toilet trained begin to wet the bed after the birth of a younger sibling.
Ex: Adults who have "temper tantrums"
Describe the defense mechanism of projection and give an example.
Ascribing to one's own unacceptable qualities or feelings to someone else. May lead to scapegoating.
Ex: A patient may state "My sister is so jealous of me", when actually the patient is jealous of her sister.
An anxious patient may say to the nurse., "why do I make you so nervous"
Describe the defense mechanism of displacement (transference).
"kick-the-dog syndrome", or transferring anger and hostility to another person or object that perceived to be less powerful than oneself. SMALL DICK ENERGY
Ex: Parent loses job without notice and then goes home and verbally abuses spouse who unjustly punishes child and who slaps the dog.
Describe the defense mechanism of restitution (undoing).
Making amends for a behavior one thinks is unacceptable. Makes an attempt at reducing guilt.
Ex: A person gives a treat to a child who is being punished for a wrongdoing.
Ex: The person who sees someone lose their wallet with a large amount of cash does not return the wallet but puts extra in the collection plate church. LMAO
Describe conversion reaction.
Anxiety is channeled into physical symptoms and disappear once the threat is over.
Ex: Nausea develops the night before a major exam causing the person to miss the exam. Nausea may disappear soon after the scheduled test is finished.
Describe the defense mechanism of avoidance.
Unconsciously staying away from events or situations that might cause feelings of aggression or anxiety.
Example: "I can't go to class reunion tonight. I'm just so tired, I have to sleep"
What is cognitive ability?
the ability to think rationally and process thoughts.
What influences verbal communication?
Tone, pitch, speech, and volume
What is "encouraging descriptions or perceptions" when it comes to verbal therapeutic communication.
Asking the patient what he or she is seeing or hearing
Ex: "tell me what the voices are saying to you"
What is "encouraging comparison"
Asking the patient to compare similarities or differences
Ex: "How is the medication working for you compared to the last time you used it?"
What is "exploring"?
Looking deeper into a subject, idea, or experience
Ex: "tell me more about the last time you were depressed"
What is "focusing"?
Concentrating on a single idea or event
Ex: "Tell me more about how your divorce made you feel"
What is "formulating a plan of action"?
Assisting the patient to come up with a plan to cope with stress.
Ex: "When this happens in the future, how could you handle it more constructively?"
What is "giving broad openings"?
Allowing the patient to steer the interaction
Ex: "What would you like to work on today?"
What is giving recognition?
Acknowledge or showing awareness
Ex: "I see you went to your therapy group today"
What is "making observations"?
Verbalizing what is observed
Ex: "I noticed you seemed upset after your visit"
What is "offering self"?
Extending one's presence
"I am available to talk whenever you like"
What is "offering general leads"?
Giving the patient encouragement to continue.
What is "placing event in time or sequence"
Clarification of events in time
Ex: "was this before or after your first hospitalization"
What is "presenting reality"
Defining reality in simple terms
"The voices may seem real to you, but they are a symptom of your illness"
What is restating?
Repeating the main idea of what the patient has verbalized.
"It sounds as if you are feeling frustrated"
What is reflecting?
Statements, questions, or feelings are stated back to the patient
"What do you think you should do"
What is seeking clarification?
Searching for understanding of what was said
"Tell me if this is what you meant when you said..."
What is verbalizing the implied?
putting into words what the patient has implied or said indirectly
"You must be feeling very sad right now"
What are the components of nonverbal communication?
Includes physical appearance, dress, body movement and posture, touch, facial expression, and eye contact.
Describe the communication block "agreeing/disagreeing".
Implies the patient's ideas or feeling are somehow right or wrong. "That is on target. I agree 100%" You should avoid this type of statement
Give an example of asking "why" questions.
It implies that the patient knows the reason for his or her behavior and feelings. "Why were you feeling so angry"
Give an example for "changing the subject"
Takes control of the conversation away from the patient.
Patient: "I am feeling hopeless"
Nurse: "Did you go to group therapy today"
Describe "giving advice"
Implies that the nurse knows what is best
"I think you should"
Describe "Giving approval or disapproval"
Passes judgement on the patient's ideas or opinions
"that sounds like a bad idea"
Describe "giving false reassurance"
devalues the patient's feelings. "Everything will be alright"
Describe self-focusing behavior.
Focuses on nurse's own feelings at the expense of the patient
"That to me once. Let me tell you about it.
Double-bind messages, what are they?
When the nonverbal message doesn't match the verbal message
"I'm listening," as the nurse fidgets in her chair, doesn't make eye contact, and then coughs.
What is milieu?
therapeutic environment that provides containment, support, structure, involvement, and validation during the patient's stay.
What are the goals of the milieu?
resocialization, ego development, and prevention of regression.
What is the resocialization and when does it occur?
Occurs when patients help govern the running of the mental health unit and attend regular meeting to set rules and assign tasks.
What is ego development?
fostered with the structure activities that are provided to assist the patient to learn coping and social skills
What are some common milieu interventions?
role modeling, positive reinforcement, schedule of events, consistent expectations and rules for behavior and unit meetings.
What is psychopharmacology?
use of medications to treat psychological disorders.
What was introduced in the 1950's that increased the number of prescription drugs used to treat mental illnesses.
Introduction of phenothiazine class of drugs
What is reason for using medications twofold:
first, the medication manage symptoms helping the patient feel more comfortable emotionally
second, the patient is generally more receptive and able to focus on other types of therapy if medications are effective.
What is psychotherapy?
term used to describe the form of treatment chosen by the psychologist, psychiatrist, social worker or advanced practice , mental health nurse.
What is the goals of psychotherapy?
*reduce the patient's emotional discomfort
*increase the level of the patient's social functioning
*increase the ability of the patient to behave or perform in a manner appropriate to the situation
Psychodynamic therapy is based on psychoanalysis. What is it?
It consists of clarifying the meaning of events, feelings, and behavior, thereby gaining insight to them.
Psychoanalysis was developed by?And what did they believe?
Sigmund Freud's psychoanalytic theory. He believed that anxiety was primary motivation for behavior and that all behavior had meaning.
What is the role of the patient for the therapist? What is the role of the therapists?
The role of the patient provide the therapist with clues to the unconscious source of problems and try to develop insights into behavior. The role of therapist is to uncover the unconscious experiences and interpret their meanings to the patient.
What is behavior management?
Called behavior management is a treatment method that stems from the studies of behavioral theorists such as B.F. Skinner and Ivan Pavlov. Usually used in long term care facilities with children and adolescents and with the individual who have a low level of cognitive functioning.
What is the behavior management theory?
all behavior is learned: therefore, it can be unlearned. Belief is that behavior can be shaped by either positive or negative reinforcement.
What is positive reinforcement?
is the act of rewarding the patient with something pleasant when the desired behavior has been performed. Ex: if the patient has a habit of using foul language to obtain what he or she needs, the desired behavior change might be to go to a staff member and ask appropriately for what he or she needs.
What is negative reinforcement?
is the act of responding to the undesired behavior by taking away a privilege or adding a responsibility. Can be misinterpreted as punishment. Parents who ground their children for unacceptable behavior are using negative reinforcement; requiring the child to perform extra household chores.
A sign consent from the patient is advised when using this form of therapy.
What do cognitive behavioral therapists believe what?
Believe that people experience mental illness due to cognitive distortions about their situations.
Describe what happens in cognitive behavior therapy?
Stresses ways of rethinking situations. Therapists confronts the patient with certain distortions of thinking and then helps the patient to out ways of thinking about them differently. Patient often has "homework"
What is counseling?
Counseling is the provision of help or guidance by a health care provider. It is licensed and regulated differently by state and sometimes also by municipality.
What is electroconvulsive therapy?
treatment that used for severely depressed who have not responded to psychotropic medications. ECT passes an electric current through the brain to produce a tonic-clonic seizure. Stimulates an increase in circulating levels of neurotransmitters serotonin, norephinerine, and dopamine in the brain.
Describe ECT procedure?
takes place in the recovery room of an operating suite, where there is ready access to emergency equipment. Informed consent must be obtained by HCP.
Before procedure patient is giving medication 30 min before to dry secretions and counteract stimulation of the vagus nerve.
Given short acting anesthetic to smooth muscle and relax. BP is given prior to administration of this.
BP and pulse are carefully monitored. Patient is oxygenated.
Seizure must last 30 seconds
What are the side effects of ECT?
*confused and forgetful immediately after procedure.
*Reserved for treatment resistant depressio
What is the nursing care for an ECT?
*Patient should receive nothing by mouth for at least 4 hours before a treatment
*Empty bladder and remove dentures, contact lenses, hair pins and other items on body
*After, monitor vital signs and document patients responses
*With hold oral meds and food until gag reflex is back
What is relaxation therapy?
deep, rhythmic breathing can increase oxygenation. For muscle relaxation, start at the head and neck and systematically tense and then relax muscle groups and they progess to lower extremities.
What is guided imagery?
use of the imagination to promote relaxation. Patient is assisted to imagine a pleasurable place or experience from his or her past
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