T4 MENTAL HEALTH #1

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BHAVES
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130694
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T4 MENTAL HEALTH #1
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2012-01-26 22:15:59
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T4 MENTAL HEALTH
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T4 MENTAL HEALTH #1
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  1. DSM-IV-TR Multiaxial System
    • AXIS I - All Mental health diagnoses
    • except those found in Axis II
    • AXIS II - Any personality disorder diagnoses & mental retardation
    • AXIS III - any general medical diagnoses (asthma, DM)
    • AXIS IV - pertinent psychosocial problems & living condition
  2. CLIENT EVALUATION - Start the nursing process by collcting subjective data (psychosocial history) & obejective data (mental status exam)
  3. MENTAL STATUS EXAMINATION - Affect - Objective expression of Mood, such as flat affect (lack of Facial expression
    • Cognitive & Intellectual Abilities:
    • Orientation & Memory - remote, recent, immediate
    • Ability to think abstractly
    • Insight - objective assessment of the clients perception of the Illness
    • Judgment - Based on the clients answer to a hypothetical question
    • Thought Process - processing differences, such as rapid change of Topic (Flight Ideas)
  4. MENTAL HEALTH NURSING INTERVENTIONS
    • Counseling - using therapeutic communication skills
    • Milieu Therapy - Orienting the client to the physical setting
    • Promotion of Self Care Activities: offering assistance with self care tasks
  5. INTENTIONAL TORTS
    • False Imprisonment - confining a client to a specific area
    • Assault - Making a threat
    • Battery - touching in a harmful or offensive way
  6. ETHICAL ISSUES - ethical issues are philosophical ideas regarding right and wrong
  7. CONFIDENTIALITY - Client's right to privacy is protected by HIPAA
  8. RESOURCES FOR SOLVING ETHICAL CLIENT ISSUES - Patient Care Partnership (formerly the Patients Bill of Rights)
  9. TYPES OF COMMITMENT TO A MENTAL HEALTH FACILITY
    • Voluntary Commitment - read p/p page 4/15
    • Involuntary Commitment - read p/p page 4/15; Clients still considered competent & have the right to refuse treatment
    • Emergency Commitment - Prevent harm to self or to others
  10. SECLUSION & RESTRAINT -
    Should be ordered for the shortest duration necessary & only if less restritive measures are insufficient.
    Never be used for: staff convenience, client punishment, for clients who are physically or mentally unstable, & for clients who can't tolerate the decrease stimulation of a seclusion room
    • Uses of Seclusion & Restraint
    • Tx must be ordered by the PCP in writing & specify duration of Tx
    • Client can be placed in seclusion or restraint in an emergency
    • Order must be rewritten every 24 hours or as specified
    • Check Circulation every 15 min, remove restraint evey 2 hours
  11. NURSE-CLIENT RELATIONSHIP - A therapeutic nurse - client relationship is:
    Purposeful & goal directed; Well defined with Clear boundaries; Structured to meet the client needs
  12. FACTORS THAT HELP DEVELOP THE THERAPEUTIC RELATIONSHIP
    • Nurse Factors: Self awareness of own thoughts/feelings
    • Client Factors: Trustful attitude, Willingness to talk (rapport)
  13. THERAPEUTIC RELATIONSHIP
    • Phases of the Therapeutic Nurse-Client Relationship
    • Orientation, Working, Termination
  14. BOUNDARIES - must be established;
    To reflect on boundary issues frequently, & to maintain an awareness of how behaviors are perceived
  15. TRANSFERENCE -
    Example: The Client may see the nurse as being like his mother
  16. COUNTERTRANSFERENCE -
    The nurse may feel defensive & angry with a client for no apparent reason
  17. THERAPEUTIC COMMUNICATION - The nurse must recognize & respond to both Verbal & Nonverbal Communications
  18. EFFECTIVE COMMUNICATIONS SKILLS & TECHNIQUES
    • Silence - serves a function, such as time for meanigful reflections
    • Clarification & Validation - of clients messages
    • Open Ended Questions - to facilitate spontaneous responses
  19. INEFFECTIVE COMMUNICATION SKILLS & TECHNIQUES
    • Taking the clients words at "face value", giving advice about the clients decisions.
    • Giving approval or d-approval of clients thoughts, feelings or behavior which implies judgment or moralizing
    • Close ended & "why" questions, which limit the clients responses
  20. ANXIETY - is a feeling of apprehension, or dread resulting from a real or perceived threat
    • Levels of Anxiety
    • Mild - occurs in the normal experience of everyday living, increase one's ability to perceive reality, has identifiable cause
    • Moderate - occurs when mild anxiety excalates; slight decrease in perception; increased heart rate and respiratory rate
    • Severe - Perceptual field is greatly reduced with distorted perceptions; not able to take direction from others.
    • Panic-Level - not able to process what is occuring in the environment & may lose touch with reality
    • Nursing Interventions for Anxiety
    • Provide a calm presence, recognizing clients distress
    • Explore Alternatives to problem situation
    • Provide a quiet environment with minimal stimulation, stay with client if in panic state
    • Encourage gross motor activities
    • Set Limits by using firm short simple statements
  21. THERAPEUTIC MILIEU -Management of the Milieu means manipulating the total environment of the mental health
  22. Prevention of Client Sel-harm or Harm by Others - No access to sharp or otherwise harmful objects
  23. Client Care in Acute Mental Health Care Settings
    Admissions Criteria - danger to self or other, failure of community based Tx, dangerous decomposition of a client undergoing long term Tx
  24. Interdisciplinary Team Members in Acute Care - The IDT has the Primary responsibility of planning & monitoring individualized Tx
  25. LEVELS OF PREVENTION
    • Primary Prevention - promotes health & prevents mental health problems from occuring
    • Secondary Prevention - Focuses on early detection of mental illness
    • Tertiary Prevention - focuses on rehabilitation & prevention of further problems in clients previously diagnosed
  26. DEFENSE MECHANISM

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