Mental Health Exam I

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Mental Health Exam I
2012-03-11 23:03:55
Mental Health Exam

Mental Health Exam 1
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  1. Maslow
    • Hierarcy of needs
    • 1) Physiological
    • 2) Safety and security
    • 3) Love and belonging
    • 4) Self-esteem and esteem of others
    • 5) Self actualization - fulfullment of one's highes potential

    *can move up and down the pyramid depending on stressors - one must be met before the other is accomplished
  2. Mental Health
    the sucessful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms
  3. Mental Illness
    maladaptive responses to stressors from the interal or external environment, evidenced by thoughs, feelings, and behavoirs that are incongruent with the local and cultural norms and interfere with the individuals social, occupational, or physical functioning
  4. Horwitz
    descrives cultural influcences that affect how individual view mental illness

    Incomprehensibility - the inability of the general population to understand the motivation behind behavior

    Cultural relativity - the normality of behavior determined by the culture
  5. Hans Selye
    The father of stress

    • General adaptation syndrome - also called the fight or flight syndrome
    • 1 alarm reaction -fight or flight initiated
    • 2. state of resistance - attemt to adapt to the stressor
    • 3. state of exhaustion - prolonged exposure - diseases of adaption - headaches, mental disorders, CAD, ulcers, colotis

    Body reacts in the same way no matter what the stresser (good or bad). Body returns to homeostasis during the stage of resistance unless stress contiues and then stage of exhaustion sets in and immune system is weakened

    Stress - state manifested by a specific syndrome which consists of all the nonspecifically induced changes within a biologic system (fight or flight syndrome)

    Adaptation - restoration of the body tohomeostasis following a physiological and/or psychological response to stress.
  6. Peplau
    Mother of Anxiety

    1950's Psychiatric nurse who described the nurse-client relationship not as what the nurse can do "for" the client, but rather do "with" the client to accomplish mental health. The focus of her care is based on the "interpersonal relationship"

    Defined four stages of Anxiety
  7. Four stages of anxiety
    Mild - sledom a problem - it is adaptive and can provide motivation for survival

    Moderate - perceptual field diminishes Ex - person who is preparing for surgery

    Severe - perceptual field is so diminished that concentration centers on one detail only or on many extraneous details, physical symptoms usually present

    Panic - the most intense state, safety is # 1 concern
  8. Anxiety
    Anxiety is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness

    Anxiety and grief have been described as two major, primary psychological response patterns to stress

    Fear comes from an external source, anxiety comes from within

    Adaptation - restoration of the body tohomeostasis following a physiological and/or psychological response to stress.

    -is determined by the extent to which the thoughts, feelings and behaviors interfere with an individuals functioning
  9. Define Ego Defense Mechanisms (15)
    1. Compensation - covering up a real or percieved weakness by emphasizing a trait one considers more desirable

    2. Denial - refusing to acknowledge the existence of a real situation or feelings associated with it

    3. Displacement - transfer of feelings from one target to another that is less threatening (mad at Dr - takes out on nurse)

    4. Identification - attempt to increase self-worth by acquiring attributes & characteristics on someone you admire

    5. Intellectualization - to avoid expressing emotions associated to a situation by using intellectural processes of logic, reasoning, and analysis

    6. Introjection - integrating belief & value system of another into one's ego structure (kids & parents)

    7. Isolation - separating thought or memory from the emotions associated with it

    8. Projection - Attributing feelings or impulses unacceptable to one's self to another person (he's coming on to me)

    9. Rationalization - make excuses or formulate logical reasons to justify unacceptable feelings or behaviors

    10. Reaction Formation - Preventing unacceptable thoughs or behaviors from being expressed by exaggerating opposite thoughs or types of behaviors

    11. Regression - Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning

    12. Repression - involuntarily blocking unpleasant feelings and experiences from one's awareness

    13. Sublimation - Rechanneling of drives or impulses that are personally or socially unacceptable into activites that are constructive (MADD)

    14. Suppression -The voluntary blocking of unpleasant feelings and experinces from one's awareness (I'll think about that tomorrow)

    14. Undoing - Symbolically negating or canceling out an experience that one finds intolerable
  10. Ego Defence Mechanisms
    • Compensation
    • Denial
    • Displacement
    • Identification
    • Intellectualization
    • Introjection
    • Isolation
    • Projection
    • Rationalization
    • Reaction Formation
    • Regression
    • Repression
    • Sublimation
    • Suppression
    • Undoing
  11. Kubler- Ross
    The Guru of Grief

    Grief - the subjective state of emotional, physical and social responses to the loss of a values entity; the loss may be real or percieved

    • Five stages of Grief
    • Denial
    • Anger
    • Bragaining
    • Depression
    • Acceptance

    Anticipatory grief - experiencing the grief process before the actual loss occurs

    Resolution - length of the grief process is entirely individual. It can last from a few weeks to years. It is influenced by a number of factors
  12. DSM-IV-TR Multiaxial Evaluation System
    Axis 1 - Clinical disorders and other conditions that me be a focus for clinical attention

    Axis 2 - Personality disorders and mental retardation

    Axis 3 - General medical conditions

    Axis 4 - Psychosocial and environmental problems

    Axis 5 - Global Assessment of Functioning
  13. Therapeutic communication
    ability to use one's personality consciously and in full awareness in an attempt to extablish relatedness and to structure nursing interventions
  14. Conditions that are essential to develop a therapeutic relationship
    1. Rapport - to create a sence of harmony based on knowledge and appreciation of each individual's uniqueness

    2. Trust - to feel confidence in a person's presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested

    3. Respect - to believe in the dignity and worth of an individual regardless of his unacceptable behavior

    4. Genuineness - nurses ability to be open, honest, and real in interactions with the client

    5. Empathy - nurse percieves or inderstands what client is feeling and encourages them to explore those feelings

    not sympathy - nurse "shares" clients feelings and feels need to alleviate distress
  15. Phases of a therapeutic relationship
    1. Pre-orientation - explore self perceptions, obtain info on client from chart, significant others, or other health team members

    2. Orientation - Establish trust, rapport, and contract for working together, formulate nursing Dx, set goals agreeable to nurse and client, develop plan of action

    3. Working - promote client change, problem solve, continuously evaluate porgress toward goal attainment

    4. Termination - progress has been made toward goal attainment, plan for future care, feelings of terminating relationship explored, ensure therapeutic closure
  16. Transference
    client transfers feelings toward significant others in past life to nurse
  17. Counter-transference
    nurse transfers feeling toward significant others in past life to client or may be in response to transference feelings from client
  18. self-awareness - why do we address it?
    clarify our own values and beliefs (spiritual, cultural) so they do not impact our communications with the client in negative ways through sterotyping. Each client is entitled to their own values and beliefs as we are, so do not impose our own on the client.
  19. Empathy vs. Sympathy
    Empathy - nurse "accurately percieves or understands" how the client is feeling (objective)

    Sympathy - nurse "shares" what the client is feeling and experiences a need to alleviate stress (objectivity lost)
  20. Culture
    each culture will find different interventions useful
  21. Therapeutic Communication Techniques (20)
    • 1. Using silence
    • 2. Accepting
    • 3. Giving Recognition
    • 4. Offering Self
    • 5. Giving Broad Openings
    • 6. Offering General Leads
    • 7. Placing the Event in Time or Sequence
    • 8. Making Observations
    • 9. Encouraging description of perceptions
    • 10. Encouraging Comparison
    • 11. Restating
    • 12. Reglecting
    • 13. Focusing
    • 14. Exploring
    • 15. Seeking Clarification and Validation
    • 16. Presenting Reality
    • 17. Voicing Doubt
    • 18. Verbalizing the Implied
    • 19. Attempting to Translate words into feelings
    • 20. Formulating a plan of action
  22. Therapeutic Communication Techniques Defined
    1. Using silence - allows client to take control of discussion, if he or she desires

    2. Accepting - conveys positive regard (eye contact, nodding)

    3. Offering self - making oneself available (i'll stay with you a while)

    4. Giving broad openings - allows client to select the topic (what would you like to talk about today)

    5. Offering general leads - encourages client to continue (yes, I see - go on - and after that?)

    6. Placing the event in time or sequence - clarifies the relationship f events in time (when did this happen? - was that before or after? - what seemed to lead up to?)

    7. Making observations - verbalizing what is observed or percieved (you seem tense - I noticed you are pacing a lot - you seem uncomfortable when you....)

    8. Encoiraging description of perceptions - asking cleint to verbalize what is being percieved (Tell me what is happening now - Are you hearing voices again - What do the voices seem to be saying?)

    9. Encouraging comparision - asking client to compare similarities and differences in ideas, experiences or interpersonal relationships (wat that something like...? - How does this compare with the time when...? - What was your response the last time this situation occured?)

    10. Restating - lets client know whether an expressed statement has or has not been understood

    11. Reflecting - directs questions or feelings back to client so that they may be recognized and accepted (what do you think you think you should do about...? - You feel angry when she dosne't help)

    12. Focusing - taking notice of a single idea or even a single word (This point seems worth looking at more closely. Perhaps you can I can discuss it together.)

    13. Exploring - delving further into a subject, idea, experience, or relationship (please explain that situation in more detail - tell me more about that....)

    14. Seeking clarification and validation - striving to explain what it vague and searching for mutual understanding (I'm not sure that I understand. would you please explain? - Tell me if I am understanding this correctly)

    15. Presenting Reality - clarifying misconceptions that the client may be expressing (I understand that the voices seem real to you, but I do not hear any voices - There is no one else in the room but you and me)

    16. Voicing doubt - expressing uncertainty as to the reality of clients perceptions - often used with clients with delusional thinking (I understand that you believe that to be true, but I find it hard to believe - That seems rather doubtful to me)

    17. Verbalizing the implied - putting into words what the client only implied - can also be used with mute or client with impaired verbal communications (client: It's a waste of time to be here. I can't talk to you or anyone.; nurse: Are you feeling that noone understands you?)

    18. Attempting to translate words into feelings - putting into words the feeling the client has only expressed indirectly (client: I'm way out in the ocean, nurse: you must be feeling very lonely right now)

    19. Formulating plan of action - striving to prevent anger or anxiety escalating to an unmanagable level when stressor recurs (what could you do to let your anger out harmlessly?)
  23. Nontherapeutic Communication Techniques
    • 1. Giving reassurance - may discourage client from further expression of feelings is client bleieves the feelings will only be downplayed or ridiculed (everything will be alright, I wouldnt worry about this if I were you)
    • SAY: We will work on that together

    • 2. Rejecting - refusing to consider or showing contempt for the client's ideas or behavior (let's not discuss....I don't want to hear about that)
    • SAY: Let's look at that a little bit closer

    • 3. Approving or disapproving - sanctioning or denouncing the clients ideas or behavior - nurses acceptance of the client is seen as conditional depending on the client's behavior (that's good. I'm glad you.... or that's bad. Id rather you wouldnt)
    • SAY: Let's talk about how your behavior involked anger in the other clients at dinner

    • 4. Agreeing or Disagreeing - indicating accord with or opposition to the client's ideas (that's right, I agree or that's wrong, I disagree)
    • SAY: Let's discuss what you feel is unfair about the new community rules

    • 5. Giving advice - it nurtures the client in the dependnet role by discouraging independnet thinkink (I think you should, Why dont you...)
    • SAY: What do you think would be best for you to do?

    • 6. Probing - perisitant questioning of the client
    • DO: the nurse should be aware of the client's response and discontinue the interaction at the first sign of discomfort

    • 7. Defending - attempting to protect someone or something from verbal attack (No one here would lie to you, you have a very capable physician. In sure he has your best interest in mind)
    • SAY: I will try to answer your questions and clarify some issues regarding your treatment

    • 8. Requesting an explination - Asking client to provide reasons for thoughs, feelings, behavior, and events (Why do you think that?, Why do you feel that way? Why did you do that?)
    • SAY: Describe what you were feeling just before that happened

    • 9. Indicating the existence of an external source of power - attributing the source of thoughts, feelings, and behavior to others or to outside influences (What makes you say that?, What makes you do that? What made you so angry last night?)
    • SAY: You became angry when your brother insulted your wife

    • 10. Belittleing feelings expresses - When one is experiencing discomfort, it is of no relief to hear that others are or have been in similar situations (Everybody gets down in the dumps at times. I feel that way sometimes)
    • SAY: You must be very upset. Tell me about what you are feeling right now

    • 11. Making stereotyped comments - Cliches and trite expressions are meaningless in the nurse-client relationship (I'm fine, how are you? Hang in there, Its for your own good, Keep your chip up)
    • SAY: The therapy must be difficult for you at times. How do you feel about your progess at this point?

    • 12. Using denial - denying that a problem exists blocks discussion with the client (Of course people care about you)
    • SAY: You're feeling like no ones cares about you right now

    • 13. Interpreting - the therapist seeks to tell the client the meaning of his or her experience (what you really mean is...., unconsciously you're saying)
    • DO: Leave interpretation of the client behavior to the psychiatrist

    • 14. Introducing an unrelated topic - nurse takes over the conversation - could be to get to a topic the nurse wished to discuss or to get away from an uncomfortable topic
    • DO: remain open and free to hear the client and to take in all that is being conveyed, both verbally and nonverbally
  24. TIme orientation
  25. - Adolescents - present/ live in the moment & no concern for the future
    • First Peoples - past oriented
    • Americans - Future oriented
  26. Nonverbal Communication
    • -physical appearance and dress
    • -Body movement and posture
    • -touch
    • -facial expressions
    • -eye behavior
    • -vocal cues or paralanguages - BFF - using text language to older client who is unfamiliar with it

    • -all communication is either verbal or nonverbal communication
    • -most communication is nonverbal
    • -nonverbal communication often reflects the client's true feelings since it is often uncensored by the subconscious
  27. Active listening - SOLER
    • S - sit squarely facing the client
    • O- Observe an open posture - relaxed - no hands on hips or arms crossed
    • L - Lean forward toward the client
    • E - Establish eye contact
    • R - Relax
  28. Client psychosocial assessment
    • 1. Biographical data
    • 2. Chief complaint - their perception of what they think is wrong with them
    • 3. Current status of heath issue and client response
    • - issues leading up to admission
    • -actions by client leading up to admission
    • -levels of function
  29. Client History: Lifestyle
    • - - educational and occupational background - highest level of education?
    • - - Socio-economic status - culture,
    • - - Home and environmental factors -
    • - - social patterns
    • - - sexual patterns
    • - - interest/ hobbies/ abilities
    • - - usual coping patterns - what do you do when you get anxious? what do you do to calm yourself?
  30. Mental Status
    Mood - client's dominant or pervasive feelings - persistant emotional trend that is maintained for hours, days, or longer such as in depression

    Affect - facial expression - changes can be seen immediately
  31. Delusions
    • Delusions- false fixed beliefs
    • grandiosity (grandiose) - friends with the pope/ president paranoia - ex-military if not sure of validity at least docuement what paranoia is
  32. sensorium and intellectual processes
  33. - orientation to T/P/P
    • - Memory - recent remote
    • - Ability to concentrate - cereal 7's backwards - spell world backwords
    • - Abstract thinking - proverbs or how are items alike "the early bird catches the worm""an ounce of prevention is worth a pound of cure"if taking literally - not thinking abstract
  34. Judgement and Insight
    - Good judgement - if you lock your keys in the car, what do you do? you find a sealed envelope with a stamp on it what do you do?