MENTAL HEALTH EXAM I STUDY GUIDE

Define and describe:

Voluntary /involuntary admission criteria/ who is eligible to be hospitalized without the

person’s consent?

Voluntary Admission: when a patient applies in writing for admission to the facility. If under 18

need a legal guardian. The PCP can reevaluate the patient and if the patient doesn’t want to

stay an involuntary admission may be required.

Involuntary Admission: In Maine patient needs to be “blue papered” to be hospitalized

involuntarily. Usually because patient is danger to themselves or others. Patient has rights to

retain freedom from unreasonable bodily restraints, right to informed consent, right to legal

counsel and the right to refuse medication. Can

Milieu=safe environment

Criteria for inpatient hospitalization

Most restrictive. Need referral by PCP or psychiatrist. Most patients admitted through

ER. Need one or more of the following to be admitted:

1. Imminent danger of harming self

2. Imminent danger of harming others

3. Unable to care for basic needs and/or gross impairment of judgment, placing an

individual at imminent risk based on inability to protect oneself.

Outpatient setting/ what does the care consist of here?

Community setting.

Tries to enhance patient strengths in the daily environment.

Uses support systems to learn how to cope with illness or difficult situations.

Intermittent supervision

Independent living environment w/ self-care and safety risks

Establish long-term relationship

Encourage med regiment.

Teach/support nutrition and self-care w/ referrals as needed.

Communicate regularly w/ support system (family) to assess and improve level of functioning

Develop comprehensive plan of care w/ attention to sociocultural needs and maintenance of

community living.

Partial hospitalization/what does the care consist of here?

Offer intensive short-term tx.

Patient can return home each day

5-6hrs/day w/individual and group psychotherapy

GOALS: improve symptoms, safety, education on illness & meds, coping strategies.

Inpatient hospitalization /what does the care consist of here?

24-hour supervision

Therapeutic milieu w/hospital supported healing environment.

Stabilization of symptoms and return to community.

Develop short-term relationship

Develop comprehensive plan of care w/ attention to sociocultural needs of pt and focus on

reintegration to the community

Administer meds

Monitor nutrition and self-care w/assistance as needed.

Provide health assessment and intervention as needed

Offer structured socialization activities

Plan for discharge w/family w/regard to housing and follow-up tx.

Recovery programs / what are they/ who do they treat? /for example, addiction, eating

disorder programs

Substance Abuse (drugs/alcohol)

Detoxification—when people quit the substance they are addicted to and go through

withdrawal. 24hr medical coverage while the patient clears out the drug from their body.

Rehab—medically monitored and has 24hr staff that provides care for those w/

biomedical or psych comorbid (multiple conditions in one illness) conditions. Patients can stay

long or short-term. Staff evaluates individuals and treats them, aiding in recovery and

improving function that possibly never developed while the patient was addicted.

Halfway House—A substance-free residential place for addicts to go. They work and go

to treatment programs (AA, NA etc). Focus is to extend sobriety, get assistance with education,

working social and economic needs.

Anorexia/Bulimia Nervosa/Binge-Eating Disorder

Acute Care—patient’s w/anorexia are admitted to an inpatient psych facility.

Long-term treatment possibly including: hospital stays, outpatient psychotherapy, and

meds.

Case management, case manager in mental health, what is their role, how do they help

persons with mental illness?

Case Management: helps the patient in the community with their mental illness, physical

health, spiritual health, education, social services and finding employment. The nurse helps the

patient and the patient’s support team with the patient’s treatment and living in the

community.

Summary of client rights /what document is this?

HIPPA (health insurance portability and Accountability Act)—privacy and confidentiality.

Right to be:

Treated w/ dignity

Involved in tx plan and decisions

Able to leave the hospital against medical advice.

Protected against harming themselves or others

Evaluated in a timely manner

Able to refuse tx and/or medications

Able to have legal counsel

Able to vote

Able to communicate privately with a person(s) or on the phone

Able to have informed consent

Able to have confidentiality protected with disorder or tx.

Able to have or not have visitors

Informed of research and refuse to participate

Able to have the least restrictive tx for their illness.

Able to send/receive mail.

Able to keep personal belongings unless its dangerous

Able to write a complaint following publicized procedure

Able to practice their religion.

What are the Laws that govern confidentiality: when is it ok to break confidentiality?

Confidentiality-the ethical responsibility of a health care professional that prohibits the

disclosure of privileged information w/o the patient’s informed consent. Can only be waived by

the patient, except if it’s to protect the patient, other persons or the public health, this is called

Duty to Warn.

Tarasoff law (duty to warn) - when patient intends to harm or kill another, health care

persons have a duty to warn that person. Tarasoff Law was a case in which a psychologist told

the police verbally and in writing that a student was going to kill another person. The police

questioned the student and cleared him. He ended up killing the person intended two months

later. This law created a duty to warn the person that is the target of the murder. It also created

the duty to protect in which the therapist they must call and warn the intended victim/victims

family/ or the police.

Tort-what is a tort? Be prepared to give an example of this (civil wrongdoing in practice)

Tort: a civil wrong for which money damages or other relief may be obtained by the injured

part from the wrongdoer.

Ex: healthcare professional overusing restraints (intentional tort), not getting patient consent.

Threats. Assault. Confinement.

Unintentional Torts—a tort that’s unintentional but still causes harm to the patient. Ex:

negligence.

What is the definition of ‘anosognosia’? (In relationship to a person with a severe/ serious

mental illness)

Anosognosia—patient’s inability to realize that they are ill due to the illness itself. Ex:

schizophrenic patients.

Therapeutic relationship and characteristics of in the nurse patient relationship

Therapeutic Relationship—when the nurse uses their skills to enhance patient’s growth.

Patient’s become more open and interact more when they realize the nurse respect their

concerns.

Characteristics:

Relying on a true understanding of what the client is telling the nurse

Relying on the verbal and nonverbal meaning conveyed by the client

Always mirroring back the understanding what the patient has told the nurse and verify

it with the patient.

Trust

Compassion

Empathy

Aware of the nurses own thoughts.

Observing, suspending judgement and negativity

Confidentiality

Manners

Respect

Use of space, silence, reflection, and offering one’s expertise and care to the patient

Boundaries in nurse/patient/family relationship/ what are they

Physical—general environment, office space, tx room, conference room. Area where patient

and nurse meet.

The Contract—confidentiality b/w nurse and patient.

Personal Space—physical and emotional space set by people involved.

Blurring of Boundaries—establish clear boundaries b/w nurse and patient.

Ex: patient becomes dependent on certain nurse, unwilling to do certain tasks without

certain nurse being there. (over-involvement)

Ex: Patient and nurse lack common goal, lack of progress towards goal, nurse doesn’t

follow-up w/patient. (under involved).

Respect /privacy- how does one demonstrate this with patients?

Respect the patient’s privacy and give respect to the patient.

SSDI (disability income) - what is it, why would persons with chronic mental illness get this.

Social security for the disabled.

SSDI- tax funded federal insurance program of US government for disabled, mentally or

physically.

Wellstone-Domenici Parity Act 2003—use of deductibles, copayments, coinsurance, tx

limitations, and out of pocket expenses. Affordable Care Act 2010-- Provides coverage for

uninsured w/ Medicaid eligibility. Created health insurance exchange in states, and insurance

mandate that people w/o coverage can obtain.

Theories of mental health care, evidence- based, Hildegard Peplau, Freud; id, ego, superego),

(nursing)

Hildegard Peplau— defined the therapeutic nurse-pt relationship as the foundation of the

nursing process.

Phases of Nurse-Patient Relationship:

Orientation—sizes up the situation, may ask for supervision/guidance, support from the

team or colleague when first meeting the patient. Establish rapport, nurse-pt relationship,

formal/informal contract, initial assessment, confidentiality, and terms of termination.

Working—maintain relationship, gather information, encourage pt’s problem-solving

skills, self-esteem and language skills. Behavioral change, work on goals, encourage the practice

of different behaviors.

Termination—summarize goals, incorporate new coping strategies, review situations of

relationship and exchange memories. Most therapeutic stage.

Freud—

ID: source of all drives (instinct, drive, genetics)

EGO: the problem solver and reality tester. (subjective/objective, memory images)

SUPEREGO: moral component, conscience, seeks perfection.

EGO DEFENSE MECHANISMS: unconscious management of anxiety to protect ego. Can

be adaptive or maladaptive (problematic).

DENIAL: failure ot acknowledge intolerable though, feeling, experience or reality.

Ex: alcoholic who says they don’t have a drinking problem.

DISPLACEMENT—redirection of emotions or feelings to a subject that is more

acceptable or less threatening. Ex: yelling at the dog when angry at the boss.

PROJECTION—attribution to others one’s unacceptable feelings, impulses

thoughts or wishes. Ex: saying someone you are angry w/ is angry with and dislikes you.

UNDOING—attempt to erase an unacceptable act, thought, feeling or desire. EX:

Apologizing excessively, OCD

COMPENSATION—an attempt to overcome a real or imagined shortcoming. Ex:

smaller in stature person excelling in sports.

SYMBOLIZATION— a less threatening object or idea is used to represent another

ex: dreams, phobias

SUBSTITUTION—replacing desired, impractical or unobtainable object w/ one

that’s acceptable or attainable. Ex: marrying someone who looks like a previous S.O.

INTROJECTION—occurs when a person internalizes ideas or voices of other

people commonly assoc. w/ the internalization of external authority, particularly of parents.

REPRESSION—unacceptable thoughts kept from awareness, inability to

remember a traumatic event, seen in PTSD patients.

REGRESSION--Return to an earlier developmental phase in the face of stress-

bedwetting, baby talk are examples.

DISASSOCIATION—detachment of painful, emotional experience form

consciousness. Ex: sleepwalking, no memory of an event

SUPPRESSION—consciously putting a disturbing thought/incident out of

awareness. Ex: deciding not to deal w/something unpleasant until the next day.

SUBLIMATION—substituting constructive activity for strong impulses that are

not acceptable.

REACTION FORMATION—expressing attitude directly opposite to unconscious

wish or fear-being excessively kind to a person who is disliked.

ERICKSON:

TRUST V MISTRUST—0-1.5yrs, forming attachment to individuals.

AUTONOMY V SHAME/DOUBT—1.5-3yrs, gaining control over self and environment

(toilet training, exploring)

INITIATIVE V GUILT—3-6yrs, becoming purposeful and directive

INDUSTRY V INFERIORITY—6-12yrs, developing social, physical and school skills

INDENTITY V ROLE CONFUSION—12-20yrs, making transition from childhood to

adulthood, sense of identity

INTIMACY V ISOLATION—20-35yrs, establishing intimate bonds of love and friendship

GENERATIVITY V SELF-ABSORPTION—35-65yrs, fulfilling life goals that involve family,

career, and society. Embrace future generations.

INTEGRITY V DESPAIR—65 to death, looking back over one’s life and accepting the

meaning of life.

Use of the Nursing process –determining priority interventions in mental health nursing, i.e.,

in the plan of care what gets to be the priority intervention (think of Maslow’s hierarchy of

needs here)

Nursing process:

Assessment—age of patient (child, adult, adolescent etc), mental status exam (MSE),

psychological assessment

Diagnosis—medical assessment, DSM IV, problem identification, identify goals, need to

be measurable, timed and attainable.

Plan—effective and client-centered. Safety, standard and compatible w/goals. Realistic

and based on evidence based practice (EBP)

Implement—coordinate tx, education, milieu, medications, safety!.

Evaluation—response to tx plan. DOCUMENT: SOAP notes, narrative notes.

Primary, secondary, tertiary care in mental health nursing community care setting

Primary—occurs before any problem occurs. Reduces incidences.

Secondary—aimed at decreasing the number of new and old cases of psych disorders.

Finds ways to detect illnesses early, and works on preventing them.

Tertiary—treatment and rehabilitation of the disease

Role of the mental health nurse in community care, what makes that nurse unique?

The nurse provides emergency services, adult services, child services, medication

administration, individual therapy, psychoeducational therapy, therapy groups, family therapy,

dual-diagnosis, psychosocial therapy (program that offers a structures day program, vocation

services and residential services), and psychiatric case management (service to help pts find

housing or entitlements.) Community health centers can provide long-term care for patients as

well.

Autonomy of the community nurse

Autonomy—respect patient’s rights to make their own decisions and respecting the patient’s

right to refuse medications.

How to: Support the client’s autonomy in community health nursing and other health care

settings

Serious mental illness: homelessness, jail, chronic illnesses

Co-morbidity: what are some of the more common chronic illnesses and why

Comorbid: multiple conditions at a time. Addiction and metabolic disease are comorbid

disorders. Types: schizophrenia, bipolar disorder and major depression.

Treatment modalities: For example, 1:1 psychotherapy, group therapy, names of group

therapy available, what nurses can conduct for therapy in mental health

Interpersonal Psychotherapy: short-term therapy that reduces symptoms by improving

social relationships.

Group Psychotherapy—leaders help a group of patients with psychiatric disorders.

CLASS #2 AND #3

Evidenced Based Care, Biology, Physiology, and Pharmacology

Maslow hierarchy of needs theory

Physiological—food, water, oxygen

Safety—security, protection, structure

Love and belonging—affiliation, affectionate relationships, love

Esteem—r/t competency, achievement, and esteem from others,

Self-actualization—becoming everything one is capable of

Self-transcendence

Nursing process in working with client with mental illness

Assessment: data gathered, subjective, objective

Diagnosis: using nursing diagnosis

Planning: setting goals with the patient, prioritizing care (always need to consider safety, i.e., is

patient suicidal? Or a danger to self or to others?)

Intervention / implementation: nursing interventions, prioritizing care (including administration

of medications)

Evaluation: Determining if goals were met

For bio-physiology and pharmacology:

Functions of the brain; function of each of the structural parts of the brain, different lobes of

the brain

Parasympathetic=rest and digest. Normal regulation of organs and systems

Sympathetic= fight or flight.

Circadian Rhythm=sleep regulated by various regions of the brain

Controls biological drives and behaviors, maintains homeostasis

Regulates autonomic nervous system and hormones

Memories, consciousness, fantasies, problem-solving, interpretation of the world, social

activities are also brain functions.

FOREBRAIN:

Cerebrum: cortex, largest part of the brain. Nerve cells make up the gray surface,

white nerve fibers carry signal b/w the nerve cells and the brain/body. Neocortex is bulk

of the cerebrum. Has 4 sections:

1. Frontal—reason, planning, speech, movement, emotion, and problem

solving

2. Parietal—sensory and motor, movement, orientation, recognition,

perception of stimuli

3. Occipital—visual processing, image recognition

4. Temporal—hearing, memory and speech

Thalamus: major relay station, monitors incoming info and then sends it to

upper regions of the brain.

Hypothalamus: (limbic system=emotional brain). Links to the pituitary gland,

regulates body temp, water, electrolytes, blood flow, sleep-wake cycle and levels of

hormones.

Amygdala: influences behavior and activities directed to the body needs,

concerned w/ emotion, drives (hunger, thirst, sex).

Hippocampus: grey matter that recognizes new experiences, learning and short

term memory.

MIDBRAIN: tectum and tegmentum. Brain stem, responsible for visual, auditory and

balance reflexes. Found underneath the limbic system. Used for basic vital functions (breathing,

heartbeat, blood pressure.

HINDBRAIN: cerebellum, pons and medulla.

Cerebellum—little brain. Two hemispheres, highly folded surface or cortex.

Assoc. w/regulation of movement, posture and balance.

Neurotransmitters, names, types, common in bio-physiology

Norepinephrine—deficiency causes depression. Affects receptors alpha 1 &2 and beta

1&2. Insufficient release of the neurotrans. by the presynaptic cell.

Serotonin—deficiency causes depression, anxiety and possibly suicide. EX: attaches to 5-

HT, 5-HT2, 5-HT3, 5-HT4. Influences hunger, mood, pain perception. Insufficient release of the

neurotrans. by the presynaptic cell.

Dopamine—excess causes schizophrenia. Affects receptors D1-D5.

Glutamate—direct influence on dopamine, creating a high risk for psychosis. NMDA and

AMPA receptor sites.

Y-amino butyric Acid (GABA)—excitability and anxiety. Increase GABA produces

soothing sense and sedation. GABA A and GABA B

Acetylcholine—released by parasympathetic NS, attaches to muscarinic receptors on

internal organs. Cholinergic, muscarinic receptors

Diagnostic brain procedures, for example, PET

EEG—electrical recording of signals in the brain. Electrodes are placed externally on

head. Show activity of brain while asleep and awake. Activity differs with each state.

CT/CAT Scan—computerized axial tomography, series of x-ray images taken, computer

analysis show 3d slices of segment. Can detect: lesions, abrasions, aneurysms, and infarct.

MRI—magnetic resonance imaging. Uses nuclei of hydrogen atoms that absorb and

remit radio waves. Shows 3d image of brain. Detects: brain edema, ischemia, infection,

neoplasm and trauma.

Functional MRI—measures brain activity by detecting changes in blood oxygen levels in

different parts of the brain. Person participates in different activities while the test is

conducted. (pts w/ OCD show brain metabolism increase in areas of frontal cortex).

(Schizophrenic pts show reduced frontal lobe brain activity)

PET— photon emission computed tomography, detects: oxygen, glucose, blood flow

and neurotrans. receptor interaction. (Pts w/ depression shows decreased activity in prefrontal

cortex).

SPEC—single photon emission computed tomography—uses radionuclides that emit y-

radiation, measure aspects of brain functioning and provides images of CNS. Detects:

circulation of CSF (cerebrospinal fluid).

Categories of psychiatric medications and the neurotransmitters they target, or enhance

1. Antidepressants-

a. Tricyclic- block muscarinic receptors, block reuptake of norepinephrine and

serotonin.

i. Nortriptyline

ii. Amitriptyline

iii. Imipramine

iv. Side effects:

1. Dry mouth

2. Blurred vision

3. Tachycardia

4. Urinary retention

5. Constipation

b. SSRIs (Selective-Serotonin Reuptake inhibitor), SNRIs (serotonin-

norepinephrine Reuptake inhibitor), NDRIs (norepinephrine- Dopamine

inhibitor)

i. Fluoxetine--SSRI

ii. Paroxetine--SSRI

iii. Citalopram--SSRI

iv. Fluvoxamine—SSRI

v. Setraline--SSRI

vi. Bupropion—NRDI

vii. Duloxetine—SNRI

viii. Venlafaxine--SNRI

2. Mood stabilizers

a. Regulates moods

b. Tx bipolar I and II

c. Lithium Carbonate —mimics sodium causing fluid/electrolyte imbalance. Need

frequent blood tests.

d. therapeutic level 0.5 to 1.5 lithium toxicity

Anticonvulsants: used as mood stabilizers

e. Valproate Acid (Depakote)—causes weight gain

f. Carbamazepine (Tegretol)

g. Lamotrigine (Lamictal)—used a lot, but can cause johnson’s stevens syndrome

(deadly rash)

h. Gabapentin (Neurontin)—chronic pain tx

i. Topiramate (Topamax)--

j. Oxcarbazepine ( Trileptal)

3. Antipsychotics

a. Schizophrenia and psychosis are r/t excess dopamine

b. First generation:

i. Antagonists of the D2 receptors of dopamine.

ii. Major problems of movement and motor activity.

iii. Chlorpromazine

iv. Haloperidol

v. Fluphenazine.

c. Second Generation:

i. Less side effects than first generation

ii. Increase in risk for metabolic syndrome

iii. *Weight gain

iv. *Increase in blood glucose level

v. *Increase in triglycerides

vi. Clozapine (Clozaril)—drooling side effect, WBCs, frequent blood draws.

vii. Risperidone (Risperdal)

viii. Olanzapine (Zyprexa)

ix. Ziprasidone (Geodon)**can cause changes in cardiac rhythm. Need

baseline EKG

x. Quetiapine (Seroquel)--sedation

d. Third Generation:

i. Dopamine system stabilizer

ii. Unique antipsychotic

iii. Partial agonist of dopamine .

iv. In areas of brain where there is excess dopamine, medication lowers the

level

v. Where dopamine is needed , it stimulates the receptors to raise the

dopamine level

vi. Aripiprazole (Abilify)

4. Anti- anxiety medications ( benzodiazepine and other anxiolytics)

a. Involved is the neurotransmitter GABA

b. GABA modulates neuron excitability and anxiety

c. increase the GABA neurotransmitter

d. Highly addictive—no alcohol, monitor renewal rate.

e. Benzodiazepines cause CNS depression and are also highly addictive

f. Diazepam (Valium)-intermediate acting

g. Clonazepam (Klonopin)-long acting , slow onset

h. Alprazolam (Xanax)-short acting, quick response

i. Lorazepam (Ativan)-short acting

j. NON addictive:

i. Buspirone (Buspar)

ii. Gabapentin (Neurontin)

iii. Some antidepressants- Paroxetine (SSRI)

5. Anticholinergics

a. Used to treat side effects from the blocking of the muscarinic receptors that

occur with antipsychotics.

b. Will review when discussing schizophrenia, psychosis

Nursing considerations for each class of medications, i.e., what to consider when

administering; for example, MAOI require a particular diet (avoid foods with tyramine) when

taking or there can be a hypertensive crisis.

Monoamine oxidase inhibitors—avoid foods w/ tyramine such as aged cheese, red

wine, hot dogs, and salami. Examples of MAOIs: phenelzine, tranylcypromine.

CLASS #4

Communication as centerpiece of nursing care and the therapeutic relationship

1. Transference , Countertransference

a. Transference—when the pt unconsciously and inappropriately displaces onto

the nurse feelings/behavior r/t significant figures in the pt’s past. Ex: you remind

me of my mother.

b. Countertransference—when the nurse unconsciously and inappropriately

displaces onto the pt feelings/behavior r/t to significant figures in the nurse’s

past. Ex: Patient decides not to go to AA. Nurse says “you always sabotage your

chances. You need AA to get in control of your life….Now you’ve disappointed

everyone”.

2. Verbal:

The types and examples of communication that are effective, non-effective

Acceptance—encouraging and receiving information in a nonjudgmental manner

Interpretation—put into words what the patient is implying/feeling

Restatement—repeating the main idea expressed letting the pt know what was

heard.

Reflecting—redirecting the idea back to the pt for classification of emotional

overtones, feelings and experiences.

Exploring—introducing and idea and letting the pt respond

Confrontation—presenting the pt w/a different reality of the situation

Doubt—expressing or voicing doubt when a pt releases a situation

Validation—clarifying the nurse’s understanding of the situation.

Silence—remaining quiet but still interested

Observation—stating to the pt what the nurse is observing

Responding with Empathy vs Sympathy

Empathy—ability to understand what a pt is going through. You can relate

Sympathy—you feel sorry for the person, but cannot relate to it.

3. Nonverbal communication:

a. Excess questioning

b. Approval/disapproval

c. Giving advice

d. “why?”

e. Eye contact

f. Bias/Prejudice/culture filters

CLASS #4 (continued)

STRESS AND CRISIS THEORY

Definition of stress—based on person’s psych perceptions; threat, vulnerability, and ability to

cope.

Distress: when the stress exceeds coping skills

Eustress: good stress, helpful and fulfilling stress.

Responses to stress

Serotonin---more active, may impair serotonin receptor sites and brains ability to use

serotonin.

Immune Response—NS and immune system interact during alarm phase of General

Adaptation Syndrome (three stages: alarm/acute, resistance/adaptation, and exhaustion).

Negative affects production of protective factors (people get sick).

Mediators—stressors: physical and psychological. Perception, individual temperament.

Social support: groups, cultures, religion/spirituality.

Definition of crisis—sudden event that disturbs homeostasis. Usual coping mechanisms do not

work. Lasts 6-8 weeks, acute and limited timing.

Theory of crisis

Aguilera, Mesnick, Roberts—crisis theorists.

Types of crisis

1. Developmental/maturational—Follows Erickson’s stages, a developmental or growth

issues that brings physical, cognitive, sexual, and instinctual changes.

2. Situational—Unanticipated, extraordinary or external event. Threatens self-concept and

self-esteem. Ex: loss of job, death of loved one, unwanted pregnancy, loss of money, loss

of home, physical illness, mental illness.

3. Adventitious—Unexplained or accidental event. Natural disaster, national disaster, crime,

violence. Ex: flood, fire, terrorism, war, riots, abuse, 9/11, Orland club shooting, Boston

bombings, tornadoes in New Orleans. In adventitious crisis there may also be a critical

incident debriefing following the crisis incident.

Phases of crisis

1. Conflict/problem, self-concept is threatened, increasing anxiety. Person tries to

solve/address problem w/usual coping skills. Uses defense mechanisms as way

of coping. Problem may be resolved decreasing anxiety.

2. If defense mechanisms fail, threat persists, anxiety still increases, extreme

discomfort, disorganized, trial-and-error attempt to solve problem.

3. When trial-and-error fails. Anxiety is now panic. Automatic relief behaviors

mobilized (fight/flight). Resolution may be devised (compromise, redefine

situation).

4. Problem is unsolved still. Coping skills are not working and pt is still panicking,

can cause depression, violence against others, and suicidal behavior.

Use of the nursing process in crisis

Assessment—perception of event, coping skills, situational support. G.ather data, other

persons perception of event, other coping skills, your thoughts and feelings

Diagnosis—risk for injury to self or others. Impairment to solve problems. Ineffective

coping. Unable to use defense mechanisms, impaired communication.

Plan—6-8 weeks plan. Realistic, SAFETY, SAFETY, SAFETY from injury to others,

violence, homicide.

Implement

Primary—therapeutic relationship, creating external controls for protection. Use

effective communication skills, identify safety skills. Promote mental health to prevent future

crisis.

Secondary—prevention of prolonged anxiety, diminished effectiveness in

meeting needs, may need inpatient care if unsafe.

Tertiary—support for those who have had a severe crisis and now in disabled

state. Tx found in outpatient clinics, partial hospital, shelter, and rehab centers

Evaluate—patient has less anxiety in 6-8 weeks. Person can now function and has

balance again. Possible growth and change in persons life.

Assessment of physiological and psychological symptoms

Injury, anxiety, depression, suicide.

Definition of Levels of care: Least restrictive to most restrictive.

1. Psychiatric services: out-pt clinics

2. Case management

3. Crisis intervention

4. Crisis beds

5. Emergency services

--Least= primary care provider, specialist, partial hospital.

--Most=Inpatient care.

Examples of questions to expect: whether the question is a knowledge, analysis,

comprehension, or application

1. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and

venlafaxine, respectively. With which patient should the nurse be most alert for

problems associated with WBC decrease? The patient receiving:

Multiple choice

What medication will you decide on?

CLOZAPINE

Knowledge and application question

2. The nurse conducts an initial crisis intervention interview of a person. . The priority

assessment the nurse must make during this initial crisis intervention interview is:

Multiple choice

What assessment is a priority when first assessing a person in crisis?

Perception of precipitating event, situational supports and personal coping skills

Knowledge question

3. The patients below present to the emergency department. The psychiatric unit has

one bed available. Which patient would the nurse expect to be admitted? The

patient:

Multiple choice

Which patient will you expect to be admitted to a psychiatric inpatient unit?

The one that is trying to harm themselves, others, or cannot physically or mentally take

care of themselves.

Knowledge and application