ATI Mental Health Chapter 1 Basic Mental Health Nursing Concepts

PSYCHOSOCIAL HISTORY
– CULTURAL BELIEFS AND PRACTICES
– SPIRITUAL AND RELIGIOUS BELIEFS

CULTURAL BELIEFS AND PRACTICES
– to be assessed in order to plan care around the clients beliefs and practices

SPIRITUAL AND RELIGIOUS BELIEFS
SPIRITUALITY
– refers to a client’s internal values, sense of morality, and how he views the purpose of life.
RELIGION
– refers to a client’s beliefs according to an organized set of patterns of worship and rituals

This affects the way in which a client finds meaning, hope, purpose , and a sense of peace.

MENTAL STATUS EXAMINATION (MSE)
– LEVEL OF CONSCIOUSNESS
– PHYSICAL APPEARANCE
– BEHAVIOR
– COGNITIVE AND INTELLECTUAL ABILITIES

LEVEL OF CONSCIOUSNESS
ALERT
– responsive and able to fully respond by opening her eyes and attending to a normal tone of voice and speech.
– answers spontaneously and appropriately
LETHARGIC
– open her eyes and respond BUT drowsy and falls asleep readily
STUPOROUS
– vigorous or painful stimuli to elicit a brief response
ex.) pinching a tendon or rubbing sternum
– might not be able to respond verbally
COMATOSE
– unconscious and does not respond to painful stimuli
DECORTICATE RIGIDITY
– flexion and internal rotation of upper-extremity
joints and legs
DECEREBRATE RIGIDITY
– neck and elbow extension, wrist and finger
flexion

PHYSICAL APPEARANCE
– personal hygiene
– grooming
– clothing choice
EXPECTED FINDINGS:
– well-kempt
– clean
– dressed appropriately for the given environment

BEHAVIOR
assessment of voluntary and involuntary body movements, and eye contact
MOOD:
– information about the emotion that she is feeling
AFFECT:
– objective expression of mood, such as:
– FLAT AFFECT
– LACK OF FACIAL EXPRESSION

COGNITIVE AND INTELLECTUAL ABILITIES
– orientation to time, person, and place.
– memory both recent and remote
IMMEDIATE:
– ask client to repeat
– a series of numbers
– a list of objects
RECENT:
– ask client to recall recent events
– visitors from the current day
– purpose of mental health appointment or
admission
REMOTE:
– ask client to state a VERIFIABLE fact from his past
– DOB
– Mother’s maiden name

CLIENT’S LEVEL OF KNOWLEDGE
– what he knows about his current illness or hospitalization
CLIENT’S ABILITY TO CALCULATE
– if he can count backward from 100 in serials of 7
CLIENTS ABILTY TO THINK ABSTRACTLY
– if he can interpret a cliché
– the ability to interpret a higher level of thought process
PERFORM AN OBJECTIVE ASSESSMENT OF THE CLIENT’S PERCEPTION OF HIS ILLNESS

CLIENT’S JUDGEMENT BASED ON HIS ANSWER TO A HYPOTHETICAL QUESTION

CLIENT’S RATE AND VOLUME OF SPEECH, AS WELL AS THE QUALITY OF HIS LANGUAGE

STANDARDIZED SCREENING TOOLS
– MINI-MENTAL STATE EXAMINATION
– GLASGOW COMA SCALE

MINI-MENTAL STATE EXAMINATION (MSE)
ASSESSMENT A CLIENT’S COGNITIVE STATUS
– ORIENTATION to time and place
– ATTENTION SPAN and ability to calculate by counting backward by seven
– REGISTRATION and recalling of objects
– LANGUAGE
– naming of objects
– following of commands
– ability to write

GLASGOW COMA SCALE
– used to obtain baseline assessment
– eye, verbal, and motor response is evaluated and a number value based on the response is assigned
– highest value possible is 15
– indicated that the client is awake and
responding appropriately
– a score of 7 or less
– indicate a client is in a coma

LIFESPAN CONSIDERATIONS
– CHILDREN AND ADOLESCENTS
– OLDER ADULTS

CHILDREN AND ADOLESCENTS

OLDER ADULTS

MENTAL HEALTH DIAGNOSES
SERIOUS MENTAL ILLNESS

ROLE AND LIFE CHANGES

THERAPEUTIC STRATEGIES IN THE MENATL HEALTH SETTING
– COUNSELING
– MILIEU THERAPY
– PROMOTION OF SELF-CARE ACTIVITIES
– PSYCHOBIOLOGICAL INTERVENTION
– COGNITIVE AND BEHAVIORAL THERAPIES
– HEALTH TEACHING
– HEALTH PROMOTION AND HEALTH MAINTENANCE
– CASE MANAGEMENT

COUNSELING
– using therapeutic communication skills
– assisting with problem solving
– crisis intervention
– stress management

MILIEU THERAPY
– orienting the client to the physical setting
– identifying rules and boundaries of the setting
– ensuring a safe environment for the client
– assisting the client to participate in appropriate activities

PROMOTION OF SELF-CARE ACTIVITIES
– offering assistance with self-care tasks
– allowing time for the client to complete self-care tasks
– setting incentive to promote client self-care

PSYCHOBIOLOGICAL INTERVENTIONS
– administering prescribed medication
-providing teaching to the client/family about medications
– monitoring for adverse effects and effectiveness of pharmacological therapy

COGNITIVE AND BEHAVIORAL THERAPIES
– modeling
– operant conditioning
– systematic desensitization

HEALTH TEACHING
– teaching social and coping skills

HEALTH PROMOTION AND HEALTH MAINTENANCE
– assisting the client with cessation of smoking
– monitoring other health condition

CASE MANAGEMENT
– coordinating holistic care to include:
– medical
– mental health
– social services

Assessment: Psychosocial History – perception of own health beliefs about illness and wellness – activity/leisure activities, how a pt passes time – substance use or disorder – stress level and coping abilities (coping strategies, support systems) – cultural beliefs and …

Alert The client is responsive and able to fully respond by opening her eyes and attending to a normal tone of voice and speech. Answers questions spontaneously and appropriately. Lethargy The client is able to open her eyes and respond …

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Healthcare is changing at a rapid pace. Movement toward evidence-based practice has evolved more in this last decade. However, mental health treatment has limited studies on evidence-based practices and guidelines compared to other specialty areas in the healthcare setting. As …

What do you assess for during a Mental Status Exam (MSE)? 1. level of consciousness 2. physical appearance 3. behavior 4. cognitive and intellectual abilities alert able to fully respond by opening eyes, attend to normal tone of voice and …

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