ATI Chapter 1: Basic Mental Health Nursing Concepts

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 practices
-spiritual beliefs

Assessment: Mental Status Examination (MSE) – Level of consciousness
– Alert – pt is responsive and able to fully respond
– Lethargy – pt is able to open eyes but is drowsy
– Stupor – pt requires vigorous or painful stimuli; unable to respond verbally
– coma – no response can be achieved
– decorticated rigidity –> flexion and internal rotation of upper extremity joints and legs
– decerebrate rigidity –> neck and elbow extension, wrist and finger flexion

Assessment: Mental Status Examination (MSE) – Physical appearance
– personal hygiene, grooming, clothing choice; is client well kept, clean, and dressed appropriately

Assessment: Mental Status Examination (MSE) – behavior
– mood –> gives info about emotion and feeling
– affect –> objective expression of mood

Assessment: Mental Status Examination (MSE) – Cognitive and intellectual abilities
– assess orientation to time and place, memory recent and remote
– immediate –> ask client to repeat a series of numbers
– recent –> recall recent events
– remote –> fact from the past that is verifiable
– assess client level of knowledge, ability to calculate, ability to think abstractly,
-perform objective assessment of illness
– assess judgement based on a hypothetical question
– assess rate and volume of speech

Assessment: Standardized Screening Tools
– Mini-Mental State Exam
-Glasgow Coma Scale – baseline assessment of pts level of consciousness (highest value is 15, 7 or less =coma)

Considerations across the Lifespan: Children and Adolescents
Assessment – temperament, social and environmental factors, cultural and religious concerns and developmental level
Mentally healthy children should trust others, view the world as safe, interpret their environments, master developmental tasks, appropriate coping skills
Assess mood, anxiety, development, behavioral, eating disorders and risk for self-injury or suicide

Considerations across the Lifespan: The older adult – Assessment
Functional ability; economic and social status; environmental facts; physical assessment

Considerations across the Lifespan: The Older adult – standardized assessment tools
Geriatric depression scale
Michigan alcoholism screening test
Mini-Mental Status Exam
Pain Assessments

Considerations across the Lifespan: The older adult – conducting assessment
– private, quiet space with enough lighting
– make an intro, and determine pt’s name preference
– stand or sit at the client’s level to conduct the interview
– Use touch to communicate caring as appropriate
– Include questions about difficulty sleeping, incontinence falls or other injuries
-Include the family and significant others as appropriate
– obtain detailed medication history
– after interview summarize and ask for feedback from client

Therapeutic Strategies in the mental health setting: Counseling
Therapeutic communication skills; help with problem solving; stress management

Therapeutic Strategies in the mental health setting: Milieu therapy
helps pt build adaptive coping interact more effectively and strengthen relation skills;
orienting the client to the physical setting; identifying rules and boundaries of the setting; ensuring a safe environment for pt

Therapeutic Strategies in the mental health setting: Promotion of self-care activities
Offer assistance with self-care tasks; allow time for the client to complete self-care tasks; setting incentives to promote self-care

Therapeutic Strategies in the mental health setting: Psychobiological interventions
Give medications; providing teaching to the client/family about medications; monitoring for adverse effects and effectiveness

Therapeutic Strategies in the mental health setting: Cognitive and behavioral therapies
modeling; operant conditioning; systematic desensitization

Therapeutic Strategies in the mental health setting: Health teaching
teaching social and coping skills

Therapeutic Strategies in the mental health setting: Health promotion and health maintenance
assisting the client with cessation of smoking; monitoring other health conditions

Therapeutic Strategies in the mental health setting: case management
holistic care –> medical, mental health, social services

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