MH Exam 1 Blueprint

Dosage/Calculation 2
Therapeutic Communication 7

- Interaction between health care team and client

- Goal oriented
- Better understanding through verbal / non verbal communication
- Strategies that encourage client to be open and expressive
o “ tell me about … ,
o go on …,
o id like to discuss what your thinking
o are you saying that
- Silence
- Active listening
- Open – Ended questions
- Clarifying techniques
o PERR- Paraphrasing, Exploring, Restating , Reflection
- Effective Comms
o Presenting reality ,
o Summarizing
o Offering self
o Touch
o Acknowledgement
o Focusing
o Asking Questions
o Giving Information
- Speech Patterns Common to Mental Illness
o Blocking
o Circumstantiality
o Echolalia
o Loose associations
o Flight of ideas
o Neologisms
o Verbigeration
 o

Therapeutic/Safe Environment 5

- Creating a supportive, therapeutic, and safe . : to learn tools necessary to cope adaptively ,
interact more effectively and appropriately , & strengthen relationship skills. Environment
should be conducive to the TRX.
 - A safe , secure and structured environment that promotes a therapeutic interaction
between clients and members of the professional health care team
- Milieu- clean , orderly, a place that promotes feelings of comfortability and safety.
- Color scheme appropriate for age +
- Remove all objects that could potentially cause self harm.
- Restriction on sexual activity
- Rapid de-escalation
- Activity room ( community meetings)
- Quiet areas for sleeping
- Good traffic flow
- Causes the client to feel safe from harm , cared for , and accepted by staff and others.
- Have rules : to enforce safety
- Space ( personal space awareness )

Therapeutic Relationships 7

- A bond where you help a client with personal growth and well being
- Collaborating with team members to provide a proper therapeutic relationship
- Essential Characteristics
o Empathy , caring, acceptance , mutual trust, honesty / integrity, consistency,
genuineness, self awareness, limit/ boundaries, reassurance, Explanations,
- Roles of the RN
o Consistently focus on the clients ideas , feelings, and experiences.
o Adjustment of pace to client needs
o Attentive listening
o Comfort level during relationship
o Self awareness of owns thoughts and feelings
o Consistent availability
- Boundaries in the relationships
o TRANSFERENCE – Patient sees one of the staff and it reminds them of someone
personal they might know
o COUNTERTRANSFERANCE – care taker sees something in the patient that reminds
them of someone they know/ had a significance in their life.
- Phases of the therapeutic relationship
o Pre- orientation
 Nurse admits pt.
 There can be anxiety on both parts
 Includes all the nurse thinks and does previous to the interaction
 Set aside all biases and opinions
o Orientations
 Nurse
 Introduction of self , set contract, discuss confidentiality, goal
setting, explore of issues and needs , explore the limits of testing
behaviors.
 Client
  Meet with RN, agree to contract , understands limits of
confidentiality, understands expectations, sets goals, explore own
thoughts , explore meaning of own behavior.
o Working phase
 Nurse – maintain relationship according to contract, data collection
ongoing, facilitation of needs via issues expressed, problem solving skills,
promote clients self- worth.
 Client – what are the problematic areas of their lives, reconsider usual
coping mechs, describes conflicts and various defenses , experience of
intense feelings , and learn to cope with anxiety reactions.
o Termination
 Nurse – provide opportunities to discuss loss / termination , discuss
previous experience with terminations / loss, what are the feelings of the
nurses therapeutic relationship , summarize goals / achievements , review
memories of sessions.
 Client – discuss thoughts and feelings of terminations, examine prev loss,
explore meaning of therapy , plans to continue behaviors of progressions ?,
make future plans, accept termination is final.

Mental Health Continuum 2

- On the ILLNESS END , the person is rarely in touch with reality, but on the HEALTHY SIDE ,
the person demonstrates a high level of wellness.
-

- Assessment of continuum of mental health – positive self concepts of MH, awareness ,

maintain satisfying relationships, adaptable , effective communicator , recognition and use
of support system.
- The point at which a person is to be deemed mentally ill is determined by :
o Behavior exhibited as well as the context the behavior is observed.
o Mental illness results in a inability to cope with overwhelming situations.
Voluntary vs. Involuntary Admission Team 2

Suicide 4

- Clients who commit suicide or intend to commit have not given a lot of thought about the
aftermath or ramification to those left behind
- Myths : - people who talk about suicide never commit it
- suicidal people only want to hurt self, not others
- there is no way to help someone who really wants to kill himself
- mentioning the word suicide will cause suicidal individual to commit suicide
- ignoring verbal threats/challenging person to carry out suicide plans will reduce
persons use of behaviors
- people who talk about suicide only wanting attention

Those at risk

o - untreated depression
- loss of employment
- financial difficulties
- prior suicide attempts
- change in functional ability
- alcohol/substance use
- loss of loved ones
- Males are more likely to follow through with the act of suicide
- Females more likely to attempt to commit
- Alaskan Native / American Indians = Highest prevalence
- RN management
o - verbal and nonverbal clues
+ are you thinking of committing suicide
- suicide comments are made to someone the client perceives as supportive
- assess potential suicide risk using screening tool
- comments can be overt or covert
 + there is just no reason for me to go on living (O)
+ everything is looking pretty grim for me (C)
- SAYING the word suicide can make a client more prone to committing : FALSE
- SAD PERSONS : suicide assessment scale

Coping Mechanisms 5

-
Antipsychotic medication 1--- RECOGNIZE THE NAMES

- Long acting

-
- Short Acting
-
Assignment/Delegation 2

- has to be a RN on suicidal checks q5s

- RNS can delegate LVN’s and AP’s
- AP’s – ADLS, intake / output checks, routine task.
o Cants – initial assess, … , …. , ….. , …… !
o 5 RIGHTS of delegation – right task, right person, right direction , right circumstance,
right environment

Legal/Ethical Principles 5

- Same civil rights as any other citizen

- Communication to all is open
- Provision of adequate interpretive services
- Least restrictive care unless is a threat to self or others
- Freedom from harm related to physical or pharm restraint, seclusion, and physical or mental
abuse
- Ethical principles
o Justice
o Fidelity
o Patient advocacy
o Veracity
o Beneficence
o Autonomy
- Commitment rights
o Under involuntary commitment – are still considered competent and have the right
to refuse treatment and meds , unless there is a court order from a judge ruling
patient to be incompetent.

Mental Status Exam

3
 -

- 1 . Level of consciousness
- 2. Physical Appearance
- 3. Behavior / Affect
- 4. Cognitive and Intellectual Abilities ( A/ O ?? )
o Check memory – remote and recent
 Recall – when a visitor came and who it was last week
 Immediate – repeat a series of numbers or a list of objects
 Remote – state a fact from their past that is verifiable
- Checking pt response and knowledge on current illness , abstract thinking, counting back
from 100 by sevens.
- Objective Data – judgement, logic processing ,speech and quality of language.
- Speech , articulation of words and how fast / slow or rate and volume.
- Clarity Techniques – PERR- paraphrase , exploring, reinstate, reflection
- Kubler 5 stages of grief : denial , anger, bargaining, depression, acceptance.

Community Based Mental Healthcare1

- Criteria to justify admission to an mental health care facility :

- clear risk of the client's danger to self or other
- inability to meet own basic needs
- failure to meet expected outcomes of community based treatments
- decline in mental health status of a client undergoing long term treatment
- having medical need in addition to mental illness

- Responsibilities of Rn in community Mental HC setting

 - - overall management of unit, client activities, and therapeutic milieu
- administration of all medications
- implementation of client treatment plans and teaching
- documentation
- managing crises as they arise

DEFINITION : A continuum of mental health agencies with varying treatment intensity levels to
allow clients to remain safe in the least restrictive environment possible.

- Primary : Promotes health and prevents mental health and prevents problems from
occurring
- Secondary : focuses on early detection of mental illnesses.
- Tertiary : rehab , prevention of further complications

Crisis 4

- Is an acute , time-limited ( usually lasting from 4 to 6 wks ) event during which a client
experiences an emotional response that cannot be manages with the clients normal coping
mechs.
o No pathological, but represents struggle for equilibrium / adaptation.
o Personal in nature , what a crisis is to one may not be one to another.
o Common characteristics include:
o 1. Experience of a sudden event with little or no time to prepare.
o 2. Perception of the event as overwhelming or life-threatening.
o 3. Loss or decrease in communication with significant others.
o 4. Sense of displacement from the familiar.
o 5. An actual or perceived loss
- Types of crises include:
o 1. Situational/external – often unanticipated loss or change experienced in
everyday, often unanticipated, life events.
o 2. Maturational/internal – achieving new developmental stages, which requires
learning additional coping mechanisms.
o 3. Adventitious – the occurrence of natural disasters, crimes, or national disasters.
- Risk Fx and protective Fx
o Accumulation of unresolved losses
o Current life stressors
o Concurrent mental and physical health issues
o Excessive fatigue or pain
o Age and developmental stage
o Support system
o Prior experience with stress/crisis
o Encourage relaxation techniques
o Support groups
o Plan follow up care
- SUICIDE RN management Care : Crisis
 o - does the client have a plan
- how lethal is the plan
- can the client describe the plan exactly
- does the client have access to intended method
- has the client's mood changed

Mental Health Exam 2 Blueprint

Dosage/Calc

Spiritual/Cultural Considerations

Schizophrenia/Psychosis

13

Abuse

Substance Abuse

11

Depressive Disorders

Bipolar Disorders

Mental Health Exam 3 Blueprint

Anxiety/GAD

16

Phobias

Conversion disorder

OCD

3
Somatization/Illness anxiety disorders

Factitious Disorder

Eating Disorders (Binge-eating, bulimia nervosa, stxia nervosa)

12

Body dysmorphic disorder

Sexuality/Gender dysphoria

Paraphilias

DID

Depersonalization

Mental Health Final Exam Blueprint

Mental Status Exam-2

Involuntary admission vs voluntary admission-1

Legal/ethical issues -5

Therapeutic communication/responses-6

Nurse/patient therapeutic relationship-3

Coping mechanisms-1

Levels of anxiety-1

Community-based mental health-4

Aversion therapy-1

Systematic desensitization-1

OCD-1
Panic disorder-1

GAD-2

Body dysmorphic disorder-1

PTSD-1

Acute stress disorder-1

Derealization-1

Depersonalization-1

Dissociative fugue-1

MDD-3

PMDD-1

Persistent depressive disorder-1

ECT-1

Bipolar disorder-2

Substance induced psychotic disorder-1d

Schizophrenia-3

Schizoaffective disorder-1

Personality disorder characteristics-2

Avoidant PD-1

Borderline PD-1

Antisocial PD-1

Denepezil-1

Dementia-3

Delirium-1

Substance abuse in older adults-1

Disulfiram-1

Alcohol withdrawal-1

Benzodiazepine withdrawal-1

Benzodiazepine overdose-1

Anorexia nervosa-2
Fluoxetine-1

Amitryptyline-1

Bupropion-1

Carbamezepine-1

Valproate-1

Clonidine-1

Nicotine gum-1

Stages of grief (Kubler-Ross)-2

Lithium-1

ADHD-1

Autism spectrum disorder-1

Maturational crisis-1

Suicide assessment/precautions-3

Communication/interaction with aggressive clients-4

First generation antipsychotics-1

EPS symptoms-1

Sexual assault-1

Dosage/calculation-9

Bulimia nervosa-1

Conversion disorder-1

Factitious disorder-1