Nursing Path

CARING is the essence of NURSING. -Jean Watson

Nursing Path

Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee

Nursing Path

Treat the patient as a whole, not just the hole in the patient.

Nursing Path

Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill

Nursing Path

A problem is a chance for you to do your best. -Duke Ellington

Psychiatric Mental Health Assessment

Definition
  • Accuracy in assessment determines whether the following steps of the nursing process will produce accurate nursing diagnoses, palnning, and intervention.
  • Psychiatric-mental health assessment is the gathering, organizing, and documenting of data about the psychiatric and mental health needs of the client and family.
Assessment
  • The first step of the nursing process.
Interview
  • The degree to which the interview is therapeutic, or helpful, to the client may determine the extent and honesty of the information shared by the client.
  • Clients expect the interviewer to be an expert who is confident in the professional role, maintains confidentiality, demonstrates warmth and genuineness, is nonjudgmental toward them and their past or current behavior, and recognizes that clients are experts on themselves and their behavior.
Assessment Data
  1. Subjective
    • Client’s current problem and reason for seeking help.
    • Past mental illness and treatment
    • Family history and mental illness
    • Medical history
    • Allergies to medications, foods, and other substances
    • Past and present medications and their effects
    • Past and present abuse
    • Substance abuse history
    • Educational and/or vocational history
    • Health habits
    • Safety issues
    • Cultural beliefs and practices
  2. Objective
    • Behavior
    • Communication
    • Physical assessment
    • Laboratory or testing data
    • Mental status
Appearance
  • Hygiene, grooming, appropriateness of clothing, posture, and gestures.
Behavior
  • Eye contact, motor behavior, body language, behavioral responses to others and environment, volume and speed of speech, tone of voice, flow of words.
Affect and Mood
  • Happy, sad, anxious, sullen, hostile, inappropriate for situation, silly, and range of emotions.
Orientation
  • To person, place, time, situation, relationship with others.
Memory
  • Immediate recall, recent and remote memory.
Sensorium or Attention
  • Ability to concentrate on a task or conversation, perception of stimuli.
Intellectual functioning
  • General fund of knowledge about the world, cognitive abilities such as a simple arithmetic.
  • Ability to think abstractly or symbolically.
Judgement
  • Decision making ability, especially regarding delay of gratification.
Insight
  • Awareness of one’s responsibility for and analysis of current problem, understanding of how client arrived in current situation.
Thought Content
  • Recurrent topics of conversation, themes.
Thought process
  • Processing of events in the situation, awareness of one’s thoughts, logic of thought.
Perception
  • Awareness of reality vs. fantasy, hallucinations, delusions, illusions, suicidal or homicidal ideation or plans.

Phobias

Definition
image credit to: metro.co.uk
  • A phobia is an anxiety disorder characterized by obsessive, irrational, and intense fear of a specific object an activity, or a physical situation.
  • The fear, which is out of proportion to reality, usually results from early painful or unpleasant experiences involving a particular object or situation.
  • A phobia may arise from displacing an unconscious conflict on an object that is symbolically related.
image credit to: metro.co.uk

Types of Phobias
  1. Agoraphobia
    • Fear of being in places or situations from which escape may be difficult or help may not be readily available.
  2. Social Phobia
    • Also called Social Anxiety Disorder
    • Characterized by persistent fear of appearing shameful, stupid or inept in the presence of others.
  3. Specific Phobia
    • Also called Simple Phobia
    • A persistent fear of a specific object or situation, other than of two phobias mentioned above.
    • Sub-categories:
      1. Injury-blood-injection
      2. Situational
      3. Natural environment
      4. Animals
      5. Other (fear of costumed character, space, etc)
Risk Factors
  1. Learning theory
    • The belief that phobias are learned and become conditioned responses when the client needs to escape an uncomfortable situation.
  2. Cognitive theory
    • Phobias are produced by anxiety-inducing self-instructions of faulty cognitions.
  3. Life experiences
    • Certain life experiences, such as traumatic events, may set the sage for phobias later in life.
Signs and Symptoms
  1. Withdrawal
  2. High levels of anxiety
  3. Inability to function and meet self-care needs
  4. Inappropriate behavior used to avoid the feared situation, object or activity
  5. Dysfunctional social interactions and relationships
Nursing Diagnoses
  1. Anxiety
  2. Powerless
  3. Ineffective individual coping
  4. Impaired verbal communication
  5. Altered thought processes
  6. Self-esteem disturbance
  7. Impaired social interaction
  8. Risk for injury
Therapeutic Nursing Management
  1. Systematic desensitization
    • This process of gradual exposure to phobic object or situation aimed at decreasing the fear and increasing the ability to function in the presence of phobic stimulus.