Mental Health Exam 2 Review

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Mental Health Exam 2 Review How and when can you delegate care?

Therapeutic nurse-client relationship

- Do:

• Allow client to control the discussion
• Give recognition/validation
• Active listening
• Use open-ended question

- Example:

• Is there something you would like to talk about?
• Tell me more about that
• So you are saying you haven’t been sleeping well?
• Tell me about

- Dont:

• ask why

• ask too many questions
• give advice
• give false reassurance
• change the conversation topic
• give approval or disapproval
• use close-ended questions/statements

Examples:

• Don’t worry
• I think you should
• Dont be silly
• Thats great

Referrals to health care professionals - 12 step program, therapy, psychiatrist, case manager, home health, community mental health services, partial hospitalization Transference and countertransference Transference vs. countertransference (always negative no matter what)

• Transference → what happens when a patient feels a certain way

about a nurse. EX: The nurse reminds the pt of someone they don’t

like (the pt may treat the nurse unfairly)

• Countertransference → Feels that the nurse feels some type of way

to the patient? EX: The patient reminds the nurse of someone they

don't like (nurse may treat that pt unfairly) What can you do when a client refuses tx?-teach pt what will happen if they do not take med, why this med is being given,

Restraints:

Temporary release is required for basic needs but doesn't discontinue the restraint Give them a trail release and discontinue as soon as possible.-All means have been tried (last resort option) -redirection, meds, de-escalation, therapeutic communication, family being there (can't be a trigger), closer to nurse station/ room assignment change, -reinstate q 4hrs for adult -reinstate q 2hrs 9-17 years old -reinstate q1hr 8 & under

Nursing Care- check skin integrity, basic needs, ABC’s, Nutrition, COmfort, toileting, ROM, assess mood/ behavior change, check bony prominences, check q 15 min Children- Keep parents notified as to why this happened and current behavior of child

• kinds of restraints
• Chemical = benzos [lam/pam] and antipsychotics [haldol, ativan, geodon]
• Seclusion = restricting their movement
• Physical = violent patient

Cannot threaten pt with restraints (“If you don't do , we’ll have to put you in restraints”) Improving medication compliance Once daily dosage versus multiple. IM injections at the clinic. Someone handling it for them Reflective communication - helps assist the client with identifying emotions and ideas

Defense mechanisms- identifying and evaluating effective use of

Suicide Risk factors

• Single, never married
• Divorced men
• Females at greater risk
• Previous mental illness history
• Have accessibility (Firearm in home)
• Comorbidities (pt has two or more mental illnesses. Ex: depression and anxiety

disorder) Screening

• Ask pt if they have thoughts/ideas of harming self, or other suicidal ideations

Safety planning/precautions