Mental Health Exam study Guide. 1
Phases of the Nurse-Patient Relationships
o Orientation Phase: first time the nurse & patient meet, interact according to their own
backgrounds/standards/values/beliefs, roles of the patient and nurse are clarified, confidentiality is
discussed and assumed, nurse becomes aware of transferences & countertransference issues, goals are
established, termination terms are introduced.
o Working Phase: exploration of feelings or situations that are causing the problems, re-experiencing of
old conflicts can awaken high levels of anxiety, intense emotional states may surface, defense
mechanisms, denying, manipulation, evaluation of problems and goals, promote alternative
reactions/behaviors to situations, etc. The nurse’s awareness of his or her own personal feelings and
reactions to the patient are VITAL for effective interaction with the patient.
o Termination Phase: summarization of goals, review of what was achieved during communication,
discussing new ways to implement new coping strategies, evokes strong feelings in both client & nurse.
Legal, Ethical, and Cultural
o Negligence –or malpractice is an act or an omission to act that breaches the duty of due care and results
in or is responsible for a person’s injuries. The five elements required to prove negligence are: (1) duty,
(2) breach of duty, (3) cause in fact, (4) proximate cause, and (5) damages.
Example – A nurse know that a patient’s IV is malfunctioning and the wires are frayed, but
decides not to act in a timely manner and leaves the IV on the patient and doesn’t tag it for
repair, this results in the patient dying.
o Beneficence - This relates to the quality of doing good and can be described as charity.
Example - A nurse helps a newly admitted client who has psychosis feel safe in the environment
of the mental health facility.
o Autonomy - This refers to the client’s right to make her own decisions. But the client must accept the
consequences of those decisions. The client must also respect the decisions of others.
Example - Rather than giving advice to a client who has difficulty making decisions, a nurse helps
the client explore all alternatives and arrive at a choice.
o Justice - This is defined as fair and equal treatment for all.
Example - During a treatment team meeting, a nurse leads a discussion regarding whether or
not two clients who broke the same facility rule were treated equally.
o Fidelity - This relates to loyalty and faithfulness to the client and to one’s duty.
Example - A client asks a nurse to be present when he talks to his mother for the first time in a
year. The nurse remains with the client during this interaction.
o Veracity - This refers to being honest when dealing with a client.
Example - A client states, “You and that other staff member were talking about me, weren’t
you?” The nurse truthfully replies, “We were discussing ways to help you relate to the other
clients in a more positive way.”
Rights for Voluntary and Involuntary Admission
o Voluntary Commitment – The client or client’s guardian chooses commitment to a mental health facility
in order to obtain treatment. A voluntarily committed client has the right to apply for release at any
time. This client is considered competent, and so has the right to refuse medication and treatment.
o Involuntary (civil) Commitment – The client enters the mental health facility against her will for an
indefinite period of time. The commitment is based on the client’s need for psychiatric treatment, the
risk of harm to self or others, or the inability to provide self-care. The need for commitment could be
, 1
determined by a judge of the court or by another agency. The number of physicians, which is usually
two, required to certify that the client’s condition requires commitment varies from state to state.
Clients admitted under involuntary commitment are still considered competent and have the right to
refuse treatment, unless they have gone through a legal competency hearing and have been judged
incompetent.
Informed Consent
o The principle of informed consent is based on a person’s right to self- determination, as enunciated in
the landmark case of Canterbury v. Spence (1972): True consent to what happens to one’s self is the
informed exercise of choice, and that entails an opportunity to evaluate knowledgeably the options
available and the risks attendant on each. Proper orders for specific therapies and treatments are
required and must be documented in the patient’s chart. Consent for surgery, electroconvulsive
treatment, or the use of experimental drugs or procedures must be obtained
Confidentiality/HIPAA
o Therefore, you may not, without the patient’s consent, disclose information obtained from the patient
or information in the medical record to anyone except those individuals for whom it is necessary for
implementation of the patient’s treatment plan.
Psychiatric Nursing Assessment – priority interventions, nursing dx, etc
Mood Disorders
Primary vs. Secondary Depression
o Primary Depression: due to family history, female gender, 40yrs +, post-partum, chronic illness, ETOH
abuse, stressful life events.
o Secondary Depression: Resultant from another mental health disorder or debilitating chronic illness.
Person is depressed BECAUSE of their decline in physical or mental functioning.
Borderline personality disorder - produces emotional lability and inconsistency in behavior.
* Nurse should be consistent with clients with a personality disorder
Nursing Diagnosis for Depression: *Risk for Suicide, Risk for Self-Mutilation, Ineffective Coping, Hopelessness,
Powerlessness, Social Isolation, Risk for Loneliness, Situational Low Self-Esteem.
First-line treatment for Depression:
o TCA’s are #1 (Amitriptyline, Imipramine, Doxepin).
o 2nd is SSRI/SNRI’s (citalopram, fluoxetine, sertraline, bupropion, Buspirone)
o Last option is MAOI (phenelzine, isocarboxazid)
EBP (evidence based practice) Using the best available research evidence, clinical expertise, & patient
preferences to make clinical decisions
The 5 A’s of integrating best evidence into clinical practices includes:
, 2
Asking
Acquiring
Appraising
Applying
Assessing
The mental health recovery model is one of helping people with psychiatric disabilities effectively manage their
symptoms, reduce psychosocial disability, and find a meaningful life in a community of their choosing.
3 specific areas are inherent within the art of nursing: caring, attending & patient advocacy.
Basic Brain Anatomy- what do the different part of brain control?
o Frontal Lobe: Thought Processes & Voluntary Movement (decision making)
o Temporal Lobe: Auditory Processes (language, speech, connects to Limbic system)
o Occipital Lobe: Vision (interprets visual images)
o Parietal Lobe: Sensory & Motor (L/R orientation, reading, math, proprioception)
o Hypothalamus: maintains homeostasis, regulates BP, Temp, libido, hunger, thirst, and sleep/wake
cycles.
o Cerebellum: Balance, Skeletal Muscle Coordination
o Neurons: Nerves that translate electrical impulses into chemical signals released at the synapse
Synapse- The space between neurons in which neurotransmitters are released and either
inhibit/excite the adjacent neuron. The 4 NT’s are dopamine, norepinephrine, serotonin and
acetylcholine.
Milieu Therapy: Creating a SAFE, structured inpatient/outpatient setting where the mentally ill can test new
behaviors and coping mechanisms with others.
o Climate is essential to healing: paint color, relaxed environments are conducive to the healing process.
o Florence Nightingale believed that the environment helps heal
Maslow’s Hierarchy of needs
o Basic Needs: food, oxygen, water, sleep, sex, and a constant body temperature. If all the needs were
deprived, this level would take priority.
o Safety Needs: Security, protection, freedom from fear/anxiety/chaos, and the need for law, order, and
limits.
o Belonging and Love Needs: intimate relationship, love, affection, and belonging, having a family and a
home and being part of identifiable groups.
o Esteem Needs: If self-esteem needs are met, we feel confident, valued, and valuable. When self-esteem
is compromised, we feel inferior, worthless, and helpless.
o Self-actualization: Reaching our full potential to feel inner peace and fulfillment.
Peplau’s Theory of Interpersonal Relations
o Created the Nurse-Patient Partnership increasing individual and family roles in recovery. (Based off of
Sullivan’s Interpersonal Theory). Relationships greatly influence recovery
Freud- contributed to psychiatric setting -Unconscious thoughts
o Id – unconscious mind, instincts (this is dominant)
o Ego – sense of self, use of defense mechanisms
o Superego – our conscious and is greatly influenced by our parents morals and ethical stances
Phases of the Nurse-Patient Relationships
o Orientation Phase: first time the nurse & patient meet, interact according to their own
backgrounds/standards/values/beliefs, roles of the patient and nurse are clarified, confidentiality is
discussed and assumed, nurse becomes aware of transferences & countertransference issues, goals are
established, termination terms are introduced.
o Working Phase: exploration of feelings or situations that are causing the problems, re-experiencing of
old conflicts can awaken high levels of anxiety, intense emotional states may surface, defense
mechanisms, denying, manipulation, evaluation of problems and goals, promote alternative
reactions/behaviors to situations, etc. The nurse’s awareness of his or her own personal feelings and
reactions to the patient are VITAL for effective interaction with the patient.
o Termination Phase: summarization of goals, review of what was achieved during communication,
discussing new ways to implement new coping strategies, evokes strong feelings in both client & nurse.
Legal, Ethical, and Cultural
o Negligence –or malpractice is an act or an omission to act that breaches the duty of due care and results
in or is responsible for a person’s injuries. The five elements required to prove negligence are: (1) duty,
(2) breach of duty, (3) cause in fact, (4) proximate cause, and (5) damages.
Example – A nurse know that a patient’s IV is malfunctioning and the wires are frayed, but
decides not to act in a timely manner and leaves the IV on the patient and doesn’t tag it for
repair, this results in the patient dying.
o Beneficence - This relates to the quality of doing good and can be described as charity.
Example - A nurse helps a newly admitted client who has psychosis feel safe in the environment
of the mental health facility.
o Autonomy - This refers to the client’s right to make her own decisions. But the client must accept the
consequences of those decisions. The client must also respect the decisions of others.
Example - Rather than giving advice to a client who has difficulty making decisions, a nurse helps
the client explore all alternatives and arrive at a choice.
o Justice - This is defined as fair and equal treatment for all.
Example - During a treatment team meeting, a nurse leads a discussion regarding whether or
not two clients who broke the same facility rule were treated equally.
o Fidelity - This relates to loyalty and faithfulness to the client and to one’s duty.
Example - A client asks a nurse to be present when he talks to his mother for the first time in a
year. The nurse remains with the client during this interaction.
o Veracity - This refers to being honest when dealing with a client.
Example - A client states, “You and that other staff member were talking about me, weren’t
you?” The nurse truthfully replies, “We were discussing ways to help you relate to the other
clients in a more positive way.”
Rights for Voluntary and Involuntary Admission
o Voluntary Commitment – The client or client’s guardian chooses commitment to a mental health facility
in order to obtain treatment. A voluntarily committed client has the right to apply for release at any
time. This client is considered competent, and so has the right to refuse medication and treatment.
o Involuntary (civil) Commitment – The client enters the mental health facility against her will for an
indefinite period of time. The commitment is based on the client’s need for psychiatric treatment, the
risk of harm to self or others, or the inability to provide self-care. The need for commitment could be
, 1
determined by a judge of the court or by another agency. The number of physicians, which is usually
two, required to certify that the client’s condition requires commitment varies from state to state.
Clients admitted under involuntary commitment are still considered competent and have the right to
refuse treatment, unless they have gone through a legal competency hearing and have been judged
incompetent.
Informed Consent
o The principle of informed consent is based on a person’s right to self- determination, as enunciated in
the landmark case of Canterbury v. Spence (1972): True consent to what happens to one’s self is the
informed exercise of choice, and that entails an opportunity to evaluate knowledgeably the options
available and the risks attendant on each. Proper orders for specific therapies and treatments are
required and must be documented in the patient’s chart. Consent for surgery, electroconvulsive
treatment, or the use of experimental drugs or procedures must be obtained
Confidentiality/HIPAA
o Therefore, you may not, without the patient’s consent, disclose information obtained from the patient
or information in the medical record to anyone except those individuals for whom it is necessary for
implementation of the patient’s treatment plan.
Psychiatric Nursing Assessment – priority interventions, nursing dx, etc
Mood Disorders
Primary vs. Secondary Depression
o Primary Depression: due to family history, female gender, 40yrs +, post-partum, chronic illness, ETOH
abuse, stressful life events.
o Secondary Depression: Resultant from another mental health disorder or debilitating chronic illness.
Person is depressed BECAUSE of their decline in physical or mental functioning.
Borderline personality disorder - produces emotional lability and inconsistency in behavior.
* Nurse should be consistent with clients with a personality disorder
Nursing Diagnosis for Depression: *Risk for Suicide, Risk for Self-Mutilation, Ineffective Coping, Hopelessness,
Powerlessness, Social Isolation, Risk for Loneliness, Situational Low Self-Esteem.
First-line treatment for Depression:
o TCA’s are #1 (Amitriptyline, Imipramine, Doxepin).
o 2nd is SSRI/SNRI’s (citalopram, fluoxetine, sertraline, bupropion, Buspirone)
o Last option is MAOI (phenelzine, isocarboxazid)
EBP (evidence based practice) Using the best available research evidence, clinical expertise, & patient
preferences to make clinical decisions
The 5 A’s of integrating best evidence into clinical practices includes:
, 2
Asking
Acquiring
Appraising
Applying
Assessing
The mental health recovery model is one of helping people with psychiatric disabilities effectively manage their
symptoms, reduce psychosocial disability, and find a meaningful life in a community of their choosing.
3 specific areas are inherent within the art of nursing: caring, attending & patient advocacy.
Basic Brain Anatomy- what do the different part of brain control?
o Frontal Lobe: Thought Processes & Voluntary Movement (decision making)
o Temporal Lobe: Auditory Processes (language, speech, connects to Limbic system)
o Occipital Lobe: Vision (interprets visual images)
o Parietal Lobe: Sensory & Motor (L/R orientation, reading, math, proprioception)
o Hypothalamus: maintains homeostasis, regulates BP, Temp, libido, hunger, thirst, and sleep/wake
cycles.
o Cerebellum: Balance, Skeletal Muscle Coordination
o Neurons: Nerves that translate electrical impulses into chemical signals released at the synapse
Synapse- The space between neurons in which neurotransmitters are released and either
inhibit/excite the adjacent neuron. The 4 NT’s are dopamine, norepinephrine, serotonin and
acetylcholine.
Milieu Therapy: Creating a SAFE, structured inpatient/outpatient setting where the mentally ill can test new
behaviors and coping mechanisms with others.
o Climate is essential to healing: paint color, relaxed environments are conducive to the healing process.
o Florence Nightingale believed that the environment helps heal
Maslow’s Hierarchy of needs
o Basic Needs: food, oxygen, water, sleep, sex, and a constant body temperature. If all the needs were
deprived, this level would take priority.
o Safety Needs: Security, protection, freedom from fear/anxiety/chaos, and the need for law, order, and
limits.
o Belonging and Love Needs: intimate relationship, love, affection, and belonging, having a family and a
home and being part of identifiable groups.
o Esteem Needs: If self-esteem needs are met, we feel confident, valued, and valuable. When self-esteem
is compromised, we feel inferior, worthless, and helpless.
o Self-actualization: Reaching our full potential to feel inner peace and fulfillment.
Peplau’s Theory of Interpersonal Relations
o Created the Nurse-Patient Partnership increasing individual and family roles in recovery. (Based off of
Sullivan’s Interpersonal Theory). Relationships greatly influence recovery
Freud- contributed to psychiatric setting -Unconscious thoughts
o Id – unconscious mind, instincts (this is dominant)
o Ego – sense of self, use of defense mechanisms
o Superego – our conscious and is greatly influenced by our parents morals and ethical stances
