ATI
Mental
Health
Basics
, ATI
ATI Mental Health Basics
• Levels of Consciousness (alphabetic until C)
o Alert : patient is responsive, opening eyes spontaneously, respond to question
appropriately
o Lethargic: falls asleep easily, opens eyes, responsive
o Obtunded: respond to light shaking, confused, slow to respond
o Stuporous: patient barely responds to painful stimuli (ex: rubbing sternum)
o Comatose: unresponsive and abnormal posturing may be present
▪ 1 . decorticate: arms are flexed and internally rotated towards core, legs
extends and internally rotated
▪ 2. Decerebrate: both arms and legs extended, head arched back
• Nursing Ethics
o Autonomy: patient has right to make own decision, even if it’s not in their best
interest
o Beneficence: doing what is best for patient
o Fidelity: loyal, keeping promises
o Justice: provide fairness in care and allocation in resources across patients
o Non-maleficence: doing no harm
o Veracity: telling the truth, being honest
• Patient rights
o Right to refuse treatment – applies to patients who are involuntary admitted
o Confidentiality: patients medical information is protected by HIPPA and cannot
be released unless permission given
o Mandatory reporting: nurses are required to report suspicion of abuse, and to
warn/protect third parties who are at risk for harm.
• Informed Consent:
o Provider Responsibilities:
▪ Communicates purpose of procedure, and complete description of
procedure in the patient’s primary language
▪ Explain risks vs. benefits
▪ Describe other options to treat condition
o RN
▪ Make sure provider gave the patient the above information
▪ Ensure the patient is competent to give informed consent (i.e. patient is
an adult or emancipated minor, not impaired)
▪ Have patient sign consent document
▪ Notify provider if patient has more questions or doesn’t understand any
information
• Restraints:
o Always have alternatives before restraints.
o Can do restraint in emergency BUT need written prescription from provider
quickly after (1hr)
1
, ATI
o Provider will need to re-write prescription every 24 hours, no PRN prescription
o Best Practice:
▪ Wrist – two fingers
▪ Quick release knot (slip knot, NOT SQURE)
▪ Use a movable part of the bed frame so if you move the bed the
restraints move with them
o Types of restraints: physical (vest, belt, mitten) or chemical (sedative or
antipsychotic medication)
o Alternatives: provide verbal interventions, diversions, calm/quiet environment
o Prescription:
▪ Prescription must be in writing
▪ If need for constraints continue, provider must re-write prescription every
24 hours
▪ In an emergency situation, a nurse can use restraints but must obtain a
written prescription per facility policy (15-30 minutes)
o Time limits:
▪ Adults: 4 hours
▪ 9-17: 2 hours
▪ <8: 1 hour
o Documentation:
▪ Complete every 15 -30 minutes
• Include: precipitating event, alternative interventions attempted,
time treatment began, medication administered, patient
assessment (current behavior, VS<, pain), patient are provided
(food, toileting)
o DC: restraints can be discontinued when patient can follow the nurses’ direction
• Torts
o Unintentional Torts
▪ Negligence: forgetting to set bed alarm for a patient at risk for falls
▪ Malpractice: medication error that harms patient
o Intentional torts:
▪ Assault: nurse threatens patient
▪ Battery: nurse hits patients or administer medication against patients will
▪ False imprisonment: nurse inappropriately restrains a patient or
administers a chemical restraint such as a sedative
• Communication
o Intrapersonal communication: “self-talk”, thinking thoughts, but not verbalizing
them
o Interpersonal communication: one-on-one communication with another person
o Open-ended questions: promotes interactive discussions
o Closed-ended questions: used to obtain, specific data. Use sparingly as it can
block further communication.
• Communication techniques
2
Mental
Health
Basics
, ATI
ATI Mental Health Basics
• Levels of Consciousness (alphabetic until C)
o Alert : patient is responsive, opening eyes spontaneously, respond to question
appropriately
o Lethargic: falls asleep easily, opens eyes, responsive
o Obtunded: respond to light shaking, confused, slow to respond
o Stuporous: patient barely responds to painful stimuli (ex: rubbing sternum)
o Comatose: unresponsive and abnormal posturing may be present
▪ 1 . decorticate: arms are flexed and internally rotated towards core, legs
extends and internally rotated
▪ 2. Decerebrate: both arms and legs extended, head arched back
• Nursing Ethics
o Autonomy: patient has right to make own decision, even if it’s not in their best
interest
o Beneficence: doing what is best for patient
o Fidelity: loyal, keeping promises
o Justice: provide fairness in care and allocation in resources across patients
o Non-maleficence: doing no harm
o Veracity: telling the truth, being honest
• Patient rights
o Right to refuse treatment – applies to patients who are involuntary admitted
o Confidentiality: patients medical information is protected by HIPPA and cannot
be released unless permission given
o Mandatory reporting: nurses are required to report suspicion of abuse, and to
warn/protect third parties who are at risk for harm.
• Informed Consent:
o Provider Responsibilities:
▪ Communicates purpose of procedure, and complete description of
procedure in the patient’s primary language
▪ Explain risks vs. benefits
▪ Describe other options to treat condition
o RN
▪ Make sure provider gave the patient the above information
▪ Ensure the patient is competent to give informed consent (i.e. patient is
an adult or emancipated minor, not impaired)
▪ Have patient sign consent document
▪ Notify provider if patient has more questions or doesn’t understand any
information
• Restraints:
o Always have alternatives before restraints.
o Can do restraint in emergency BUT need written prescription from provider
quickly after (1hr)
1
, ATI
o Provider will need to re-write prescription every 24 hours, no PRN prescription
o Best Practice:
▪ Wrist – two fingers
▪ Quick release knot (slip knot, NOT SQURE)
▪ Use a movable part of the bed frame so if you move the bed the
restraints move with them
o Types of restraints: physical (vest, belt, mitten) or chemical (sedative or
antipsychotic medication)
o Alternatives: provide verbal interventions, diversions, calm/quiet environment
o Prescription:
▪ Prescription must be in writing
▪ If need for constraints continue, provider must re-write prescription every
24 hours
▪ In an emergency situation, a nurse can use restraints but must obtain a
written prescription per facility policy (15-30 minutes)
o Time limits:
▪ Adults: 4 hours
▪ 9-17: 2 hours
▪ <8: 1 hour
o Documentation:
▪ Complete every 15 -30 minutes
• Include: precipitating event, alternative interventions attempted,
time treatment began, medication administered, patient
assessment (current behavior, VS<, pain), patient are provided
(food, toileting)
o DC: restraints can be discontinued when patient can follow the nurses’ direction
• Torts
o Unintentional Torts
▪ Negligence: forgetting to set bed alarm for a patient at risk for falls
▪ Malpractice: medication error that harms patient
o Intentional torts:
▪ Assault: nurse threatens patient
▪ Battery: nurse hits patients or administer medication against patients will
▪ False imprisonment: nurse inappropriately restrains a patient or
administers a chemical restraint such as a sedative
• Communication
o Intrapersonal communication: “self-talk”, thinking thoughts, but not verbalizing
them
o Interpersonal communication: one-on-one communication with another person
o Open-ended questions: promotes interactive discussions
o Closed-ended questions: used to obtain, specific data. Use sparingly as it can
block further communication.
• Communication techniques
2
