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22 Cards in this Set
- Front
- Back
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what is voluntary hospitalization? |
voluntary hospitalization is when a patient chooses to admit themselves into a mental institution. a patient who is voluntary hospitalized must: be 16 years or older. agrees and accepts treatment sign the voluntary admissions form show some insight to current illness or problem (meaning patient must know they have a problem and what is it) |
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what can a patient who voluntarily admitted themselves into a mental institution do to leave when he/she feels the treatment is no longer needed? |
the patient can sign a 72 hour notice, meaning that the patient can leave after 72 hours from the moment he/she signed the form. if the doctor sees it that the patient will not cause harm to themselves or others then the doctor can order for the patient to be discharged. however the doctor can also CHANGE the admissions from voluntary to involuntary if he/she feel that the patient can hurt themselves or others. |
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what is involuntary hospitalization? |
this is when a patient is forced against his/her will to be admitted, thus the patient does NOT GIVE CONSENT to be admitted. this can happen if the patient does not recognize that he/she is in need of treatment i.e. if pt is manic, delusional, has halluciations) 2 physicians or a physician and a pyschologists can sign for patient to be involuntary hospitalized BUT MUST EVALUATE THE PATIENT 24 AFTER HOSPITALIZATION. THERE MUST BE AN INVOLUNTARY HEARING WITHIN 10 DAYS AFTER HOSPITALIZATION TO DETERMINE IF PATIENT HAS MET THE CRITERIA TO BE HOSPITALIZED INVOLUNTARY. |
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what is the criteria for involuntary hospitalization? |
patient must have a mental disorder and is in need of inpatient treatment. patient is a danger to themselves and others. patient is unwilling to be admitted voluntarily. patient can't be treated at a less restrictive means. |
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what are the components of the mental status exam (MSE)? |
the mental status exam is used to evaluate a patient's CURRENT emotional and cognitive functioning. it consist of: appearance speech motor activity attitude/behavior toward the examiner mood affect perception thought content thought process level of consciousness cognitive functioning |
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what is being assessed in a patient's appearance? |
age: does the patient look his/her age? do they look older or younger? body build: how is the patient built? (thin, muscular, obese, cachetic/anorexic) race gender hygiene/grooming: is the patient well-groomed or dirty? does the patient smell unpleasant, highly performed? dress: is the patient dressed appropriately for the occasion and season? position: sitting, lying, standing etc? posture: rigid, threatening? gait: how do they walk? eye contact: do they look you in the eye or not? state of health and nutrition: are they well-nourished or not. |
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what is being assessed in a patient's speech? |
rate of speech: how fast or slow are they talking? volume: how high or low are they speaking? amount: how much are they saying? poverty speech (saying minimal words - 1 or 2), pressured speech (talking rapidly and continuously can't interrupt or mute) characteristics: how do they speak? slurring, stuttering, latent speech (talking after long pauses) |
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what is being assessed in a patient's motor activity? |
speed of movement: how fast or slow does the patient move. ex: purposeless movement - pacing around the room psychomotor retardation - slowed movement psychomotor agitation - fast movement types of movements: tics, tremors odd gestures: fixed posture (they stay in one posture for a time), compulsive behaviors |
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what is being assessed in a patient's attitude/behavior towards the examiner?
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how does the patient treat the examiner? was the patient cooperative or not? hostile or friendly? pleasant, irritable, seductive, guarded or suspicious etc. |
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what is being assessed in a patient's mood?
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a patient's mood is their emotional state. this is assessed by asking HOW ARE YOU FEELING TODAY OR MOST DAYS?
asking the patient to rate their mood on a scale from 0-10. (does their rate reflect what's observed?) is the mood appropriate to the situation? Example: *pt's mother dies* nurse: how do you feel about your mother's death? patient: I feel fabulous never better. |
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what is being assessed in a patient's affect?
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affect: is the patient's emotional tone displayed by the patient i.e. facial expression. full range/board/appropriate affect - normal meaning variations of emotions. labile - rapid emotional shifts. constricted - limited variability of emotions flat - absence of emotional expression, voice meaning monotone, face immobile. |
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what is being assessed in a patient's perception?
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perception: is what the patient is sensing (taste, hear, see, feel) and how they interpret it. hallucinations: are false sensory impressions (they are not real but the patient is perceiving them nonetheless) Example: auditory hallucinations HENCE ASKING THE PATIENT DO YOU HEAR/SEE THINGS OTHERS DO NOT? DOES WHAT YOU HEAR/SEE COMMAND YOU TO DO THINGS? illusion: a wrong perception (interpretation) of a REAL physical external stimuli. Example: seeing a electric cord but mistaking it for a snake. ASK QUESTIONS LIKE DOES WHAT YOU HEAR TELL YOU TO DO THINGS? OBSERVE IF PATIENT IS TALKING TO THEMSELVES OR HAVING A THOUGH BLOCK - SIGNS OF HALLUCINATING. |
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what is thought content? what are examples of though content? |
thought content: is what the patient thinks about. the thoughts can be disturbed i.e. suicidal or homicidal thoughts. Examples: delusion: strong beliefs in things that other people would consider false. though broadcasting: the belief that other people can hear your thoughts. thought insertion: pts belief that people or forces are placing thoughts into their heads. ideas of reference: pt. believes that external events i.e. TV, radio have a significant message for them. |
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what are types of delusions? |
grandiose delusions: pts believe to have super powers or unusual talents. ex. pt. believes to be Jesus. paranoid delusions: pts believe people are against them and desire to hurt or kill them. ex. pt believes the FBI is against them and wants to kill them, so he attacks anyone who looks like they could be an FBI agent. somatic delusions: false beliefs involving the body. ex pt. believes their brain is rotting erotic delusions: pt. believes someone of a higher social class is in love with them. ex. pt. believes Chris Brown loves them and expresses his love through his music. |
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how do you assess thought content? |
asking questions such as: do you have any special power or abilities? (grandiose delusion) do you feel people want to harm you? (paranoid delusion) do you feel someone is trying to influence? (thought insertion) are you bothered by thoughts that disturb you? |
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what is thought process? how is it observed? |
thought process: the movement and connect of thoughts. thought process is observed through SPEECH!!! THE PATTERN OF THE SPEECH ex. pt stated I want to bath, do homework, and take a walk around the building. what he/she said shows that he/she has been thinking. |
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how do you describe thought process? |
since thought process is observed through speech to describe the thought process is to describe what the patient is saying:
logical - it makes sense. goal directed - thoughts are on a target. rambling - thoughts are unrelated to the topic at hand. flight of ideas - going from one topic to another. though blocking - stream of processing seems to stop quickly, often in the middle of a sentence. THIS IS SEEN IN PTS WITH COMMAND HALLUCINATIONS, THEY STOP TALKING TO LISTEN TO THE VOICES IN THEIR HEAD. word salad - their words are random. Ex. Nurse: how are you today? Pt: the sheep languished blue trains suffer. clang association - pt is rhyming their words racing - talking very fast expressing rapid thoughts. neologism - making up new words.
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what is judgment and insight mean? |
judgment: the ability to make sound decisions. does the pt understand the consequences of his/her actions? insight: does the pt understand that he/she has a problem? |
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what does the level of consciousness mean? |
level of consciousness: is the overall state of arousal,readiness, preparedness to respond to environment and orientation to person, place, and time. lethargic, drowsiness, alert = overall state of arousal orientation = what is your name?, what day is it?, where are you? |
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what is the difference between mental status exam (MSE) and the mini mental status exam (MMSE)? |
mental status exam assess the pt's overall functioning as a whole. mini mental status exam assess only pt's cognitive functioning |
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what does cognitive functioning mean? what does the cognitive functioning test consist of? |
cognitive functioning: is the assessment of mental status focused on thinking, learning,knowing, and judging. thus the ability to organize, process, and recall information. Components: memory abstract thinking information and intelligence |
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how do you assess memory? how do you assess abstract thinking? how do you assess information and intelligence? |
memory is assessed by: remote - past events (ask the pt questions about past history - beware of confabulation) recent - memory over the past week immediate - memory over a second or minute (give patient 3 words to recall and then ask about it later) abstract thinking - test of higher cortical functioning and reasoning. information and intelligence - assess patient's ability to count, calculate - simple addition and substraction. |
