Bakersfield College NURS B25 2021 ATIMental Health Review Guide
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Course
ATI Mental Health (NURSB25)
Institution
Bakersfield College
Bakersfield CollegeNURS BATIMentalHealthReviewGuide
ATI Mental Health
LOC
Alert: responsive, answer questions appropriately, opens eyes spontaneously.
Lethargic: open their eyes, can answer questions but easily falls asleep.
Stupor: barely responds to painful stimuli (like rubbing ...
opens eyes spontaneously lethargic open their eyes
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ATI Mental Health (NURSB25)
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ATI Mental Health
LOC
Alert: responsive, answer questions appropriately, opens eyes spontaneously.
Lethargic: open their eyes, can answer questions but easily falls asleep.
Stupor: barely responds to painful stimuli (like rubbing the patients’ sternum)
Comatose: unconscious/does not respond to painful stimuli
Decorticate: flexion/ internal rotation of upper extremities, joints and legs
Decerebrate: neck/elbows extension, wrist and finger flexion
Torts: unintentional torts- negligence: forgetting to set the bed alarm for a patient who is at risk for
falling and falls out of bed.
Malpractice- giving the wrong medication to the patient, error that harms the patient.
Intentional torts:
Assault vs Battery:
Assault is if you threaten someone, “If you do not take this pill, I will smack you.”
Battery: when you actually hurt someone, “You actually act by smacking the patient.”
False imprisonment: Nurse will purposely restrain the patient or give them a chemical to a pt.
for the nurse convenience, instead of doing alternatives techniques.
Six Ethical Principles
Beneficence – Doing good by the patient, what is best for the patient. Making the patient feel
safe in the environment that their in.
Autonomy- respecting their rights by what they decide for their health care. Clients making
decisions but the patient must accept consequences of those decisions.
*Veracity- truthfulness “Being honest with the patient’s treatment”
Justice- fair/equal rights for everyone.
*Fidelity- being loyal to the patient, keeping promises.
Non-maleficence: Doing No Harm
Legal Rights of the patients in Mental Health
Pt has the right to refuse treatment even if they’re in a mental health facility.
Pts confidentiality: HIPPA: cannot be released without the consent of the patient
If someone calls the unit asking about the patient refer them to contact the patient’s
family regarding the patient well being
Over hear a conversation in a public place: tell them to go have the conversation in a
private setting.
Mandated that abuse is reported, with a child or an older adult.
Our duty to warn third parties if they’re at risk for harm.
,Informed Consent: Provider:
Communicate the purpose of the procedure
Give a clear description of the procedure in the patient primary language.
Explain the risks vs the benefits
Other options in treating the condition
RN Role:
make sure the provider gives this information to the patient.
Pt is competent in receiving the information, they must be an adult or an emancipated
child, THERE CAN BE NO IMPAIRMENTS!
If they do not understand the information then we do not answer the questions, have
the provider answer the questions.
Restraints:
Physical- vest, belt, and mittens. LAST RESORT
Chemical- sedative/antipsychotic medications
Alternatives before restraints: verbal interventions, calm/quiet environment, diversions.
Prescriptions must be written
Write an order for restraints to be placed on patient. If the orders need to be renewed it has to
be renewed within 24 hours.
Care for the Patient:
Assessing the patient vital signs q 15 mins
Offer them food and fluid- Every hour
Make sure they get the chance to toilet- Every hour
Monitor vital signs.
Emergency Restraints Placed:
get an order from the doctor within 15-30 mins
Time limits: 18 and older: 4 hours, 9-17: 2 hours, 8 and under= 1-hour, extra documentation:
event that caused the restraints to be placed, alternative interventions that were attempted,
time treatment began, med administered, patient assessment including current behavior, v/s,
pain. Pts care provided: food, helping them to the bathroom.
Therapeutic Communication:
*Always try to get more information from the patient. You never want to shut down
communication between you and the patient. *“Always go for tell me more response”
Intrapersonal communication: self-talk, thinking thoughts, not verbalizing them.
Interpersonal communication: one on one communication with another person.
, Open ended questions: promote interactive discussions “Tell me more, can you share more
about x y,z
Closed ended= when looking for a specific answer/ Medical History. Yes/no answers
Clarifying techniques:
Restating = repeating back the patient exact words
Reflecting= returning focus back to the patient
Paraphrasing = restating the patients’ feelings and thoughts to confirm what has been
communicated. “What I think I hear you saying is this”
Exploring= gathering more information about something that the patient has mentioned. “You
mentioned this can you tell me little more about that.”
General leads= allows the patient to guide the discussion
*Presenting reality= focus on what is actually happening to stop the hallucination, delusions,
faulty beliefs. “Must be really scary to hear voices can you tell me what their saying”
Offering self: demonstrates a willingness to spend time, and the nurse has a genuine concern.
Barriers:
Do not offer personal opinions: Never say “ You should do this”
Do not give advice
Do not give false reassurance.
*NEVER ASK WHY!
Never offer value judgements
Don’t do excessive questioning.
Respond approvingly or disapprovingly
Always stay neutral while talking. “ I know exactly how you feel” Never say this!
Best Practices when working with older adults:
Minimize distractions, discuss health in a private setting, face the patient when speaking, use a
low-pitched voice, in the beginning of the interview identify the concerns/needs of the patient,
limit the number of items on the questionnaire,* give the patient plenty of time to respond to
questions when gathering data*
Defense Mechanisms:
*Repression: putting unacceptable ideas out of unconscious awareness. “ Pushing it out of your
mind and not thinking about it actively.
Displacement: Substituting a different target, Ex: A person who loses his job at work but comes
home and destroys his son favorite toy.
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