Mental health exam 2 power point with
100% Complete Solutions Verified
UPDATED!!!
, lOMoAR cPSD| 47061011
1. Nursing Process Overview
• Lydia Hall (1983): Introduced the term “nursing process” to describe care in three
phases: Observation, Ministration of Care, and Validation.
• ANA (1965): Adopted the nursing process to promote education, structure care, and
support patient safety.
• Joint Commission Requirement (1970s): Hospitals must use the nursing process for
accreditation.
Purpose of the Nursing Process
• Ensure safe, culturally competent, and high-quality care.
• Applied to individuals, families, groups, or communities.
2. Six Steps of the Nursing Process with Examples
1. Assessment
o Collect data (primary: patient, secondary: family/records). o Example: A nurse
interviews a patient with depression and asks about recent changes in sleep or
appetite.
2. Diagnosis
o Identify nursing problems and risk factors. o Example: Diagnosis of
“Ineffective Coping” for a patient who exhibits anxiety and avoids social
interactions.
3. Outcomes Identification o Set goals based on patient needs. o Example: “Patient will
report reduced anxiety from 8/10 to 4/10 within one week.”
4. Planning
o Create a care plan with appropriate, individualized interventions.
o Example: Schedule relaxation therapy sessions twice daily to reduce anxiety.
5. Implementation
o Carry out the care plan interventions. o Example: Administer anti-anxiety
medication as prescribed, and engage the patient in breathing exercises.
6. Evaluation
o Assess whether goals were achieved. Adjust the plan if necessary. o Example:
If the patient’s anxiety remains high, the nurse adjusts the treatment to include
cognitive behavioral therapy (CBT).
3. Age-Specific Assessments
• Children: o Use play therapy to assess behavior. o Red flag: Developmental
regression (e.g., bedwetting in a previously toilettrained child).
, lOMoAR cPSD| 47061011
• Adolescents:
o Use the HEADSSS Model:
H: Home environment – How is your relationship with family?
E: Education – How are your grades?
A: Activities – What do you do for fun?
D: Drug use – Do you drink alcohol or use drugs?
S: Sexuality – Are you sexually active? Do you practice safe sex?
S: Suicide – Have you thought about hurting yourself?
S: Safety – Do you wear a seatbelt? Do you feel safe at home?
• Older Adults:
o Screen for sensory impairments. o Example: Provide a patient with hearing aids
to ensure effective communication during assessments.
4. Psychiatric Assessment Components
• Mental Status Exam (MSE)
o Evaluate cognitive and emotional processes.
o Example Questions:
“Have you been sad or full of energy recently?”
“What day is it today?” Lab Data: o Thyroid
Disorders: Hypothyroidism may mimic depression. o Toxicology
Screening: Substance use can cause unusual behaviors or symptoms (e.g.,
alcohol-related delirium).
• Spiritual/Religious Assessment:
o Explore the patient’s beliefs about life and purpose. o Example: Ask, “How do
your beliefs help you cope with stress?”
5. Therapeutic Communication Techniques with Examples
• Active Listening: o Give full attention to the patient.
o Example: Nodding and saying, “Tell me more about how you’ve been
feeling.” Clarifying Techniques:
o Paraphrasing: Restate the patient’s words.
Example: “You’re saying you feel overwhelmed with work and family?”
o Reflecting: Focus on the patient’s emotions.
Example: “It sounds like you feel really frustrated with your situation.”
o Exploring: Encourage deeper discussion.
Example: “Can you describe how this affects your day-to-day life?”
100% Complete Solutions Verified
UPDATED!!!
, lOMoAR cPSD| 47061011
1. Nursing Process Overview
• Lydia Hall (1983): Introduced the term “nursing process” to describe care in three
phases: Observation, Ministration of Care, and Validation.
• ANA (1965): Adopted the nursing process to promote education, structure care, and
support patient safety.
• Joint Commission Requirement (1970s): Hospitals must use the nursing process for
accreditation.
Purpose of the Nursing Process
• Ensure safe, culturally competent, and high-quality care.
• Applied to individuals, families, groups, or communities.
2. Six Steps of the Nursing Process with Examples
1. Assessment
o Collect data (primary: patient, secondary: family/records). o Example: A nurse
interviews a patient with depression and asks about recent changes in sleep or
appetite.
2. Diagnosis
o Identify nursing problems and risk factors. o Example: Diagnosis of
“Ineffective Coping” for a patient who exhibits anxiety and avoids social
interactions.
3. Outcomes Identification o Set goals based on patient needs. o Example: “Patient will
report reduced anxiety from 8/10 to 4/10 within one week.”
4. Planning
o Create a care plan with appropriate, individualized interventions.
o Example: Schedule relaxation therapy sessions twice daily to reduce anxiety.
5. Implementation
o Carry out the care plan interventions. o Example: Administer anti-anxiety
medication as prescribed, and engage the patient in breathing exercises.
6. Evaluation
o Assess whether goals were achieved. Adjust the plan if necessary. o Example:
If the patient’s anxiety remains high, the nurse adjusts the treatment to include
cognitive behavioral therapy (CBT).
3. Age-Specific Assessments
• Children: o Use play therapy to assess behavior. o Red flag: Developmental
regression (e.g., bedwetting in a previously toilettrained child).
, lOMoAR cPSD| 47061011
• Adolescents:
o Use the HEADSSS Model:
H: Home environment – How is your relationship with family?
E: Education – How are your grades?
A: Activities – What do you do for fun?
D: Drug use – Do you drink alcohol or use drugs?
S: Sexuality – Are you sexually active? Do you practice safe sex?
S: Suicide – Have you thought about hurting yourself?
S: Safety – Do you wear a seatbelt? Do you feel safe at home?
• Older Adults:
o Screen for sensory impairments. o Example: Provide a patient with hearing aids
to ensure effective communication during assessments.
4. Psychiatric Assessment Components
• Mental Status Exam (MSE)
o Evaluate cognitive and emotional processes.
o Example Questions:
“Have you been sad or full of energy recently?”
“What day is it today?” Lab Data: o Thyroid
Disorders: Hypothyroidism may mimic depression. o Toxicology
Screening: Substance use can cause unusual behaviors or symptoms (e.g.,
alcohol-related delirium).
• Spiritual/Religious Assessment:
o Explore the patient’s beliefs about life and purpose. o Example: Ask, “How do
your beliefs help you cope with stress?”
5. Therapeutic Communication Techniques with Examples
• Active Listening: o Give full attention to the patient.
o Example: Nodding and saying, “Tell me more about how you’ve been
feeling.” Clarifying Techniques:
o Paraphrasing: Restate the patient’s words.
Example: “You’re saying you feel overwhelmed with work and family?”
o Reflecting: Focus on the patient’s emotions.
Example: “It sounds like you feel really frustrated with your situation.”
o Exploring: Encourage deeper discussion.
Example: “Can you describe how this affects your day-to-day life?”
