PN Mental Health Flashcards (Latest Update)

Mental Health Flashcards
Levels of Consciousness
 Alert
 Patient is Responsive, Opens Eyes Spontaneously, and Answers
Questions Appropriately
 Lethargic
 Patient Can Open Eyes & Respond to Questions, But Falls Asleep
Quickly
 Obtunded
 Patient Responds to Light Shaking, But is Confused & Slow to
Respond
 Stuporous
 Patient Barely Responds to Painful Stimuli (Like Sternal Rub)
 Comatose
 Patient is Unresponsive & Abnormal Posturing May Be Present
 Decorticate
 Arms Flexed & Inwardly Rotated, Legs Extended & Inwardly
Rotated
 Decerebrate
 Head Arched Back, Arms & Legs Extended

Nursing Ethical Principles
 Autonomy
 Patient has the right to make his/her own decisions, even if not in
their best interest
 Beneficence
 Do what is Best for the Patient (Do Good)
 Fidelity
 Keep Your Promises
 Justice
 Provide Fairness in Care & Allocation of Resources
 Nonmaleficence
 Do No Harm
 Veracity
 Tell the Truth



Patient Rights
 Refusal of Treatment
 Even Pts Who Are Involuntarily Admitted Have the Right to Refuse
Treatment
 Confidentiality
 HIPPA States Health Info Cannot be Released W/O the Pt’s
Permission

, If Someone Calls to Get an Update, Suggest They Reach Out to
the Pt’s Family Regarding the Pt’s Condition
 If You Overhear a Convo in the Elevator, Take Immediate Action to
Stop the Violation
 Mandatory Reporting
 Nurses are Required to Report Suspicion of Abuse, and to
Warn/Protect 3rd Parties Who are at Risk for Harm

Informed Consent
 Provider Responsibilities
 Communicate Purpose of Procedure, & Complete Description of
Procedure in Pt’s Primary Language (Use Interpreter)
 Explain Risk v. Benefits
 Describe Other Options
 RN Responsibilities
 Make sure Provider Gave the Pt the Above Information
 Ensure Pt is Competent to Give Consent (Adult or Emancipated
Minor, Not Impaired)
 Have Pt Sign Consent
 Notify Provider if Pt Has More Questions or Doesn’t Understand
Any of the Info




Restraints
 Types
 Physical (Vest, Belt, Mittens)
 Chemical (Sedative or Antipsychotic)
 Alternatives
 Reorientation
 Supervision
 Diversions
 Prescriptions
 Prescriptions Must be in Writing
 If Need For Constraints Continues, Provider Must Rewrite Rx Every
24 Hours
 In an Emergency Situation, a Nurse can Use Restraints, But Must
Obtain a Written Rx Per Facility Policy (Usually Within 15-30 Mins)
 Time Limits
 Adults (18 & Up): 4 Hours

,  Ages 9-17: 2 Hours
 Ages 8 & Under: 1 Hour
 Documentation
 Complete Every 15-30 Minutes
 Include: Precipitating Event, Alternative Interventions Attempted,
Time Treatment Began, Medication Administration, Patient
Assessment (Current Behavior, VS, Pain), Pt Care Provided (Food,
Toileting)
 Discontinuation
 Restraints Can be Discontinued When Pt Can Follow the Nurse’s
Directions

Torts
 Unintentional
 Negligence (Forgetting to Set Bed Alarm for Pt At Risk For Falls)
 Malpractice (Medication Error That Harms Pt)
 Intentional
 Assault (Nurse Threatens Pt)
 Battery (Nurse Hits Pt, or Administers Medication Against Their Will)
 False Imprisonment (Nurse Inappropriately Restrains a Patient or
Administers a Chemical Restraint Such as a Sedative
Communication
 Intrapersonal
 Self-Talk, Thinking Thoughts, But Not Verbalizing Them
 Interpersonal
 One-on-one Communication w/ Another Person
 Open-Ended
 Promotes Interactive Discussions Ex. Tell me more….
 Closed-Ended
 Used to Obtain Specific Data, Use Sparingly as it Can Block
Further Communication
 Restating
 Repeat the Pt’s Exact Words
 Reflecting
 Return Focus Back to Pt
 Paraphrasing
 Restate Pt’s Feelings to Confirm Understanding of What Pt is
Saying
 Exploring
 Gathering More Info About Something Pt Has Mentioned
 General Leads
 Allows Pt to Guide Discussion
 Presenting Reality
 Communicate What is Actually Happening, Dispel Hallucinations,
Delusions, False Beliefs
 Offering Self