NURSING MISC mental health ATI study guide.

 American Psychiatric Nurse Association  Psychosocial Assessment o Perception of health/belief o Leisure activities o Coping abilities o Cultural: factors that impact care/health care beliefs  Culture specific food  Specific practices  Awareness of culture alleviates stereotyping  Interpreter o Spiritual/ Religious  Spiritual: internal values/ morality/purpose of life  Religion: beliefs, worship, rituals  May not connect spiritual views with religion  Mental Status Exam  Level of consciousness o Alert: Respond/open eyes/ answers questions o Lethargic: open eyes but drowsy /falls asleep o Stuporous: require painful stimuli (sternum rubbing) may not respond verbally o Comatose: unconscious & don’t respond to stimuli  Decorticate rigidity: flexion/internal rotation of legs/upper body  Decerebrate rigidity: extension of neck/elbow & finger flexion  Physical appearance: personal hygiene, grooming, well kempt, clean, dressed appropriately  Behavior: voluntary/involuntary body movement o Mood: emotions o Affect: objective expression (lack of facial expression)  Cognitive/Intellectual ability o Orientation: time, place, person o Memory  Immediate: repeat series (numbers or objects)  Recent: recent events (current day)  Remote: fact from past (b-day) o Assess: level of knowledge (current illness), Ability to calculate (count backwards), abstract thinking, perception of illness, judgement based on hypothetical questions (what would you do if there was a fire), rate and volume of speech  Screening tool: assess cognitive stat