Download Module 1: Some things to think about and more Exams Psychiatry in PDF only on Docsity!
Module 1: Some things to think about What advice can nurses/midwives give patients to promote and maintain positive mental health and wellbeing? Talk about opening up and expressing their feelings, exercise (30 minutes a day), encourage balanced meals, set goals that are realistic in order to pmroote a sense of accomplishment. Spend time with loved ones, priortise getting enough sleep. How do nurses/midwives minimise stigma in relation to mental illness? Awareness of mental illness, knwing the facts Education of self and others about mental illness Being mindful of the language you use. Encouraging positive language Facilitating social inclusivity. How does stigma impact patients with a mental disorder? Stigma can worsen mental illness for some, it can cause discrimination against persons which impacts them getting and seeking out help, treatment and impacts their recovery. It can also cause social isolation. What is recovery-oriented practice in mental health? Mental health services that are being delivered ina way that supports the recovery of mental health consumers. Recovery orientated mental health recognises the uniqueness of an individual and that recovery outcomes are personal and unique. Supports and empowers individuals to make their own choices and how they lead their lives and build on their strengths. Involves listening to, learning from and acting up communications from the consumer and their carers about what is important to each individual. Consists of being courteous, respectful and honest in all interactions and mainting dignity and respect. Works in partnership and communicates with individuals as they are an expert in their own life and recovery should be in partnership with indiicudlas. Ensures and enables continuous evaluation of recovery based practice. How do nurses/midwives promote personal and clinical recovery?
By following the recovery oreientated prinicples as a gudline on promoting person and clinical recovery in partnership with consumers. This list is not exhaustive. What other things might nurses/midwives need to know from module 1? Module 2: Some things to think about What is holistic care in mental health nursing? How does this relate to the multi- discliplinary team we use in mental health settings? An approach to patient care in which physical, mental and social factors in pateins condition are taken into account rather than just the diagnosed disease. It is healing the person as a whole. This developed multidiscplnary teams as it involves healing the biolgocial, psychological, sociological and spiritual aspects of individuals. What is the therapeutic relationship? How would you develop a therapeutic relationship with a patient? Building an alliance with a client in order to enhance treatment outcomes and facilitate shared unsertsanding of the situation. It is the ability to indeifty stregnths and potential barriers to treatment with the client. A mutually defined relationship that encourages collabratice work between nurse and consumer/client In order to reach the consumer/clients goasl (phsycail, social, emotional, therapeutic) through a set of sequential interactions over a period of time. What are the professional qualities and skills nurses/midwives need to be effective in mental health nursing? Key charactersitcs= courtesy, kidness, honesty, compassion, respects for others, unconditional acceptance acception patients and people. Professional boundaries. Compassion; acceptance, non judgemental attitude, awareness and being present. Caring; Interperosnla processes and sensitivity, clear communication, emotional intelligence, empathy & trust, cultural sensitivity and prmotoe consumer autonomy. Why might it be difficult to develop a therapeutic relationship with a patient? How could you overcome these as a nurse/midwife? Consumer barriers being low levels of mental health literacy, distrust, stigma, long waiting lists, poor accessability, marginalised groups and co morbidity with substance abuse. Nurse/midwife barriers: Time constraints, personal discomfort, knowledge/skills deficit and lacking empathy, clinical perpetuated stigma/labelling/judgement.
Sub-module 3.4 & 3.5 - Why do nurses/midwives conduct a risk assessment? What risks might nurses/midwives need to assess for in a mental health context? When assessing one for risks in their mental health you are assessing if a person has the potentional to self harm (actively or passicly) and could be a risk to harming someone else. You are assessing if there are factors that increase a persons risk EG. Psychosis, Paranoia, loss of insight and judgement, suicidal ideation, threats/attempts. A risk assessment helps to maintain a safe environment and safe practices. It aims to measure the seriousness of a person intent, indentifies underlying issues causing distress, identifies supports and strengths and determines the potentional for future risk of harm. Sub-module 3.2 - What is a clinical formulation? How would you gather information for a clinical formulation? The process of developing with the consumer a summary of various influences on a persons current state (physical, psychological, problems, stressors), and how the consumer and nurse can word towards resolving those problems. When doing a physical health assessment and during the initial mental health assessment of a patient you can gather this information. This list is not exhaustive. What other things might nurses/midwives need to know from module 3? Module 4: Some things to think about Why is there a Mental Health Act? To protect the public and provide care for people with mental illness in the least restrictive manner possible. Protects the rights of consumers and families living with mental illness. What makes a patient voluntary or involuntary under the MH Act (2014)? Involuntary is someone who has been admitted because they meet the criteria for admission/detention and does not require the consent of a patient. Voluntary is when a person has come into care facility of their own volition because they feel they aren’t coping or need help. What are the most common MH Act (2014) forms nurses/midwives might come across in Western Australia? 1A- referral for examination by the psychiatrist (referral time frame= 72 hours).
2A- detain a voluntary patient in an authorised hospital 3A & 3B- Detention order (up to 24 hours) 4A- transport orders: transport officer: similar powers to police to apprehend detain, restrain and trspont. Police officers will transport from rural areas to metroploitean or vice versa. RFDS to facilitate safe transport. 5A- community treatment order up to 3 motnhs 6A- detained for a further 21 days after they have been assessed. Made involuntary patient in authroised MH hostipal 6B & 6C- a psychiatrist may make a person an involuntary detained patient in a GENERAL hopstial. If medical condition poses a significant risk to their physical health and transport is not viable. 6C- continuation order: extends beyod the 21 days to 3 months. Why do nurses/midwives need to know about the MH Act (2014)? To ensure lawful practice is applied when administering nursing care and to use to guide their practice by outlining the treatment, care, support and protection of people who have mental illness. It is important for nurses to know and understand the rights of mental health patients when providing care. This list is not exhaustive. What other things might nurses/midwives need to know from module 4? Modules 5-9: Some things to think about. Generalised anxiety disorder - module 5 What are the signs and symptoms of each of these disorders? igns & symptoms & nurse/midwife considerations Physiological – ‘fight or flight’ – adrenergic response (elevated clinical obs). Constant excessive (uncontrollable) worry, inability to focus or concentrate & sleep. Can increase risk of physical health issues if left untreated. Comorbidity – muscle tension, gastric reflux, thyroid disorders, cardiac is Psychological: unrelastic or exceesive fear and worry, nervousness and feeling on egde, mind racing or going blank, decreased concentration and memory, indeciveness and confusion, irritability, impatience, anger, tiredness, sleep disturbances, vivid dreams, a sense of doom, panic attacks, depression. Physiological : palpatations, chest pain, increased HR, flushed face, Hyperventatlion, SOB, Dizziness/Light headed, headache, tingling and numbness. Choking, dry mouth, nausea, vomiting, diarrhea. Muscle aches, restless and tremor/shaking. Behavioural: Avoidance of situations, distress in social situations, becoming overly attached to an object, routine or person, phobic bheaviour, increase use of alcohol or other drugs. What do nurses/midwives need to know or be able to do to recognise these disorders in clinical practice?
What are the potential side effects of prescribed medications for each of these disorders? Drowsiness & sedation, Imparied memory & concentration, low mood, poor motor coordination, mood swings and irritability. Why do nurses/midwives need to know about common side-effects of prescribed medications of each of these disorders? To ensure the patient is on the right medication that works for their boyd, if they are shoing side effects they can have a different type of medication prescribed better suited to them. What therapy is indicated for each of these disorders (if any)? Behavioural therpay and cognitive behaviour therapy. Are there any other treatments recommended for any of these disorders? Develop personal coping stratergies and mindfulness. Regular checks with GP, talking with someone they trust, Breathing techniques, Post traumatic stress disorder - module 6 What are the signs and symptoms of each of these disorders?] ymptoms and characteristics of PTSD can vary between individuals and depends on the trauma or experience which has caused the PTSD.
- Re-experiencing – where the individual re-lives the trauma or experience (flashbacks, nightmares).
- Avoidance – avoiding people and places that remind them of the event.
- Emotional numbing – trying not to feel anything at all – can include using drugs and alcohol.
- Hyperarousal – constantly aware of surrounding and possible threats (hypervigilant), difficulty switching off and relaxing (Irritability, sleeping problems, concertation impaired).
- Physical symptoms – headaches, dizziness, chest pains and digestive issues.
- Psychological symptoms – depressed mood, anxiety, self-harming/destructive behaviours. What do nurses/midwives need to know or be able to do to recognise these disorders in clinical practice? Must consider the hisptorial/ precipitating factors. Understanding interpersonal trauma. Sudden death of a loved one, natural disasters, terrorist attacks, car or plane crash, war, kidnapping, assault, sexual or physical abuse, childhood neglect.
What are the 'causes' of each of these disorders? Sudden death of a loved one, natural disasters, terrorist attack, car or plane crash , war, kidnapping, assault, sexual or physical abuse, childhood neglect. Comobidities such as depression anxiety, substance abuse. How would nurses/midwives assess each of these disorders in clinical practice? Directyl experience event, witnessed it or learned about it inderectialy, the event was life threatning, involved serious injury or threatened physcail integrity, triggered an intense emotional response of fear, horror or helplessness Risk assesemnt Accurate assessment of signs and symtpomes MSE DSM-5. What are some of the challenges nurses/midwives might encounter working with patients who have these disorders? How can nurses/midwives overcome or manage these challenges? What are the recommended treatments for each of these disorders? Is the main treatment for each disorder medication, therapy or something else? Medications not first line intervention (antiaxiety or anti depressant)= symptom relief. Therpy CBT, acceptance and commitment therpay, slef help treatmenst. Psychoeducation- self awareness, resources, indeitfying strengths. Trauma informed care- To understand what happened not whats wrong. What are the potential side effects of prescribed medications for each of these disorders? Why do nurses/midwives need to know about common side-effects of prescribed medications of each of these disorders? What therapy is indicated for each of these disorders (if any)? CBT, Acceptance & commitment therapy. Are there any other treatments recommended for any of these disorders? Promote lifestyle changes, estabihs routine, focus on self care, limit futher exposure, grounding tecniques, social support, education, seeking help. Depression (major depressive disorder) - module 7 What are the signs and symptoms of each of these disorders? Depressed mood most of the day Diminished interest or pleasure in all or most activites
Are there any other treatments recommended for any of these disorders? ECT: Side effect- muscle aches, headache, confusion and memory loss (temp). Application of brief electric current to unipolar or bipolar sites on the scalp. Transcranial magnetic stimulation TMS: Side affects: headache, facial twitching, tempory hearing problems. Treatment administered via coil that is placed over scalp applying a magnetic field that stimulate brain activity. Bipolar affective disorder - module 7 What are the signs and symptoms of each of these disorders? Mania/Hypomania: Decreased need for sleep Pressured speech Racing thoughts on flight of idea Distractability Increased activity Inflated self esteem or grandiositself esteem or grandiosity Excess pleasure or risky activity Depressed mood: Diminished interest or pleasure Weight loss or gain Insomnia or hypersomnia Psychomotor agitation or retardation Loss of energy Feeling worthless or guilty Reccurent though of death Indeciciveness Present more or equal to 7 days. What do nurses/midwives need to know or be able to do to recognise these disorders in clinical practice? What are the 'causes' of each of these disorders? Bio: genetic, first degree relative, nuerotransmitters, circadian rhythm (sleep cycle), Menstraul cycle. Individual: stress & maldaptive coping mechanism (substance use), head injury, childhood trauma, neglect, parental death. Enviromental: High income countries, relationships, prenatal environment, substance use/misuse. How would nurses/midwives assess each of these disorders in clinical practice? Risk assessment:
MSE
Sucide assessment Physcial assessment What are some of the challenges nurses/midwives might encounter working with patients who have these disorders? How can nurses/midwives overcome or manage these challenges? What are the recommended treatments for each of these disorders? Is the main treatment for each disorder medication, therapy or something else? Antidepressants and mood stabilisers (Anticonvulsants, anti psychotics, anxiolytics). Psychological therapies CBT Physcial treatments- Electroconvulsice therapy. What are the potential side effects of prescribed medications for each of these disorders? Sleepiness, dizziness, metallic taste in mouth, nausea, vimting, skin rashed, tremor, chnges in blood count. Why do nurses/midwives need to know about common side-effects of prescribed medications of each of these disorders? What therapy is indicated for each of these disorders (if any)? CBT, Mindfullness based cognitive therapy, interpersonal therapy. Are there any other treatments recommended for any of these disorders? Behavioural stratergies: assist in regular rotine, exercise, socialisation and goal planning Cognitive strategies: patterns of thinking, indefitying beliefs anf assumptions that ideas are built on ECT TMS Schizophrenia - module 8 What are the signs and symptoms of each of these disorders?
- Disturbance in level of functioning (social and occupational, self care, interpersonal relationships)
- Evidence of dysfunction in previous 6 months. What are the 'causes' of each of these disorders? Genetics o Disease can run in families(combination of genes) o Having the genes does not necessarily mean that the person will develop schizophrenia Brain Development o Subtle differences in the brains of people with schizophrenia ( not everyone with schizophrenia) Neurotransmitters o Change in level of serotonin and dopamine (imbalance between the 2) Pregnancy and birth complications o people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as:
- a low birthweight
- premature labour
- a lack of oxygen (asphyxia) during birth How would nurses/midwives assess each of these disorders in clinical practice? Comprehensive and holistice risk assessment Predicting violence- history, drusg/substance use, symptom related (hallucination, paranoia, suspiciousness) Risk assessment Asses if in a self care deficit. Physcial assessment Previous history What are some of the challenges nurses/midwives might encounter working with patients who have these disorders? How can nurses/midwives overcome or manage these challenges? What are the recommended treatments for each of these disorders? Is the main treatment for each disorder medication, therapy or something else? Antipsychotics- reuce positive symptoms of schizophrenia Anticholinergics- reduce distressing or unwanted side affects of antipsychotic meds.
What are the potential side effects of prescribed medications for each of these disorders? Antipsychotic side aeffects Dystonas (dystonia) Muscle spasms, oculogyric crisis torticollis. Akathisia Restlessness, compulsion to move. Parkinsonism Tremor/ rigidity, hyper-salivation. Tardive dyskinesia Abnormal involuntary movements. Neuroleptic Malignant Syndrome Severe parkinson like symptoms and hyperthermia- medical emergency. Anticholnergics: Tachy, nausea, vomiting, dry mouth, constipation, dizziness, delirium, hallucinations. Why do nurses/midwives need to know about common side-effects of prescribed medications of each of these disorders? What therapy is indicated for each of these disorders (if any)? CBT and music therapy. Are there any other treatments recommended for any of these disorders? Music theory- Borderline personality disorder - module 9 What are the signs and symptoms of each of these disorders? Clinical Manifestations (DSM-5)
- Frantic efforts to avoid abandonment or being alone
- A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes or idealisation and devaluation
- Identity disturbance: markedly & persistently
- Impulsivity: spending on items they don’t need, promiscuity, substance abuse, reckless driving, binge eating
Family and patient involvement What are the recommended treatments for each of these disorders? Is the main treatment for each disorder medication, therapy or something else? Antidpressants- regulate mood Antipsychotics- reduce paranoia and psychotic features Mood stabiliser- reduce impulsivity and mood swings Anti-anxiety- reduce emotional distress. What are the potential side effects of prescribed medications for each of these disorders? Antipsychotic side aeffects Dystonas (dystonia) Muscle spasms, oculogyric crisis torticollis. Akathisia Restlessness, compulsion to move. Parkinsonism Tremor/ rigidity, hyper-salivation. Tardive dyskinesia Abnormal involuntary movements. Neuroleptic Malignant Syndrome Severe parkinson like symptoms and hyperthermia- medical emergency. Anticholnergics: Tachy, nausea, vomiting, dry mouth, constipation, dizziness, delirium, hallucinations. Antidepressants & anxiolytics: Sleepiness, dizziness, metallic taste in mouth, nausea, vimting, skin rashed, tremor, chnges in blood count. Why do nurses/midwives need to know about common side-effects of prescribed medications of each of these disorders? What therapy is indicated for each of these disorders (if any)? Personality disorder therapy: psychodynamic therapy (enhace self awareness and understand how their past effect present) CBT- chaning attidues and behaviours by focusin on thoughts and beleifs Dialectical behavour therpay (uses mindfulness and acceptance to change thoughts) Acceptance and commitiment therapy ( Confronting painful thoughts and experiences). Are there any other treatments recommended for any of these disorders?
Group therapy, support groups. This list is not exhaustive. What other things might nurses/midwives need to know about each of these disorders? Referral for Examination / Detention Form 1A Referral for examination by a psychiatrist Form 1A attachment Referral for examination by a psychiatrist Form 1B Variation of referral Form 2 Order to detain voluntary inpatient in authorised hospital for assessment Form 3A Detention order Form 3B Continuation of detention Form 3C Continuation of detention to enable a further examination by psychiatrist Form 3D Order authorising reception and detention in an authorised hospital for further examination Form 3E Order that a person cannot continue to be detained Transport / Transfer orders Form 4A Transport order Form 4B Extension of transport Order Form 4C Transfer order Form 4D Interstate transfer order (Currently unavailable) Form 4E Approval of interstate transfer order (Currently unavailable) Community Treatment Orders Form 5A Community treatment order Form 5B Continuation of community treatment order
Form 10E Record of examination of restrained person Form 10F Variation of bodily restraint order Form 10G Revocation of expiry of bodily restraint order Form 10H Review of bodily restraint order by psychiatrist Form 10I Record of post restraint examination Seclusion Form 11A Record of oral authorisation of seclusion Form 11B Written seclusion order Form 11C Record of information medical practitioner and treating psychiatrist of seclusion order Form 11D Record of observations made of secluded person Form 11E Record of examination of secluded person Form 11F Revocation or expiry of seclusion Form 11G Record of post seclusion examination Access to Information Form 12A Nomination of nominated person Form 12B Refusal of request to access document Form 12C Restriction on freedom of communication Form 12C attachment Restriction on freedom of communication ECT Form 13 Statistics about ECT (contact OCP monitoring if required)
