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NR548 Exam 2 Questions With Complete Solutions According to Peplau's Theory of Interpersonal Relations, establishing early rapport allows the role of the nurse to evolve from stranger to: Correct Answers resource person, teacher, leader, surrogate, technical expert, and counselor Active Listening Correct Answers involves preparing to be fully attentive to the interaction -note verbal and non-verbal cues
- including what is said and how it is said -indicate attentiveness through their feedback and body language Advanced communication skills Correct Answers critical listening critical questioning critical thinking Body of the Interview Correct Answers -30-40 minutes -Chief Complaint Established
- additional Q's asked to elicit info r/t the complaint -ask about HPI, family hx, social/developmental hx, medical hx, psychiatric ROS -basis for dx and tx formulation
Client Considerations: mute or catatonic clients Correct Answers use of observation techniques will help in formulating a potential diagnosis. Closing the Interview Correct Answers -5-10 minutes, final phase Should include 2 components: discussion of your assessment using patient education techniques & negotiated agreement about tx or f/u plans -wrap-up statement and inquiry about missing info that may be of value -Patient education regarding working dx & recommended plan of tx
- education about meds if recommended -Homework may be assigned
- especially in CBT -Return visit agreed upon Common precipitants of psychiatric syndromes Correct Answers -arguments with friends or relatives -rejection or abandonment -death or major illness of loved ones -anniversary of a negative event, such as a death or divorce
Establishing the Relationship Correct Answers -Trust is essential for a therapeutic alliance -First impressions are important -PMHNP should take time to make introductions and ensure the client is comfortable -Ask general questions to arrive at an empathic understanding of how the client feels -Listen carefully and communicate an appreciation for the client's concerns -Building a trusting relationship based on respect, kindness, and acceptance will break down barriers and allow for client needs to be the center of the plan of care -Being present and openly engaged will enhance the communication experience Family Hx Correct Answers Document info about the client's parents, grandparents, siblings, children, and grandchildren -regarding age, health, & cause of death. -Include whether they have conditions such as hypertension, coronary artery disease, stroke, diabetes, or cancer. -Many psychiatric disorders have a genetic component
- info about family psych hx including tx that was successful/unsuccessful may help form dx/tx plan, can
help ID those available for support, ID stresses/contributing factors to clients condition Focused Questions for The Psychiatric Assessment: Family Psychiatric History Correct Answers -Has any relative of yours ever been hospitalized for a mental health issue? -Has any blood relative of yours ever been diagnosed with a mental health issue? -Has any blood relative of yours had a history of seizures or dementia/Alzheimer's? Focused Questions for The Psychiatric Assessment: History of Present Illness Correct Answers -How long have you been feeling this way? -Did something happen in your life that may have triggered these emotions? -How is this current situation impacting your life? Focused Questions for The Psychiatric Assessment: Medical History/Screening for General Medical Conditions Correct Answers -Do you have a primary care provider? -Do you have any medical illnesses? -Are you currently taking any medications or herbal supplements?
Four Tasks of the Diagnostic Interview Correct Answers 1. Build a therapeutic alliance
- Obtain the psychiatric database
- Interview for diagnosis
- Negotiate a tx plan with your patient Go CHaMP Correct Answers Mnemonic for tx hx: General questions Current caregivers Hospitalization history Medication history Psychotherapy history How to approach threatening topics (sensitive/embarrassing material) Correct Answers - Normalization -Symptom Expectation -Symptom Exaggeration -Reduction of Guilt -Use Familiar Language When Asking about Behaviors How to Change Topics with Style Correct Answers - Smooth Transition
- cue off something the patient just said to introduce a new topic
-Referred Transition
- refer to something the patient said earlier in the interview to move to a new topic -Introduced Transition
- introduce the next topic or series of topics before actually launching into it HPI Correct Answers history of the present illness -concise, clear, and chronological description of the chief complaint which prompted the client's visit
- details what the client believes to be causing the present symptoms -guided by the mnemonic "OLDCARTS" -gather information about the timeframe of symptom onset or exacerbation, triggers or stressful life events, and recent treatment and treatment changes -nature of the symptoms, when they emerged, and how they have progressed -Documentation:
- opening statement
- characterization of the chief complaint in chronological order
- pertinent positive symptoms
Stay on time. -builds trust and communicates that respect for the client. Discuss follow-up visits in the closure phase of the interview -The timing of subsequent visits is informed by the client's unique circumstances, diagnosis and treatment, and medication regimens. match the assessment question with the related symptom attribute: Onset: Location: Duration: Characteristics: Aggravating Factors: Relieving Factors: Treatments: Severity of the Symptoms: "How bothersome is this problem?" "Have you taken any medications or nonpharmaceutical treatments for this problem?"
"Does anything make it better?" "When did this start?" "Where did the problem start; does it move anywhere?" "How long does the problem last or is it constant?" "Can you describe what the problem feels like?" "Does anything make it worse?" Correct Answers - Onset: "When did this start?" -Location: "Where did the problem start; does it move anywhere?" -Duration: "How long does the problem last or is it constant?" -Characteristics: "Can you describe what the problem feels like?" -Aggravating Factors: "Does anything make it worse?" -Relieving Factors: "Does anything make it better?" -Treatments: "Have you taken any medications or nonpharmaceutical treatments for this problem?" -everity of the Symptoms: "How bothersome is this problem?" Medical diagnoses may present with psychiatric symptoms: chronic pain Correct Answers depression, anxiety, poor sleep
Much of the information collected during the interview is obtained through ______________ & ______________ Correct Answers active listening & observation Non-verbal communication: Correct Answers Active listening Using touch Using silence Normalization Correct Answers Introducing Q with some type of normalizing statement -two principal ways to do this:
- start the question by implying that the behavior is a normal or understandable response to a mood or situation
- ex: Sometimes when people are very depressed, they think of hurting themselves. Has this been true for you?
- Begin by describing another patient (or patients) who has engaged in the behavior, showing your patient that she is not alone
- ex: I've talked to several patients who've said that their depression causes them to have strange experiences, like hearing voices or thinking that
strangers are laughing at them. Has that been happening to you? Observation Correct Answers may include client presentation, grooming, and facial expressions -Observation skills are also used to collect objective data Obtain the Psychiatric Database Correct Answers Also known as the psychiatric history -includes historical information relevant to the current clinical presentation
- history of present illness, psychiatric history, medical history, family psychiatric history, and aspects of the social and developmental history Obtaining the HPI Correct Answers Two approaches: -History of present crisis approach
- Often, psychiatric crises occur over a 1- to 4-week period, so focus your initial questions on this period.
- What has been happening over the past week or two that has brought you into the clinic?
- Tell me about some of the stressors you've dealt with over the past couple of weeks.
Patient Questionnaire Correct Answers decrease the time needed to acquire basic information Advantages -allows more time during the first session to focus on issues of immediate concern to the patient -may heighten patient's sense they're actively participating in their care Disadvantages -invalid information may be collected -Some patients may view filling out the questionnaire as a burden Personal and Social Hx Correct Answers Personal Hx: -personality and interests, sources of support, coping style, strengths, and concerns -sexual orientation and gender identification, occupation and education, relationships, safety, spirituality, and support systems -older adults/clients with diabilities: level of function and activities of daily living Social Hx: -tobacco, illicit drug, and alcohol use -sexuality & risk-taking sexual practices
-Five Ps+
- Partners (gender & # of partners)
- Practices (oral, vaginal, anal)
- Protection from STIs
- Past hx of STIs
- Pregnancy plans
- +Plus (assess for trauma, violence, sexual health concerns & provide support for sexual orientation and gender identity) pitfalls that can subvert the therapeutic alliance Correct Answers -rushing the interview -giving advice -transference and countertransference pitfalls: transference and countertransference Correct Answers two phenomena that can impact the therapeutic alliance -Transference: a client's displacement or projection of feelings or wishes towards important individuals in the client's past, such as parents, onto the therapist
- not always (-), provides opportunity to bring repressed feelings to the surface, If client is reminded of someone for whom they have fond memories, may allow for a (+) experience during the initial interview. If
-secure a space -protect your time protect your time Correct Answers -Arrive Earlier than the Patient -Prevent Interruptions -Don't Overbook Patients -Leave Plenty of Time for Notes and Paperwork Psychiatric interview Correct Answers the process by which psychiatric assessment is conducted -primary tasks
- building a therapeutic alliance between the PMHNP & client
- obtaining a database of psychiatric info about the client
- establishing a dx
- negotiating a tx plan Psychiatric Interview Long Form Correct Answers adapted from the one used by Anthony Erdmann, an attending psychiatrist at MGH. He takes notes on it while talking to patients and puts it in his chart Advantages
-ensures a thorough data evaluation and saves time, because notes can be placed directly into the chart Disadvantages -patients may be alienated if you seem more interested in completing a form than in getting to know them Psychiatric Interview Pocket Card Correct Answers used to remind you of all the topics to cover -jot rough notes on a blank piece of paper or not take notes at all Advantages -card allows maximum interaction between clinician and patient Disadvantages -Required information not fully spelled out on pocket card
- more use of memory is required Psychiatric interview setting Correct Answers typically in either the inpatient or outpatient setting -inpatient interviews in the emergency department, psychiatric unit, or any unit in the hospital, often serving in a consultation-liaison role
