genogram, mse and sensory stimulation.docxnd sensory stimulation

7/28/2019 Genogram, MSE and Sensory Stimulation.docxnd Sensory Stimulation

1/22

CEBU DOCTORSUNIVERSITYCOLLEGE OF NURSING

NCM105RLE1

07.04.12

Genogram,

Mental Status Examination,

And Sensory Stimulation

Submitted to:

Ms. Ricci Zolayvar

B S N 3 - C

Submitted by:

Ms. Hernani, Mary Jean

Ms. Into, Jayfein Mae

Ms. Jose, Joyce Dianne

Ms. Lasala, Jazmin Venice


2/22

GENOGRAMObjectives:

After 5 hours of classroom activities, the level III students will be able to:

1. define the ff. terms1.1Family1.2Nuclear family1.3Extended family1.4Multigenerational Family1.5Generation1.6Genogram

2. state the importance of making a genogram;3. enumerate the information needed in making a genogram;4. illustrate the different symbols used in making a genogram;5. enumerate the guidelines in making a genogram;6. demonstrate the beginning skills in constructing a three generational genogram.


3/22

I. DEFINITION OF TERMS

1. Family- Is a basic social unit consisting of parents and their

children, considered as a group, whether dwelling together or not.

2. Nuclear Family- It is a term used to define a family group consisting of a pair of adults and their

children.

- It is a group of people who are united by ties of partnership and parenthood andconsisting of a pair of adults and their socially recognized children.

3. Extended Family- A family group that consists of parents, children, and other close relatives, often

living in close proximity.

- A group of relatives, such as those of three generations, who live in close geographicproximity rather than under the same roof.

4. Multigenerational Family- A type of family relating to several generations.

5. Generation- also known as procreation in biological sciences- .The average interval of time between the birth of parents and the birth of their

offspring.

- All of the offspring that are at the same stage of descent from a common ancestor:Mother and daughters represent two generations.

6. Genogram- It is a diagram of a persons family relationships and medical history usually over 3

generation. It goes beyond a traditional family tree by allowing the user to visualize

hereditary patterns and psychological factors that punctuate relationships. It can be

used to identify repetitive patterns of behavior and to recognize hereditary

tendencies.


4/22

II. IMPORTANCE OF MAKING A GENOGRAM

In Medicine Provides a quick and useful context in which to evaluate an individual's health

risks. Provides knowledge of diseases and illnesses that "run" in families can give

individuals an important head start in pursuing effective preventive measures.

It is helpful in determining patterns of disease or illness within a family. In Genealogy

It allows the genealogist to graphically portray complex family trees that showmarriages and divorces, reconstituted families, adoptions, strained relationships,

family cohesion, etc.

In Education It is helpful in illustrating book reviews, or family trees of a famous politician,

philosopher, scientist, musician, etc. They allow them to focus their attention on

specific details and also see the big picture of the books and individuals they are

studying.

III. THE INFORMATION NEEDED IN MAKING A GENOGRAM

a.Necessary data such as: Names Age Sibling Position Birthdates Gender Social status (e.g Single, Married, Widowed, Diseased, etc.) Hereditary Disease

Closeness and distance of each generation level Physical location of family members Emotional cut offs.


5/22

IV. THE SYMBOLS IN MAKING A GENOGRAM

Intimate

Friends/ close


6/22

V. GUIDELINES IN MAKING A GENOGRAM

1. Gather the needed information such as names of all persons to be included in yourgenogram, including the birth order and gender of each child in each family, marital

status of couples, and any other pertinent information, such as dates of birth, marriage,

divorce, death, etc.

2. Use standardized symbols:a. Use squares to represent males: and circles for females:b. Use double lines around the square or circle to indicate yourself, the index

person.

c. Names, dates for birth and/or death should be written above or below thesymbol.

d. Place an X inside the figures of those who are deceased:3. Marital relationships are shown by connecting lines that go down and across between

the partners.

a. The husband is on the left and the wife on the right. Divorce is indicated withtwo slashes (//) in the horizontal marriage line. The dates for marriage and

divorce, if applicable, should be written above the marriage line.

4. Vertical lines are drawn below marriage lines for the children of the marriage, with theoldest child on

a. The left and the youngest child on the right.5. Make sure that you use the right symbols corresponding to the family member and their

relationship to one another and other members of the family.

6. If there is a deceased person in the family, dont forget to put an X mark7. The male parent is always at the left of the family and the female parent is always at the

right of the family

8. In the case of ambiguity, assume a male-female relationship rather than male-malerelationship

9. The oldest child is always at the left , the youngest is always at the right.10.Ages are put in the center of the symbols for people11.Dates of events(day , month, year) appear next to the appropriate symbols12.Indicate the occupation of the middle generation.


7/22

MENTAL STATUS

EXAMINATIONObjectives:

After 5 hours of varied learning experience, the level III students will be able to:

1. define the following terms:

1.1 Mental Status Examination1.2 Cognition

1.3 Coma

1.4 Delusion

1.5 Dementia

1.6 Hallucination

1.7 Catatonia

1.8 Illusion

1.9 Obsession

1.10 Assessment1.11 Speech

1.12 Mood

1.13 Affect

1.14 Appearance

1.15 Behavior

1.16 Perception

2. state the purpose of mental status examination;

3. give the description of the following categories to be explored during a mental status

examination:

3.1 Appearance

3.2 Behavior


8/22

3.3 Affect

3.3.1 Range

3.3.2 Type

3.3.3 Intensity

3.3.4 Appropriateness

3.4 Mood

3.5 Speech

3.5.1 Volume

3.5.2 Productivity

3.5.3 Rate

3.5.4 Goal Direction

3.5.5 Tone

3.6 Thought Content

3.7 Thought Process

3.7.1 Form

3.7.2 Delusions

3.7.3 Disorders of Perception

3.7.4 Phobias

3.8 Intellectual Functions

3.9 Insight

3.10 Judgment

3.11 Cognition

3.12 Consciousness

3.13 Memory


9/22

III. CATEGORIES TO BE EXPLORED DURING MENTAL STATUS EXAMINATION

1. Appearance

The clients overall appearance, including dress, hygiene, grooming as well as thedominant attitude presented before, during and after the interview.

Possible questions: Is the client appropriately dressed for his or her age and theweather? Is the client unkempt or dishevelled? Does the client appear to be his

or her staged age? Is the client in his or her ideal body weight and height

according to his or her age?

2. Behavior

The nurse also observes the clients posture, eye contact, facial expression, andany unusual movements and positions such as tics or tremors.

He or she documents observations and examples of behaviours to avoid personaljudgement or misinterpretation.

Specific terms used in making assessments of general appearance and motorbehaviour include the following:

- Automatisms: repeated purposeless behaviours often indicative of anxiety,such as drumming fingers, twisting locks of hair, tapping of foot, tics or

unnecessary shaking of the hands (chorea)

- Psychomotor retardation: overall slowed movements- Waxy flexibility: maintenance of posture or position over time even when it

is awkward or uncomfortable.

3. Affect

Is the outward expression of the clients emotional state? The client may make statements about feelings, such as Im depressed or Im

elated

The nurse must note such inconsistencies. For example, the client may be talkingabout the recent loss of a family member while laughing and smiling.

Range: Does the patient exhibit a full range of emotion (objectively) in response to

the interview? Is the range constricted, blunted, or completely absent?

Appropriateness: Is his affect, as far as one can observe it, compatible and

appropriate to the ideas he expresses, the general content of his thought, and his

appearance and motor activity? Is it consistent with his subjectively described

mood? Or is his affect not compatible with these aspects of his functioning?


10/22

4. Mood

Refers to the clients pervasive and enduring emotional state. The nurse may infer the clients mood from data such as posture, gestures, tone

of voice, and facial expression.

May be described as happy, sad, depressed, euphoric, anxious, or angry. Can be combined with affect

5. Speech

The patient's style of talking should be studied carefully, and its various featuresrecorded under the general headings of volume, rate and flow of speech,mannerisms, accent, stress or the lack of it and stuttering.

May be described as laboured, monotonous, emotional, loud and garrulous.6. Thought Content

Is what the client actually says The nurse assesses whether or not the clients verbalizations make sense; that is,

if ideas are related to flow logically from one to the next.

Assess thoughts that preoccupy such as compulsion and rumination; phobias orconcerns about physical symptoms; and, overload of ideas and delusions

7. Thought Process

Refers to how the client thinks and content The nurse can infer a clients thought process from speech and speech patterns

8. Intellectual Functions

The nurse must consider the clients level of formal education. Lack of formaleducation could hinder performance in many tasks.

The nurse also may assess the clients intellectual functioning by asking him orher to identify the similarities between pairs of objects.

9. Insight

It is the ability to understand the true nature of ones situation and accept somepersonal responsibility for that situation.


11/22

The nurse frequently can infer insight from the clients ability to describerealistically the strengths and weaknesses of his or her behaviour.

10. Judgment

Refers to the ability to interpret ones environment and situation correctly and toadapt ones behaviour and decisions accordingly.

Problems may be seen if the client describes recent behaviour and activities thatreflect a lack of reasonable care for self or others.

11. Cognition

Refers to the level of consciousness and alert level of the patients memory Level of abstract thought

12. Consciousness

Includes the special sensory perceptive powers and their central correlation andintegration in the brain. A clear consciousness conveys the presence of a

reasonably accurate memory together with a correct orientation for time, place,

and person.

13. Memory

The nurse directly assesses memory, both recent and remote, by askingquestions with verifiable answers.

Includes short-term and long-term memory Short-term memory is the initial memory stage in which information is held in

consciousness for about 10-20 seconds

Long-term memory is the final phase of memory in which the informationstorage may last from hours to a lifetime.


12/22


1.1 Mental Status Examination

The mental status examination is an essential tool that aids physicians inmaking psychiatric diagnoses.

The mental status examination includes historic report from the patient andobservational data gathered by the physician throughout the patient encounter.

It composes of specific questions and methods to assess the patient'sappearance and general behavior, motor activity, speech, mood and affect,

thought process, thought content, perceptual disturbances, sensorium and

cognition, insight, and judgment serve to identify features of various psychiatric

illnesses.

1.2 Cognition

It is the mental process of knowing, including aspects such as awareness,perception, reasoning, and judgment.

That which comes to be known, as through perception, reasoning, or intuition;knowledge.

1.3 Coma

A state of deep and often prolonged unconsciousness as usually the result ofinjury, disease, or poison, in which an individual is incapable of sensing or

responding to external stimuli and internal needs.

1.4 Delusion

A false belief strongly held in spite of invalidating evidence, especially as asymptom of mental illness.

1.5 Dementia

A deterioration of intellectual faculties, such as memory, concentration, andjudgment, resulting from an organic disease or a disorder of the brain.

It is sometimes accompanied by emotional disturbance and personality changes.


13/22

1.6 Hallucination

It is the perception of visual, auditory, tactile, olfactory, or gustatory experienceswithout an external stimulus and with a compelling sense of their reality, usually

resulting from a mental disorder or as a response to a drug.

TYPES OF HALLUCINATIONo VISUAL

The most common modality referred to when people speak ofhallucinations. These include the phenomena of seeing things

which are not present or visual perception which does not

reconcile with the consensus reality.

o AUDITORY Auditory hallucinations (also known as Paracusia), particularly of

one or more talking voices, are particularly associated with

psychotic disorders such as schizophrenia or mania, and hold

special significance in diagnosing these conditions, although many

people not suffering from diagnosable mental illness may

sometimes hear voices as well.

o TACTILE Other types of hallucinations create the sensation of tactile

sensory input, simulating various types of pressure to the skin or

other organs. This type of hallucination is often associated with

substance use, such as someone who feels bugs crawling on them

(known as formicating) after a prolonged period of cocaine or

amphetamine use.

o GUSTATORY This type of hallucination focuses typically on food and is common

to individuals presenting persecutory perceptions along with the

experience of epileptic aura.

o GENERAL SOMATIC SENSATIONS General Somatic Sensations of a hallucinatory nature is

experienced when an individual feels that his body is being

mutilated i.e. twisted, torn, or disembowelled. Other reportedcases are invasion by animals in the person's internal organs such

as snakes in the stomach or frogs in the rectum.

The general feeling that one's flesh is decomposing is alsoclassified under this type of hallucination.


14/22

1.7 Catatonia

An abnormal condition variously characterized by stupor, stereotypy, mania, andeither rigidity or extreme flexibility of the limbs.

It is most often associated with schizophrenia.1.8 Illusion

It is a perception that is not true to reality, having been altered subjectively insome way in the mind of the perceiver

1.9 Obsession

It is a compulsive preoccupation with a fixed idea or an unwanted feeling oremotion, often accompanied by symptoms of anxiety.

1.10 Assessment

It is an examiner's evaluation of the disease or condition based on the patient'ssubjective report of the symptoms and course of the illness or condition and the

examiner's objective findings, including data obtained through laboratory tests,

physical examination, medical history, and information reported by family

members and other health care team members.

1.11 Speech

The faculty or act of expressing thoughts, feelings, or perceptions by thearticulation of words.

1.12 Mood

It is a pervasive and sustained emotion that, when extreme, can color one'swhole view of life; in psychiatry and psychology the term is generally used to

refer to either elation or depression.

1.13 Affect

It is an external or observable expression of emotion attached to ideas or mentalrepresentations of objects.


15/22

TYPES OF AFFECT:If mood is the subjective portion, affect describes the objective portion

(i.e., what you see and observe). Affect can be described in terms of four

variables: Range, Intensity, Lability, and Appropriateness to mood/context.

o Range refers to the amount of variation in behavior/emotion during theinterview (such as enthusiasm that fluctuates with sadness). There is a

normal amount of variation patients will display during an interview,

usually equivalent to those seen in every day conversations with

associates, friends, significant others, etc. If the patient demonstrates

more variation in affect than is usual, this is considered an increased

range of affect. For example, if a patient expresses euphoria and then

changes, within the same interview, to a deep, non-responsive depressed

appearance, this would be increased range. Likewise, if another patient

were to present with extreme, sustained euphoria this might be

described as expansive. The other presentation may also be seen

decreased range of affect (also described as restricted, constricted,

blunted, or limited range). An example of this is often seen in depressed

individuals. They will most likely be confined to a depressed range of

affect, with little indication of joy, hope, or smiling. Finally, when there is

absolutely no change in affect (as seen in negative symptoms of

psychosis), this can be described as flat.

o Intensity can be thought of as the emotional amplitude and power iscoming forth from the patient.

o Lability can be thought of as of rapid, extreme, brief swings of emotionfollowed by a quick return to normal. A presentation of labile affect

would a be patient who appears depressed and solemn, breaks into

sudden laughter with little prompting for one minute, followed by crying

for another minute, and then back to appearing depressed again.

o Appropriateness of affect refers to whether the emotion is expected forthe patients current expressed thought. For example, a patient who

laughs uncontrollably while recalling a tragic event is demonstrating an

inappropriate affect. It is also important to examine if the affect iscongruent to mood (which is another area to assess appropriateness).

For example, if a patient states he is deeply depressed and laughs,

jokes, and smiles throughout the entire interview this would

demonstrate an affect that is not congruent with mood.


16/22

1.14 Appearance

It is the outward or visible aspect of a person or thing; therefore, it is anobjective cue

1.15 Behavior

It is the actions or reactions of a person or animal in response to external orinternal stimuli.

It is simply the manner of which one behaves.1.16 Perception

It is the recognition and interpretation of sensory stimuli based chiefly onmemory.

It is the neurological processes by which such recognition and interpretation areaffected.

II. IMPORTANCE OF MENTAL STATUS EXAMINATION

It serves as asnapshot of the person the medical health care team is evaluating It describes the state of the patient It can serve as a baseline data of the current condition of the patient and may serve as a

reference for improvement during the progression of treatment

It can help substantiate a diagnosis, convey information to another provider It can assist in determining most appropriate step in treatment It can help distinguish between mood disorders, thought disorders, and cognitive

impairment and it can guide appropriate diagnostic testing and referral to

a psychiatrist or other mental health professional.


17/22

SENSORY

STIMULATIONObjectives:

After 5 hours of varied learning experience, the level III students will be able to:

1. Define the following terms:1.1 Sensory stimulation1.2 Therapist1.3 Client1.4Visual aid1.5 Hallucination1.6 Illusion1.7Delusion

2. state purpose of sensory stimulation;3. discuss the five basic senses;4. give the indications and contraindications of Sensory Stimulation;5. state the guideliness of Sensory Stimulation;6. state the Nursing responsibilites during, before and after Sensory Stimulation.


18/22


1. Sensory Stimulation

- It is a form of psychotherapy aimingto test a persons sense of

awareness on utilizing the 5 senses.

- It requires stimulating the sensescan have a positive effect on

learning as well as emotional and

social growth.

2. Therapist

- A person who conducts an activityusually to treat a bodily or mental

behavior.

- One trained in methods oftreatment and rehabilitation other

than the use of drugs or surgery.

3. Client

- A person who is the recipient of aprofessional service outside a

medical health care facility.


19/22

4. Visual Aids

- Materials needed by the therapist toenhance learning process.

- It is any object or picture thatrelates to the subject being taught.

Posters, pictures, or even the object

itself can be used to help teach.

5. Hallucination

- A false sensory perception orperceptual experiences that do notexist.

- A profound distortion in a person'sperception of reality, typically

accompanied by a powerful sense of

reality. A hallucination may be a

sensory experience in which a

person can see, hear, smell, taste, or

feel something that is not there.

6. Illusion

- A perception, as of visual stimuli,that represents what is perceived in

a way different from the way it is in

reality.


20/22

7. Delusion

- Fixed false belief with no basis inreality

- A false belief regarding the self orpersons or objects outside the self

that persists despite the facts and

occurs in some psychotic states.

II. PURPOSE OF SENSORY STIMULATION

For the assessment of reality. To assist the patients level of stimuli perception. In order to correct misperception. To improve use of senses. To maintain clients contact with reality. To estimate sense of awareness for the patient.


21/22

III. FIVE SENSES OF THE BODY

Sense of Sight- Refers to the ability to interpret visible light formation reaching the eyes which is then

made available for planning and action. The resulting perception is also known as eyesight.

Sense of Touch- Stimulation of skin informs the person of what is directly adjacent to its body. Sense of Taste- Refers to the ability to detect the flavor of foodstuffs and other substances. Classical

sensations include sweet, sour, salty, umami and bitter.

Sense of Hearing- Refers to the ability to detect sounds. Hearing is performed primarily by the auditory

system. Sound is detected by ear and traduced into nerve impulses that are perceived

by the brain.

Sense of Smell- The detection of chemicals dissolved in the air. The chemicals themselves generally at

very low concentration called odor.

IV. INDICATIONS AND CONTRAINDICATIONS OF SENSORY STIMULATION

Indications

Isolated patients Patients with sensory deprivation Socially withdrawn patients Victims of Alzheimers disease Severely developmentally delayed child or adult

Contraindications

Patients having hallucinations

Patients having illusions

Patients who are afraid in the dark

Patients who are violent

Patients having delusions

Uncooperative patients


22/22

V. GUIDELINES IN SENSORY STIMULATION

1. Create a quiet, comfortable environment.2. Face the individual, introduce self and activity.3. Present an stimulus.4. Observe for subtle response. If no response after one minute try another alerting

stimulus.

5. If a positive response is noted, move to a pleasant stimulus and observe.6. Continue presenting pleasant stimuli for up to ten minutes.7. Stop the activity if nonverbal behavior indicates discomfort or agitation.

VI. NURSING RESPONSIBILITIES BEFORE, DURING AND

AFTER SENSORY STIMULATION

Before

1. Be acquainted with the patient.2. Inform the client about the activity that you are conducting.3. Orient the client on the day itself, during the morning stretching.4. Student nurse is one responsible for bringing the patient.5. Let the patients stay in a semicircular sitting position.

During

1. Place name tags on each participant.2. Introduce yourself and state purpose and duration of the activity.3. Let the client let the patient know what to prepare and what to discuss.4. Encourage patients to participate.5. Present stimuli systematically.

After

1. Ask individuals opinion about the topic.2. Give recognition to the answers given by the patient.3. Thank the participants for coming.4. Show appreciation for the cooperation of the group.5. Do recording.

genogram, mse and sensory stimulation.docxnd sensory stimulation

Documents