objective 4 recalling the major functions controlled by · recalling the major functions controlled...
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Objective 4
Recalling the major
functions controlled by
various areas of the brain
Cerebrum
Frontal lobes – voluntary body movement – movements that control speaking, thinking, and
judgment formation
Parietal lobes – perception & interpretation of most sensory
information – touch, pain, taste, and body position
Temporal lobes – auditory functions – short-term memory
Occipital lobes – visual reception and interpretation
Diencephalon
Thalamus
– integrates all sensory input except smell
Hypothalamus
– regulates the pituitary gland
– regulates appetite and temperature
Limbic system
– associated with fear, anxiety, anger, aggression, love, joy, hope, sexuality, and social behavior
Mesencephalon – integration of reflexes (visual, auditory,
righting)
Pons – respiration
– skeletal muscle tone
Medulla – regulates heart rate, blood pressure, and
respiration
– swallowing, sneezing, coughing, vomiting
reflexes
Cerebellum – involuntary movement, such as the
coordination/maintenance of posture
Neurotransmitters – essential functions of human emotion and
behavior
– many psychotropics work here
– categories of neurotransmitters include
cholinergics, monoamines, amino acids,
and neuropeptides
Neurotransmitters (cont’d) Cholinergics Acetylcholine
– 1st chemical to be identified as neurotransmitter – involved in disorders of motor behavior and
memory
Monoamines Norepinephrine
– fight-or-flight syndrome
Dopamine – physical activation of the body
Serotonin – levels dictate heightened or lowered sense of
arousal
Neurotransmitters (cont’d) Amino Acids
Gamma-aminobutyric acid (GABA)
– decreased levels in anxiety and movement disorders
– Huntington’s disease, epilepsy
Glutamate
– decreased receptor activity can induce psychotic behavior
Neuropeptides
Somatostatin
– low concentrations in Alzheimer’s disease
Autonomic Nervous System
Sympathetic nervous system
– dominant during stressful situations
– fight-or-flight response
– increases cardiac and respiratory activity, and decreases GI functioning
– involves acetylcholine and norephinephrine
Parasympathetic nervous system
– dominant in the nonstressful or relaxed state
– promotes efficient GI functioning
– maintains heart and respirations at resting rate
– involves acetylcholine
Objective 5
Reviewing diagnostic procedures used to detect altered brain function
Electroencephalography (EEG)
– measures brain electrical activity
– detects dysrhythmias, asymmetries, and suppression of brain rhythms
– epilepsy, metabolic disorder, degenerative disease
Computed tomographic (CT) scan
– measures accuracy of brain structure
– identifies anatomical differences
– schizophrenia, organic mental disorders, bipolar disorder
Magnetic resonance imaging (MRI)
– measures anatomical and biochemical status of various segments of the brain
– detects changes in myelination
– schizophrenia
Positron emission tomography (PET)
– measures specific brain activity and functioning
– identifies problems with blood flow, oxygen utilization, glucose metabolism, and neurotransmitter/receptor interaction
Objective 6
Discussing commonly used physiological and psychological tests utilized in evaluating the
function of the brain
Physiological Tests
Basic Metabolic Profile (BMP)
– electrolytes
– glucose
Complete Blood Chemistry (CBC)
Thyroid Panel
Urinalysis
Mental Status Examination (MSE)
Describes all areas of mental functioning:
Appearance
Mood and affect
Speech and language
Thought content
Perceptual disturbances
Insight and judgment
Sensorium
Memory and attention
General intellectual level
Objective 7
Reviewing the steps of the nursing process in the psychiatric/mental
health setting
The Nursing Process:
Provides a systematic framework for the delivery of nursing care
Consists of six steps
Uses a problem-solving approach
Accepted as nursing’s scientific methodology
Assessment = a systematic, dynamic process by which the nurse, through interaction with the client, significant others, and health care providers, collects and analyzes data about the client.
Data may include the following dimensions:
-- Physical -- Psychological
-- Sociocultural -- Spiritual
-- Functional Abilities -- Cognitive
-- Developmental -- Economic
-- Lifestyle
Diagnosis = clinical judgments about individual, family, or community responses to actual or potential health problems and/or life processes.
A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.
Outcome Identification = measurable, expected, patient-focused goals that translate into observable behaviors.
Planning = developed by the nurse and negotiated among the patient, nurse, family, and health care team; prescribes evidence-based interventions to attain expected outcomes.
Implementation = putting in place interventions identified in the plan of care.
Evaluation = the process of determining both the client’s progress toward the attainment of expected outcomes and the effectiveness of nursing care.
In the psychiatric/mental health setting –
Nursing care is always goal-directed
Nursing diagnoses are prioritized according to life-threatening potential
– Maslow’s Hierarchy of Needs
– Concept mapping
Documentation
– SOAP notes
– SBAR charting
– DAR (data/action/response)
Objective 8
Describing the nurse’s role in psychiatric evaluation
Assessment
Observation
– Thought processes
– Behaviors
1:1
– Mood scale
– Subjective data
Diagnosis (NANDA)
Evaluation
Documentation
Treatment planning
Objective 9
Examining documentation practices of the psychiatric/mental health
nurse
Problem-oriented recording (SOAPIE):
Subjective data = information gathered from what the client, family, or other source has said or reported
Objective data = information gathered by direct observation
Assessment = nurse’s interpretation of the subjective and objective data
Plan = actions/treatment to be carried out
Intervention = nursing actions actually carried out
Evaluation = assessment of the problem following nursing interventions
Focus charting (DAR and AIR):
Data = information that supports the focus or describes pertinent observations
Action = nursing actions that address the focus
Response = description of client’s response to any part of the medical or nursing care
_____________________________________
Assessment = observations about the client
Intervention = nursing actions that address the observations
Response = client’s response to actions
Objective 10
Defining the DSM-IV-TR and identifying its relevance to psychiatric nursing practice
Defining the DSM-IV-TR
The DSM-IV-TR is a handbook for mental health professionals that lists different categories of mental disorder and the criteria for diagnosing them
The manual has been revised five times since its inception
Organizes each psychiatric diagnosis into 5 levels, or axes, relating to different aspects of the disorder or disability
Relevance to Nursing Practice
Provides uniformity and consistency in psychiatric diagnoses
Groups diagnoses by characteristics according to specific criteria
Allows health care team to provide treatment based on diagnostic classification
Used by the nurse to organize patient care and determine appropriate priority psychiatric nursing diagnosis
Objective 11
Relating the Axes I-V to the classifications of
psychiatric/mental health clients
Axis I
Clinical disorders and other conditions that may be a focus of clinical attention
Includes major mental disorders
Developmental and learning disorders
Does not include personality disorders and mental retardation
Axis II
Underlying pervasive conditions or personality disorders
Mental retardation
Usually begins in childhood or adolescence and persist into adulthood
Axis III
General medical conditions
Includes current condition(s) potentially relevant to the understanding or management of the mental disorder
Axis IV
Psychosocial and environmental problems
Impacts diagnosis, treatment, and prognosis of Axis I or Axis II disorders
Relates to primary support group, social environment, education, occupation, housing, economics, access to health care services, and interaction with the legal system or crime
Axis V
Global assessment of functioning
Rates client’s overall functioning on the GAF Scale
Score on a scale of 0-100
Represents psychological, social, and occupational functioning