The Use of the Nursing Process in the Care of Psychiatric Patients se in psychiatry

n 1.What is nursing care plan? n 2.Nursing process in psychiatry. n 3.The examination of mental health patient

n A nursing care plan outlines the nursing care to be provided to a patient. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment.nursing careassessment n The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that carenursing process

Characteristics of the nursing care plan – It focuses on actions which are designed to solve or minimize the existing problem. – It is a product of a deliberate systematic process. – It relates to the future. – It is based upon identifiable health and nursing problems. – Its focus is holistic.

Elements of the plan n In the USA, the nursing care plan consists of a NANDA nursing diagnosis with related factors and subjective and objective data that support the diagnosis, nursing outcome classifications with specified outcomes (or goals) to be achieved including deadlines, and nursing intervention classifications with specified interventions.NANDAnursing diagnosis

The nursing process n Care plans are formed using the nursing process- a process by which nurses deliver care to patients. The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved.nursing process

Stages of nursing procese: n Assessment (of patient's needs) n Diagnosis (of human response needs that nursing can assist with) n Planning (of patient's care) n Implementation (of care) n Evaluation (of the success of the implemented care)

When patients enter the office... n pay close attention to their personal grooming. n establish adequate rapport with the patient by introducing himself or herself.

PATIENT HISTORY: Identifying data n name(or what name they prefer to be called) n marital status n occupation n religious belief n living circumstance. n sex n race

Chief complaint n "What brings you here today?"

History of present illness n This is the main part of the interview because there are no specific elements that will lead to the diagnosis and ultimately treatment besides the interview. An exact history allows one to gather basic information along with specific symptoms including timing in the patient's life to allow the healthcare provider to take care of the whole patient.

History of present illness n LISTENING

n Past medical history n Past surgical history n Medication n Allergies n Past psychiatric history n Family history n Social history n Perinatal and developmental history n Assets

Mental Status Examination n Appearance n Attitude toward the examiner n Mood n Affect;Speech n Thought process n Thought content n Insight n Impulsivity n Reliability

Appearance n Recall how the patient first appeared, n Note:1. whether this posture has changed, 2.whether the patient appears more relaxed,3. whether the patient has maintained eye contact 4. has avoided eye contact,5. whether the patient still seems nervous.

Attitude toward the examiner n patient's facial expressions and attitude, n the patient appeared interested, n the patient appeared bored, n the patient is hostile and defensive, n the patient is friendly and cooperative, n the patient seems guarded, n the patient seems relaxed, n the patient seems uncomfortable.

Mood n is defined as "sustained emotion that the patient is experiencing.» n Ask questions such as "How do you feel most days?". n Helpful answers : "depressed," "anxious," "good," and "tired." n Less helpful: "OK," "rough," and "don't know."

Affect n defined in the following terms: expansive (contagious), euthymic (normal), constricted (limited variation), blunted (minimal variation), and flat (no variation). n A patient whose mood could be defined as expansive may be so cheerfucheerful and full of laughter that it is difficult to refrain from smiling while conducting the interview.

Speech n quality, n quantity, n rate, n volume, n how fast or slow they are speaking.

Thought process n looseness of association (irrelevance), n flight of ideas (change topics), n racing (rapid thoughts), n tangential (departure from topic with no return), n circumstantial (being vague, ie, “beating around the bush”), n word salad (nonsensical responses, ie, jabberwocky), n derailment (extreme irrelevance), n neologism (creating new words),

Thought process n clanging (rhyming words), n punning (talking in riddles), n thought blocking (speech is halted), n poverty (limited content).

Thought content n Hallucinations: "Do you hear voices when no one else is around?” n Delusions: ”Do you have any special powers or abilities?" n Obsessions or compulsions: "Are you afraid of dirt? n Phobias: "Do you have any fears, including fear of animals, needles, heights, snakes, public speaking, or crowds?"

Thought content n Suicidal ideation or intent: "Do you have any thoughts that you would be better off dead?» n Homicidal ideation or intent: "Do you have any thoughts of wanting to hurt anyone?" n Orientation:. "What is your full name?" n Visuospatial ability: Have the patient draw interlocking pentagons in order to determine constructional apraxia.

Thought content n Concentration and attention: Ask the patient to subtract 7 from 100, then to repeat the task from that response. This is known as "serial 7s.” Next, ask the patient to spell the word world forward and backward. n Reading and writing: Ask the patient to write a simple sentence (noun/verb). Then, ask patient to read a sentence (eg, "Close your eyes.").

Thought content n Memory: "What was the name of your first grade teacher?» n Abstract thought: "Don't cry over spilled milk" (good response is "don't get upset over the little things"; poor response is "spilling milk is bad"). n General fund of knowledge: “List 5 major US cities."

Thought content n Consciousness: levels of consciousness: (1) coma, characterized by unresponsiveness; (2) stuporous, characterized by response to pain; (3) lethargic, characterized by drowsiness; (4) alert, characterized by full awareness. n Intelligence: estimate the patient's intelligence quotient (ie, below average, average, above average).

Folstein Mini-Mental State Examination

Insight n Assess the patients' understanding of the illness.

Judgment n "What would you do if you smelled smoke in a crowded theater?

Impulsivity n Estimate the degree of the patient's impulse control. Ask the patient about doing things without thinking or planning. Ask about hobbies such as coin collecting, golf, skydiving, or rock climbing.

Reliability n seems reliable, n difficult to determine, n seems "unreliable."

Conclusions n 1. Nursing care plan proclaimes the nursing care to be provided to a patient.nursing care n 2. Nursing process- a process by which nurses deliver care to patientursing process n 3.The examination of mental health patient