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