VSIM Psychiatry (Mental Health)

VSIM PSYCH PART 2 00:00 You checked scene safety. It was correct to check scene safety in order to maintain your own safety. 00:06 You introduced yourself. 00:39 You asked the patient: Is it OK for your husband to be here, while we talk? The patient said: Yes. It was correct to let the patient give her consent for letting her husband be a part of the interview. 00:54 You washed your hands. 01:01 You identified the patient. 02:10 You educated about medication reconciliation. 05:16 You educated about depression. 06:15 You educated about medications. 07:51 You performed medication reconciliation. This is reasonable. 08:13 You asked if the patient had any known allergies. 08:43 You asked the patient: I would like to ask you a series of questions about how you are feeling to help me better understand how together we can start to plan your care. These are questions I ask all of the patients I see. May I ask you these questions? 09:07 The patient said: Do you think I'm getting better? You answered: Do you think you are getting better? You used the therapeutic technique of restating. 09:18 You asked the patient: Can you tell me a little bit more about what's going on with you today? It was appropriate to ask the patient what was going on with her to get an understanding of this. 09:34 The patient said: I hope to be able to take care of myself. You answered: Can you tell me one thing you can do this week that would help you to take better care of yourself? You used the therapeutic technique of exploring. 09:47 You asked the patient: Do you have energy to do the normal activities necessary to get through the day? 10:04 The patient said: What do I do if I get overwhelmed at home? You answered: What are some things you did in the past that helped when you felt overwhelmed? You used the therapeutic technique of formulating a plan of action. 10:16 You asked the patient: Tell me about any changes you have had in your sleep over the past few weeks? The patient said: I'm sleeping better, but I wake up in the middle of night and have a really hard time falling back asleep, and I still feel exhausted all the time. 10:39 You asked the patient: Approximately how many hours of sleep do you get each night? The patient said: I don't know. Lately I think about 7 hours. 10:48 You asked the patient: Do you nap during the day? If so, how often and for how long? The patient said: Now I want to nap all the time. 10:59 You asked the patient: Do you have any trouble falling asleep? The patient said: No, not usually. 11:14 You asked the patient: Do you wake up in the early hours of the morning and have trouble returning to sleep? The patient said: Yes, I do. 11:34 You asked the patient: Do you have nightmares or vivid dreams on a regular basis? The patient said: Sometimes, and I have had more the past few days. 12:41 You asked the patient: Have you had any changes in your appetite over the past month? 12:55 The patient said: When I get home, I'm going to cook a traditional dinner for my family. You answered: Are you feeling as if you have increased energy? You used the therapeutic technique of verbalizing the implied. 13:02 You asked the patient: Do you eat between meals? The patient said: Sometimes I have a snack. 13:15 You asked the patient: Have you been eating much less or much more over the past few weeks? The patient said: I have not been hungry over the past few weeks. 13:32 You asked the patient: Have you lost or gained weight over the past month? The patient said: I think I lost about 10 pounds. 13:41 You asked the patient: Do you notice that your clothes are fitting looser or tighter than they were a few weeks ago? The patient said: Yes, my pants are bigger. 14:08 You assessed the thought processes. 14:16 You observed the appearance. 14:24 You assessed the attention. 14:30 You assessed the speech. 14:36 You observed the motor activity. 15:04 You asked the patient: Do you feel alert to answer questions? The patient said: Yes, I am. 15:14 You asked the patient: Please tell me your name. The patient said: My name is Li Na Chen. 15:25 You asked the patient: Can you tell me where we are? The patient said: We are in the hospital. 15:34 You asked the patient: Please tell me what today's date is. The patient said: It is the 15th. 15:43 You asked the patient: How would you describe your mood? 15:54 The patient said: I know I'm going to do better this time around. You answered: Tell me more about that. You used the therapeutic technique of offering general leads. 16:33 You supported the patient's husband about learning more about depression triggers. 16:55 You supported the patient about participating in groups and medications. 17:21 You asked the patient: Have you lost interest in activities that you once enjoyed? The patient said: Yes. 17:30 You asked the patient: Name an activity that you enjoy. 17:44 The patient said: I can't wait until I get home so I can talk to my parents. It's been a while since I have called them. You answered: Your parents must mean a great deal to you. You used the therapeutic technique of making observations. 17:57 You supported the patient about being away from her family. 18:12 You asked the patient: Can you name the last five American presidents starting with Barack Obama and going back? The patient said: I'll give it a try. Barack Obama, George W. Bush, Bill Clinton, George H. W. Bush, Ronald Reagan. 18:35 You asked the patient: Can you tell me what you ate for breakfast? The patient said: I had some coffee and a bowl of cold cereal. 18:51 You asked the patient: Have you ever tried to harm or kill yourself? 19:06 The patient said: I'm so ashamed about what I did. I hope it does not happen again. You answered: What could you do if you find yourself becoming more depressed? You used the therapeutic technique of formulating a plan of action. 19:22 You asked the patient: Do you have any thoughts or wishes to harm or kill yourself? The patient said: No, I don't feel like I want to end my life anymore. 20:05 You supported the patient about her progress. 20:43 You educated about risk factors. 25:06 You asked the patient: Have you ever tried to harm or kill yourself? The patient said: Yes, several times. 25:23 You asked the patient: Do you think it would be better if you were not alive? The patient said: I don't think that right now. 25:36 You asked the patient: Do you have any thoughts or wishes to harm anybody else? The patient said: No. 25:47 You asked the patient: Have you ever tried to harm or kill somebody else? The patient said: No. 25:57 You asked the patient: Can you tell me what a desired outcome of treatment would be for you? 26:10 The patient said: I want to get better. You answered: Do you have any concerns now that you are leaving the hospital? You used the therapeutic technique of focusing. 26:33 You asked the patient: How do you understand your problems? 26:50 The patient said: I'm happy to be getting out of the hospital, but I'm nervous at the same time. You answered: What concerns you the most about leaving the hospital? You used the therapeutic technique of focusing. 27:29 You educated about support mechanisms. 28:27 You supported the patient about coping with stress. 28:45 You asked the patient: Do you ever see or hear things that other people do not? The patient said: No, I do not. 28:56 You asked the patient: Do you find that you worry more than others? 29:12 The patient said: There is always so much going on at home. It's not like the hospital. You answered: Tell me more about your concerns. You used the therapeutic technique of exploring. 29:29 You supported the patient's husband in his concerns for the children. 30:08 You asked the patient: Are you frightened of anything? 30:23 The patient said: I'm not sure about going to a partial hospitalization program. You answered: What are your concerns about partial hospitalization? You used the therapeutic technique of seeking information. 31:13 You supported the husband and patient about discharge. 32:16 You educated about partial discharge. 33:16 You educated about medications. 34:40 You educated about depression. 36:03 You supported the patient about coping with stress. 36:45 You educated about nonpharmalogical interventions. 37:56 You educated about sleep hygiene. 41:16 You checked the pulse oximetry. 41:33 You measured the blood pressure. 41:49 You measured the temperature. 42:04 You checked the radial pulse. 42:27 You assessed the respiration. 43:00 You asked the patient: Do you have any difficulty with your breathing? The patient said: No. 43:13 You auscultated the lung sounds. 43:33 You auscultated the heart sounds. 43:46 You asked the patient: Do you have chest pain? The patient said: No, I don't. 43:50 You asked the patient: Do you have any pain? The patient said: No, I don't have any pain. 43:54 You asked the patient: How would you rate your pain, on a scale of 0 to 10? The patient said: I don't have any pain. 45:19 You asked the patient: Have you had any changes in your appetite over the past month? The patient said: I've been able to eat more. 46:12 You checked the patient's skin. 47:11 You educated about nonpharmalogical interventions. 51:20 You submitted the Mental Status Examination form. Some of your assessment answers were incorrect.Regarding the indicator "2. Psychomotor behavior. Automatisms": You should not have checked any indications.Regarding the indicator "5. Language and speech. Indications of": You should not have checked any indications.Regarding the indicator "6. Thought content. Indications of": You should have indicated "Worries."Regarding the indicator "10. Level of interest. Anhedonia": You should have indicated "Yes." 51:36 You called the charge nurse. 52:19 You educated about sleep hygiene. 52:47 You called the provider. 53:06 You washed your hands. 53:17 You performed medication reconciliation. This is reasonable. 53:40 You washed your hands. General case considerations It is important to discuss the aftercare and patient and family education needs as the patient transitions from the inpatient hospital setting. Partial hospitalization is one option to assist patients struggling with the persistent and complicated symptoms of anxiety, depression, and suicidal ideation. Partial hospitalization offers structure, education, and continuity over a longer period of time to assist patients to further develop their coping skills as they reintegrate into everyday life. A partial hospitalization program provides more intensive treatment than is usually possible outside an inpatient mental health unit, generally 5 days per week over 6 hours (e.g., 9 am to 3 pm). These programs make use of cognitive behavioral therapies to promote healthy living and help clients manage their symptoms and develop better coping skills. As a more comprehensive approach to therapy, these programs generally include milieu therapy, counseling for both the individual and the family, and assisting individuals and families with medication management. The patient may have had success using coping strategies in the past but may have lost confidence in his or her ability to cope with stressors and feelings. It is important to discuss with the patient and the family not only stress management techniques but also triggers for behaviors or feelings that could easily set off the cascade of atrisk behaviors. Family members can encourage and support their loved one by assisting the patient to identify systematic methods for solving problems and cues that symptoms may be re-emerging. Successful use of positive problem-solving can reinforce coping strategies and facilitate the patient's confidence in his or her coping skills.