CEBU DOCTORS UNIVERSITYCOLLEGE OF NURSING NCM 105 RLE 1

Genogram,
Mental Status Examination, And Sensory Stimulation
Submitted to:
Ms. Ricci Zolayvar

07.04.12
Submitted by:
Ms. Hernani, Mary Jean Ms. Into, Jayfein Mae Ms. Jose, Joyce Dianne Ms. Lasala, Jazmin Venice

BSN 3-C

GENOGRAM
Objectives: After 5 hours of classroom activities, the level III students will be able to: 1. define the ff. terms 1.1 Family 1.2 Nuclear family 1.3 Extended family 1.4 Multigenerational Family 1.5 Generation 1.6 Genogram

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.

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 and consisting 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 geographic proximity 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.

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 show marriages 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.

IV. THE SYMBOLS IN MAKING A GENOGRAM

Intimate

Friends/ close

V. GUIDELINES IN MAKING A GENOGRAM

1. Gather the needed information such as names of all persons to be included in your genogram, 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 the symbol. 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 with two 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 the oldest 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 mark 7. 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-male relationship 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 people 11. Dates of events(day , month, year) appear next to the appropriate symbols 12. Indicate the occupation of the middle generation.

MENTAL STATUS EXAMINATION

Objectives: After 5 hours of varied learning experience, the level III students will be able to: 1. define the following terms: 1.1 Mental Status Examination 1.2 Cognition 1.3 Coma 1.4 Delusion 1.5 Dementia 1.6 Hallucination 1.7 Catatonia 1.8 Illusion 1.9 Obsession 1.10 Assessment 1.11 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

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

III. CATEGORIES TO BE EXPLORED DURING MENTAL STATUS EXAMINATION

1. Appearance The clients overall appearance, including dress, hygiene, grooming as well as the dominant attitude presented before, during and after the interview. Possible questions: Is the client appropriately dressed for his or her age and the weather? 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, and any unusual movements and positions such as tics or tremors. He or she documents observations and examples of behaviours to avoid personal judgement or misinterpretation. Specific terms used in making assessments of general appearance and motor behaviour 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 talking about 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?

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 features recorded 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 or concerns 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 formal education could hinder performance in many tasks. The nurse also may assess the clients intellectual functioning by asking him or her to identify the similarities between pairs of objects. 9. Insight It is the ability to understand the true nature of ones situation and accept some personal responsibility for that situation.

 The nurse frequently can infer insight from the clients ability to describe realistically the strengths and weaknesses of his or her behaviour. 10. Judgment Refers to the ability to interpret ones environment and situation correctly and to adapt ones behaviour and decisions accordingly. Problems may be seen if the client describes recent behaviour and activities that reflect 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 and integration 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 asking questions 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 information storage may last from hours to a lifetime.

I. DEFINITION OF TERMS
1.1 Mental Status Examination The mental status examination is an essential tool that aids physicians in making psychiatric diagnoses. The mental status examination includes historic report from the patient and observational data gathered by the physician throughout the patient encounter. It composes of specific questions and methods to assess the patient's appearance 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 of injury, 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 a symptom of mental illness. 1.5 Dementia A deterioration of intellectual faculties, such as memory, concentration, and judgment, resulting from an organic disease or a disorder of the brain. It is sometimes accompanied by emotional disturbance and personality changes.

1.6 Hallucination It is the perception of visual, auditory, tactile, olfactory, or gustatory experiences without 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 HALLUCINATION o VISUAL The most common modality referred to when people speak of hallucinations. 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 reported cases 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 also classified under this type of hallucination.

1.7 Catatonia An abnormal condition variously characterized by stupor, stereotypy, mania, and either 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 in some way in the mind of the perceiver 1.9 Obsession It is a compulsive preoccupation with a fixed idea or an unwanted feeling or emotion, often accompanied by symptoms of anxiety. 1.10 Assessment It is an examiner's evaluation of the disease or condition based on the patient's subjective 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 the articulation of words. 1.12 Mood It is a pervasive and sustained emotion that, when extreme, can color one's whole 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 mental representations of objects.

 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 the interview (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 is coming forth from the patient. o Lability can be thought of as of rapid, extreme, brief swings of emotion followed 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 for the 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 is congruent 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.

1.14 Appearance It is the outward or visible aspect of a person or thing; therefore, it is an objective cue 1.15 Behavior It is the actions or reactions of a person or animal in response to external or internal stimuli. It is simply the manner of which one behaves. 1.16 Perception It is the recognition and interpretation of sensory stimuli based chiefly on memory. It is the neurological processes by which such recognition and interpretation are affected.

II. IMPORTANCE OF MENTAL STATUS EXAMINATION

It serves as a snapshot 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.

SENSORY STIMULATION
Objectives: After 5 hours of varied learning experience, the level III students will be able to: 1. Define the following terms: 1.1 Sensory stimulation 1.2 Therapist 1.3 Client 1.4 Visual aid 1.5 Hallucination 1.6 Illusion 1.7 Delusion 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.

I. DEFINITION OF TERMS
1. Sensory Stimulation
-

It is a form of psychotherapy aiming to test a persons sense of awareness on utilizing the 5 senses. It requires stimulating the senses can have a positive effect on learning as well as emotional and social growth.

2. Therapist A person who conducts an activity usually to treat a bodily or mental behavior. One trained in methods of treatment and rehabilitation other than the use of drugs or surgery.

3. Client A person who is the recipient of a professional service outside a medical health care facility.

4. Visual Aids Materials needed by the therapist to enhance learning process. It is any object or picture that relates to the subject being taught. Posters, pictures, or even the object itself can be used to help teach.

5. Hallucination A false sensory perception or perceptual experiences that do not exist. A profound distortion in a person's perception 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.

7. Delusion Fixed false belief with no basis in reality A false belief regarding the self or persons 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.

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 eye sight. 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

V. GUIDELINES IN SENSORY STIMULATION

1. 2. 3. 4. Create a quiet, comfortable environment. Face the individual, introduce self and activity. Present an stimulus. 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. 2. 3. 4. 5. During 1. 2. 3. 4. 5. After 1. 2. 3. 4. 5. Ask individuals opinion about the topic. Give recognition to the answers given by the patient. Thank the participants for coming. Show appreciation for the cooperation of the group. Do recording. Place name tags on each participant. Introduce yourself and state purpose and duration of the activity. Let the client let the patient know what to prepare and what to discuss. Encourage patients to participate. Present stimuli systematically. Be acquainted with the patient. Inform the client about the activity that you are conducting. Orient the client on the day itself, during the morning stretching. Student nurse is one responsible for bringing the patient. Let the patients stay in a semicircular sitting position.