fear being poisoned and refuse medications or food. Religious delusions can also occur where the patient may feel persecuted by demons or may be very excited about a special relationship with God or with angels. Careful assessment by the healthcare provider is important to determine a patient’s baseline religious beliefs so as not to label a thought as delusional when it is a well-accepted belief for the patient. Somatic delusions are uncomfortable beliefs that there is something wrong with one’s body (Boyd, 2018). For example, some patients may believe that their bowels are necrotic or dead or may believe that their brain is missing. Other delusions may exist such as a belief that aliens are broadcasting signals, or a belief that loved ones have been replaced by clones. It is always essential to determine what feelings are elicited in the patient because of the delusional thoughts. Paranoid thoughts will drive fear and fight-or-flight responses. The patient may set up protective traps around the home to prevent others from entering. Religious delusions may be pleasant and make the patient feel special, or they may be so persecutory that the patient becomes depressed and suicidal. Somatic delusions can lead to excess visits to healthcare providers and may result in the label of “hypochondriac” for the patient. Ideas of reference can also occur in which the patient may believe that all events in the environment are related to or about them (Boyd, 2018). Patients experiencing ideas of reference may believe that, when in a group setting, others are talking about or ridiculing them (Boyd, 2018). Sometimes, ideas of reference are associated with grandiosity, or the belief that one is especially important or powerful (Boyd, 2018). An elderly homemaker who suddenly believes herself to be the next Marilyn Monroe may be experiencing grandiosity. Grandiose patients attempt to convince others of their importance and may present with perceived rude or arrogant behavior patterns. 2018). A simple test of recall is to give the patient three items to remember and then 5 minutes later ask the patient to state those items. Immediate recall can be quickly determined by asking what a patient consumed for breakfast. Recent memory is recall of one to several days. Questions regarding family members’ names or place of residence help assess recent memory. Remote memory is recalled from several days to a lifetime. Asking patients where they grew up, what their parents’ names were, or where they went to school readily provides this information. Memory assessments help in differentiating a thought disorder from a dementia disorder. Patients with a primary psychiatric disturbance may be delusional in their beliefs but extremely accurate in memory and recital of facts and dates. A patient with early dementia may lose some short-term memory first, progressing to the loss of immediate recall, then finally to long- term memory loss (Boyd, 2018). Orientation means that patients are aware of who they are (person), where they are now (place), the approximate time and date (time), and awareness of the circumstances (situation). A disoriented person may be suffering from a cognitive disorder, drug or alcohol use or withdrawal, or several physical or psychological health problems. about barriers to treatment, such as financial constraints or concerns regarding health insurance. The stigma of having a psychiatric diagnosis may lead the patient to feel ashamed or angry. Anger may be causing the patient to intentionally deny and refuse adequate treatment. Hidden motivations, such as the defense mechanisms may also have a significant impact on the patient.
are thoughts that seem stuck in the patient’s mind. An obsessive patient may have ruminative thoughts that may be unusual, such as a desire to check the door repeatedly to ensure it is locked or the belief that germs may be everywhere. Obsessive thoughts will often lead to compulsive behaviors – such as ritualized handwashing – in part as an attempt to relieve intrusive thoughts and their accompanying anxiety. The nurse’s role is to help the patient understand that these thought processes are irrational. Thought content problems are of essential importance. Hallucinations are false sensory perceptions (Boyd, 2018). Auditory, visual, olfactory, gustatory, or tactile symptoms may be present. Auditory hallucinations, such as hearing voices, are the most common in psychiatric disorders (Boyd, 2018). Visual hallucinations are false visual perceptions, such as seeing people who are not present. Patients can also experience a tactile hallucination, known as a false perception of touch (Boyd, 2018). Tactile hallucinations can present as “hands touching me” or “bugs crawling on me” and can exist with psychological or medical conditions such as withdrawal. When caring for a patient experiencing hallucinations, it is important to remember that the brain perceives the reported sensation, meaning that to the patient, it is very real. It is important for the nurse to address hallucinations with the patient; however, nursing judgment on how to therapeutically address them is critical. Initially, pointing out that the hallucination does not exist may jeopardize the development of a secure nurse-patient relationship; however, rationalizing with and helping the patient reason are important elements in the progression of treatment. Delusions are fixed false beliefs (Boyd, 2018). The patient experiencing a delusion is certain that something is true, even when there is no substantiating evidence to prove the belief. Paranoid patients may be frightened as they often believe they are being watched, monitored, or spied upon by others. These individuals may report cars following them or mysterious phone calls late at night. Occasionally, a patient with paranoia may Cognition and memory Cognitive abilities are the elements of thinking that determine attention, concentration, perception, reasoning, intellect, and memory (Boyd, 2018). Attention span is particularly important in evaluating the mental status because a decreased attention span often limits comprehension. Decreased concentration levels and distractibility may occur in patients with disorders that affect attention, as well as for those with depression and other mental health concerns. The nurse can assess the patient’s perception by asking open- ended questions that encourage description, such as “What makes you feel anxious?” (Boyd, 2018). Intellect is assessed through clinical assessment as well as intelligence testing (American Psychiatric Association, 2020). Intelligence quotients (IQs), as well as cognitive, social, and psychomotor capabilities, are assessed to determine intellectual function. Intellectual disabilities are categorized as mild, moderate, severe, or profound. Although IQ scores can serve as a parameter for these categories, the level of severity is determined by adaptive functioning (American Psychiatric Association, 2020). An assessment of memory consists of three basic parts: immediate recall, recent memory, and remote memory (Boyd, Insight and motivation Insight refers to patients that demonstrate understanding of their illness and the steps necessary to treat or manage the illness. The determination of a patient’s level of insight is often associated with treatment adherence. The goal is that understanding leads to adherence. Occasionally, nurses encounter patients who demonstrate good insight and knowledge, but continue to display nonadherence to recommended treatments. Nurses should ask these patients
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Book Code: ANCCUS3023
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