Model Answers to Questions for Mental Nurses
by Hector MacPhail 1928 [Second edition 1932 - Reissued as two volumes in 1940. These extracts from Mental Nursing Final Examination Questions and Answers, with a Forward dated 1944. The Forward welcomes the second edition and says "The contents have been slightly revised".]
1: Enumerate the methods by which patients may be artificially fed.
Describe fully the apparatus and feed used. Give the method of
administration in one of these feeds.
6:
What poisons and infections are liable to produce insanity?
30: In what cases may suicidal attempts be made? How do they arise, and how
do you guard against them?
[This was in the May 1902 paper]
32: What precautions would you take to prevent the escape of patients?
34: Describe a nurses's duties in
supervising a continuous bath. For what type of patient is it
used?
48: What is hydrotherapy? Write what you
know regarding this form of treatment
51:
Describe amentia and enumerate the different varieties
66:
What causes are recognized as important in the occurrence of
mental illness?
68:
What do you mean by 'heredity,' and what influence has it on mental
disease?
104: If in charge of a shopping walk, how would you act if a patient
escaped?
QUESTION No. 6
ANSWER
Drugs: alcohol; belladonna; cannabis indica; chloral; cocaine, and
other habit-producing drugs.
Trade Poisons, such as lead and arsenic.
Toxaemia from Acute Infections, such as puerperal fever, influenza,
typhoid, typhus, scarlet fever, and pneumonia.
Systemic Diseases, such as
phthisis, cancer, uraemia, diabetes, and intestinal toxaemia.
Diseases Produced by Micro-organisms, of which
syphilis is the most important.
ANSWER
Digestive Disorders. - These may be partly due to diminished
secretion of saliva, and inability to swallow it owing to diminished
pharyngeal reflexes, or they may be due to interference with the secretions
of internally secreting glands.
Constipation occurs in most cases of indigestion, in cases of acute mental
disorder, and especially in melancholia.
Cardio-vascular Disease. - The mental condition may be one of
excitement and nocturnal restlessness, a tendency to depression; or it may
be agitation, restlessness, apprehension, and severe excitement may occur.
Diabetes. - This disease is often accompanied by agitation,
irritability, and depression, or the patient may become much confused.
Dysentery. - The causal organism is commonly found in the faeces of
acute cases; old, demented, and degraded patients are especially liable to
contract and transmit the infection.
Gout. - The patient during the attack suffers from marked depression
and morning irritability.
Menstrual Irregularities, of which amenorrhcea is common in mental
disorders, conduce towards irritability, impulsiveness, and peevishness.
Bright's Disease. - Depression often occurs in the chronic form of
this diseases.
Uraemia. - This disease may be accompanied by confusion, acute
excitement, hallucinations, occupation delirium, or convulsions.
Syphilis. - This disease may be connected with mental
disorder in
many ways.
Pulmonary Tuberculosis. - In the terminal stages of
this disease there is usually marked depression with suicidal tendencies.
Myxcedema. - In this disease there is dullness and slowness of
intelligence; the emotional reaction and memory are defective. The mental
symptoms may be more marked, when there may be delusions and
hallucinations, or even mania.
Exophthalmic Goitre.-The patient suffers from undue apprehension,
irritability, and fears which may be obsessional in their vividness and
intermittence; restlessness may progress to acute mania, and death may be
due to profound exhaustion from toxaemia.
Acromegaly. - In this disease there is often irritability, marked
depression, and progressive dementia.
Addison's Disease. - Depression, irritability, and signs of
exhaustion occur in this disease.
ANSWER
1. A nurses's duties are to:-
Obtain from the Medical Officer exact instructions as to temperature
and duration of the bath.
Prepare the bath and have everything ready before disturbing the
paptient.
Attend to the patient's bowels and bladder before he enters the bath.
See that warm blankets and towels are at hand. See that a folded
blanket is placed at the bottom of the bath, that the patient is placed in
a reclining position with the feet towards the tap end of the bath, and
that a comfortable support is arranged for the patient's head.
Remember that the temperature of the bath is usually about 98 [degrees]
F., that the temperature must be maintained evenly throughout the duration
of the bath by the addition of hot water, and that great care is necessary
in adding hot water.
Bear in mind that the temperature of the bath should always be tested
by a bath thermometer, and that the water should be moved about with the
hand, so as to keep the temperature of the whole as even as possible.
Remember that the patient should lie immersed in the bath for half an
hour the first day, one hour the second day, two hours the third day, three
hours the fourth day, and so on up till six or seven hours or longer,
according to the doctor's orders.
Use tact - should the patient become restless - to keep him quiet
during the treatment.
Remember that this is an exhausting method of treatment which may
induce headache, fainting or prostration, and that this may be guarded
against by applying to the head a cloth wrung out of cold water and by
giving an extra supply of nourishment during the treatment in the form of
beef-tea, milk or cocoa with biscuits.
Watch carefully for adverse symptoms, such as the pulse becoming weak
and irregular and the face cyanosed.
Act promptly on observing signs of fainting by running off the water
immediately, and then cover the patient with blankets, lifting him out and
on to a bed when his condition improves. Remember that when the patient is
immersed for a. long period it may be necessary for him to pass all his
emunctories in the bath, and that such necessitates lifting the patient out
and renewing the bath.
Dry the patient quickly and thoroughly with a couple of
towels after remaining in the bath for the prescribed period, and then put
to bed in a warm nightdress.
See that the bath is left clean and dry and that the bathroom is in a
tidy condition.
ANSWER
...
The Warm Bath is essentially the cleansing bath. It stimulates the
skin to proper elimination, removes waste matter from the body surface,
relieves fatigue by relaxation of the muscles, and produces a sedative
effect if prolonged. Owing to its sedative effect the ideal time is just
before bed-time.
Prolonged Bath. See Question
No. 34.
Cold Bath. Its chief effect is the reaction produced by the sudden
sensation of cold. It stimulates the general circulation and produces a
sudden stimulation of metabolism. The reaction should be promoted by
vigorous rubbing with a dry towel.
It is also used for the reduction of fever.
A cold bath should not be taken at night, nor for at least two hours after
a meal, and should never be administered until the patient's physical
condition has been determined by examination.
Cold Pack is used to reduce fever; to act as a circulatory
stimulant, a sedative to the nervous system, to allay nervous irritability,
lessen delirium and induce sleep.
It may be contra-indicated on account of the feeble condition, or the
mental effect upon the patient, e.g., the patient may believe that the
process of wrapping him in a sheet is a preparation for his burial.
Hot Pack is usually used to induce copious perspiration and acid
excretion in certain kidney diseases.
It may be used to subdue excitement of a violent character.
The wet pack has rather gone out of fashion, because there was reason to
believe that some patients regarded it as a punitive measure.
The Needle Spray. It stimulates the sensory nerves of the skin
mechanically by its weight apart from its temperature.
It serves as a beneficial stimulus in stuporous conditions.
The Cold Shower is valuable for its tonic effect, and is sometimes
given daily to patients suffering from states of stupor, so as to overcome
certain resistance in the nervous system.
Cold, Tepid or Hot Sponging may be used to reduce a persistently
high temperature, and is useful in allaying restlessness and producing
sleep.
Sitz Bath is one in which the patient sits in a special tub -
usually for 12 minutes - so that the abdomen and thighs are immersed in
water and the feet on the floor.
Its uses are:
Turkish Bath. - It produces a soothing and refreshing experience,
but it may produce temporary violent fluctuation of the blood-pressure and
should not be taken oftener than once a week.
It has not been found efficacious in the treatment of mental cases.
Electric Baths of various kinds are sometimes given to mental
patients, and are said to be found of especial benefit in the treatment of
stuporous cases, and some cases of dementia praecox.
Supervision is of the utmost importance, and the strictest attention must
be paid to the details of administration. Whether the patient is in a bath
for the purpose of cleansing or treatment or in a 'wet pack,' he must never
be left. The prolonged bath, however tedious the watch, and however quiet
the patient, demands the constant care of the nurse.
ANSWER
Mental deficiency is a state of mental defect dating from birth or arising
in such early childhood that the individuals never develop a normal mind,
but remain for ever mentally deficient.
Some authorities state that mental deficiency runs in families
independently of insanity, that it has special features of its own, and
that actual insanity has nothing to do with it; while others maintain that
mental deficiency arises in the offspring of families saturated with
insanity. Neuropathic heredity is regarded by many as the most frequent
cause.
The physical characteristics consist for the most part of
stigmata of
degeneration, such as deformed ears, exceptionally large or
small ears,
unduly narrow or broad palates, receding or prominent chins or brows,
abnormally large or small skulls, misshapen limbs, with webbed or
supernumerary fingers or toes.
Briefly the general mental characteristics are:-
Inability to attend and easily distracted.
Lack of the faculty of forming judgments and concepts.
Failure to profit by past experience and inability to plan the future.
Unusually poor memory for such things as are taught at school, or
hypermnesia which is limited in range.
Emotional instability which is liable to be shown in impulsive outbursts of
violence or screaming.
Inability to understand the real difference between right and wrong.
Some are capable of being guided by the fear of punishment rather than by a
desire to act correctly.
Some are persistently obnoxious and intractable; others are amenable and
capable of a certain degree of affection.
Three degrees of mental deficiency are recognized in the
Mental Deficiency
Act, 1913, in addition to moral imbecility:
a. Idiots.- Persons so deeply defective in mind from birth or from an early
age as to be unable to guard themselves against common physical dangers.
The mentality of an idiot is considered to be that of a child of three
years or under.
b. Imbeciles.- Persons in whose case there exists from birth or from an
early age, mental defectiveness not amounting to idiocy, yet so pronounced
that they are incapable of managing themselves or their affairs, or, in the
case of children, being taught to do so. The mentality is that of a child
between the age of three and seven.
c. Feeble-minded Persons.-Persons in whose case there exists from birth or
from an early age, mental defectiveness, yet so pronounced that they
require care, supervision, and control, for their own protection or for the
protection of others, or in the case of children, that they by reason of
defectiveness appear to be permanently incapable of receiving proper
benefit from instruction in ordinary schools. The mentality of an adult is
that of a child between the age of twelve and fifteen years.
Moral Imbecile. - The moral defect may be associated with normal
intelligence, so that moral imbecility is not an
intellectual defect in the ordinary sense and does not come within the
category of amentia.
The following special varieties (which include most cases) are based on the
cause of the mental deficiency or on some associated character:-
a. Genetous Idiots, or imbeciles or morons. - The disease process in the
brain occurred in those cases before birth.
b. Mongolian Idiots. - These are so named because they bear facial
resemblance to normal members of the Mongolian race.
c. Epileptic Idiocy. - This is due to epilepsy beginning in early life.
d. Paralytic Idiocy. - This is associated with paralysis brought about
through injury to the brain at birth.
e. Cretinism. - This is due to defective secretion of the thyroid gland,
which is unduly small in children so affected. The condition becomes
apparent, as a rule, between six and seven months and the second year.
f. Inflammatory Idiocy. - This is ascribed to infections of the central
nervous system, such as encephalitis and meningitis.
g. Idiocy by Deprivation. - This is due to concurrent blindness and
deafness. Thus the individual is deprived of the senses by means of which
he may learn.
h. Microcephalic Idiocy. - This is due to smallness and insufficient growth
of the brain, the skull being usually less than 17 in. in circumference.
i. Hydrocephalic Idiocy. - This is due to the brain being distended with
cerebrospinal fluid.
j. Syphilitic Idiocy. - A special variety used to be attributed to
syphilis, but it has now been discovered that nearly 50 per cent of mental
deficiency is probably due to this cause.
...
QUESTION No. 66
ANSWER
The following factors are recognized as important in the causation of
mental illness.
Hereditary predisposition towards the disease. See
Question No. 68.
Age of the individual, and the physical and mental stress incidental to the
different periods of life, i.e., stresses accompanying the physical or
mental adjustments at puberty, in connection with the menstrual functions
and child-birth, at the menopause; and during the involutional and senile
period.
Effects of Physical Disease, impairing the nutrition and metabolism of the
brain, through alteration in the blood supply, e.g., cardiac and
respiratory disease, or toxins of various kinds - uraemia, diabetes,
alcohol, trade poisons - such as lead and microbial infection_which act
injuriously on the nervous system.
Disease of the Central Nervous System, e.g., vascular degeneration,
cerebral tumour, abscesses, meningitis,
cerebral haemorrhage, embolism and thrombosis, all of which may give rise
to mental symptoms.
Trauma or Head Injury may be followed by mental symptoms, as the result of
actual damage to the brain, or by precipitating the onset in a predisposed
individual.
Syphilis may be associated with mental disorders in various ways.
Disease of the Endocrine System. - The thyroid and pituitary disorders may
cause mental symptoms.
Effect of Special Experience._Mental stresses due to unpleasant
experiences; such as fright, exposure to danger, bereavement, business
worries, love affairs and nervous shocks:-
Over-Education._Hard study in the case of a person of unstable nervous
constitution, when it leads to insufficiency of sleep is bound to have a
deleterious influence.
QUESTION No. 68
ANSWER
1) Heredity is the transmission of qualities of like kind with those of
parents or ancestors to their offspring.
The material basis of inheritance in all ordinary cases of sexual
reproduction is the union of the reproductive cells of the female (ova) and
the reproductive cells of the male (spermatozoa).
When the ova are fertilized by the spermatozoa, the physical
characteristics of both parental families are mingled and the inheriting
must be dual.
There is a complete hereditary equipment of paternal origin and another of
maternal origin, and these form the warp and woof of the organism, though
it does not follow that both will be equally expressed. The offspring may
exhibit an intimate mixture of the characters of its two parents.
It frequently happens that an hereditable characteristic of a parent is
unexpressed in the development of the offspring but reappears in the third
generation.
It should be remembered that all that is inherited is a predisposition
towards the disease, and not the mental disease itself. Bacterial disease,
such as tuberculosis, cannot from its very nature be transmitted as such,
yet constitutional predisposition towards tuberculosis is certainly
hereditable.
The offspring of near relations tend to inherit the characteristics of both
parents in an exaggerated form, but there is no evidence that the children
of near relations (such as first cousins) are specially predisposed to
insanity, if both stocks are healthy.
Hereditary influence is said to be:-
a. Direct when the father of the patient has been mentally afflicted.
b. Collateral when mental disease appears only amongst brothers, sisters,
cousins, aunts, and uncles of the patient.
c. Atavistic or Reversive when any of the ancestors but not the patient's
parents have been mentally afflicted; this means skipping a generation.
d. Similar when the inherited mental disease is of the same type, in
members of the same family.
e. Dissimilar when the mental disorders in a family bear little resemblance
to the diseases of the ancestors.
Hereditary influence may be antedating in character, that is, the
appearance of the mental disorder at an earlier age in the offspring than
in the parents; thus a parent who develops manic-depressive insanity at the
age of thirty years, may beget a child who develops dementia praecox at the
age of puberty.
2. Among the general predisposing causes of insanity, heredity is
undoubtedly the first in importance, and there seems little doubt that
nervous disorders have their roots in some germinal defect and are
therefore in various degrees transmissible.
In the case of female mammals it is improbable that a seriously impaired
nervous system will admit of normal nutrition of the foetus, and thus a
nervous disorder due to arrest of development may reappear in the
offspring.
It is generally believed that a father is more likely to pass his mental
abnormalities on to his daughters, and a mother to her sons; the insanity
of the mother, however, is considered more dangerous.
Andrew Roberts likes to hear from users:
What poisons and infections are liable to produce insanity ?
The following poisons and infections are liable to produce insanity:
QUESTION No. 7
What are the common bodily derangements met with in mental disorders,
and what are the mental symptoms with which they are associated?
QUESTION No. 34
Describe a nurses's duties in supervising a continuous bath.
For what type of patient is it used?
QUESTION No. 48
What is hydrotherapy? Write what you know regarding this form of
treatment
To relieve congestion of the pelvic organs.
A remedy for retention of urine.
To relieve tenesmus.
To induce menstruation and relieve dysmenorrhoea.
To relieve painful haemorrhoids.
QUESTION No. 51
Describe
amentia, and
enumerate the different varieties
The term 'amentia' literally means absence of mind This term is now
applied to mental deficiency.
What causes are recognized as important in the occurrence of
mental illness?
What do you mean by 'heredity,' and what influence has it on mental
disease?
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hydrotherapy 34 - 48