ATI Mental Health Study Set

Withdrawals from Opioids are?

-Abstinence syndrome begins with sweating and rhinorrhea progressing to piloerection (gooseflesh), tremors, and irritability followed by severe weakness, diarrhea, fever, insomnia, pupil dilation, nausea and vomiting, pain in the muscles and bones, and muscle spasms. -Withdrawal is very unpleasant but not life‑threatening.

Bipolar disorder phases?

-Acute phase -Continuation phase -Maintenance phase

Cluster B (Dramatic, emotional, or erratic traits)

-Antisocial -Borderline -Histrionic -Narcissistic

Cluster C (Anxious or fearful traits; insecurity and inadequacy)

-Avoidant -Dependent -Obsessive-compulsive

Behavioral therapy

-Behavioral therapy is based on the theory that behavior is learned and has consequences. Abnormal behavior results from an attempt to avoid painful feelings. Changing abnormal or maladaptive behavior can occur without the need for insight into the underlying cause of the behavior. -Behavioral therapies teach clients ways to decrease anxiety or avoidant behavior and give clients an opportunity to practice techniques. Behavioral therapy teaches activities to help the client reduce anxious and avoidant behavior like relaxation training and modeling.

What are the types of Bipolar Disorders

-Bipolar 1 disorder -Bipolar 2 disorder -Cyclothymic disorder

What can alcohol and substance abuse disrupt in the body? (Systems)

-Blackout or loss of consciousness -Changes in bowel movements -Weight loss or weight gain -Experience of stressful situation -Sleep problems -Chronic pain -Concern over substance use -Cutting down on consumption or behavior

Withdrawal effects of caffeine are?

-Can occur within 24 hr of last consumption -Headache, nausea, vomiting, muscle pain, irritability, inability to focus, drowsiness

What are some strategies that we as nurses can use for someone experiencing a crises to help decrease their anxiety?

-Develop a therapeutic nurse‑client relationship. -Remain with the client. -Listen and observe. -Make eye contact. -Ask questions related to the client's feelings. -Ask questions related to the event. -Demonstrate genuineness and caring. -Communicate clearly and, if needed, with clear directives. -Avoid false reassurance and other non-therapeutic responses

Intended effects of cannabis?

-Euphoria -sedation -hallucinations -decrease of nausea and vomiting secondary to chemotherapy -management of chronic pain

Common crisis characteristics

-Experiencing a sudden event with little or no time toprepare -Perception of the event as overwhelming or life‑threatening -Loss or decrease in communication with significant others -Sense of displacement from the familiar -An actual or perceived loss

Examples of Torts:

-False imprisonment -Assault -Battery

Depressive Charateristics

-Flat, blunted, labile affect -Tearfulness, crying -Lack of energy -Anhedonia: loss of pleasure and lack of interest in activities, hobbies, sexual activity -Physical reports of discomfort/pain -Difficulty concentrating, focusing, problem‑solving -Self‑destructive behavior, including suicidal ideation -Decrease in personal hygiene -Loss or increase in appetite and/or sleep, disturbed sleep -Psychomotor retardation or agitation

Sedatives hypnotics and anxiolytics have what type of intoxication effects?

-Increased drowsiness and sedation, agitation, slurred speech, uncoordinated motor activity, nystagmus, disorientation, nausea, vomiting -Respiratory depression and decreased level of consciousness, which can be fatal -An antidote, flumazenil, available for IV use for benzodiazepine toxicity -No antidote to reverse barbiturate toxicity

Personality disorder characteristics are?

-Inflexibility/maladaptive responses to stress -Compulsiveness and lack of social restraint -Inability to emotionally connect in social and professional relationships -Tendency to provoke interpersonal conflict -Ability to merge personal boundaries with others

Manic Characteristics

-Labile mood with euphoria -Agitation and irritability -Restlessness -Dislike of interference and intolerance of criticism -Increase in talking and activity -Flight of ideas: rapid, continuous speech with sudden and frequent topic change -Grandiose view of self and abilities (grandiosity) -Impulsivity: spending money, giving away money or possessions -Demanding and manipulative behavior -Distractibility and decreased attention span -Poor judgment -Attention‑seeking behavior: flashy dress and makeup, inappropriate behavior -Impairment in social and occupational functioning -Decreased sleep -Neglect of ADLs, including nutrition and hydration -Possible presence of delusions and hallucinations -Denial of illness

What are some nursing actions to consider when providing care for someone with bipolar disorder

-prevent client self-harm -decrease client's physical activity -ensure adequate fluid and food intake -promote an adequate amount of sleep each night -assist the client with self-care needs -manage medication appropriately

Medications for PDs are?

-psychotropic agents, to provide relief from manisfestions -antidepressants -anxiolytic -antipsychotic -mood stabilizers

what are the type(s) of crises?

-situational/external -maturational/internal -adventitious

Alcohol withdrawal delirium can occur how many days after cessation of alcohol?

2 to 3 days afterwords; it is considered a medical emergency. within the delirium symptoms are severe disorientation, psychotic manifestations (hallucinations), severe hypertension, cardiac dysrthythmias, and delirium. this can end in death.

What is the client age range when the rate of substance use is highest?

20 to 29

Suicide

A client who is suicidal may be ambivalent about death; intervention can make a difference. ● A client contemplating suicide believes that the act is the end to problems. Little concern is givento the aftermath and the ramifications to those left behind. Long-term therapy is needed for the survivors. Suicidal ideation occurs when a client is having thoughts about committing suicide. ◯ Those at highest risk for suicide include adolescent, young adult, and older adult males; NativeAmericans as a group; and persons with comorbid mental illness, such as depressive disorders, anxiety disorders, substance use disorder, schizophrenia, eating disorders, bipolar disorder, and personality disorders.

Premenstrual Dysphoric Disorder (PMDD)

A depressive disorder associated with the luteal phase of the menstrual cycle. Primary manifestations include emotional lability and persistent or severe anger and irritability. Other manifestations include a lack of energy, overeating, and difficulty concentrating.

Substance abuse pharmacological therapy

Alcohol withdrawal - Diazepam (Valium), lorazepam (Ativan), carbamazepine (Tegretol), clonidine (Catapres), chlordiazepoxide (Librium) ■ Alcohol abstinence - Disulfiram (Antabuse), naltrexone (Revia), acamprosate (Campral Opioid withdrawal - methadone (Dolophine) substitution, clonidine (Catapres), buprenorphine (Subutex) ■ Nicotine withdrawal from tobacco use - Bupropion (Zyban), nicotine replacement therapy (nicotine gum [Nicorette] and nicotine patch [Nicotrol])

Hallucinogens intoxication effects are?

Anxiety, depression, paranoia, impaired judgment, impaired social functioning, pupil dilation, tachycardia, diaphoresis, palpitations, blurred vision, tremors, incoordination, and panic attacks

Sedatives hypnotics and anxiolytics can have what kind of withdrawal symptoms

Anxiety, insomnia, diaphoresis, hypertension, possible psychotic reactions, hand tremors, nausea, vomiting, hallucinations or illusions, psychomotor agitation, and possible seizureactivity

Splitting is most commonly associated with which disorder?

BPD (Borderline Personality Disorder)

Bipolar Disorder

Bipolar disorders are mood disorders with recurrent episodes of depression and mania. Bipolar I disorder - The client has at least one episode of mania alternating with major depression. ◯ Bipolar II disorder - The client has one or more hypomanic episodes alternating with major depressive episodes. ◯ Cyclothymia - The client has at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes. -Periods of normal functioning alternate with periods of illness, though some clients are not able to maintain full occupational and social functioning. -Psychotic, paranoid, and/or bizarre behavior may be seen during periods of mania. Mania - an abnormally elevated mood, which may also be described as expansive or irritable; usually requires hospitalization. Hypomania - a less severe episode of mania that lasts at least 4 days accompanied by three to four findings of mania. Hospitalization, however, is not required, and the client who has hypomania is less impaired. Mixed episode - a manic episode and an episode of major depression experienced by the client simultaneously. The client has marked impairment in functioning and may require admission to an acute care mental health facility to prevent self-harm or other-directed violence Rapid cycling - four or more episodes of acute mania within 1 year.

Nicotine withdrawal from tobacco use

Bupropion, nicotine replacement therapy (nicotine gum and nicotine patch), varenicline, bupropion

Inhalants intoxication effects are?

Depend on the substance, but generally can cause behavioral or psychological changes, dizziness, nystagmus, uncoordinated movements or gait, slurred speech, drowsiness, hyporeflexia, muscle weakness, diplopia, stupor or coma, respiratory depression, and possible death

Bipolar disorders are mood disorders with recurrent episodes of what?

Depression and mania

Depressive Disorders

Depression is a mood (affective) disorder that is a widespread issue, ranking high among causes of disability. ● Depression may be comorbid with the following: ◯ Anxiety disorders These disorders are comorbid in approximately 70% of clients who have a depressive disorder. This combination makes a client's prognosis poorer, with a higher risk for suicide and disability. ◯ Psychotic disorders such as schizophrenia ◯ Substance use disorder Clients often use substances in an attempt to relieve manifestations of depression and/or self-treat mental health disorders. ◯ Eating disorders ◯ Personality disorders Major depressive disorder (MDD) is a single episode or recurrent episodes of unipolar depression (not associated with mood swings from major depression to mania) Depression S/S ◯ Anergia (lack of energy) ◯ Anhedonia (lack of pleasure in normal activities) ◯ Anxiety ◯ Reports of sluggishness (most common), or feeling unable to relax and sit still ◯ Vegetative findings, which include a change in eating patterns (usually anorexia in MDD, increased intake in dysthymia, and PMDD), change in bowel habits (usually constipation), sleep disturbances, and decreased interest in sexual activity ◯ Somatic reports, such as fatigue, gastrointestinal changes, pain Affect - The client most often looks sad with blunted affect. ■ The client exhibits poor grooming and lack of hygiene. ■ Psychomotor retardation (slowed physical movement, slumped posture) is more common, but psychomotor agitation (restlessness, pacing, finger tapping) can also occur. ■ The client becomes socially isolated, showing little or no effort to interact. ■ Slowed speech, decreased verbalization, delayed response - The client may seem too tired even to speak.

Withdrawals symptoms of Cocaine are?

Depression, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation, agitation not life threatening

Alcohol withdrawal medications consist of what?

Diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone

Alcohol abstinence medications consist of...

Disulfiram, naltrexone, acamprosate

Brain Stimulation Therapies

ECT (Electroconvolsive Therapy) ● Major Depressive Disorder ◯ Clients whose manifestations are not responsive to pharmacologic treatment ◯ Clients for whom the risks of other treatments outweigh the risks of ECT, such as a client who is in her first trimester of pregnancy ◯ Clients who are actively suicidal or homicidal and for whom there is a need for rapid therapeutic response ◯ Clients who are experiencing psychotic manifestations ● Schizophrenia spectrum disorders that are less responsive to neuroleptic medications, such as schizoaffective disorder ● Acute Manic Episodes ◯ ECT is used for clients who have bipolar disorder with rapid cycling (four or more episodes of acute mania within 1 year) and very destructive behavior. Both of these features tend to respond poorly to lithium therapy. These clients receive ECT and then a regimen of lithium therapy Mental health conditions for which ECT has not been found useful include the following: ◯ Substance use disorders ◯ Personality disorders ◯ Dysthymic disorder 3 x a week total of 6 to 12 treatments ■ Any medications that affect the client's seizure threshold must be decreased or discontinued several days before the ECT procedure. ■ MAOIs and lithium should be discontinued 2 weeks before the ECT procedure Memory Loss and Confusion ◯ Short-term memory loss, confusion, and disorientation may occur immediately following the procedure. Memory loss may persist for several weeks. Whether or not ECT causes permanent memory loss is controversial

Electroconvulsive therapy (ECT)

ECT can be used to subdue extreme manic behavior, especially when pharmacological therapy, such as lithium, has not worked. Clients who are suicidal or those who have rapid cycling can also benefit from ECT.

Assessment

Each encounter with a client involves an ongoing assessment. Psychosocial History ◯ Perception of own health, beliefs about illness and wellness ◯ Activity/leisure activities, how the client passes time ◯ Use of substances/substance use disorder ◯ Stress level and coping abilities - usual coping strategies, support systems ◯ Cultural beliefs and practices ◯ Spiritual beliefs

Ethical issues in MH Setting

Ethical principles must be used to decide ethical issues. These include the following: Beneficence- This relates to the quality of doing good and can be described as charity Autonomy- This refers to the client's right to make her own decisions. Justice- This is defined as fair and equal treatment for all. Fidelity- This relates to loyalty and faithfulness to the client and to one's duty. Veracity- This refers to being honest when dealing with a client

Anxiety Disorder Interventions

Eye movement desensitization and reprocessing (EMDR) is a therapy for clients who have PTSD. EMDR encourages eye focus on a separate stimuli while think SSRI antidepressants, such as sertraline (Zoloft), are the first line of treatment for trauma- and stressor-related disorders. Clients who have anxiety disorders also can benefit from other types of antidepressants ◯ Sedative hypnotic anxiolytics, such as diazepam (Valium), are indicated for short-term use. ◯ Nonbarbiturate anxiolytics, such as buspirone (BuSpar), are used to manage anxiety ◯ Other medications that can be used to treat anxiety disorders include beta blockers and antihistamines to decrease anxiety. Anticonvulsants are used as mood stabilizers for the client who is experiencing anxiety.

Justice

Fair and equal treatment for all

Rapid cycline

Four or more episodes of hypothermia or acute mania within 1 year

GAD Generalized Anxiety Disorder

GAD causes significant impairment in one or more areas of functioning, such as work-related duties. ■ Manifestations of GAD include the following: ☐ Restlessness ☐ Muscle tension ☐ Avoidance of stressful activities or events ☐ Increased time and effort required to prepare for stressful activities or events ☐ Procrastination in decision-making ☐ Seeks repeated reassurance

Stress

GAS- General Adaptation Syndrome is the body's response to an increased demand. The first stage is the initial adaptive response, also known as the "fight or flight" mechanism. If stress is prolonged, maladaptive responses can occur. Acute Stress (Fight or Flight) Apprehension Unhappiness/Sorrow Decreased Appetite Increased RR/ HR/ Cardiac Output/ BP Increased Metabolism and Glucose use Depressed Immune System Prolonged Stress (Maladaptive) Chronic Anxiety and Panic Attacks Depression/Chronic Pain/Sleep Disturbance Weight Gain/Loss Increased Risk MI/Stroke Poor Diabetes Control/ Hypertension Fatigue/Irritablity Decreased ability to concentrate Increased Risk Of Infection

Withdrawals from hallucinogens are?

Hallucinogen persisting perception disorder: Visual disturbances or flashback hallucinations can occur intermittently for years.

Veracity

Honesty when dealing with a client

S/S Aggression

Hyperactivity such as pacing, restlessness ◯ Defensive response when criticized, easily offended ◯ Eye contact that is intense, or no eye contact at all ◯ Facial expressions, such as frowning or grimacing ◯ Body language, such as clenching fists, waving arms ◯ Rapid breathing ◯ Aggressive postures, such as leaning forward, appearing tense ◯ Verbal clues, such as loud, rapid talking ◯ Drug or alcohol intoxication

Seclusion and Restraint client rights

In general, seclusion and/or restraint should be ordered for the shortest duration necessary, and only if less restrictive measures are not sufficient Restraints can be either physical or chemical, such as neuroleptic medication to calm the client. Clients have the right to request seclusion

Defense Mechanisms

Individuals may use defense mechanisms as a way to manage conflict in response to anxiety. Defense mechanisms are reversible, and can be adaptive or maladaptive Defense mechanisms become maladaptive when they interfere with functioning, relationships, and orientation to reality Altruism and sublimation are defense mechanisms that are always healthy. Other defense mechanisms can be used in a healthy manner. However, they can become maladaptive if used inappropriately or repetitively. ● Intermediate defenses include repression, reaction formation, displacement, rationalization, and undoing. ● Immature defenses include projection, dissociation, splitting, and denial.

Caffeine intoxication effects are?

Intoxication commonly occurs with ingestion of greater than 250 mg. (One 2 oz high‑energy drink can contain 215 to 240 mg caffeine.) Tachycardia and arrhythmia's, flushed face, muscle twitching, restlessness, diuresis, GI disturbances, anxiety, insomnia

Withdrawal effects of cannabis are?

Irritability, aggression, anxiety, insomnia, lack of appetite, restlessness, depressed mood, abdominal pain, tremors, diaphoresis, fever, headache

Assault

Making a threat to a client's person, such as approaching the client in a threatening manner with a syringe in hand, is considered assault.

Opioid withdrawal medications consist of

Methadone substitution, clonidine, buprenorphine, naltrexone, levo‑alpha‑acetylmethadol

Cocaine's effects of intoxication are?

Mild toxicity - dizziness, irritability, tremor, blurred vision Severe effects - hallucinations, seizures, extreme fever, tachycardia, hypertension, chest pain, possible cardiovascular collapse and death

Anxiety

Mild: › Mild anxiety occurs in the normal experience of everyday living. › It increases one's ability to perceive reality. › There is an identifiable cause of the anxiety. › Other characteristics include a vague feeling of mild discomfort, restlessness, irritability, impatience, and apprehension. › The client may exhibit behaviors such as finger- or foot-tapping, fidgeting, or lip-chewing as mild tension-relieving behaviors. Moderate: › Moderate anxiety occurs when mild anxiety escalates. › Slightly reduced perception and processing of information occurs, and selective inattention may occur. › Ability to think clearly is hampered, but learning and problem solving may still occur. › Other characteristics include concentration difficulties, tiredness, pacing, change in voice pitch, voice tremors, shakiness, and increased heart rate and respiratory rate. › The client may report somatic complaints including headaches, backache, urinary urgency and frequency, and insomnia. › The client with this type of anxiety usually benefits from the direction of others Severe: › Perceptual field is greatly reduced with distorted perceptions. › Learning and problem-solving do not occur. › Functioning is ineffective. › Other characteristics include confusion, feelings of impending doom, hyperventilation, tachycardia, withdrawal, loud and rapid speech, and aimless activity. › The client with severe anxiety usually is not able to take direction from others. Panic Level: › Panic-level anxiety is characterized by markedly disturbed behavior. › The client is not able to process what is occurring in the environment and may lose touch with reality. › The client experiences extreme fright and horror. › The client experiences severe hyperactivity or flight. › Immobility can occur. › Other characteristics may include dysfunction in speech, dilated pupils, severe shakiness, severe withdrawal, inability to sleep, delusions, and hallucinations.

Cognitive and behavioral therapies

Modeling Operant conditioning Systematic desensitization

Behavioral Therapy Types

Modeling: › A therapist or others serve as role models for a client, who imitates this modeling to improve behavior Operant Conditioning: › The client receives positive rewards for positive behavior (positive reinforcement). Systematic Desensitization: › This therapy is the planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life situations, or by imagining events that cause anxiety. During exposure, the client uses relaxation techniques to suppress anxiety response Aversion Therapy: › Pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote a change in the behavior MEDITATION, gUidEd iMAgERy, diApHRAgMAtiC BREAtHiNg, MUsCLE RELAxAtioN, ANd BiofEEdBACk: › This therapy uses various techniques to control pain, tension, and anxiety.

Bipolar Meds

Mood stabilizers ■ Lithium carbonate (Lithobid) ■ Anticonvulsants that act as mood stabilizers, including valproic acid (Depakote), clonazepam (Klonopin), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topax) ◯ Benzodiazepines, such as lorazepam (Ativan), used on a short-term basis for a client experiencing sleep impairment related to mania ◯ Antidepressants, such as the SSRI fluoxetine (Prozac), used to manage a major depressive episode

Care of Client w/Bipolar Disorder

Care of a client who has bipolar disorder will mirror the phase of the disease that the client is experiencing: Acute Mania Hospitalization may be required. › Reduction of mania and client safety are the goals of treatment. › Risk of harm to self or others is determined. › One-to-one supervision may be indicated. Continuation: › Remission of clinical manifestations › Treatment is generally 4 to 9 months in duration. › Relapse prevention through education, medication adherence, and psychotherapy is the goal of treatment Maintenance: Increased Ability to Function › Treatment generally continues throughout the client's lifetime. › Prevention of future manic episodes is the goal of treatment

Narcissistic

Characterized by arrogance, grandiose views of self‑importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism

Antisocial

Characterized by disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, and failure to accept personal responsibility; sense of entitlement, manipulative, impulsive, and seductive; nonadherence to traditional morals and values; verbally charming and engaging

Paranoid

Characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person

Histrionic

Characterized by emotional attention‑seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious

Schizoid

Characterized by emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative

Dependent

Characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends

Borderline

Characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often self‑injurious and potentially suicidal; ideas of reference are common; often accompanied by impulsivity

Schizotypal

Characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations

Obsessive-Compulsive (OCD)

Characterized by perfectionism with a focus on orderliness and control to the extent that the individual might not be able to accomplish a given task

Avoidant

Characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations

Milieu therapy

Orienting the client to the physical setting Identifying rules and boundaries of the setting Ensuring a safe environment for the client Assisting the client to participate in appropriate activities

What are the 4 phases of a crises?

PHASE 1: Escalating anxiety from a threat activates increased defense responses. PHASE 2: Anxiety continues escalating as defense responses fail, functioning becomes disorganized, and the client resorts to trial‑and‑error attempts to resolve anxiety. PHASE 3: Trial‑and‑error methods of resolution fail, and the client's anxiety escalates to severe or panic levels, leading to flight or withdrawal behaviors. PHASE 4: The client experiences overwhelming anxiety that can lead to anguish and apprehension, feelings of powerlessness and being overwhelmed, dissociative symptoms (depersonalization, detachment from reality), depression, confusion, and/or violence against others or self.

Panic Attacks

Panic disorder ■ Panic attacks typically last 15 to 30 min. ■ Four or more of the following manifestations are present during a panic attack: ☐ Palpitations ☐ Shortness of breath ☐ Choking or smothering sensation ☐ Chest pain ☐ Nausea ☐ Feelings of depersonalization ☐ Fear of dying or insanity ☐ Chills or hot flashes

Crisis Manifestations

Phase 1 › Escalating anxiety from a threat activates increased defense responses Phase 2 › Anxiety continues escalating as defense responses fail, functioning becomes disorganized, and the client resorts to trial-and-error attempts to resolve anxiety Phase 3 › Trial-and-error methods of resolution fail, and the client's anxiety escalates to severe orpanic levels, leading to flight or withdrawal behaviors Phase 4 › The client experiences overwhelming anxiety that can lead to anguish and apprehension,feelings of powerlessness and being overwhelmed, dissociative symptoms (depersonalization, detachment from reality), depression, confusion, and/or violence against others or self. ◯ Initial task of nurse is to promote a sense of safety by assessing client's potential for suicide or homicide.

Complications from a manic state in bipolar disorder

Physical exhaustion and possible death can occur; a client in a true manic state usually will not stop moving, and does not eat drink, or sleep. This can become a medical emergency

Therapeutic Communication

Client centered - not social or reciprocal Purposeful, planned, and goal-directed Children ☐ Use simple, straightforward language. ☐ Be aware of own nonverbal messages, as children are sensitive to nonverbal communication. ☐ Enhance communication by being at the child's eye level. ☐ Incorporate play in interactions. Older Adult Clients ☐ Recognize that the client may require amplification. ☐ Minimize distractions, and face the client when speaking. Allow plenty of time for the client to respond. ☐ When impaired communication is assessed, ask for input from caregivers or family to determine the extent of the deficits and how best to communicate. Identify any cultural considerations that may impact communication. Asking why questions is a barrier to communciation

Legal rights of clients in MH settings

Clients who have been diagnosed and/or hospitalized with a mental health disorder are guaranteed the same civil rights as any other citizen. These include the following: The right to humane treatment and care, such as medical and dental care The right to vote The right to due process of law, including the right to press legal charges against another person Clients also have various specific rights, including the following: Informed consent and the right to refuse treatment Confidentiality A written plan of care/treatment that includes discharge follow-up, as well as participation in the care plan and review of that plan Communication with people outside the mental health facility, including family members, attorneys, and other health care professionals Provision of adequate interpretive services if needed Care provided with respect, dignity, and without discrimination Freedom from harm related to physical or pharmacologic restraint, seclusion, and any physical or mental abuse or neglect Provision of care with the least restrictive interventions necessary to meet the client's needs without allowing him to be a threat to himself or others

Care w/ Personality Disorder

Safety is always a priority concern because some clients who have a personality disorder are at risk for self-injury or violence. Limit-setting and consistency are essential with clients who are manipulative, especially those who have borderline or antisocial personality disorders. Clients who have dependent and histrionic personality disorders often benefit from assertiveness training and modeling. ☐ Clients who have schizoid or schizotypal personality disorders tend to isolate themselves, and the nurse should respect this need. ☐ For clients who have histrionic personality disorder, who may be flirtatious, it is important for the nurse to maintain professional boundaries and communication at all times.

Cyclothymic disorder

The client has at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes.

Bipolar 1 Disorder

The client has at least one episode of mania alternating with major depression

Bipolar 2 disorder

The client has one or more hypomanic episodes alternating with major depressive episodes

acute phase

acute mania -hospitalization can be required -reduction of mania and client safety are the foals of treatment -risk of harm to self or others is determined -one to one supervision can be indicated for client safety

Defense Mechanism

altruism › Dealing with anxiety by reaching out to others sublimation › Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression suppression › Voluntarily denying unpleasant thoughts and feelings Repression › Putting unacceptable ideas, thoughts, and emotions out of conscious awareness Displacement › Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation Reaction formation › Overcompensating or demonstrating the opposite behavior of what is felt undoing › Performing an act to make up for prior behavior Rationalization › Creating reasonable and acceptable explanations for unacceptable behavior Dissociation › Temporarily blocking memories and perceptions from consciousness splitting › Demonstrating an inability to reconcile negative and positive attributes of self or others Projection › Blaming others for unacceptable thoughts and feelings Denial › Pretending the truth is not reality to manage the anxiety of acknowledging what is real Regression › Demonstrating behavior from an earlier developmental level › Often exhibited as childlike or immature behavior

Mania

an abnormally elevated mood, which can also be described as expansive or irritable; usually requires hospitalization. Manic episodes last as least 1 week.

Interpersonal psychotherapy (IPT)

assists clients in addressing specific problems. It can improve interpersonal relationships, communication, role‑relationship, and bereavement.

priority restructuring

assists clients to identify what requires priority, such as devoting energy to pleasurable activities

Dream analysis and interpretation

believed by Freud to be urges and impulses of the unconscious mind that played out through the dreams of clients

secondary care

collaborate with client to identify interventions while in an acute crisis that promote safety

tertiary care

collaborate with client to provide support during recovery from a severe crisis that include outpatient clinics, rehabilitation centers, and workshops

Primary care

collaborating with the client to identify potential problem; instruct on coping mechanisms; assist in lifestyle changes

Withdrawal effects with use of Amphetamines are?

cravings, depression, fatigue, sleeping, not life threatening

Sedatives hypnotics and anxiolytics have intended effects of what?

decreased anxiety, sedation

Psychodynamic psychotherapy

employs the same tools as psychoanalysis, but it focuses more on the client's present state, rather than his early life

Alterations In Speech

flight of ideas › Associative looseness › The client may say sentence after sentence, but each sentence may relate to another topic, and the listener is unable to follow the client's thoughts. Neologisms › Made-up words that have meaning only to the client, such as, "I tranged and flittled." echolalia › The client repeats the words spoken to him. Clang association › Meaningless rhyming of words, often forceful, such as, "Oh fox, box, and lox." Word salad › Words jumbled together with little meaning or significance to the listener, such as, "Hip hooray, the flip is cast and wide-sprinting in the forest."

monitoring thoughts

helps clients to be aware of negative thinking

journal keeping

helps clients write down stressful thoughts and has a positive effect on well-being

Delusions

ideas of reference › Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about him Persecution- Feels singled out for harm by others Grandeur- Believes that she is all powerful and important like god Somatic Delusions- Believes that the body is changing in an unusual way such as growing a third arm Jealousy- May feel that her spouse is cheating Being Controlled- Believes that a force outside of the body is controlling him Thought Broadcasting- Believes that her thoughts can be heard by others Thought Insertion- Believes that others thought are being inserted into her mind Thought Withdrawal- Believe that her thoughts have been removed from her mind by an outside agency Religiosity- Is obsessed with religious beliefs

Effects if intoxication with the use of Amphetamines are?

impaired judgement, psychomotor agitation, hyper-vigilance, extreme irritability and acute cardiovascular effects-which could cause death

maintenance phase

increased ability to function -treatment generally continues throughout the client's lifetime -prevention of future manic episodes is the goal of treatment

Dialectical behavior therapy

is a cognitive‑behavioral therapy for clients who have a personality disorder and exhibit self‑injurious behavior. This therapy focuses on gradual behavior changes and provides acceptance and validation for these clients.

Classical psychoanalysis

is a therapeutic process of assessing unconscious thoughts and feels, and resolving conflict by talking to a psychoanalyst.

Cognitive therapy

is based on the cognitive model, which focuses on individual thoughts and behaviors to solve current problems. It treats depression, anxiety, eating disorders, and other issues that can improve by changing a client's attitude toward life experiences

Autonomy

is the client's right to make their own decisions. But he client must accept the consequences of those decisions. The client must also respect the decisions of others.

Splitting is what?

is the inability to incorporate positive and negative aspects of oneself or others into a whole image, is frequently seen in the acute mental health setting. For example: the client might say, "You are the worst person in the world." Later that day, she might say, "You are the best, but the nurse from the last shift is absolutely terrible."

Beneficence

is the quality of doing good; can be described as charity

Fidelity

loyalty and faithfulness to the client and to one's duty

situational/external crisis

often unanticipated loss or change experienced in everyday, often unaticipated, life events

Aversion therapy

pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote a change in the behavior

Tort

referred to as a civil wrong doing, in which monetary damages can potentially be awarded to the plaintiff (injured party) and collected from the defendant (responsible party).

Continuation phase

remission of manifestations -treatment is generally 4 to 9 months in duration -relapse prevention through education, medication adherence, and psychotherapy is the goal of treatment

assertivness training

teaches clients to express feelings, and solve problems in a nonaggressive manner

Involuntary admission

the client enters the mental health facility against their will for an indefinite period of time. The admission is based on the client's need for psychiatric treatment, the risk of harm to self or others, or the inability to provide self-care. -it takes 2 physicians to certify a client's admission (involuntarily) -the client can request a legal review of the admission -limited to 60 days before another legal review needs to be done upon the admission -clients have the right to refuse treatments and medications

Temporary emergency admission

the client is admitted for emergent mental health care due to the inability to make decisions regarding care. The medical healthcare provider may initiate the admission which is then evaluated by a mental healthcare provider. The length of the temporary admission caries by the client's need and state laws but often is not to exceed 15 days.

Voluntary admission

the client or client's guardian chooses admission to a mental health facility in order to obtain treatment. A voluntary admitted client has the right to apply for release at any time. This client is considered competent, and so has the right to refuse medication and treatment.

operant conditioning

the client receives positive rewards for positive behavior (positive reinforcement)

What should the nurse do when a client is experiencing an acute manic episode?

the nurse should focus on safety and maintaining physical health

Cognitive reframing

this assists the clients to identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk

systematic desensitization therapy

this therapy is the planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life situation, or by imagining events that cause anxiety.

Cognitive-behavioral therapy

uses both cognitive and behavioral approaches to assist a client with anxiety management

free association

which is the spontaneous, uncensored verbalization of whatever comes to a client's mind

Opioid Withdrawal

› Abstinence syndrome begins with sweating and rhinorrhea progressing to piloerection (gooseflesh), tremors, and irritability followed by severe weakness, diarrhea, fever, insomnia, pupil dilation, nausea and vomiting, pain in the muscles and bones, and muscle spasms. › Withdrawal is very unpleasant but not life-threatening, and it is self-limiting to 7 to 10 days.

Tobacco Withdrawal

› Abstinence syndrome is evidenced by irritability, craving, nervousness, restlessness, anxiety, insomnia, increased appetite, difficulty concentrating, anger, and depressed mood

Negative Symptoms

› Affect - usually blunted (narrow range of normal expression) or flat (facial expression never changes) › Alogia - poverty of thought or speech; the client may sit with a visitor but may only mumble or respond vaguely to questions. › Anergia - lack of energy › Anhedonia - lack of pleasure or joy; the client is indifferent to things that often make others happy, such as looking at beautiful scenery. › Avolition - lack of motivation in activities and hygiene; for example, the client completes an assigned task, such as making his bed, but is unable to start the next common chore without prompting

Sedative and Hypnotic Withdrawal

› Anxiety, insomnia, diaphoresis, hypertension, possible psychotic reactions, hand tremors, nausea or vomiting, hallucinations or illusions, psychomotor agitation, and sometimes seizure activity

Battery

Touching a client in a harmful or offensive way is considered battery. This would occur if the nurse threatening the client with a syringe actually grabbed the client and gave the injection.

Counseling

Using therapeutic communication skills Assisting with problem solving Crisis intervention Stress management

Brain Stimulation Therapies VNS

VNS- Vagus Nerve Stimulation VNS provides electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on the client's chest. Depression that is resistant to pharmacological treatment and/or ECT. ● Current research studies are determining the effectiveness for VNS in clients who have anxiety disorders. The VNS device delivers around-the-clock programmed pulsations. ◯ The client can turn off the VNS device at any time by placing a special external magnet over the site of the implant Voice changes due to the proximity of the implanted lead on the vagus nerve to the larynx and pharynx. ● Other potential adverse effects include hoarseness, throat or neck pain, dysphagia. These commonly improve with time. ● Dyspnea, especially with physical exertion, is possible. Therefore, the client may want to turn off the VNS during exercise

Nicotine abstinence medications consist of?

Varenicline, rimonabant

Type of commitment to a MH facility

Voluntary commitment - The client or client's guardian chooses commitment Involuntary (civil) commitment - The client enters the mental health facility against her will for an indefinite period of time. Emergency involuntary commitment - A type of involuntary commitment in which the client is hospitalized to prevent harm to self or others. Observational or temporary involuntary commitment - A type of involuntary commitment in which the client is in need of observation, a diagnosis, and a treatment plan. Long-term or formal involuntary commitment - A type of commitment that is similar to temporary commitment but must be imposed by the courts. Time of commitment varies, but is usually 60 to 180 days. Clients admitted under involuntary commitment are still considered competent and have the right to refuse treatment, unless they have gone through a legal competency hearing and have been judged incompetent.

modeling

a therapist or others serve as role models for a client, who imitates this modeling to improve behavior

Long-term involuntary admission

a type of admission that is similar to temporary commitment but must be imposed by the courts. Time of commitment varies, but is usually 60 to 180 days. Sometimes, there is no set release date.

Phobias

Social phobia - The client has a fear of embarrassment, is unable to perform in front of others, has a dread of social situations, believes that others are judging him negatively, and has impaired relationships. ■ Agoraphobia - The client avoids being outside and has an impaired ability to work or perform duties Specific phobias ☐ The client has a fear of specific objects, such as spiders, snakes, strangers. ☐ The client has a fear of specific experiences, such as flying, being in the dark, riding in an elevator, being in an enclosed space.

Effects of intoxication of tobacco/ nicotine use are?

-highly toxic, but acute toxicity seen only in children or when exposure is to nicotine in pesticides -contains harmful chemicals that are highly toxic and have long-term effects -long term effects - cardiovascular diease, repiratory disease

Safety is the primary focus of nursing care duuing acute intoxication or withdrawal and the following should be kept in mind or implemented.

-Maintain a safe environment to prevent falls; implement seizure precautions as necessary. -Provide close observation for withdrawal manifestations, possibly one‑on‑one supervision. Physical restraint should be a last resort. -Orient the client to time, place, and person. -Maintain adequate nutrition and fluid balance. -Create a low‑stimulation environment. -Administer medications as prescribed to treat the effects of intoxication or to prevent or manage withdrawal. This can include substitution therapy. -Monitor for covert substance use during the detoxification period. Provide emotional support and reassurance to the client and family. Educate the client and family about codependent behaviors. --Begin to educate the client and family about addiction and the initial treatment goal of abstinence. --Educate the client and family regarding removing any prescription medications in the home that are not being used. Encourage the client not to share medication with someone for whom that medication is not prescribed. --Begin to develop motivation and commitment for abstinence and recovery (abstinence plus developing a program of personal growth and self‑discovery). --Encourage self‑responsibility. --Help the client develop an emergency plan: a list of things the client would need to do and people he would need to contact. --Encourage attendance at self‑help groups

What are some behaviors that are shown with bipolar disorders?

-Mania -Hypomania -Rapid cycling

What are some standard screening tools?

-Michigan Alcohol Screening Test (MAST) -Drug Abuse Screening Test (DAST) or DAST-A: Adolescent version -CAGE Questionaire -Alcohol Use Disorders Identification Test (AUDIT) -Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) -Clinical Opiate Withdrawal Scale

What type of medication are used for a person with bipolar disorders?

-Mood stabilizers -Lithium carbonate -Anticonvulsants that act as mood stabilizers, including valproate, lamotrigine, carbamazepine -Antianxiety medications: e.g., lorazepam, clonazepam -Second‑generation antipsychotic medications: including aripiprazole, clozapine, ziprasidone -Antidepressants: e.g., the SSRI fluoxetine, used to manage a major depressive episode

Cluster A (Odd or eccentric traits)

-Paranoid -Schizoid -Schizotypal

There are 3 psychotherapeutic interventions for a crises what are they?

-Primary care -secondary care -tertiary care

What can a therapeutic milieu provide for a patient?

-Provide a safe environment during the acute phase. -Assess the client regularly for suicidal thoughts, intentions, and escalating behavior. -Decrease stimulation without isolating the client if possible. Be aware of noise, music, television, and other clients, all of which can lead to an escalation of the client's behavior. In certain cases, seclusion might be the only way to safely decrease stimulation for the client. -Follow agency protocols for providing client protection (restraints, seclusion, one‑to‑one observation) if a threat of self‑injury or injury to others exists. -Implement frequent rest periods. -Provide outlets for physical activity. Do not involve the client in activities that last a long time or that require a high level of concentration and/or detailed instructions. -Protect client from poor judgment and impulsive behavior, such as giving money away and sexual indiscretions

What are some defense mechanisms

-Repression -suppression -regression -undoing -splitting

When assisting a client developing an action plan a nurse should remember what?

-Short‑term, no longer than 24 to 72 hr -Focused on the crisis -Realistic and manageable

Opioids intoxication effects are?

-Slurred speech, impaired memory, pupillary changes. -Decreased respirations and level of consciousness, which can cause death -Maladaptive behavioral or psychological changes, including impaired judgment or social functioning -An antidote, naloxone, available for IV use to relieve effects of overdose

Adventitious crises

-The occurrence of natural disasters, crimes, or national disasters -people in communities with large-scale psychological trauma caused by natural disasters

Withdrawals from alcohol and substances consist of what?

-abdominal cramping -vomiting -tremors -restlessness and inability to sleep -increased heart rate -transient hallucintations or illusions -anxiety -increased blood pressure -increased respiratory rate -increased temperature -tonic-clonic seizures

Family and Community Violence

A female partner is the victim in the majority of family violence, but the male partner may also bea victim of violence. ◯ Victims are at the greatest risk for violence when they try to leave the relationship. ◯ Pregnancy tends to increase the likelihood of violence toward the intimate partner. The reason forthis is unclear. ◯ Factors that increase the risk for abuse toward a child ■ The child is under 3 years of age ■ A perpetrator perceives the child as being different (the child is the result of an unwanted pregnancy, is physically disabled, or has some other trait that makes him particularly vulnerable) ◯ Older or other adults who are vulnerable within the home may suffer abuse because they are in poor health, exhibit disruptive behavior, or are dependent on a caregiver. The potential forviolence against an older adult is highest in families where violence has already occurred.

Hypomania

A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania. Hospitalization is not required, and the client who has hypomania is less impaired. Hypomania can progress to mania

Dysthymic DIsorder

A milder form of depression that usually has an early onset, such as in childhood or adolescence, and lasts at least 2 years in length for adults (1 year in length for children). Dysthymic disorder contains at least three clinical findings of depression and may, later in life, become major depressive disorder.

Withdrawals from tobacco/ nicotine are?

Abstinence syndrome evidenced by irritability, craving, nervousness, restlessness, anxiety, insomnia, increased appetite, difficulty concentrating, anger, and depressed mood

Major Depressive Disorder (MDD)

Accompanied by at least five of the following specific clinical findings, which must occur almost every day for a minimum of 2 weeks, and last most of the day: ■ Depressed mood ■ Difficulty sleeping or excessive sleeping ■ Indecisiveness ■ Decreased ability to concentrate ■ Suicidal ideation ■ Increase or decrease in motor activity ■ Inability to feel pleasure ■ Increase or decrease in weight of more than 5% of total body weight over 1 month MDD may be further diagnosed in the DSM-5 with a more specific classification (specifier), including the following: ■ Psychotic features - the presence of auditory hallucinations (for example, voices telling the client she is sinful) or the presence of delusions (for example, client thinking that she has a fatal disease) ■ Postpartum onset - a depressive episode that begins within 4 weeks of childbirth (known as postpartum depression) and may include delusions, which may put the newborn infant at high risk of being harmed by the mother ■ Seasonal characteristics - seasonal affective disorder (SAD), which occurs during winter and may be treated with light therapy Care of a client who has MDD will mirror the phase of the disease that the client is experiencing: Acute: Severe Clinical Findings of depression › Treatment is generally 6 to 12 weeks in duration. › Potential need for hospitalization. › Reduction of depressive manifestations is the goal of treatment. › Assess suicide risk, and implement safety precautions or one-to-one observation as needed. Continuation: Increased Ability to function › Treatment is generally 4 to 9 months in duration. › Relapse prevention through education, medication therapy, and psychotherapy is the goal of treatment Maintenance: Remission Of Manifestations › This phase may last for years. › Prevention of future depressive episodes is the goal of treatment.

Maturational/ internal crises

Achieving new developmental stages, which requires learning additional coping mechanisms

Psychobiological interventions

Administering prescribed medications Providing teaching to the client/family about medications Monitoring for adverse effects and effectiveness of pharmacological therapy

Anger Mgmt

Anger becomes negative when it is denied, suppressed, or expressed inappropriately, such as by usingaggressive behavior. ◯ Denied or suppressed anger can manifest as physical or psychological findings, such as headaches,coronary artery disease, hypertension, gastric ulcers, depression, or low self-esteem. ● Aggression, unlike anger, is typically goal-directed with the intent of harming a specific person or object. ◯ Inappropriately expressed anger can become hostility or aggression. ◯ Aggression includes physical or verbal responses that indicate rage and potential harm to self, others,or property. ◯ A client who is often angry and aggressive may have underlying feelings of inadequacy, insecurity,guilt, fear, and rejection. Categories/Taxonomies of Disorder ◯ Preassaultive - The client begins to become angry and exhibits increasing anxiety, hyperactivity,and verbal abuse. ◯ Assaultive - The client commits an act of violence. Seclusion and physical restraints may be required. ◯ Postassaultive - Staff reviews the incident with the client during this stage

Eating Disorders

Anorexia nervosa ■ Clients are preoccupied with food and the rituals of eating, along with a voluntary refusal to eat. ■ Clients exhibit a morbid fear of obesity and a refusal to maintain a minimally normal body weight (body weight is less than 85% of expected normal weight for the individual) in the absence of a physical cause. Bulimia nervosa ■ Clients recurrently eat large quantities of food over a short period of time (binge eating), which may be followed by inappropriate compensatory behaviors, such as self-induced vomiting (purging), to rid the body of the excess calories. ■ Most clients who have bulimia nervosa maintain a weight within a normal range or slightly higher Binge eating disorder ■ Clients recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa. ■ Binge eating disorder affects men and women of all ages, but is most common in adults age 46 to 55.

Appropriate Communication To Address Hallunicatons

Ask the client directly about hallucinations. The nurse should not argue or agree with the client's view of the situation, but may offer a comment, such as, "I don't hear anything, but you seem to be feeling frightened." Do not argue with a client's delusions, but focus on the client's feelings and possibly offer reasonable explanations, such as, "I can't imagine that the president of the United States would have a reason to kill a citizen, but it must be frightening for you to believe that." Assess the client for paranoid delusions, which can increase the risk for violence against others. ■ Provide for safety if the client is experiencing command hallucinations due to the increased risk for harm to self or others. ■ Attempt to focus conversations on reality-based subjects. ■ Identify symptom triggers, such as loud noises (may trigger auditory hallucinations in certain clients) and situations that seem to trigger conversations about the client's delusions. ■ Be genuine and empathetic in all dealings with the client. ◯ Assess discharge needs, such as ability to perform activities of daily

Health promotion and health maintenance

Assisting the client with cessation of smoking Monitoring other health conditions

Types Of Personality Disorders

CLUSTER A( ODD OR ECCENTRIC) Paranoid › Characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person schizoid › Characterized by emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative schizotypal › Characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations CLUSTER B (DRAMATIC,EMOTIONAL,IRRATIONAL) antisocial › Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility borderline › Characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often tries self-injury and may be suicidal Histrionic › Characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious Narcissistic › Characterized by arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism CLUSTER C (ANXIOUS,FEARFUL,INSECURITY) avoidant › Characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations dependent › Characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends obsessive compulsive › Characterized by perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task

Stress Reduction Techniques

Cognitive Techniques ◯ Cognitive reframing: The client is helped to look at irrational cognitions (thoughts) in a more realistic light and to restructure those thoughts in a more positive way. Behavioral Techniques: ◯ Relaxation techniques ■Meditation includes formal meditation techniques, as well as prayer for those who believe in a higher power. ■ Guided imagery - The client is guided through a series of images to promote relaxation. Images vary depending on the individual. For example, one client might imagine walking on a beach, while another client might imagine himself in a position of success. ■ Breathing exercises are used to decrease rapid breathing and promote relaxation. ■ Progressive muscle relaxation (PMR) - A person trained in this method can help a client attain complete relaxation within a few minutes. ■ Physical exercise (yoga, walking, biking) causes release of endorphins that lower anxiety, promote relaxation, and have antidepressant effects. Journal Writing Priority Restructuring Biofeedback Mindfullness Assertiveness Training Hobbies Music Therapy Pet Therapy

Other Assessment components

Conduct an assessment of all clients, including older adult clients in the following manner: Use a private, quiet space with adequate lighting to accommodate for impaired vision and hearing. Make an introduction, and determine the client's name preference. Stand or sit at the client's level to conduct the interview, rather than standing over a client who is lying in bed or sitting in a chair. Use touch to communicate caring as appropriate. However, respect the client's personal space if he does not wish to be touched. Be sure to include questions relating to difficulty sleeping, incontinence, falls or other injuries, depression, dizziness, and loss of energy. Include the family and significant others as appropriate. Obtain a detailed medication history. Following the interview, summarize and ask for feedback from the client.

False imprisonment

Confining a client to a specific area, such as a seclusion room, is false imprisonment if the reason for such confinement is for the convenience of the staff.

The Mental State exam

Contains the following components: LOC Alert - The client is responsive Lethargy - The client is able to open her eyes and respond but is drowsy and falls asleep readily Stupor - The client requires vigorous or painful stimuli Coma- No response can be achieved from repeated painful stimuli -Physical appearance -Behavior: mood and affect -Cognitive and intellectual abilities: Memory, knowledge level, ability to calculate, Abstract thinking, Judgement, rate and volume of speech.

Case management

Coordinating holistic care to include medical, mental health, and social services

Anxiety Disorders

Normal anxiety is a healthy response to stress that is essential for survival. Elevated or persistent anxiety can result in anxiety disorders causing behavior changes and impairment in functioning. Anxiety disorders tend to be persistent and are often disabling -mild (restlessness, increased motivation, irritability) -moderate (agitation, muscle tightness) -severe (inability to function, ritualistic behavior, unresponsive) - panic (distorted perception, loss of rational thought, immobility). Separation anxiety disorder - The client experiences excessive fear or anxiety when separated from an individual to which to client is emotionally attached. ◯ Panic disorder - The client experiences recurrent panic attacks. ◯ Phobias - The client fears a specific object or situation to an unreasonable level. ◯ Generalized anxiety disorder (GAD) - The client exhibits uncontrollable, excessive worry for more than 3 months. -Acute stress disorder - Exposure to a traumatic event causes numbing, detachment, and amnesia about the event for at least 3 days but for not more than 1 month following the event. -Posttraumatic stress disorder (PTSD) - Exposure to a traumatic event causes intense fear, horror, flashbacks, feelings of detachment and foreboding, restricted affect, and impairment for longer than 1 month after the event. Manifestations may last for years. OCD Hoarding Disorder

Obsessive Compulsive Disorders

OCD - Persistent thoughts or urges that the client attempts to suppress through compulsive or obsessive behaviors. Obsessions or compulsions are time-consuming and result in impaired social and occupational functioning. ■ Hoarding disorder - Client has obsessive desire to save items regardless of value. Experiences extreme stress with thoughts of discarding or getting rid of items. Client's hoarding behavior results in social and occupational impairment and often leads to an unsafe living environment.

Promotion of self-care activities

Offering assistance with self-care tasks Allowing time for the client to complete self-care tasks Setting incentives to promote client self-care

Depression Meds

Selective Serotonin Reuptake Inhibitors (SSRIs) » Citalopram (Celexa) » Fluoxetine (Prozac) » Sertraline (Zoloft) -Tricyclic Antidepressants » Amitriptyline (Elavil) -Monoamine Oxidase Inhibitors (MAOIs) » Phenelzine (Nardil) -Atypical Antidepressants » Bupropion (Wellbutrin) Serotonin Norepinephrine Reuptake Inhibitors Venlafaxine (Effexor) Duloxetine (Cymbalta

Substance Use Disorders

Substance use disorders are related to alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics, stimulants, and tobacco. ◯ A substance use disorder involves a repeated use of chemical substances, leading to clinically significant impairment during a 12-month period, and at least two of the following criteria: ■ Uses substance in larger amounts or over a longer period of time than intended. ■ Has a continued desire or unsuccessful attempt to control substance use. ■ Spends a considerable amount of time obtaining, using, or recovering from the effects of the substance. ■ Continues to use substance regardless of social or interpersonal problems associated with substance use. ■ Reduces or quits participation in social, occupational, or recreational activities because of substance use. ■ Uses substance repeatedly in physically hazardous situations, such as driving impaired. ■ Continues to use substance regardless of physical or psychological problems associated with substance use. ■ Develops a tolerance to the substance. ■ Requires additional amounts of the substance to achieve the desired effect or to become intoxicated. ■ Exhibits manifestations of withdrawal. ■ Feels a strong urge to use the substance.

Brain Stimulation Therapies TMS

TMS- Transcranial Magnetic Stimulation TMS is a noninvasive therapy that uses magnetic pulsations to stimulate specific areas of the brain Major depressive disorder ◯ Clients who are not responsive to pharmacologic treatment TMS is commonly prescribed daily for a period of 4 to 6 weeks. Common adverse effects include mild discomfort or a tingling sensation at the site of the electromagnet. ● Monitor the client for lightheadedness after the procedure. ● Seizures are a rare but potential complication. ● TMS is not associated with systemic adverse effects or neurologic deficits.

Mini Mental State exam

This examination is used to objectively assess a client's cognitive status by evaluating the following: Orientation to time and place Attention span and ability to calculate by counting backward by seven Registration and recalling of objects Language, including naming of objects, following of commands, and ability to write

Glasgow Coma Scale

This examination is used to obtain a baseline assessment of a client's level of consciousness, and for ongoing assessment. Eye, verbal, and motor response is evaluated, and a number value based on that response is assigned. The highest value possible is 15, which indicates that the client is awake and responding appropriately. A score of 7 or less indicates that the client is in a coma.

Oppositional Defiant Disorder

This disorder is characterized by a recurrent pattern of the following antisocial behaviors: ■ Negativity ■ Disobedience ■ Hostility ■ Defiant behaviors (especially toward authority figures) ■ Stubbornness ■ Argumentativeness ■ Limit testing ■ Unwillingness to compromise ■ Refusal to accept responsibility for misbehavior ◯ Misbehavior is usually demonstrated at home and directed toward the person best known. ◯ Children and adolescents who have oppositional defiant disorder do not see themselves as defiant.They view their behavior as a response to unreasonable demands and/or circumstances. ◯ Clients who have this disorder may exhibit low self-esteem, mood lability, and a low frustration threshold. ◯ Oppositional defiant disorder can develop into conduct disorder

transference

Which includes feelings that the client has developed toward the therapist in relation to similar feelings toward significant persons in the client's early childhood

Psychotic Disorder Meds

› Atypical antipsychotics are current medications of choice for psychotic disorders, and they generally treat both positive and negative symptoms › Risperidone (Risperdal) › Olanzapine (Zyprexa) › Quetiapine (Seroquel) › Ziprasidone (Geodon) › Aripiprazole (Abilify) › Clozapine (Clozaril) Symptoms of agitation, dizziness, sedation, and sleep disruption may occur. Instruct the client to report these adverse effects because the provider may need to change the medication. Conventional antipsychotics are used to treat mainly positive psychotic symptoms. › Haloperidol (Haldol) › Loxapine (Loxitane) › Chlorpromazine (Thorazine) › Fluphenazine (Prolixin) › To minimize anticholinergic effects, advise the client to chew sugarless gum, eat foods high in fiber, and to eat and drink 2 to 3 L of fluid a day from food and beverage sources. › Instruct the client about signs of postural hypotension (e.g., light-headedness, dizziness). If these occur, advise the client to sit or lie down. Minimize orthostatic hypotension by getting up slowly from a lying or sitting position Antidepressants are used to treat the depression seen in many clients who have a psychotic disorder. › Paroxetine (Paxil) › Used temporarily to treat depression associated with psychotic disorders. › Monitor the client for suicidal ideation because this medication may increase thoughts of self-harm, especially when first taking it. › Notify the provider of any adverse effects, such as deepened depression. › Advise the client to avoid abrupt cessation of this medication to avoid a withdrawal effect. Anxiolytics/benzodiazepines are used to treat the anxiety often found in clients who have psychotic disorders, as well as some of the positive and negative symptoms. › Lorazepam (Ativan) › Clonazepam (Klonopin) › Inform the client of this medication's sedative effects. › Inform the client of the need for blood tests to monitor for agranulocytosis. › These medications are used with caution in older adult clients.

Cocaine Withdrawal

› Characteristic withdrawal syndrome occurring within 1 hr to several days of cessation of drug use › Depression, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation or agitation › Not life-threatening, but possible occurrence of suicidal ideation

Amphetamines Withdrawal

› Craving, depression, fatigue, sleeping (similar to those of cocaine) › Not life-threatening

Alcohol Withdrawal

› Effects usually start within 4 to 12 hr of the last intake of alcohol, peak after 24 to 48 hr, and then suddenly disappear. › Manifestations include abdominal cramping; vomiting; tremors; restlessness and inability to sleep; increased heart rate; transient hallucinations or illusions; anxiety; increased blood pressure, respiratory rate, temperature; and tonic-clonic seizures. › Alcohol withdrawal delirium may occur 2 to 3 days after cessation of alcohol and may last 2 to 3 days. This is considered a medical emergency. Symptoms include severe disorientation, psychotic symptoms (hallucinations), severe hypertension, cardiac dysrhythmias, and delirium. Symptoms may progress to death.

Bipolar S/S Depressive

› Flat, blunted, labile affect › Tearfulness, crying › Lack of energy › Anhedonia - loss of pleasure and lack of interest in activities, hobbies, sexual activity › Physical reports of discomfort/pain › Difficulty concentrating, focusing, problem-solving › Self-destructive behavior, including suicidal ideation › Decrease in personal hygiene › Loss or increase in appetite and/or sleep, disturbed sleep › Psychomotor retardation or agitation

Neurocognitive DIsorders

› Gradual deterioration of function over months or years › Impairments in memory, judgment, speech (aphasia), ability to recognize familiar objects (agnosia), executive functioning (managing daily tasks), and movement (apraxia); impairments do not change throughout the day. › Level of consciousness is usually unchanged. › Restlessness, agitation are common; sundowning may occur; behaviors usually remain stable. › Personality change is gradual. › Vital signs are stable unless other illness is present › Cognitive deficits are not related to another mental health disorder. › Subtypes of neurocognitive disorder may be related to: » Alzheimer's disease » Traumatic brain injury » Parkinson's disease » Other disorders affecting the neurological system › Irreversible and progressive

Positive Symptoms

› Hallucinations › Delusions › Alterations in speech › Bizarre behavior, such as walking backward constantly

Hallucinogens Withdrawal

› Hallucinogen Persisting Perception Disorder - Visual disturbances or flashback hallucinations can occur intermittently for years

Cannabis Withdrawal

› Irritability, aggression, anxiety, insomnia, lack of appetite, restlessness, depressed mood, abdominal pain, tremors, diaphoresis, fever, headache

Bipolar S/S Manic

› Labile mood with euphoria › Agitation and irritability › Restlessness Dislike of interference and intolerance of criticism › Increase in talking and activity › Flight of ideas - rapid, continuous speech with sudden and frequent topic change › Grandiose view of self and abilities (grandiosity) › Impulsivity - spending money, giving away money or possessions › Demanding and manipulative behavior › Distractibility and decreased attention span › Poor judgment › Attention-seeking behavior - flashy dress and makeup, inappropriate behavior › Impairment in social and occupational functioning › Decreased sleep › Neglect of ADLs, including nutrition and hydration › Possible presence of delusions and hallucinations › Denial of illness

Delirium

› Rapid over a short period of time (hours or days › Occurrence of impairments in memory, judgment, ability to focus, and ability to calculate; these impairments may fluctuate throughout the day. › Level of consciousness is usually altered and may rapidly fluctuate. › Restlessness, agitation, and fluctuating mood are common; sundowning (confusion during the night) may occur; behaviors may increase or decrease daily. › Personality change is rapid. › Some perceptual disturbances may be present, such as hallucinations and illusions. › Vital signs may be unstable and abnormal due to medical illness. › Caused secondary to another medical condition, such as infection, or to substance use › Reversible if diagnosis and treatment are prompt

Transference/Countertransference

› Transference occurs when the client views a member of the health care team as having characteristics of another person who has been significant to the client's personal life'' › Countertransference occurs when a health care team member displaces characteristics of people in her past onto a client

Rape Trauma Syndrome

■ Acute phase - Occurs immediately following the rape, lasts for about 2 weeks, and consists ofthe following: ☐ Initial emotional (or impact) reaction X An expressed reaction is overt and consists of emotional outbursts, including crying, laughing, hysteria, anger, and incoherence. X A controlled reaction is ambiguous; the survivor may appear calm and have blunted affect, but may also be confused, have difficulty making decisions, and feel numb. ☐ A somatic reaction occurs later and lasts about 2 weeks. The client may have a variety of symptoms, including: X Bruising and soreness from the attack X Muscle tension, headaches, and sleep disturbances X Gastrointestinal symptoms (nausea, anorexia, diarrhea, abdominal pain) X Genitourinary symptoms (vaginal pain or discomfort) X A variety of emotional reactions, including embarrassment, a desire for revenge, guilt, anger, fear, anxiety, and denial Long-term reorganization phase occurs 2 weeks or more after the attack. Long-term psychological effects of sexual assault include: ☐ Flashbacks and other intrusive thoughts about the assault ☐ Increased activity, such as visiting friends frequently or moving residence, due to a fear thatthe assault will recur ☐ Increased emotional responses (crying, anxiety, rapid mood swings) ☐ Fears and phobias (fear of being alone, fear of sexual encounters) ☐ Difficulties with daily functioning, low self-esteem, depression, sexual dysfunction, and somatic reports, such as headache or fatigue Silent rape reaction: the victim does not report or tell anyone of the sexual assault, including family, friends, or the authorities. X Abrupt changes in relationships with partners X Nightmares X Increased anxiety during interview X Marked changes in sexual behavior X Sudden onset of phobic reactions X No verbalization of the occurrence of sexual assault

Suicide Precautions

■ Initiate one-on-one constant supervision around the clock, always having the client in sightand close. ■ Document the client's location, mood, quoted statements, and behavior every 15 min or perfacility protocol. ■ Remove all glass, metal silverware, electrical cords, vases, belts, shoelaces, metal nail files, tweezers, matches, razors, perfume, shampoo, and plastic bags from the client's room and vicinity. ■ Allow the client to use only plastic eating utensils. ■ Check the environment for possible hazards (such as windows that open, overhead pipes thatare easily accessible.) ■ During observation periods, always check the client's hands, especially if they are hidden from sight. ■ Do not assign to a private room if possible and keep door open at all times. ■ Ensure that the client swallows all medications. ■ Identify whether or not the client's current medications can be lethal with overdose. If so, collaborate with the provider to have less dangerous medications substituted if possible. ■ Restrict the visitors from bringing possibly harmful items to the client. Ask the client to agree to a no-suicide contract, which is a verbal or written agreement that the client makes to not harm himself, but instead to seek help. ☐ A no-suicide contract is not legally binding and should only be used according to facility policy. ☐ A no-suicide contract may be beneficial, but it should not replace other suicide prevention strategies. ☐ A no-suicide contract can be used as a tool to develop and maintain trust between the nurse andthe client. ☐ A no-suicide contract is discouraged for clients who are in crisis, under the influence of substances, psychotic, very impulsive, and/or very angry/agitated. A contract does not take the place of suicide precautions.

Aggression Interventions

■ Responding quickly ■ Remaining calm and in control ■ Encouraging the client to express feelings verbally, using therapeutic communication techniques(reflective techniques, silence, active listening) ■ Allowing the client as much personal space as possible ■ Maintaining eye contact and sitting or standing at the same level as the client ■ Communicating with honesty, sincerity, and nonaggressive stance ■ Avoiding accusatory or threatening statements ■ Describing options clearly and offering the client choices ■ Reassuring the client that staff are present to help prevent loss of control Tell the client calmly and directly what he must do in a particular situation, such as, "I need you to stop yelling and walk with me to the day room where we can talk." ☐ Use physical activity, such as walking, to deescalate anger and behaviors. ☐ Inform the client of the consequences of his behavior, such as loss of privileges.

Children and Adolescent MH

● A child's behavior is problematic when it interferes with home, school, and interactions with peers. ◯ Behaviors are considered pathologic when they ■ Are not age appropriate. ■ Deviate from cultural norms. ■ Create deficits or impairments in adaptive functioning ◯ Depressive disorders, such as major depressive disorder and dysthymic disorder ◯ Anxiety disorders, including separation anxiety disorder and panic disorder ◯ Trauma- and stressor-related disorders, such as posttraumatic stress disorder (PTSD) ◯ Substance use disorders, such as alcohol use disorder, tobacco use disorder, and cannabis use disorder ◯ Feeding and eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder ◯ Disruptive, impulse control, and conduct disorders, such as oppositional defiant disorder, disruptivemood dysregulation disorder, and conduct disorder ◯ Neurodevelopmental disorders, including attention deficit/hyperactivity disorder (ADHD), autismspectrum disorder, intellectual developmental disorder, and specific learning disorder ◯ Bipolar and related disorders ◯ Schizophrenia spectrum and other psychotic disorders ◯ Nonsuicidal self-injury and suicidal behavior disorder; suicide is a leading cause of death for youth between the ages of 10 and 24.

Personality Disorders

● A client who has a personality disorder demonstrates pathological personality characteristics. Defense mechanisms used by clients who have personality disorders include repression, suppression, regression, undoing, and splitting. Of these, splitting, which is the inability to incorporate positive and negative aspects of oneself or others into a whole image, is frequently seen in the acute mental health setting. Individuals who have personality disorders often have comorbid substance use disorders, and may have a history of nonviolent and violent crimes, including sex offenses. ◯ Psychosocial influences, such as childhood abuse or trauma, and developmental Clients who have a personality disorder will exhibit one or more of the following common pathological personality characteristics: ■ Inflexibility/maladaptive responses to stress ■ Compulsiveness and lack of social restraint ■ Inability to emotionally connect in social and professional relationships ■ Tendency to provoke interpersonal conflict ■ Ability to merge personal boundaries with others

Crisis Management

● A crisis is an acute, time-limited (usually lasting 4 to 6 weeks) event during which a client experiencesan emotional response that cannot be managed with the client's normal coping mechanisms. Common characteristics include ◯ Experience of a sudden event with little or no time to prepare ◯ Perception of the event as overwhelming or life-threatening ◯ Loss or decrease in communication with significant others ◯ Sense of displacement from the familiar ◯ An actual or perceived loss Situational/external - often unanticipated loss or change experienced in every day, often unanticipated, life events ◯ Maturational/internal - achieving new developmental stages, which requires learning additionalcoping mechanisms ◯ Adventitious - the occurrence of natural disasters, crimes, or national disasters

Seclusion

● Restraints can be either physical or chemical, such as neuroleptic medication to calm the client. ● Seclusion and/or restraint must never be used for: ◯ Convenience of the staff ◯ Punishment of the client ◯ Clients who are extremely physically or mentally unstable ◯ Clients who cannot tolerate the decreased stimulation of a seclusion room the following must occur in order for seclusion or restraint to be used: ◯ The treatment must be ordered by the primary care provider in writing. ◯ The order must specify the duration of treatment. ◯ The provider must rewrite the order, specifying the type of restraint, every 24 hr or the frequency of time specified by facility policy.

Psychotic Disorders

● Schizophrenia spectrum and other psychotic disorders affect thinking, behavior, emotions, and the ability to perceive reality. Schizophrenia - The client has psychotic thinking or behavior present for at least 6 months. Areas of functioning, including school or work, self-care, and interpersonal relationships, are significantly impaired. ◯ Schizotypal personality disorder - The client has impairments of personality (self and interpersonal) functioning. However, impairment is not as severe as with schizophrenia. ◯ Delusional disorder - The client experiences delusional thinking for at least 1 month. Self or interpersonal functioning is not markedly impaired. ◯ Brief psychotic disorder - The client has psychotic manifestations that last between 1 day to 1 month in duration. ◯ Schizophreniform disorder - The client has manifestations similar to those of schizophrenia, but the duration is from 1 to 6 months, and social/occupational dysfunction may or may not be present. ◯ Schizoaffective disorder - The client's disorder meets both the criteria for schizophrenia and depressive or bipolar disorder. ◯ Substance-induced psychotic disorder - The client experiences psychosis within 1 month of substance intoxication or withdrawal. May be caused by medications intended for therapeutic use.

Cognitive DIsorders

● The various cognitive disorders recognized and defined by the DSM-5 include the following categories: ◯ Delirium ◯ Neurocognitive Disorder (can be classified as mild or major) Alzheimer's disease is a subtype of neurocognitive disorder that is neurodegenerative, resulting in the gradual impairment of cognitive function Assess for defense mechanisms used by the client to preserve self-esteem and to compensate when cognitive changes are progressive: ■ Denial - Both the client and family members may refuse to believe that changes, such as loss of memory, are taking place, even when those changes are obvious to others. ■ Confabulation - The client may make up stories when questioned about events or activities that she does not remember. This may seem like lying, but it is actually an unconscious attempt to save self-esteem and prevent admitting that she does not remember the occasion. ■ Perseveration - The client avoids answering questions by repeating phrases or behavior. This is another unconscious attempt to maintain self-esteem when memory has failed.

Conduct Disorder

◯ Clients who have conduct disorder demonstrate a persistent pattern of behavior that violates the rights of others or rules and norms of society. Categories of conduct disorder include the following: ■ Aggression to people and animals ■ Destruction of property ■ Deceitfulness or theft ■ Serious violations of rules › Demonstrates a lack of remorse or care for the feelings of others › Bullies, threatens, and intimidates others › Believes that aggression is justified › Exhibits low self-esteem, irritability, temper outbursts,reckless behavior › May demonstrate signs of suicidal ideation › May have concurrent learning disorders or impairments incognitive functioning › Demonstrates physical cruelty to others and/or animals › Has used a weapon that could cause serious injuries › Destroys property of others › Has run away from home › Often lies, shoplifts, and is truant from school

Aggression Meds

◯ Olanzapine (Zyprexa) ◯ Ziprasidone (Geodon ◯ Haloperidol (Haldol)

Eating Disorder Meds

◯ Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) ☐ Instruct the client that medication may take 1 to 3 weeks for initial response, with up to 2 months for maximal response. ☐ Instruct the client to avoid hazardous activities (driving, operating heavy equipment/machinery) until individual side effects are known Refeeding syndrome ■ Refeeding syndrome is the potentially fatal complication that can occur when fluids, electrolytes, and carbohydrates are introduced to a severely malnourished client.