MENTAL HEALTH TEST #3

ECT procedural care

-2-3X a week for a total of 6-12 treatments -Provider obtains informed consent, if ECT is involuntary, the provider may obtain consent from next of kin or a court order MED MANAGEMENT: -30 mins prior to the beginning of the procedure, an IM injection of atropine sulfate/glycopyrrolate is admin to decrease secretions that could cause aspiration& to counteract any vagal stimulation effects -At the time of procedure, an anesthesia provider admins a short acting anesthetic -A muscle relaxant is then admin to paralyze the clients muscles during the seizure activity, which decreases the risk for injury -Severe HTN should be controlled b/c a short period of HTN occurs immed after ECT -Any cardiac conditions should be monitored&treated before the procedure -The nurse monitors VS&mental status before&after the procedure -The nurses assess the clients&familys knowledge&understanding of the procedure and teaches as necessary... many have misconceptions about ECT due to media portrayals of the procedure -IV line is inserted&maintained until full recovery -Electrodes are applied to the scalp for EEG monitoring -The client gets 100% oxygen during&after ECT until return of spontaneous respers -Ongoing cardiac monitoring is provided, including BP, ECG and oxygen sat -Clients are expected to become alert about 15 min after ECT

Psychological factors affecting other medical conditions expected findings

-A confirmed medical diagnosis A psychological/behavioral factor that is linked to the medical diagnosis in one of the following ways: -Contributes to the development, exacerbation, or delayed recovery of the medical diagnosis -Interferes w/ the client's adherence to the treatment of the medical diagnosis -Places the client at increased risk for physical health problems -Causes or exacerbates physical manifestations or the clients need for medical treatment

Normal anxiety

-A healthy life force that is necessary for survival, normal anxiety motivates people to take action

Dysthymic disorder

-A milder form of depression that usually has an early onset, such as in childhood or teen years, and lasts at least 2 years for adults (1 year for children) -Contains at least three clinical findings of depression and can, later in life, become MDD

Negative symptoms of psychotic disorders

-Absence of things that are normally present, these manifestations are more difficult to treat successfully than positive symptoms AFFECT: Usually blunted or flat ALOGIA: Poverty of thought or speech, the client might sit w/ a visitor but only mumble/respond vaguely to questions ANERGIA: Lack of energy ANHEDONIA: Lack of pleasure of joy, client is indifferent to things that often make others happy such as looking at beautiful scenery AVOLITION: Lack of motivation in activities&hygiene, the client completes an assigned task, such as making their bed but is unable to start the next common chore /out prompting

Somatic symptom nursing care

-Accept somatic symptoms as being real to the client -Assess for suicidal ideation and thoughts of self harm -Identify secondary gains from somatic symptoms (attention, distraction from personal obligations or problems) -Report new physical manifestations to the provider -Limit the amount of time allowed to discuss somatic symptoms -Encourage independence in self care -Encourage verbalization of feelings -Educate the client on alternative coping mechs -Educate the client on assertiveness techniques - Encourage daily physical exercise

Suicide environmental factors

-Access to lethal methods, such as firearms -Lack of access to adequate mental health care -Unemployment

Crisis management risk factors

-Accumulation of unresolved losses -Current life stressors -Concurrent mental&physical health issues -Excessive fatigue or pain -Age&developmental stage

Crisis management meds

-Admin antianxiety and/or antidepressant med as prescribed

ECT complications relapse of depression

-Advise the client that ECT is not a permanent cure, weekly or monthly maintenance of ECT can decrease the incidence of relapse

Eating disorders reproductive system expected findings

-Amenorrhea can be seen in clients who have anorexia -Menstrual irregularities

Suicide cultural risk factors

-American Indian or Native ethnic groups have the highest rate

Somatic symptom meds

-Analgesics -Antidepressants -Anxiolytics

Depressive disorders expected findings

-Anergia (lack of energy)- -Anhedonia (lack of pleasure in normal activities) -Anxiety -Reports of sluggishness (most common), or feelings unable to relax and sit still -Vegetative findings, which include a change in eating patterns (usually anorexia in MDD, increased intake in dysthymia&PMDD), change in bowel habits (usually constipation), sleep disturbances, and decreased interest in sexual activity -Somatic reports, such as fatigue, GI changes and pain -The client most often looks sad w/ a 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 might seem too tired to speak and can sigh often

Illness anxiety meds

-Antidepressants -Anxiolytics

Conversion disorder meds

-Antidepressants -Anxiolytics

Haloperidol

-Antipsyhotic agent -Used to control aggressive/impulsive behavior -Monitor for clinical findings of parkinsonian&anticholinergic adverse effects -Keep the client hydrated, check VS, and test for muscle rigidity due to the risk of NMS

Cluster B (dramatic, emotional, or erratic traits) personality disorders

-Antisocial -Borderline -Histrionic -Narcissistic

Acute stress (fight or flight) expected findings

-Apprehension -Unhappiness or sorrow -Decreased appetite -increased RR, HR, cardiac output, BP -Increased metabolism&glucose use -Depressed immune stystem

Suicide expected findings

-Assess carefully for verbal&nonverbal clues -It is essential to ask the client if he his thinking of suicide, this will not give the client the idea to commit suicide -Suicidal comments usually are made to someone that the client perceives as supportive -Assess for potential suicide risk using a standardized assessment tool such as the SAD PERSONS scale -Comments or signals can be overt (direct) or covert (indirect) OVERT COMMENT: There is just no reason for me to go on living COVERT: Everything is looking pretty grim for me -Assess the clients suicide plan (does the client have a plan, how lethal is the plan, can the client describe the plan exactly, dose the client have access to the intended method, has the clients mood changed, a sudden change in mood from sad and depressed to happy and peaceful can indicated a clients intention to commit suicide) -Lacerations -Scratches/scars that could indicated previous attempts at self harm

older adult and vulnerable adults violence assessment

-Assess for any bruises, lacerations, abrasions or fractures in which the physical appearance doesn't match the hx of mechanism of injury

Violence assessment preschoolers to teens

-Assess for unusual bruising, such as on abdomen, back or butt.. bruising is common on arms and legs in these age groups -Assess the mechanism of injury, which might not be congruent w/ the physical appearance of the inquiry, numerous bruises at different stages of healing can indicate ongoing beatings, be suspicious of bruises or welts that resemble the shape of a belt buckle or other object -Assess for burns, burns covering glow or stocking areas of the hands or feet indicate forced immersion into boiling water, small, round burns can be from lit cigarettes -Assess for fractures w/ unusual features, such as forearm spiral fractures, which could be a result of twisting the extremity forcefully, the presence of multiple fractures is suspicious -Assess for human bite marks -Assess for head injuries, LOC, equal&reactive pupils and n/v

Eating disorders care after d/c

-Assist the client to develop and implement a maintenance plan related to weight management -Encourage followup treatment in an outpatient setting -Encourage client participation in a support group -Continue individual and family therapy as indicated

Interpersonal psychotherapy

-Assists client in addressing specific problems, it can improve interpersonal relationships, communication, role relationship&bereavement

Premenstrual dysphoric disorder (PMDD)

-Associated w/ the luteal phase of the menstrual cycle -Primary manifestations include emotional liability and persistent or severe anger and irritability -Other manifestations include a lack of energy, overeating and difficulty concentrating

Olanzapine, ziprasidone

-Atypical antipsychotics -Used to control aggressive&impulsive behaviors, these are used more commonly than haloperidol b/c of the severity of adverse effects

Cluster C (anxious or fearful traits, insecurity and inadequacy) personality disorders

-Avoidant -Dependent -Obsessive-compulsive

Cognitive therapy

-Based on the cognitive model, which focuses on individual thoughts&behaviors to solve current problems.. it treats depression, anxiety, eating disorders and other issues that can improve by changing a clients attitude towards life experiences

Anxiety assessment

-Basic to therapeutic intervention in any setting

Illness anxiety nursing care

-Build rapport and trust w/ client -Encourage independence in self care -Encourage verbalization of feelings -Educate clients on alternative coing mechs -Educate clients on stress management techniques

Conversion disorder nursing care

-Build rapport&trust w/ clients -Ensure safety of clients -Encourage verbalization of feelings, assist the client to identify the psychological trigger of the manifestations -Educate client on alternative coping mechs -Educate client on stress management techniques -Understand the incidence of remissions and recurrence, remission occurs w/.out intervention in approx 95% of clients, especially if the onset of the manifestations is due to an acute stressful event.. recurrence rate is approx 25%, usually w/in one year of initial diagnosis

Other meds

-Can be used to prevent violent behavior by treating the underlying disorder, these include antidpressants (SSRIS, SNRIS, mood stabilizer, sedative hypnotic meds)

ECT complications headache, muscle soreness and nausea

-Can occur following the imeed recovery period -Observe the client to determine the degree of discomfort -Admin antiemetic &analgesic as needed

Bipolar disorder client education

-Case management to provide follow up for the client&family -Group, family, and individual psychotherapy -Chronicity of the disorder requiring long term pharm&psyco sypport -Benefits of psychotherapy&support groups prevent relapse -Indications of impending relapse and ways to manage the crises -Precipitating factors of relapse -Importance of maintaining a regular sleep, meal and activity pattern -Med admin&adherence

Psychotic disorders client education

-Case management to provide followup -Group, family and individual psychoeducation to improve problem solving&interperesonal skills -Social skills training focuses on teaching social&ADL skills HEALTH TEACHING: -Understanding of the disorder -Need for self care to prevent relapse -Med effects, adverse effects, and importance of compliance -Importance of attending support groups -Abstinence from the use of alcohol or other substances -Keeping a log/journal of feelings&changes in behavior to help monitor med effectiveness

Panic level anxiety

-Characterized by markedly disturbed behavior -The client is not able to process what is occurring in the environment and can lose touch w/ reality -The client experiences extreme fright&horror -The client experiences severe hyperactivity or flight -Immobility can occur -Other characteristics include dysfunction in speech, dilated pupils, severe shakiness, severe withdrawl, inability to sleep, delusions, and hallucinations

Violence risk factor for abuse towards children

-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 them particularly vulnerable)

Prolonged stress (maladaptive response)

-Chronic anxiety or panic attacks -Depression, chronic pain, sleep disturbances -Weight gain/loss -Increased risk for MI, stroke -Poor diabetes control, HTN, fatigue, irritability, decreased ability to concentrate -Increased risk of infection

Psychological factors affecting other medical conditions risk factors

-Chronic stressors -Depressive disorder and anxiety disorder -Malfunction of neurotransmitters

Agoraphobia expected findings

-Client avoids certain places/situations that cause anxiety.. this avoidance might disrupt the clients ability to maintain employment or participate in routine activities of daily life -Clients fear and manifestations of anxiety are out of proportion w/ the actual danger of the place or situation

Eating disorders psychosocial expected findings

-Client can exhibit self esteem, impulsivity, and difficulty w/ interpersonal relationships -Depressed mood -Irritability -Insomnia -Social withdrawal

Separation anxiety disorder expected findings

-Client exhibits excessive levels of anxiety and concern when separated from someone to whom they have an emotional attachment, fearing that something tragic will occur resulting in permanent separation -Clients anxiety disrupts the ability to participate in routine daily activities -Physical manifestations of anxiety develop during the separation or in anticipation of the separation and include headaches, nausea, vomiting and sleep disturbances

GAD expected findings

-Client exhibits uncontrollable excessive worry for more than 6 months -Causes significant impairment in one or more areas of functioning Manifestations include: -Restlessness -Muscle tension -Avoidance of stressful activities or events -Increased time and effort required to prepare for stressful activities/events -Procrastination in decision making -Seeks repeated reassurance

Specific phobias expected findings

-Client reports a fear of specific objects -Client reports a fear of specific experiences -Client might experience anxiety manifestations just by thinking of the feared objects or situation and might attempt to decrease the anxiety through the use of alcohol or other substances

Social phobias expected findings

-Client reports difficulty performing or speaking in front of others or participating in social situations due to an excessive dear of embarrassment or poor performance -Client might report physical manifestations in an attempt to avoid the social situation or need to preform

Anorexia characteristics

-Clients are preoccupied w/ food and the rituals of eating, along w/ a voluntary refusal to eat -This condition occurs most often in female clients from teens to young adulthood -Onset can be associated w/ a stressful life even -Compared to clients who have restricting type, those who have binge eating/purging type have higher rates of impulsivity and are more likely to abuse drugs and alcohol

Bulimia nervosa

-Clients recurrently eat large quantities of food over a short period of time (binge eating), which can be followed by inapprop compensatory behaviors, such as self induced vomiting (purging), to rid the body of excess calories -Binge eating and inapprop compensatory behavior both occur on average of once per week for 3 months -Binge eating is in a discrete period of time (usually less than 2 hours) and an amount of food def larger than what most people would eat in a similar period of time, clients have a sense of lack of control over eating

Binge eating disorder

-Clients recurrently eat large quantities of food over a short period of time w/out the use of compensatory behaviors associated w/ bulimia -An excessive food consumption must be accompanied by a sense of lack of control -At least once per week for 3 months -Binge eating disorder affects men&women of all ages, but most common in adults age 46-55 -The weight gain associated w/ binge eating disorder increases the client's risk fr other disorders, including type 2 DM, HTN and cancer

Eating disorders integumentary expected findings

-Clients w/ anorexia can have fine, downy hair (lanugo) on the face and back, yellowed skin, mottled, cool extremities and poor skin turgor -Clients who have bulimia can have calluses or scars on hands (Russels sign)

Eating disorder weight expected findings

-Clients who have anorexia have a body weight that is less than 85% of expected normal weight -Most clients who have bulimia maintain a weight w/in the normal range or slightly higher -Clients who have binge eating disorder are typically overweight or obese

ECT potential diagnosis acute manic episodes

-Clients who have bipolar disorder w/ rapid cycling -Clients who are unresponsive to treatment w/ lithium and antipsych meds

Eating disorders head, neck, mouth and throat expected findings

-Clients who have bulimia can have enlargement of the parotid glands -Dental erosion and caries (if the client is purging)

ECT potential diagnosis schizo spectrum disorder

-Clients who have schizo w/ catatonic manifestations -Clients who have schizoaffective disorder -Clients who are pregnant and have a shizo spectrum disorder, therefore having an increased risk for adverse effects from med therapy

ECT potential diagnosis major depressive disorder

-Clients whose manifestations are not responsive to pharm treatment -Clients for whom the risk of other treatments outweigh the risks of ECT -Clients who are suicidal or homicidal and for whom there is a need for rapid therapeutic response -Clients who are experiencing psychotic manifestations

Substance induced depressive disorder

-Clinical findings of depression that are associated w/ the use of, or withdrawal from, drugs&alcohol

Stress management nursing care

-Cognitive techniques -Behavioral techniques -Journal writing -Priority restructuring -Biofeedback -Mindfulness -Assertiveness training -Other individual stress reduction techniques

Dialectical behavior therapy

-Cognitive-behavioral therapy for clients who have a personality disorder and exhibit self injurious behavior.. it focuses on gradual behavior changes&provides acceptance and validation for these clients

VNS considerations

-Commonly preformed as an outpatient surgical procedure -Device delivers around the clock programmed pulsations, usually every 5 mins for a duration of 30 seconds -Therapeutic antidpressant effects usually take several weeks to achieve -Client can turn off VNS device at any time by placing a special external magnet over the site of the implant -Assist the provider in obtaining informed consent

TMS considerations

-Commonly prescribed daily for a period of 4-6 weeks -Can be preformed as an outpatient procedure -Lasts 30-40 mins -Noninvasive electromagnet is placed on the clients scalp, allowing pulsations to pass through -Client is alert during the procedure -Clients might feel a tapping or knocking sensation in the head, scalp skin contraction and tightening of the jaw muscles during

NCDs communication

-Communicate in a calm, reassuring tone -Speak in positively worded phrases, don't argue or question hallucinations or delusions -Reinforce reality -Reinforce orientation to time, place and person -Introduce self to client w/ each new contact -Establish eye contact&use short, simple sentences when speaking to the client, focus on one item of info at a time -Encourage reminiscence about happy times, talk about familiar things -Break instructions and activities into short timeframes -Limit the number of choices when dressing or eating -Minimize the need for decision-making and abstract thinking to avoid frustration -Avoid confrontation -Approach slowly and from the front, address the client by name -Encourage family visitation as aprop

Personality disorders risk factors

-Comorbid substance use disorders, and can have a hx of nonviolet and violent crimes, including sex offenses -Psycho social influences, such as childhood abuse or trauma, and developmental factors w/ a direct link to parenting -Biological influences include genetic and biochemical factors

Factitious disorder (AKA Munchausens)

-Conscious decision by the client to report physical or psychological manifestations, the falsification of manifestations is done in the absence of personal gain by the client other than possible fullfillment of an emotional need for attention, in some cases clients inflict self injury FACTITIOUS DISORDER IMPOSED ON ANOTHER PERSON (Munchausens by proxy): is present when the client deliberately causes injury or illness to a vulnerable person, the emotional need for attention or relief of responsibility remains a possible motivating factor -Clients often have an average or above average IQ, the client is dramatic in the description of the illness, uses proper medical terminology, and is often hesitant for the provider to speak to family members or prior providers -The client often reports new manifestations following negative test results -Factitious disorder differs from malingering, it is a mental illness while malingering isn't... malingering is consciously motivated and driven by personal gain

Eating disorders GI system expected findings

-Constipation (dehydration) -Diarrhea (laxative use) -Abdominal pain -Self induced vomiting -Excessive use of diuretics or laxatives -Esophageal teras, gastric ruptures (bulimia)

Types of cognitive disorders

-Delirium -Mild neurocognitive disorder (NCD) -Major neurocognitive disorder (Dementia) -Major&mild NCD subtypes are further classified (Alzheimers, Parkinsons, Huntingtons) ALZHEIMERS: Neurodegenerative, resulting in the gradual impairment of cognitive function.. most common type -It is important to distinguish b/w a cognitive disorder&other mental health disorders that can have similar manifestations.. depression in older adults can mimic Alzheimers

Neurocognitive disorder expected findings

-Delirium&neurocognitive disorder have some similarities and important differences -Clients who have NCD can also develop delirium

Vulnerable person characteristics

-Demonstration of low self esteem and feelings of helplessness, hopelessness, powerlessness, guilt and shame -Attempts to protect the perpetrator and accept responsibility for the abuse -Possible denial of the severity of the situation and feelings of anger&terror

VNS indications

-Depression that is resistant to pharm treatment and/or ECT, approved by the FDA -Current research studies are determining the effectiveness for VNS in clients who have anxiety, obesity and pain

Anger management cormobidities

-Depressive disorders -PTSD -Alzheimers disease -Personality/psychotic disorders

Crisis management nursing care

-Designed to help provide rapid assistance for people or groups who have an urgent need -The initial task of the nurse is to promote a sense of safety by assessing the clients potential for suicide/homocide INITIAL INTERVENTIONS: -Identifying the current problem&directing interventions for resolution -Taking an active, directive role w/ the client -Helping the client to set realistic, attainable goals -Critical incident stress debriefing is a group approach that can be used w/ a group of people who have been exposed to a crisis situation PROVIDE FOR CLIENT SAFETY: -Initiate hospitalization to protect clients who have suicidal or homicidal thoughts -Prioritize interventions to address the clients physical needs first UES STRATS TO DECREASE ANXIETY: -Develop a therapeutic nurse-client relationship -Remain w/ the client -Listen&observe -Make eye contact -Ask questions related to client's feelings and the event -Demonstrate genuineness and caring -Communicate clearly and, if needed, with clear directives -Avoid false reassurance and other non-therapeutic responses -Teach relaxation techniques -Identify and teach coping skills (assertiveness training&parenting skills) ASSIST THE CLIENT W/ THE DEVELOPMENT OF THE FOLLOWING TYPE OF ACTION PLAN: -Short term, no longer then 24-72 hrs -Focused on the crisis -Realistic&manageable

Eating disorders interprofesional care

-Dietitian should be involved to provide the client w/ nutritional and dietary guidance -Consistency of care among all staff is important

Psychological factors affecting other medical conditions nursing care

-Discuss the clients physical exam findings -Assess for SI, thoughts of self harm -Explore the clients feelings and fears -Allow the client time to express feelings -Educate the client on alternative coping mechs -Educate the client on assertiveness techniques -Address both physical and psychological needs -Admin prescribed meds

Following an aggressive/violent episode

-Discuss ways for the client to keep control during the aggression cycle -Encourage the client to talk about the incident, and what triggered&escalated the aggression from the clients perspective -Debrief to staff to evaluate the effectiveness of actions -Document the entire incident completely by including the following (behaviors leading up to, as well as those observed throughout the incident, nursing interventions implemented and the clients response)

Depressive disorders medications client teaching

-Don't d/c the med suddenly -Therapeutic effects are not immediate, and it can take several weeks or more to reach full therapeutic benefits -Avoid hazardous activities, such as driving or operating heavy machinery, due to the potential of adverse effects of sedation -Notify the provider of any thoughts of suicide --Avoid alcohol while taking an anitidepressant

Eating disorders standardized screening tools

-Eating disorder inventory -Body attitude test -Diagnostic survey for eating disorders -Eating attitude test

Anxiety client education

-Educate client regarding identification of manifestations of anxiety -Instruct the client to notify the provide of worsening effects&to not adjust med dosages, warn the client against stopping/increasing meds w/out consulting the provider -Assist the client to eval coping mechs that work and don't work for controlling the anxiety, and assist the client to learn new methods.. use of alternative stress relief&coping mechs might increase med effectiveness&decrease the need for meds in most cases

Psychodynamic psychotherapy

-Employs the same tools as psychoanalysis, but it focuses more on the clients present state, rather than his early life

Somatic symptoms client education

-Encourage client participation in individual and group therapy -Educate clients on prescribed meds -Assist a case manager to develop a followup appointment schedule w/ provider every 4-6 weeks.. this strat provides the client w/ set appointments and decreases the clients need for unscheduled health care, as well as medical costs associated w/ lab&diagnostics if the client seeks treatment from other providers

Factitious disorder client education

-Encourage client participation in individual and group therapy -Refer client to community support groups -Educate client on prescribed meds

Conversion disorder client education

-Encourage client participation in individual and group therapy -Refer clients to community support groups -Educate clients on prescribed meds

Illness anxiety client education

-Encourage client participation in individual and group therapy -Refer clients to community support groups -Educate clients on prescribed meds -Collab w/ the provider for the client to get bried, frequent office visits

Psychological factors affecting other medical conditions client education

-Encourage client participation in treatment plan -Provide care that meets both the physical&psychological needs of the client -Educate the client on prescribed meds

Anger management client education

-Encourage clients to return to follow up -Encourage clients to attend a support group -Teach clients how to manage meds -Assist clients to develop problem solving skills

Illness anxiety expected findings

-Excessive anxiety that a serious illness is present or will be acquired.. this anxiety is present for more than 6 months though the actual illness the client fears can change -Preoccupation w/ performance of behaviors that are health related, such as performing a daily breast self exam due to fear of breast cancer -Some clients have illness anxiety disorder that is the health seeking type (frequently seeking medical care&diagnostics) while others exhibit the care avoidant type (avoids all contact w/ providers due to the correlation w/ increased levels of anxiety)

Common crisi characteristics

-Experiencing a sudden event w/ little or no time to prepare -Perception of the event as overwhelming or life threatening -Loss or decrease in comm w/ significant others -Sense of displacement from the familiar -An acute or perceived loss

Economic maltreatment

-Failure to provide for the needs of a vulnerable person when adequate funds are available -Unpaid bills, resulting in d/c of heat or electricity

suicide biological risk factors

-Family hx of suicide -Physical disorders such as AIDS, cancer, cardiovascular disease, stroke, chornic kidney disease, cirrhosis, dementia, epilepsy, head injury, Huntington's disease and MS

Depressive disorders risk factors

-Family hx& a previous personal hx of depression are the most significant risk factors -Twice as common in females b/w the ages of 15&40 than in males -Very common among clients over age 65, but the disorder is more difficult to recognize in the older adult clients and can go untreated, it is important to differentiate b/w early dementia&depression, some clinical findings of depression that can look like dementia are memory loss, confusion, and behavioral problems such as social isolation or agitation, clients can seek health care for somatic problems that are manifestations of untreated depression -Neurotransmitter deficienices, such as serotonin deficiency (affects mood, sexual behavior, sleep cycles, hunger&pain perception) or a norepi deficiency (affects attention&behavior) can be risk factors for depression.. imbalances of norepi, dopamine, acetylcholine, GABA and possibly glutamate can play a role in the occurrence of depression -Stressful life events -Presence of medical illness -A womans postpartum period -Poor social support network -Comorbid substance use disorder -Being unmarried -Trauma occurring early in life ***OCCUR THROUGH ALL GROUPS OF PEOPLE*** ***CAN BE PRIMARY DISORDER OR A RESPONSE TO ANOTHER PHYSICAL OR MENTAL HEALTH DISORDER***

Suicide protective factors

-Feelings of responsibility toward partner and children -Current pregnancy -Religious and cultural beliefs -Overall satisfaction w/ life -Presence of adequate social support -Effective coping&problem solving skills -Access to adequate medical care

Conversion disorder risk factors

-First degree relative who has conversion disorder -childhood physical or sexual abuse -Comorbid psychiatric conditions (depressive disorder, PTSD, Personality disorder, other somatic disorder) -Cormobid medical or neuro condition -Recent acute stressful event -Females -Teens or young adults

Illness anxiety risk factors

-First degree relative who has illness anxiety disorder -Previous losses or disappointments resulting in feelings of anger, guilt or hostility -Childhood trauma, abuse or neglect -Depressive disorder or anxiety disorder -Major life stressor -Low self esteem

Somatic symptom risk factors

-First degree relative who has it -Decreased level of neurotransmitters (serotonin and endorphins) -Depressive disorder, personality disorder or anxiety disorder -Childhood trauma, abuse or neglect -Learned helplessness -Female gender (ages 16-25)

Depressive characteristics

-Flat. blunted labile effect -Tearfullness, crying -Lack of energy -Anhedonia (lack of interest) -Physical report of discomfort/pain -Difficulty concentrating, focusing and 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

Acute manic episode nursing care

-Focus is on maintaining physical health&safety -Therapeutic mileu -Provide a safe environment during -Assess the client regularly for suicidal thoughts, intentions and escalating behavior -Decrease stimulation w/out isolating the client if possible.. be aware of noise, music, TV and other clients, all of which can lead to an escalation of the clients behavior... in some cases seclusion may be the only way to safely decrease stimulation -Follow agency protocols for providing client protection if a threat to self or othersexists -Implement frequent rest periods -Provide outlets for physical activity, dont involve the client in activities that last a long time or that require a high level of concentration and/or detailed instructions -Protect client form poor judgement&impulsive behavior MAINTENANCE OF SELF CARE NEEDS: -Monitoring sleep, fluid intake and nutrition -Providing portable, nutritious food b/c the client might not be able to sit down to eat -Supervising choice of clothes -Giving step by step reminders for hygiene and dress COMMS: -Use a calm, matter of fact specific approach -Give concise explanations -Provide for consistency w/ expectations&limit setting -Avoid power struggles&don't react personally to the clients comments -Listen to&act on legit client greivances -Reinforce nonmanipulative behaviors -Use therapeutic comm techniques

Moderate Alzheimer's (middle stage)

-Forgetting events of one's own history -Difficulty performing tasks that require planning and organizing -Difficulty w/ complex mental arithemetic -Personality and behavioral changes ( appearing withdrawn/subdued, especially in social or mentally challenging situations, compulsive, and repetitive actions) -Changes in sleep patterns -Can wander and get lost -Can be incontinent -Clinical findings that are noticeable to others

Seasonal affective disorder (SAD)

-Form of depression that occurs seasonally, usually during the winter, when there is less daylight... light therapy is the first line treatment for SAD

Depressive disorders screening tools

-Hamilton depression scale -Beck depression inventory -Geriatric depression scale (short form) -Aung Self rating depression scale -Patient Health Questionnaire-9 (PHQ-9)

Standardized screening tools anxiety

-Hamilton rating scale for anxiety -Fear questionnaire -Panic disorder severity scale -Yale Brown Obsessive compulsive disorder -Hoarding scale self report

Violence care after discharge

-Help the client develop a safety plan, identify behaviors and situations that might trigger violence, and provide information regarding safe places to live -Encourage participation in support groups -Use case management to coordinate community, medical, criminal justice and social services -Use crisis intervention techniques to help resolve family or community situations where violence has been devastating

Affective symptoms of psychotic disorders

-Hopelessness -Suicidal ideation

Factitious disorder risk factors

-Hx of emotional, or physical distress, child abuse, or frequent/chronic childhood illnesses requiring hospitalization -Impaired neuro ability for info processing -Dependent personality -borderline personality disorder

Anger management expected findings

-Hyperactivity such as pacing/restlessness -Defensive response w/ criticized, easily offended -Eye contact that is intense, or no eye contact at all -Facial expression, such as frowning/grimacing -Body language, such as clenching fists, waving arms -Rapid breathing -Aggressive postures -Verbal clues, such as loud/rapid talking -Drug/alcohol intoxication

Common lab abnorms w/ anorexia

-Hypokalemia, especially for those who have bulimia (there is a direct loss of potassium due to purging, dehydration stimulates increased aldosterone production, which leads to NA&H2O retention and K+ excretion) -Anemia&leukopenia w/ lymphocytosis, thrombocytopenia -Possible impaired liver function, evidenced by increased enzyme levels -Hypoalbuminemia -Possible elevated cholesterol -Abnormal thyroid function tests -Elevated carotene levels, which cause skin to appear yellow -Decreased bone density -Abnormal blood glucose level -ECG changes (Prolonged Qt interval) -Possible increase serum bicarb (metabolic alkalosis) related to self induced vomiting -Possible decrease serum bicarb (metabolic acidosis) related to laxative use

Crisis management client education

-Identify&coordinate w/ support agencies&other resources -Plan and provide for followup care

Behavioral therapy

-In protest of Freuds psychoanalytic behavioral theorists such as Pavlov, Watson and Skinner feel that changing behavior was the key to treating problems such as anxiety or depressive disorders -Based on the theory that behavior is learned&has consequences, abnorm behavior results from an attempt to avoid painful feelings... changing abnorms or maladaptive behavior can occur w/out the need for insight into the underlying cause of the behavior -Therapies teach clients ways to decrease anxiety or avoidant behavior and give clients an opp to practice techniques, behavioral therapy teaches activities to help the client reduce anxious&avoidant behavior like relaxation training and modeling -Has been successfully used to treat clients who have phobias, substance use or addictive disorders and other issues

Continuation phase client care

-Increased ability to function -Treatment is generally 4-9 months in duration -Relapse prevention through education, med therapy, and psychotherapy is the goal of treatment

Suicide precautions

-Initiate one on one constant supervision around the clock, always having the client in sight&close, documentation should indicated which staff member is accountable for the client, w/ specific start&stop times, there is an increased risk for suicide during staff rotation times -Document the clients location, mood, quoted statements and behavior every 15 mins or per protocol -Search the clients belongings w/ the client present, remove a;; glass, metal silverware, electrical cords, vases, belts, shoelaces, metal nail files, tweezers, matches razors, perfume, shampoo, plastic bags and other potentially harmful items from the clients room&vicinity -Allow the client to use only plastic eating utensils, count utensils when brought in&out of the clients room -Check the environment for possible hazards (such as windows that are open, overhead pipes that are easily accessible, non breakaway shower rods, non recessed shower nozzles) -Ensure that the client swallows all meds, clients can try to hoard meds until there is enough for a suicide attempt -Identify whether the client's current meds can be lethal w/ overdose, if so collab w/ the provider to have less dangerous meds substituted if possible -restrict visitors from bringing possible harmful items to the client

Violence client education

-Instruct clients regarding normal growth&development -Teach clients self care and empowerment skills -Teach clients ways to manage stress

Eating disorders cardiovascular system expected findings

-Irregular heart rate, heart failure, cardiomyopathy -Peripheral edema -Acrocyanosis

Journal writing

-Journaling has been shown to allow for a therapeutic release of stress -This activity can help the client identify stressors&specific plans to decrease stressors

Manic characteristics

-Labile mood w/ euphoria -Agitation&irritability -Restlessness -Dislike of interference&intolerance of criticism -increase in talking&activity -Flight of ideas... rapid, continuous speech w/ sudden and frequent topic change -Grandiose view of self abilities -Impulsivity -Demanding&manipulative behavior -Distractibility&decreased attention span -Poor judgement -Attention seeking behavior -Impairment in social&occupational functioning -Decreased sleep -Neglect of ADLs -Possible presence of delusions&hallucinations -Denial of illness

Severe alzheimers (late stage)

-Losing ability to converse w/ others -Assistance required for ADLs -Incontinence -Losing awareness of environment -Progressing difficulty w/ physical abilities -Eventually loses all ability to move, can develop stupor&coma -Death frequently related to choking or infection

Eating disorders vital signs expected findings

-Low BP w/ possible orthostatic hypotension -Decreased pulse& body temp -HTN can be present in clients who have binge eating disorder

Depressive disorders recognized by the DSM-5

-Major depressive disorder -Seasonal affective disorder -Dysthymic disorder -Premenstrual dysphoric disorder (PMDD) -Substance-induced depressive disorder

Conversion disorder expected findings

-Manifestations of an alteration in voluntary motor or sensory function MOTOR: Paralysis, movement/gait disorders, seizure like movements SENSORY: Blindness, inability to speak (APHONIA), inability to smell (ANOSMIA), numbness, deafness, tingling/burning sensations -Clients who have an extreme desire to become pregnant can manifest a false pregnancy (psuedocyesis)

Behavioral techniques

-Meditation techniques includes formal 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 person... for example, one client might imagine walking on a beach, while another client might imagine himself in a position of success BREATHING EXERCISES: Used to decrease rapid breathing and promote relaxation PROGRESSIVE MUSCLE RELAXATION: A person trained in this method can help a client attain complete relaxation w/in a few mins PHYSICAL EXERCISE: Causes release of endorphins that lower anxiety, promote relaxation, and have antidepressant effects -Use nursing judgement to determine the approp of relaxation techniques for clients who are experiencing acute manifestation of a psychotic disorder

Mild Alzheimer's (early stage)

-Memory lapses -Losing or misplacing items -Difficulty concentrating and organizing -Unable to remember material just read -Still able to preform ADL's -Short term memory loss noticeable to close relations

TMS complications

-Mild discomfort or a tingling sensation at the site of the electromagnet and headaches -Monitor for lightheadedness after -Seizures are a rare but potential complication -Not associated w/ systemic adverse effects of neuro deficits

Psychotic disorders nursing care

-Mileu therapy is used for clients who have a psychotic disorder both in the acute mental health facilities and in community health facilities -Provide a structured, safe mileu for the client in order to decrease anxiety&to distract the client from constant thinking about hallucinations PROGRAM OF ASSERTIVE COMMUNITY TREATMENT (PACT): Intensive case management to assist clients w/ community living needs -Promot therapeutic comm to lower anxiety, decrease defensive patterns and encourage participation in the mileu -Establish a trusting relationship w/ the client -Encourage the development of social skills&friendships -Encourage participation in group work&psychoeducation -Use aprop comm to address hallucinations&delusions -Ask the client directly about hallucinations, the nurse should not argue or agree w/ the clients view of the situation, but can offer a comment -Don't argue w/ a clients delusions, but focus on the clients feelings&possibly offer reasonable explanations -Assess the client for paranoid delusions, which can increase the risk for violence against others -If the client is experiencing command hallucinations, provide for safety due to increased risk for harm to self or others -Attempt to focus conversations on reality based subjects Identify symptom triggers, such as loud noises, hallucinations and situations that seems to trigger conversations about the clients delusions -Be genuine&empathetic in all dealings w/ the client -Assess discharge needs, such as ability to preform ADLs -Promote self care by modeling and teaching self care activities w/in the mental health facility -Relate wellness to the elements of symptom management -Collab w/ the clients to use symptom management techniques to cope w/ depressive symptoms&anxiety -Symptom management techniques include using music to distract from voices, attending activities, walking, talking to a trusted person when hallucinations are most bothersome, and interacting w/ an auditory/visual hallucination by telling it to stop or go away -Encourage med compliance -Provide teaching regarding meds -Whenever possible, incorporate family in all aspects of care

Psychotic disorders nursing care

-Milieu therapy is used for clients who have a psychotic disorder both in acute mental health facilities and in community facilities, such as residential crisis centers, halfway houses, and day treatment programs -Provide a structured, safe environment for the client in order to decrease anxiety and to distract the client from constant thinking about hallucinations -PROGRAM OF ASSERTIVE COMMUNITY TREATMENT (PACT): Intensive case management and interprofessional team approach to assist clients w/ community living needs -Promote therapeutic comm to lower anxiety, decrease defensive patterns and encourage participation in milieu -Establish a trusting relationship w/ the client -Encourage the development of social skills and friendships -Encourage participation in group work&psychoeducation -Use approp comm to address hallucinations and delusions -Ask the client directly about hallucinations, the nurse should not argue or agree w/ the clients view of the situation but can offer a comment, such as, "I don't hear anything, but you seemed frightened" -Don't argue w/ a clients delusions, but focus on the client's feelings&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 -If the client is experiencing command hallucinations, provide for safety due to increased risk for harm to self or others -Attempt to focus conversations on reality based subjects -Identify symptoms triggers, such as loud noises (can 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 w/ the client -Assess discharge needs such as ability to perform activities of daily living -Promote self care by modeling and teaching self care activities w/in the mental health facility -relate wellness to the elements of symptom management -Collab w/ the client to use symptom management techniques to cope w/ depressive symptoms&anxiety.. symptom management techniques include such strats as using music to distract from voices, attending activities, walking, talking to a trusted person when hallucinations are most bothersome, and interacting w/ an auditory or visual hallucination by telling it to stop or go away -Encourage med compliance -Provide teaching regarding meds -Whenever possible, incorporate family in all aspects of care

Types and uses of behavioral therapy

-Modeling -Operant conditioning -Systematic desensitization -Aversion therapy -Meditation, guided imagery, diaphragmatic breathing, muscle relaxation, biofeedback

ECT complications cardiovascular changes

-Monitor VS&cardiac rhythm regularly per protocol

NCDs physical needs

-Monitor neuro status -Identify disturbances in physiologic status which can contribute to the cause of delirium -Assess skin integrity which can be compromised due to poor nutrition, bed rest. -Monitor VS... tachycardia, elevated BP, dilated pupils can be associated w/ delirium -Implement measures to promote sleep -Monitor the clients level of comfort&assess for nonverbal indications of discomfort, provide eyeglasses&assistive hearing devices as needed -Ensure adequate food&fluid intake, underlying causes of delirium can result in electrolyte imbalance

Anxiety risk factors

-More likely to occur in women, OCD also affect women more than men w/ the exception of hoarding disorder which has a higher prevalence in mean... they have a genetic and neurological mix -Clients can experience anxiety due to an acute medical condition, such as hyperthyroidism or PE, it is important to assess the manifestations of anxiety in a med facility to rule out physical cause -Adverse effects of many meds can mimic anxiety disorder -Substance induced anxiety is related to a current use of a chemical substance or to withdrawal effects from a substance

Eating disorders musculoskeltal system expected findings

-Muscle weakness -Decreased energy -Loss of bone density

Eating disorders risk factors

-Occupational choices that encourages thinness -Individual hx of being a "picky" eater in childhood -Participation in athletics, especially at an elite level of competition or in a sport where lean body build is prized or where a specific weight is necessary -A hx of obesity FAMILY HX: More commonly seen in families w/ a hx of eating disorders BIOLOGICAL: Hypothalamic, neurotransmitter, hormonal or biochemical imbalance, w/ disturbances of the serotonin neurotransmitter pathways seeming to be implicated INTERPERSONAL BELIEFS: Influenced by parental pressure and the need to succeed PSYCHOLOGICAL INFLUENCES: Rigidity, ritualism, separation and individualization conflicts, feelings of ineffectiveness, helplessness, and depression, distorted body image, internal or external locus of control or self identity, and potential hx of physical abuse ENVIRONMENTAL FACTORS: Media influence and pressure from society to have the perfect body TEMPERAMENTAL: Anxiety or obsessional traits in childhood

Mild level of anxiety

-Occurs in the normal experience of everyday living -Increases ones ability to perceive reality -There is an identifiable cause of the anxiety -Other characteristics include a vague feeling of imld discomfort, restlessness, irritability, impatience and apprehension -The client can exhibit behaviors such as finger or foot tapping, fidgeting or lip chewing as mild tensions relieving behaviors

Moderate level anxiety

-Occurs when mild anxiety escalates -Slightly reduced perception&processing of information occurs, and selective inattention can occur -Ability to think clearly is hampered, but learning&problem solving can still occur -Other characteristics include concentration difficulty, tiredness, pacing, change in voice pitch, voice tremors, shakiness, and increased HR/RR -The client can report somatic headaches, backache, urinary urgency/frequency and insomnia -The client who has this type of anxiety usually benefits from the direction of others

Sexual violence

-Occurs when sexual contact takes place w/out consent, whether the vulnerable person is able or unable to give that consent

Anger management meds

-Olanzapine, Ziprasidone -Haloperidol -Other meds

Cluster A (odd or eccentric traits) personality disorders

-Paranoid -Schizoid -Schizotypal

Anger management risk factors

-Past hx of aggression, poor impulse control, violence -Poor coping skills, limited support systems -Comorbidity that leads to acts of violence -Living in a violent environment -Limit setting by the nurse w/in the therapeutic milieu

Myths regarding suicide

-People who talk about suicide never commit it -People who are suicidal only want to hurt themselves, not others -There is no way to help someone who really wants to kill themselves -Mention of the word suicide will cause the person to actually commit it -Ignoring verbal threats of suicide, or challenging a person to carry out suicide plans, will reduce the individual's use of these behaviors -People who talk about suicide are only trying to get attention

Severe level anxiety

-Perceptual field is greatly reduced w/ distorted perceptions -Learning and problem solving do not occur -Functioning is ineffective -Other characteristics include confusion, feelings of impending doom, hyperventilation, tachycardia, withdrawal, loud&rapid speech and aimless activity -The client is usually not able to take direction from others

Factitious disorders nursing care

-Perform a self assessment prior to care -Avoid confrontation -Build rapport and trust w/ client -Ensure safety of client and vulnerable persons affected by the client -Encourage verbalization of feelings -Educate the client on alternative coping mechs -Educate client on stress management techniques -Communicate openly w/ the health care team any suspicions of factitious disorder or dsorder imposed on another.. this action can help reduce medical costs and possible unnecessary treatments/surgical procedures

Eating disorders nursing care

-Perform a self assessment regarding possible feelings of frustration regarding the clients eating behaviors, the belief that the disorder is self imposed, or the need to nurture rather than care or the client -Provide a highly structured millieu in an acute care unit for the client requiring intensive therapy -Develop and maintain a trusting nurse/client relationship through consistency and therapeutic comm -Use a positive approach and support to promote client self esteem and positive self image -Encourage client decision making&participation in the plan of care to allow for a sense of control -Establish realistic goals for weight loss or gain -Promote cognitive behavioral techniques (cognitive reframing, relaxation techniques, journal writing, desensitization exercises) -Monitor the clients VS, I&O, and weight (2-3 lb/weeks is medically okay) -Use behavioral contracts to modify client behaviors -Reward the client for positive behaviors, such as completing meals or consuming a set number of calories -Closely monitor the client during and after meals to prevent purging, which can necessitate accompanying the client to the bathroom -Monitor the client for maintenance of approp exercise -Teach and encourage self care activities -Incorporate the family when approp in client education& d/c planning -Work w/ a dietitian to provide nutrition education to include correcting misinformation regarding food, meal planning, and food selection -Consider the clients preferences and ability to consume food when developing the initial eating plan -A structured and inflexible eating schedule at the start of therapy, only permitting food during scheduled times, promotes new eating habits&discourages binge or binge purge behavior -Provide small, frequent meals, which are better tolerated and will help prevent the client from feeling overwhelmed -Provide liquid supplement as prescribed -Provide a diet high in fiber to prevent constipation -Provide a diet low in sodium to prevent fluid retention -Limit high fat and gassy foods during the start of treatment -Amin a multivitamin and mineral supplement -Instruct the client to avoid caffeine to reduce the risk for increased energy, resulting in difficulty controlling eating disorder behaviors.. caffeine also can be used by clients as a sub for healthy eating -Make arrangements for the client to attend individual, group and family therapy to assist in resolving personal issues contributing to the eating disoder

Anorexia nervosa

-Persistent energy intake restriction leading to significantly low body weight in context of age, sex, developmental path, and physical health -Fear of gaining weight or becoming fat -Disturbance in self perceived weight or shape

Cognitive disorder risk factors

-Phsyiological changes including neurologic, metabolic, cardiovascular, respiratory diseases, infections, surgery and substance use/withdrawal -Other risk facators for delirium include older age, multiple co-morbidities, severity of disease, polypharmacy, ICU, aphasia, restraint use, change in client environment -Risk factors for neurocognitive disorder and AD include advanced age, prior head trauma, cardiovascular disease, lifestyle factors and a family hx of AD.. there is a strong genetic link in early onset familial AD

Perpetrator characteristics

-Possible use of threats&intimidate to control the vulnerable person -Usually an extreme disciplinarian who believes in physical punishment -Poor impulse control -Perceives the child as bad -Violent outbursts -Poor coping skills -Low self esteem -Feelings of worthlessness -Possible hx of substance use disorder -Difficulty assuming typical adult roles -Likely to have experienced family violence as a child

Anger management nursing care

-Provide a safe environment for the client who is aggressive, as well as for the other clients&staff on the unit -Follow policies of the mental health setting when working w/ clients who demonstrate aggression -Assess for triggers or preconditions that escalate client emotions

Anxiety nursing care

-Provide a structured interview to keep the client focused on the present -Assess for comorbid condition of substance use disorder -Provide safety and comfort to the client during the crisis period of severe to panic level anxiety are unable to problem solve&focus... clients experiencing panic level anxiety benefit from a clam, quiet environment -Remain w/ the client during the worst of the anxiety to provide reassurance -Perform a suicide risk assessment -Provide a safe environment for other clients&staff -Provide miley therapy the employs (a structured environment for physical safety and predictability, monitoring for and protection from self harm/suicide, daily activities that encourage the client to share and be cooperative, use of therapeutic comm skills to help the client express feelings of anxiety&validate those feelings, client participation in decision making regarding care) -Use relaxation techniques w/ the client as needed for relief of pain, muscle tension and feelings of anxiety -Instill hope for positive outcomes -Enhance client self esteem by encouraging positive statements and discussing past achievements -Assist the client to identify defense mechs that interfere w/ recovery -Postpone health teaching until after acute anxiety subsides, clients experiencing a panic attack or severe anxiety are unable to concentrate or learn

NCDs cognitive support

-Provide compensatory memory aids, such as clocks, calendars, photographs, memorabilia, seasonal decorations, and familiar objects.. reorient as necessary -Keep a consistent daily routine -Maintain consistent caregivers -Cover or remove mirrors to decrease fear&agitation

ECT complications rxs to anesthesia

-Provide continuous monitoring during the procedure and in the immed recovery phase

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 clients chest -Believed to result in an increased level of neurotransmitters

Depressive disorders interprofessional care

-Psychotherapy by a trained therapist can include individual cognitive behavioral therapy, interpersonal therapy, group therapy and family therapy -CBT assists the client to identify and change negative behavior&thought patterns -IPT encourages the client to focus on personal relationships that contribute to the depressive disorder

Eating disorders criteria for acute care treatment

-Rapid weight loss or weight loss of greater than 30% of body weight over 6 months -Unsuccessful weight gain in outpatient treatment, failure to adhere to treatment contract -VS demonstrating HR less than 40/min, systolic BP less than 70 mm Hg, body temp less than 36 (96.8) -ECG changes -Electrolyte imbalances -Psychiatric criteria (severe depression, suicidal behavior, ,family crisis or psychosis)

Maintenance phase client care

-Remission of manifestations -This phase can last for years -Prevention of future depressive episodes is the goal of treatment

Factitious disorder expected findings

-Report of false physical and psychological manifestations -Possible evidence of self injury or injury to others

Steps to handle aggressive behavior

-Respond quickly -Remaining calm&in control -Encouraging the client to express feelings verbally, using therapeutic comm techniques (reflection, silence, active) -Allowing the client as much personal space as possible -Maintaining eye contact&sitting or standing at the same level as the client -Communicating w/ honesty, sincerity and nonaggressive stance -Avoiding accusatory or threatening statements -Describing options clearly&offering choices -Reassuring the client that staff members are present to help prevent loss of control -Setting limits for the client (tell the client calmly and directly what he must do in a particular situation, use physical activity to deescalate anger/behaviors, inform the client of the consequences of his behavior, such as loss of privileges, use pharm interventions if the client doesn't respond to the limit setting, plan for 4-6 staff members to be available and in sight of the client as a "show of force" if approp

Types of crisis

-SITUATIONAL/EXTERNAL:Often unanticipated loss or change experienced in everyday, often unanticipated, life events MATURATIONAL/INTERNAL: Achieving new developmental stages, which requires learning additional coping mechanisms -ADVENTITIOUS: The occurrence of natural disasters, crimes or national disasters, people in communities w/ large scale psychological trauma caused by natural disasters

Suicide meds

-SSRIS -Sedative hypnotics anxiolytics (benzos) -Mood stabilizers -Second generation antipsychotics

Types of disorders

-Schizophrenia -Schizotypal personality disorder -Delusional disorder -Brief psychotic disorder -Schizophreniform disorder -Shiczoaffectice disorder -Substance-induced psychotic disorder -Psychotic or catatonic disorder not otherwise specified

Depressive disorder meds

-Selective serotonin reuptake inhibitors (SSRIS) -Tricyclic antidepressants (TCAs) -MAOIs -Atypical antidepressants -Serotonin norepinephrine reuptake inhibitors (SNRIS0

Personality disorders nursing care

-Self assessment is vital for nurses caring for clients who have personality disorders and should be performed prior to care -Clients who have personality dx can evoke intense emotions in the nurse -Awareness of personal reactions to stress promotes effective nursing care -Therapeutic comm&intervention are promoted when client behaviors are anticipated -The nurse should repeat the self assessment if experiencing a personal stress response to client behavior -Milieu management focuses on approp social interaction w/in a group context -Safety is always a priority concern b/c some clients who have a personality dx are at risk for self injury or violence

Suicide psychosocial risk factors

-Sense of hopelessness -Intense emotions, such as rage, or guilt -Poor interpersonal relationships at home, social and work -Developmental stressors, such as those experienced by teens

Acute phase client care

-Severe clinical findings of depression -Treatment is generally 6-12 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

Violence infant assessment

-Shaken baby syndrome: shaking can cause intracranial hemorrhage, assess for respiratory distress, bulging fontanels, and an increase in head circumference.. retinal hemorrhage can be present -Any bruising on an infant before age 60 months is susupcious

ECT complications memory loss&confusion

-Short term memory loss, confusion and disorientation occurs immed following the procedure may persist for several hours -Memory loss can persists for several weeks -Whether ECT causes permanent memory loss is controversial, but most clients fully recover from any memory deficits -Provide frequent orientation -Provide safe environment to prevent injury -Assist the client w/ personal hygiene as needed

Somatic symptom disorder expected findings

-Somatic symptoms that disrupt the client's daily life -Excessive preoccupation w/ somatic symptoms -Increased level of anxiety about somatic symptoms -Somatic symptoms are usually present (though actual manifestations can vary) for longer than 6 months -Remissions and exacerbations of somatic symptoms -Probable alcohol or other substance use -Client overmed w/ analgesics and antianxiety meds

Bipolar disorder comorbidities

-Substance use disorder -Anxiety -Borderline personality disorder -oppositional defiant disorder -Social phobia and specific phobia -Seasonal affective disorder

Crisis management protective factors

-Support system -Prior experience w/ stress/crisis

Cognitive behavioral therapy

-The anxiety response can be decreased by changing cognitive disorders, the therapy uses cognitive reframing to help the client identify negative thoughts that produce anxiety, examine the cause and develop supportive ideas that replace negative self talk

NCDs nursing care

-The best way to prevent&manage delirium is to minimize risk factors&promote early detection... timely recognition is essential -Perform self assessment regarding possible feeling of frustration, anger of fear when performing daily care for clients who have progressive cognitive decline -nursing interventions are focused on protecting the client from injury, as well as promoting client dignity and quality of life -Provide for a safe therapeutic environment (assess for potential injury, such as falls or wandering, assign the client to a room close to the nurses station for close observation, provide a room w/ a low level of visual&auditory stimuli, provide a well lit environment, minimizing contrasts&shadows, have the client sit in a room w/ windows to help w/ time orientation, have the client wear an identification bracelet... use monitors&bed alarm devices as needed, use restraints only as an intervention of last resort, use caution when admin meds PRN for agitation/anxiety, assess the clients risk for injury&ensure safety in the physical environment, such as a lowered bed)

Mindfulness

-The client is encouraged to be mindful of his surroundings using all of his senses, such as the relaxing warmth of sunlight or the sound of a breeze blowing through the trees -The client learns to restructure negative thoughts and interpretations into positive ones, instead of saying "it's so frustrating that the elevator isn't working", the client restructures the thought into "Using the stairs is a great opp to burn off some extra calories"

Assertiveness training

-The client learns to comm in a more assertive manner in order to decrease psychological stressors -One technique teaches the client to assert his feelings by describing a situation or behavior that causes stress, stating his feelings about the behavior or situation, and them making a change, The client states "When you keep telling me what to do, I feel angry&frustrated, I need to try making some of my own decisions"

Priority restructuring

-The client learns to prioritize differently to reduce the number of stressors affecting her -A person who is under stress due to feeling overworked might delegate some tasks to others rather than doing them all herself

Eating disorders expected findings

-The client's perception of the issue -Eating habits -Hx of dieting -Methods of weight control (restricting, purging, exercising) -Value attached to a specific shape&weight -Interpersonal and social functioning -Difficulty w/ impulsivity, as well as compulsivity -Family and interpersonal relationships (frequently troublesome and chaotic, reflecting a lack of nurturing)

Suicide self assessment

-The nurse must determine how she feels personally about suicide -The nurse must become comfortable asking personal questions about suicidal ideation and following up on clients answers -Death of a client by suicide can cause health care professionals to experience hopelessness, helplessness, ambivalence, anger, anxiety, avoidance, and denial Nurses who work w/ clients who have SI can benefit personally by debriefing, sharing and collab w/ other health professionals

Other individual stress reduction techniques

-The nurse should assist each client in identifying individual strats to improve her ability to cope w/ stress -Examples include individual hobbies, such as fishing, scrapbooking, music therapy and pet therapy

Suicide therapeutic procedures

-Therapeutic communication -ECT

Chronic (trait) anxiety

-This level of anxiety is one that usually develop over time, often starting in childhood -The adult who experiences chronic anxiety might display that anxiety in physical manifestations, such as fatigue and frequent headaches

Acute (state) anxiety

-This level of anxiety is precipitated by an imminent loss or change that threatens ones sense of security

Panic disorder expected findings

-Typically lasts 15-30 mins FOUR OR MORE of the following manifestations are present during a panic attack: -Palpitations -SOB -Choking or smothering sensation -Chest pain -Nausea -Feelings of depersonalization -Fear of dying or insanity -Chills or hot flashes -The client might experience behavior changes and/or persistent worries about when the next attack will occur

Suicide older adults risk factors

-Untreated depression -Loss of employment and finances -feelings of isolation, powerlessness -Prior attempts at suicide -Alcohol or other substance use disorder -Loss of loved ones

Bipolar disorder relapse

-Use of substances can lead to an episode of mania -Sleep disturbances can come before, or be associated w/ an episode of mania -Psychological stressors can trigger an episode of mania

Cognitive-behavioral therapy

-Uses both approaches to assist a client w/ anxiety management

Anxiety

-Viewed on a continuum w/ increasing levels of anxiety leading to decreasing ability to function

VNS complications

-Voice changes due to the proximity of the implanted lead on the vagus nerve to the larynx and pharynx -Hoarseness, throat/neck pain, dysphagia.. these commonly improve with time -Dyspnea is possible.. there fore the client might want to turn off the VNS during exercise or when periods or prolonged speaking are required

Therapeutic communication

-When questioning the client about suicide, always use a followup question if the first answer is negative, for example, "I'm feeling completely hopeless" the nurse says "Are you thinking of suicide?" -Establish a trusting therapeutic relationship -Limit the amount of time an at risk client spends alone -Involve significant others in the treatment plan -Carry out treatment plans for the client who has a comorbid disorder

Bulimia characteristics

-most clients who have bulimia maintain a weight w/in normal range or slightly higher... BMI is 18.5-30 -The average age of onset in female clients is late teens to early adulthood -Bulimia occurs most commonly in females -B/w binges, clients typically restrict caloric intake and select low calorie diet foods

Types of violence

A nurse must prepare to deal w/ various types of violence and the mental health consequences: -Violence can be directed toward a family member, stranger of acquaintance, or it can came from a human made madd casualty incident, such as a terrorist attack -Natural disasters, such as hurricanes and earthquakes, can cause mental health effects comparable to those caused by human made violence -Violence against a person who has a mental illness is more likely to occur when factors such as poverty, transient lifestyle, or a substance use disorder are present -A person who has a mental illness is no more likely to harm strangers than anyone else -The factor most likely to predict violence b/w strangers is a past hx of violence and criminal hx

Biofeedback

A nurse or other health professional trained in this method uses a sensitive mechanical device to assist the client to gain voluntary control of such autonomic functions as HR&BP

Major depressive disorder (MDD)

A single episode or recurrent episodes of unipolar depression (not associated w/ mood swings from major depression to mania) resulting in a significant change in a clients normal functioning (social, occupational, self care) accompanies 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 -SI -Increase or decrease in motor activity -Inability to feel pleasure -Increase or decrease in weight of more than 5% total body weight over 1 month MDD can be further diagnosed in the DSM-5 w/ a more specific classification, including: PSYCHOTIC FEATURES: The presence of auditory hallucinations (voices telling the client she is sinful) or the presence of delusions (client thinking that she has a fatal disease) POSTPARTUM ONSET: Depressive episode that begins w/in 4 weeks of childbirth (known as PPD_ and can include delusions, which can put the newborn infant at high risk of being harmed by the mother

Modeling

A therapist/others serve as role models for a client, who imitates this modeling to improve behavior USE IN MENTAL HEALTH NURSING: -can occur in the acute care mileu to help clients improve interpersonal skills, the therapist demonstrates aprop behavior in a stressful situation w. the goal of having the client imitate the behavior

Psychotic disorders standardized screening tools

ABNORMAL INVOLUNTARY MOVEMENT SCALE (AIMS): -Used to monitor involuntary movements&tardive dyskinesia in clients who take antipsych meds WORLD HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE (WHODAS): -Helps to determine the clients level of global functioning

Psychotic disorders standardized screening tools

ABNORMAL INVOLUNTARY MOVEMENT SCALE (AIMS): This tool is used to monitor involuntary movements&tardive dyskinesia in clients who take antipsychotics meds WORLD HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE (WHODAS): This scale helps to determine the client's level of global functioning

TCAs

AMITIPTYLINE -Advise the client to change positions slowly to minimize dizziness from orthostatic hypotension -To minimize anticholinergic effects, advise, the client to chew sugraless gum, eat foods high in fiber&increase fluid intake to 2-3 L/day from food&beverage sources

Common comorbidities

ANXIETY DISORDERS: These disorder are comorbid in approx 70% of clients who have a depressive disorder, this combo makes a client's prognosis poorer, w/ a higher risk for suicide and disability PSYCHOTIC DISORDERS: Such as schizophrenia SUBSTANCE USE DISORDERS: Clients often use substances in an attempt to relieve manifestations of depression or self treat mental health disorders EATING DISORDERS PERSONALITY DISORDERS

Characteristic dimensions of psychotic disorders negative symtpoms

Absence of things that are normally present, these manifestations are more difficult to treat successfully than positive symptoms: AFFECT: Usually blunted (narrow range of expression) or flat (facial expression never changes) ALOGIA: Poverty of thought or speech, the client might sit w/ a visitor but 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

Violence nursing care

All states have mandatory reporting laws that require nurses to report suspected abuse, there are civil and criminal penalties for not reporting suspicions of abuse Nursing interventions for child or vulnerable adult abuse must include the following: -Mandatory reporting of suspected or actual cases of child or vulnerable adult abuse -Complete&accurate documentation of subjective&objective data obtained during assessment -A forensic nurse has advanced training in the collection of evidence for suspected or actual cases of sexual assault or other forms of physical abuse Conduct a nursing hx: -Provide privacy when conducting interviews about family abuse -Be direct, honest&professional -Use language the client understands -Be understanding&attentive -Use open ended questions to elicit descriptive responses -Inform the client if a referral must be made to child or adult protective services.. and, be sure to explain the process -Provide basic care to treat injuries -Make approp referrals

Conversion disorder

Also known as functional neurological disorder, conversion disorder results when a client exhibits neurologic manifestations in the absence of a neurologic diagnosis, clients who have conversion disorder transmit emotional or psychological stressors into physical manifestations -Neurologic manifestations can cause extreme anxiety and distress in some clients while others can exhibit a lack of emotional concern (la belle indifference) -The neurologic manifestation causes a significant impairment in multiple aspects of the clients life -Clients who have conversion disorder have deficits in voluntary motor or sensory functions

Psychotic disorders alterations in thought (delusions)

Alterations in thought are false fixed beliefs that cannot be corrected by reasoning and are usually bizarre, these include the following: IDEAS OF REFERENCE: Misconstrues trivial events&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 a god SOMATIC DELUSIONS: Believes that his body is changing in an unusual way, such as growing a third arm JEALOUSY: Believes that her partner is sexually involved w/ another individual even though there is not any factual bases for this belief BEING CONTROLLED: Believes that a force outside his body is controlling him THOUGHT BROADCASTING: Believes that thoughts are heard by others THOUGHT INSERTION:Believes thoughts are inserted into his mind THOUGHT WITHDRAWAL: Believes that her thoughts have been removed from her mind by an outside agency RELIGIOSITY: Obsessed w/ religious beliefs MAGICAL THINKING: Believes that actions or thoughts are able to control a situation or affect others, such as wearing a certain hat makes them invisible to others

TMS indications

Approved by the FDA for the treatment of major depressive disorders for clients who are not responsive to pharm treatment

Suicide client education

Assist the client to develop a support ystem list w/ specific names, agencies, and telephone numbers that the client can call in case of an emergency CARE AFTER DC: -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 seek help -Not legally binding and should only be used according to facility policy -Can be beneficial, but should not replace other prevention strats -Can be used as a tool to develop and maintain trust b/w the nurse&client -Discouraged for clients who are in crisis, under the influence of substances, psychotic, very impulsive and/or very angry/agitated

Types of bipolar disorders

BIPOLAR I DISORDER: -Client has at least one episode of mania alternating w/ major depression BIPOLAR II DISORDER: -Client has one or more hypomania episodes alternating w/ major depression CYCLOTHYMIC DISORDER: -Client has at least 2 years of repeated hypomanic manifestations that don't meet the criteria for hypomanic episodes alternating w/ minor depressive episodes

Atypical antidepressants

BUPROPION: -Advise the client to observe for headache, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, or insomnia and to notify the provider if they become intolerable -monitor the clients food intake and weight due to appetite syndrome -Avoid admin to clients at risk for seizures

NCDs client education

CARE AFTER DISCHARGE: -Educate family/caregivers about the clients illness, methods of care and adaptation of the home environment -Ensure a safe environment in the home QUESTIONS TO ASK; -Will the client wander out into the street if doors are left unlocked -Is the client able to remember his address and his name -Does the client harm others when allowed to wander in a long term care facility HOME SAFETY MEASURES: -Remove scatter rugs -Install door locks that cannot be easily opened -Lock water thermostat and turn water temp down to a safe level -Provide good lighting, especially on stairs -install a handrail on stairs, and mark step edges w/ colored tape -Place mattresses on the floor -Remove clutter, keeping clear, wide pathways for walking through a room -Secure electrical cords to baseboards -Store cleaning supplies in locked cupboards -Install handrails in bathrooms SUPPORT FOR CAREGIVERS -Encourage the client&family to seek legal counsel regarding advanced directives -Determine teaching needs for the client&family members as the clients cognitive ability progressively declines - Review resources available to the family as the clients health declines, include long term options, a variety of home care&community resources can be available in many areas, these resources can allow the client to remain at home rather than a care facility -Provide support for caregivers, encourage them to ask for help&other family members for respite care, and to take advantage of local support groups -Encourage caregivers to take care of themselves and to take one day at a time

NCDs meds

CHOLINESTERASE INHIBITOR MEDS: Increase acetylcholine at cholinergic synapses by inhibiting its breakdown by acetylcholinesterase, which increases the availability of acetylcholine at neurotransmitter receptor sites in the CNS -In some clients, these meds improve the ability to perform self care&slow cognitive deterioration of alzheimers disease in the mild to moderate stages ADVERSE EFFECTS: -GI effects -Monitor for GI adverse effects and for fluid volume deficits -Promote adequate fluid intake -The provider may titrate the dosage to reduce GI effects -Bradycardia/syncope -Teach the family to monitor pulse rate for the client who lives at home -The client should be screened for underlying heart disease CONTRAINDICATIONS/PRECAUTIONS: -Cholinesterase inhibitors should be used w/ caution in clients who have re existing asthma or other obstructive pulmonary disorders.. bronchoconstriction can be caused by an increase of acetylcholine

SSRIS

CITALOPRAM, FLUOXETINE, SERTRALINE ***LEADING TREATMENT FOR DEPRESSION*** -Advise he client that adverse effects can include nausea, headache, and central nervous system simulation (agitation, insomnia, anxiety) -Instruct the client that sexual dysfunction can occur&to notify the provider if effects are intolerable -Advise the client to observe for manifestations of serotonin syndrome, if nay occur, instruct the client to w/hold the med&notify the provider -Instruct the client to avoid concurrent use of St Johns wort which can increase the risk of serotonin syndrome -Instruct the client to follow a healthy diet& exercise regimen b/c weight gain can occur w/ long term use

SSRIS for suicide

CITALOPRAM, FLUOXETINE, SERTRALINE -Decreased risk of lethal overdose compared to other categories of antidepressants -Don't stop taking abruptly -Meds can take 1-3 weeks for therapeutic effects for initial response w/ up to 2 months for maximal response -Avoid hazardous activities until med adverse effects are known, which could include CNS stimulation, nausea, headache. -Sexual dysfunction can occur, notify the provider if effects are intolerable -Follow a healthy diet, as weight gain can occur w/ long term use -Monitor for indications of increased depression and intent of suicide

Stress cognitive techniques

COGNITIVE REFRAMING (SEE ANOTHER NOTECARD)

Use of cognitive thearpy

COGNITIVE REFRAMING: -Changing cognitive distortions can decrease anxiety, cognitive reframing assists clients t identify negative thoughts that produce anxiety, examine the cause and develop supportive ideas that replace negative self talk. -Through therapy the client can change his thinking to realize that they might have made some bad choices but that doesnt make them a bad person PRIORTY RESTRUCTURING: -Assists clients to identify what requires priority such as devoting energy to pleasurable activities JOURNAL KEEPING: -Helps clients write down stressful thoughts&has a positive effect on well being ASSERTIVENESS TRAINING: -Teaches clients to express feelings, and solve problems in a nonaggressive manner MONITORING THOUGHTS: -Helps clients to be aware of negative thinking

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 -As an example, a client may think he is a "terrible father to my daughter", a health professional using therapeutic comm techniques, could help the client reframe that thought into a positive thought, such as "I've made some bad mistakes as a parent, but I've learned from them and have improved my parenting skills"

NCDs Interactions

CONCURRENT USE OF NSAIDS, SUCH AS ASPIRIN, CAN CAUSE GI BLEEDING: -Assess the use of over the counter NSAIDs -Monitor for indications of GI bleeding ANTIHISTAMINES, TCAS, CONVENTIONAL ANTIPSYCHS CAN REDUCE THE THERAPEUTIC EFFECTS OF DONEPEZIL: -Use of cholinergic receptor blocking meds for clients taking any cholinesterase inhibitor is not recommended -Dosage should start low&gradually be increased until adverse effects are no longer tolerable or meds is no longer beneficial -Monitor for adverse effects&educate family about these effects, taper meds when d/c to prevent abrupt progression of clinical manifestations -Monitor the client for the ability to swallow tabs, most meds are available in tabletes and oral solutions -Admin w/ or w/out food -Donepezil has a long half lilfe and is admin once daily at bedtime, the other cholinesterase inhibitors are usually admin twice daliy -Rivastigmine is available in oral form, and as a patch that is applied once daily MEDS SUCH AS MEMANTINE: -Block the entry of Ca into nerve cells, thus slowing down brain cell death -Approved for moderate to severe stages of AD -Can be used concurrently w/ a cholinesterase inhibitor -Admin med w/ or w/out food -Monitor for common adverse effects, including dizziness, headache, confusion and constipation OTHER MEDS: SSRIs for depression and antiaxiety agents as needed for agitation -Antipsychs are reserved for clients who experience hallucinations or delusions but are used as a last resort b/c these meds carry many side effects

NCDs screening/assessment tools

CONFUSION ASSESSMENT METHOD (CAM): For delirium NEELON-CHAMPAGNE (NEECHAM) CONFUSION SCALE: For delirium FUNCTIONAL DEMENTIA SCALE: This tool will give the nurse info regarding the clients ability to perform self care, extent of the clients memory mood changes, and the degree of danger to self and/or others BRIEF INTERVIEW FOR MENTAL STATUS (BIMS): Used for clients in long term care settings MINI MENTAL STATUSE EXAM (MMSE) FUNCTIONAL ASSESSMENT SCREENING TOOL (FAST) GLOBAL DETERIORATION SCALE BLESSED DEMENTIA SCALE: This tool provides the nurse w/ client behavioral information based on an interview w/ a secondary source

Depressive disorder client education

CONTINUATION PHASE FOLLOWED BY MAINTENANCE PHASE: -Review manifestations of depression w/ the client&family members in order to identify relapse -Reinforce intended effects and potential adverse effects of meds -Explain the benefits of adherence to therapy -Thirty mins of exercise daily for 3-5 days each week improves clinical findings of depression&can help to prevent relapse, even shorter intervals of exercise are helpful, exercise should be regarded as an adjunct to the other therapies for the client who has MDD

Factitious disorders labs and diagnostics

CT scans and MRI can be performed to rule out underlying pathology

Illness anxiety labs&diagnostics

CT scans and MRIS can be performed to rule out an underlying pathology

Somatic symptom lab and diagnostic tests

CT scans and MRIS can be performed to rule out underlying pathology

Conversion disorders lab and diagnostics

CT scans and MRIs can be performed to rule out an underlying pathology

Client care depressive disorders

Care of a client who has MDD will mirror the phase of the disease that the client is experiencing: -Acute phase -Continuation phase -Maintenance phase

Bipolar disorder client care

Care of a client who has bipolar disorder will mirror the phase of the disease that the client is experiencing: ACUTE PHASE/MANIA: -Hospitalization can be required -Reduction of mania&client safety are the goals of treatment -Risk of harm to self or others is determined -One to one supervision can be indicated for client safety CONTINUATION PHASE: -Remission of manifestations -Treatment generally is 4-9 months -Relapse prevention through education, med adherence and psychotherapy is the goal of treatment MAINTENANCE PHASE: -Increased ability to function -Treatment generally continues throughout the clients 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 relationships, often sensitive to criticism

Antisocial

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

Paranoid

Characterized by distrust and sus towards 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 w/ 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 tries self-injury and may be suicidal. ideas of reference are common and often are 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

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

Avoidant

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

Operant conditioning

Client gets positive rewards for positive behavior

Eating disorders mental status expected findings

Cognitive distortions include the following: -OVERGENERALIZATIONS: "Other girls don't like me b/c i'm fat" -ALL OR NOTHING THINKING: "If I eat any dessert, I'll gain 50 pounds) -CATASTROPHIZING: "My life is over if I gain weight" -PERSONALIZATION: "When I walk through the hospital hallway, everyone is looking at me" -EMOTIONAL REASONING: "I know I look bad b/c I feel bloated" -Client demonstrates high interest in preparing food, but not eating -Client is terrified of gaining weight -Client perception is that she is severely overweight&sees this image reflected in the mirror -Client can exhibit low self-esteem, impulsivity, and difficulty w/ interpersonal relationships -Client can exhibit the need for an intense physical regimen -Client can experience guilt or shame due to binge eating behavior -Obsessive compulsive features can be related&unrelated to food

Violence risk factors

Cultural differences can influence whether the nursing assessment data is valid, how the client responds to interventions and the approp of nursing interactions w/ the client: -A female partner is the vulnerable person in the majority of family violence, but the male partner can also be a vulnerable person -Vulnerable persons are at the greatest risk for violence when they try to leave the relationship -Pregnancy tends to increase the likelihood of violence toward the intimated partner, the reason for this is unclear -Older adults or other adults who are vulnerable w/in the home can suffer abuse b/c they are in poor health, exhibit disruptive behavior, or are dependent on a caregiver, the potential for violence against an older adult is highest in families where violence has already occurred

Second generational/conventional antipsych meds

Current meds of choice for psych disorders, and the generally treat both positive&negative symptoms -Risperidone -Olanzapine -Quetiapine -Ziprasidone -Clozapine -To minimize weight gain, advise the client to follow a healthy, low cal diet, engage in regular exercise and monitor weight -Adverse effects of agitation, dizziness, sedation and sleep disruption can occur... instruct client to report these manifestations b/c the provider might need to change the med -Inform the client of the need for blood tests to monitor for agranulocytosis

Sedative hypnotic anxiolytics

DIAZEPAM, LORAZEPAM -Observe for CNS depression, such as sedation, lightheadedness, ataxia, and decreased cognitive function -Avoid the use of other CNS depressants, such as alcohol -Avoid hazardous activities -Caffeine interferes w/ the desired effects of the med -Advise the client who wants to d/c a benzo to see the advice of a provider, the client should not abruptly d/c these meds, they should gradually taper the dosage over several weeks

Personality disorders defense mechanisms

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 of oneself or others into a whole image, is frequently seen in the acute mental health setting -Splitting is commonly associated w/ borderline. - In splitting, the client tends to characterize people or things as all good or bad at any particular moment.. for example the client might say "You are the worst person in the world" and later that day may say "You are the best, but the nurse from the last shift is terrible"

Personality dx comm strats

Developing a therapeutic relationship is often challenging due to the clients distrust or hostility toward others, feelings of being threatened or having no control can cause a client to act out toward the nurse: -A firm, yet supportive approach&consistent care will help build a therapeutic nurse client relationship -Offer the client realistic choices to enhance the clients sense of control -Limit setting and consistency are essential w/ clients who are manipulative, especially those who have borderline or antisocial -Clients who have dependent&histrionic often benefit from assertiveness training&modeling -Clients who have schizoid or schizotypal tend to isolate themselves and the nurse should respect this need -For clients who have histrionic and can be flirtatious, it is important for the nurse to maintain professional boundaries&comm at all times -When caring for clients who exhibit dependent behavior, self assess frequently for contertransfernce reactions

Psychotic disorders personal boundary difficulties

Disenfranchisement w/ one's own body, identity and perceptions: DEPERSONALIZATION: Nonspecific feeling that a person has lost her identity, self is different or unreal DEREALIZATION: Perception that the environment has changed

Personal boundary difficulties

Disenfranchisement w/ ones own body, identity, and perceptions.. this includes: DEPERSONALIZATION: nonsepcific feeling that a person has lost their identity, self is is different or unreal DEREALIZATION: Perception that the environment has changed

Bipolar disorder therapeutic procedure

ECT SEE OTHER NOTECARD

Electroconvulsive therapy

ECT uses electrical current to induce brief seizure activity while the client is anesthetized.. the exact mech is unknown, one theory suggests that the seizure activity produced by ECT may enhance the effects of neurotransmitters in the brain

Depressive disorders therapeutic procedures

ECT: -Can be useful for some clients who have a depressive disorder and are unresponsive to other treatments -A specially trained nurse is responsible for monitoring the client before&after this therapy TMS: -Uses electromagnetic stimulation of the brain, it is indicated for depressive disorders that are resistant to other forms of treatment VNS: -uses an implamnted device that stimulates the vagus nerve, it can be used for clients who have depression that is resistant to antidepressant meds

Psychotic disorders alterations in behavior

EXTREME AGITATION: Including pacing&rocking STEREOTYPED BEHAVIORS: Motor patterns that had meaning to the client (sweeping the floor) but now are mechanical&lack purpose AUTOMATIC OBEDIENCE: Responding in a robot like manner WAXY FLEXIBILITY: Maintaining a specific position for an extended period of time STUPOR: Motionless for longe periods of time, coma like NEGATIVISM: Doing the opposite of what is requested ECHOPRAXIA: Purposeful imitation of movements made by others

Alterations in Behavior

EXTREME AGITATION: Pacing&rocking STEREOTYPED BEHAVIORS: Motor patterns that had meaning to client but now are mechanical&lack purpose AUTOMATIC OBEDIENCE: Responding in a robot like manner WAXY FLEXIBILITY: Maintaining a specific position for an extended period of time STUPOR: Motionless for long periods of time NEGATIVISM: Doing the opposite of what is expected ECHOPRAXIA: Purposeful imitation of movements made by others

Suicide ECT

Effective in decreasing suicidal ideation in clients who have a depressive or psychotic disorder

Common lab abnorms w/ bulimia

Electrolyte imbalances can depend on the client's method of purging (laxatives, diuretics, vomiting) -Hypokalemia -Hyponatremia -Hypocholremia -Hypomagnesemia -Hypophosphatemia -Decreased estrogen -Decreased testosterone

Personality disorders expected findings

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&professional relationships -Tendency to provoke interpersonal conflict -Ability to merge personal boundaries w/ others

Acute stress expected findings

FIGHT OR FLIGHT: -Apprehension -Unhappiness or sorrow -Decreased appetite -Increased RR, HR, CO, BP -Increased metabolism&glucose use -Depressed immune system

Psychotic disorders alterations in speech

FLIGHT OF IDEA: Associative looseness, the client might say sentence after sentence, but each sentence can relate to a different topic, and the listener is unable to follow the client's thoughts NEOLOGISMS: Made up words that have meaning only to the client ECHOLALIA: The client repeats the words spoken to them CLANG ASSOCIATION: Meaningless rhyming of words, often forceful WORD SALAD: Words jumbled together w/ little meaning or significance to the listener

Alterations in speech

FLIGHT OF IDEAS: Associative looseness, client might say sentence after sentence, but each sentence can relate to a different topic, and the listener is unable to follow the clients thoughts NEOLOGISMS: Made up words that have meaning only to the client ECHOLALIA: The client repeats the words spoken to them CLAN ASSOCIATION: Meaningless rhyming of words, often forceful WORD SALAD: Words jumbled together w/ little meaning or significance to the listener

Other techniques

FLOODING: Exposing a client, while in the company of a therapist, to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response RESPONSE PREVENTION: Preventing a client from preforming a compulsive behavior w/ the intent that anxiety will diminish THOUGHT STOPPING: Teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout stop and substitutue a positive thought, the goal over time is for the client to use the command silently

Alterations in thoughts (delusions)

False fixed beliefs that cannot be corrected by reasoning&are usually bizarre, these include" IDEAS OF REFERENCE: Misconstrues trivial events&attaches personal significance to them, such as believing that others, who are discussing the next meal are talking about them PERSECUTION: Feels singled out for harm by others GRANDEUR: Believes that that they are all powerful&important, like a god SOMATIC DELUSIONS: Believes that their body is changing in an unusual way, like growing a third arm JEALOUSY: Believes that their partner is sexually involved w/ another individual even though there is not any factual basis BEING CONTROLLED: Believes that a force outside of their body is controlling them THOUGHT BROADCASTING: Believes that their thoughts are heard by others THOUGHT INSERTION: Believes that others thoughts are being inserted into their mind RELIGIOSITY: Obsessed w/ religious beliefs MAGICAL THINKING: Believes their actions/thoughts are able to control a situation/affect others

Bipolar disorder risk factors

GENETICS: -Having an immed family member who has it PSYCHOLOGICAL: -Stressful events or major life changes PHYSIOLOGICAL: -Neurobiological and neuroendocrine disorders SUBSTANCE USE

Psychotic disorders alterations in perception

Hallucinations are sensory perceptions that don't have any apparent external stimulus: AUDITORY COMMAND VISUAL OLFACTORY GUSTATORY TACTILE

Alterations in perception

Hallucinations are sensory perceptions that don't have any apparent external stimulus: AUDITORY: Hearing voices or sounds COMMAND: The voice instructs the client to perform an action, such as to hurt self or others VISUAL: Seeing persons or things OLFACTORY: Smelling odors GUSTATORY: Experiencing tastes TACTILE: Feeling bodily sensations

Emotional violence

Includes behavior that minimizes an individuals feelings of self worth or humiliates, threatens or intimidates a family member

Psychotherapy

Involves more verbal therapist to client interaction than classic psychoanalysis, the client and therapist develop a trusting relationship to explore the clients problems -Psychodynamic psychotherapy -Interpersonal psychotherapy -Cognitive therapy -Behavioral therapy -Cognitive behavioral therapy -Dialectical behavioral therapy

Stress other techniques

JOURNAL WRITING PRIORITY RESTRUCTURING: -Client learns to prioritize differently to reduce the number of stressors affecting them BIOFEEDBACK: -Nurse or other healthcare professionals trained in this method use a sensitive mechanical device to assist the client to gain voluntary control of autonomic functions (HR&BP) MINDFULLNESS: -Client is encouraged to be mindful of their surroundings using all of their senses -Client learns to restructure negative thoughts& interpretations into positive ones ASSERTIVENESS TRAINING: -Client learns to comm in a more assertive manner in order to decrease physiological stressors -The nurse should assist each client in identifying individual strats that improve their ability to cope w/ stress

Mood stabilizers

LITHIUM -The client can minimize GI effects by taking med w/ food or milk -Maintain a healthy diet, and exercise regularly to minimize weight gain -Maintain fluid intake of 2-3 L/day from food&beverage sources -Maintain adequate sodium intake -Encourage the client to comply w/ lab appts needed to monitor lithium effectiveness&adverse effects

Stress standardized screening tools

Life changing events questionnaires, such as the Holmes and Rahe stress scale measure life changing units and Lazzarus cognitive appraisal

Stress management standardized screening tools

Life changing events questionnaires: -Holmes&Rahe stress scale to measure life changing units -Lazarus's cognitive appraisal

Prolonged stress expected findings

MALADAPTIVE RESPONSE: -Chronic anxiety or panic attacks -Depression, chronic pain, sleep disturbances -Weight gain or loss -Increased risk for MI, stroke -Poor diabetes control, HTN, fatigue, irritability, decreased ability to concentrate -Increased risk for infection

Behaviors shown w/ bipolar disorder

MANIA: -Abnormally elevated mood, which can also be described as expansive or irritable, usually requires hospitalization -Can last 1 weeks HYPOMANIA: -Less severe episode of mania that lasts at least 4 days accompanied by three+ manifestations of mania -Hospitalization is not required, and the client is less impaired.. can progress to mania RAPID CYCLING: -Four or more episodes of hypomania or acute mania w/in 1 year

Depressive disorders nursing care

MILIEU THERAPY: SUICIDE RISK: Assess the clients risk for suicide, and implement approp safety precautions SELF CARE: Monitor the clients ability to preform activities of daily living, and encourage independence as much as possible COMMUNICATION: Relate therapeutically to the client who is unable/unwilling to comm (make time to be w/ the client even if they don't speak, make observations rather than asking direct questions, which can cause anxiety in the client, give directions in simple, concrete sentences b/c a client who has a depression can have difficultly focusing on&comprehending long sentences, give the client sufficient time to respond when holding a conversation due to a possible delayed response time.) MAINTENANCE OF A SAFE ENVIRONMENT BY COUNSELING ON THE FOLLOWING: -Problem solving -Increasing coping abilities -Changing negative thinking into positive -Increasing self esteem -Assertiveness training -Using available community resources

Bipolar disorder meds

MOOD STABILIZERS: -Lithium carbonate -Anticonvulsants that act as mood stabilizers ANTIANXIETY MEDS SECOND GEN ANTIPSYCH MEDS ANTIDEPRESSANTS

Seclusion and restraints

MUST BE USED ONLY ACCORDING TO LEGAL GUIDELINES AND SHOULD BE THE INTERVENTIONS OF LAST RESORT AFTER OTHER LESS RESTRICTIVE OPTIONS HAVE BEEN TRIED -New initiatives are being proposed to reduce or eliminate the use of retsraints.. national, state and local initiatives advocate for restraint elimination, there is also heightened awareness of the damaging effects restraints can have on clients, health care professionals and caretakers -Seclusion&restraints don't usually lead to positive behavior change, they can keep people safe during a violent outburst, but the use of restraint itself can be dangerous, and has, on rare occasions, led to death of clients due to reasons such as suffocation/strangulation -IM meds can need to be given if aggression is threatening and if no meds were previously admin -When it is deemed essential to use restraints, remove the client from seclusion or restraint as soon as the crisis is over&when the client attempts to reconile and is no longer aggressive

Psychotic disorders affective symptoms

Manifestations involving emotions: -Hopelessness -SI

Characteristic dimensions of psychotic disorders positive symptoms

Manifestations of things that are not normally present, these are most easily identified manifestations: -Hallucinations -Delusions -Alterations in speech -Bizarre behavior, such as walking backward constantly

Positive symptoms of psychotic disorders

Manifestations of things that are not normally present, these are the most easily identified manifestations: -Hallucinations -Delusions -Alterations in speech -Bizarre behavior

Delirium meds

Meds can be the underlying cause of delirium, recognize med rxns before it occurs -Pharm management focuses on the treatment on treatment of the underlying disorder -Antipsych or antianxiety meds may be prescribed

Illness anxiety disorder

Misinterpret physical manifestations as evidence of a serious disease process, previously known as hypochondriasis, can lead to obsessive thoughts and fears about illness. -Clients who have this are overly aware of bodily sensations and attribute them to a serious illness, physical manifestations can be minimal or absent.. however, clients still have a preoccupation about having an undiagnosed, serious illness -Clients research their suspected disease excessively and examine themselves repeatedly -Clients might seek numerous medical opinions or avoid seeking health care so as not to increase their anxiety -Clients continue to have anxiety despite negative diagnostic tests and reassurance from the provider

Bipolar disorder standardized screening tool

Mood disorders questionnaire: -Places mood progression on a continuum from hypomania to acute mania and hyperactivity to delirious mania

Stress nursing care

Most nursing care involves teaching stress reduction strats to clients

Transcranial magnetic stimulation (TMS)

Noninvasive therapy that uses magnetic pulsations to stimulate the cerebral cortex of the brain

Crisis management expected findings

Nursing hx should include: -Presence of SI/HI requiring hospitalization -The clients perception of the precipitating event -Cultural of religious needs for the client -Support system -Present coping skills

Violence nursing care interventions

Nursing interventions for community-wide or mass casualty incidents, such as a school shooting or gang violence EARLY INTERVENTIONS: -Provide psychological first aid -Make sure clients are physically and psychologically safe from harm -Reduce stress related manifestations, such as using techniques to alleviate a panic attack -Provide interventions to restore rest and sleep, and provide links to social supports and info about critical resources -Depending on their level of expertise&training, mental health nurses can provide assessment, consultation, therapeutic communication&support, triage and psychological and physical care

Obsessive compulsive disorders (OCD)

OCD and related disorders are not actual anxiety disorders but have similar effects and include the following: OCD: Client has intrusive thoughts of unrealistic obsessions and tries to control these thoughts w/ compulsive behaviors HOARDING: Client has difficulty parting w/ possessions, resulting in extreme stress&functional impairments BODY DYSMORPHIC: Client has a preoccupation w/ perceived flaws or defects in physical appearance

OC disorders

OCD: Client attempts to suppress persistent thoughts or urges that cause anxiety through compulsive or obsessive behaviors.. they are time consuming and result in impaired social&occupational functioning HOARDING: Client has an obsessive desire to save items regardless of value&experiences extreme stress w/ thoughts of discarding or getting rid of items... behavior results in social&occupational impairment and often leads to an unsafe living environment BODY DYSMORPHIC: Client attempts to conceal a perceived physical flaw&practices repetitive behaviors, such as mirror checkin or comparison to others, in response to the anxiety experienced over the perception.. may have social&occupational impairment in response to the perceived physical defects or flaws

Physical violence

Occurs when physical pain or harm is directed toward the following: -An infant or child, as is the case w/ shaken baby syndrome (caused by violent shaking of young infants) -An intimate partner, such as striking or strangling the partner -A vulnerable adult in the home, such as pushing an older adult parent and causing them to fall

Neurocognitive disorder defense mechanisms

Often use defense mechs to preserve self esteem and to compensate when cognitive changes are progressive DENIAL: Both the client&family members can refuse to believe that changes are taking place, even when those changes are obvious to others CONFABULATION: Client can make up stories when questioned about events or activities that they don't remember, this can seem like lying, but it is actually an unconscious attempt to save self esteem and prevent admitting the inability to remember the occasion PRESERVATION: The client avoids answering questions by repeating phrases or behavior, this is another unconscious attempt to maintain self esteem when memory has failed

Somatic symptom assessment tools

PATIENT HEALTH QUESTIONNAIRE 15 (PHQ-15): Used to identify the presence of the 15 most commonly reported somatic symptoms -Ab pain -Back pain -Pain in the extremities/joints -Menstrual problems or cramps -Headaches -Chest pain -Dizziness -Fainting -Heart pounding or racing -Dyspnea -Problems w/ pain or sex -Problems w/ bowel elimination -Nausea, indigestion, or gas -Lethargy -Problems sleeping

Crisis management phases of a crisis

PHASE 1: Escalating anxiety from a threat activates increased defense responses PHASE 2: Anxiety continues escalating as defense responses fail, functioning becomes disorganized, & the client resorts to trail-and-error attempts to resolve anxiety PHASE 3: Trail-and-error methods of resolution fail, and the clients 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&apprehension, feelings of powerlessness&being overwhelmed, dissociative symptoms (depersonalization, detachment from reality), depression, confusion and/or violence against others or self

MAOIS

PHENELZINE -Due to the risk for HTN crisis, advise the client to avoid foods w/ tyramine (ripe avacados or figs, fermented/smoked meats, liver, dried or cured fish, most cheeses, some beer&wine, and protein dietary supplements) -Due to the risk of med interactions, instruct the client to avoid all meds, including OTC, w/out first discussing them w/ the provider

Bipolar disorder complications

PHYSICAL EXHAUSTION&POSSIBLE DEATH: -A client in a true manic state usually will not stop moving, and doesnt eat, drink or sleep.. this can become a medical emergency -Prevent client self harm -Decrease clients physical activity -Ensure adequate fluid&food intake -Promote an adequate amount of sleep each night -Assist the client w/ self care needs -Manage meds aprop

Anger management categories/taxonomies of disorder

PREASSAULTIVE: Client begins to become angry and exhibits increasing anxiety, hyperactivity, and verbal abuse ASSAULTIVE: Client commits an act of violence, seclusion and physical restraints can need to be required POSTASSUALTIVE: Staff reviews the incident w/ the client during this stage

Crisis management psychotherapeutic interventions

PRIMARY CARE: -Collab w/ client to identify potential problems, instruct on coping mechanisms and assist in lifestyle changes SECONDARY CARE: -Collab w/ client to identify interventions while in an acute crisis that promote safety TERTIARY CARE: -Collab w/ client to provide support during recovery from a severe crisis that include outpatient clinics, rehab centers and workshops

Suicide nursing care

PRIMARY: Focus on suicide prevention through the use of community education and screenings to identify people at risk SECONDARY: Focus on suicide prevention for an individual client who is having an acute suicidal crisis, suicide precautions are included in this level TERTIARY: Focus on providing support&assistance to survivors of a client who completed suicide

Severe to panic level anxiety nursing interventions

PROVIDE AN ENVIRONMENT THAT MEETS THE PHYSICAL&SAFETY NEEDS OF THE CLIENT, REMAIN W/ CELINT: -Minimizes the risk to the client, who might be unaware of the need for basic things, such as fluids, food and sleep PROVIDE A QUIET ENVIRONMENT W/ MINIMAL STIMULATION: -Helps to prevent intensification of the current level of anxiety USE MEDS&RESTRAINTS, BUT ONLY AFTER LESS RESTRICTIVE INTERVENTIONS HAVE FAILED TO DECREASE ANXIETY TO SAFER LEVELS: -Meds and/or restraints might be necessary to prevent harm to the client ,other clients and provider ENCOURAGE GROSS MOTOR ACTIVITIES, SUCH AS WALKING AND OTHER FORMS OF EXERCISE: -Provides an outlet for pent up tension, promotes endorphin release, and improves mental well being SET LIMITS BY USING FIRM, SHORT AND SIMPLE STATEMENTS.. REPETITION MAY BE NECESSARY: -Can minimize the risk to the client&providers, clear, simple comm facilitates understanding DIRECT THE CLIENT TO ACKNOWLEDGE REALITY&FOCUS ON WHAT IS PRESENT IN THE ENVIRONMENT: -Focusing on reality assists w/ reducing the clients anxiety level

Personality dx interprofessional care

PSYCHOBIOLOGICAL INTERVENTIONS: -Psychotherapy, group therapy, and cognitive&behavior therapy are effective treatment modalities for clients w/ personality dx -Dialectical behavior therapy is a cognitive-behavioral therapy used for clients who exhibit self injurious behaviors.. it focuses on gradual behavior changes&provides acceptance and validation for these clients -Case management is beneficial for clients who have personality dx and are persistently and severely impaired -In acute care facilities, case management focuses on obtaining pertinent hx from current or previous providers, supporting reintegration w/ the family, and ensuring appropriate referrals to outpatient care -In long term outpatient facilities, case management goals include reducing hospitalization by providing resources for crisis services and enhancing the social support system

Bulimia types

PURGING TYPE: Client uses self induced vomiting, laxatives, diuretics, and/or enemas to lose or maintain weight NON PURGING TYPE: Client can compensate for binge eating through other means, such as excessive exercise and the misuse of laxatives, diuretics and/or enemas

Aversion therapy

Pairing of a maladaptive behavior w/ a punishment or unpleasant stimuli to promote a change in the behavior USE IN MENTAL HEALTH SETTING: -Therapist or treatment team can use unpleasant stimuli, such as bitter taste or mild electric shock, as punishment for behaviors such as alcohol use disorder, violence, self mutilation and thumb sucking

Cognitive symptoms of psychotic disorders

Problems w/ thinking make it very difficult for the client to live independently -Disordered thinking -Inability to make decision -Poor problem solving ability -Difficulty concentrating to preform tasks -memory deficits -Long term memory -Working memory such as inability to follow directions to find an address

Psychotic disorders cognitive symptoms

Problems w/ thinking make it very difficult for the client to live independently: -Disordered thinking -Inability to make decision -Poor problem solving ability -Difficulty concentrating to perform tasks -Memory deficits -Long term memory -Working memory, such as inability to follow directions to find an address

Stress Management Assessment

Protective factors increasing a client's resilience, or ability to resist the effects of stress, include the following: -Physical health -Strong sense of self -Religious or spiritual beliefs -Optimism -Hobbies or other outside interests -Satisfying interpersonal relationships -Strong social support systems -Humor

Stress management assessment

Protective factors increasing a clients resilience, or ability to resist the effects of stress, include: -Physical therapy -Strong sense of relief -Religious/spiritual beliefs -Optimism -Hobbies or other outside interests -Satisfying interpersonal relationships -Strong social support systems -Humor

Psychological factors affecting other medical conditions

Psychological and behavioral factors can play a role in any medical condition.. the mind-body connection has been the subject of research, proving a link b/w a client's psychological state and their physical conditions -The development of certain medical conditions, such as heart disease&cancer, has been linked to clients who have depressive and anxiety disorders -Psychological factors affecting other medical conditions indicate that the client has a medical diagnosis that is caused or perpetuated by a psychological or behavioral factor

Personality dx meds

Psychotropic agents to provide relief from manifestations.. antidepressants, anxiolytics, antispychotics, or mood stabilizers

Eating disorders complications

REFEEDING SYNDROME: -Potentially fatal complication that can occur when fluids, electrolytes and carbs are introduced to a severely malnourished client -Care for the client in a hospital setting -Consult w/ the provider and dietitian to develop a controlled rate of nutritional support during initial treatment -Monitor serum electrolytes, and admin fluid replacement as prescribed CARDIAC DYSRHYTHMIAS, SEVERE BRADYCARDIA, AND HYPOTENSION: -Place the client on continuous cardiac monitoring -Monitor VS frequently -Report changes in the clients status to the provider

Stress behavioral techniques

RELAXATION TECHNIQUES: -Meditation -Guided imagery -Breathing exercises -Progressive muscle relaxation -Physical exercise

Anorexia types

RESTRICTING TYPE: Person drastically restricts food intake and doesn't binge or purge BINGE EATING/PURGING TYPE: Person engages in binge eating or purging behaviors

Second gen antipsychs

RISPERIDONE, OLANZAPINE -Preferred over first gen due to decreased adverse effects -To minimize weight gain, advise the client to maintain a healthy diet&exercise regularly -Instruct the client to report clinical findings of agitation, dizziness, sedation and sleep disruption to the provider, as the med might need to be changed

Behavioral therapies

SAME AS PREVIOUSLY NOTED MODELING, ETC.

Types of psychotic disorders

SCHIZOPHRENIA: The client has psychotic thinking/behavior present for at least 6 months... areas of functioning, including school or work, self care, and interpersonal relationships are greatly impaired SCHIZOTYPAL PERSONALITY DISORDER: The client has impairments of personality functioning, impairment is not as severe w/ schizo DLEUSIONAL DISORDER: The client experiences delusional thinking for at least 1 month, self/interpersonal functioning is not markedly impaired BRIEF PSYCHOTIC DISORDER: Client has manifestations that last 1 day to 1 month in duration SCHIZOPHRENIA DISORDER: Client has manifestations similar to schizo, but the duration is 1-6 months and social/occupational dysfunction might not be present SHIZOAFFECTIVE DISORDER: Clients disorder meets the criteria for both schizo and depressive/bipolar disorder SUBSTANCE INDUCED PSYCHOTIC DISORDER: Client experiences psychosis due to substance intoxication or withdrawal, however the manifestations are more severe than typically expected PSYCHOTIC/CATATONIC PSYCHOTIC DISORDER: Client exhibits psychotic features such as impaired reality testing or bizarre behavior or a significant change in motor activity or behavior but doesn't meet criteria for diagnosis w/ another specific psychotic disorder

Anxiety meds

SSRI ANTIPDEPRESSANTS: First line of treatment for anxiety and OCD SNRI ANTIDEPRESSANTS: Effective in treatment of anxiety disorders ANTIANXIETY MEDS: Helpful in treating the manifestations of anxiety disorders.. benzos are indicated for short term use BUSPIRONE: Effective in managing anxiety and can be taken for long term treatment of anxiety -Other meds that can be used include beta blockers&antihistamines to decrease anxiety -Anticonvulsants are used as mood stabilizers for the client who is experiencing anxiety

Eating disorder medications

SSRIS (FLUOXETINE): -Instruct the client that meds can take 1-3 weeks for initial response, w/ up to 2 months for max response -Instruct the client to avoid hazardous activities until individual side effects are known -Instruct the client to notify the provider if sexual dysfunction occurs and is intolerable

Depressive disorders alternative or complementary therapies

ST JOHNS WORT: -A plant product not regulated by the FDA, is taken by some people to relieve manifestations of mild depression -Adverse effects include photosensitivity, skin rash, rapid HR, GI distress and abdominal pain -Can increase or reduce levels of some meds, if taken concurrently the client should inform the provider if taking it ***INTERACTIONS INCLUDE POTENTIALLY FATAL SEROTONIN SYNDROME CAN RESULT IF ST JOHNS WORT IS TAKEN W/ SSRIS OR OTHER TYPES OF ANTIDEPRESSANTS, FOODS CONTAINING TYRAMINE SHOULD BE AVOIDED*** LIGHT THERAPY: -First line treatment for SAD, light therapy inhibits nocturnal secretion of melatonin -Exposure of the fact to 10,000-lux light box 30 min/day, once or in two divided doses

Somatic symptom disorder

Somatization is the expression of psychological stress through physical manifestations, the physical manifestations of somatic symptom disorder cannot be explained by underlying pathology -Somatic symptoms cause distress for clients&often lead to long term use of health care services.. manifestations can be vague or exaggerated.. the course of the disease can be acute but is often chronic, w/ periods of remission and exacerbation -Clients who have somatic symptom disorder spend a significant amount of time worrying about their physical manifestations to the point where is assumes a central role in the clients life&relationships.. clients often reject a psychological diagnosis as the cause for their physical manifestations, they seek care from several providers.. increasing medical costs -Clients are usually seen initially in a primary or medical care setting rather than a mental health setting

Alternative/complementary therapies

Some vitamins&herbal products are currently under investigation for the treatment of NCDs, there is currently no evidence that these products are effective

Cycle of violence

TENSION BUILDING PHASE: -The abuser has minor epsiodes of anger&can be verbally abusive and responsible for some minor physical violence, the vulnerable person is tense during this stage and tends to accept the blame for what is happening ACUTE BATTERING PHASE: -The tension becomes too much to bear, and serious abuse takes place, the vulnerable person can try to cover up the injury to get help HONEYMOON PHASE: The situation is defused for a while after the violent episode, the abuser becomes loving, promises to change and is sorry for the behavior, the vulnerable person wants to believe this and hopes for a change, eventually the cycle begins again PERIODS OF ESCALATION AND DEESCALATION: -Usually continue w/ shorter&shorter periods of time b/w the two, emotions for the abuser and vulnerable person, such as fear or anger, increase in intensity.. repeated episodes of violence lead to feelings of powerlessness

Psychotic or catatonic disorder not otherwise specified

The client exhibits psychotic features such as impaired reality testing or bizarre behavior (psychotic) or a significant change in motor activity behavior (catatonic) but doesn't meet criteria for diagnosis w/ another specific psychotic disorder

Delusional disorder

The client experiences delusional thinking for at least one month, self or interpersonal functioning is not markedly impaired

Substance induced psychotic disorder

The client experiences psychosis due to substance intoxication or withdrawal.. however the psychotic manifestations are more severe than typically expected

Schizoptypal personality disorder

The client has impairments of personality (self and interpersonal) functioning, however, impairment is not as severe as w/ schizophrenia

Schizoprheniform disorder

The client has manifestations similar to schizophrenia, but the duration is 1-6 months, and social/occupational dysfunction might not be present

Brief psychotic disorder

The client has psychotic manifestations that last 1 day to 1 month in duration

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

Schizoaffective disorder

The client's disorder meets the criteria for both schizophrenia and depressive or bipolar disorder

Critical incident stress debriefing

The crisis intervention strategy that assists individuals who have experienced a traumatic event, usually involving violence (staff experiencing the violent death of a student, rescue workers after an earthquake) in a safe environment -Debriefing can tak place in group meetings w/ a facilitator who promotes a safe environment where there can be expression of thoughts&feelings -The facilitator will acknowledge reactions, provide anticipatory guidance for manifestations that can still occur, teach stress management techniques, and provide referrals -The group can choose to meet on an ongoing basis or disband after resolution of the crisis

ECT contraindications

There are no absolute contraindications... the nurse should assess for medical conditions that place the clients at higher risk of adverse effects which include: CARDIOVASCULAR DISORDERS: -Recent MI, HTN, heart failure, cardiac arrhythmias... ECT increases the stress on the heart due to seizure activity that occurs during the treatment CEREBROVASCULAR DISORDERS: -hx of stroke, brain tumor, subdural hematoma.. ECT increases intracranial pressure and blood flow through the brain during treatment Conditions for which ECT has not been found useful: -Substance use disorders -Personality disorders -Dysphoric disorders

Neurocognitive disorders diagnostic procedures

There is no sepcific lab or diagnostic testing to diagnose NCDs.. definitive diagnosis cannot be made until autopsy, testing is done to rule out other pathologies that could be mistaken for NCDs: -Chest&head Xrays -EEG -ECG -Liver function studies -Thyroid function tests -Neuroimaging -Urinalysis -Blood electrolytes -Folate& vitamin B12 levels -Vision&hearing tests -Lumbar puncture

MMSE

This exam is used to objectively assess a clients cognitive status by evaluating the following: -Orientation to time&place -Attention span&ability to calculate by counting backward by 7 -Registration&recalling of objects -Language, including naming of objects, following commands & ability to write

Systematic dsensitization

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 USE IN MENTAL HEALTH NURSING: -Begins w/ the client mastering relaxation techniques, the client is then exposed to increasing levels of the anxiety producing stimuli and uses relxation to overcome anxiety.. the client can then tolerate a greater&greater level of the stimulus until anxiety no longer interferes w/ functioning

Mild to moderate anxiety nursing interventions

USE ACTIVE LISTENING TO DEMONSTRATE WILLINGNESS TO HELP, AND USE SPECIFIC COMMUNICATION TECHNIQUES: -Encourage the client to express feelings, develop trust, and identify the source of the anxiety PROVIDE A CALM PRESENCE, RECOGNIZING THE CLIENTS DISTRESS: -Assist the client to focus and to begin to problem solve EVAL PAST COPNG MECHS: -Assists the client to identify&adaptive/maladaptive coping mechs EXPLORE ALTERNATIVES TO PROBLEM SOLVING -Offers options for problem solving ENCOURAGE PARTCIPATION ACTIVITIES THAT CAN TEMP RELIEVE FEELINGS OF INNER TENSION: -provides an outlet for pent up tension, promotes endorphin release, and improves mental well being

Mood stabilizing agents&benzos

Used to treat anxiety often found in clients who have psych disorders, as well as some of the positive&negative symptoms -Valporate -Lamotrigine -Lorazepam -Inform clients of sedative effects -Use these meds w/ caution in older adults

Third generation antipsych meds

Used to treat both positive&negative symptoms while improving cognitive function -Aripiprazole -Decreased risk of EPSs or tardive dyskinesia -Lower risk for weight gain&anticholinergic effects

First generational/conventional antispych meds

Used to treat mainly positive symptoms -Haloperidol -Loxapine -Chlorpromazine -Fluphenazine -To minimize anticholinergic effects advise ways to promote wetness -Instruct client about indications of postural hypotension.. if it occurs advise the client to sit or lie down and minimize it by getting up slowly from a lying/sitting position

Antidepressants

Used to treat the depression seen in many clients who have a psychotic disorder -Paroxetine -Used temp to treat depression associated w/ psych disorders -Monitor the client for suicidal ideation b/c tis med can 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 med to avoid a withdrawal effect

Meditation, guided imagery, diaphragmatic breathing, muscle relaxation and biofeedback

Uses various techniques to control pain, tension and anxiety

SNRIS

VENLAFAXINE DULOXTETINE -Adverse effects include nausea, insomnia, weight gain, diaphoresis and sexual dysfunction -Caution in admin to clients who have a hx of HTN

Violence risk factors family groups

Violence is most common w/in family groups, and most is aimed at family&friends rather than strangers -Family violence occurs across all economic and educational backgrounds& racial&ethnic groups in the U.S., it is often termed maltreatment -Family violence or maltreatment can occur against children, intimate partners, or vulnerable adult family members -W/in a family, a cycle of violence can occur b/w intimate partners

Neglect

Which indicates a failure to provide the following: -Physical care, such as feeding -Emotional care, such as interacting w/ a child or stimulation necessary for a child to develop normally -Education, such as enrolling a young child in school -Necessary health or dental care

Suicide risk factors

While females are more likely to attempt suicide, teens, middle and older adult males are more likely to have a completed suicide... other people at increased risk for suicide include active military personnel/veterans, those who are lesbian, gay, bisexual or trans, and people w/ a comorbid mental illness (depressive disorders, substance use disorders, schizophrenia, bipolar, and personality disorders

Reattribution treatment

Work w/ provider to provide reattribution treatment, which assists clients to identify the link b/w physical manifestations and psychological factors while promoting a sense of caring and understanding FOUR STAGES: STAGE ONE FEELING UNDERSTOOD: Use therapeutic comm, active listening, and empathy to obtain a thorough hx of manifestations while focusing on the clients perception of the manifestations and their case, also includes a brief physical assessment STAGE TWO BROADENING THE AGENDA: Provide acknowledgement of the client's concerns and provide feedback about assessment findings STAGE THREE MAKING THE LINK: Use therapeutic comm to acknowledge the lack of a physical cause for the manifestations while allowing the client to maintain self esteem STAGE FOUR NEGOTIATING FURTHER TREATMENT: Work w/ the provider and client to develop a treatment plan that allows for regular followup visits