ATI Mental Health - combined

echolalia

automatic and immediate repetition of what others say

hoarding - s/s

- obsessive desire to save items - extreme stress at thought of discarding items - social/occupational impairment and unsafe living conditions

denial

- refusal to acknowledge real situation and feelings - (+): initial reaction of "that can't be true" to cancer diagnosis - (-): parent who says son will be back when he is dead

non-therapeutic technique - rejecting

- refuse to consider client's idea - may cause client to stop interaction - ex. "let's not discuss..." - instead say: "let's look at that a little closer"

avoidant

- cluster C - extreme fear of rejection - socially inhibited, timid, feelings of inadequacy - avoids situations that require interpersonal contact - desires relationships with others (vs. schizoid) - anxious in social settings

obssesive-compulsive

- cluster C - perfectionist - focus on orderliness and control - may not get tasks accomplished b/c perfectionism

Clozapine (Clozaril)

- for severe schizophrenia - NOT if WBC < 3K cell/mm3

addictive disorders

- gambling - sexual activity - shopping - social media - internet gaming

SUD/addictive disorders - sociocultural link

- Alaska, Native American - ↑ incidence - Asians - ↓ incidence - peer pressure - older adults - SUD later in life (loss of spouse, retirement, social isolation)

psychosocial predisposing factors in depression development - cognitive theory

- Beck et al. (1979) - primary disturbance in depression - cognitive (not affective) a) principle - underlying cause - cognitive distortions that result in negative, defeated attitudes - defect in cognitive development → person feels inadequate, worthless, rejected by others → pessimism and hopeless future - depression = product of negative thinking (others: negative thinking is caused by depression) - 3 distortions: 1. negative expectation of environment 2. negative expectation of self 3. negative expectation of future b) tx: - focus on altering mood by changing way of thinking - teach to control negative thought distortions

Methylphenidate (Ritalin, Concerta)

- CNS stimulant - for ADHD tx

depression related to developmental stage - adolescence

- MDD - can be identified using criteria similar to those used by adults a) manifestations - harder to ID since similar to normal developmental feelings - look for behavior change that lasts weeks - feelings of sadness, loneliness, anxiety, hopelessness - inappropriately expressed anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out, substance abuse, restlessness, apathy - ↓ self-esteem, sleeping/eating disturbances, psychosomatic complaints b) precipitating factors - stress, independence conflicts, death of loved one, breakup c) tx - supportive psychosocial interventions d) meds - FDA warning - suicidal ideation a) floxetine (Prozac) - approved by FDA if > 7 yrs b) escitalopram (Lexapro) - approved if > 11 yrs c) "off label" = not approved (sertraline, citalopram, paroxetine, SNR's such as duloxetine, vanlafaxine, desvanlafaxine)

depression related to developmental stage - childhood

- MDD - can be identified using criteria similar to those used by adults a) manifestations - symptoms can manifest differently than in adults and include: hyperactivity, delinquency, school problems, psychosomatic complaints, sleeping/eating disturbances, social isolation, delusional thinking, suicidal thoughts/actions a) 0-3 yrs: feeding problems, tantrums, lack of playfulness/emotional expression, FTT, speech/motor delays b) 3-5 yr: prone to accidents, phobias, aggressiveness, excessive self-reproach, auditory hallucinations c) 6-8 yrs: vague physical complaints, aggressive behavior, clingy, avoidance of new people/challenges, social/academic lag d) 9-12 yrs: morbid thoughts, excessive worrying, poor self-esteem, lack of interest in play b) precipitating factors - death of loved one, move, academic failure, physical illness c) tx - focus on alleviation of symptoms, coping/adaptive skills, family therapy d) meds - SSRI's - may cause suicidal ideation - Floxetine (Prozac) - approved by FDA (> 7 yr olds)

home care

- MH assessment, interventions, family support in client's home - for elderly, children, clients w/medical conditions

hallucinogens

- PO, can be injected and smoked - ↑ sense of self and perceptions (colors = more vivid) a) types - lysergic acid diethylamide (LSD) - mescaline (peyote) - phencyclidine piperidine (PCP) b) intoxication s/s - anxiety, depression, paranoia, impaired judgement, impaired social functioning, pupil dilation, ↑ HR, diaphoresis, palpitaitons, blurred vision, tremors, incoordination, panic attacks c) withdrawal s/s - hallucinogen persistent disorder (visual disturbances, flashback hallucinations - intermittently for yrs)

non-verbal behaviors that facilitate attentive listening

- SOLER - S - sit squarely facing client - message: ready to listen - O - open posture (no crossed legs/arms) - message: open to what client has to say - L - lean forward - message: nurse is involved, interested - E - eye contact (intermittent) - message: willing to listen, involved - R - relax (no fidgeting) - message: comfortable w/client

psychosocial predisposing factors in depression development - Learning theory

- Seligman (1973) - "learned helplessness" = predisposition to depression - person abandons attempt to succeed after repeated failures ("throws in the towel) - feeling of lack of control over life situations - especially damaging early in life

neologism

- a new word, expression, or usage - creation or use of new words or senses

confidentiality

- act of holding information in confidence, not to be released to unauthorized individuals - protected by 4th, 5th and 14th Amendments - only those directly involved in patient care have access to medical records - client can give informed consent to give access to people outside medical team - nurses have duty to warn - override: 1. if client discloses intent to harm self/others b/c duty to inform and protect potential victim 2. HC workers can protect patients from themselves b/c vulnerable and unable to identify harmful situations

advocacy

- acting on behalf of others as supporter/defender - help clients fulfill needs that may go unfulfilled b/c mental illness or can't be done w/out assistance - ex. educate clients/family about their rights, ensure patient/family has sufficient information to make decisions, consider alternatives, support patient's decision, ensure essential MH services for patient

depression

- alteration in mood - feelings of sadness, despair, pessimism - loss of interest in usual activities - somatic symptoms - changes in appetite, sleep pattern, cognition - melancholia = severe form of depression, exaggeration of symptoms, loss of pleasure in all activities

therapeutic technique - encouraging comparison

- ask client to compare similarities and differences in ideas, experiences, relationships - helps client recognize experiences that recur - ex. "how does this compare with time when...?"

non-therapeutic technique - requesting explanation

- ask client to provide reason for feelings, behaviors, thoughts, events - intimidating, implies need to defend self/behaviors - ex. "WHY do you think that?" - instead say: "describe what you were feeling..."

therapeutic technique - encouraging description of perceptions

- ask client to verbalize what is perceived by client (used when hallucinations are happening) - ex. "what do the voices seem to be saying?"

CAGE questinnaire

- asks questions to determine how patients perceive their current alcohol use - C - anyone asked to cut down on drinking? - A - get annoyed when asked about drinking? - G - feel guilty for drinking? - E - use alcohol as eye-opener?

client/family teaching regarding MAOIs

- assess cognitive ability to understand info regarding food interactions to avoid HTN emergency a) foods to avoid - aged cheese, wine, beer, chocolate, coffee, tea, colas, sour cream, smoked meats, beef/chicken liver, canned figs, soy sauce, overripe avocados, raisins, caviar, yogurt, pickled herring, yeast products, broad beans, cold remedies, diet pills b) med names - isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline transdermal system (Emsam) c) avoid alcohol and other meds

mild anxiety

- associated w/events of daily life (normal) - prepares for action - sharper senses, ↑ motivation and productivity, ↑ perceptual field - heightened awareness of environment - function at optimal level a) signs/symptoms - fidgeting, restlessness b) nursing strategies - assist w/problem solving - relaxation (abdominal breathing) - exercise

panic disorder - s/s

- attacks last ~ 15-30 minutes - ≥ 4 manifestations: 1. palpitations 2. SOB 3. choking/smothering sensation 4. chest pain 5. nausea 6. feelings of depersonalization 7. fear of dying or insanity 8. chills/hot flashes - behavior changes and/or persistent worry about next panic attack

body dysmorphic disorder (BDD) - s/s

- attempt to conceal physical flaw - practice repetitive behaviors (mirror checking, comparison to others) b/c anxiety felt over perception - social/occupational impairment

non-therapeutic technique - defending

- attempting to protect someone from verbal attack - defending what client has criticized - does not change clients' feelings - client feels nurse is taking sides vs. him/her - ex. "no one here would lie to you" - instead say: "I will try to clarify ... "

active listenting

- attentive and willing to hear and understand what client is saying - verbally and nonverbally - creates climate where client can communicate - client feels accepted, respected - enhances trust - promotes openness and honest expression

projection

- attribute own unacceptable feelings/thoughts onto others - (-): married woman attracted to friend accuses husband of having afair

non-therapeutic technique - indicate existence of external source of power

- attributing thoughts, feelings, behaviors to others - encourages client to blame others and not take responsibility for actions/behaviors - ex. "what made you do that?" - instead say: "you became angry when...."

natural law

- based on St. Thomas Aquinas writings - do good, avoid evil (must know difference) - decisions about right/wrong are self-evident and determined by human nature - rational humans - inherently know difference between good and evil → guides decision making - ex. it is universally accepted that to kill someone is wrong, and that to punish someone for killing that person is right, and even necessary

common law

- based on decisions made in previous cases - evolve from court decisions - on state basis (not federal) - ex. how to deal w/nurses who refuse to tx for specific patient

flumazenil (Romazicon)

- benzodiazepine antagonist (antidote)

ethics

- branch of philosophy - deal with systematic approaches to distinguishing right vs. wrong - bioethics - deals with ethics in medicine, nursing, health

delirium/dementia communication techniques

- calm, reassuring tone - do not argue or question hallucinations - reinforce reality - orient to time, place, person - introduce self w/each new contact - eye contact, short simple sentences - reminiscence about happy times - talk about familiar things - break activities into small timeframes - limit # choices when dressing/eating - ↓ need to make decisions and abstract thinking (avoid frustration) - avoid confrontation - encourage family and visitors as approrpriate

non-therapeutic technique - introducing unrelated topic

- changing the subject - nurse takes over direction of discussion - done to get away from topic uncomfortable to nurse or to discuss what nurse wants to discuss - ex. client states he has "nothing to live for", nurse replies "did you have visitors last weekend?" - instead: remain open and free to hear client and be attentive to verbal/nonverbal communication

neurotransmitters

- chemical messengers - cross synaptic gaps between neurons 1. adrenaline - fight or flight 2. noradrenaline - concentration 3. dopamine - pleasure 4. serotonin - mood 5. GABA - calming 6. acetylcholine (ACTH) - learning 7. glutamate - memory 8. endorphins - euphoria

therapeutic technique - formulating plan of action

- client has plan to deal w/stressful situation - may help prevent anger/anxiety from escalating - ex. "what could you do to let your anger out harmlessly?"

right to least restrictive treatment

- client's have right to not be hospitalized if can be adequately tx'd in outpatient setting - if client needs to be hospitalized - has right to not be sedated, restrained, or secluded UNLESS less restrictive measures have failed = right to restrictive treatment that is effective and least restricts patient's freedom

paranoid

- cluster A - distrust and suspicious - based on unfounded beliefs - afraid of exploitation, harm, deceit by others

schizotypal

- cluster A - eccentric appearance - odd beliefs - magical thinking (can affect the world by thinking of it) - interpersonal awkwardness NURSING CARE - respect need to self-isolate

schizoid

- cluster A - voluntary social isolation - emotional detachment - disinterest in close relationships - indifferent to praise/criticism - can be uncooperative NURSING CARE - respect need to self-isolate

narcissistic

- cluster B - grandiosity, arrogance, sense of entitlement - lacks empathy - requires excessive admiration - demands the "best" - reacts to criticism with range

borderline

- cluster B - in a constant state of crisis - promiscuous - unable to tolerate anxiety-causing situations - afraid of being alone - intense but brief relationships - splitting behaviors - manipulative, impulsive - self-injury, suicidal NURSING CARE - set limits and consistency to stop manipulation

antisocial

- cluster B - lack of empathy - repeated unlawful actions - failure to accept responsibility - sense of entitlement - manipulative, impulsive, seductive - non-adherence to traditional values - verbally charming and engaging NURSING CARE - set limits and consistency to stop manipulation

histrionic

- cluster B - over dramatic - emotional attention-seeking behavior - wants to be center of attention - seductive and flirtatious NURSING CARE - may benefit from assertiveness training and modeling - maintain professional boundaries and communication

dependent

- cluster C - extreme dependency in close relationship - urgent sense to find replacement if relationship ends NURSING CARE - may benefit from assertiveness training and modeling - assess for countertransference reactions

OCD - s/s

- compulsive disorders done in attempt to control persistent thoughts/urges - time consuming - result in impaired social/occupational functioning

moral behavior

- conduct that results from critical thinking about how to treat others - way person interprets basic respect for others

flight of ideas

- confused state - thoughts and speech go in all directions with no unifying concept - associative looseness - sentences do not relate to each other

non-therapeutic technique - belittling feelings expressed

- conveys lack of empathy/understanding - client feels insignificant - no relief to hear other are/have been in similar situations - ex. "everybody gets down sometime" - instead say: "you must be very upset, tell me what you are feeling right now"

compensation

- covering up a real / perceived weakness by emphasizing more desirable trait - emphasize strengths to make up for weaknesses - (+): handicap child excels in music/academics b/c can't do sports - (-): shy person works at computers to avoid socializing

ethical egoism

- decisions - based on what is best for individual making the decision - action - may or may not be best for anyone else involved - consideration is only for person making decision - ex. good to scratch another's back, but only because this act will result in the other scratching my back in return

regression

- defense mechanism - individual faced with anxiety retreats to a more infantile psychosexual stage - reverting to an earlier, more primitive and child-like pattern of behavior - ex. if a promotion is lost, maladaptive regression is seen through poor work performance, missing appointments, and being late.

non-therapeutic technique - using denial

- denies problem exists - blocks discussion - blocks client from identifying difficult areas to explore - ex. client says "I'm nothing", nurse answers "of course you are something, everyone is someone" - instead say: "you feel like no one cares about you right now"

seasonal affective disorder

- depression during winter months - caused by drastic temperature and barometric pressure changes - ↑ levels of melatonin and/or changes in serotonergic fucntion - improved mood during spring - 2 prevalent periods: spring (March, April, May), fal (Sept, Oct., Nov) - gender differences - not related to months or seasons - treated using phototherapy (bright light and high levels of negative ions)

therapeutic technique - reflecting

- directs questions/feelings back to client - client feels feelings are recognized/accepted - ex. client states his sister doesn't help w/care of mother, nurses says "you feel angry b/c..."

distributive justice

- distribution of scarce resources among all socioeconomic groups and population sector

therapeutic technique - presenting reality

- nurse defines reality or indicates her perception of situation for client - clarify misconceptions client may be expressing - used when client has misperception of environment - ex. "there is no one else in the room but you and me"

antidepressants - client teaching

- do not discontinue abruptly (risk withdrawals) - effects may take weeks to reach full potential (~ 4 wks) - avoid hazardous activities (drowsiness) - report thoughts of suicide - avoid alcohol (potentiation effect) - avoid smoking (↑ metabolism of tricyclics) - sunblock, protective clothing (photosensitivity) - report signs of allergic rxn (sore throat, malaise, fever, yellow skin, bleeding, N/V, severe headache, ↑ HR, difficulty urinating, anorexia/wt loss, seizures, stiff neck, chest pain) - watch for hypotension (orthostatic) - avoid foods that interact w/MAOIs - avoid mixing w/other meds, do not double up on meds if miss dosee - carry card w/name of meds taking

delirium tremens (DT's)

- dramatic physical and psychological effects of alcohol withdrawal - 2-3 days after stopping alcohol abuse - disorientation, hallucinations, severe HTN, cardiac dysrhythmias, delirium - can → death

cluster B

- dramatic, emotional, erratic 1. antisocial 2. borderline 3. histrionic 4. narcissistic

nonmaleficence

- duty to do no harm - may be more important than beneficence - cause for ethical dilemmas - ex. respect autonomy of psychiatric client who refuses meds? how to maintain patient safety if psychotic symptoms continue?

beneficence

- duty to promote good of others - holistic focus - may override duty to respect autonomy of individual is deemed harmful to self or others - ex. report if patient talks about abuse, intent to hurt others

stress as transaction between person and environment

- emphasis on relationship between internal (w/in person) and external (w/in environment) variables - based on individual's perception of event - illness depends on external factors AND susceptibility of receiving organism (person) - consider - internal characteristics (appraisal of stressor as taxing or exceeding resources) of person in relation to environment

therapeutic technique - general leads

- encourages client to continue - ex. "go on... and then what?"

reminiscence therapy

- encourages people with Alzheimer's dz to remember and talk about past - intention: ↑ client's self-esteem and attain ego integrity

phobias - s/s

- ex. spiders, snakes, strangers - fear of specific experiences (flying, being in the dark, riding in elevator, being in enclosed space) - anxiety manifestation w/just though of object/experience - use alcohol, substances to ↓ anxiety feelings

social phobia - s/s

- excessive fear of embarrassment or poor performance - difficulty speaking in public or participating in social events - may include real or factitious physical manifestations to avoid social situation

therapeutic technique - voicing doubt

- express uncertainty of clients perception of reality - used with clients with delusional thinking - ex. "that seems rather doubtful to me..."

malpractice

- failure by a health professional to meet accepted standards - in civil courts (not criminal) -patient has the right to financial compensation or damages - ALL ELEMENTS MUST BE PROVEN TO WIN MALPRACTICE SUIT - elements of malpractice include: 1. a duty - ex. nurse has obligation to provide competent care an follow acceptable standards of care 2. breach of duty - fails to act with the same responsible care an ordinary individual would use in a similar context - ex. failure to do hand hygiene → patient acquires infection 3. patient was harmed 5. proof - breach of duty → led to patient harm

agoraphobia - s/s

- fear of open spaces - avoidance of certain places/situations that cause anxiety - disrupt ability to keep employment, routine life - anxiety - out of proportion w/actual danger

separation anxiety -s/s

- fear of permanent separation from loved one due to tragic event - disruption in ability to participate in routine daily activities - headaches, N/V, sleep disturbances

cluster C

- fear, insecurity, inadequacy 1. avoidant 2. dependent 3. obsessive-compulsive

milieu therapy - nursing actions

- for dealing with anxiety crisis - provide safe environment - ensure safe from harm - encourage sharing/cooperation - use therapeutic communication - help express feelings, validate feelings - teach client to ID manifestations of anxiety - evaluate coping mechanisms that work/don't work - assist client to learn new methods of coping

dialectical behavior therapy

- for self-injurous clients - focuses on gradual behavior change - provides acceptance and validation

relationship between stress and dzs of adaptation

- general adaptation syndrome: 1. alarm reaction - fight/flight response, ↑ SNS response 2. resistance - use of physiological defenses to attempt to adapt - goal: preservation of integrity of person and quick return to equilibrium 3. exhaustion - body's response to prolonged stressor - depletion of adaptive energy - body - struggles to compensate for chronic physiological / psychological arousal - significant vulnerability to illness

SUD/addictive disorders - risks

- genetics, family hx - chronic stress (SES) - hx of trauma (abuse, war) - ↓ self-esteem - inability to tolerate pain, frustration - lack of support system - few life successes - risk-taking tendencies

therapeutic technique - use of silence

- gives client opportunity to collect thoughts and think thru point - client - able to take control of discussion - ex. nurse remains quiet and does not "rescue client w/prompts

therapeutic technique - exploring

- going deep into subject, idea, experience - good for clients who stay superficial - DO NOT push client if not willing to disclose further - ex. "please explain...tell me more about..."

utilitarianism

- greatest good principle - actions are right if they promote happiness - actions are wrong if they produce unhappiness - action - taken on basis of end results → most good (happiness) for most people - ex. in emergencies - do what is best for most people

schizophrenia

- group of severe disorders - characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions a) nursing actions - acknowledge - DO NOT reinforce - minimize # of questions → client w/ acute schizophrenia has difficulty concentrating on information and answering assessment questions - plan to use other sources of client information, such as medical records, family members, or reports from other interprofessional sources b) meds - olanzapine - adverse effect = hyperglycemia

personality disorders - assessment

- hx of non/violent crimes, including sex offenses - childhood abuse/trauma w/direct link to parenting - genetic and biochemical factors

adaptive/coping strategies in stress management

- impede development of dzs of adaptation 1. awareness - of factors that create stress - can chose to omit, avoid, accept stressors 2. relaxation - motor activities (sports), breathing, progressive relaxation 3. interpersonal communication - ability to "talk it out" w/supportive empathetic person to deescalate stress 4. pets, music - soothing 5. meditation - 20 mins, 2-3/wk - helps ↓r bp and stress-related symptoms 6. problem-solving - i. assess facts ii. formulate goals for resolution iii. study alternatives iv. determine risks/benefits of e/alternative v. select alternative vi. implement alternative vii. evaluate outcome viii. select different alternative if not desired outcome

non-therapeutic technique - approving/disapproving

- implies nurse has right to pass judgement - client is expected to please nurse - nurse's acceptance seems conditional - ex. "that's bad/good..." - instead say: "let's talk how that invoked anger in others"

non-therapeutic technique - agreeing/disagreeing

- implies nurse has right to pass judgement - if agree - client feels bound to not change mind - if disagree - client feels defensive - ex. "that is right/wrong. I agree/disagree" - instead say: "let's discuss what you feel about..."

non-therapeutic technique - giving advice

- implies nurse knows what is best - put client in dependent position - ex. "I think you should" - instead say: "what do you think would be best?"

personality disorders - nursing care

- importance of self-assessment - patient responses may evoke intense emotions - therapeutic communication and intervention - most effective if can anticipate client behavior - milieu management - focuses on social interaction - safety - self-injury or violence - use firm, supportive communication - provide realistic choices - obtain hx from current/previous providers - reintegration w/family - appropriate referrals

splitting

- inability to incorporate positive/negative aspects on self /others into a whole image - associated w/borderline personality disorder - characterize people as "all good" or "all evil"

personality disorders

- inflexible and enduring behavior patterns that impair social functioning - impairments in self-identifying/self-direction and interpersonal functioning - maladaptive behaviors - often co-occur w/ other diagnosis (depression, anxiety, eating/substance use disorders)

nicotine (tobacco)

- inhaled (cigarettes, cigars) - chewed, snuffed - relax, ↓ anxiety a) intoxication s/s - acute toxicity - in children or in pesticides - long-term effects: 1. CV dz (HTN, stroke) 2. respiratory dz (emphysema, lung cancer) 3. irritation to oral mucosa, cancer b) withdrawal s/s - abstinence syndrome (irritability, craving, nervousness, restlessness, anxiety, insomnia, ↑ appetite, difficulty concentrating, anger, depressed mood)

amphetamines

- injected, IV, smoked, PO a) types - dexamphetamine - to tx ADHD - amphetamine sulphate (speed) - methamphetamine - more potent ('crystal', 'meth', 'rock' or 'ice') b) intoxication s/s - s/s CNS stimulants + impaired judgement, hypervigilance, ↑ BP (could → death) c) withdrawal s/s - s/s CNS stimulants - NOT life-threatening

cocaine

- injected, smoked or inhaled (snorted) a) intoxication s/s i. mild - dizziness, irritability, tremor, blurred vision ii. severe - hallucinations, seizures, extreme fever, ↑ HR, chest pain, CV collapse, death b) withdrawal s/s - s/s CNS stimulants + insomnia, unpleasant dreams, agitation - NOT life-threatening, but could cause suicidal ideation

territoriality

- innate tendency to own space - influences communication - when happens in "owned" territory or others - to avoid - chose neutral space - ex. psychosocial interview done in interview room rather than nurse's office (her territory)

introjection

- integration beliefs/values of other into one's own ego - ex. child integrates parents' value system

assertive community treatment (ACT)

- intensive type of case management - for people with serious, persistent psychiatric symptoms - ↓ repeated hospitalizations - multidisciplinary team - comprehensive array of services

communication

- interactive process of transmitting information between 2+ entities - transaction between sender and receiver - includes simultaneous participation, perceiving each other, listening, being mutually involved in creating meaningful relationship - influenced by pre-existing conditions both sender and receiver bring, for example: a) values, attitudes, beliefs - learned ways of thinking/acting b) culture and religion - norms, ideas, customs - ex. language barrier c) social status - convey high-power position w/gestures, hands on hips, greater height d) gender - masculine/feminine gestures e) age/developmental level - ex. use of slang (teens) f) environment - where communication happens

identification

- internalizing and becoming - attempt to ↑ self-worth by acquiring attributes of someone else - (+): girl w/CF pretends to be nurse to dolls - (-): boy sees abusive father and becomes bully

repression

- involuntary blocking of unpleasant feeling/experience - putting unpleasant feelings/thoughts out of awareness - like amnesia (← has physical aspect too) - repressed memory/feeling will come back - (+): preparing for speech unconsciously puts bad experience out of mind - (-): person who doesn't like dentist keeps forgetting appts

substance use disorder (SUD)

- involves alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, etc. - repeated use → clinical impairment - most common - 20-29 yrs of age - younger age at onset → ↑ incidence of abuse - MJ - choice for adolescents - older adults - ↑ risk of falls, injuries, memory loss, headaches, changes in sleep pattern

ethical dilema

- involves need to choose from ≥ 2 morally acceptable options or 2+ equally unacceptable courses of action - in nursing - nurse must make choice between 2 equally unfavorable alternatives - dilemma - when there is no clear reason to choose one action over another - generate great emotions - not acting = taking an action - ex. suicidal patient w/heart issues refuses meds - allow autonomy or prevent self-harm?

word salad (schizophasia)

- jumble of words - meaningless to the listener and perhaps to the speaker - extreme level of disorganization

involuntary admission (commitment)

- made without the patient's consent. - when a person is in need of psychiatric treatment, presents danger to self or others, or is unable to meet his or her own basic needs - 2 physicians must certify client's condition - imposed by family member, legal guardian, primary care provider, MH provider - limited to 60 days - still considered competent - has right to refuse tx and meds - Long-term involuntary: 60-180 days, sometimes no release date

anxiety disorders

- main symptom is excessive or unrealistic anxiety and fearfulness - produce marked by feelings of excessive apprehension and anxiety 1. separation anxiety - extreme fear when separated from individual w/whom emotionally attached 2. phobias - irrational fears of certain objects / situations a) agoraphobia - extreme fear of being outdoors, on a bridge, etc.) 3. social anxiety disorder - excessive fear of social or performance situations 4. panic disorder - recurrent panic attacks 5. generalized anxiety disorder (GAD) - uncontrollable, excessive worry for > 6 mo.

flouxetine (Prozac)

- major depression, OCD, bulemia, panic attacks - check GLU while taking - may take up to 4 weeks or more to take full effect - must continue taking after panic attacks are gone - control caloric, ↑ exercise to avoid weight gain

rationalization

- making excuses - creating reasonable/acceptable explanations for unacceptable behavior/feelings - (+): boy says "she must already have boyfriend" when rejected by girl - (-): teenager says he had to drive after drinking to feed dog

non-therapeutic technique - making stereotyped/cliché comments

- meaningless - empty conversation encouraged - ex. "keep your chin up" - instead say: "therapy must be difficult for you at times, how do you feel about it at this point?"

defense mechanisms

- mental processes - protect individuals from strong or stressful emotions and situations - employed by ego n face of threats to biological/psychological intergrity - help relieve mild to moderate anxiety - redirect focus - self-deceptive - best when used in combination and variety rather than applying same mechanism to every situation a) adaptive (+) - help achieve goals in acceptable ways b) maladaptive (-) - interfere w/functioning, relationships, orientation to reality

physiological predisposing factors in depression development

- multiple causations - combination of genetic, biochemical, psychological influences a) biological - genetics (hereditary) - twin studies (MDD-RU), family studies, adoption studies b) biochemical - deficiency in neurotransmitters i. catecholamines - norepinephrine, serotonin, dopamine ii. neuroendocrine disturbances iii. hypersecretion of cortisol - diminished TSH response to thyrotropin-releasing factor (TRF) c) physiological = secondary depression i. medication effects - direct effect on CNS ii. neurological disorders - hx cardiovascular accidents, CVA, Alzheimers, Parkinsons, Huntington's dz iii. electrolyte imbalances - ↑ NaHCO3, ↑ Ca, ↓ Na, ↓ Mg iv. hormonal disturbances - adrenal cortex issues, Addison's dz, estrogen/progesterone issues v. nutritional deficiencies - ↓ prots, CHOs, B1, B2, B6, B12, Fe, Zn, ca, Cr, iodine, lithium, selenium, K, omega-3s

severe depression - nursing action

- no motivation - extreme difficulty making decisions - functions must be assumed by staff (temporary basis) - nurse - must use active communication to encourage clients participate in therapy

SUD/addictive disorders - nursing care

- nonjudgemental, objective approach 1. safety - during acute intoxication/withdrawal - safe environment - fall and seizure precautions 2. orient to time and place 3. adequate nutrition and fluid balance 4. low-stimulation environment 5. meds as prescribed 6. patient/client teaching - codependent behaviors - addiction and abstinence goals - remove prescription meds from home - self-responsibility - self-help groups - emergency plan - things needed, people to contact - adhere to med tx plan

obsessive-compulsive disorders (OCD)

- not actual anxiety disorders - have similar effects of anxiety disorders 1. OCD - intrusive thoughts of unrealistic obsessions - try to control w/compulsive behaviors - ex. repetitive washing of hands or objects 2. hoarding disorder - difficulty parting w/possessions - extreme stress and functional impairment if separate from object 3. body dysmorphic disorder - preoccupation w/perceived flaws/defects in physical appearances

severe anxiety

- only able to focus on 1 thing - unable to problem solve - severely ↓ perceptual field - very limited attention span - difficulty w/simplest tasks - no learning or problem solving - all behaviors - aimed at relieving anxiety a) signs/symptoms - rapid speech, tachycardic, tachypnic - headaches, palpitations, insomnia - confusion, dread, horror b) nursing strategies - quiet environment - minimal distractions - remain w/patient - set limits - short simple sentences - help focus on reality

reaction formation

- overcompensating / showing opposite behavior of what is felt - prevent undesirable behavior/thought/feeling from being expressed by exaggerating the opposite behavior/thought/feeling - (+): man trying to quit smoking talks about dangers of nicotine - (-): woman who dislikes neighbor tells other how great he is

criteria for forcing medication w/out consent

- overrides autonomy of patient - in emergency cases when patient is at risk of hurting self or others 1. client must exhibit behavior that is dangerous to self/others 2. meds must have reasonable chance of helping client (prescribed by physician) 3. client is judged incompetent to evaluate benefits of med/treatment in question

statutory law

- passed by legislative body (city council, state, US Congress) - ex. nurse practice acts

biofeedback therapy

- patients learn to control certain internal bodily processes that normally occur involuntarily, such as heart rate, respiration rate, and skin temperature

informed consent

- permission granted by client to perform therapeutic procedure - voluntary un-coerced decision made by a competent autonomous individual - decides to accept or reject some proposed course of action, including taking medicine, getting procedures done, etc. a) should include: - explanation - alternatives - pros vs. contras - benefits vs. risks - possible outcomes, adverse effects - options and consequences of declining b) override when: 1. client is mentally incompetent and tx is necessary to preserve life/avoid serious harm 2. refusing endangers life of others 3. in emergency when client is not able to make judgement 4. client is child (get consent from parents) 5. withhold info if full disclosure will hinder compliance w/needed tx, cause severe psychological harm, information is so upsetting client won't be able to decide

autonomy

- person has right to determine their destiny and to have their decisions respected - right of the patient to determine his/her own health issues - psych patients - don't have to take meds if don't want to - fundamental ethical principle in health care a) examples when autonomy is not practiced 1. restricted when nurse withholds information to client - ex. not giving birth control info to teen b/c in Catholic hospital 2. override - to prevent death or serious harm to patient or others

dissociative identity disorder

- person seems to have 2+ distinct personalities within one body

values

- personal beliefs about what is important and desirable

restraints, seclusion

- prescribed by physician - renewed e/24 hrs - can restraint before prescription in emergencies (w/in 15-30 mins) - time limits (18+ yrs: 4 hrs, 9-17 yrs: 2 hrs, <9 yrs: 1 hr) - document e/15-30 mins: a) client behavior b) offer food/fluid c) toileted d) monitor vitals, pain e) alternative actions taken f) precipitating events g) meds given h) time of release

non-therapeutic technique - probing

- pressuring client to share information not ready to share - makes client feel valued only for what is shared - ex. "tell me how s/he abused you as a child" - instead: be aware of clients response and discontinue if notice client becomes uncomfortable

values clarification

- process of self-exploration - identify and rank own personal values - important in nursing → ↑ understanding of why choices /decisions are made over others and how values affect nursing outcomes

alcohol (ethanol, ETOH)

- produce dependence, addictive effect when taken w/other CNS depressants a) blood alcohol concentration (BAC) - illegal intoxication ≥ 0.08% (80 g/dL) ETOH - death ≥ 0.4% (400 g/dL) ETOH b) intoxication s/s - s/s CNS depressants + nystagmus, ↓ motor skills, stupor → coma, peripheral collapse, death c) chronic use - CV damage - liver damage (fatty liver → cirrhosis) - erosive gastritis - GI bleeding - acute pancreatitis - sexual dysfunction d) withdrawal s/s - s/s CNS depressants + abdominal cramps, ↑ HR, ↑ BP, ↑ RR, ↑ temp., tonic-clonic seizures

criminal law

- protect public welfare

civil law

- protects private and property rights of individuals and businesses - courts - impose liability - 2 types: 1. tort - violation of civil law where individual was harmed and seeks compensation a) intentional - ex. touching another w/out their consent - in healthcare: i. intentional touching w/out consent → battery ii. providing life-sustaining tx w/out consent → assault and battery b) unintentional i. negligence - conduct < standard of care - ex. running a stop sign, dog bites, car accidents ii. malpractice = negligence committed by professional - ex. client falls b/c did not implement fall precautions 2. contract - binding legal agreement - one party fails to fulfill contract obligations - breach of contract - seek compensation/fulfillment of obligation

feedback

- provide information about how client is perceived by others - helps consider behavior modification - useful if objective and from trusted source - describe behavior observed objectively - must be specific - give detail about behavior - direct towards behavior that can be modified (not to situation client can't change) - only gives information - doest not advice - most useful - when given at earliest appropriate opportunity - if focus of feedback is client → nurse make judgment about client → client becomes defensive - ex. client called other client a 'cow' and laughed - evaluative: "you were rude and inconsiderate to other pterm-67atient"

community mental health facility

- provide services to the community - educational groups - medication dispensing - individual/family counseling

personality disorders - meds

- psychotropic → relief from manifestations - antidepressants - anxiolytic - antipsychotic - mood stabilizers

personality disorders - therapies

- pyschotherapy, group therapy, cognitive behavioral therapy - dialectical behavior therapy - case management - enhance social supporty system

altruism (+)

- reaching out to others - ex. victim of fire becomes firefighter

Health Insurance Portability and Accountability Act (HIPAA)

- relates to protected health information (PHI) - identifiable health information indicators (ex. name, zip code, social, telephone number, etc.) - patient - has right to access own med records, request corrections, decide w/whom to share - override: a) information may be released w/out consent if in life-threatening information (emergency) b) civil/criminal proceedings

stress

- response to perceived/real events (stressors) a) stressors = threatening / challenging - cause physical (fight/flight response), emotional tension - biological, psychological, social, chemical - cause anxiety

rights of clients in MH settings

- right to humane tx and care - right to vote - right to due process of law - right to refuse tx - right to informed consent - right to plan of care including discharge F/U, participation and review of care plan - right to confidentiality - right to communicate w/outside world - right to adequate interpretive services - right to receive respectful care w/dignity and w/out discrimination - right to be free from harm - right to psychiatric advance directive w/client preferences for tx if involuntary admission needed - right to care w/least restrictive interventions

delirum/demential treatment

- room w/windows for orientation - ID bracelet, bed alarm - room close to nurse's station - low visual/auditory stimuli - well-lit environment - allow safe pacing/wandering - meds PRN for agitation - remove mirrors (↓ fear/agitation) - restraints only as last resort - adequate food/fluid intake - consistent daily routine - consistent caregivers - low bed, no rugs - provide eyeglasses, hearing aids - memory aids (clocks, calendars, photographs, memorabilia, seasonal decorations, familiar objects) - reorient as needed

retribution / restorative justice

- rules for responding when expectations for fairness are violated

non-therapeutic technique - interpreting

- seek to make conscious what is unconscious and tell client meaning of his/her experience - ex. "what you really mean is...." - instead: let psychiatrist interpret behavior

isolation

- separating thought/memory from feeling - ex. woman describes rape w/out showing emotion

mental status exam (MSE)

- set of interview questions and observations - designed to reveal degree and nature of a client's abnormal functioning - focuses on a) appearance b) behavior c) speech d) mood e) disorders of the form of thought f) perceptual disturbances g) cognition h) ideas of harming self or others - ex. grooming, long-term memory, support systems, affect

ethical theory

- set of moral principles - can be used in assessing what is morally right or wrong

displacement

- shifting feelings to a less threatening person/target/situation - (+): angry teen punches punching bag - (-): recently fired man comes home and kicks cat

steps in making ethical decision

- similar to ADPIE 1. assess - gather information about situation, consider personal values 2. ID problem - identify conflict between 2+ alternatives actions 3. plan a) explore benefits and consequences of e/alternative b) consider principles of ethical theories c) pick alternative 4. implement - act on decision made 5. evaluate - evaluate outcomes

CNS depressants

- slow down normal brain function a) intoxication s/s - slurred speech, impaired memory - ↓ respirations, ↓ LOC - impaired judgement b) withdrawal s/s - hallucinations/illusions, anxiety, diaphoresis, tremors, irritability, insomnia, N/V c) types - opioid agonists - alcohol - sedatives/hypnotics/anxiolytics - cannabis

dementia

- slow progressive, irreversible decline in mental abilities - includes memory, thinking, and judgment - often accompanied by gradual personality changes - patient safety - important - stable vitals - unless other illness present

cannabis (marihuana, hashish)

- smoked or PO - produce euphoria, ↓ N/V in chemo, pain management a) intoxication s/s - paranoia (delusions/hallucinations), ↑ apetite, dry mouth, ↑ HR b) chronic use - lung cancer, chronic bronchitis, respiratory problems c) withdrawal s/s - s/s CNS depressants + aggression, anorexia, depressed mood, fever, headache

inhalants

- sniffed, puffed, bagged (children/adolescents) a) types - amyl nitrate, nitrous oxide, solvents b) intoxication s/s - s/s CNS stimulants + behavior or psychological changes, nystagmus, uncoordinated movements/gait, slurred speech, drowsiness, hyporeflexia, muscles weakness, diplopia, stupor/coma, respiratory depression, death c) withdrawal s/s - none

antidepressants - types

- stimulate SNS → stimulate fight/flight response - anticholenergic 1. tricyclic (Amitriptyline, Toframil) - causes hypotension - chew gum, ↑ fiber, ↑ fluids (2-3L/da) 2. SSRIs (Fluxetine, Prozac) - selective serotonin re-uptake inhibitors - nausea, vomiting, CNS stimulation (anxiety, agitation), sexual dysfunction, avoid w/St. John's wort (serotonin syndrome) - healthy diet, exercise 3. MAOIs (Phenelzine, Nardil) - risk HTN crisis - avoid foods w/tyramine (ripe avocados, aged cheese, sardines, figs, beer, smoked meats, bananas, dried fruit, chocolate, coffee, etc.) - avoid OTC meds 4. heterocyclics (Bupropion, Wellbutrin) - also for weight loss and smoking cessation - headache, dry mouth, GI distress, constipation, ↑ HR, nausea, restlessness, insomnia - avoid if seizures 5. SNRIs (Duloxetine, Cymbalta) - serotonin nonepinephrine re-uptake inhibitors - nausea, insomnia, wt. gain, diaphoresis, sexual dysfunction - caution with HTN

CNS stimulants

- stimulate specific areas of brain and spinal cord a) intended effect - ↑ energy, euphoria (extreme well-being), pleasure b) intoxication s/s - psychomotor agitation, irritability, ↑ HR, dizziness c) withdrawal s/s - cravings, depression, fatigue, sleepiness, psychomotor retardation d) types - cocaine - amphetamines - inhalants - hallucinogens - caffeine - nicotine

therapeutic technique - focusing

- stopping flow of conversation to focus on one topic - take notice of single idea/word - DO NOT use if client is feeling very anxious (wait until anxiety level subsides) - ex. "this point seems important, perhaps we can discuss further"

stress as environmental event

- stress - event that triggers adaptive response - changes life pattern - req's adjustment in lifestyle, taxes resources - ↑ stress = ↑ susceptibility to physical or psychological illness (Miller Questionnaire) - imp. to consider: 1. perception of event 2. coping strategies, 3. support system - ex. change in social activities, vacation, engagement to marry, sexual difficulties, accident, being in jail, relationship problems, death of loved one, personal achievement, changes in residence, changes in health, marriage, PG, miscarriage, starting/ending job, arguments w/spouse, change in marital status, separation/divorce, birth of grandchild, financial, loss of property, moderate purchase, foreclosure

undoing

- symbolically negating/canceling an intolerable experience - performing act to make up for prior behavior - (+): teenager cleans room after argument w/parents - (-): man buys wife flowers after incident of DV

intellectualization

- taking emotions out - separation of emotions about a situation thru use of logic, analysis, and reasoning - (+): police officers objectively focuses on facts of horrible homicide - (-): person given terminal illness diagnosis focuses on things to do rather than grief

anxiety disorders/ OCDs - therapeutic procedures

- teach ways to ↓ anxiety or avoidant behavior - allow opportunity to practice techniques 1. relaxation training - to control pain, tension, anxiety 2. modeling - demonstration of appropriate behavior during stress 3. systemic desensitization - use of relaxation to overcome stress of anxiety when exposed to ↑ng levels of anxiety producing stimulus 4. flooding - expose to great amount of undesirable stimulus - attempt to turn off the anxiety response - in phobias 5. response prevention - focus is to stop client from performing compulsive behavior 6. thought stopping - teach client to say "stop" when negative thoughts/compulsive behaviors arise

non-therapeutic technique - giving false reassurance

- tells client no cause of anxiety - devalues client's feelings and discourages from further expression of feelings - ex. "I wouldn't worry..." - instead say: "we will work on that together"

lithium

- therapeutic range: 0.8-1.4 mEq/L - toxicity: vision changes, neurological impairment, hypotension, at risk for hyponatremia (↓Na+)

delirium

- transient disorder - altered LOC - rapid personality change - secondary to other medical condition - more common in older adults - change in cognition - ↓ attention span - occurs over a short period of time - alterations in memory, agitation, restlessness, illusions, or hallucinations - results from a secondary physiological condition (e.g., infection, surgery, prolonged hospitalization, hypoxia, fever, medications) a) manifestations -rapid, inappropriate, incoherent, and rambling speech - acutely confused and agitated client, may be showing manifestations of delirium

therapeutic technique - translating words into feelings

- try to desymbolize indirect expression of feelings - ex. client says he feels "out in the ocean", nurse replies "you must be feeling very lonely"

panic anxiety

- unable to focus - loss of contact w/reality (delusions/hallucinations) - wild desperate actions - extreme withdrawal - ineffective functioning and communication - feeling of horror and "going crazy" - can lead to physical/emotional exhaustion - can be life-threatening a) signs/symptoms - dilated pupils, severe shaking, hallucinations b) nursing strategies - assess for suicide risk - quiet environment - minimal distractions - remain w/patient - set limits - short simple sentences - help focus on reality

sublimation (+)

- unconscious substitution of unacceptable feelings/impulses w/ acceptable forms of expression - rechanneling of socially unacceptable activities into constructive ones - ex. feeling anger - sublimate by working out hard at gym

historical perspective of depression

- unknown exact cause - genetic, biochemical, environmental influences a) old testament - Book of Samuel/King Saul - depression = evil spirit b) Greek medical community - Hippocrates, Celsus, Galen - rejected divine origin - brain = seat of all emotional states - melancholia = accumulation of black bile in brain (produced by spleen or intestine) c) Reinaissance - depression = obstructed air circulation, excessive brooding, situations beyond control d) contemporary - Freud, Kraepelin, Meyer - intraspsychic, behavioral, biological perspectives - multiple causation

regression

- use of child-like/primitive behaviors that don't match developmental level - (+): young child temporarily wets bed after pet dies - (-): man throws things when argues with co-worker

therapeutic technique - giving broad opening

- use of open-ended questions - allows client to take initiative in introduction of topic - ex. "tell me what you are thinking"

distance

- use of space to communicate 1. intimate (0-18") - closest distance - nurses get into intimate space - ex. foley's, dressing changes, etc. 2. personal (18-40") - between friends when chatting 3. social (4-12 ft) - conversations w/strangers 4. public (> 12 ft) - public speaking

SUD/addictive disorders - assessment

- use open-ended questions a) ask about 1. type of substance/addictive behavior 2. pattern and frequency 3. amount 4. age at onset 5. changes in school/work performance 6. history of abstinence periods 7. manifestations of withdrawal 8. date of last use b) body systems review - LOC and/or blackouts - changes in bowel movements - wt loss or gain - sleep patterns - experience of stressful situation - chronic pain - concern over substance use - cutting down or consumption behavior

defense mechanisms

- used by people w/personality disorders 1. repression 2. suppression 3. regression 4. undoing 5. splitting

right

- valid, legally recognized claim or entitlement - encompasses freedom from government interference or discriminatory treatment and entitlement to a benefit or service a) absolute right - no restrictions whatsoever on individual's entitlement b) legal right - formalize into law c) US Constitution i. First Amendment - right of speech, thought, expression ii. 5th Amendment - right to due process of law iii. 8th Amendment - right to freedom from cruel and unusual punishment iv. 14th Amendment - right to equal protection for all

therapeutic communication

- verbal and nonverbal communication techniques - encourage patients to express their feelings - focuses on care receiver needs - advances promotion of healing and change - helps achieve positive relationship between nurse and patient - nonjudgemental, discourages defensiveness, promotes trust - avoid "WHY?" - judgemental, causes defensiveness

damages awarded to patient defendat

- when can prove malpractice - must meet all criteria for malpractice

intentional harm / tort in nursing

- willful act - violates patient's rights. - ex.: assault, battery, invasion of privacy and defamation of character

serotonin syndrome

- with MAO inhibitors, SNRIs, TCAs - begins 2-72 hrs after start tx - can be lethal a) S/S - hyperthermia, confusion, myoclonus, hallucinations, hyperreflexia, tremors, diaphoresis, abdominal pain, cardiovascular instability, flushing, diarrhea, seizures. b) Treatment - cyproheptadine (5-HT2 receptor antagonist) - cooling blankets - anticonvulsants - artificial ventilation - meds to create serotonin receptor blockade

state board of nursing

- written intentionally vague - generally - do NOT state what nurse can/cannot do

caffeine

- ↑ alertness, ↓ fatigue a) types - cola drinks, coffee, tea, chocolate, energy drinks b) intoxication s/s - when > 250 mg (1 energy drink can of 2 oz = 215-240 mg) - ↑ HR, arrhythmia, flushed face, muscle twitching, restlessness, diuresis, GI disturbances, anxiety, insomnia c) withdrawal s/s - headache, N/V, muscle pain, irritability, inability to focus, drowsiness

physical responses to stress

- ↑ glucogenesis (diabetes) - ↑ bp, fluid retention (HTN) - ↑ BMR, TSH (thyroid problems, endocrine problems) - ↑ inflamation respose (stress on body, - ↓ immune response (infections, dz)

moderate anxiety

- ↓d perceptual field - less alert to environment - ↓ attention span and ability to concentrate - may require help w/problem solving a) signs/symptoms - impacted (↑d) vitals (RR, HR, BP) - pacing, ↑ muscular tension, ↑ restlessness b) nursing strategies - evaluate previous successful coping mechanisms - help retap into coping mechanisms

personality disorders - expected findings

- ≥ 1 of the following: 1. inflexibility/maladaptive response to stress 2. compulsiveness, lack of social restraint 3. inability to connect emotionally in social/professional relationships 4. tendency to provoke conflict 5. merging of personal boundaries w/others

cocaine withdrawal symptoms

-Depression -Fatigue -Disturbed sleep -Anxiety -Psychomotor agitation

cocaine intoxication manifestations

-Tachycardia -Pupillary dilation -Elevated BP -Perspiration/chills -Nausea/vomiting -Visual or tactile hallucinations

SUD/addictive disorders - screening tools

1. Michigan Alcohol Screening Test (MAST) 2. Drug Abuse Screening Test (DAST) - DAST-A for adolescents 3. CAGE questionnaire 4. Alcohol Use Disorders Identification Test (AUDIT) 5. Clinical Institute Withdrawal Assessment of Alcohol Scale, revised (CIWA-Ar) 6. Clinical Opiate Withdrawal Scale

anxiety disorders/ OCD's - meds

1. SSRI antidepressants - ex. sertraline, paroxetine - first line treatment for anxiety 2. SNRI antidepressants - ex. venlafaxine, duloxetine - for anxiety disorders 3. antianxiety meds - tx manifestations of anxiety a) benzodiazepines (diazepam) - for short-term use b) buspirone - for management of anxiety - can be used long-term - no physical or psychological dependence - does not produce tolerance - causes drowsiness, N/V, initial effects in 1-2 weeks - therapeutic effects in 3-4 weeks - avoid erythromycin, ketoconazole, St. John's wort, grapefruit juice 4. other meds - mood stabilizers a) beta blockers b) antihistamines c) anticonvulsants

SUD/addictive disorders - meds

1. alcohol withdrawal - diazepam, carbazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone 2. alcohol abstinence - disulfiram (MUST avoid alcohol), naltrexone (take w/meals), acamprosate (NOT if PG, causes diarrhea) 3. opioid withdrawal - methadone substitution, clonidine, buprenorphine, naltrexone, levo-⍺-acetylmethadol 4. nicotine withdrawal from tobacco use - bupropion, nicotine replacement therapy (gum/patch), varenicline, burpropion 5. nicotine abstinence - varenicline, rimonabant NURSING CARE: - monitor vitals, neurological status - seizure precautions (safety)

behaviors that may result in malpractice charges to psychiatric nurses

1. breach of confidentiality - acknowledging patient was hospitalized 2. defamation of character - detrimental to client's reputation - lible = in writing - slander = oral - avoid by being objective in charting, backing up info w/factual evidence 3. invasion of privacy - client is body-searched w/out probable cause and w/out physician's orders (must explain reason for body search) 4. assault - results in patient genuine fear/apprehension of being touched w/out consent 5. battery - touching patient w/out permission (excluding emergencies) 6. false imprisonment - confining patient against will (excluding emergencies) - ex. locking patient in room, taking client's clothes so can't leave, restraining competent voluntary client who demands to be released

personality disorder - types

1. cluster A (odd/eccentric) a) paranoid b) schizoid c) schizotypal 2. cluster B (dramatic, emotional, erratic traits) a) antisoical b) borderline c) histrionic d) narcissistic 3. cluster C (anxious/fearful traits, insecurity and inadequacy) a) avoidant b) dependent c) obssesive-compulsive

non-therapeutic techniques and ineffective responses

1. defending - ex. your doctor is really good 2. requesting explanation - ex. WHY did you do that? 3. rejecting - ex. you are not supposed to talk like that! 4. literal response - ex. if you feel empty you should eat more 5. looking too busy 6. appearing uncomfortable in silence 7. being opinionated 8. avoiding sensitive topics 9. arguing and telling client s/he is wrong 10. having closed posture (crossing arms on chest) 11. making false promises - ex. I'll make sure to call you when you get home 12. ignoring patient - ex. I can't talk right now 13. making sarcastic remarks 14. laughing nervously 15. showing disapproval - ex. you shouldn't do that

stages of Grief (Kubler-Ross)

1. denial - offer support to client - when opportunity arises - intervene to ↑ awareness of loss 2. anger 3. bargaining 4. depression 5. acceptance

avoiding liability

1. effective communication - follow SBAR model 2. accurate/complete documentation 3. complying w/standards of care 4. building relationship w/client - get to know client 5. practice w/in scope and level of competence

areas of brain affected by depression

1. hippocampus - memory impairment, feeling worthlessness, hopelessness, guilt 2. amygdala - anhedonia (inability to feel pleasure of activities used to enjoy), anxiety, ↓ motivation 3. hypothalamus - ↑ or ↓ sleep/appetite, ↓ energy/libido 4. other limbic structures - emotional alterations 5. frontal cortex - depressed mood, concentration problems 6. cerebellum - psychomotor retardation/agitation

types of depressive disorders

1. major depressive disorder (MDD) - depressed mood/loss of interest or pleasure in usual activities - impaired social/occupational functioning - > 2 weeks - no history of manic behavior, substance use - single or recurrent - mild, moderate or severe - w/ or w/out anxiety, suicidal risk 2. persistent depressive disorder (PDD) = depressed mood for most of day, most days, > 2 yrs (dysthymia) - chronically "down in the dumps" - no evidence of psychotic symptoms - early (< 21 yrs old) or late onset (> 20 yrs old) - diagnosed with DSM-5 diagnostic criteria 3. premenstrual dysphoric disorder (preDD) - week prior to menses - markedly depressed mood, excessive anxiety, mood swings, ↓ interest in activities - symptoms improve shortly after onset of menses - no symptoms after menses

code of ethics for nursing

1. nurse practices with compassion and respect 2. primary commitment is to patient 3. promotes, advocates for, strives to protect health, safety and rights of patient 4. has authority, accountability, responsibility for nursing practice 5. owes same duties to self as to others 6. establishes, maintains, improves ethical environment 7. advances profession through research and scholarly inquiry 8. collaborates with other health professionals 9. articulates nursing values, maintains integrity of profession - through professional organizations

top 5 ethical issues in healthcare

1. patient confidentiality 2. patient relationships 3. torts (malpractice/negligence) 4. informed consent 5. physician assisted suicide (PAD)

handling aggressive behavior

1. respond quickly 2. stay calm and in control 3. encourage client to express feelings verbally 4. give as much personal space as possible 5. maintain eye contact 6. be honest, sincere 7. avoid accusations, threats 8. describe options clearly 9. have other staff present (4-6) 10. set limits 11. tell client what s/he must do 12. use of physical activity to deescalate (ex. walk) 13. inform of consequences 14. pharmacological intervention

anxiety disorders/OCDs - nursing care

1. structured interview - keep patient focused 2. assess for substance use disorder 3. provide safety and comfort during crisis (calm, quiet environment) 4. remain w/client during crisis 5. suicide risk assessment 6. safe environment for others 7. milieu therapy 8. relaxation techniques 9. enhance self-esteem 10. help ID defense mechanisms that interfere w/recovery 11. no teaching until after acute anxiety subsides

depression - meds

1. tricyclic antidepressants - amitriptyline 2. nonbarbiturate anxiolytics - buspirone 3. sedative hypnotic anxiolytics - diazepam 4. selective serotonin reuptake inhibitors (SSRIs) - citalopram 5. monoamine oxidase inhibitors (MAOIs) - phenelzine 6. serotonin norepinephrine reuptake inhibitors (SNRIs) - venlafaxine 7. alternative complementary therapy - St. John's Wort - watch for photosensitivity, skin rash, ↑ HR, GI distress, abd. pain - can ↑ or↓ level of some meds - interactions: potentially fatal serotonin syndrome if taken w/SSRIs, MAOIs, atypical antidepressants (amitriptyline, clomipramine) - avoid foods with tyramine

density

= # people in given space - correlation: ↑ density situations → ↑ aggression, hostility, stress, criminal activity, ↓ mental and physical health

opiod agonists

= CNS depressants - alter reception and response to pain - schedule II drugs - heroin, morphine, hydromorphone a) route - injected, smoked, inhaled b) side effects - s/s of CNS depressants + pupillary changes c) antidote - naloxone (Narcan) - IV d) withdrawal s/s - s/s of CNS depressants + rhinorrea, piloerection, severe weakness, diarrhea, fever, pupil dilation, muscle/bone pain, muscle spasms - NOT life-threatening

Christian ethics

= Golden Rule: "do unto others as you would have them do unto you" (empathy) - importance of virtues (love, forgiveness, honesty) - centered in love for God - tx others w/same respect and dignity as expect others to tx me - ex. "what would Jesus do?" attitude in making decisions - ex. a duty to affirm life (of which health is an aspect),

therapeutic technique - accepting

= attitude of reception and positive regard - ex. eye contact, nodding

non-therapeutic communication

= blocks the development of a trusting and therapeutic relationship - giving advice - talking about self - telling client is wrong - entering into client's hallucinations/delusions - cliché - giving approval - asking WHY? - changing subject - defending doctors and other HC team members

therapeutic technique - placing event in time/sequence

= clarifying timeline of events - allow clients to view events in perspective - ex. "what seemed to lead up to ...?"

kantianism

= deontology - directly opposed to utilitarianism - principle or motivation behind action - makes action right/wrong - actions - bound by sense of duty - decisions - made out of respect for moral law - ex. make choice b/c is morally right, not out of consideration of possible outcome

justice

= fairness, equality - right to be treated equally and fairly - integrate social justice as rule everyone must follow - social contract

therapeutic technique - giving recognition

= indicating awareness, acknowledging - better than complementing - ex. "I see you made your bed"

nursing interventions - powerlessness

= lack of control over situation a) ST goal: participate in decision-making related to own care, w/in 5 days b) LT goal: problem solve ways to control life situations by discharge c) interventions: - encourage to take responsibility in self-care - include client in setting goals - allow client to establish own schedule for self-care - provide privacy as needed - help set realistic goals - help ID areas of life that can be controlled - provide positive feedback - encourage verbalization of feelings related to inability to deal w/unresolved issues

SUD/addictive disorders

= loss of control - participation in behavior despite continuing associated problems - tendency to relapse - defense = denial (prevents from getting help)

therapeutic technique - offering self

= making self available - ex. "I'll stay w/you for a while"

comorbidity

= mental health disorder (depression) + SUD/addictive disorder - must treat both simultaneously - require team approach

sedatives/hypnotics/anxiolytics

= mood depressants - sedative = calming - hypnotics = sleep-inducing - anxiolytics = ↓anxiety - benzodiazepams (diazepam) - barbiturates (pentobarbital) - club drugs (flunitrazepam = date rape drug) a) intoxication s/s - CNS depressants s/s + ↑ drowsiness, agitation, disorientation b) antidote - flumazenil - IV (for benzodiazepine toxicity) - none for barbiturate toxicity c) withdrawal s/s - s/s CNS depressants + HTN, psychotic reactions, hand tremors, psychomotor agitation, seizures

cluster A

= odd/eccentric 1. paranoid 2. schizoid 3. schizotypal

therapeutic technique - rephrasing

= paraphrasing (summarizing what was said) - client may recognize value of his/her point of view - ex. client asks what nurse thinks he should do, nurse replies "what do you think you should do?"

effective communication

= process of sending a message - message received = as close in meaning as possible - open-ended questions - focus on feelings - state behaviors observed - reflect, restate, rephrase what patient said - neutral responses - appropriate - simple - adaptive - concise - credible

therapeutic technique - verbalizing the implied

= putting into words what client has only implied - good for clients who are withdrawn or experiencing impaired verbal communication - ex. client states "it's waste of time to be here", nurse asks "are you feeling no one understands you?"

therapeutic technique - restating

= repeat main idea - client feels understood or clarifies - ex. client states his mind wonders and can't focus, nurse responds "you have trouble concentrating"

veracity

= truthfulness, honesty - not intentionally deceiving or misleading of patients - patients have right to know diagnosis, treatment, prognosis

therapeutic technique - seeking clarification/validation

= trying to understand vague statements - searching for mutual understanding - ex. "do I understand correctly that you said..?"

therapeutic technique - making observations

= verbalizing what is observed/perceived by client - allows client to recognize specific behaviors and compare to nurse's perception - ex. "you seem tense"

adaptation vs. maladaptation

a) adaptation - protect individual from harm or strengthen ability to meet challenging situations - help restore homeostasis - impede development of dz = resilience b) maladapatation - behavior disrupts integrity of person - when conflict is unresolved

psychological adaptations to stress

a) anxiety - arises from chaos and confusion - fear of unknown/ambiguity - problematic when can't prevent response from escalating and interferes w/basic needs - ex. ego-defense mechanisms, psychophysiological responses, psychoneurotic responses, psychotic responses b) grief - subjective state of emotional, physical, and social responses to loss of valued entity - intense emotional anguish - b/c of loss (real or perceived) - ex. death, loss of feeling, failure - stages: 1. denial 2. anger 3. bargaining 4. depression 5. acceptance

anger management

a) categories 1. preassaultive - hyperactive (pacing, restlessness), anxiety, verbal abuse, defensive, intense eye contact, frowning, clenched fists, waving arms, rapid breathing, aggressive postures, tense, loud, rapid talking, drug/alcohol intoxication 2. assaultive - act of violence may need restraint/seclusion 3. postassaultive - staff review incident b) nursing care - provide safe environment - assess for triggers

depression related to developmental stage - senescence

a) manifestations - 16.6% suicide rate among 65-84 yrs - can be confused w/common issues w/growing old - ↓ self-esteem, helplessness, hopelessness - environmental stressors - financial, illness, changes in body functions, approaching death - bereavement overload - can't recover from death of one loved one b/c many dying b) precipitating factors - illness associated, memory loss, confused thinking, apathy, endocrinological, neurological, nutritional, metabolic disorders, medication that cause depression, Parkinson's, cancer, arthitis, Alzheimer's c) tx - psychosocial and biological approaches - electroconvulsive therapy (ECT) - interpersonal., behavioral, congnitive, group, family psychotherapies d) meds - careful w/age-related changed changes in absorption, distribution, elimination and brain-receptor sensitivity

adaptive/maladaptive responses to mental health and mental illness continuum

a) mental health = successful adaptation to stressors from internal /external environment - evidenced by: thoughts, feelings, behaviors that are congruent w/society and age appropriate b) mental illness = maladaptive response to stressors from internal /external environment - interferes w/ social, occupational, and/or physical functioning

alcohol withdrawal

a) symptoms - appear within 4-12 hrs - can last 5-7 days - abd cramping, N/V - ↑ RR, temp - TACHYCARDIA - HTN -diaphoresis - tremors, tonic-clonic seizures - anxiety, restlessness, inability to sleep - transient hallucinations or illusions b) tx i. benzodiazepines - chlordiazepoxide, diazepam, lorazepam, oxazepam - given in acute phase of withdrawal - raise seizure threshold and prevent seizures, ↓ agitation, stabilize vital signs, ↓ withdrawal manifestations ii. adjunct meds - carbamazepine (antiepileptic), clonidine, propanalol, atenolol - ↓ seizures, depress autonomic response (↓ BP, ↓ HR), ↓ cravings - side effects: vision problems, vertigo, headache, staggering gait, leukopenia, anemia, thrombocytopenia, risk fluid overload, rash (Steven-Johnson syndrome) c) nursing care - PRN - baseline vitals - neurological checks (ongoing) - seizure precautions - watch for vertigo, ataxia and drowsiness

nicotine withdrawal symptoms

a) symptoms - irritability - nervousness - restlessness - insomnia - difficulty concentrating b) tx - bupropion - ↓ craving - replacement therapy (gum, patch, nasal spray, lozengers, inhaler) - varenicline - ↓ craving (NOT for truck/bus drivers, pilots, air controllers) c) nursing care - dry mouth - avoid caffeine - spray/inhaler - NOT if asthma - taper gradually (2-3 months) - void eating/drinking 15 mins prior to gum - no other nicotine products if wearing patch - 1 spray in nostril = 1 cigarette - NOT if PG or BF - monitor BP w/varenicline - caution if DM2

opioid withdrawal

a) symptoms - w/in hrs → days of cessation - agitation - insomnia - flu-like symptoms - yawning - sweating - diarrhea - suicidal ideation - not life-threatening b) tx - methadone substitution - prevents abstinence syndrome - clonidine - does not reduce cravings for opioids - buprenorphine - withdrawal/maintenance, ↓ cravings (sublingual) c) nursing care - encourage 12-step program - must be slowly tapered - administered from approved tx center - baseline VS - drowsiness, dry mouth

SUD/addictive disorders - therapies and programs

a) therapies - relaxation techniques - acceptance and commitment therapy (ACT) - relapse prevention therapy - group therapy - family therapy (teach about codependence) b) programs - 12-step Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Gambler's Anonymous - family groups (Al-Anon, Al-Teen) - abstinence → necessary for recovery - higher power → needed to assist in recovery - own responsibility for recovery - can not blame others

dissociative amnesia and fugue

confusion, failure to recall information or events related to own identity a) amnensia - unable to recall personal information related to traumatic/stressful event b) fugue - unable to remember one's own identity when traveling to new area - can last weeks to months - follows traumatic event

clang association

meaningless rhyming of words

non-verbal communication

~ 70-80% of all communication - vary by cultures a) physical appearance - dress, body coverings, hair, body adornments, jewelry - ex. bipolar manic - lots makeup, jewelry, provocative clothing b) body movement/posture - warm: lean towards other, smile, still hands, eye contact - cold: slumped, looking around, finger tapping, no smile c) touch i. functional-professional - impersonal, needed to accomplish task - ex. tailor ii. social/polite - impersonal, conveys acceptance of person - ex. handshake iii. friendship/warmth - indicates strong liking for other - ex. hand on other's shoulder iv. love/intimacy - emotional attachment/attraction - ex. strong mutual embrace v. sexual arousal - expression of physical attraction only d) facial expression - reveal emotional state (happiness, anger, sadness, surprise, fear) - complement and qualify other communication behaviors e) eye behavior - conveys interest in other person - indicates communication channels are open f) vocal cues/paralanguage - gestural component of spoken word - pitch, tone, loudness, word emphasis, pauses, rate of speaking - huge determinant on how message is interpreted