NURS 144 Exam 1 Mental Health

HPV

(Human Papillomavirus) a virus that can cause genital warts, cervical cancer, or be asymptomatic

Common crisis characteristics

- experiencing a sudden event with little or no time to prepare - perception of the event as overwhelming or life-threatening - loss or decrease in communication with significant others - sense of displacement from the familiar - an actual or perceived loss

types of crises

- situational/external - maturational/internal - adventitious

restraint time limits

Adult (18+) 4 hrs 9-17: 2 hrs 8 and below: 1 hr

Mental Status Exam (MSE)

Alert- responsive and able to fully respond by opening their eyes and responding to a normal tone of voice. Lethargic- able to open eyes and respond but is drowsy and falls asleep easily. Stuporous- requires vigorous or painful stimuli to elicit a brief response. Comatose- unconscious and does not respond to painful stimuli

interpersonal psychotherapy

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

narcissistic

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

antisocial

Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility

histrionic

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

dependent

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

borderline

Characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often tries self-injury and may be suicidal

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

avoidant

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

CIWA-Ar

Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised 9 item symptom rating scale, max score 67; <10 does not warrant intervention

COWS

Clinical Opiate Withdrawal Scale Quantifies severity of withdrawal syndrome, guides dosing, monitors over time Used for induction of Suboxone 5-12=mild; 13-24= moderate; 25-36=mod to severe; >36=severe

communication strategies

Limit-setting and consistency are essential with clientswho are manipulative, especially those who haveborderline or antisocial personality disorder• Clients who have dependent and histrionic personalitydisorders often benefit from assertiveness training andmodeling as well as psychotherapy.• Clients who have schizoid or schizotypal personalitydisorders tend to isolate themselves, and the nurseshould respect this need. Psychotherapy can help theclient's ability to respond to social cues from others.• For clients who have histrionic personality disorders,and can be flirtatious, it is important to maintainprofessional boundaries and communication at alltimes.• When caring for clients who exhibit dependentbehavior, self-assess frequently forcountertransference reactions.

Steps to handle aggressive behavior

Respond quickly, remain calm and in control, encourage the client to express feelings verbally, allow the client as much personal space as possible, maintain eye contact, sit or stand at the same level of the client, avoid accusatory or threatening statements, describe options clearly and offer choices, reassure the client that staff members are present to help prevent loss of control, set limits for the client

neurocognitive disorders

a group of conditions characterized by the disruption of thinking memory processing and problem solving

suicide

a leading cause of death for youth between 10-14

amenorrhea

absence of menstruation

risk factors for crisis

accumulation of unresolved losses, current life stressors, concurrent mental and physical health issues, excessive fatigue or pain, age and developmental stage.

maturational/internal

achieving new developmental stages, which requires learning additional coping mechanisms

medication education for pts

adv all clients taking disulfiram to avoid all alcohol, med is an aversion therapy for alcohol addiction meant to prevent impulse drinking, pt must not consume anything containing alcohol (vanilla extract, OTC meds like cough syrup, mouthwash)

Syphilis

an STD that attacks many parts of the body and is caused by a small bacterium called a spirochete

Cluster B personality disorders

antisocial, borderline, histrionic, narcissistic

psychosocial history

ask pt for perception of own health and beliefs about health and illness, ask about activity and leisure activity, hx of substance abuse, assess stress level and coping abilities, assess for support systems.

CAGE questionnaire

asks questions to determine how clients perceive their current alcohol use

Protocol for restraints/seclusions

assessments, food, drink, toileting, VS, pain monitoring all must be done according to facility policy

cluster C personality disorders

avoidant, dependent, obsessive-compulsive

Gonorrhea and Chlamydia

bacterial infections transmitted by sexual fluids

what to include when documenting a violent episode

behaviors leading up to as well as those observed throughout the incident, nursing interventions implemented and the clients response.

substance use disorders

can include alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, seditives/ hypnotics/ anxiolytics, stimulants, tobacco

non substance related disorders

can include gambling, sexual activity, shopping, social media, internet gambling

Somatic reaction

can occur later in which the client can have a variety of physical manifestations including sleep issues, GI manifestations, genitourinary manifestations

paranoid

chacterized by distrust and suspiciousness towards others bases on unfound beliefs that others want to harm, exploit or deceive them

oppositional defiant disorder

characterized by a recurrent pattern of negativity, disobedience, hostility, defiant behaviors toward authroity, stubbornness, argumentativeness, limit testing, unwillingness to compromise, refusal to accept responsibility for misbehavior

schizoid

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

obsessive compulsive

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

addictive disorders

characterized by loss of control due to the substance use or behavior that continues despite continuing associated problems and a tendency to relapse back into the substance use or behavior

intermittent explosive disorder

client exhibits recurrent episodic violent and aggressive behavior with the possibility of hurting people property or animals

dialectical behavioral therapy

cognitive- behavioral therapy for clients who have a personality disorder and exhibit self injurious behavior.

autism spectrum disorder

complex neurodevelopment disorder thought to be of genetic origin with a wide spectrum of behaviors affecting an individuals ability to communicate and interact with others

Selective Serotonin Reuptake Inhibitors (SSRIs)

complications- agitation can indicate serotonin syndrome, take with food to minimize GI upset contraindications- can increase SI in children and adolescents, abrupt withdrawal from medication can lead to discontinuation syndrome interactions- concurrent use of MAOIs, SNRIs. bus-irons or St. johns wort can cause serotonin syndrome Nursing administration- do not crush or chew SR tabs, assist pt with med regiment adherence by informing pr that the intial response occurs n 1-2 weeks and max therapeutic effect occurs by 12 weeks pt education- can be taken with or without food, sleep disturbances can be minimized by taking in the morning, take daily to est therapeutic levels, do not abruptly stop med, report suicidal thoughts to provider

effects of assaults

compound rape reaction- mental health disorders, manifestations of a prior physical illness silent rape reaction- pt does not report or tell anyone of the sexual assault including family, friends or authorities.

contraceptives

condoms, spermicides, diaphragms, cervical sponge, withdrawal method, oral pill, transdermal hormonal delivery vaginal rings, patches, depo shot, IUD, basal body temp method, hysterectomy, vasectomy, rhythm method

Fluazenil (Romazicon)

considered antidote for benzodiazepine toxicity, given IV

Typical Antipsychotics

contraindications/precautions- avoid alcohol use, use cautiously in pts with cardiovascular disease, seizures or DM, DM pts should have baseline fasting BS and glucose should be monitored closely interactions- CNS depressants, alcohol, avoid hazardous activities, TCAs nursing administration- oral or IM client ed- low doses of med are given initially and then are gradually increased nursing evaluation of effectiveness- autism- reduction in hyperactivity, improvement in mood. conduct disorder- decreased effectiveness OCD- reduced anxiety, ability to manage compulsive actions, ability to perform self care, increase interaction with peers. ADHD- reduction in hyperactivity and impulsivity

alpha 2 adrenergic agonists

contraindications/precautions- safety has not been establish for use of guanfacine or clonidine in children younger than 6, use cautiously in clients who have cardiac disease interactions- CNS depressants, antihypertensives, foods with high fat content nursing administration- assess use of alcohol and CNS depressants, monitor BP/HR at baseline with initial treatment each dosage can change. client ed- avoid abrupt DC of meds, should be tapered off, do not chew crush split extended release

Do not use restraints for:

convivence, punishment, pts who are mentally or physically unstable, pt who can not tolerate the decreased stimulation of a seclusion room.

milieu therapy

creates an environment that is supportive, therapeutic and safe.

Comatose Posturing

decorticate rigidity- flexion and internal rotation of upper extremity joint and legs. Decerebrate rigidity- neck and elbow extension wrist and finger flexion.

types of cognitive disorders

delirium- short term/ reversible Mild nerurocognitive disorder- may or may not progress to a major disorder Major NCD- Alzheimers, Parkinson's, Huntingtons disease

conduct disorder

demonstrates a persistant pattern of behaviors that violate the rights of others or rules and norms of society contributing factors- parental rejection and neglect, difficult infant temperament, inconsistent child rearing practices with harsh discipline, physical or sexual abuse, lack of supervision, early institutionalization, frequent changing of caregivers, large families, association with delinquent peer groups, parent with hx of mental illness, chaotic home life, lack of male role model

common mental health disorders in children and adolescents

depression, anxiety, substance use, feeding/eating disorders, disruptive, impulse control and conduct disorders

following a violent episode

discuss ways for the pt to keep control during the aggression cycle, reassess the milieu and identify potential stressors, encourage pt to talk about the incident, debrief staff, document entire incident completely.

psychodynamic psychotherapy

employs the same tools and psychoanalysis but focuses more of the clients present state than their early life, tends to be a long form of treatment

violence interprofessional collaboraton

encourage participation in support groups, assist with pt relocation if needed, discuss therapies that could be beneficial, talk with caregivers about community agencies that could provide relief

initial emotional reaction of sexual assault

expressed- overt and consists of emotional outbursts. controlled- ambiguous, blunt affect can also be confused or have difficulty making decisions.

nursing care of NCD

focused on protecting the pt from injury as well as promoting client dignity and quality of life, provide a safe and therapeutic environment, do not argue or question hallucinations or delusions

cognitive therapy

focuses on individual thoughts and behaviors to solve current problems.

older adult assessment

functional ability, economic and social status, environmental factors

Risk factors for anger

history of aggression, poor impulse control and violence, poor coping skills, limited support systems, comorbidity that leads to acts of violence, living in a violent environment

HEADSSS assessment tool for children/adolescents

home environment education/employment activities drugs/ substance abuse sexuality suicide/depression safety

Herpes

inflammatory skin disease caused by herpes virus characterized by small blisters in clusters

expected findings in personality disorders

inflexibility/maladaptive responses to stress, compulsiveness and lack of social restraint, tendency to provoke interpersonal conflict, inability to emotionally connect in social and professional relationships.

ADHD

involves the inability of a person to control behaviors requiring sustained attention

nursing care of victims of sexual assault

let the client know it was not their fault, assess for suicidal ideation, refrain from asking why questions, assess for support systems, use reflection, open ended questions and active listening

anger

normal feeling, is an emotional response to frustration as perceived by the individual, becomes negative when it is denied, suppressed or expressed inappropriately

Transference

occurs when a client views a member of the health care team as having characteristics of another person who has been significant to the clients personal life.

Risk factors for personality disorders

often have comorbid substance use disorders, hx of nonviolent and violent crimes, psychological influences and developmental factors with a direct link to parenting, biological influences include genetic and biochemical factors.

situational/external

often unanticipated loss or change experienced in everyday often unanticipated life events (ex: job change or divorce)

dysmenorrhea

painful menstruation

Cluster A personality disorders

paranoid, schizoid, schizotypal

types of violence

physical, sexual, emotional violence, neglect, economic abuse

PTSD

precipitated by experiencing, witnessing, or learning of a traumatic event, children may exhibit psychological indications of anxiety, depression, phobia, or conversion reactions

sexual assault

pressured or forced sexual conduct, sexually stimulated talk or actions, inappropriate touching or intercourse, incest, human trafficking, female genital mutilation, rape

NEED TO KNOW for older adults assessment

private quiet space with adequate lighting to accommodate for impaired vision and hearing, introduction and determine clients name preference, stand or sit at the clients level to conduct the interview

date/rape drugs

produce sedative effects include gamma-hydroxzybityrate (liquid ecstasy) flunitrazepam (roofies, club drug, roachies) ketamine (black hole, kitkat, special k)

Selective Norepinephrine Reuptake Inhibitors (SNRIs)

prototype drug: atomoxetine interactions: MAOis- concurrent use can cause HTN crisis, paroxetine, fluoxetine, quinidine gluconate- inhibit metabolizing enzymes thereby increasing levels of atomoxetine Nursing administration- note any changes in client related to dosing and timing of medications, administer the med in a one daily dose in the morning or in two divided doses morning and afternoon with or without food Client ed: initial response may take a few days to develop but maximal therapeutic effect can take up to 6 weeks to fully develop, avoid alcohol use, avoid use of all OTC meds unless approved by provider

Tricyclic Antidepressants (TCAs)

prototype drug: desipramine contraindications- pregnancy risk category c or d depending on exact med in class, recent MI , hx of heart failure, prolonged QT complex interactions- MAOIs- concurrent use can lead to HTN crisis, antihistamines, epinephrine, alcohol, benzodiazepines, opioids nursing actions- instruct pt to administer med as prescribed on daily basis to establish therapeutic plasma levels

CNS stimulants

prototype drug: methylphenidate nursing actions: decrease dosage as prescribed, monitor Vs and ECG client ed: observe for effect and notify provider if they occur, decrease use of caffeine, eat at regular mealtimes and avoid unhealthy snacks, report manifestations immediately and d/c medication. avoid abrupt cessation of medication. Pregnancy risk category C Interactions: MAOIs- can cause HTN crisis. caffeine- concurrent use can increase in CNS stimulate effect, phenytoin, warfarin, phenobarbital-methylphenidate inhibits the metabolism of these medications leading to increased blood levels

violence assessment

provide privacy, be direct and honest, use language the client understands, be understanding and attentive, use therapeutic techniques, use open ended questions, inform pt if a referral must be mad to a clid to adult protective services.

patient centered care (anger)

provide safe enviornment, follow policies of mental health setting, assess for triggers or preconditions that escalate client emotions, self assessment/self awareness

specific learning disorder

pt demonstrates persistent difficulty in acquiring reading, writing, or math skills

disruptive mood dysregulation

pt exhibit recurrent temper tantrums that are severe and do not correlate to the situation

Narcan (naloxone)

rapid acting opioid antagonist that function by blocking opiate receptors almost immediately

Legal rights of mental health clients

same rights as any other citizen.right to refuse treatment, confidentiality, written plan of care and discharge follow up, communication with people outside the facility, provision of adequate interpretive services if needed.

Rights regarding seclusions and restraints

seclusion rooms and or restraints can be warranted or authorized in some cases, can be physical or chemical, pt can voluntarily request a temporary time out

blurred boundaries

social relationship> the primary purpose should not be a social relationship. Therapeutic relationship> the primary purpose should be to identify and focus on patient needs.

patient centered care 3 (crisis)

teach relaxation techniques, identify and teach coping skills, assist the client with development of the an action plan (short term, focused on the crisis, self assessment by the nurse, debriefing for staff)

cycle of violence

tension building phase, acute battering phase, honeymoon phase, periods of escalation and de-escaltion

Patient centered care 1 (crisis)

the initial task of the nurse is to promotes a sense of safety for the client and protect the client by assessing the potential for suicide or homicide.

adventitious

the occurrence of natural disasters, crimes or national disasters.

classical psychoanalysis

therapeutic process of assessing unconscious thoughts and feelings and resolving conflict by talking to a psychoanalyst

client education on violence

understand expected growth and development patterns for children, develop skills to assist with problem solving, find ways to manage stress in a positive way, consider external changes that can help reduce stress.

patient centered care 2 (crisis)

use strategies to decrease anxiety such as: listen and observe, remain with the client, make eye contact, ask questions, avoid false reassurances and other nontheraputic techniques

Physical Assessment

use touch to communicate caring, but respect personal space. Ask questions regarding difficulty sleeping, incontinence, falls or injuries, depression, dizziness or loss of energy, gather medication history, ask for pt feedback

cognitive behavioral theory

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

Before implementing restraints attempt:

verbal interventions, diversion/redirection, providing calm/ quiet environment, offering PRN medication (still considered chemical restraint but less restrictive than mechanical restraint)

risk factors- family

violence is most common within family groups and most is aimed at family and friends rather than strangers.