Unit 10 Mental Health

Neologism

"I'm going to the fribity to see a megnat" flight of ideas and word salad are commonly seen

Therapeutic Interventions for drug abuse

-Narcotics anonymous -Group therapy -Psychotherapy -Methadone programs

Cognitive disorders

-Neurocognitive Disorders -Major and Minor Neurocognitive Disorders -Delirium -Pseudodementia -Depression

opiate anatagonist

-Used for opioid OD -In delivery of NB with respiratory depression caused from mother on opiod -NARCAN-Naloxone -If given to someone addicted can cause death from antagonist effect -Use only after withdrawn from opiates (Ie:heroin, MSO4)

benzodiazepine adverse reactions

-drowsiness -daytime sedation -ataxia -dizziness -fatigue -muscle weakness -dryness of mouth -n/v -increased irritability -insomnia -hyperactivity -blood dyscrasias

miscellaneous sedatives/hypnotics adverse reactions

-drowsiness -resp depression

biologic theory

-sympathoadrenal response -lack of GABA (brain's most abundant inhibitory/ "calming" neurotransmitter

LOC is described how?

AAOx4=person, place, time, and event

What are substance abuse disorders related to?

Alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics, stimulants, and tobacco

opiate agonists examples

Codeine Morphine-never mix with other med in IV tube Oxycodone Fentanyl Meperidine

False imprisonment

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

Withdrawal symptoms of alcohol disorders

Delirium Tremens, Hallucinations, Tremors, Seizures, Elevated BP & P, Medical Emergency!!

Psychiatric disorders can arise from??

External conditions, life stressors, metabolic changes, or brain disorders

Anorexia nervosa occurs frequently in whom?

FEMALES! From adolescence to young adulthood. Avg age of onset in females is 12-18 yo

Nurses must follow which policies that govern the use of restraints?

Federal, state, & facility

What are some characteristic behaviors of ADHD?

Inattention, impulsivity, and hyperactivity

When does bipolar disorder usually emerge?

Late adolescence and early adulthood but can be diagnosed in the school-aged child

Defense Mechanisms Used in Cognitive Disorders

Monitor for defense mechanisms used by the client to preserve self-esteem and to compensate when cognitive changes are progressive

Lithium monitored carefully in?

Patients who sweat profusely; experience diarrhea, vomiting; have infection or fever causing fluid loss

Goals of bipolar disorder

Reduction of mania and client safety

what is a drug that can be used to treat mild to moderate dementia?

Tacrine **must monitor wkly for at least 18 wks of tx and every 3 months thereafter

True/False? In acute mania, hospitalization can be required.

True

When do delirium tremens occur?

When early alcohol withdrawal symptoms are not promptly recognized and treated. Tx w/ benzos should reduce or eliminate withdrawal symptoms

milieu therapy

a form of psychotherapy that involves the use of therapeutic communities

what are the three CNS stimulants?

analeptics, amphetamines, anorexiants

skeletal muscle relaxants meds

baclofen, soma, flexeril, valium, robaxin, norgesic

Tests to rule out physical illness

blood work, CT, MRI, PET

amantadine side effects of dopamine supplements

bluish skin color on legs

angranulocytosis

dangerous leukopenia (lowered WBC)

amphetamine examples

dexedrine and methamphetamines (desoxyn) **sympathomimetic that stimulate the CNS**

reflecting

directs the focus back to the client in order for the client to examine his feelings

affective disorder

disturbance of mood, accompanied by a manic or depressive syndrome

tricyclic uses

episodes of major depression

malingering

exaggerated illness to escape work/duty ex. fabricating that you have the stomach bug to miss school/work

how do nurses collect data?

focused interviews and various family assessment tools

miscellaneous sedatives/hypnotics action

generalized CNS depression

autocratic

leader completely controls the direction and structure of the group w/o allowing group interaction/decision making to solve problems

akinesia

loss of muscle control

analgesic uses

moderate to severe pain

are forms of tx for parkinsons palliative or curative?

palliative

bradykinesia

slow mvmt

Coping

the way one handles stress or the way one adapts psychologically, physically, and behaviorally to a stressor

repression

unconsciously inhibiting an impulse or emotion that is unacceptable to the person ex. Lauren, who was in an automobile accident in which she did not lose consciousness or suffer any brain damage, cannot recall anything that happened directly before, during, or after the event

Anxiety is most commonly seen in?

women

Do psych pts have to give consent before tx can be preformed?

-72 hr hold then consent from pt/court ordered to hold further -DPOA/ family memeber will give consent if pt is cognitively unable to do so for the first 72 hours -CONSENT TO TREAT MUST BE OBTAINED!!

phenothiazines adverse reactions

-Acute dystonia: severe spasm, usually in the back muscles, tongue, and facial muscles; twitching mvmts -Akathisia: constant pacing, repetitive compulsive mvmts -Parkinsonism: see antiparkinsons -Tardive dyskinesia: Unusual tongue and face mvmts such as lip smacking and wormlike motions of the tongue, puffing of cheeks, uncontrolled chewing mvmts. -Anticholinergic effects -Sedation - usually ↓ -Hypotension when moving from lying to upright position -Sexual dysfunction - impotence and ↓ libido -Neuroleptic malignant syndrome: high fever, confusion, muscle rigidity, high serum creatine kinase - can be deadly Blood dyscrasias - agranulocytosis, WBC destruction and infection

Etiological Theories for substance use disorders

-Addictive Personality -Failed to pass through ORAL stage of development -Genetic metabolic disorder -Perception of drugs as miracle cure

Side effects of dopamine supplements

-Adrenergic affect—stimulation. -Choreiform - (resembling rapid jerky mvmt - involuntary muscle twitching and dystonic movement(impaired muscle tone) -Commonly occurs in head, neck and tongue -May have facial paralysis; protruding tongue

Cluster B (dramatic/emotional) personality disorder

-Antisocial (pattern of disregard for and violation of rights of others) -Borderline (pattern of instability of interpersonal relationships, self-image, and affects) -Narcissistic (pattern of grandiosity, need for admirations, and lack of empathy "THE WORLD OWES THEM EVERYTHING") -Histrionic (pattern of excessive emotionally and attention seeking)

Depression can be comorbid w/ the following:

-Anxiety disorders -Psychotic disorders, such as schizophrenia -Substance use disorder -Eating disorders -Personality disorders **A client w/ depression has a potential risk for suicide, especially if he has family/personal hx of suicide attempts**

Nursing Diagnosis for Risk for Suicide:

-Ask directly about suicidal ideation -Initiate suicide precautions PRN -Create safe environment -Encourage pt to seek help

Nursing Diagnosis for Powerlessness:

-Assess for powerless feelings -Help pt identify controllable/uncontrollable factors -Allow ventilation of feelings -Encourage active participation in goal directed activities

Nrsg interventions for the client w/ depression

-Assess for symptoms -Evaluate clients for risk for self harm -Evaluate clients use of drugs and alcohol -Assess the clients hx of depression -Assess the clients support system -Encourage activities that raise self esteem -Encourage exercise -Work w/ client to identify cognitive distortions -Encourage problem solving -Encourage formation of supportive relationships

nrsg considerations for dopamine supplements

-Assess motor function -Monitor B/P and HR early in treatment -Avoid using in patients with glaucoma -Give meds with food to avoid GI irritation -Instruct to never stop taking the med suddenly - may cause rebound effect -Instruct patient that may have to take several wks before see effects(max effect may take 6mo) -Instruct to change position slowly to minimize orthostatic hypotension

Nrsg interventions for the client w/ bipolar disorder

-Assess whether client is a danger to self or others -Assess the need to protect the client from uninhibited behaviors -Assess for coexisting medical conditions such as substance use disorder -USE FIRM CALM APPROACH -Provide frequent high-calorie fluids/foods during manic phase -Maintain low level stimuli -Pharmacotherapy -Psychotherapy -Electroconvulsive Therapy (ECT)- ONLY FOR SEVERE MANIC EPISODES! **ALWAYS SAFETY FIRST**

Nrsg care for cognitive disorders

-Assign the client to a room close to the nurses' station for close observation -Provide a room with a low level of visual and auditory stimuli -Provide for a well-lit environment, minimizing contrasts and shadows -Have the client sit in a room w/ windows to help w/ time orentation -Have the client wear an identification bracelet. Use monitors and bed alarm devices as needed -Use restraints only as an intervention of LAST resort -Monitor the client's level of comfort for non-verbal indications of discomfort -Use caution when adm meds PRN for agitation/anxiety -Check the client's risk for injury and ensure safety in the physical environment, such as a lowered bed and removal of scatter rugs to prevent falls -Provide compensatory memory aids, such as clocks, calendars, photographs, memorabilia, season decorations, and familiar objects. Reorient as necessary -Provide eyeglasses and assistive hearing devices as needed -Keep a consistent daily routine -Maintain consistent caregivers -Ensure adequate food and fluid intake -Allow for safe pacing and wandering -Cover or remove mirrors to decrease fear and agitation

non-opioid analgesics

-Available without Rx -Pt ed important -Easy to OD -For mild to moderate pn -Co-analgesic -Prevent formation of prostoglandins that produce s/s inflammation. -Inhibit release of prostoglandins in brain causing lower fever

Nrsg Interventions for clients w/ personality disorders

-Avoid being too nice/friendly -Set clear limits on specific behavior -Provide clear and consistent boundaries -Assess for self-mutilating behaviors -Be aware of clients suspiciousness -Remain natural and avoid power struggles -Monitor pts behavior closely -Redirect violent behavior by means of physical outlets for client's anxiety (ex. exercise machines, walking) -Remove all dangerous objects from client's environment (ex. sharp items, belts, ties, straps, breakable items, smoking materials)

Parkinson's Meds - Antiparkinsonian agents

-Basic defect is deficiency of dopamine in relation to amount of acetylcholine. -Dopamine decreases the activitiy of the involuntary neurons and muscles of the CNS -Acetylcholine increases activity of the involuntary neurons and muscles of CNS.

Nrsg Care for alcohol disorders

-Be sure to ask pt when their last drink was! -V/S including O2 -Labs -Seizure precautions -Suicide watch -Meds as ordered (Narcan, Mucomist) -Low stimulus environment

what is the action for phenothiazines, butyrophenones, and atypical antipsychotics?

-Blocks dopamine in limbic system inhibiting transmission of neural impulses -Also inhibit chemoreceptors in medulla

Etiological theories for personality disorders

-Causes are unknown -Genetic factors -Family environmental factors -Neurobiological and neurotransmitter factors -Social factors (what kind of environment they grew up in)

anorexiant general info

-Chemically r/t amphetamines and are used short term to tx obesity. -Available only by Rx and have addiction potential -Some nonRx diet aids contain phenylpropanolamine, an adrenergic agent that has actions similar to the adrenergic agent ephedrine. -These are not true anorexiants and those containing phenylpropanolamine have limited appetite suppressing ability when compared to the true anorexiants

phenothiazines examples

-Chlorpromazine(Thorazine) - may be used for uncontrollable hiccoughs -Thioridazine HCl (Mellaril) -Prochlorperazine(Compazine) - may be used for nausea

Anorexia nervosa

-Clients are preoccupied w/ food and the ritual of eating, along with a voluntary refusal to eat -Clients exhibit a morbid fear of obesity and a refusal to maintain a minimally normal body weight (body wt is less than 85% of expected wt for the individual) in the absence of a physical cause

Electroconvulsive Therapy (ECT)

-Clients may experience temporary short-term memory loss/confusion. THIS IS NORMAL. -Induced seizure activity found to be helpful in treating clients w/ depression

Bulimia nervosa

-Clients recurrently eat LARGE amt of food over a short period of time (binge eating), (purging), to rid the body of the excess calories -Most clients who have this condition maintain a wt within a normal range or slightly higher -Occurs most commonly in females. Onset generally occurs btwn 18-26yo

anticholinergics used to treat parkinson's examples

-Cogentin -Artane -Benadryl

Personality disorder manifestations

-Cognition -Affectivity -Interpersonal functioning -Poor impulse control -Unstable moods, behavior, and relationships -Paranoia -Detachment from personal relationships

Therapeutic Interventions for personality disorders

-Cognitive Behavioral Therapy -Dialectical Behavioral Therapy -Psychodynamic psychotherapy -Psychoeducational -Meds for selected symptoms

Types of ADHD include the following:

-Combined type -ADHD predominantly inattentive -ADHD predominantly hyperactive-impulsive

tardive dyskinesia

-Consists of irreversible, involuntary dyskinetic movements -Characterized by rhythmic, involuntary movements of the tongue, face, mouth, jaw, extremities

Stage 6 Alzheimer's disease

-Continued worsening of memory difficulties, loss of awareness of recent events and surroundings, ability to recall own name but not personal hx, evidence of significant personality changes (delusions, hallucinations, compulsive behaviors), wondering behavior, assistance required for ususal daily activities, such as dressing, toileting, and other grooming, disruption of normal sleep/wake cycle, increased episodes of urinary and fecal incontience, violent tendencies w/ potential danger to self or others

Seclusion and/or treatment must NEVER be used for?

-Convenience of the staff -Punishment of client -Clients who are extremely physically or mentally unstable -Clients who cannot tolerate the decreased stimulation of a seclusion room

CAGE Questionnarie

-Cut Down? -Annoyed? -Guilty? -Eye Opener?

Cluster C (anxious/fearful) personality disorder

-Dependent (excessive need to be take care of that leads to submissive behavior) -Obsessive Compulsive (pattern of preoccupations with orderliness, perfectionism, and control at the expenses of flexibility) -Avoidant (pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation)

opiate partial agonists (stadol)

-Depends on whether an opiate agonist has been adm previously and the extent to which physical dependence has developed to that opiate agonist. -When used without prior adm of opiate agonist these are effective agonist -Potency similar to MSO4 -If adm to addicted pt on opiate agonist (ie: MSO4, demerol) will induce withdrawal s/s. -If not addicted no s/s-pain relieved. -Used for short term pn relief

Interventions for Autism Spectrum Disorder

-Discuss referral for EARLY intervention -Provide for a structured environment -Consult w/ parents to provide consistent and individualized care -Encourage parents to participate in the child's care and tx plan as much as possible -Use short, concise, and developmentally appropriate communication -Identify desired behaviors and reward them -Role-model social skills -Role-play situations that involve conflict and conflict-resolution strategies -Encourage VERBAL communication -Limit self-stimulation and ritualistic behaviors by providing alternative play activities -Determine emotional and situational triggers -Give plenty of notice before changing routines -Carefully monitor the child's behaviors to ensure SAFETY

skeletal muscle relaxants SE

-Dizziness, drowsiness, dry mouth, nausea and GI upset -Urinary retention -Tachycardia , postural hypotension -See Valium SE

dopamine supplement interactions

-Dopamine interacts with most CNS meds -Avoid OTC drugs -If take levodopa with MAOIs may cause hypertensive crisis -Effects of Levodopa reduced if given with iron, vitamin B6, ETOH or antianxiety agents. -Levodopa contraindicated in narrow angle glaucoma

butyrophenones adverse reactions

-EPS(Extrapyramidal symptoms): Restlessness, pseudoparkinsonism -Tardive Dyskinesia(discontinue med) -Sedation, dry mouth, blurred vision, constipation, blood dyscrasias, photosensitivity reaction (see text), sunburn, heat intolerance.

Delirium Tremens require physician notification:

-Early alcohol symptoms -Dry heaves, drenching sweats, agitation, panic, seizures, visual, tactile and/or auditory hallucinations -Confusion, disorientation, agitation and/or marked tremor

Therapeutic Measures for Neurodevelopmental Disorders

-Early intervention services -Applied behavior analysis -Speech therapy -Occupational therapy -Sensory integration therapy -Medication -Impaired social interaction -Assign consistent staff -Provide positive reinforcement for pt's voluntary interactions -Provide direct feedback about pt's interactions -Help pt learn to respond more appropriately in interactions -Give POSITIVE feedback for eye contact

Bipolar Disorder (Mania)

-Euphoric Moods -Increased Energy, Restlessness -Decreased Sleep -Grandiosity -Irritability -Distractibility -Poor Judgment -Rapid Speech -Flight of Ideas -Goal-directed behavior -Delusions -Focus on pleasurable activities -Intrusive/ Provocative Behavior

Nrsg Care for drug abuse: ineffective coping

-Expect sobriety -Identify behavior while under the influence -Teach physical impact on body -Be honest -Provide support group -Confront behaviors -Use positive reinforcement -Provide safe environment -Observe for use during hospitalization -Practice tough love

Risk factors for depression:

-Female gender -Unmarried status -Low socioeconomic class -Early childhood trauma -Family hx of depression -Postpartum period -Medical illness

Stage 2 Alzheimer's disease

-Forgetfulness, especially of everyday objects -No memory problems evident to provider, friends, coworkers

Miscellaneous psychotherapeutic drugs

-If divided doses give last dose prior to 6pm to avoid insomnia -These may mask fatigue, impair physical coordination, or produce dizziness. -Notify MD if nervousness, insomnia, palpitations, or vomiting occur

Stage 5 Alzheimer's disease

-Increasing cognitive deficits, disorentation and confusion as to time and place, inability to recall important details, such as address and telephone numbers, but ability to remember information about self and family

Nrsg responsibilites skeletal muscle relaxants

-Instruct on safety measures -Avd ETOH and CNS depressants -Give with food if recommended -Encourage good oral hygiene for dry mouth -Monitor urinary status -Take as prescribed. -Monitor pain level

anticholinergics used to treat nrsg considerations

-Instruct to avoid ETOH, smoking, caffeine and ASA -Give oral meds with food if GI irritation -Avoid giving with antacids -Monitor for urinary retention and constipation -Instruct to take med as prescribed. -Instruct the patient to avoid excessive exposure to heat, and monitor for heat stroke during the summer

Parkinson's syndrome s/sx

-Involuntary muscle movement, tremors, trembling or shaking, mainly in UE, during voluntary mvmts or at rest. -Rigidity-stiffness, bradykinesia-extremely slow mvmts. -Akinesia -Bradykinesia -dyskinesia Advanced: jerky mvmts and shuffle gait, poor dexterity, changes in handwriting, lack of facial expression, rubbing the thumb(pill rolling) and drooling

Autism

-Life-long neurodevelopmental disabilities -Abnormality of brain development and function -Prevalence 1% of US population -Diagnosed four times in men than in women

Etiologies (things that trigger disease)

-Loss -Unresolved Anger -Altered Perception of Events -Low Serotonin and Epinephrine

Stage 7 Alzheimer's disease

-Loss of ability to resopond to environment, to speak, and to control movement, unrecognizable speech, general urinary incontinency, inability to eat w/o assistance, and impaired swallowing, gradual loss of all ability to move, stupor and coma, death frequently related to choking or infection

MAOI uses

-Major depression usually last line of drug -Bulimia when depression present -Panic disorder

anticholinergics used to treat parkinson's interactions

-May cause delay in stomach emptying and decrease peristalsis -Interacts with CNS meds

Stage 3 Alzheimer's disease

-Mild cognitive deficits, including losing or misplacing important objects, decreased ability to plan, short term memory loss noticeable to close relations, decreased attention span, difficulty remembering words/names, difficulty in social/work situations

Nrsg considerations for lithium

-Monitor lithium levels -Assess psychological state -Monitor renal function -Assess for s/s of lithium toxicity regardless of level -Encourage po fluid intake of 3000mL day and to maintain normal Na intake of 3-4g/day -Blood should be drawn 12hr after last dose of med -Take with food or snack to decrease GI irritation -If dose missed, take ASAP but do not double dose -AVOID dehydration - excessive fluid loss -Instruct to avoid excessive intake of caffeine which may increase diuresis -Instruct of safety measures r/t drowsiness, confusion and possible blackouts

general nrsg considerations for antidepressants

-Monitor physical condition, including I&O, fluids, sleep patterns and exercise. -Give fiber, small - feeding, well balanced diet -Assess Neuro and psychological status -Allow time for patient to respond to questions, limit choices and use calm, matter of fact, nonjudgmental attitude -Continually assess for suicidal tendencies -Most dangerous time is 2-3 wks after initiation of treatment -Full therapeutic effect may not be achieved for 2-3 weeks -Give antidepressant medications late in afternoon or early evening to maintain normal sleep patters -Monitor for urinary retention -Patients on MAOIs must maintain strict dietary control because of interactions and must AVOID tyramine foods

nrsg consideration analeptics

-Monitor pts resp character -Evaluate pt prior to adm -O2 is usually ordered for before and after adm of resp stimulant. -Review ABGs

nrsg analgesics

-Monitor rate and depth of resp after giving IV/IM -SR up -Baseline V/S -fluid retention/urinary retention -response to medication -abd giving meds to clients with head injury, trauma, or ICP (masks assessment) -Schedule II narcotic

Nursing responsibilities must be identified in the protocol, including how often the client should be:

-Monitored (including for safety and physical needs), and the client's behavior documented -Offered food and fluid -Toileted -Monitored for vital signs -Complete documentation includes a description of the following -Precipitating events and behavior of the client prior to seclusion or restraint -Alternative actions taken to avoid seclusion or restraint -The time tx began -The client's current behavior, what foods or fluids were offered and taken, needs provided for, and v/s -Med adm

Eating Disorders

-Mortality rate for eating disorders is high. Suicide is also a risk. -Tx modalities focus on normalizing eating patterns and addressing the issues raised by the illness -Comorbidities include depression, personality disorders, substance use disorder, and anxiety

lithium adverse reactions

-Most common reaction includes tremors, nausea, vomiting, thirst and polyuria. -Toxic reaction may be seen when serum lithium levels reach greater than 1.5mEq/L.

SSRI adverse reactions

-Most common: sexual dys -70% ↓ Libido and ability to reach orgasm. -Men: delayed ejaculation and/or impotence -Nausea, HA, anxiety and insomnia -Seizures, drowsiness

opiate agonists

-Naturally occurring, semisynthetic and synthetic drugs -Relieve pn without Loss of consciousness -May develop drug tolerance -Addiction may develop after 3 to 6 wks of tx used for acute or chronic moderate pn -Preop sedation/supplement anethesia -Small doses reduce anxiety producing positive CV effects(MS04)

Stage 1 Alzheimer's disease

-No memory problems -No memory problems evident to provider

Personality disorder:

-Onset: childhood (ex. young children murdering animals for fun) -Exhibits multiple personalities -Rigid lifestyle (no balance; up and down) -Behaviors differ w/ cultural expectations

MAOI adverse reactions

-Orthostatic hypotension is most common -Dizziness, vertigo, nausea, constipation, dry mouth, diarrhea, HA, and over activity. -One serious is hypertensive crisis with may occur when foods containing tyramine (an amino acid) are eaten.

barbiturate dosage and route

-PO/IV -determine your scope of practice when adm IV

miscellaneous sedatives/hypnotics dosage and route

-PO/IV -determine your scope of practice when adm IV

Cluster A (odd/eccentric) personality disorder

-Paranoid (distrust and suspiciousness of others) -Schizoid (pattern of detachment from social relationships often choosing solitary activities) -Schizotypal (pattern of social and interpersonal deficits marked by discomfort w/ close relationships and perceptual distortions

antipsychotic general nrsg considerations

-Patient education related to SE -Monitor V/S, I&O, S/S infection, Bowel status -Liver function test -Instruct compliance with med -MD will adm smallest dose possible for desired effect -Client may become resistant to med over a period of time -Encourage good oral hygiene -Avoid other CNS medications -Take med as directed -Use cautiously with seizure disorder -When Tardive dyskinesia occurs med should be discontinued. Depending on the severity of condition MD may taper drug or discontinue. -Highest incidence of this is found in patients receiving antiparkinson agent with antipsychotic med. -Always inspect oral cavity to ensure med swallowed

Borderline personality disorder

-Pattern of instability in interpersonal relationships, self-image, and affects -Marked impulsivity -Intense fear of abandonment -Intense anger and irritability -Chronic feelings of emptiness -Transient paranoia/dissociative symptoms -Splitting -Self-mutilation and recurrent suicidal behavior, gestures, and threats are common

Stage 4 Alzheimer's disease

-Personaility change: appearing withdrawn or subdued, especially in social or mentally chanllenging situations, obvious memory loss, limited knowledge and memory of recent occasions, current events, or personal history, difficulty performing tasks that require planning and organizing (paying bills, managing money), difficulty w/ complex mental arithimetic

Anti-Social personality disorder

-Pervasive pattern of disregard for, and violation of the rights of others -Lack of empathy and/or remorse -Impulsive and aggressive -Reckless disregard for the safety of self or others -Deceitfulness and consistent irresponsibility is common

Nrsg care for eating disorders

-Provide a highly structured milieu in an acute care unit for the client requiring intensive therapy -Develop and maintain a trusting nurse/client relationship through consistency and therapeutic communication -Use a POSITIVE approach and support to promote client self-esteem and positive self-image -Encourage client decision-making and participation in the plan of care to allow for a sense of control -Establish realistic goals for wt loss/gain -Promote cognitive-behavioral therapies -Use behavioral contracts to modify client behaviors -Reward the client for positive behaviors, such as completing meals or consuming a set number of calories -Closely monitior the client during and after meals (20-40min) to prevent purging, which can necessitate accompanying the client to the bathroom -Monitor the client for maintenance of appropriate exercise -Provide a diet high in FIBER to prevent constipation -Provide a diet low in SODIUM to prevent fluid retention -Limit high-fat and gassy foods during the start of the tx -Adm a multivitamin and mineral supplement

Etiological theories for schizophrenia

-Psychoanalytical (failure to attain oral gratification and lack of nurturing mother-child relationship) -Biological (genetic and elevated dopamine lvls)

Criteria for acute care tx for eating disorders:

-Rapid wt loss/wt loss greater than 30% of body wt over 6mo -Unsuccessful wt gain in outpatient tx, failure to adhere to tx contract -V/s demonstrating HR less than 40/min, systolic blood pressure less than 70mmHg, body temp less than 36 degrees C (98.6 degrees F) -ECG/EKG changes -Electrolyte disturbances -Psychiatric criteria--severe depression, suicidal behavior, family crisis, psychosis

extrapyramidal symptoms

-Reactions occurring on extrapyramidal portion of nervous system -Antipsychotics: Abnormal muscle movement -Extrapyramidal effects: Akathisia, dystonia -Extrapyramidal effects diminish with reduction in the dosage

Antimanic (LITHIUM) action

-Reduce concentration of norepinephrine and serotonin by inhibiting release and reuptake by neurons -Sodium is partially replaced by lithium in cell membranes therefore it alters the sodium transport in nerve and muscle cells. -Specific mechanism may be unknown

analgesic SE

-Resp: depression and resp arrest decrease cough reflex -CV: decrease b/p and HR, diaphoresis, vasodilation and flushing -GI: n/v, constipation -Pupil constriction -urinary retention -CNS: drowsiness, disorientation, wkness and loss of consciousness -Tolerance, addiction

What are the legal rights of clients in the mental health setting?

-Right to humane treatment & care (medical & dental) -Right to vote -Right to due process of law -Right to press legal charges against another person -Informed consent & the right to refuse treatment -Confidentiality -A written plan of care/tx that includes discharge follow-up, as well as participation in the POC & review of the plan -Communication with people out of the facility -Provision of adequate interpretive services if needed -Care provided with respect, dignity, and without discrimination -Freedom from harm related to physical/pharmacologic restraint, seclusion, and any physical or mental abuse or neglect -Provision of care with the least restrictive interventions necessary to meet the client's needs w/o allowing him to be a threat to himself or others

Nrsg Care for Substance Use Disorders

-SAFETY is the PRIMARY FOCUS of nursing care during acute intoxication/withdrawal -Maintain a safe environment to prevent FALLS. Implement seizure precautions as necessary -Provide close observation for withdrawal symptoms, possibly one-on-one supervision. Physical restraint should be LAST RESORT. -Orient the client to time, place, and person -Maintain adequate nutrition and fluid balance -Create a LOW-STIMULI environment -Adm med to treat the effects of intoxication or to prevent or manage withdrawal -Monitor for covert substance use during the detoxification period -Provide emotional support and reassurance to the client and family -Reinforce client and family edu regarding codependent behaviors -Reinforce client and family edu about addiction and the initial tx goal of ABSTINENCE -Reinforce client and family edu regarding removing any prescription meds in the home that are not being used. Encourage the client not to share meds with someone who isn't prescribed them -Begin to develop motivation and commitment for abstinence and recovery (abstinence plus working a program of personal growth and self-discovery) -Encourage self-RESPONSIBILITY -Help the client develop an emergency plan--a list of things the client would need to do and people he would need to contact -Encourage attendance at self-help groups

barbiturate examples

-Seconol -Phenobarbital

amphetamine uses

-Short-term only for obesity -Long-term use is not recommended b/c of additive properties -May be helpful in tx of narcolepsy -Also may be used in tx of ADD - how this works is unknown

S/Sx of drug abuse

-Similar to alcohol use disorders -Red, watery eyes -Runny nose -Hostile behavior -Paranoia -Needle tracks

Stages of Alzheimer's

-Stage 1: No impairment (normal function) -Stage 2: Very mild cognitive decline, which can be normal age-related changes or very early signs of Alzheimer's disease -Stage 3: Mild cognitive decline, including problems w/ memory or concentration that can be measurable in clinical testing or during a detailed medical interview -Stage 4: Moderate cognitive decline (mild or early-stage Alzheimer's disease) that is clearly detected during a medical interview -Stage 5: Moderately severe cognitive decline (moderate or mid-stage Alzheimer's disease) -Stage 6: Severe cognitive decline (moderately severe or mid-stage Alzheimer's disease) -Stage 7: Very severe cognitive deline (sever or late-stage Alzheimer's disease)

action of analeptic

-Stimulate the respiratory center of the CNS -Increase respiration by stimulating special receptors located in the carotid arteries and upper aorta. -These are sensitive to the amount of 02 in arterial blood. -Stimulation of these results in an increase in the depth of respirations. -Larger doses increases respiratory rate by stimulating the medulla

Other psychoses

-Substance-induced -Schizoaffective disorder (SCAD)

Therapeutic Interventions for Alcoholism

-Support groups (AA) -Cognitive behavioral therapy -Psychotherapy -Medication -Hospitalization

When all other less restrictive means have been tried to prevent a client from harming self or others, the following must occur in order for seclusion or restraint to be used:

-The treatment must be ordered by the primary care provider in writing -The order must specify the duration of tx -The provider must rewrite the order, specifying the type of restraint, every 24hr or the frequency of time specified by facility policy

analeptic uses

-Treatment of drug induced resp. Depression and for temp tx of respiratory depression in chronic pulmonary disease. -Used to stimulate deep breathing in postanesthesia patient. -Usually given IM or IV.. -Because caffeine has so many effects it has been replaced by narcotic antagonist for resp depression

Substance Use Disorders

-Unable to fulfill role obligations -Recurrent legal/personal problems -Continued use despite problems -Participation in hazardous situations -Dysfunctional relationships -Codependence -Hx of mental illness

Interventions for ADHD

-Use a calm, FIRM, respectful approach w/ child -Use modeling to show acceptable behavior -Obtain the child's attention before giving directions -Provide short and clear explanations -Set clear limits on unacceptable behaviors and be consistent -Plan physical activities through which the child can use energy and obtain success -Assist parents to develop a reward system using methods such as a wall chart/tokens -Encourage the child to participate -Focus on the family and child's strengths, not just the problems -Support the parents' efforts to remain hopeful -Provide a safe environment for the child and others -Provide the child with specific POSITIVE feedback when expectations are met -Identify issues the result in power struggles -Assist the child in developing COPING mechanisms -Encourage the child to participate in group, individual, and family therapy -Adm meds, such as antipsychotics, mood stabilizers, anticonvulsants, and antidepressants (Monitor for SE)

Collect data from all clients, including older adult clients in the following manner:

-Use a private, quiet space w/ adequate lighting to accommodate for impaired vision and hearing -Make an introduction, and determine the client's name preference -Stand/ sit at the client's lvl to conduct the interview, rather than standing over a client who is lying in bed or sitting in a chair -Use touch to communicate caring as appropriate. However, respect the client's personal space if he does not wish to be touched -Be sure to include questions relating to DIFFICULTY SLEEPING, INCONTINENCE, FALLS/OTHER INJURIES, DEPRESSION, DIZZINESS, AND LOSS OF ENERGY -Include the family and significant others as appropriate -Obtain a detailed med hx -Following the interview, summarize and ask for feedback from the client

Nursing Diagnosis for Ineffective Coping:

-Use therapeutic communication -Allow pt to verbalize feelings -Assist pt to describe stressors and identify coping mechanism -Help pt set goals -Encourage participation in care

anticholinergics used to treat parkinson's uses

-Used in early stages of disease -Helps to control drooling, muscle stiffness and rigidity. -May be used with levodopa in later stages of the disease

A substance use disorder involves a repeated use of chemical substances, leading to clinically significant impairment during a 12 month period, and at least 2 of the following criteria:

-Uses substance in larger amts or over a longer period of time than intended -Has a continued desire or unsuccessful attempt to control substance use -Spends a considerable amt of time obtaining, using, or recovering from the effects of the substance -Continues to use the substance regardless of social or interpersonal problems associated w/ substance use -Reduces/quits participation in social, occupational, or recreational activities bc of substance use -Uses the substance repeatedly in physically hazardous situations, such as driving impaired -Continues to use the substance regardless of physical/psychological problems associated w/ substance abuse -Develops a tolerance to the substance -Requires additional amts of the substance to achieve the desired effect or to become intoxicated -Exhibits manifestations of withdrawal (tremors, HA, irritability) -Feels a strong urge to use the substance

contraindications of antipsychotics

-With hypersensitivity; who are comatose; who are severely depressed; with bone marrow depression; with blood dyscrasias; with Parkinson's disease; with liver impairment; with coronary artery disease; with severe hypotension or hypertension -Used when potential good outweighs any potential harm to fetus

benzodiazepine examples

-Xanax -Librium -ProSom -Versed -Valium -Restoril

benzodiazepines nrsg considerations/education

-adm w/ food or meals to decrease possibility of GI upset -suggest hard candy or freq sips of water -check BP prior to adm: if systolic drops 20mm/Hg do not adm and notify MD -abrupt d/c after taking 3-4 months may cause withdrawal: irritability, nervousness, insomnia, dry mouth, tremors, or convulsions

Inpatient Psychiatry Unit

-admission status -commitment -special circumstances -discharge planning -provisional discharge -payment for mental healthcare

tricyclic examples

-amitriptyline (elavil) -imipramine (tofranil)

miscellaneous-atypical antipsychotics examples

-anafranil -clozaril -zyprexa -seroquel -risperdal -geodon

therapeutic interventions for psychoses

-antipsychotic meds (have to take as prescribed) -social skills training -ECT -psychotherapy

miscellaneous sedatives/hypnotics uses

-anxiety -insomnia -preoperative sedation -general anesthetic -PEDS (phenergan)

barbiturates nrsg considerations/education

-assess sleeping patterns -determine your scope of practice when adm IV -prevent hoarding of med -use cautiously in suicidal pts and drug abuse pts -gradually withdraw -avoid driving -assess resp status prior to giving

Types of hallucinations

-auditory (hearing voices or sounds) **command (the voice instructs the client to perform an action, such as to hurt self or others) -visual (seeing persons or things) -olfactory (smelling odors) -gustatory (experiencing tastes) -tactile (feeling bodily sensations) **ask them "what are you hearing?" **know the triggers**

general nrsg considerations for sedatives/hypnotics

-avoid in glaucoma pts -monitor resp status -instruct pt regarding short term use only -avoid ETOH use, OTC cold and allergy meds and other CNS altering meds -avoid driving and other activities which require concentration -monitor for abuse or addiction -may cause seizures w/ sudden withdrawal -most sedative-hypnotics are schedule IV meds

panic attacks

-characterized as a sudden onset of extreme apprehension or fear usually associated with impending doom -s/sx: chest pain, breathing difficulties, nausea, feelings of choking -usually last 15-30 minutes

varying age groups can use group therapy:

-children: form of play while talking about a common experience -adolescent: valuable, as this age group typically as strong peer relationships -older adult: helps w/ socialization and sharing of memories

SSRI examples

-citalopram (celexa) -lexapro -fluoxetine (prozac) -paroxetine (paxil) -sertraline (zoloft)

benzodiazepine dosage and route

-commonly give PO -some given IV as conscious education by RN only

goals of psychotherapy include:

-decrease pts emotional discomfort -increase the lvl of pt's social functioning -increase the ability of pt to behave in a manner appropriate to the situation

analgesic actions

-decreases perception of pain by binding the opiod receptor sites in the brain and blocking transfer of pain to these receptor sites. -Produce sedation by suppressing CNS -Decrease emotional response to pain

what is a family?

-defined as a group w/ reciprocal relationships in which members are committed to each other -vary widely and usually nontraditional (child living w/ grown brother and his wife)

s/sx of depression

-depressed mood (prolonged and severe-interferes with normal ADLs) -lack of energy -appetite disturbances (usually a loss of appetite (anorexia)) -sleep disturbances (insomnia, may have problems falling asleep, may awaken several times during the night, some may want to sleep all the time) -slow motor mvmts -slow mental abilities -slow verbal responses and thought responses -feelings of low self-esteem -suicidal thoughts -poor hygiene -poor posture -dark clothing

actions of sedatives/hypnotics

-depression of the limbic system of the brain -increase in the effectiveness of the inhibitory neurotransmitters -suppress CNS

Nrsg Care for psychoses Disturbed Sensory Perception

-develop trust -allow verbalization -maintain consistent staff assignments -never whisper in front of pt -avoid placing pt in embarrassing situation -do not reinforce hallucinations, delusions -distract from hallucinations, delusions -provide calm milieu (safe place) -provide written instructions -monitor med compliance -keep communication simple -use touch cautiously

general side effects for sedatives/hypnotics

-drowsiness -dizziness -disorientation -weakness -"hangover" the next day -nausea -vomiting -dry mouth -MS -loss of coordination -resp depression -resp arrest

Therapeutic communication for mental illness

-encourage description of perceptions -encourage comparison -exploring -focusing -formulating a plan of action -giving broad openings -giving recognition -making observations -offering self -offering general leads -placing event in time/sequence -presenting reality -reflecting -seeking clarification -verbalizing the implied -using silence

barbiturate action

-exact action unknown -thought to cause generalized CNS depression

SSRI uses

-generalized anxiety -depression -OCD -bulimia

barbiturate adverse reactions

-hangover feeling -ataxia -dizziness -drowsiness Long term use: -bone pain -anorexia -muscle pn -wt loss

nrsg interventions for anxiety disorders

-help pt identify patterns -maintain calm milieu -maintain open communication -encourage positive self-talk -observe for suicidal thoughts -report changes in behavior -encourage appropriate activities **for example a pt w/ OCD: first identify their lvl of anxiety, have them identify it, then work on interventions to help decrease that lvl of anxiety**

anticholinergics used to treat parkinson's action

-increase proportion of dopamine in relation to acetylcholine by decreasing acetylcholine. Inhibits acetylcholine. -Blocks some effects of acetylcholine -Blocks effects of the parasympathetic system and allowing the sympathetic to take over

barbiturate uses

-induce anesthesia -insomnia -occasionally used w/ seizures

general interactions for sedatives/hypnotics

-interact w/ most CNS meds -ETOH potentiates effects

caffeine

-mild CNS stimulant -Stimulates at level of cerebral cortex, medulla, and spinal cord. -Has a mild analeptic effect -Other actions:cardiac stimulation, dilation of coronary and peripheral blood vessels, constriction of cerebral blood vessels and skeletal muscle stimulation. -Also has mild diuretic effect. -Withdrawal - HA

benzodiazepine uses

-mngmt of anxiety d/o -short term relief -can be used as a hypnotic, or relaxant -sometimes used as an anticonvulsant -withdrawal from ETOH -preop apprehension and anxiety

Chronic pain analgesics

-neuralgias: tricyclic antidepressants for neuopathies -some anticonvulsants given for neuropathies: dilantin, neurotin, tegretol

miscellaneous sedatives/hypnotics examples

-noctec (oldest sedative) -ambien -seconol -benadryl -phenergan -buspar -visteril

benzodiazepine and barbiturate implications for pt care

-observe for hypersensitivity -improvement of pt status -observe for adverse reactions -during hosp: monitor v/s, record I & O -be aware for s/sx of confusion, drowsiness, ataxia -provide safety

Obsessive-compulsive disorder

-obsession-thoughts, impulses or images that persist and cannot be dismissed from the mind -compulsions-ritualistic behaviors an individual feels driven to preform to attempt a reductions of anxiety (ex. handwashing, praying, checking and rechecking)

Types of psychosis in schizophrenia

-paranoid (and intense and strongly defended suspicion can be regarded as paranoria) (Onset 20-30s) -disorganized (most regressed and socially impaired due to disorganization of thoughts) (onset early to mid teens) -catatonic (abnormal lvls of motor retardation or motor agitation are seen) (onset abrupt) **risk for skin breakdown**

what is the selection of antipsychotic drugs based on?

-patients condition -symptoms -side effects -effectiveness of drug -patient's life style

Benzodiazepines action

-primary action on limbic system of the brain -suppress the response to conflict or aggression -produce muscle relaxation and control induced seizures

Nrsg interventions for psychoses

-provide a safe secure environment -if delusion exist try to provide a method that the client can accept -communication should be concise, clear and concrete -remain objective -avert frustrations and anger when client does not participate in activities -simulation reduction -monitor for adequate caloric intake and rest -MEDS, MEDS, MEDS **LAB WORK RULES OUT PHYSICAL SYMPTOMS!** **SCHIZOPHRENC=HAVE THEM FOCUS ON REALITY BASED ISSUES**

Therapeutic interventions for anxiety disorders

-psychopharmacology (benzos & SSRIs) -Systemic desensitization -psychotherapy -group therapy -hypnosis -relaxation, imagery -biofeedback

Methods of psychiatric therapy

-psychotherapy (individual and group) -verbal and other therapies (behavior modification; remotivation; reality therapy; rational emotive behavior therapy (REBT); transactional analysis; psyhodrama; occupational therapy; drawing and art; recreational therapy/therapeutic recreation; music therapy and video games, pet therapy, play therapy; hydrotherapy -electroconvulsive therapy -med therapy

DSM-V

-published by the American Psychiatric Association, is used as a diagnostic tool to identify mental health diagnosis -it is used by mental health professionals for clients who have mental health disorders -nurses use the DSM-V in the mental health setting to identify diagnoses and diagnostic criteria to guide data collection; to assist w/ the identification of nursing diagnoses; to assist w/ the POC; and to implement and evaluate care

tricyclic adverse reactions

-sedation and dry mouth are most commonly seen w/ tricyclics -tolerance to these will develop w/ continued use -orthostatic hypotension -hypertension -mental confusion -disorientation -rash -n/v -visual disturbances -nasal congestion

group therapy goals:

-sharing of common feelings and concerns -sharing of stories and experiences -diminishing feelings of isolation -creating a community of healing and restoration -providing a more cost-effective environment than that of individual therapy

Nrsg actions in specific behaviors

-suicidal (supervison, emotional support, documentation, safety) -overactive (quiet atmosphere, calm & soft voice, avoid long discussions, set limits, be consistent, safety) -hypomanic/manic (channel their behavior) -highly disturbed (protection from self and others, encouragement for ADLs, encourage caloric and fluid intake, encourage good hygiene, LIMITING OVERSTIMULATION) -Delusions/hallucinations (safety) -Confused/demented (calm environment, reorient, maintain ADLs, speak short & clear, give instructions one at a time) -Withdrawn (safety) -Depressed (suicide prevention, safety) -Regressed (remotivation, help focus on reality, indpendecy, bathroom schedule, encourage contact w/ peers, encourage expressing feelings)

Client in inpatient setting

-therapeutic environment (rights of client, prevention of dehumanization, visitors, outings) -security (restraints, client safety devices, seclusion)

miscellaneous antidepressant examples

-wellbutrin (uses: smoking cessation) -remeron -desyrel -effexor

miscellaneous nrsg considerations/education

-when adm IM Z track to prevent tissue irritation -know benadryl in several OTC meds -adm noctec pc to prevent GI irritation

Eye, verbal, and motor responses are evaluated and a number value based on that response is assigned. What is the highest and lowest scores?

15 is the highest value which indicates client is awake and responding appropriately. 7 or lower indicates that the client is in a coma

What percent of nurses in the US are chemically impaired?

6 to 15%

what is MAOI?

A complex enzyme system that is reasonable for breaking down amines. Which results in an increase in endogenous epinephrine, norepinephrine and serotonin in the nervous system.

Mental illness

A difference in degree of behavior, affects all spheres of a person's life, may be influenced by, or may be a contributing cause of, substance abuse and other addictions, **rule out drugs or alcohol**

Depression is:

A mood (affective) disorder that is a widespread issue, ranking high among causes of disability

Communication Blocks

AVOID THESE -Agreeing/Disagreeing -Changing the subject -giving advice -giving approval/disapproval -giving false reassurance -focusing on nurse -asking irrelevant personal questions -offering personal opinions -giving false reassurance -minimizing feelings -changing the topic -asking "why" questions -offering value judgments -excessive questioning

3 phases of tx and recovery

Acute phase, Continuation phase, Maintenance phase **These can relate to more than just depression**

Clinical diagnosis

Acute/chronic, in remission, prior hx

Nrsg assessment for mental illness

Appearance and behavior, lvl of awareness and reality orientation, thinking/content of thought, memory, speech/communication, mood & affect, judgment, perception

Recent memory check

Ask client to recall recent events, such as visitors form the current day, or the purpose of the current mental health apt/admission

Immediate memory check

Ask client to repeat a series of numbers/list of objects

Remote memory check

Ask client to state a fact from his/her past that is verifiable, such as DOB/mother's maiden name

Mental Health

Be flexible, form close relationships, make appropriate judgments, solve problems, cope w/ daily stress, have a positive sense of self

Additional symptoms of alcohol use disorders

Binges, Blackouts, Vomiting, Dehydration, Disorientation, Vulnerability to Infection and Accidents

Denial

Both the client and family members can refuse to believe that changes, such as loss of memory, are taking place, even when those changes are obvious to others

Etiology of mental illness

Brain dysfuntion, environmental factors

Drug that are commonly abused

Caffeine, nicotine, marijuana, cocaine, crack, PCP, meth, prescription meds

Basic principles of mental health apply to?

Care of all clients, in all settings

Combined type of ADHD

Client exhibits both inattentive and hyperactive-impulsive behaviors

neuroleptic malignant syndrome

Combination of extrapyramidal effects, hyperthermia, autonomic disturbance (↑↓BP, ↑HR & RR, diaphoresis, incontinence, flushing)

Tx centers and resources

Community based programs, outpatient mental health clinics or centers, psychiatric home care/community outreach, telephone services, other community services (CMHC), community-based living facilities, partial hospitalization programs; emergency services, inpatient psychiatric unit

Lithium >3mEq/L

Complex clinical picture involving organs and organ systems including: seizures (generalized and focal), arrhythmias, hypotension, peripheral vascular collapse, stupor, muscle group twitching, spasticity, coma.

Neurologic tests

Computed tomography (CT) scan; magnetic resonance imaging (MRI); positron emission tomography (PET); single-photon emission computed tomography (SPECT); transcranial Doppler (TCD), EEG

A nurse must encourage client to seek?

Counseling for stress before it becomes a greater concern

Diagnostic test for mental health diagnosis

DSM-V (Diagnostic & statistical manual of mental disorders, 5th edition) Tests to rule physical illness -psychological tests

Autism is characterized by what?

Deficits in social communication and social interaction and restricted repetitive behaviors, interests, and activities (RRBs)

Leaders guide group and family therapy, and they can employ various leadership styles such as:

Democratic, laissez-faire, and autocratic

What are the three defense mechanisms of cognitive disorders?

Denial, Confabulation, Perservation

What are some common defense mechanisms for substance abuse?

Denial, rationalization, and projection

Lithium 1.5-2mEq/L

Diarrhea, vomiting, nausea, drowsiness, muscular wkness, lack of coordination(early signs of toxicity)

People w/ physical illnesses also develop?

Emotional/psychiatric problems that interfere w/ or influence their recovery

Organic Mental Disorder

Evidence from the person's hx, physical examination, and lab findings indicates that the mental disturbance is a direct result consequence of a medial condition

True/False? Clients who have been diagnosed and/or hospitalized with a mental health disorder are not guaranteed the same civil rights as any other citizen.

False. They ARE guaranteed the same civil rights as any other citizen.

Continuation phase

Focused on prevention of a relapse through pharmacotherapy, edu and psychotherapy and last 4-9mo

Maintenance phase

Focused on prevention of further episodes and last 1yr or more

Acute phase

Focused on reducing depressive symptoms and lasts for 6-12 wks

How are anxiety lvls scaled?

From mild to panic lvl

Lithium 2-3mEq/L

Giddiness, ataxia, blurred vision, tinnitus, vertigo, increasing confusion , slurred speech, blackouts, myoclonic twitching or movement of entire limbs, choreoathetoid movements, urinary or fecal incontinence, agitation or manic-like behavior, hyperreflexia, hypertonia, dysarthria.

what are the earliest signs of HTN crisis in MAOIs?

HA (usually occipital followed by stiff or sore neck, n/v, sweating, fever, c/p, dilated pupils and bradycardia or tachycardia.

adverse reactions analeptics

HA, Dizziness, apprehension, disorientation, and hyperactivity, n/v, cough, dyspnea, urinary retention, Varied HR

Symptoms of Psychosis

Hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, negative symptoms, impaired cognition, mania

A client who has a personality disorder exhibits?

Impairments in self-identity/self-direction and interpersonal functioning

When can a nurse apply restraints w/o a doctor's orders? When should the doctor be notified in this situation?

In an emergency situation and within 15-30 minutes after restraints are put on.

Splitting

Inability to incorporate positive and negative aspects of oneself/others into a whole image (seen frequently in acute mental health setting) **splitting is commonly associated w/ borderline personality disorder**

What kind of behavior can put the child at risk for injury in neurodevelopmental disorders?

Inattentive or impulsive behaviors

All personality disorder share characteristics of?

Inflexibility and difficulties in interpersonal relationships that impair social or occupational functioning

behavioral changes for antipsychotics

Intensity of the psychotic symptoms; lethargy; hyperactivity; paranoid reactions; agitation; confusion

Decreased dopamine

Involuntary activity of CSN ↑, this leads to Parkinsonian Symptoms

Attention deficit hyperactivity disorder (ADHD)

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

Inattention

Is evidenced by a difficulty in paying attention, listening, and focusing

Impulsivity

Is evidenced by difficulty waiting for turns, constantly interrupting others, and acting w/o the considerations of consequences

Hyperactivity

Is evidenced by fidgeting, an inability to sit still, running and climbing inappropriately, difficulty with playing quietly, and talking excessively

Mood disorders

Major depressive episode (MDE), Dysthmia, Bipolar disorder (BPD)

Sinemet (levadopa-carbidopa)

Makes more levodopa available for transport to brain and conversion to dopamine in the brain.

Assault

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

Symptoms of bipolar disorder

Mania, depression, grandiosity (an illusion of grandness), decreased need for sleep, more talkative than usual, flight of ideas, increase in goal directed activity, excessive buying sprees, poor business investments, sexual indiscretions, loss of impulse control **Risk of harm to self or others is determined** **One-to-one supervision can be indicated** **Can be depressed w/ periods of happiness**

what is administered for ADD/ADHD? (miscellaneous psychotherapeutic drugs)

Methylphenidate (Ritalin) and pemoline (cylert)

What are the early alcohol withdrawal symptoms to monitor in pt's?

N/V, anorexia, tremor, tachycardia, tachypnea, hypertension, fever, diaphoresis, anxiety, insomnia, restlessness, light/sound sensitivity, HA

Do you make eye contact w/ a schizophrenia client?

NO!

Can restraints be used for staff convenience?

NO.

Bargain w/ client to establish behavioral expectations

NON-THERAPEUTIC bc client behavioral expectations should be achievable and mutually agreed upon

non-opiod analgesics examples

NSAIDS: Antiinflammatories Salicylates: ASA, analgesic, antipyretic, antiinflammatory, antiplatelet -Be aware for s/s of ASA toxicity(salicylism)--tinnitis -Ibuprofen , Motrin, Naproxsyn Sodium - Naprosyn -Cause GI irritation - must be taken with food Misc analgesic: Tylenol-acetaminophen (liver toxic), Darvon -Ultram

Low Risk

No prior hx of alcohol withdrawal symptoms ("shakes") or DT, pt consumes minimal (less than or equal to 2 drinks per day) alcohol, pt is not exhibiting any s/sx of early alcohol withdrawal

Functional Mental Disorder

No specific causative agents is identified

Mini Mental Status Exam (MMSE)

Objectively collect data about a client's cognitive status by evaluating the following: -Orientation to time and place -Attention span and ability to calculate by counting backward by 7 -Registration and recalling of objects -Language, including naming objects, following commands, and ability to write -Check the client's memory, both recent and remote

What type of supervision should an actively suicidal person be placed on?

One-on-one supervision

Forms of meds used in psychiatry

Oral, TD, injections **warn pts taking MAOIs against eating foods w/ high tyramine content

Brain-spotting is found in what disorder?

PTSD

What is Parkinson's syndome?

Parkinson's syndrome is a chronic, progressive, degenerative condition that affects the CNS.

Interpersonal functioning

Pattern of deviation in a client w/ personality disorder

Dysthymia

Persistent depressive disorder over time (at least 2 consecutive years)

MAOI examples

Phenelzine (Nardil)

anorexiant examples

Phentermine(Fastin), Diethylpropion HCL(Tenuate, Tepanil), or Fenfluramine HCL(Pondimin)

High Risk

Prior hx of alcohol withdrawal or DT, hx of withdrawal seizures, daily consumption of large quantities (more than 2 drinks per day) of alcohol, pt exhibits s/sx of early alcohol withdrawal

Balanced is when they are most able to?

Process a plan = increase risk for suicide!

pyschotherapies

Psychoanalysis, behavior mngmt, cognitive behavioral therapy, counseling, group therapy, ECT, relaxation therapy

Theories of mental illness

Psychoanalytic, psychobiological, behavioral, environmental

phenothiazines uses

Psychosis, schizophrenia, schizoaffective disorder, depression

butyrophenones uses

Psychosis; Tourette syndrome; behavioral problems in children

Mania

Psychotic, paranoid, and bizarre behavior can be seen during period of mania

What are the two types of bulimia nervosa?

Purging & nonpurging

Benefits of defense mechanism use

Resolve mental conflicts, reduce anxiety (fear of impending danger), protect self-esteem (self-value), maintain a sense of security and balance

A mentally healthy person is?

Responsible for his or her own behavior and able to manage his or her own ADLs, able to adjust to new situations and handle personal problems w/o severe discomfort, has intellectual insight into personal strengths and weaknesses, and able to accept weaknesses and use strengths positively, able to accept frustration and change w/o resorting to harmful behavior

What are the two types of anorexia nervosa?

Restricting & Binge-eating/purging

A client can request voluntary temporary ______________ in cases in which the environment is disturbing or seems too stimulating.

Seclusion

generalized systems reactions for antipsychotics

Sedation; headache; hypotension; dry mouth; nasal congestion; urticaria; photophobia; photosensitivity

Safety is always a priority concern bc some clients who have personality disorder are at risk for what?

Self-injury or violence

opiate partial agonists examples

Stadol(Butophanol) Nubain(Nalbuphine) Talwin(Pentazocine)

What are frequent reason for admission to a mental health unit?

Suicidal ideation, suicide attempts, and suicidal gestures

types of defense mechanisms

Suppression, repression, reaction-formation, rationalization, displacement, denial, projection, sublimation, intellectualization

dopaminergics/dopamine supplements examples

Symmetrel (amantadine), sinemet (levadopa-carbidopa), L-dopa (levadopa)

What is the TALK method?

T-Tell A-Ask L-Listen K-Keep safe

Encourage client to participate in problem-solving

THERAPEUTIC bc client should consistently participate in problem solving w/ professional guidance

Assist client to identify consequences and benefits of his/her behavior

THERAPEUTIC bc it allows client to reflect on behavior

Discuss concerns about behavior w/ client

THERAPEUTIC bc it allows the client to reflect on behavior

Communicate behavioral expectation that are easily understood and non-punitive

THERAPEUTIC bc it helps establish trust and positive rapport

Perseveration

The client avoids answering questions by repeating phrases or behavior. This is another unconscious attempt to maintain self-esteem when memory has failed

Nonpurging type

The client can also compensate for binge eating through other means, such as excessive exercise and the misuse of laxatives, diuretics, and/or enemas

Confabulation

The client can make up stories when questioned about events or activities that she does not remember. This can seem like lying, but it is actually an unconscious attempt to save self-esteem and prevent admitting that she does not remember the occasion

Bipolar 1 disorder

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

Bipolar 2 disorder

The client has one or more hypomanic episodes alternating w/ major depressive episodes

Purging type

The client uses SELF-INDUCED vomiting, laxatives, diuretics, and/or enemas to lose or maintain wt

In family therapy, who is the focus on?

The family as a system, rather than on each person as an individual

Restricting type

The individual drastically restricts food intake and does not binge or purge

Binge-eating/purging type

The individual engages in binge eating/purging behaviors

Is a suicidal client with a plan or a client who is feeling vaguely suicidal considered more serious?

The suicidal client with a plan!

Therapeutic Measures for mental illness

Therapeutic milieu, psychopharmacology, psychotherapy

ADHD predominantly inattentive

Think of MEGAN. "Huh?" Completely clueless.

ADHD predominantly hyperactive-impulsive

Think of our favorite person who loves STORIES and talks a lot

Mental Illness Impairment of Ability to

Think, feel, make sound judgments, adapt, cope w/ reality, and form strong personal relationships

Brief Psychiatric Rating Scale (BPRS)

This attempts to scale grade mental illness **Pyschometric tests**

Glasgow Coma Scale

This examination is used to obtain baseline data of a client's LOC, and for ongoing monitoring **check out the picture in the slideshow for more info**

Psychosis

Thought disorder that interferes w/ one's ability to recognize and deal w/ reality and to communicate

Battery

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

True/False? Care of a client who has bipolar disorder mirrors the phase of the disorder the client is experiencing.

True

True/False? Period of normal functioning alternate w/periods of illness, though some clients aren't able to maintain full occupational and social functioning

True

True/False? Behaviors associated with ADHD must be present prior to age 12 and must be present in more than one setting to be diagnosed as ADHD. Behaviors associated with ADHD can receive negative attention from adults and peers.

True!

True/False? The use of seclusion rooms and/or restraints can be warranted & authorized for clients in some cases.

True!

True/False? Women attempt suicide more often than men, however men are more likely to complete an attempt.

True!

Bipolar disorder

Unusual shifts in mood, energy, and activity lvls from elation to major depression

S/Sx of Depressive Disorders Subjective

What they tell us: Anergia (lack of energy), anhedonia (lack of pleasure in normal activities), anxiety, reports of sluggishness (most common), or feeling unable to relax and sit still, vegetative findings, which include a ced rehange in eating patterns change in bowel habits, sleep disturbances, and decreased interest in sexual activity, somatic reports, such as fatigue, GI changes, pain, wt/appetite changes (wt loss/gain greater than 5% in one month), sleep disturbances, psychomotor retardation, feelings of worthlessness, diminished ability to think, recurrent thoughts of death or suicidal ideation

Lithium contraindications

With hypersensitivity to tartrazine; with renal or cardiovascular disease; with sodium depletion; with dehydration; on diuretics; during pregnancy and lactation

affect

a client's affect is an objective expression of mood, such as a flat affect or a lack of facial expression

mood

a client's mood provides information about the emotion that she is feeling

delusions

a false belief that cannot be changed w/ reason

hallucination

a false perception have no basis in reality

sympathoadrenal system

a physicological connection btwn the sympathetic nervous system and the adrenal medulla and is crucial in an organism's physiological response to outside stimuli

dykinesia

abnormal involuntary mvmt

negative symptoms

absence of things that are normally present. difficult to treat successfully

Tryamine containing foods

aged cheeses, beef or chicken livers, some meats, meat tenderizers, some sausages, imported beers and ales, red wine, figs, bananas, raisins soy sauce and avocados.

exploring

allows the nurse to gather more info regarding important topics mentioned by the client. offering general leads, broad opening statements. this encourages the client to determine where the communication can state and to continue talking

silence

allows time for meaningful reflection

what are the two defense mechanisms that are always healthy?

altruism and sublimation **other defense mechanisms can be used in a healthy manner, however, they become maladaptive is used inappropriately or repetitively**

What is therapy?

an intensive tx that involves open therapeutic communcation w/ participants who are willing to take part in therapy

Anxiety disorders

an uncomfortable feeling of dread that occurs in response to extreme or prolonged periods of stress

levadopa side effects of dopamine supplements

anorexia, n/v, orthostatic hypotension, cardiac dysrhythmias, abrupt changes in motor function

Cognitive behavioral therapy

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

projection

attributing to another person one's unacceptable thoughts and feelings ex. Chuck accidentally erases files from his computers. He yells at his son, "See what you made me do with all that noise," and calls the computer names

what are the types of sedative/hypnotics

benzodiazepines and barbiturates

Lithium uses

bipolar, mania, alcohol abuse, schizophrenia

tricyclic action

block the reuptake of the neurohormones, norepinephrine and serotonin which then results in stimulation of the CNS

CNS side effects of dopamine supplements

bradkinesia, dyskinesia, agitation, ataxia, confusion, hallucinations, insomnia, dizziness

Symmetrel (amantadine)

causes increase of dopamine by releasing more or blocking the reuptake of it

Antipsychotic drugs-neuroleptics

characterized by extreme personality disorganization and loss of contact w/ reality

lethargy

client is able to open her eyes and respond but is drowsy and falls asleep readily

Alert

client is responsive and able to fully respond by opening her eyes and attending to a normal tone of voice and speech. the client answers questions spontaneously and appropriately

stupor

client requires vigorous or painful stimuli (pinching a tendon or rubbing the sternum) to elicit a brief response. she may not be able to respond verbally

suppression

consciously inhibiting an impulse or emotion that is unacceptable to the person ex. Joe does not want to discuss his mother's recent death and continually tells his wife "we'll talk about it tomorrow"

abnormal posturing in the client who is comatose

decorticate rigidity (flexion and internal rotation of upper-extremity joints and legs) decerebrate rigidity (neck and elbow extension, wrist and finger flexion)

S/Sx of psychoses positive

delusions, hallucinations, illusions, use of clang associations, bizarre motor mvmts

offering self

demonstrates a willingness to spend time w/ client. limited personal info can be shared, but the focus should return to the client asap. relevant self-disclosure by the nurse allows the client to see that his experience is shared by others and understood

what is parkinson's syndrome cause by?

depletion, degeneration or destruction of dopamine in the basal ganglia of the brain(type of gray matter at top of brain stem that controls muscular coordination

denial

disavowing the existence of unpleasant realities ex. Gordon, recently diagnosed w/ terminal cancer, tells his family that he feels fine and the doctors do not know what they are talking about

reaction-formation

displaying a behavior, attitude, or feeling opposite to that which one would normally exhibit in the same situation ex. Peter does not like his stepfather, but is overly polite and kind to him

sublimation

diverting unacceptable urges into personally and socially acceptable channels ex. Madeline, who has always been very shy and nervous, forces herself to join the college drama team

what are the two main drug classes to treat parkinsons?

dopaminergics & anticholinergics

examples of analeptics

doxapram and caffeine

summarizing

emphasizes important points and reviews what has been discussed

behavior

examination includes observation of voluntary and involuntary body movements, and eye contact

psychological findings of anxiety?

feeling of nervousness, apprehension, tension, inadequacy, indecisiveness, insomnia

S/Sx of psychoses negative

flat affect, alogia, avolition, apathy, anhedonia, social isolation

Nurses work w/ families to reinforce teaching

for example, a nurse might provide reinforcement to a family regarding med adm, or ways to help a family member manage his mental health disorder

a person can have symptoms of several mental disorders simultaneously

for example, a person w/ depression may also have hallucinations. an individual's diagnosis may change over time. therefore, the nurse must learn to deal w/ various behaviors and not to classify people in terms of their original diagnosis

miscellaneous antidepressants uses

generally for depression

butyrophenones examples

haloperidol (haldol)

normal anxiety

healthy response to stress that is essential for survival

focusing

helps the client to concentrate on what is important

barbiturate contraindications

hypersensitivity to med

benzodiazepine contraindications

hypersensitivity to med

miscellaneous sedatives/hypnotics contraindications

hypersensitivity to med

touch

if appropriate, touch communicates caring and can provide comfort to the client

Immature defenses

include projection, dissociation, splitting, and denial

Intermediate defense

includes repression, reaction formation, displacement, rationalization, and undoing

group and family therapy

individual therapy is important for tx of mental illness, group and family therapy is also included in POC in mental health settings

MAOIs action

inhibit the activity of monoamine oxidase

leukopenia

lowered WBC

what are the areas of functioning for families?

management, boundaries, communication, emotional support, and socialization **dysfunction can occur in any one or more areas**

Postive symptoms

manifestation of things that are not normally present. easily identifiable

Factitious disorders

mental disorder in which a person acts as if he/she has a physical/mental illness when, in fact, he/she has consciously created those symptoms *ganser syndrome *munchhausen syndrome *munchhausen by proxy

antidepressant agents uses

mngmt of various types of depression or depression accompanied by anxiety

what kind of disorder is depression?

mood disorder

bipolar disorder is classified as?

mood disorders in which the person's mood fluctuates from mania to depression (lithium is the drug of choice and is classified as an antipsychotic and antimanic)

antidepressant agents action

most of the time caused by low lvls of neurotransmitters in the brain, particularly serotonin and norepinephrine

coma

no response can be achieved from repeated painful stimuli

can antipsychotics cure mental illness?

no, but the illness will usually stay in remission as long as the medication regimen is adhered to (at times when stress factors arise or worsen the condition may also be exacerbated)

active listening

nurse is able to hear, observe, and understand what the client communicates and to provide feedback

amphetamine adverse reactions

overstimulation of CNS, insomnia, tachycardia, nervousness, HA, anorexia, dizziness, excitement

what are some s/sx of anxiety?

palpitations, nausea, dyspepsia, muscle tension, cold sweaty tremulous hands, heart pain, anorexia, constriction of throat, pressure in head

phobias

persistent irrational fear of a specific object, activity or situation that leads to avoidance ex: acrophobia=fear of heights ex: hemaphobia=fear of blood ex: claustrophobia=fear of closed spaces ex: agoraphobia=fear of being in places where help might not be available

Posttraumatic stress disorder

persistent re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others to which the individual responds w/ intense fear, helplessness, or horror (flashbacks, dreams, thoughts, images, startled response, hypervigilance)

what are the types of antipsychotic drugs-neuroleptics?

phenothiazines, butyrophenones, and atypical antipsychotics

mental health nrsg skills

physical care, emotional support, socializing agent, teacher, support person, observation, if a client escapes, nrsg actions in specific behaviors

nrsg care of the severely disturbed client

physical care, teaching life skills and recreation, building employment or occupational skills

Restraints can either be ______________ or ______________, such as neuroleptic med to calm the client.

physical or chemical

L-dopa (levodopa)

precursor of dopamine, Converted by enzymes in the brain to dopamine.

sedatives

primary purpose is to produce relaxation and to decrease the levels of anxiety

hypnotics

primary purpose of which is to include sleep (treat insomnia)

Laissez-faire

process progresses w/o any attempt by the leader to control the direction

When pts who have severe to panic lvl anxiety and are unable to focus and problem solve, what does the nurse do?

provide safety and comfort to the client during the crisis **provides reassurance during the words of anxiety** **postpone health teaching until anxiety subsides**

giving info

provides details that the client can need for decision making

Team members

psychiatrist, nurse, psychiatric technicians, mental health workers, human service workers, psychologists, psychometrists, recreation therapists and music therapists, occupational therapists, vocational rehabilitation and veteran's services, chaplains and social workers

miscellaneous-atypical antipsychotics uses

psychotic disorders, OCD, bipolar

Med therapy

pyschotropic drugs, antipsychotic drugs (neuroleptic), antianxiety agents, mood stabilizers, and antidepressants

nursing for anorexiants

record BP, P, RR, wt

analgesics

relieve pain

paraphrasing

restates the client's feelings and thoughts for the client to confirm what has been communicated

Psychomotor agitation

restlessness, pacing, finger tapping

what is the reversal agent for versed?

romazicon

Schizophrenia

serious brain disorder of thought and association, characterized by inability to distinguish btwn what is real and what is not

In general, seclusion and/or restraints should be ordered for the _____________ duration necessary, and only if ______________ restrictive measures are not sufficient. They are for the physical protection of the client, other clients, and/or staff.

shortest; less

SSRI action

slow the reuptake of serotonin which a natural neurotransmitter in the CNS

Psychomotor retardation

slowed physical movement, slumped posture

what is an example of a positive response to anxiety?

student who is anxious about an upcoming mental health exam, cancel all nonessential activities and plan for 3 day of study time

Democratic

supports group interactions and decision-making to solve problems

amphetamines action

suppress appetite **results in elevation of BP, wakefulness and increase or decrease in P**

anorexiants action

suppress appetite (also thought to be due to their action on the appetite center in the hypothalamus)

open ended questions

technique facilitates spontaneous responses and interactive discussion

Schizophrenia shouldn't be diagnosed for children until?

the age of 7 to rule out attention deficit hyperactivity disorder (ADHD) w/ violent tendencies

the ability of these drugs to act as anorexiants and suppress appetite is thought to be due to what?

their action on the appetite center in the hypothalamus

psychoanalytic theory

theory of personality organization and the dynamic of personality development that guides psychoanalysis, a clinical method for treating psychopathology **conflict between ID and Superego** **first laid out by Sigmund Freud in the late 19th century, psychoanalytic theory has undergone may refinements since his work**

clarifying techniques

these are used to determine if the message received was accurate

showing acceptance and recognition

this technique acknowledges the nurse's interest and nonjudgmental attitude

miscellaneous antidepressants action

thoughts to inhibit the reuptake of serotonin, but also affects the activity of norepinephrine and dopamine

why do nurses work to identify family resources?

to improve communication, and to strengthen the family's ability to cope w/ the illness of one member

what are the types of antidepressants?

tricyclic, SSRIs, MAOIs

True/False? Psychotic disorders become problematic when manifestations interfere w/ interpersonal relationships, self-care, and ability to work

true

true/false? adverse effects of many meds can mimic anxiety disorders.

true

true/false? anxiety, obsessive-compulsive, and even trauma and stressor-related disorders have a generic and neurobiological link.

true

true/false? elevated/persistent anxiety can result in anxiety disorders causing behavior changes and impairment in functioning

true

rationalization

trying logically to justify irrational, socially, or personally unacceptable behaviors or feelings ex. 12yo Jill fails to be elected to student council. She says that "The elections were probably fixed, and student council is for nerds, anyways."

Dual diagnosis

two separate chronic conditions at the same time: -mental illness and sexual addiction -anorexia and chemical dependency -mental illness combined w/ chemical dependency (MI/CD)

intellectualization

unconsciously transferring emotions into the realm of intellect; using reasoning as a means of avoiding confrontation w/ objectionable impulses ex. Lincoln, going through a messy divorce, refuses to become emotional. He continually philosophizes about the meaning of relationships and love, saying things like "Nothing lasts forever."

displacement

unconsciously transferring feelings onto another person or object ex. Michelle is upset w/ her husband, but yells at her preschool-age daughter, who in turn kicks the family dog

presenting reality

used to hep the client focus on what is actually happening and to dispel delusions, hallucinations, or faulty beliefs

restating

uses the client's exact words

how do clients w/ anxiety try to control their anxiety?

using ineffective behaviors

asking questions

way to seek additional info

what do behavior therapies teach pts w/ anxiety?

ways to decrease their anxiety/avoid behavior and allow opportunity to practice techniques

S/Sx of Depressive Disorders Objective

what we collect: affect-the client most often looks sad w/ blunted affect, exhibits poor grooming and lack of hygiene, psychomotor retardation is more common, but psychomotor agitation also can occur, client becomes socially isolated, showing little or no effort to interact, slowed speech, decreased verbalization, delayed response-client can seem too tired even to speak