Test 2
Mental Health Study Guide
Ch 5 Creating and Maintaining Therapeutic and Safe Environment
Milieu Therapy: environment that is supportive, therapeutic, and safe
Phases and tasks of a therapeutic relationship:
Orientation: set the contract, establish boundaries, discuss confidentiality, build trust,
develop/set goals, EXPLORE CLIENTS IDEAS/ISSUES/NEEDS, enforce limits, start
the relationship with patient
Working: maintain the relationship, reassess problems and goals and revise plan as
necessary
Termination: discussion, summarize goals and achievements
Transference: client views member of health care team as having characteristics of another
person who has been significant to the client’s personal life – more likely to occur with a person
in authority
Countertransference: health care team displaces characteristics of people in her past onto a client
Ch 7 Psychoanalysis, Psychotherapy, and Behavioral Therapies
Classical psychoanalysis: therapeutic process of assessing unconscious thoughts and feelings,
and resolving conflict by talking to a psychoanalyst – months to years
past relationships are common focus
help find the CAUSE of the anxiety
Psychoanalysis Therapeutic Tools:
Free association: spontaneous, uncensored verbalization of whatever comes to client’s
mind
Dream analysis and interpretation: urges and impulses of the unconscious mind
Transference
Cognitive Therapy: focuses on individual thoughts and behaviors to solve current problems
(depression, anxiety, eating disorders, other issues that can improve by changing a client’s
attitude toward life experiences)
Priority restructuring
Journal keeping
Assertiveness training
Monitoring thoughts
Behavioral Therapy:
Modeling: imitates therapist to improve behavior
Operant Conditioning: positive rewards for positive behavior
Systematic Desensitization: exposure to events that cause anxiety then practicing
RELAXATION techniques
Aversion Therapy: pairing of a bad behavior with a punishment or unpleasant stimuli
to promote change (ex. electric shock, Disulfiram for alcohol use)
Biofeedback: behavioral therapy to control pain, tension, and anxiety
uses mechanical device to help gain voluntary control over autonomic such as HR,
pulse, BP
Flooding: great deal of undesirable stimuli in attempt to turn off anxiety response
Ch 9 Stress Management
Acute Stress (Fight or Flight): apprehension, unhappiness/sorrow, decrease appetite, increase
respiratory rate, increase heart rate, increase CO, increase bp, increase metabolism and glucose
use, depressed immune system Prolonged Stress (Maladaptive Response): chronic anxiety or
panic attacks, depression, chronic pain, sleep disturbances, weight gain or loss, increase risk for
MI and stroke, poor diabetes control, hypertension, fatigue, irritability, decrease ability to
concentrate, increase risk for infection
Ch 10 Brain Stimulation Therapies
ECT: Major depressive disorder, Schizophrenia, Acute manic episodes, Bipolar, suicidal
THREE TIMES A WEEK, 6-12 treatments
meds:
30 min before, give IM of Atropine (antimuscarinic) or Glycopyrrolate to decrease
secretions that can cause aspiration and to counteract vagal stimulation (bradycardia)
anesthetic: Methohexital or Propofol via IV bolus
muscle relaxant: Succinylcholine – paralyze muscles/decrease injury
give oxygen, monitor vitals and mental status before and after, monitor EEG (S/E: cardiac
problems), place on side to prevent aspiration – make sure gag reflex is back!
S/E: HYPERTENSION, short-term memory loss and confusion, headache, muscle soreness,
nausea
Education: FASTING bc sedation, will become alert w/n 15min after procedure, not a cure
Transcranial magnetic stimulation: noninvasive electromagnetic placed on scalp – alert during
procedure
DAILY for 4-6weeks
not associated with systemic adverse effects or neurological deficits
Vagus Nerve Stimulation: electrical stimulation through surgically implanted device
S/E: voice changes, hoarseness, throat or neck pain, dysphagia, dyspnea
Education: turn off VNS during exercise or when periods of prolonged speaking
Ch 11 Anxiety
Generalized Anxiety Disorder: uncontrollable, excessive worry for SIX months
restlessness, muscle tension, avoidance of stressful stuff, increased time and effort
required to prepare for stressful stuff, procrastination in decision making, seeks
repeated reassurance
Panic disorder: attacks last 15-30min
FOUR OR MORE manifestations: palpitations, SOB, choking or smothering sensation,
chest pain, nausea, feelings of depersonalization, fear of dying or insanity, chills or hot
flashes
Levels of anxiety
Mild: normal; increase ability to perceive reality*, identifiable cause. Mild discomfort,
restlessness, etc. with finger-tapping or foot-tapping, fidgeting, or lip-chewing
Moderate: ability to think clearly is hampered -> difficulty concentrating*, but learning
and problem-solving can still occur – increased heart rate, increased respiration rate,
change in voice
o somatic manifestations like headache, body ache, insomnia
Severe: perceptual field is greatly reduced (not able to focus on anything except
relieving the anxiety) – hyperventilation, tachycardia, loud and rapid speech, aimless
activity
o not able to take direction from others
o ex. sense of impending doom
Panic-level: SOB*, markedly disturbed behavior, lose touch with reality, severe
hyperactivity or flight, dilated pupils, delusions, hallucinations
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The anxious patient takes anxiolytics because the medication will relax them so they can
focus on problem-solving
Stand or sit in the center of the anxious client’s visual field to facilitate attention when
therapeutically communicating
The nurse should instruct the client with General Anxiety Disorder to avoid caffeine
Nursing interventions that are appropriate for all clients with anxiety disorders are to
reduce anxiety and develop alternative responses to anxiety-provoking situations
When a client is experiencing severe anxiety, the priority intervention is to move the
client to a quiet environment
When a client is learning to cope with anxiety and stress, the expected outcome is that he
will change reactions to stressors (practice yoga, breathing exercises, meditation)
GAS is the three-stage process that describes the physiological changes the body goes
through when under stress. Hans Selye, a medical doctor and researcher, came up with
the theory of GAS. During an experiment with lab rats at McGill University in Montreal,
he observed a series of physiological changes in the rats after they were exposed to
stressful events. With additional research, Selye concluded that these changes were not an
isolated case, but rather the typical response to stress. Selye identified these stages as
alarm, resistance, and exhaustion. Understanding these different responses and how they
relate to each other may help you cope with stress.
General adaptation syndrome stages
1. Alarm reaction stage
The alarm reaction stage refers to the initial symptoms the body experiences when under
stress. You may be familiar with the “fight-or-flight” response, which is a physiological
response to stress. This natural reaction prepares you to either flee or protect yourself in
dangerous situations. Your heart rate increases, your adrenal gland releases cortisol (a
stress hormone), and you receive a boost of adrenaline, which increases energy. This
fight-or-flight response occurs in the alarm reaction stage.
2. Resistance stage
After the initial shock of a stressful event and having a fight-or-flight response, the body
begins to repair itself. It releases a lower amount of cortisol, and your heart rate and
blood pressure begin to normalize. Although your body enters this recovery phase, it
remains on high alert for a while. If you overcome stress and the situation is no longer an
issue, your body continues to repair itself until your hormone levels, heart rate, and blood
pressure reach a pre-stress state.
Some stressful situations continue for extended periods of time. If you don’t resolve the
stress and your body remains on high alert, it eventually adapts and learns how to live
with a higher stress level. In this stage, the body goes through changes that you’re
unaware of in an attempt to cope with stress.
Your body continues to secrete the stress hormone and your blood pressure remains
elevated. You may think you’re managing stress well, but your body’s physical response
tells a different story. If the resistance stage continues for too long of a period without
pauses to offset the effects of stress, this can lead to the exhaustion stage.
Signs of the resistance stage include:
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irritability
frustration
poor concentration
3. Exhaustion stage
This stage is the result of prolonged or chronic stress. Struggling with stress for long
periods can drain your physical, emotional, and mental resources to the point where your
body no longer has strength to fight stress. You may give up or feel your situation is
hopeless. Signs of exhaustion include:
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fatigue
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burnout
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depression
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anxiety
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decreased stress tolerance
The physical effects of this stage also weaken your immune system and put you at risk
for stress-related illnesses.
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Stress is the wear on our bodies caused by life’s difficulties.
Anxiety is the physical, emotional, and cognitive responses to the stress that wears on us.
Feelings of passing out is generated from severe anxiety
Feelings of having to go to the bathroom is generated from moderate anxiety
Depersonalization is described as feeling disconnected or detached from one's self.
Individuals experiencing depersonalization may report feeling as if they are an outside
observer of their own thoughts or body, and often report feeling a loss of control over their
thoughts or actions.
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Anxiety is learned in childhood through interactions with caregivers
Derealization is a sense of feeling detached from your environment and the objects and other
people in it. The world may seem distorted and unreal as if you're observing it through a veil.
You may feel as if a glass wall is separating you from people you care about.
Ch 12 Trauma and Stressor-Related Disorders
Acute Stress Disorder: at least THREE days but not more than ONE month
Posttraumatic stress disorder (PTSD): longer than ONE month and can last YEARS
Avoid caffeine, alcohol
Depersonalization: observe their own body from a distance – detached from own’s body
Derealization: disconnected from environment – ex. furniture in room is small and far away
Chapter 13 Depressive Disorders
Major Depressive Disorder (MDD): at least 5 of the findings + occurs almost every day for a
minimum of 2 weeks and last almost all day
depressed mood, difficulty sleeping or excessive sleeping, indecisiveness, decreased
ability to concentrate, suicidal ideation, increase or decrease in motor activity, inability
to feel pleasure (anhedonia), increase or decrease in weight of more than 5% of total
body weight over 1 month
Acute phase: severe clinical findings of depression & may need hospitalization
o treatment: 6-12w
o goal: reduction of depressive manifestations; assess suicide risk
Continuation phase: increased ability to function
o treatment: 4-9m
o goal: relapse prevention*
Maintenance phase: remission of manifestations
o treatment: years
o goal: prevention of future episodes
Dysthymic Disorder: mild depression, can be early onset (childhood or adolescence); TWO
YEARS (adults; 1yr child) + THREE findings; can become MDD
Depression more common in females and unmarried people