Mental Health Exam 1 Study Guide:
Chapter 2:
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Stigma:
o Public Stigma:
o Self-stigma:
o Label Avoidance:
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Recovery-Oriented Care:
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Trauma-Informed Care:
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Guiding Principles of Recovery:
o Recovery emerges from hope:
o Recovery is person driven:
o Recovery occurs via many pathways:
o Recovery is holistic:
o Recovery is supported by peers and allies:
o Recovery is supported through relationship and social networks:
o Recovery is culturally based and influenced:
o Recovery is supported by addressing trauma:
o Recovery involves individual, family, and community strengths and responsibility:
o Recovery is based on respect:
Chapter 3:
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Key terms define and understand:
o Acculturation:
o Cultural Competence:
o Cultural Identity:
o Cultural Idiom of Distress:
o Linguistic Competence:
o Religiousness:
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Health Literacy Precautions:
o Health literacy universal precautions are aimed at the following:
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o Four domains are important for promoting health literacy:
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Chapter 5: Mental Health Care in the Community
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What is Continuum of Care?
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What is Least Restrictive Environment?
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Define Crisis Care?
o Crisis Intervention:
o 23-Hour Observation:
o Crisis Stabilization:
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Crisis Intervention Teams:
o Acute Inpatient Care:
o Residential Services:
o Outpatient Care:
Chapter 10: Communication and the Therapeutic Relationship
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Know Thyself:
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o Why is knowing thyself important?
o How does it impact patient care?
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Principles of Therapeutic Communication:
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Self-Disclosure in Therapeutic Versus Social Relationships: 10.1
o What is Self-Disclosure?
o What are Social Relationships?
o When is Self-discloser appropriate?
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Verbal Communication Techniques:
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Acceptance:
o Confrontation:
o Doubt:
o Interpretation:
o Observation:
o Open-ended statements:
o Reflection:
o Restatement:
o Silence:
o Validation:
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Techniques That Inhibit Communication:
o Advice:
o Agreement:
o Challenges:
o Reassurance:
o Disapproval:
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Specific Defense Mechanism and Coping Styles:
o Acting Out:
o Affiliation:
o Altruism:
o Anticipation:
o Autistic Fantasy:
o Denial:
o Devaluation:
o Displacement:
o Dissociation:
o Help-rejecting complaining:
o Humor:
o Idealization:
o Intellectualization:
o Isolation of affect:
o Omnipotence:
o Passive Aggression:
o Projection:
o Projective identification:
o Rationalization:
o Reaction formation:
o Repression:
o Self-assertion:
o Self- observation:
o Splitting:
o Sublimation:
o Suppression:
o Undoing:
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Phases of the Nurse Patient Relationship:
o Orientation:
o Working:
o Resolution:
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Understand the difference between therapeutic and nontherapeutic relationships.
o Therapeutic Relationship:
o Nontherapeutic Relationship:
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What is Motivational Interviewing:
o Eight features of MI that should appear in every application of this technique:
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Chapter 11: The Psychiatric-Mental Health Nursing Process
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Mental Health Assessment:
o Patient Interview:
o Current and Past Health Status:
o Physical Examination:
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Body System Review:
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Neurological Status:
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Laboratory Results:
o Physical Function:
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Elimination:
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Activity and Exercise:
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Sleep:
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Appetite and Nutrition:
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Hydration:
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Sexuality:
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Self-Care
o Pharmacological Assessment:
o Strengths and Wellness Assessment:
o Psychological Assessment:
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Mental Status Examination:
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General Observations:
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Orientation
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Mood and Affect:
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Speech:
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Thought Process:
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Cognitive and Intellectual Performance:
o Behavior:
o Self-Concept:
o Stress and Coping Pattern?
o Risk Assessment:
o Social Assessment:
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Family:
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Cultural:
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Occupation:
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Economic:
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Legal Status:
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Quality of Life:
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Psychological Strengths and Wellness:
o Spiritual Assessment:
Chapter 19: Stress and Mental Health
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What is difference between acute and chronic stress?
o Acute Stress:
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Allostasis
o Chronic Stress:
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General Adaptation Syndrome (GAS):
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Allostatic Load:
The consequences of chronic stress.
o The immune system is
o Cortisol is primarily immunosuppressive and contributes to
o The continuous sustained activation of the sympathetic nervous system; HPA axis;
cardiovascular, metabolic, and immune systems contribute to a hormonal overload, leading to
impairment in memory, immunity, cardiovascular, and metabolic function.
Chronic Stress and Mental Illness
o When stress is associated with the development or exacerbation of a mental illness, what model
can be applied?
o A diathesis is a
 Exposure to childhood trauma can lead to
 Example, a woman whose mother had a long history of depression (indicating a genetic
predisposition to mental disorders for the daughter) and who was assaulted as she was
leaving work and sustained multiple injuries. Her first manic episode occurred within 2
months.
 No one lives in a stress-free environment, yet stress reduction leads to positive mental
health.
 Conversely, many patients attribute their first illness episode to a stressful event such as
an assault, rape, or family tragedy.
Understand the responses to stress: review table 19.4.
o Emotions
o Emotions can be categorized as follows:
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Negative emotions
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Positive emotions
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Borderline emotions
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Nonemotions
o Core Relational Themes for each Emotion Table 19.4
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Anger:
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Anxiety:
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Fright:
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Guilt:
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Shame:
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Sadness:
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Envy:
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Jealousy:
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Disgust:
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Happiness:
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Pride:
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Relief:
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Hope:
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Love:
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Compassion:
Understand coping & coping strategies.
o Coping is a deliberate, planned, and psychological effort to manage stressful demands. he is
coping process may inhibit or override the innate urge to act.
o Positive coping leads to ___________
 which is characterized by a balance between health and illness, a sense of well-being, and
maximum social functioning.
o When a person does not cope well, _____________ occur that can shift the balance toward
illness, a diminished self-concept, and deterioration in social functioning.
o Two types of coping:
 Problem-focused coping
 Emotion-focused coping
o Reappraisal:
o Adaptation is a person’s capacity to survive and flourish.
 Adaptation affects three important areas:
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 If a person copes successfully with stress, they return to a previous level of adaptation.
 Successful coping results in an improvement in
o Examples of ineffective coping include using emotion-focused coping when a problem-focused
approach is appropriate, such as if a woman reinterprets an abusive situation as her fault instead
of getting help to remove herself from the environment.
 In addition, if a coping strategy violates cultural norms and lifestyle, stress is often
exaggerated. Some coping strategies actually increase the risk for mortality and
morbidity, such as the excessive use of alcohol, drugs, or tobacco.
 Many people use overeating, smoking, or drinking to reduce stress. They may feel better
temporarily but are actually increasing their risk for illness
How the nurse can care for individuals suffering with stress?
o resolve the stressful person–environment situation, reduce the physiologic and psychological
stress response, and develop positive coping skills.
o The goals for those who are at high risk for stress: (experiencing recent life changes, vulnerable
to stress, or have limited coping mechanisms)
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o the nurse can determine any illnesses, the intensity of the stress response, and the effectiveness of
coping strategies. Nurses typically identify stress responses in people or family members who are
receiving treatment for other health problems.
o For patients with changes in eating, sleeping, or activity, the priorities of care can focus on
reestablishing these functional patterns. For other patients, the priorities may focus on
psychological issues such as low self-esteem, fear, and hopelessness. Other patients may not
have the psychological resources to cope with the situation, which will lead to a focus on coping
skills.
Chapter 20: Management of Anger, Aggression, and Violence
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How to manage anger without violence?
o Anger management:
 The desired outcomes of any anger management intervention are to teach people to:
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o Cognitive-behavioral therapy is often recommended for the treatment of ___________. The
first step is establishing a therapeutic alliance because some angry individuals are not in a stage
of readiness to change their behavior.
 Cognitive-behavioral therapy:
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Relaxation or mindfulness training is:
How to promote safety and prevent violence.
o Nurse works toward these goals by establishing ________________________________ and
creating a therapeutic milieu. Intervening with a potentially violent patient begins with
assessment of the history and the predictive factors outlined in the next section.
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o Interventions for Promoting Safety:
 focus on communication and development of the nurse–patient relationship, cognitive
interventions, interventions for the milieu and environment, and violence prevention.
 Communication and Development of the Therapeutic Nurse–Patient Relationship
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 Cognitive Interventions to Address Aggression:
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 Milieu and Environmental Interventions
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 Interventions for Managing Imminent Aggression and Violence
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Environmental Management: Maintaining Patient Safety: Box 20.6.
o DEFINITION
 Maintaining patient safety includes:
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o ACTIVITIES
 Search the environment routinely to maintain it as hazard free.
 Remove potential weapons (e.g., sharps, ropelike objects) from the environment.
 Search the patient and belongings for weapons or potential weapons
 Monitor the safety of items that visitors bring to the environment.
 Instruct visitors and other caregivers about relevant patient safety issues.
 Limit patient use of potential weapons (e.g., sharps, ropelike objects).
 Monitor patient during use of potential weapons (e.g., razors).
 Place the patient with potential for self-harm with a roommate to decrease isolation and
opportunity to act on self-harm thoughts, as appropriate.
 Assign a single room to the patient with potential for violence toward others.
 Place the patient in a bedroom located near a nursing station.
 Limit access to windows unless they are locked and shatterproof, as appropriate.
 Lock utility and storage rooms.
 Provide paper dishes and plastic utensils at meals.
 Place the patient in the least restrictive environment that still allows for the necessary
level of observation.
 Provide ongoing surveillance of all patient access areas to maintain patient safety and
therapeutically intervene, as needed.
 Remove other individuals from the vicinity of a violent or potentially violent patient.
 Maintain a designated safe area (e.g., seclusion room) for patient to be placed when
violent.
 Provide plastic, rather than metal, clothes hangers, as appropriate.
Chapter 21: Crisis, Loss, Grief, Response, Bereavement, and Disaster Management
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Crisis:
o
o A crisis results from stressful events for which previous coping mechanisms fail to provide
adequate adaptive skills to address the perceived challenge or threat.
o Adaptation to crisis typically occurs in __ weeks.
o Crisis occurs when an individual is at a ______________ and has positive or negative outcomes.
o Situational crisis: A crisis that occurs whenever a specific stressful event threatens a person
biopsychosocial integrity and results in some degree of psychological disequilibrium.
 the event can be an internal one such as a disease process or any number of external
threats.
 Graduation from high school marks the end of an established routine of going to school
participating in school activities and doing assignments. when starting a new job after
graduation the former student must learn an entirely different routine and acquire new
knowledge and skills. If a person enters a new situation without adequate coping skills a
crisis may occur.
o Maturational crisis: Also know as Developmental crisis.
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o Traumatic crisis:
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Examples of events include national disasters, violent crimes, kidnappings, and
environmental disasters.
o Adjustment disorder:
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o Things to be aware of:
 It is important to be accurately aware that a person in crisis may be at high risk for
suicide or homicide period to determine the level of effectiveness of coping capabilities
the person the nurse should complete a careful assessment for suicide and or homicidal
risk.
 During a crisis the behaviors and verbalizations of a person may provide data that are
indicative of a mental illness nursing care should be prioritized according to the severity
of the response after a crisis has been resolved assess whether the abnormal thoughts or
feelings disappear.
Understand crisis intervention: goals, nursing assessments, interventions, and priorities.
o The first priority is determining the __________________________________.
o Goals: immediate goals during a crisis may be providing first aid, preventing the person from
committing suicide or homicide, arranging for food and shelter, and mobilizing social support.
 after safety needs are met the individual can work toward recovery by addressing other
goals such as reestablishing self-care routines and using positive coping strategies. during
the assessment strengths should be identified to develop a plan of care. previous coping
strategy should be identified to understand how the individual deals with stress.
o Nursing Assessment:
 Because the response to a crisis is individual and differs from person to person, the nurse
should make sure that a very complete assessment is done.
 Physical Health:
 Crisis can be physically exhausting. disturbances in sleep pattern eating patterns
and the reappearance of physical or psychiatric
 symptoms are common. changes in body function may include tachycardia,
tachypnea, profuse perspiration, nausea, vomiting, dilated pupils, and extreme
shakiness. some individuals may exhibit loss of control and total disregard for
their personal safety.
 if sleep patterns are disturbed or nutrition is inadequate the individual may not
have the physical resources to deal with the crisis.
 Emotional and behavioral responses:
 the focus is on the individuals: emotions and coping strengths.
 at the beginning of a crisis a patient may report feelings of numbness and shock.
Responses to psychological distress should be differentiated from symptoms of
psychiatric illness that may be present later.
 as the reality of the crisis sinks in the person will be able to recognize and
describe the felt emotions the nurse should expect these emotions to be intense
and be sure to provide some support during their expression.
 initial thoughts and behaviors can be erratic or illogical and the nurse should
assess for evidence of depression, confusion, uncontrolled weeping or screaming,
disorientation, or aggravation. the person may be suffering from a loss of feeling
of well-being in safety.
 in addition, panic responses may be present such as anxiety and fear.
 the ability to cope by problem solving maybe disrupted.
 by assessing the person's ability to solve problems the nurse can evaluate whether
they can cognitively cope with a crisis situation and determine the kind and
amount of support needed.
 Coping Skills:
 Coping skills should be identified in an assessment of anyone undergoing a crisis.
the coping skills of some individuals are sufficient to weather crisis but many
skills are inadequate for the situation.
 Social functioning and support:
 it is critical to assess the person's perception of the problem and availability of
support systems emotional and financial.
 the extent of disruption of normal daily activities and routine is assessed to
determine the need for additional support. planner should identify the social
network of family and friends who are available to provide help and support.
 Clinical Judgement: safety is a priority.
 physical consequences of crisis are first priority. reports of potential self-harm
such as suicide idealization or intention should be the focus of the next
interventions.
 body systems can change during a crisis: diarrhea and urinary incontinence can
occur.
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food and shelter should be considered.
emotional and psychological consequences of the crisis such as fear, extreme
distress will also be important to address.
o Interventions:
 Guidelines for crisis intervention:
 support the expression or non expression of feelings according to cultural or
ethical practices
 emotional support helps the person face reality. The emotional expression by the
victim may be done culturally driven
 help the person think clearly and focus on one implication at a time
o focusing on all of the implications at once can be too overwhelming
 avoid giving false reassurance such as it will all be alright or it is all for the best
o giving false reassurances blocks communication. It may not all be alright
 clarify fantasies with facts
o accurate information is needed to solve problems
 link the person and family with community resources as needed
o social support can ease the effect of crisis or loss.
 Self-care:
 the nurse should encourage the person to reestablish a healthy diet, practice sleep
hygiene strategies and attend personal grooming. if the patient cannot perform
these tasks or is unable to function or referral can be made to other health care
clinicians. medication may be needed to maintain a high level of psychophysical
functioning.
 Medication interventions:
 medication cannot resolve a crisis but the use of these agents can help reduce its
emotional intensity.
 Counseling:
 counseling reinforces healthy coping behaviors and interaction patterns.
counseling which focuses on identifying emotions and positive coping strategies
helps a person integrate the effects of the crisis into real life experience.
 Social support strategies:
 a crisis often disrupts a person's social network leading to changes in available
social support. development of new social support network may be helpful to the
person to cope more effectively with the crisis. the nurse can contact available
local and state agencies for assistance as well as specific private support groups
and religious groups.
o Priorities:
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Review the definitions associated with grief and bereavement. Know what the nurse should assess and
what appropriate interventions are in various situations.
o Loss: can evoke minor to complex thoughts, feelings, and behaviors depending on the perceived
relationship of the person with the lost loved object or person.
o Grief: is a natural, intense, physical, emotional, social, cognitive, or social reaction to death of a
loved one period spontaneous expression to loss can include sobbing, crying, anger, expression
of guilt.
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Pre death grief: occurs prior to death such as when a loved one has a terminal illness.
higher pre death grief levels are associated with depression symptoms caregiver burden
and less communication within the family about dying.
Acute grief occurs immediately after the death of a loved one and normally evolves to a
permanent state of integrated grief after a process of adaptation.
Integrated grief is a long term process where there continues to be mild yearning and
other painful emotions, thoughts, and memories but they are not intrusive. occasional
periods of grief intensity but they do not interfere with ongoing life in a sense of wellbeing.
 failure to adapt to the loss can lead to prolonged grief disorder PGD which is
Types of Grief:
 Physical: stunned, weight gain/loss, insomnia, anorexia, exhausted, restless,
aching arms, sleep difficulties, headaches, aching arms, feels ill, palpitations,
breathlessness, sighing, lack of strength, blurred vision
 Emotional: crying, sobbing, sadness, guilt, anger, sense of failure, irritability,
resentment, bitterness, denial, frustration, shame, fear of own death,
oversensitivity to environment, senses the presence of the deceased
 Social: social withdrawal from normal activity, isolation from others
 Cognitive: forgetful, difficulty in making decisions, disorganized, concentration
is difficult, preoccupation with thoughts of the deceased, time confusion, short
attention span, think they are going crazy
o Bereavement: is the process of healing and learning how to cope with loss period it begins
immediately after the loss and can last months or years period individual differences, age,
religious and cultural practices, social support influence grief and bereavement.
 Dual process model DPM: offers a nonlinear explanation of how grieving persons and
families come to terms the loss over time. according to DMP the person adjusts to the
loss by auscultating between loss oriented coping (preoccupation with the deceased) and
restoration oriented coping (preoccupation with stressful events as a result of the death
including financial issues.
 Auscultation is the process of confronting loss oriented coping and avoiding
restoration oriented coping. The stress is associated with bereavement.
 Loss oriented coping mode emotions relate to the relationship with the deceased
person
 restoration oriented coping the bereaved persons emotions relate to stressful
events associated with the responsibilities and changes as a result of the loss.
 Uncomplicated bereavement: Is painful and disruptive however there is always
movement.
 traumatic grief: it's a term used for a more difficult and prolonged grief. in traumatic
grieving external factors influence the reactions and potential long term outcomes.
 memories of the traumatic death of the deceased may lead to more traumatic
memories including violent death scene, external circumstances of the death
associated with traumatic grief include suddenness or lack of anticipation;
Violence mutilation and destruction; degree of preventability or randomness of
death; Multiple deaths which would be bereavement overload; Mourners personal
encounter with death involving significant threat to personal survival or a massive
and shocking confrontation with the death of the death.
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Complicated bereavement or PGD occurs in about 10% to 20% of bereaved persons.
the person is frozen or stuck in a state of chronic mourning which lasts for more than a
month to six months after loss. there is no movement in the thought process in how the
bereaved person view and experience their loss.
 in complicated grief there's an intense longing and yearning for the person who
died that lasts for more than six months additionally the person may have trouble
accepting the death and an inability to trust other since the death, excessive
bitterness related to the death, and the feeling that life is meaningless without the
deceased person.
 Those who are more vulnerable for developing complicated bereavement are
those who have experienced sudden, unexpected loss, stigmatic loss, or death of a
loved one after a long term chronic illness as these situations have the potential to
limit their social support.
Phases of disaster and responses.
o Disaster is a sudden overwhelming catastrophic event that causes great damage and destruction
that may involve mass casualties and human suffering requiring assistance from all available
resource.
o Phases of disaster:
 Pre warning of the disaster: this phase entails preparing the community for possible
evacuation of the environment, mobilization of resources, and reviewing the community
disaster plans.
 example: 2011 earthquake in Japan there is very little warning in other instances
such as COVID-19 pandemic there was unheated warnings more than a decade
before the disease appeared.
 The disaster event occurs in this phase the rescuers provide resources, assistance, and
support as needed to preserve the biopsychosocial functioning and survival of the
victims. In large disasters the rescuers and health care professionals also experienced the
traumatic events as both residents and healthcare providers. The victims experience initial
trauma and threats that occur immediately after the disaster such as confusion, lack of
safety, and lack of health care services.
 Recuperative effort: in the third phase the focus is on implementing strategies for
healing sick and injured people, preventing complications of health problems, repairing
damages, and reconstructing the community. The disruption can be traumatic to the
community residence. The debris, lack of trust of the government, fragmentation of
families, financial problems, lack of adequate housing, inadequate temporary housing,
and fear of another disaster contribute to the long-term negative effects of disasters.
o Responses to disaster:
 three different types of disaster victims:
 the first category is the victims who may or may not survive: if they survive
the victims often experience severe injuries. The more serious the physical injury
the more likely the victim will experience a mental health problem such as PTSD,
depression, anxiety, or other mental health problem. victims and families need
ongoing health care to prevent complications related to their physical and mental
health.
 The second category of victims include the professional rescuers. these
persons who are less likely to experience physical injuries but often experience
psychological stress. The professional rescuer such as police officers firefighters,
nurses, so on so forth have effective coping skills greater than volunteer rescuers

who are not prepared for the emotional impact of a disaster. However, many
professional responders report experiencing PTSD for many months after the
traumatic event in which they were involved.
The third category includes everyone else in the disaster. Psychological effects
may be experienced worldwide by millions of people as they experience terrorism
or disaster vicariously or as direct victims of the terrorism/disaster event. after an
act of terrorism most people will experience some psychological stress including
an altered sense of safety, hypervigilance, sadness, anger, fear, decreased
concentration, and difficulty sleeping. others may alter their behavior by traveling
less, staying at home avoiding public events, keeping children out of school, or
increasing smoking and alcohol abuse.
Chapter 29: Trauma and Stressor – Related Disorders
o Key Terms:
 Complex posttraumatic stress disorder (CPTSD): is a subgroup of PTSD that occurs
with severe chronic, repetitive trauma that continues for months or years.
 CPTSD is understood as a betrayal of trust and occurs in extreme childhood
neglect, repeated sexual or physical abuse, domestic abuse, and human trafficking
 these traumas result in fundamental damage to one's sense of self, personality
changes, and significant impairment in personal, family, social, education, and
occupational functioning.
 CPTSD symptoms include the core PTSD symptoms plus emphasis on affective
dysregulation, negative self concept, and interpersonal problems.
 Depersonalization: A nonspecific experience in which the individual loses a sense of
personal identity and feels strange or unreal.
 The experience of self or the environment as strange or unreal.
 Derealization: Feelings of unreality.
 Dissociation: A disruption in the normally occurring linkages among subjective
awareness, feelings, thoughts, behavior, and memories (i.e., a person is physically present
but mentally in another place).
 A person who disassociates is making themselves disappear that is a person has
the feeling of leaving their body and observing what happens to them from a
distance. during trauma disassociation enables a person to observe the event while
experiencing no pain or limited pain to protect themselves from awareness of the
full impact of the traumatic event.
 Examples of disassociation: derealization and depersonalization; Periods of
disengagement from the immediate environment during stress such as spacing
out; Alterations and body perception; Emotional numbing; Out of body
experiences; Amnesia about abuse related memories.
 Emotional reactions: strong agitation of feelings
 Hyperarousal: characterized by aggressive, reckless, or self-destructive behavior.
 After a traumatic experience the stress system seems to go on permanent alert as
if the danger might return at anytime.
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Hypervigilance: Sustained attention to external stimuli as if expecting something
important or frightening to happen.
Intrusion: Thoughts, memories, or dreams of traumatic events occur involuntarily,
especially when there are cues that symbolize or resemble the events, causing
psychological and sometimes physiological distress.
 Often intrusive thoughts are associated with cues that symbolize or resemble
the original event.
 Common Occurrences: nightmares are common. Intrusive symptoms also include
dissociative reactions. Sleeping is difficult. Terrifying flashbacks nightmares often
include fragments of traumatic events exactly as they happened. many stimuli
associated with the trauma can cause flashbacks or dreams consequently affected
individuals avoid such stimuli.
Numbing:
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Posttraumatic stress disorder (PTSD):
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Trauma-informed care:
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Understand the importance of resilience.
o Resilience reduces the impact of risk factors and enhances the ability to bounce back and recover
from stressful events. The stronger the resilience the less likely the individual will experience
reactions that lead to maladaptive behaviors and outcomes. An important mental health
promotion nursing strategy is enhancing resilience especially for persons with mental and or
substance abuse problems.
 Resilience develops in association with positive self concept and self worth a feeling of
being in control of one's life and a feeling of power.
 Resilience is acquired over time beginning in early childhood as a problem solving,
communication and coping skills are learned. some children seem more resilient to
trauma and are able to cope quite well with traumatic events. Positive family and
community support also play a role in developing resistance.
 Not everyone who experiences a traumatic event will be emotionally injured one of the
explanations for the variability in experiencing psychological trauma is resilience.
Understand symptoms/diagnostic criteria for PTSD including box 29.2 on page 515
o PTSD: is diagnosed following exposure to a traumatic event when symptoms in four general
areas appear: intrusive symptoms, avoidance of persons, places, or objects that our reminder of
the traumatic event; Negative mood and cognitions or negative thoughts associated with the
event; hyper arousal characterized by aggressive, reckless, or self-destructive behavior; Sleep
disturbances or hypervigilance for at least a month,
 Symptoms:
 Children:
o
o
o
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 Adolescences:
o
o
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Intrusion:

o How is it expresses?
 in children older than six repetitive play may occur that expresses
themes or aspects of traumatic events. They may reenact specific
trauma. Nightmares of these children may not have content.
Avoidance and numbing (disassociative symptoms):

Mood and cognition: after traumatic event moods often become

o in PTSD the thought process becomes distorted with exaggerated negative
beliefs or expectations about oneself, others, in the world they may believe
that no one can be trusted or that they are terrible people
Hyperarousal and hypervigilance:

o They are looking for signs of physical danger, a repeat of trauma, or
something wrong in the relationship.
o The state of hyper arousal causes other problems for family members. The
affective individual is irritable and overreacts to others which causes
others to avoid the person who in return maintains a state of continual
arousal.
Sleep disturbances: one of the most commonly reported symptoms of PTSD.
o The disruption falls into two categories

Insomnia:

Nightmares
o sleep disturbances prior to the trauma is believed to be a risk factor for
o insomnia immediately after the trauma is predictive of


Time Frame?
o Diagnostic Criteria: is diagnosed following
 symptoms in four general areas appear:




Priorities in treating PTSD.
o Priorities: PTSD is associated with an increased risk for suicide, suicide attempts, aggression,
and substance abuse.

The first contact the nurse often has with the patient is after a suicide attempt or an
aggressive episode. A careful assessment should be include determination of risk for self
injury or aggression towards others. These individuals are in high risk for substance
abuse and suicide, so that suicide risk assessment should be included in the nursing
assessment
 After the physical health needs are met and suicidal/aggressive safety measures are
established the mental health nursing assessment targets specific areas



 The nurse needs to guide the patient in prioritizing goals because it is unrealistic to
expect the patient to work on all goals at once.
o Trauma informed care:

Medication interventions (SSRI antidepressants Zoloft, Paxil)
o SSRI:
 Two SSRI antidepressants:
 Sertraline (Zoloft):
o
 Paxil:
o
Chapter 31: Addiction

Substance Use Disorder:

Substance Induced Disorder:

Alcohol use disorder:
o Screening tool:
o Medical Complications of Alcohol:

Cardiovascular system:

Respiratory system:

Hematologic system:

Nervous system:

Digestive system and nutritional deficiencies:

Endocrine and metabolic systems:

Immune system:


Integumentary system:

Musculoskeletal system:

Genitourinary system:
Alcohol Withdrawal Syndrome:
o Characteristics:

Vital Signs:

Stage 1: Mild
o

Stage 2: Moderate
o

Stage 3: Severe
o

Diaphoresis

Stage 1: Mild
o

Stage 2: Moderate
o

Stage 3: Severe
o

Central nervous system

Stage 1: Mild
o

Stage 2: Moderate
o

Stage 3: Severe
o

Gastrointestinal system:

Stage 1: Mild
o

Stage 2: Moderate
o

Stage 3: Severe
o

Benzodiazepines, Librium, and/or Ativan during detoxification.
o Benzodiazepines:
o Librium: Chlordiazepoxide and diazepam
o Ativan: lorazepam, better for older adults and people with liver impairment.
o Antidepressants are initiated
o

Anticonvulsive antipsychotic medications are also used if needed
Role of Disulfiram:
o

Stimulants effects of the body and health risks of abuse:
o Cocaine:

Effects:

Health Risks:
o Methamphetamine:

Effects:

Health Risks:
o MDMA:

Effects:

Health Risks:
o Nicotine:

Effects:

Health Risks:
o Nicotine

Effects:

Health Risks:
o Caffeine: Stimulation, increased mental acuity, inexhaustibility


Effects:

Health Risks:
Opioid use/overdose/withdrawal:
o Two important effects:
o Opioids cause tolerance and physical
o Overdose:


Naloxone an opioid antagonist is given as a rescue drug when extreme drowsiness,
slowed breathing or loss of consciousness occurs.
o Withdrawal:


Onset:

Mild:

Moderate:

Severe:
Duration:

Mild:

Moderate:

Severe:
o Methadone:

Methadone maintenance:


detoxification is accomplished by

Treatment programs determine the

Methadone treatment combined with
Understand the roles of Brief intervention, motivational interviewing, and harm reduction in treatment.
o Brief Intervention:

brief intervention is most successful in working with people who




 It is recommended that brief intervention at minimum include.



o
o

o
o
o Motivational Intervention:

FRAMES:

How does Motivational Interviewing help?
o Harm Reduction in Treatment:

The goal is to.

Harm reduction initiatives






Chapter 36: Mental Health Assessment in Children

Strategies for Interviewing Children:
o
o
o
o
o
o
o
o
o
o

Self-concept:
o What is it?
o How do we test it?

Temperament:
o What is it?
o Three main patterns:




Mood:
o What is it?

Age-appropriate interventions and assessments:
o What is the most important factor for determining age appropriateness?

What is confidential with adolescents?
Chapter 39: Neurocognitive

What is delirium?
o Types:



o Causes:
o Risk Factors:









o Characteristics:

On set:

24 hour course:

Consciousness:

Attention:

Cognition:

Hallucinations:

Orientation:

Psychomotor activity:


Speech:

Involuntary movement:

Physical illness or drug toxicity:
Dementia:
o Types:



o Characteristics:


On set:

24 hour course:

Consciousness:

Attention:

Cognition:

Hallucinations:

Orientation:

Psychomotor activity:

Speech:

Involuntary movement:

Physical illness or drug toxicity:
Alzheimer Disease:
o Two Subtypes:


o Essential Features:


o Typical Deficits:




o Stages:



Chapter 43: Medically Compromised

What is the connection between mental and medical disorders?

What are comorbidities?

How do comorbidities effect people with mental disorders?

How does pain impact mental health?