lOMoARcPSD|32770214 Mental Health Cheat Sheets Medical Surgery 2 (Florida State College at Jacksonville) Studocu is not sponsored or endorsed by any college or university Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Mental Health 1. Therapeutic Communication 2. Non-Therapeutic Communication 3. Defense mechanisms 4. Legalities and Ethics 5. In Patient - Out Patient 6. Restraints and Seclusion 7. Anxiety 8. Panic Attacks 9. OCD 10. PTSD 11. Depression 12. Eating Disorder 13. Personality Disorders 14. Dissociative Identity Disorders 15. Schizophrenia 16. Schizoaffective 17. Bipolar Disorder / Manic 18. Substance Abuse 19. Alcohol Addiction & Abstinence medication 20. Dementia 21. Alzheimer 22. Delirium 23. Anti psychotics 24. Antidepressants 25. Anxiety medications 26. Mood stabilizers 27. ADHD medication 28. Mental heath - children 29. Communication with children 30. Erickson's Stages Of Development 31. Maslow's hierarchy of Needs 32. Test Prep and Guide Table of Contents RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Therapeutic Communication What is it? The use of words and actions that promote a positive response in the client that will allow the Nurse to obtain vital information and develop rapport that facilitates a working relationship. Uses Gain clients attention Gain Information on patients thoughts, feelings, needs, concerns Information and feedback about the clients condition promotes functional and effective behavior and relationship Client centered, its purposeful, planned, and goal oriented Parts Time: Dont rush the client, mental health clients will often require more time Active Listening: Nonverbal actions that show the client you're paying attention Eye contact if situation and culturally appropriate Body language comfort and ease, (try not to tense up, or look guarded) Techniques What types are there? Silence: Allows time for the client to reflect and offer more information Questions: Open-ended, Close-ended, What if, Presupposition - goals assessment Clarifying: Restating, Reflecting, Paraphrasing, Exploring Opening statements: Gives the client a starting point for communication Acceptance and recognition: Nurse demonstrates interest and no judgement Touch: If appropriate can show compassion and care for client Focusing: Keeps the client on topic Age are group What By types there? Children: simple and straight to the point language, assess developmental level be at eye level, use play during interactions, nonverbal is very important. Adolescents: Assess how the client feels about the diagnosis, may refuse treatment as a desire to feel normal, how with the diagnosis affect relationships with peers Older adult: Minimize distractions, face the client, allow additional time for response, interview family to determine best communication with impaired client RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Non-Therapeutic Communication What is it? The use of words and actions that inhibit communication and relationships Types False Reassurance: I'm sure everything will be okay Uses Rejecting: refusing to discuss clients concerns Agreeing / Disagreeing: instead try Lets discuss how you feel Probing: Not appropriate when client becomes severely uncomfortable Giving Advice: I think you should.. What do you think you should Defending: The staff is the best, nobody lies here: I will answer your questions Approval / Disapproval: That's good or that's bad: How did this behavior affect... Belittling: Everybody feels this way at times: Keep the focus on client not everybody Stereotype comments: hang in there, keep your head up. Denial: Denying the problem exist: make sure to address the feelings Interpreting: What you really mean is.. Unrelated topics: Stay on the topics that need to be addressed Notes These are all barriers to communication Don't look guarded Don't rush a mental health client Mental health clients can be very hard to read sometimes and once they decide you don't care about their feelings and concerns it can be a very hard barrier to overcome RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Defense mechanisms What is it? Protective behaviors used to protect ones mental state or ego. Can have both adaptive and maladaptive uses. Defense mechanisms Altruism: Reaching out for help Compensation: Focusing on strength to make up for weaknesses Conversion: Physiological symptoms present from mental thoughts Denial: Refusing to accept the truth Displacement: Shifting feelings towards something or someone less threatening Dissociation: Compartmentalizing of information to ignore or block it out Projection: Placing ones negative emotions/ actions onto another (cheating spouse accuses the other of cheating) Rationalization: Making excuses for bad behavior or actions Reaction Formation: Displaying feelings or behavior other than what is felt Regression: Revert to childlike behavior Repression: Unknowingly removing unacceptable feelings from consciousness Splitting: Lacks ability to reconcile difference between positive and negative emotions Sublimation: Substituting acceptable forms of expressions for unacceptable feelings Suppression: Denying unpleasant thoughts and feelings by choice. Undoing: Performs actions to make up for wrong doings. RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Legallities and Ethics What is it? A nurse must know the laws and regulations dealing with clients, protecting their rights, while abiding by local, state, federal laws and within the nurse practice act. Legal Rights in Mental Health Humane treatment Informed Consent Right to refuse treatment Complete plan of care written out Right to communication - with anybody to include Law, family, legal, medical Ethical Considerations Beneficence: The act of goodness Autonomy: Allowing the patient to decide their fate, treatments, actions Justice: Fair and equal treatment: nurses can tend to shy away from MH clients. Fidelity: faithfulness to the client and the nurses duty. Veracity: Honesty - Don't lie to the client: This often happens with diagnosis, simply let the patient know the physician will be the one talking about the diagnosis. Ethical Resources for decision making Code of Ethics for nurses: Can be found on the ANA website Nurse Practice Act: Specific to each State / Region Senior Nursing Staff Ethics Department Torts Intentional Tort: Acts that are done with conscious thought that damage or violate the client or their rights. False Imprisonment: Confining or Restraining a patient against will w/o orders Assault: Making a threat Battery: Causing Bodily harm Unintentional Tort: Accidental action or inaction that damage or violate the client or their rights. Negligence: Simply failing to provide quality care that could have prevented injury Malpractice: Professional negligence RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 In Patient - Out patient What is it? In-Patient: When a client is admitted to the hospital for overnight stay or longer. Out-Patient: The client is assessed, treated, and leaves upon completion. Admission types in a Mental Health Facility Informal: Least restrictive form: No threat from client to self or others and is free to leave at any time. Voluntary: Client or guardian chooses the admission to obtain treatment: The client is considered competent and may refuse both treatment and medication. Before leaving the client is assessed and a provider may initiate involuntary admission for the client to keep them in the facility. Emergency: The client is considered unable to make decision regarding care due to Mental health. A Mental Health care provider will evaluate the admission to verify the appropriateness. This type of admission usually is limited by law to 15 days. Involuntary: A client is entered into a mental health care facility against their will for an indefinate time frame. Involuntary Admission Criteria for admission: Presence of a mental illness Is danger to self or others Severe disability or inability to meet basic needs. Needs Mental help but is unable to seek it out voluntarily due to the illness Typically at least 2 physicians must sign off on the Involuntary Admission Client can request a legal review of the admission at any time. Limited to 60 days before a review must be completed to extend the admission. Clients still maintain the right to refuse treatment and medication. Long Term Involuntary Admission Must be imposed by the court, usually last from 60 - 180 days. RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Restraints and Seclusion What is it? Restraints: Use of Physical or Chemical means that limit the patients ability to function. Types Physical: Belts, Cloth Bands, Cloth Vest, Use of physical restraints should be considered only when other methods fail. Medication / Chemical: Benzodiazepines and Anti psychotics (Typical meds, but not the only ones) Less Restrictive means Verbal Interventions: encourage client to calm down Diversion and/ or redirection Creating calm / quite environment Offer the clients PRN meds Rules WhatCommon types are there? Restraints and seclusion are limited by age: 8 years and younger: 1hr 9-17 years: 2 hours 18 years and older: 4 hours Provider must physically assess patient and re-write the prescription Q24 hours Prescription must state the type of restraint to be used and Do WhatDO types areNot there? DO: Use restraints as a last means Only when there is an ORDER Abide by state and local laws Follow Time Limits CHECK ON PATIENT Q15 -30Min and complete documentation DO NOT use Restraints for: Staff Convenience Intentional Punishment Extreme physically / Mentally unstable RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 ANXIETY What is it? Anxiety is the bodies natural response to stress What levels are there and the assessment findings Mild: Restless, increased motivation, and irritability Moderate: Agitation, muscle tightness Severe: Inability to function, ritualistic behavior, unresponsive Panic: Loss of rational thoughts, distorted perceptions, unable to move What types are there? Separation: Occurs when not around a specific person Phobias: Irrational fears of objects or situation. (Agoraphobia) Social: Fear in social gatherings or when performing/ speaking Panic: Recurrent attacks that immobilize the individual Generalized (GAD): uncontrolled and excessive worry for over 6 months Agoraphobia: Extreme fear of being in certain places. Heights, bridges What Risk types Factors are there? Anxiety is more common in women than men Family History of Mental disorders / Anxiety What types Medication are there? SSRI Antidepressants Benzodiazepines Buspirone TherapeuticWhat Managementtypes are Behavioral there? Training Relaxation: Focus on control and decreasing systemic response Modeling: Attempt to imitate appropriate behaviors Desensitization: Systemically introducing the anxiety inducing trigger Flooding: Used for phobias: Large exposure to stimulus Prevention: Attempt to stop anxiety inducing behaviors like OCD Thought Stop: Client states "STOP" when negative behaviors arise RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Panic Attack What is it? Sudden onset of extreme and intense fear that triggers severe physical reactions Assessment findings Tachycardia / Chest pain Tachypnea / Short of Breath / Choking Increased Blood Pressure Diaphoresis / Chills / hot flash Feeling Depersonalized Immobility Loss of rational though feeling of helplessness Fear of dying / going insane Behavior changes due to fear of the next attack. Diagnostics DSM 5: Criteria for Panic attack / Panic Disorders Episodes typically last 15-30 minutes Must meet 4 or more of the criteria under assessment findings Interventions/ nursing Care What types are there? Keep a calm environment / Free of extra stimuli Remain with client during attacks and provide reassurance Monitor for Self Harm / substance abuse / Suicide assessment Encourage relaxation techniques / Medication What types are there? Benzodiazepines Antidepressants Both medications may be used together depending on severity Therapeutic ManagementTraining What types areBehavioral there? Relaxation: Focus on control and decreasing systemic response Modeling: Attempt to imitate appropriate behaviors Desensitization: Systemically introducing the anxiety inducing trigger Flooding: Used for phobias: Large exposure to stimulus Prevention: Attempt to stop anxiety inducing behaviors like OCD Thought Stop: Client states "STOP" when negative behaviors arise RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 OCD What is it? Obsessive-Compulsive disorder (OCD) is a recurrent, persistent, unwanted, and actions of a client. Could also be thoughts, urges and images.The patient is driven to do these actions and if they fail to do them could lead to a panic attack. Assessment findings Obsessions: are unwanted, intrusive thoughts, urges, or images, the presence of which usually causes marked distress or anxiety. Compulsions: More commonly refereed to as rituals. Washing: can be showering or washing hands to kill germs Checking: May be lights, Stoves, or if doors are locked Counting: Doing a behavior for X times: Switching the lights on/off 3 times Ordering: Everything must be in order / lined up / in its specific place Hoarding and Body Dysphoric are types of OCD Comorbidity: Other Mental health diagnosis often accompany OCD Anxiety Disorders >70% Depressive or Bipolar > 60% / Major depressive >40% 25-33% estimated have suicidal ideation Diagnostics A clinical diagnosis will be made based off of observation in accordance with DSM-V Interventions/ nursing Care Keep stress levels low Create rigid rules Keep the patient accountable Medication What types are there? SSRI - Fluoxetine, Paroxetine, sertraline, fluvoxamine Tricyclic Antidepressant - Clomipramine Therapeutic ManagementTraining What types areBehavioral there? Cognitive-Behavioral therapy: change negative distorted feelings Exposure/ Flooding: Exposing large amounts of undesired trigger/ stimulus Response prevention: preventing the client from performing the action RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 PTSD What is it? Post Traumatic Stress Disorder is recurring, intrusive memories of an overwhelming event that occured in the patients life. (Can be direct or indirect) Assessment findings Reoccurring memories - involuntary intrusive Reoccurring dreams Feeling as if the event is happening again Intense psychological or physiologic distress when the event is remembered Avoidance of thoughts, feelings, memories Avoiding places, things, people Memory loss of the even Persistent negative beliefs about oneself-negative emotional state Trouble sleeping, concentrating Hyper-vigilance, reckless, irritable Diagnostics DSM 5: Criteria for PTSD Screen for self harm / suicide risk screen for Substance abuse Assess for family and occupational issues barrier Assess for other Psychological conditions Interventions/ nursing Care What types are there? Keep a calm environment / Free of extra stimuli assess for memory gaps Medication What types are there? Antidepressants Prazosin to reduce hyper vigilance and insomnia SSRI Beta blockers / control physiological reactions Therapeutic ManagementTraining What types areBehavioral there? Cognitive-Behavioral therapy: change negative distorted feelings Prolonged exposure Therapy: Exposure therapy and relaxation techniques Eye movement Desensitization: DO NOT USE IF SUICIDAL Group/ Family therapy: Seek support from those close/ or same experiences Hypnotherapy: used in dissociative disorders Biofeedback: Increases awareness and gain control of triggers and reactions RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Depression What is it? Mood disorder that is expressed by feelings of sadness, despair, and pessimism. Assessment findings Sadness Despair pessimism loss of interest Changes in: Sleep Eating Cognition level Indecisiveness lack of pleasure suicidal ideation >5% weight gain / loss Types Major Depressive: Single or recurrent episodes of uni polar depression accompanied by 5 of the assessment findings above. Seasonal Affective: occurs seasonally, most commonly winter/ short daylight Persistent Depressive: Milder form of Depression that has a early onset in adolescent or children, and last for at least 2 years for adults / 1 for kids. Premenstrual Dysphoric: associated with the luteal phase of menstrual cycle Substance Induced: Withdrawal from drugs / alcohol Interventions/ nursing Care What types are there? Administer "Hamilton Depression Rating Scale" Questionnaire Suicide / self harm assessment Encourage Self care / Accomplish small goals to keep patient moving if possible Medication What types are there? SSRI Tricyclic Antidepressants MOI Atypical Antidepressants Serotonin Nor epinephrine Re uptake inhibitors (St. Johns Wart may also be taken OTC) Therapeutic ManagementTraining What types areBehavioral there? Electroconvulsive Therapy: Transcranial magnetic Stimulation: MRI strength magnets to stimulate cerebral cortex Vagus Nerve Stimulation: Implanted device that provides small shocks Light Therapy: First line treatment for Seasonal Affective Disorder (SAD) RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Eating disorder What is it? Serious and sometimes fatal that present as highly abnormal consumption practices that lead to inadequate or excess caloric intake. Types / diagnostics Bulimia Nervosa Binge eating the purging (recurrent episodes) Weight within normal BMI Eat low calorie diets between episodes Anorexia Nervosa Fear of gaining weight Disturbed body image refuse to eat ritualistic eating habits restrictive diet Binge eating Disorder Often eat large Meals lack of control once per week for 3 months Both men and women 40s-50s most common age Assessment What types are there? Obsession of food / fat and calories Fatigue with anemic signs Eating in Seclusion Muscle wasting Brittle nails and hair from poor nutrition excessive wight loss/ gain abnormal dieting / restrictive eating Distorted view of body Interventions/ nursing Care What types are there? Assess for food hoarding provide small snacks Routine weights Monitor labs / Vitals / I&Os Establish goals Encourage Therapy / groups Dietician Consultation Promote self care / education Medication What types are there? SSRI antidepressants TPN nutrition Anxiolytics Therapeutic ManagementTraining What types areBehavioral there? RE-FEEDING SYNDROME: fatal complications due to nutritional imbalances that occur after initiating feedings for a severely malnourished client Cognitive-Behavioral therapy: change negative distorted feelings RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Personality Disorders What is it? Impairments in Self-Identity, Self destruction, and interpersonal functioning 10 types in 3 clusters Cluster A (Odd or Eccentric traits) Paranoid: Distrustful, suspicious of others: People want to harm, exploit, or deceive Schizoid: Emotional Detachment, no interest in relationships, indifferent to praise or criticism Schizotypal: Magical thinking or distorted perceptions, may not be clear delusions Cluster B (Dramatic, Emotional, Erratic) Antisocial: Disregard for others feelings / well being, outside of traditional morals and values, will harm, steal, lie and accept no personal responsibility Borderline: instability in identity, relationships, and affect. manipulative, impulsive Histrionic: Attention Seeking, needs to be the center of attention Always. Narcissistic: arrogant, believes self is most important, lack of empathy for others Cluster C (Anxious, fearful, Insecure, and /or inadequate) Avoidant: Actively avoids social events, gatherings, situations of contact / relations Dependent: Always needs a close relationship, finds one immediately as one ends Obsessive-Compulsive: indecisive, perfectionist, need for things to be a specific way which can prevent accomplishing even basic task. Assessment - commonalities What types are there? Inflexible/ maladaptive responses Compulsive Lack of Social restraint Inability to emotionally connect Interpersonal conflict provoking Nursing Care Be aware of personal reactions - Physical / Mental Dont let your actions ruin building rapport / caring for patients Milieu management - Orient the client to reality/ safety / appropriate activities Communication: Use firm and supportive approach offer realistic choices consistency in actions and words respect certain clients needs to self isolate when appropriate RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Dissociative Identity Disorders What is it? Formerly referred to as Multiple Personalities it is characterized by having 2 or more personality states within one individual. (Often from trauma or stressful event and is a coping mechanism to deal with these situations) Assessment findings Depression Anxiety Suicidal Ideation Foggy state (mentally) Detached feelings distant or seclusive limited coping abilities Memory loss Erratic Behavior Diagnostics Dissociative identity 2 or more identities (Distinct) Abnormal Behaviors Gaps in memory (Recurrent) Denationalization Disorders Describe out of body experience Dreamlike or foggy state aware of reality / real vs fake Interventions/ nursing Care What types are there? Patient Safety Calm, supportive environments Promote coping skill Keep patient oriented to reality Assess clients ADL's / Assist if needed Incorporate family where possible Medication What types are there? Medication is highly dependent on diagnosis and symptom presentation Anti psychotics, Anxiolytics may be more commonly prescribed (typically PRN) Therapeutic ManagementTraining What types areBehavioral there? Set limits and firm rules Be assertive but compassionate Therapeutic communication Establish and maintain trust Identify and avoid triggers provide resources for coping identify paranoid delusion (additional risk of violent tendencies) promote group activities and friendships when applicable RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Schizophrenia What is it? Mental disorder that limits a persons ability to distinguish between reality and imagination - disruption in how the person thinks, feels, and acts. Assessment findings Positive Findings: Delusions hallucinations disorganized speech Disorganized Behavior Negative Findings: Flat affect Decreased emotion expression Loss of interest / activities and relationships Minimal communication Symptoms by stage Premorbid Phase: (1) Signs occur prior to diagnosis being very shy / antisocial Prodromal Phase: (2) Clearly manifested signs Active Psychotic Phase: (3) Psychotic symptoms are prominent Residual Phase: (4) remission period / follows active phase Diagnostic Minimal one positive symptom and one additional symptom (positive or negative) Present for 6 months or longer with one month of active symptoms Not substance induced Interventions/ nursing Care Maintain safe environment and protect client from injury Continuously monitor cognitive state Maintain stable and controlled reactions Dont let patient block the exit/ get inbetween nurse and exit. Medication What types are there? Atipical Antipsychotics Therapeutic Management- Behavioral Training Assess for Suicidal ideations What types are there? Keep patient oriented to reality Educate on coping skills to recognize and manage delisional states RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Schizoaffective disorder What is it? Client meets clinical criteria for both Schizophrenia and depression or Bipolar disorder Assessment findings Psychotic: Delusions hallucinations Altered speech, actions, thoughts Manic: Agitation, Distracted Insomnia, Self-harm Rapid speech, actions, thoughts Depressive: Loss of interest poor appetite sleep changes feeling worthless, guilty suicidal ideation Diagnostics Made according to health history and current symptoms Interventions/ nursing Care What types are there? Maintain a calm supportive environment Assess for suicidal ideation Keep client oriented to reality Allow client to express thoughts, feelings Stay with patient during hallucinations identify triggers / avoid triggers Encourage coping skills Medication What types are there? Antipsychotics Antidepressants Mood Stabilizers Therapeutic ManagementTraining What types areBehavioral there? Cognitive-Behavioral therapy Social Skills training Support groups Family counseling Healthy consistent diet Avoid stressors Avoid Alcohol / illegal substances Maintain calm environment RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Bipolar disorder / Manic What is it? Mood disorder that affect the emotional state of a prolonged period of time. emotions and moods may fluctuate without any reason. Types Bipolar 1: At least one episode of mania and depression alternation Bipolar 2: One or more hypomanic episodes that switch to depressive episodes Cyclothymic: 2 years or more of hypomanic and minor depressive episodes Assessment findings Depressive: Flat, affect sad, tearful low energy loss of pleasure Wont maintain ADL's Manic: Euphoria agitation and irritable restless flight of ideas impulsive Attention seeking poor judgment decreased sleep neglect ADL's manipulative behavior delusions/ hallucinations Diagnostics Mood Disorder questionaire Clinical presentation Intervention / Care Phases Acute Phase: may require hospitalization, Self harm assessment / safety Continuation: Remission of symptoms / focus on treatment adherence Maintenance: Treatment may last for lifetime, goal is to prevent manic episodes Medication Mood Stabilizer - LITHIUM** Antidepressants - SSRI, MAOI, TCA Antipsychotics - Haloperidol Therapeutic ManagementTraining What types areBehavioral there? Electoconvulsive Therapy (ECT) Counseling/ Individual or group Minimize Stimuli Set limits and boundaries Maintain patient Safety Encourage expression/ communication Promote self care needs/ education Educate on identifying relaspe early RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Substance Abuse - Addiction What is it? Dependence and repeated use on chemical substances to alter mood/ gain a sense of euphoria or escape from reality Assessment Questions Type used Amount used Frequency of use Age started using changes in performance Precious withdrawal symptoms Date last used How it affects their daily life and body Diagnostics / Screening Drug Abuse Screening Test CAGE Questionnaire Alcohol Use Disorder identification test Clinical Opiate withdrawal scale Types / side effects What types are there? Opioid: Heroin, Morphine - Slurred speech, respiratory depression, decreased LOC Reversal: Naloxone Alcohol: 0.08% blood alcohol level is intoxication: Death risk at 0.4% BAC Sedatives: Benzodiazepines, barbiturates, Club drugs - drowsiness, sedation, respiratory depression, decreased LOC Reversal: Flumazenil (Not for Barbituats) Cannabis: Increased risk of lung cancer, relaxed, euphoric, paranoia w/ high dose CNS stimulant: Cocaine, dizziness, tremors, blurred vision, tachycardia, seizures, cardiovascular collapse, can lead to death Amphetamines: Impaired judgment, hyper vigilant, irritability, tachycardia, elevated blood pressure. Inhalants: Depends on substance inhaled, nystagmus, phych changes, slurred speech, dizziness, muscle weakness Hallucinogens: anxiety, depression, hallucinations, pupil dilation, tremors, panic attacks Therapeutic ManagementTraining What types areBehavioral there? Maintain safe environment use reversal agent if applicable support patient to maintain vitals Cognitive Behavioral Therapy Therapy / support groups Client education Provide with resources for quitting 12 - step program encouragement RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Alcohol Addiction & Abstinence meds Withdrawal Medications Withdrawal symptoms by time frame: Within 6 hours: Tremors, anxiety, N/V, Insomnia Peak: 48-72 hours: Hypertension, diaphoresis, hallucinations, seizures 3-10 days after last drink: Withdrawal Delirium: Medical emergency DEADLY Confusion, Disorientation, agitation, autonomic instability, seizures. Withdrawal Medications Diazepam, Chlordiazepoxide, lorazepam are used because they act on the GABA receptors and mimic the effects of alcohol. It takes several days for the neurotransmitters to readjust to normal function without alcohol. Phenobarbital: Used for severe cases of Alcohol Withdrawal that are suspected to go into Withdrawal Delirium long acting Barbiturate targeting GABA receptors: Carbamazepine: Outpatient treatment to prevent relapse by decreasing cravings and convulsions Clonidine: used to control Neuroautonomic hyperactivity (decreases SNS side effects of withdrawal) Naltrexone: Suppresses the euphoric effect of alcohol (DOES NOT DECREASE CRAVINGS) Alcohol Abstinence Disulfiram (Antabuse): Treat chronic alcoholism Causes unpleasant symptoms / Nausea, Vomiting, chest pain, respiratory issue and makes the client extremely uncomfortable. Medication last up to 2 weeks in system Symptoms occur within 5-10 minutes DON'T GIVE TO AN IMPAIRED CLIENT = Risk of death if enough ETOH is ingested Acamprosate: Thought to stabilize chemical signaling in the brain that has been disrupted by chronic alcohol use. (Does not reduce craving or cause reduced euphoria if patient continues to drink) Naltrexone: Same as above: RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Major Neurocognitive disorder (Dementia) What is it? Progressive decline in cognitive ability that mainly affects memory, has a slow onset and is generally irreversable Dementia Stages / Assessment Early: Recent memory impaired, mood swings. Agnosia, Apraxia, Aphasia Intermediate: Cannot learn new information, flat affect, depressed, wandering off Late: cannot perform ADL's incontinent, almost in a comatose state - leads to coma Diagnostics Rule out delirium Neurological assessment Neuroimaging (CT, PET scans) (X-ray of head / chest ECG - Electroencephalography EEG - Electrocardiography ABG testing Complete Metabolic Panel - assess for imbalances Perform screening Functional dementia scale Blessed Dementia scale (Family interview) Interventions/ nursing Care What types are there? Client Safety Room close to nursing station Limit stimuli Well lit environment Bed / Chair alarms Keep bed low learn / avoid triggers encourage ADL's Medication What types are there? Cholinesterase inhibitor: donepezil, rivastigmine, galantamine *Caution w/ Asthma & COPD patients due to Bronchoconstriction* Anxiolytics Therapeutic ManagementTraining What types areBehavioral there? Educate caregiver on household dangers Scatter rugs, clutter, electric cords Install hand rails Door locks / alert system on doors Lower water temperatures in household Provide caregiver with support resources Provide options for long term care Encourage self care of Caregivers RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Alzheimer What is it? Sub type of a Neurocognitive Disorder progressive and irreversible neurological disorder, the client suffers from memory loss and reduced cognitive function. Symptoms have a slow onset that are commonly overlooked. Assessment findings Reduced short term memory can't recognize faces difficulty performing ADL's Random pacing, wandering Inappropriate behavior Trouble remembering words Trouble remember names Forgetting details about the past Loss of bladder and bowel Personality changes Diagnostics No other explainable med/ condition that causes the change Slowed learning ability Declining Memory No brain injury or stroke Inappropriate speech, loss for words inappropriate judgement / Reasoning Unable to interpret things around them Visual-spatial No Specific test to diagnose NC disorders Interventions/ nursing Care What types are there? Patient safety assisting ADL's Assessing Cognition / noting deficits Promote social engagement enhance cognition, mood, behavior Medication What types are there? SSRI antidepressants NMDA receptor antagonist Cholinesterase Inhibitors Therapeutic ManagementTraining What types areBehavioral there? Keep patient oriented Implement consistent schedule Provide structure Guided activities Educate on resources available Caregiver support and therapy Provide memory aids, games assess risk for injury RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Delirium What is it? Change in awareness and attention with a change in cognitive function that develops rapidly over a short period. Transient and usually reversible. Common Risks Drugs Dehydration High Fever Sun downing Systemic infections ABG imbalance seizures Migraines Brain neoplasms heat stroke stroke head trauma Assessment unable to focus disorganized thinking scrambled speech time and place disoriented Hyper vigilance and stupor -fluctuating between states vivid dreams / nightmares *attempts to flee* Agitation restlessness fighting hallucinations self destruction Diagnostics Mental status Examination / history CT / MRI / CBC / Culture / Urine test Confusion Assessment Method (CAM) NEECHAM Scale Interventions/ nursing Care What types are there? TREAT THE CAUSE Bed / Chair alarms Keep bed low Nurses Safety/ dont let patient block exit Client Safety Room close to nursing station Limit stimuli Well lit environment Medication What types are there? Antipsychotics Benzodiazepines Therapeutic ManagementTraining What types areBehavioral there? Client safety measures -bed alarm** Nutrition consult structured schedule Redirect patient to reality reassure the patient is safe Community Resources education maintain consistent staff during shift use of TV / radio / photos to calm client Assist client with ADL's RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Antipsychotics Types Typical - Conventional 1st generation Positive manifestations Hallucinations, Delusions, behavior chlorpromazine, haloperidol A-Typical-2nd / 3rd generations Positive and Negative manifestations 1st line treatment Schizophrenia risperidone, clozapine How it works Typical - Conventional 1st generation A-Typical-2nd / 3rd generations Blocks Dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain. Blocks Serotonin, lesser effect dopamine, acetylcholine, histamine, norepinephrine Uses What types are there? Bipolar (Manic phase) Acute/Chronic psychotic disorders Schizophrenia Schizophrenia (positive and negative levodopa induced psychosis Bipolar disorder Impulse control disorders Complications notify provider What types=are there? Extrapyramidal Side Effects** Dystonia Parkinsonism Akathisia Tardive Dyskinesia Lip smacking/ puckering / pursing Excessive Eye blinking Abnormal tongue movements Neuroleptic Malignant Syndrome !!Life Threatening!! **FEVER** stop med - give antipyretics Use cooling blankets monitor vitals increase fluids monitor Dysrhythmias Diazepam - anxiety Dantrolene, Bromocriptine (Muscle relaxant) Wait 2 weeks to resume therapy Contraindications Cautions What types are /there? C/I - Dementia (Risk of CVA) Alcohol use Seizures Diabetes Mellitus Education / Considerations What types are there? Dissolving pill - clients who hide / pocket Urine may turn pink / brown 1-6 weeks for therapeutic Taper down medication Case management if cost is an issue RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Anti depressants Types SSRI- Fluoxetine, sertraline, Paroxetine, Fluvoxamine Citalopram, escitalopram, SNRI- Venlafaxin, Duloxetine, Desvenlaxafine Levomilnacipran TCA - Imipramine, Doxepin Nortiptyline, Amoxapin, Trimipramine, Desipramine Clomipramine. MAOI: Isocarboxazid Tranylcpromine Selegiline (Transdermal) How it works TCA Increase serotonin and Norepinephrine SSRI: Increase Serotonin in blood /blocks uptake MAOI Seotonine, Melatonin, Epi, NorEpi, Dopamine, Tyramine What types are there? Uses Bipolar (Manic phase) psychotic disorders Schizophrenia Bipolar Combined with SSRI for resistant depression Depression - Bulimia Nervosa Social &Generalized anxiety OCD PTSD WhatComplications types are there? SSRI *Sexual Dysfunction Serotonin Syndrome: Rapid onset Tachycardia, hallucination, coma and death (*NO= St. Johns Wart) TCA: Arrhythmia Anticholinergic effects Seizure precaution Cardiac arrest/ overdose MAOI: MOST Drug Interactions **NO TYRAMINE (Cured meats, Cheese, yogurt, wine**) (Wait 14 days between SNRI) Contraindications Cautions What types/are there?common C/I - SSRI / SNRI do not mix with MAOI Seizures NO - Alcohol use Diabetes Mellitus TAPER ALL MEDS SLOWLY *One week supply for Suicide Risk Educate on Sedative affects Education / Considerations What types are there? May take 2 weeks to start working Can take up to 8 weeks for full effect Dont mix with Grapefruit juice Support / group Therapy / Give resources Assess bowel and bladder function (Anticholinergic effects from med) RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Anxiety medications Types Benzodiazepines Diazepam Lorazepam Chlordiazepoxide Clorazepate Oxazepam, Clonazepam SSRIParoxetine, sertraline, Fluvoxamine Citalopram, escitalopram Others Atypical - Buspiron TCAs amitriptyline, Imipramine, clomipramine How it works SSRI Increase Serotonin in blood /blocks uptake Benzodiazepines Increases inhibitory effects of GABA Trauma - stress events Hyper-arousal with -dissociative disorders Seizures & Muscle Spasms Insomnia Buspiron Exact action unknown What types are there? Uses Social & General Anxiety Panic Disorder - OCD Trauma / stress events Depression Adjustment Disorders Dissociative Disorders Long term anxiety treatment WhatComplications types are there? Benzodiazepines Sedation / CNS depressant Respiratory Depression SSRI Serotonin Syndrome Sexual Dysfunction Buspiron Nothing major / very safe drug Contraindications Cautions What types/are there?common C/I - SSRI / SNRI Do not mix with MAOI NO - Alcohol use TAPER ALL MEDS SLOWLY *SSRI One week supply / Suicide Risk Higher risk of side effects with anxiolytics mixing Educate on Sedative affects Education / Considerations What types are there? May take 2 weeks to start working Buspiron / SSRI Can take up to 8 weeks for full effect Support / group Therapy / provide resources Dont mix with Grapefruit juice RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Mood Stabilizer - Lithium How it works Lithium exact actions are unknown Lithium produces neurochemical changes in the brain and affects serotonin receptor blocks Uses What types are there? Bipolar (Manic phase) Controls manic episodes and prevents the return of mania and depression Possibly decreases neuron atrophy Side effects What types are there? Fine Tremors (in hands) weight gain Hypotension Hypothyroidism Polyuria with mild thirst Complications notify provider What types=are there? Lithium Toxicity: > 1.5 mEq/L Diarrhea, nausea, vomiting muscle weakness, tremor mental confusion, sedation Lithium Toxicity: > 2 mEq/L tinnitus, extreme involuntary movements ataxia, seizures rapid progression - coma and death Contraindications Cautions What types are /there? Pregnancy Renal , heart, liver issues Use caution with Thyroid, seizure, - diabetes disorders Care What Nursing types are there? Therapeutic levels = 0.6 - 1.2 mEq/L Measure levels 10-12 hours after last dose in hospital / new prescription Measure every 2 to 3 months after patient is stabilized on medication Educate: Dehydration increases toxicity risk Nutrition counseling is key for safety Effects may take 5-7 days No OTC NSAIDS, Antihistamines RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 ADHD medications Types Methylphenidate Dexmethylphenidate Dextroamphetamine Amphetamine Mixture Lisdexamfetamine dimesylate How it works Raises the levels of Dopamine and Norepinephirin withing the CNS Uses What types are there? ADHD Conduct disorders Narcolepsy Obesity Complications notify provider What types=are there? Dysrhythmias, chest pain, Decreased appetite Increased Blood Pressure Weight loss Psychotic manifestations Monitor height and weight Can cause hallucinations and paranoia Withdrawal Reactions What types are there? Headache, nausea, vomiting, depression and possible muscle weakness TAPER MEDICATION - Never stop Abruptly Contraindications What types are there? Pregnancy Substance abuse disorder Severe anxiety MAOI = Hypertensive crisis Education / Considerations What types are there? Do not chew If patch/ alternate site daily (max 9 hours use from patch) No alcohol Resources for Family therapy Cognitive behavioral Therapy RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Mental health - Children What is it? Mental health issues in children pose a special challenge as it can be hard to communicate with them and the rate at which they develop, and activity levels very greatly. (Healthcare treatment occurs when school, home life, peer interactions are disrupted) Assessment findings ADHD Autism Intermittent explosive Oppositional Defiant Disruptive mood Conduct disorders Anxiety PTSD Diagnostics Genetic testing for abnormalities Family / child interview, assessment Lifestyle / home life assessment Traumatic exposure assessment Interventions/ nursing Care What types are there? Use age appropriate words and speech Identify desired behaviors Encourage verbal communication Determine triggers and avoid Encourage family attachment / bonding Assess risk for self harm Assess drug / alcohol use Encourage open communication and effective coping strategies Medication What types are there? ADHD: Psychostimulants, SNRI Autism: SSRI, Anti psychotics Explosive Disorder: fluoxetine, lithium, clozapine Conduct disorder: Varies depending on issue Anxiety: SSRI may be given Treatment for children try to identify the issues and address them with counseling if possible before the start of medication interventions Therapeutic ManagementTraining What types areBehavioral there? Cognitive-Behavioral therapy: change negative distorted feelings Group/ Family therapy: Seek support from those close/ or same experiences Grief and trauma Intervention for children Music, play, and story telling to promote a calm and relaxing environment Provide education and handouts on community resources RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Children - Communication What to do Try to be at eye level - standing over them can create a sense of anxiety and a lower level of control that will reduce their willingness to communicate. Smile! seriously, smile let them know that not everything about being in the hospital is terrifying! Get the parents to help depending on age - young children who want to cling to their parents can help by calming the child and interacting with you to show the client that you are not a threat or "Bad person" Reassure the client and give praise - Children love doing things right and getting told they are doing so. Most of the time. Use their clients"help" let them think they are helping "Can you hold my penlight" "Do you want to help me with this equipment / test" use toys and play time when appropriate - this can be helpful to calm anxiety but must be used with caution as it could over stimulate the client and reduce your ability to complete a task. Ask the client what they are interested in / talking about their favorite things or what makes them happy can help to ease their fears Crayons and paper if available DON'T LIE! Keeping the client calm with help get more accurate information RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 Eriksons Stages of Development Stages Infancy (birth to 18 months) Trust vs. Mistrust Feeding Hope Early Childhood (2 to 3 years) Autonomy vs. Shame and Doubt Toilet Training Will Preschool (3 to 5 years) Initiative vs. Guilt Exploration Purpose School Age (6 to 11 years) Industry vs. Inferiority School Confidence Adolescence (12 to 18 years) Identity vs. Role Confusion Social Relationships Fidelity Young Adulthood (19 to 40 years) Intimacy vs. Isolation Relationships Love Middle Adulthood (40 to 65 years) Generativity vs. Stagnation Work and Parenthood Care Maturity (65 to death) Ego Integrity vs. Medication Despair Reflection on Life Diagnostics Wisdom Importance These stages will not only help to determine where the individual should be at developmentally, but can also help to identify if they have a regression or if an identity crisis is present. Understanding this chart can help open communication flow, build a professional relationship, and help identify possible sources of issues that you can use to better direct treatment, education, while providing more accurate community resources to aid the client. RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 SE L AN F-FU D G LF RO ILLM WT E H NT Maslows Hierarchy of needs BA SIC NE ED S PS YC H OL OG ICA LN EE DS Self - Actualization Morality/ Spontaneity/ problem solving Esteem Confidence/ achievement/ respect Love / Belonging Friends / family/ sexual intamacy Safety Security/ employment/ family/ health/ property Psychological needs Breathing/ food/ sleep/ water/ sex/ homeostasis How it applies Mental health issues will often times lead to a person lacking multiple items from this list that prevents their recovery. It is also common that a person has developed a mental illness because they lacked an essential part of feeling complete and maybe were simply not able to realize it, lacked the knowledge what was missing, or had a barrier to seeking treatment. As you are learning about mental health or treating patient try to identify what is missing in their life and if there is a resource to help them in regaining stability beyond simply giving them a pill. RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com) lOMoARcPSD|32770214 General Rules and Test Prep Always think Patient Safety! Fall risk, sedatives, suicide, wandering Always assess risk for suicide Limited supply of meds Meds will take time for full effect, may be at an increased risk of suicide Dont forget about Maslow and ABCs, sometimes its the most basic answer Mental Health patients still have their rights MAOIs = no tyramine = cured meats, cheese, wine, yogurt SSRI and MAOI can cause life threatening issue DO NOT MIX Taper Medication / Do not stop abruptly Use therapeutic techniques when possible, music, art, therapy Alcohol and drug abuse: Last use, how much, how often Lithium toxicity 2.5 or above think hemodialysis Blurred vision, ataxia, TINNITUS, nausea, vomiting, diarrhea, coarse tremor Consume enough Sodium/ kidneys conserve lithium with low salt diet Diuretics and Nsaids increase lithium Patients should NOT drive until they know how medication affects them Abuse reporting child, sexual, domestic, elderly Somatoform Disorder - psychological disorder that show physical signs without any apparent physical cause. (no medical explanation) May be called Conversion Crisis Intervention: decrease emotional stress, protect victim, assist with resources, return to per-crisis functioning level Communication is a large part of testing questions (And they can be tricky) Never ask why... Coping and defense Mechanisms come up often (in my experience) Drugs: Most severe side effects, Contraindications, diet REMEMBER: NCLEX, ATI, and other test have a huge focus on Patient Safety!! Practice questions can be your best friend, they help identify weak areas. RN Study Buddy Downloaded by Solon Papageorgiou (papageorgiousolon970@gmail.com)
