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Stress =an individuals reaction to any change that requires an adjustment or response, which can be physical, mental or emotional
stressors =a biological, social, or chemical factor that causes physical or emotional tension and may contribute to the development of certain illnesses
stress is based on a reactionin our bodies - from inflammation etc
Hans selyes general adaptation syndrome - three stages-alarm reaction stage<br>-stage of resistance<br>-stage of exhaustion
Alarm reaction stage =fight or flight syndrome&nbsp;<br>-Increased HR, BP
vagus nerve -part of parasympathetic nervous system: helps relax and calm down body
stage of resistanceuse physiological responses of first stage as a defense in an attempt to addapt to the stressor
stage of exhaustion -the body responds to prolonged exposure of a stressor<br>-adaptive energy is depleted<br>--diseases of adaptation may occur
prolonged stress leads to:HTN, IBS, upset stomach, etc
"<div><span style=""color: rgb(28, 173, 228);"">&nbsp;</span>A 25-year-old man barely avoids a
motor vehicle accident. His heart is pounding, his palms are sweaty, and his
respirations are increased. This is an example of which stage of the general
adaptation syndrome?</div><div><br></div><div><div><span style=""color: rgb(28, 173, 228);"">&nbsp;</span>A. Alarm reaction stage</div>
<div><span style=""color: rgb(28, 173, 228);"">&nbsp;</span>B. Stage of resistance</div>
<div><span style=""color: rgb(28, 173, 228);"">&nbsp;</span>C. Stage of exhaustion</div>
<div><span style=""color: rgb(28, 173, 228);"">&nbsp;</span>D. Stage of biological stress</div></div>"Alarm Reaction Stage<br>-the physiological responses of the fight or flight syndrome are initiated in the alarm reaction stage<br>(his body responded with increased HR and RR, HA, sweaty palms, and dizzy)
Constant thoughts of fear and anxiety can lead from stage of resistance to..stage of exhaustion (may lead to PTSD, etc)
stress begins at thehypothalamous pituitary adrenal axis (HPA)
HPA releases -cortisol
amygdala =the brains fear center
Hipppocampus =the part of the brain associated with learning, memories, and stress control
Prefrontal cortex =part of the brain that regulates concentration, decision making, judgement, and social interaction
stress management=the use of coping strategies to respond to stressful situations
a person cannot be considered healthy without accounting for:mental AND physical health
mental health =the state of well being in which an indiviual is able to realize their own potential, cope with the normal stress of life, work productively, and make a contribution to the community
mental health provides people with the capacity to:think rationally, communicate, skills, learning, emotional growth, resillience, and self esteem
mental health is shaped byculture, society, political climents, reimbursement
factors influencing mental healthstress, behaviors, disease, trauma, drug use, culture, environment
social determinants of healtha persons MH is shaped by various enviorments operating at different stages of life.&nbsp;<br>-social inequalities (the higher the inequality the higher the risk)
positive stress =&nbsp;eustress
Maslows hierarchy of needs-self actualization<br>-self esteem/respect of others<br>-love and belonging<br>-safety and security<br>-physiological needs (1st)
physiological needsfood, water, air, sleep, exercise, shelter
safety and securityavoiding harm and protection<br>-maintain comfort, order, structure<br>-physical safety<br>-freedom from fear
love and belonginggiving and receiving affection<br>-companionship<br>-interpersonal relationships<br>-identification with a group
self esteem / respect of othersthe individual seeks self-respect and respect of others<br>-works to achieve success and recognition<br>-desires prestige from accomplishments
self actualization&nbsp;self fulfillment<br>realization of highest potential
"Self
actualized individuals' posses:&nbsp;"appropriate perceptions of reality, accepting oneself or others, spontaneity, focus/concentration, problem solving, privacy, creativeness, ethics, etc
Burdents of mental illness1. the illness itself<br>2. the stigma attached to the disorder
"Mental
Health Parity Act 1996-&nbsp;""required insurers that provide mental health
coverage to offer annual and lifetime benefits at the same level provided for
medical/surgical coverage; By 2000, the Govt found that only 86% of health
plans actually
complied with
the law."
DSM-V"<div>•Developed by APA for evaluation of the client’s mental
status and standardization of symptomology to develop diagnoses of mental
illness.</div><div><br></div><div>-For
clinicians to have a common language to communicate characteristics of mental
disorders presented by their patients</div>"
4 out of 10 disabilities in the US are related to:mental health disorders
DSM =diagnostic statistical manual
DSM determines-what classifies as a disorder vs what doesnt
a disorder is diagnosed when it starts to affect:level of functioning (ADLs, quality of life)
holistic carebiological, psychological, social, and spiritual components
treatment of mental disorders is:"multidisciplinary<br>-Nurses,
social workers, mental health technicians, nurse practitioners, general
practitioners, case managers, etc."
therapeutic use of self"the ability to use one’s personality
consciously &amp; in full awareness in an attempt to establish relatedness
&amp; structure nursing interventions"
therapeutic use of self requires:"Requires self awareness &amp; self
understanding/compassion<br>-Foundation of philosophical belief about
life, death, &amp; overall human condition"
<div>•Hildegard Peplau (1962) =</div>considered mother of psychiatric nursing…identified counseling as major sub-role of psychiatric nursing
"<span style=""color: rgb(0, 0, 0);"">Hildegard
Peplau - theory of interpersonal relationships in nursing</span>"descrives the nurse-patient relationship as the foundation of nurse practice.
"Harry
Stack Sullivan"human beings are driven by the need for interaction;&nbsp;&nbsp;
hildegard peplau taught nurses to viewpatients as PEOPLE before illnesses, care for the pt as well as the illness<br>-nurses help make positive changes and growth
how do nurses build therapeutic relationships:build rapport*&nbsp;<br>-trust<br>-reliability<br>-integrity<br>-sincerity<br>-ensure confidentiality
empathy =considered one of the most important characteristics of therapeutic relationshops
"<span style=""color: rgb(0, 0, 0);"">Which
is the primary nursing goal when establishing a therapeutic relationship with a
client?</span><br><div><span style=""color: rgb(0, 0, 0);"">A.To
promote client growth</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">B.To
develop the nurse’s personal identity</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">C.To
establish a purposeful social interaction</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">D.To
develop communication skills</span></div>"A. To promote client growth<br>-promote client insight and behavioral change directed at growth
phases of therapeutic relationships-preinteraction phase<br>-orientation/introductory phase<br>-working phase<br>-termination phase
preinteraction phase"<div>explore
self-perceptions</div><div>-obtain information about the client from the chart,
significant others or health care team</div><div>-examine own feelings, fears and
anxieties about working with a particular client</div>"
orientation/introductory phase"<div>establish trust and rapport</div><div>-gather assessment data</div><div>- identify strengths and
limitations</div><div>-nursing diagnoses</div><div>-set mutually agreeable goals; develop plan of
action</div><div>-explore feeling both client and nurse</div>"
working phase"<div>promote client change in problem solving</div>
<div>maintain
trust and rapport</div><div>-&nbsp; prmote client’s insight and perception of
reality</div><div>-problem solving model</div><div>-overcome resistance behaviors</div><div>- evaluate
progress toward goal achievement</div>"
termination phase"evaluate
goal attainment &amp; ensure therapeutic closure<br>-feelings about termination should
be discussed<br>-plan of active to continue more adaptive coping <br>-evaluate
progress"
values clarification=clarifying our own values/beliefs so we can step away and provide non-judgemental care<br>*preinteraction phase*
Goals of nurse-patient relationship:-facilitate<br>-assist<br>-help<br>-promote
facilitate:&nbsp;communication of distressing thoughts and feelings<br>-active listening***
assist:assist patients with problem solving
help:help patients examine self-defeating behaviors and test alternatives
promote:self care and independence
therapeutic commincation techniques**open ended questions<br>-close-ended questions for specific info<br>-clarify<br>-paraphrase<br>-restate<br>-reflect<br>-use silence<br>-active listening
therapeutic communication guidlines:-speak briefly<br>-avoid advice<br>-avoid too many questions<br>-watch nonverbal<br>-keep the focus on the client
nontherapeutic communication:-dont approve/disapprove pt (no good jobs, etc)<br>-dont agree or disagree (make their own decisions)<br>-no advice<br>-no probing (asking about what they dont want to talk about)<br>-no defending<br>-no requesting an explanation (why did you..)<br>-dont minimize feelings
"if there is a ""why"" question"it will NEVER be the answer
"communication is based on"""values<br>culture/religion<br>social status<br>gender<br>age / developmental level<br>environment
70-90% of communication isnonverbal
therapeutic phenomena:-transference<br>-countertransference<br>-professional boundaries
transference =a patient develops unconscious feelings about you because you remind them of someone (may like or hate you)
countertransference:you start feeling a specific way about a patient because they remind YOU of someone (biased care or unfair care becauase of negative feelings)
therapeutic use of self requires =dilegence in self awarenes ***
a key to nurse-patient relationships =MUTUAL RESPECT
"""can you please tell me more"" ="exploring
Building trust in therapeutic communication:1. ask and assess emotions<br>2. state the facts (VS, empathy)<br>3.combination&nbsp;
*****view communication techniques in textbook table*****
ETHICAL AND LEGAL = 5Qs
legislation=what is right or good within a society
ethics=branch of philosophy that deals with systematic approaches to distinguishing right and wrong behaviors
bioethics =the term applied when these principles refer to concepts within the scope of medicine, nursing, etc
moral behavior =conduct that results from serious critical thinking about how individuals treat others
values =personal beliefs about what is important or desirable
values clarification =process of self-exploring through which indiviuals indetify and rank their own personal values
right =&nbsp;a valid legally recognized claim or entitlement<br>-encompassing both freedom from government interference or discriminary treatment and entitlement to a benfit or service
legal right =formalized into law
autonomy =&nbsp;patients are autonomous moral agents whose rights to determnine their destiny should always be respected<br>*making their own decisions*
beneficience =ones duty to&nbsp; benefit or promote the good of others
nonmaleficience =do no harm
justice =principle based on the notion of a hypothetical social contract between free, equal, and rational persons
veracity =ones duty to always be truthful
patients have the right to refuse tx: unlessintervention is required to prevent death or serious harm to the pt or another person
"pts have the right to the least restrictive treatment"""-if they can be treated in outpatient, they should not be hospitalized<br>-if hospitalized, they shouldnt be sedated, restrained, or secluded unless less restrictive measures failed
visitors may be restricted if:it negatively effects the pts care
confidentiality =visitors/callers must have the security code in order to know the pt is there.&nbsp;
restraints are considered:abusive (chem or physical)<br>-if you havent first tried the least restricitive methods
medications can be forced if:-pt is a danger to self or others<br>-emergency<br>-med must have a reasonable chance to provide help<br>-if judged imcompetant&nbsp;
who decides competancy:ONLY by a judge in court<br>
deemed: incompetant to make decisions about medications-children<br>-intellectual disabilities
Seclusion and restraints used:-only if less restrictive measures failed<br>---&gt; sitter, nurse prn meds, talk to pt, therapeutic choices
1 hour rule - seclusion/restraintsmust have a face to face evaluation by a licensed independent practioner within one hour of the restraints***
can a nurse initiate seclusion/restraints?YES -&gt; if all else fails and they are an immediate threat<br>--must get an order within an hour of initiation and must be assessed within an hour
Seclusion and restraints: nurses role-15min monitoring &amp; documentation<br>-2hour monitoring &amp; documentation<br>-monitored q30min after discontinued<br>-continuous monitoring<br>-length of order
15 minute monitoring - seclusion/restraints-circulation<br>-behavior<br>-ready to be released?
2 hour monitoring - seclusion/restraints- VS q2hrs (doc. if too violent)<br>- bathroom<br>-food and water<br>-ROM (done one at a time)
Discontinuing restraints/seclusion:-does NOT need an order<br>-- based on nurses judgement<br>-if you need to put them back in, you need a new order
violent restraints =a danger to themselves or others
medical restraints =if they are pulling out tubes or IVs, etc
Medical restraints last:24 hours (renewed qday)
Violent restraints last:order lasts only 4 hours **<br>9-17yr = 2hours<br>&lt;9yr = 1hour
Violent restraints on 9-17yrs oldorder last two hours
Violent restraints on &lt;9 yrs oldorder lasts one hour
After removing restraints: therapeuti care =-debrief the patient<br>-discuss what happened/how to prevent again<br>-reestabilsh rapport
"<div><span style=""color: rgb(11, 208, 217);"">—</span>The
Nurse Practice Act defines&nbsp;</div>"the legal parameters of professional and practical nursing
Confidentiality can be broken if:&nbsp;-a duty to warn<br>-suspected child or elder abuse<br>-certain circumstances in adolescents
-Doctrine of privleged communicationcan share information with the treatment team but have the right to withhold certain information shared with the pt/pt told them
duty to warn =if a patient is going to harm someone, you must warn that person of the potential of being harmed<br>-protected by the state if you warn that person
nurses must document :&nbsp;FACTS, nonjudgemental, and objective data
child or elder abuse:mandatory to report<br>-only people with intellectual disabilities, children, elderly, etc
Abuse of a pregnant partner: nurses rolewe can not call and report a spouse beating a pregnant woman because that child does not have 'rights' until it is born
Communicable diseases: confidentiality-some must be reported to state, etc for public safety&nbsp;<br>-HIV, etc
Confidentiality: allegationsallegations of sexual misconduct with a therapist is to be reported
informed consent:-knowledge<br>-competency<br>-free will<br><br>*help them weigh benefits, provide education, competency
All individuals have the right to decide to accept/reject tx:to preserve and protect their individual autonomy&nbsp;
informed consent: knowledge"<div>Knowledge- client received adequate info
on which to base his/her decision</div>"
informed consent: competency"<div>the
individual’s cognition is not impaired to an extent that would interfere with
decision making or he/she has a legal representative</div>"
informed consent: free will"<div>the individual has given
consent voluntarily without pressure or coercion from others</div>"
tx without informed consent:-if mentally incompetant and tx is necessary<br>-if tx endangers life or health<br>-in an emergency&nbsp;<br>-if a child (consent = parent/surrogate)
Voluntary hospitalization:may institute a 72hr hold to determine need to be admitted involuntarily<br>-if they are a danger to self/others, or very disabled
Involuntary (IVC)-danger to self or others: ***hearing with judge within 7days unless&nbsp;<br>-very disabled and cant care for self<br>-involuntary outpatient
involuntary outpatient-if IVC --&gt; go to court and get 180days (6mos)&nbsp;<br>-must visit provider/therapist and if they dont go the cops can bring them to the inpatient psych ward
"<span style=""color: rgb(0, 0, 0);"">As
a last resort, an agitated, physically aggressive patient is placed in
four-point restraints. The patient yells, “I’ll sue you for assault and
battery!” the unit manager determines that the nurses are protected under which
condition?</span><br><div><span style=""color: rgb(0, 0, 0);"">—A.
the client is voluntarily committed and poses a danger to others on the unit</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">—B.
the client is voluntarily committed and has a history of being a danger to
others</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">—C.
the client is voluntarily committed because of a history of violent behavior</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">—D.
the client in involuntarily committed and refusing treatment</span></div>
<div></div>""<div><span style=""color: rgb(11, 208, 217);"">—</span>A. the client is voluntarily committed and poses a danger to others on the unit</div><div>-as a threat to others, the client can be restrained despite objections and voluntary commitment</div>"
Culture:-shared beliefs, values, and practices that guide a group members in patterned ways of thinking/acting<br>*the blueprint for guiding actions that impact care, health, wellbeing
Culture develops concepts of MH and illness:-stigma changes from each culture<br>-the views of MH change from culture to culture
western culture =science based: individuality, mind and body = two seperate entities
Eastern culture:based on balance - family as basis for identity, body-mind-spirit = one entity
indigenous culture:based on harmony: significance on the place of humans in the natural world<br>-relationship with nature: time is focused on the present
Nonverbal: culture-eye contact<br>-personal space<br>-touch<br>-conversation styles<br>-expressions
Cultural assessment: questions"-what do you call this illness?<br>-what do you think caused it?<br>""what do you think/how do you think"""
cultural assessment - key points-diagnosis<br>-onset<br>-etiology<br>-course<br>-prognosis<br>-treatment
cultural assessment •Goal:&nbsp;to develop a therapeutic plan that is mutually agreeable, culturally acceptable, and productive of positive outcomes
"Health
disparities:&nbsp;""<div>Differences in health status among
distinct segments of the population including differences that occur by gender,
race or ethnicity, education, or income, disability, or living in various
geographic localities</div>"
<div>Health inequities:&nbsp;</div>disparities in health that are a result of systemic, avoidable, and unjust social and economic policies and practices that create barriers to opportunity
health disparities and inequalities: examples"<div>**ACES, social exclusion, poor education,
discrimination, poverty, food insecurity, un(under)employment, high-risk
behaviors, poor access to care, Health policy, genetics, pathogens, toxins</div>"
ACES =adverse childhood experiences<br>-the more = the worse the outcome<br>-food insecurities, commitment, neglect
<div>Food insecurity:&nbsp;</div>availability of nutritionally adequate and safe foods or the ability to acquire such foods in socially acceptable ways, is limited or uncertain
disparities in MH:-most racial/ethnic group have same amount of MH disorders as whites BUT the consequences are more severe&nbsp;<br><br>*less access to care, higher stigma, etc
Racial minorities: MH-black depression is more persistant (higher incarceration rates, lower incomes, less education) --&gt; INSTITUTIONAL RACISM**<br>-american indians = higher rates of PTSD and alcohol dependence
Minority youth:behavioral issues more likely to be put in juvenille justice system instead of primary care<br>-stigma
solutions to disparities:-reduce stigma<br>-proper dx<br>-increase number of minority providers<br>-tx mental health problems instead of incarceration<br>-MH providers for MH crisis instead of police
NAMI : mental health emergencu number988
spirituality definition:"<div>•human quality that gives meaning &amp; sense of purpose
to an individual’s existence</div>"
Spirituality:&nbsp; nursing diagnosis&nbsp;"<div>Risk for spiritual distress&nbsp; (disasters, severe injuries, PTSD, unexpected
deaths, violence, terminal illnesses)</div>"
Spiritual assessment: FICAF- faith (do they have belief?)<br>I - importance (how important is it)<br>C - community (do they belong to a faith community, church)<br>A - address (how would you like the psych team to integrate this into your care)
Spiritual outcome:-ID meaning and purpose in life<br>-acceptance as self<br>-accept and incorporate healthy changes in life
"<div><span style=""color: rgb(0, 0, 0);"">—A
patient with a bipolar disorder diagnosis is having religious delusions. How
might the delusions impact the spiritual assessment?</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">—A.
Delusional patients cannot participate in assessments</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">—B.
Religious delusions will have no impact on the spiritual assessment</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">—C.
Assessment findings cannot be relied upon</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">—D. It
may be difficult to differentiate from general religious beliefs&nbsp;</span></div>""<span style=""color: rgb(11, 208, 217);"">—</span>D. It may be difficult to differentiate from general religious beliefs&nbsp;<br>-approx. 15% of people with bipolar disorder have religious delusions (can be hard to differentiate from general relgious beliefs)"
hyperreligiousity -relgion obssession that interferes with their ability to fxn
religious delusion : ex.believing they are jesus
Ethics/legal: summaryKnowledge and consistency of ethical and legal issues: ***<br>cultural sensitivity with diverse populations<br>significance of spirituality of health and well-being
which statement made by the nursing student is an example of steroetyping and requires correction"""since you are hispanic, I will call a priest and have him come bring you communion"""
when working with clients of any culture, which action should the nurse avoidadduming all individuals within a culture / ethnic group are similar
a clients wife tells the nurse that her husband strongly believes he is jesus. she states that she tells her husband he is not but he truly believes he can perform miracles. What disorder should the nurse suspect the patient has?schizophrenia
during the first interview with a man from syria who just lost his son in a car accident, the female nurse hugs him. WHich is an accurate regarding the nurses action?it is unacceptable as it may pose a breach of cultural norms
the nurse notices the filipino client has not been eating. the client moves the food around on the plate. which nursing diagnosis would be appropriateimbalanced nutrition, less than body requirements, related to unfamiliar foods provided in the health care setting.&nbsp;
the nurse is assesssing a new client. which strategy indicates an understanding of appropriate cultural considerationsthe nurse speaks slowly and clearly and repeats questions if needed
"The psych mental health nurse is performing the admission assesssment on a client who is being admitted for depression and anxiety. The client reports a long hx of alcohol use and the recent loss of her job. She states "" I used to believe in God, but I dont anymore. I dont understand how GOd can allow bad things to keep happening to me. Which nursing diagnosis will the nurse use?"risk for spiritual distress
the nurse is developing outcomes related to the nursing diagnosis of spiritual distress. which outcmoes will the nurse make a priority for this pt.&nbsp;identify and understand the meaning and purpose in life
which statement refelcts an understanding of the concepts of religion and spirituality?an individual mayexpress their spirituality through religion
propr to interviewing a client of a different culture, which question would the nurse consider asking?-who may be present during the interview<br>-should communication patterns be modified to accomodate this pt<br>-how much eye contact should be made<br>-would hand shaking/touch be acceptable
which stateents are correlated with an individuals affiliation with a religious faith-decreased incidence of mental illness<br>-increased chance of survival after serious illness<br>-better phys and mental health
which statements indicate the effects of love on the healing process?-increased produuction of norepi reduces susceptability to depression<br>-decreased inflammation is due to improved immune fxn<br>-increased oxytocin reduces cardiovascular stress
hippocampus =stores memories
frontal lobe =-personality, decision making, problem solving
if stressed and in fight or flight: frontal lobe=shuts down - cant make decisions
amygdala = responsible foranger and fear
brainstem =&nbsp;breathing and regulation --&gt; calms and slows thoughts
learning and storage of memories =happens when we are CALM
&nbsp;hypothalamus = responsible for-temperature regulation<br>-appetite<br>-BP<br>-thirst<br>-circadian rhythms (sleep)<br>*when pts are on meds that affect serotonin -it can affect all those areas)
what neurotransmitter do meds for anxiety and depression work on?serotonin**&nbsp;<br>-monoamines = serotonin, norepi, dopamine
parasympathetic + vagus nerve&nbsp;-slow down HR<br>-constricts bronchi<br>-stimulates peristalsis and secretions<br>-stimulates release of bile + saliva<br>contracts bladder
sympathetic + stress-dilates pupils<br>-inhibits saliva<br>-increase HR<br>- dilats bronchi<br>-inhibits peristalsis&nbsp;<br>-glycogen --&gt; glucose<br>-secretes adrenaline and noradrenaline<br>-inhibit bladder contractions
Thyroid testing - hyperthyroidism&nbsp;hyperthyroidism can MIMIC anxiety (TSH less than 0.4)
Thyroid testing - hypothyroidism&nbsp;hypothyroidism can MIMIC depression
neurotransmitters: cholinergicsacetlycholine
neurotransmitters: monoaminesnorepinephrine<br>dopamine&nbsp;<br>serotonin<br>histamine
neurotransmitters: amino acidsinhibitory amino acids<br>excitatory amino acids
neurotransmitters: neruopeptidesopiod peptides<br>substance P<br>somatostatin
benzodiazapines:increases GABA affect
SSRIs:increase serotonin
SNRIs:increase both serotonin &amp; norepi
TCAs :increase norepi and serotonin and some increase acetlycholine and histamine
NDRIs:&nbsp;increase norepi and dopamine
MAOIs&nbsp;increase monoamines
Antipsychotics:decrease dopamine,<br>&nbsp;atypical decarease dopamine and increase serotonin
Sleep: is represented bysix stages<br>-must go through each stage --&gt; not going through each stage affects MH
Sleep: serotonin and norepiappear most active during non-REM sleep.<br>--&gt; not geting enough sleep means not replenishing norepi and serotonin to appropriate levels
L-tryptophan =**high protein foods<br>--&gt; turkey, milk, etc
the master clock that controls circadian rhythms =the HYPOTHALAMUS
Brain : forebrain =cerebrum<br>diencephalon
brain : midbrainmesencephalon
brain : hindbrainpons<br>medulla<br>cerebellum
cerebrum =largest part of the brain<br>-corpus callosum seperates each side
parietal lobes:&nbsp;sensory areas + reading / arithmetic<br>-temp, taste, smell, touch, etc
temporal lobes:auditory<br>short term memory<br>interpretation of language (left)
occipital lobe:visual reception/interpretation<br>-spatial awareness
limbic system:the emotional brain&nbsp;
TSH: thryoid stimulating hormone =TSH is essential blood test for mood/behavior symptoms
acetylcholine -nerves and muscle junction&nbsp;<br>-sleep<br>-srousal<br>-pain<br>-perception<br>-coordination<br>-memory retention<br>*parkinsons and alzheimers
noerpinephrine - monoamine-fight or flight&nbsp;<br>-mood<br>-cognition<br>-perception<br>-cardio fxn<br>-sleep
dopamine - monoamines:-regulation of movement<br>-emotions<br>-voluntary decision making<br>-inhibits release of prolactin --&gt; (high) = associated with mania and schizo<br>(low) = parkinsons and depression
serotonin - monoamine:-sleep&nbsp;<br>-arousal<br>-libido<br>-appetite<br>-mood<br>-aggresion<br>-pain pereption<br>*anxiety
histamine - monoamine-allergic and inflammatory rxn<br>-sleep<br>-mood<br>-learning<br>-cognition<br>-appetite<br>-eating behaviours<br>*alterations --&gt; epilepsy, stroke, anxiety, depression, psychosis, neuroinflamm.&nbsp;
inhibitory amino acidsGABA and glycine:<br>-gabe --&gt; anxiety, movement, epilepsy&nbsp;<br>glycine - spastic disorders
excitatory amino acids =glitamate and aspartate<br>- glutamate - neuroegenerative disorderse (increased glutamate = alzheimers)<br>-lack of glutamate --&gt; autism, OCD, schizo, depression
opiod peptides:pain modulation
substance P-sensory transmision and pain regulation<br>-elevated - depression and PTSD
somatostatin-high concentrations - huntingtons disase<br>-low concentrations - alzheimers disease
narcolepsydont go through all the stages of sleep and dont get the deep enough sleep that they need and fall asleep during day
sleep apnea-often have MH issues because not getting enough sleep from waking up at night
Mental health assessment - 3qs
mental status exam-full hx<br>-physical exam<br>-mental exam<br>-interviews (with a kid --&gt; interview caregivers and teachers)<br>-scales (suicide scales, etc)
mental status exam - presentation and appearance-apparent age<br>-dress<br>-cleanliness<br>-posture (anxious fold in on self)<br>-gait<br>-expressions (and affect)<br>-eye contact<br>-pupils (dilated, constricted)
mental status - motor activity and behavior- level of activity (lethary, tense, etc)<br>-type of activity (tics, grimace, tremors)<br>-unusual mannerisms, compulsions
mental status exam: speech-rate<br>-volume<br>-ammount<br>-characteristics (stutter, slurr, accent)
mental status exam: mood and affectMood = how they say they feel<br>Affect = how their expression looks<br>*does their face match their mood*
euthymic =good mood
mental status exam: interaction during interview-cooperative, hostile, guarded,etc<br>-clarify observed behavior
&nbsp;normal thought processlogical<br>goal directed<br>meaningful
disordered thought - loose associations*psychosis<br>-thoughts are looseley connected but dont form a coherent thought
disordered thought - flight of thought*mania*<br>-jump from one thought to another with no connections
disordered thought - neologismsmade up words
disordered thought - word saladwords put together with no meaning
disordered thought - clang associations-rhyming or same letter words
disordered thought - thought blockingtake a long time to answer/process
disordered thought - tangentialitygo on tangent and never answer the question
disordered thought - circumstantiality&nbsp;give unrelated information and then finally answer the question
disordered thought - perseverationstuck on one thought and cant get over it
disordered thought - ruminationsstuck on one thought and goes over and over --&gt; churning thought
thought content - delusionsfixed false beliefs
thought content - thought broadcastingthink people can read thoughts
thought content - though insertionthink people are putting thoughts in your head
thought content - depersonalizationfeels like they are outside of theirselves looking in --&gt; trauma
thought content - idea of reference&nbsp;special messages on tv, etc
thought content - magical thinkingspecial abilities&nbsp;
thought content - nihilistic ideasnothing is real or nothing matters
thought content - obsessionsOCD + compulsions = the need to act
perceptual disturbances =deals with the five senses **
perceptual disturbances: hallucinationssee something without sensory stimulation --&gt; nothing there
perceptual disturbances = illusionssees something from a sensory stimulus (waterbottle = see a doll head)
Hallucinations --auditory **most common**<br>-visual<br>-tactile<br>-gustatory - potential tumor?<br>-olfactory<br>- ---- others may be organic cause like potential tumor?
cognition assessmentLOC<br>orientation<br>memory&nbsp;<br>intellect<br>attention<br>abstraction<br>insight<br>judgement
mini-mental assessment-clock drawing<br>-recall<br>-etc
abstract thought:developed in elementary school<br>- being able to understand analogies (if not = concrete thinking)
insight =do they understand illness, what it means, and how to care for it
psychosocial assessment also includescultural and religious&nbsp;
TYPES OF THERAPY - Qs2
delusion vs hallucinationdelusion = she strongly believes a camera is watching her<br>hallucination = she sees a camera that isnt there
the best treatment for a patient with MH disorders =combination therapy<br>-meds + other forms of therapy
therapeutic milieu =therapeutic ENVIRONMENT&nbsp;
somatic therapies =body - grounding, yoga, light, etc
Therapy groups =recreational therapist<br>-teach coping skills&nbsp;<br>to regulate emotions
group concepts - group development-orientation<br>-working<br>-termination<br>*open or closed -- rotate in and out
Yalom's therapeutic factors -&nbsp;- instillation of hope<br>-universality<br>-imparting of information<br>-altruism<br>-corrective recapilatuion of the primary family group<br>-development of socializing techniques<br>-imitative behavior<br>-group cohesiveness<br>-catharsis<br>-existential resolution
Yalom's therapeutic factors -&nbsp; universalityhelps people realize they are not alone -&gt; others go through similar
Yalom's therapeutic factors - altruismdoing good --&gt; helps to help others
Yalom's therapeutic factors - corrective recapitulation of the primary family grouphelps work through family problems in a group setting
Yalom's therapeutic factors - catharsisgets the weight off your chest
Yalom's therapeutic factors -&nbsp; existential resolutionfind purpose
issues in individual therapy: resistancedo NOT want to discuss a topic --&gt; dont go there but make a note about it
&nbsp;therapeutic alliance"Ability of client and therapist to work
together and be invested emotionally in the therapy”&nbsp;"
classical conditioning&nbsp;leaning by involuntary behaviors (pavlov)
operant conditioning&nbsp;relationship between voluntary behavior and environment .. influenced by consequences of actions (skinner)
self-change =pt is the change agent, nurses are just the coach
self-efficacy -&nbsp;all pts have strengths<br>knowledge is NOT change
"<font color=""#564b3c"">Goals of cognitive therapy</font>""<div><span style=""color: rgb(0, 0, 0);"">Monitor
his/her negative, automatic thoughts</span><br></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Recognize
the connections between cognition, affect and behavior</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Examine
the evidence for and against distorted automatic thoughts</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Substitute
more realistic interpretations for the distorted thoughts</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Learn
to identify and alter dysfunctional beliefs that predispose him/her to distort
experiences</span></div>"
automatic thoughts ="immediate negative thoughts<br>- gets revised journal and thinks "" I am a bad writer"""
cognitive behavioral therapy =most researched form of psychotherapy<br>-ABCs - affective (feeling), behavioral (actions) and cognitive (thoughts)
automatic thought: types-catastrophic - think worst will happen<br>-minimization - minimize hard work<br>-mindreading
Dialectical Behavioral Therapy (DBT) =-problem solving<br>-social skills<br>-mood monitoring<br>-modeling<br>-meditation<br>-homework
DBT therapy - forBoderline personality disorder **
family interventionsindividual problems affect entire family<br>-psychopathology often rises from family dysfxn
somatic therapy - phototherapylight therapy&nbsp;<br>-depressive disorders<br>--sunlight, lamps, boxes, visors<br>-seasonal affective disorder
somatic therapy - phototherapy **must know**may precipitate mania or hypomania in Bipolar disorder
therapy main types-use multiple therapuetic methods<br>-individual<br>-group<br>-family
defense mechanisms-protect against feelings, pain, anxiety
DEPRESSIVE DISORDERS - 8Qs
depressive disorder-cant care for themselves<br>- anger turned inward - irritable<br>-one of the most common psych illnesses
depression becomes a pathological problem when-adaptation is ineffective<br>-it impairs fxn, mood, being with friends, etc
Mood =pervasive and sustained emotionthat may have a major influence on perception
affect =&nbsp;observable emotion
depression =&nbsp;alteration in mood expressed by sadness, despair, and pessimism<br>-appetite, sleep, and cognition changes
persisent depressive disorder =&nbsp;dysthymia
Premenstrual dysphoric&nbsp; disorder (PMDD)the week prior to menses<br>- improves shortly after onset of menstruation<br>-goes away after menses
anhedonia =loss of interest or pleasure in usual activities **
Major depressive disorder***-depressed mood or<br>-anhedonia<br>-wt loss/gain<br>-fatigue<br>-insomnia / hypersomnia&nbsp;<br>-s/s for 2 weeks<br>-no hx of manic behavior<br>-may have psychosis
depressive disorder associated with a medical conditionattributable to the direct physiological effects of a general medical condition
persistant depressant disorder&nbsp;-'down in the dumps'<br>-no psychotic s/s<br>-***chronically dpressed for most of the day, more than not, at least 2 years***
substance or medication induced depressive disorder-result of substance use<br>-meds or toxin exposure<br>-intoxication or withdrawal increase depressive mood
major depressive disorder = leading cause of&nbsp;disability in the united states
"<div><span style=""color: rgb(86, 86, 86); font-weight: bold;"">A client is admitted to the mental health unit with a diagnosis of
depression. The nurse should develop a plan of care for the client that
includes which intervention?</span></div>
<div><br></div>""<div><span style=""color: rgb(86, 86, 86);"">4</span><span style=""color: rgb(86, 86, 86);"">) A structured program of
activities in which the client can participate</span></div>"
predisposing factors to depression"<span style=""color: rgb(0, 0, 0);"">-genetics may be involved<br>-**deficiency of norepinephrine, serotonin, and dopamine **</span>"
physical movement comes to a standstillpsychomotor retardation
persistent depressive disorderdysthymic disorder
childhood depression =can be very hard to diagnose
adolescense depression-"<span style=""color: rgb(0, 0, 0);"">loss of self asteem<br>sleep disturbances<br>changes in appetite<br>*change in behavior**</span>"
older adult depression =-suicide and depressive are&nbsp; very serious because lonely and old
postpartum depression =-50-85% of women
four spheres of human functioning-affective (flat, no emotion, apathy = no pleasure)<br>-behavioral (posture, activity, hygiene)<br>-cognitive (concentration, confusion, decisions)<br>-physiological (slowdown of entire body, constipation, decreased output and libido, sleep changes)
"<div>The
nurse suspects the client of having MDD due to the client having psychomotor
retardation. Which of the following would be an example of psychomotor
retardation?&nbsp;</div>""<div>&nbsp;The client is disheveled and
malodorous.</div>"
"<div>The front of this card is blank.<br><a href='https://docs.ankiweb.net/templates/errors.html#front-of-card-is-blank'>More information</a></div>""<div>The front of this card is blank.<br><a href='https://docs.ankiweb.net/templates/errors.html#front-of-card-is-blank'>More information</a></div>"
priorities for someone with major depressive disorder-risk for suicide (create safe environment)<br>-low self-esteem/self-care deficit (perform ADLs, teach assertiveness, I+Os)<br>-powerlessness (encourage self-care and goals)
major depressive disorder - treatments-individual psychotherapy, group therapy, family therapy<br>-cognitive therapy (changing automatic thoughts)<br>*use very basic language**<br>-ECT<br>-rTMS (magnetic energy to stimulate nerve cells in brain)<br>-Vagal nerve stimulation &amp; deep brain stimulation<br>-light therapy (seasonal affective disorder)<br>-physical exercise&nbsp;
major depressive disorder - drugs to -tx resistant depression-ketamine (IV)/esketamine (nasal spray)/psychedelic drugs<br>-tx resistant depression
the most effective tx for major depressive with psychotic effectsECT&nbsp;<br>(only after meds tried and failed)
ketamine / esketamine are&nbsp;fast acting antidepressants&nbsp;<br>-work within hours/days
antidepressants (6Qs) - depression 2Qs
Antidepressants - Black Box warningSSRI - increased risk of suicide among children, adolescent, and young adults ****
types of antidepressantsSSRI<br>SNRI<br>TCA<br>MAOI<br>Atypical anto-depress<br>Atypical anti-psych
How do antidepressants work?- neurotransmitters (seratonin, norepi, dopamine)<br>--&gt; stored in presynaptic neurons<br>*antidepressants block reuptake -&gt; leaving more neruotransmitters available
antidepressants may take:up to two weeks for s/s of improvement<br>-up to four weeks for full therapeutic benefits
Goal of antidepressant therapy:complete remission of s/s
tricyclic antidepressants - can take ___ to work4-8wks to work
SSRI's - increase serotonin&nbsp;***first line of tx --&gt; fewest side effects***<br>-citalopram (celexa)<br>-escitalopram (lexapro)<br>-fluoxetine (prozac)<br>-paroxetine (paxil)<br>-sertraline (zoloft)
SSRIs side effectsnausea<br>agitation<br>headache<br>sexual dysfxn
serotonin syndrome =accumulation of serotonin (usually from combination of SSRI with other meds)
initial s/s of serotonin syndrome&nbsp;restless/agitation<br>diaphoresis<br>elevated BP<br>cog wheel rigidity<br>-diarrhea<br>-fever
progressive s/s of serotonin syndrome-hyperpyrexia<br>-tonic rigidity ***<br>*can be FATAL*
pts develop serotonin syndrome if they combine SSRIs:with other serotonin increasers<br>-MAOIs<br>-ecstasy<br>-st. johns worts<br>-SNRIs
dyscontinuation syndrome -&nbsp;not fatal<br>-from abrupt withdrawal<br>-flu-like s/s<br>-2-4 days after stoping med and can last 2-4wks<br>**taper slowly**
SNRIs - meds-Venlafaxine<br>-duloxetine&nbsp;<br>-Desvenlafaxine&nbsp;
SNRIs- venlafaxinemonitor hypertension
SNRIs - duloxetine-may reduce pain or SOMATIC S/S associated with depression<br>-used for fibromyalgia and diabetic neuropathy
SNRI = increasesserotonin and norepinephrine increases
SNRIs - side effects- nausea<br>-sweating<br>-insomnia<br>-tremors<br>-sexual dysfxn
Tricyclic antidepressants (TCAs)-amytriptyline<br>-doxepin (neuropathy)<br>-imipramine (*bedwetting)<br>clomipramine
Tricyclic antidepressants (TCAs) - increasenorepi and serotonin<br>-10-14 days to start to work<br>4-8wks<br>*cause sedation so TAKE AT NIGHT
Tricyclic antidepressants (TCAs) - side effects"<span style=""color: rgb(0, 0, 0);"">sexual dysfxn<br>-sedation<br>-weight gain<br>-dry mouth, constipation, blurry vision, urinary retention (anti-cholinergic)<br>-postural hypotension and tachycardia</span>"
Tricyclic antidepressants (TCAs) - elderlyuse caution due to *postural hypotension* and tachycardia<br>**most serious SE = cardiovascular - risk in older pt with heart issues
Tricyclic antidepressants (TCAs) **must know risks**VERY LETHAL&nbsp;<br>-not a good choice if risk of suicide/attempts
MAOIs - meds-phenelzine<br>-tranycypromine<br>-isocaboxacid<br>-selegiline transdermal patch
MAOIs - side effects"<span style=""color: rgb(0, 0, 0);"">sedation and dizzy<br>sexual dysfxn<br>*HTN crisis (interaction with tyramine and high caffeine food/drink) **dont take with OTC cold/cough meds**</span>"
high tyramine foods - avoid with MAOIs-aged cheese, wine and beer, chocolate, coffee, colas, sourcream, smoked/processed meet, raisins, soy sauce, diet pills,cold meds
atypical antidepressants - meds-bupropion<br>-nefazadone<br>-trazodone<br>-mirtazaphine
atypical antidepressants - bupropion- also for smoking cessation (zyban)<br>-no sexual dysfxn **<br>SE: insomnia, dry mouth, tremor, seizure, decreased appetite<br><br>-increases Norepi and dopamine but NOT serotonin (no risk of serotonin syndrome)
atypical antidepressants - nefazadoneBlack box warning - hepatotoxic
atypical antidepressants - trazodone&nbsp;given for sleep and anxiety<br>-can cause priapism *prolong errection **
atypical antidepressants - mirtazaphine&nbsp;sleep and appetite
"<div><span style=""color: rgb(86, 86, 86); font-weight: bold;"">When teaching about the tricyclic group of <br>
antidepressant medications, which information should the nurse include?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">B) The full therapeutic
potential of tricyclics may not be reached for 4 weeks.</span></div>"
"<div><span style=""color: rgb(86, 86, 86); font-weight: bold;"">A patient has been diagnosed with major depression. The
psychiatrist prescribes Paroxetine (Paxil). Which of the following medication
information should the nurse include in discharge teaching?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">C) The medication should
not be discontinued abruptly.</span></div>"
"<div><span style=""color: rgb(86, 86, 86);"">&nbsp;first antidepressant prescription.</span></div>""<span style=""color: rgb(217, 156, 33);"">•</span><span style=""color: rgb(86, 86, 86);"">Between 30 and 50 percent of patients do not respond to</span>"
**loss of interest or pleasure in usual acitivitiesanhedonia
3 neurotransmitters with depression ***-seratonin<br>-dopamine<br>-norepinephrine
***depressed pts cognition -have trouble so use SIMPLE sentences and explanations so they can understand
cognitive therapy for pts with depression ***turns automatic thought (negative) into something more positive
***tx for seasonal affective disorder**light therapy&nbsp;
**SSRI + SNRI** or SSRI + st john wort =serotonin syndrome
** most common s/s of serotonin syndrome**diaphoresis and rigidity<br>FATAL risk
**antidepressant - discontinuation syndrome&nbsp;- DO NOT ABRUBTLY WITHDRAWAL<br>- taper off
*tricyclic antidepressants can take4-8wks for full effect
**MAOIs must know-avoid tyramine high foods - aged cheese
**atypical antidepressant - mirtazaphine - used forsleep and appetite
highest priority for someone with depression **suicide risk and safety
tricyclic antidepressants - concerns ***very lethal&nbsp;<br>-do NOT give to pt with hx of overdose/suicide attempt
trazidone - given for **depression and SLEEP
which antidepressants have the feweest SE? **SSRIs
duloxetine - SNRI ** helps withSOMATIC - body s/s<br>-fibromyalgia and neuropathic pain
The aging adult 2Qs
average life expectancy for a child in the US77 years
"being ""old"" is based on"-attitude<br>-MH<br>-physical health<br>-degree of independence
"<div><span style=""color: rgb(0, 0, 0);"">Which population do you think is more likely to be married?</span></div>""<div><span style=""color: rgb(0, 0, 0);"">&nbsp;Men &gt; 65 years of age</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">Do you think that most older adults live in institutions?</span></div>"NO&nbsp;
"<div><span style=""color: rgb(0, 0, 0);"">Do you think individuals 65 and older work or are seeking work?</span></div>"yes
Mental illness in elderly"<div><span style=""color: rgb(0, 0, 0);"">•Emotional and mental
illnesses also increase over the life cycle – <span style=""font-weight: bold; font-style: italic;"">Depression</span> is particularly prevalent</span></div>"
most common conditions in older adults-HTN<br>-arthritis&nbsp;<br>-heart disease<br>-DM<br>-cancer<br>-stroke
short term memory&nbsp;deteriorates with age
Long term memorydoes not deteriorate with age
time required for older aduly memory scanning =linger for both recent and remote recall
intellectual fxn: in older adult-appears to be regular across adult life span<br>-fluid abilities --&gt; solving novel problems tend to decline (solving new problems)
learning ability in older adults-continues through life, strongly influenced by activity, interests, health, experiencs<br>-teacher may need to adjust teaching methods
bereavement overload =several people die in short time --&gt; grief --&gt; implicated in depression
Neurocognitive disorders (NCDs) in older adultsgradual, progressive cognitive impairment
delirium in older adults-abrupt onset and time limited<br>-new medications, med interactions, infection, electrolyte imbalance<br>**short onset --&gt; can be reversed
neurocognitive disorders in older adult =slow and gradual onset*
depression in older adultsmost common affective illness in elderly
older adult sexuality- if healthy and able, they can have full and sexual activities
elderly abuse=1 in 10 adults in US&nbsp;<br>-only 45% of adults &gt;65 yrs old report the abuse<br>-abuser = realtive or caregiver
risk factors for elder abuse-white female<br>-&gt;70yr<br>-mental or physical impairment<br>-inability to meet ADLs<br>-care needs that exceed caretakers abilities
Elder abuse MUST be:reported!
factors that contribute to elder abuselonger life<br>dependency<br>stress<br>learned violence
recognize cues of elderly abuse -&nbsp;(psych and verbal abuse)-depressed, withdrawn, confused, agitated
recognize cues of elderly abuse -&nbsp; (phys abuse)-bruises, welts, lacerations, hair pulling, dislocations and fractures, broken glasses
recognize cues of elderly abuse - (neglect)-wt loss, poor hygiene, innappropriate dress, fatgiue, unattended needs
recognize cues of elderly abuse - sexual abuse-pain or itching<br>-bruising or bleeding<br>-STIs&nbsp;<br>-torn or ripped clothing
recognize cues of elderly abuse -&nbsp; financial abusedisparity between assets and living conditions<br>-sudden lack of funds
"<div><span style=""color: rgb(0, 0, 0);"">Abuse of elderly individuals is a serious form of family violence.
The abuser is often found to be which of the following?</span></div>""<div><span style=""color: rgb(0, 0, 0);"">a relative who lives with the elderly person and may be the
assigned caregiver</span></div>"
Suicide - elderly population"<div><span style=""color: rgb(0, 0, 0);"">•Men 65 years and older have the highest overall rate of suicide </span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Suicide rate for White men over 65 – 5x higher than the general
population</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Older adults account for 18% of all suicides</span></div>"
predisposing factors to elderly suicide-lonely<br>-financial problems<br>-illness<br>-loss:depression
"<div><span style=""color: rgb(0, 0, 0);"">Assessment of elderly people must consider</span></div>""<span style=""color: rgb(0, 0, 0);"">&nbsp;the possible biological, psychological, sociocultural, and sexual changes that occur in the normal aging process.</span>"
"<div><span style=""color: rgb(0, 0, 0);"">Reminiscence therapy is
especially helpful with elderly patients.</span></div>""<div><span style=""color: rgb(0, 0, 0);"">‒Increases self-esteem</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">‒Decreases likelihood of
depression</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">*Can take place on a
one-to-one basis or in a group setting</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">Which therapy is most effective in decreasing depression in elderly
patients?</span></div>""<div><span style=""color: rgb(0, 0, 0);"">Reminiscence therapy</span></div>"
advanced directives for elderly adultwrite down wishes if no longer competant for making decisions<br>-healthcare power of attorny --&gt; makes healthcare decisions for an incompetent patient (living will + POA = best)
**most elderly do ____ live in institutionsNOT
elderly ___ are more likely to be married **MEN
** ____ is veryprevelent in elderly populations&nbsp;Depression and suicide
*short term memoryDOES decline with age
**long term memorydoes NOT decline with age
**intellectual fxn&nbsp;does NOT decrease with age, but may need adjusted teaching ways
**MUST reportsuspected elder abuse
**bereavement overload** sudden loss of a lot of close friends --&gt; grief and depression
SCHIZOPHRENIA (5Qs) - meds for psychosis (7Qs)
Schizophrenia is derived from&nbsp;skhizo (split) + phren (mind)
schizophrenia is believed to be an accumulation of too muchdopamine or serotonin
"<div><span style=""color: rgb(0, 0, 0);"">•Schizophrenia is most likely a biologically based disease, the
onset of which is influenced by</span></div>""<span style=""color: rgb(0, 0, 0);"">&nbsp;factors in the internal or external environment.</span>"
"<div><span style=""color: rgb(0, 0, 0);"">Of all mental illnesses, schizophrenia probably causes more:</span></div>""<div><span style=""color: rgb(0, 0, 0);"">•Lengthier hospitalizations</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Chaos in family life</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Costs to individuals/governments</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Fears</span></div>"
Schizophrenia - suicide"<div><span style=""color: rgb(0, 0, 0);"">Risk for suicide is a major concern.</span></div><div><span style=""color: rgb(0, 0, 0);"">-About 20-40% of people with schizophrenia attempt suicide and about
5% die from the act.</span></div>"
"<span style=""color: rgb(0, 0, 0);"">Psychosis</span>""<div><span style=""color: rgb(0, 0, 0);"">disorganization of the personality, deterioration in social
functioning, and loss of contact with, or distortion of, reality.</span></div><div><br></div><div><div><span style=""color: rgb(0, 0, 0);"">•May be evidence of
hallucinations and delusional thinking</span></div></div>"
"<div><span style=""color: rgb(0, 0, 0);"">Schizophrenia causes disturbances in</span></div>""<div><span style=""color: rgb(0, 0, 0);"">•Thought processes</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Perception </span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Affect</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">With schizophrenia, there is a severe deterioration of</span></div>""<span style=""color: rgb(0, 0, 0);"">social and occupational functioning.</span>"
"<div><span style=""color: rgb(0, 0, 0);"">In the United States, the lifetime prevalence of schizophrenia is
about</span></div>""<span style=""color: rgb(0, 0, 0);"">&nbsp;1 percent.</span>"
thought processes =the thoughts are not connected&nbsp;
perception =hallucinations auditory and visual
affect in schizophreniavery blunted --&gt; restriction of emotions or blank
"<div>The front of this card is blank.<br><a href='https://docs.ankiweb.net/templates/errors.html#front-of-card-is-blank'>More information</a></div>""<div>The front of this card is blank.<br><a href='https://docs.ankiweb.net/templates/errors.html#front-of-card-is-blank'>More information</a></div>"
schizoaffective disorder =schizophrenia mixed with bipolar s/s
schizophrenia - Thought Content : delusionsfalse personal beliefs
schizophrenia - Thought Content : delusions of persecution/paranoiaextreme suspiciousness of others - thinking they are going to poison/kill/etc them
schizophrenia - Thought Content : grandiose delusionsfeel they are very important people --&gt; mission from God or think they are Jesus
schizophrenia - Thought Content : delusions of referencethink people are sending them messages through paper or tv
schizophrenia - Thought Content : delusions of control or influenceMAGICAL THINKING:<br>believe they have powers or believe thoughts can control things
schizophrenia - Thought Content : somatic delusionsbelieve there is something wrong with them (believe prgenant even with neg tests)
schizophrenia - Thought Content : erotomanic delusionsin love and obsessed with someone
schizophrenia - Thought Content : jealous delusionsthink their partner is cheating on them even if no evidence, may attack 'cheater/cheatee'
"<span style=""color: rgb(86, 86, 86);"">positive symptoms =</span>"highly exagerated symptoms that you would not see in normal population --&gt; highly out of tune with reality&nbsp;
DELUSIONS =&nbsp;THOUGHT CONTENT<br>**positive signs**
"<span style=""color: rgb(86, 86, 86);"">“The alien implanted a chip into my brain, so they can now control my thoughts.” =&nbsp;</span>"delusions of control or influence --&gt; believe that certain objects or persons have control over their behavior
grandiouse delusions -&gt;exagerated feeling of importance, power, knowledge
Disturbance in thought processes - manifested in speech: flight of ideasabruptly changing topics&nbsp;<br>-very severe<br>talk very fast
Disturbance in thought processes - manifested in speech:&nbsp; loose associationsshift of ideas from one unrelated topic to another<br>-speech may be incoherent
Disturbance in thought processes - manifested in speech:&nbsp; tangentialityinabile to get to the point in communication because they introduce many new topics
Disturbance in thought processes - manifested in speech:&nbsp; circumstantialitydelay in reaching the point because of unnecessary details, but do eventually get to the point
Disturbance in thought processes - manifested in speech: word saladgroup of words put together that make no sense
Disturbance in thought processes - manifested in speech:&nbsp; neologismsmade up words with no real meaning
Disturbance in thought processes - manifested in speech:&nbsp; clang associationsgroup words because they rhyme or sound nice
Disturbance in thought processes - manifested in speech: perseverationpersitant repetition of the same word or idea in response to different questions<br>-repeated over and ovr
Disturbance in thought processes - manifested in speech:&nbsp; echolaliarepeating words or phrases someone else says back to them
THOUGHT PROCESSES =disturbances in speech
"<div><span style=""color: rgb(0, 0, 0);"">2.The patient hears the word “match.” The patient replies, “A match. I like matches. They are the
light of the world. God will light the world. Let your light so shine.” Which
communication pattern does the nurse identify?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">Loose association</span></div>"
Disturbances in PERCEPTION: hallucinations-auditory<br>-tactile<br>-visual<br>-gustatory<br>-olfactory
Disturbances in PERCEPTION: illusionsmisperceptions or minterpretations of real external stimuli<br>-see a pole and imagine a person&nbsp;
Disturbances in PERCEPTION: hallucinations **most commonauditory (command hallucinations --&gt; voices tell them what to do)<br>visual
Disturbances in PERCEPTION: illusions =&nbsp;a miss-perception of something that is really there
Disturbances in PERCEPTION: exhopraxiaimitates movements made by others
POSITIVE symptoms =-thought processes<br>-thought content<br>-delusions<br>-perception
"<div><span style=""color: rgb(0, 0, 0);"">3.A patient diagnosed with schizophrenia experiences identity confusion and
communicates with the nurse using echolalia. What is the patient attempting to
do by using this form of speech?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">Identify with the person speaking</span></div>"
NEGATIVE SYMPTOMS- something taken away - deficits
Distrubances in Affect:feeling stae or emtotional tone (what their face says)<br>-innapropriate = incongurent with mood/circumstances<br>-flat/bland = void/weak emotional tone
apathy =disinterest in the environment
avolitioninability to initate goal-directed activity
thought blocking -stops talking mid-sentence or difficulty expressing thoughts
Anosognosia =lack of insight into illness
anergialack of energy
anhedoniainability to experience pleasure
waxy flexabilitypt will leave limbs how you move them. lift arm in air and they will keep it there
negative symptoms associated features-waxy flexability<br>-posture<br>-pacing and rocking<br>-regression<br>-eye mvmt abnormalities
"<div><span style=""color: rgb(86, 86, 86);"">Disturbed thought content
[Delusions]: ACTION&nbsp;</span></div>"-build TRUST<br>-respond in calm manner<br>-dont argue against them<br>-validate if part of the delusion IS real<br>-**let them know you are there to keep them safe**
Disturbed sensory perception (hallucinations): ACTION-ask directly&nbsp;<br>-watch for cues<br>-avoid referring to them as real<br>-focus on reality based&nbsp;
Risk for violence: schizo-low stimuli<br>-observe frequently<br>-assess for suicidal ideations/command hallucinations
"<div><span style=""color: rgb(86, 86, 86); font-weight: bold;"">To deal with a client'</span><span style=""color: rgb(86, 86, 86); font-weight: bold;"">s hallucinations therapeutically, which nursing intervention should
be implemented?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">Distract the patient’s attention.</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">Psychological treatments - schizo</span></div>""<div><span style=""color: rgb(0, 0, 0);"">•Individual psychotherapy</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Group therapy</span></div><div><span style=""color: rgb(0, 0, 0);"">behavior therapy</span></div><div><span style=""color: rgb(0, 0, 0);"">ACT team (assertive community tx)</span></div>"
Schizophrenia medical tx =antipsychotics - decrease agitation and psychotic s/s of schizo and other psychotic disorders
Typical antipsychotics - tx Positive symptoms-chlorpromazine<br>-fluphenazine<br>-haloperidol<br>-loxapine<br>-perphenazine<br>-thioridazine<br>-trifluoperazine
Typical antipsychotics - tx Positive symptoms =-delusions<br>-hallucinations (perceptions)<br>-thought content<br>-thought processes
Typical antipsychotics - side effectsAnticholingergic effects:<br>-dry mouth<br>-constipation<br>-blurred vision<br>-urinary retention<br><br>Antihistamine SE:<br>-sedation<br>-wt gain
Typical antipsychotics - extrapyramidal symptoms (EPS)-dystonia<br>-akathisia<br>-akinesia<br>-pseudoparkinsonism
-dystonia"<div><span style=""color: rgb(0, 0, 0);"">•involuntary muscular movements
(spasms) of face, arms, legs, neck</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">•Akathisia –&nbsp;</span></div>"restlessness; jumping out of skin
"<div><span style=""color: rgb(0, 0, 0);"">•Akinesia</span></div>"&nbsp;– difficulty with coordinated muscle movement
"<div><span style=""color: rgb(0, 0, 0);"">•Pseudoparkinsonsim
-</span></div>"&nbsp;tremor, shuffling gait, drooling, rigidity
"<div><span style=""color: rgb(0, 0, 0);"">Treatment of Extrapyramidal
symptoms (EPS) <span style=""background-color: yellow;"">(Except for Tardive Dyskinesia</span>)</span></div>""<div><span style=""color: rgb(0, 0, 0);"">•A = Artane (anticholinergic)</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•B = Benadryl (antihistamine)</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•C = Cogentin (anticholinergic) **most common</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•S = Symmetrel(dopamine agonist)</span></div><div><br></div><div><div><span style=""font-style: italic; color: rgb(0, 0, 0);"">*anticholinergics best
treatment*</span></div></div>"
"<span style=""color: rgb(0, 0, 0);"">typical antipsychotics - tardive dyskinesia</span>"-involuntary rhythmic movements<br>*neuro s/s
"<span style=""color: rgb(0, 0, 0);"">tardive dyskinesia - involuntary rhythmic movements</span>"-twitching/facial mvmts<br>-dysphagia<br>-grimace<br>-smacking lips<br>-protruding tongue
tardive dyskinesia occurs-**after prolonged use of typicals and will persist until discontinue med
if pt shows s/s of tardive dyskinesia: ****HOLD the med<br>-perform the AIMS test - abnormal involuntary mvmt scale<br>-call provider
antipsychotics - neruoletpic malignant syndrome*rare but potentially fatal<br>-more common with typicals<br>CHARMR
CHARMR - neuroleptic malignant syndrome***"<div><span style=""color: rgb(0, 0, 0);"">•C – CPK Elevated</span><br></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•H – Hyperprexia</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•A – Autonomic Instability</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•R – Rigidity</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•M – Mental Status Change </span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•R - Rhabdomyolysis</span></div>"
"<div><span style=""color: rgb(86, 86, 86);"">Neuroleptic Malignant Syndrome – Treatment</span></div>""<div><span style=""color: rgb(0, 0, 0);"">•Supportive Care (hydration, cooling)</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Monitor Vital Signs</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Monitor I &amp; O</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Monitor Rigidity</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Provider may order bromocriptine or dantrolene</span></div>"
*know difference between serotonin antidepressants and antipsych meds**
Atypical antipsychotics = tx"positive AND negative symptoms<br>-newest meds<br><div><span style=""color: rgb(86, 86, 86);"">“Imagine a Fat Ghost Really Can See Lazy Zebras Sleeping”</span></div>"
Atypical antipsychotic - meds"<div><span style=""color: rgb(0, 0, 0);"">“Imagine a Fat Ghost Really Can See Lazy Zebras Sleeping”</span></div><div><div><span style=""color: rgb(0, 0, 0);"">•Invega</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Abilify</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Fanapt</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Geodon&nbsp;</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Risperdal&nbsp;</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Clozaril&nbsp;</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Seroquel&nbsp;</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Latuda&nbsp;</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Zyprexa&nbsp;</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Saphris&nbsp;</span></div></div>"
"Atypical antipsychotics - side effects&nbsp;<span style=""color: rgb(86, 86, 86);"">Anti-alpha-adrenergic side effects</span>""<div><br></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Orthostatic hypotension</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Dizziness</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Cardiac abnormalities</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Sexual dysfunction</span></div>"
Atypical antipsychotics - side effects - dermatologicPhotosensitivity
Atypical antipsychotics - side effects - seizureslowered seizure threshold
Atypical antipsychotics ** at risk for** =metabolic syndrome
Atypical antipsychotics - metabolic syndrome"<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Weight gain</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Dyslipidemia</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Increased blood glucose</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Insulin resistance</span></div>"
Atypical antipsychotics - metabolic syndrome&nbsp; - ASSESS ****- baseline weight<br>-lipid levels<br>-glucose levels<br>-monitor for HTN&nbsp;
Action : typical antipsychotics"<div><span style=""color: rgb(86, 86, 86);"">Block Dopamine</span></div>
<div><span style=""color: rgb(86, 86, 86);"">Treat POSITIVE symptoms</span></div>"
Action : atypical antipsychotics"<div>-<span style=""color: rgb(86, 86, 86);"">Weak dopamine antagonists</span></div>
<div>-<span style=""color: rgb(86, 86, 86);"">Serotonin receptor antagonists</span></div>
<div>-<span style=""color: rgb(86, 86, 86);"">Treat POSITIVE AND NEGATIVE symptoms</span></div>"
"<div><span style=""color: rgb(86, 86, 86);"">Clozaril – Atypical antipsychotic with
special considerations/precautions</span></div>""<div><span style=""color: rgb(0, 0, 0);"">•Use if standard
antipsychotic treatment has failed</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Reduces risk of recurrent
suicidal behavior **</span></div>"
"atypical antipsychotic -&nbsp;<span style=""color: rgb(86, 86, 86);"">Clozaril – Side Effects</span>""<div><span style=""color: rgb(0, 0, 0);"">•Weight gain</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Drooling</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Seizures</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Myocarditis</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Agranulocytosis</span></div>"
"<span style=""color: rgb(86, 86, 86);"">Agranulocytosis</span>""<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Strict monitoring
guidelines</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Baseline/Weekly/Biweekly/Monthly
ANC and WBC</span></div><div><div><span style=""color: rgb(217, 156, 33);"">•</span><span style=""color: rgb(86, 86, 86);"">Immediately report signs of
infection ****</span></div></div>"
"<div><span style=""color: rgb(0, 0, 0);"">Clozaril - signs of
infection</span></div>""<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Fever</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Chills</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Sore throats</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Flu-like symptoms</span></div>"
"<div><span style=""color: rgb(86, 86, 86);"">Options for patients who do not stay on their meds: long acting injections</span></div>""<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Haldol Decanoate</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Invega </span><span style=""color: rgb(86, 86, 86);"">Sustena</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Risperdal </span><span style=""color: rgb(86, 86, 86);"">Consta</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Prolixin</span><span style=""color: rgb(86, 86, 86);""> Decanoate</span></div>"
"<span style=""color: rgb(86, 86, 86);"">Options for patients who do not stay on their meds: extended release tablets</span>""<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Invega</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Seroquel</span></div>"
"<div><span style=""color: rgb(86, 86, 86);"">Options for patients who do not stay on their meds: dissolving tablets</span></div>""<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Zyprexa </span><span style=""color: rgb(86, 86, 86);"">zydis</span></div>
<div><span style=""color: rgb(115, 115, 115);"">‒</span><span style=""color: rgb(86, 86, 86);"">Risperdal</span></div>"
"<span style=""color: rgb(86, 86, 86);"">Options for patients who do not stay on their meds: liquid form</span>""<span style=""color: rgb(86, 86, 86);"">Haldol</span>"
"<div><span style=""color: rgb(0, 0, 0);"">6.A client who has been taking chlorpromazine (Thorazine) for several
months presents in the emergency department with EPS of restlessness, drooling,
and tremors. What medication will the nurse expect the physician to order?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">Benztropine</span><span style=""color: rgb(86, 86, 86);""> (Cogentin)</span></div>"
"**auditory hallucinations #1 concern ="command delusions
**delusions&nbsp; =thought content
**flight of ideas&nbsp;thought processes
**auditory hallucinations =perceptions
** illusionsperceptions
Positive symptoms ***-perceptions<br>-hallucinations<br>-delusions<br>-thought process<br>-thought content
**how&nbsp; to respond to auditory hallucinations""" I dont hear them but tell me what you are hearing"""
**thought blockingstop talking mid sentense
**typical antipsychotics targetpositive symptoms
**atypical antipsychotics targetpositive and negative symptoms
*antispychotic that causes metabolic syndrome =atypicals
if pt starts atypical **-assess baseline wt<br>-lipid level<br>-glucose level<br>-HTN<br>**metabolic syndrome
EPS syndrome is often caused by&nbsp; **typical antipsychs
EPS medsA- artane<br>B- benadryl<br>C-cogentin<br>S- symmetrel
Tardive dyskinesia ***HOLD med<br>AIMS test<br>call dr
Neuroleptic malignant syndromeCHARMR
a client exhibits paranoia, bizare behaviors, neoglism, and delusions of persecution. WHile eating breakfast in the dayroom, the client starts yelling at others. what is the nurses first actionask the other pts to step out of the dayroom
a 16 yr old client is diagnosed with schizophrenia is experiencing auditory command hallucination. the client reports the voices are telling him to harm others. the clients parents ask where the voices come from. what is the nurses best reply?auditory hallucinations are caused by increased/excess levels of dopamine in the brain
a client is diagnosed with schizophrenia and says cant you hear him/ the devil keeps telling me I am going to hell. what is the nurses most appropriate reply/it must be scary to hear that. but I dont hear that voice
if a pt asks do you ever get messages through things, like the tv or microwave what are they experiencingdelusions of refernce
a client with brief psychotic disorder states the voices keep telling me to kill the president. what is priority nursing diagnosisrisk for violence: other directed
which statement indicates that a client is experienceing a delusionsspies watch everything I do
the nurse observes a client with schizophrena is slow to respond and appears to be listening to unseen others. which medication does the nurse atnicipate the provider will prescribe(positive symptoms)<br>-risperidone
the nurse is administering medication to a pt with acute psychosis. the clients medication orders include haloperidol 50mg PO bid: benztropine 1mg PO daily, and zolpidem 10 mgPO at bedtime. the nurse administers benztropine for what reason?involuntary facial movements
the nurse asses a client who exhibits a flat affect, paranoia, anhedonia, anergia, neoglisms, and echolalia.which statement indicates the nurse understands the characteristics of positive and negative s/s of schizophreniaparonia, neologism, and echolalia are positive symptoms
the nurse is administering clozapine to a client with schizophrenia. whcih symptoms require nurse to intervene immediatelysore throat, fever, and malaise<br>agranulocytosis
the nurse is caring for a college student who started hearing voices, he has not attended class in the past 4 wks, was yelling accusaitons at others, and has stop communicating with family. what is the priority nursing diagnossirisk for other-directed violence related to yelling accutsations
a client states the voices keep saying i am evil. which outcome criteria is more important to inclide in plan of careidentifies factors that increase anxiety and illicit hallucinations
a client is diagnosed with psychosis asks the nurse to make the voices stop so he can go to sleep. what is the primary nursing interventionask what the voices are saying to him.&nbsp;
the psych nurse is evaluating care of a client recovering from an episode of psychosis. which is the most appropriate long term goaldefine and test reality
the nursing instructor asks student to describe concepts of the recovery model. whiich should be included-uses personal values to determine meaning in life<br>-allows client primary control over care decisions
COMMUNITY HEALTH 2Qs
The public health model-primary prevention<br>-secondary prevention<br>-tertiatry prevention
"<div><span style=""color: rgb(86, 86, 86);"">Which of the following
represents a nursing intervention at the primary level of prevention?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">a. Teaching a class in parent effectiveness training</span></div>"
primary prevention =before s/s have started<br>-education class for people at risk for certain problems
"<div><span style=""color: rgb(86, 86, 86);"">Which of the following
represents a nursing intervention at the secondary level of prevention?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">b. Providing support in the
emergency department to a rape victim</span></div>"
secondary preventionhas a developed problem and needs support
"<div><span style=""color: rgb(86, 86, 86);"">Which of the following
represents a nursing intervention at the tertiary level of prevention?</span></div>""<div><span style=""color: rgb(86, 86, 86);"">a. Serving as case manager
for a mentally ill homeless client</span></div>"
tertiary prevention&nbsp;-reduce residual effects with severe mental illness<br>-have had the issue for a while now
"<div><span style=""color: rgb(86, 86, 86);"">Which of the following
issues have been identified as contributing to the increase in the population
of those who are homeless? (Select all that apply.)</span></div>"-poverty<br>-lack of afforable health care<br>-substance abuse<br>-severe and persistant mental illness
primary prevention - aimedat reducice the incidence of mental disorders within the population
"<div><span style=""color: rgb(86, 86, 86);"">Primary prevention targets&nbsp;</span></div>""<span style=""color: rgb(0, 0, 0);"">both individuals and the environment and its emphasis is twofold.</span><br><div><span style=""color: rgb(0, 0, 0);"">•Assisting individuals to increase their ability to cope effectively
with stress</span></div><div><div><span style=""color: rgb(0, 0, 0);"">•Targeting and diminishing harmful forces (stressors) within the
environment</span></div></div>"
primary prevention&nbsp; **"<div><span style=""color: rgb(0, 0, 0);"">•To identify stressful life
events that precipitate crises and target the relevant populations at risk</span></div>"
primary prevention - populations at risk-types of crisis experienced in their lives<br>-maturational crises and situational crisis
maturational crises (maturing)-adolescense<br>-marriage<br>-parenthood<br>-midlife<br>-retirement
Adolescence - maturational crises-a big transition<br>-STDs<br>-sexuality<br>-self esteem<br>-alcohol and substance use<br>***education to PREVENT issues from occuring
"<div><span style=""color: rgb(86, 86, 86);"">Secondary prevention =</span></div>""<div><span style=""color: rgb(0, 0, 0);"">•Interventions aimed at minimizing early symptoms of psychiatric
illness and directed toward reducing the prevalence and duration of the illness</span></div>"
secondary prevention is accomplished with =EARLY IDENTIFICATION of problems and initate effective treatment
"<div><span style=""color: rgb(0, 0, 0);"">•Nursing in secondary prevention focuses on recognition of symptoms
and&nbsp;</span></div>""<span style=""color: rgb(86, 86, 86); background-color: rgb(255, 255, 255);"">provision of, or referral for, treatment.</span>"
improve family problems with adolescence to&nbsp;improve coping and communication
adolescence - focus on:stabilizing the pt
secondary prevention - problem is identified-hotlines<br>-working with a pt with mental illness<br>-et&nbsp;
Tertiary prevention = most intensive"<div><span style=""color: rgb(0, 0, 0);"">•Services aimed at reducing the residual defects that are associated
with severe and persistent mental illness</span></div>"
"<div><font color=""#28805c"">t</font><span style=""color: rgb(86, 86, 86);"">ertiary prevention is accomplished in two ways:</span></div>""<div><span style=""color: rgb(0, 0, 0);"">•Preventing complications of the illness</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Promoting rehabilitation directed toward achievement of each individual’s maximum level of
functioning</span></div><div><span style=""color: rgb(0, 0, 0);"">-rehab, aftercare services</span></div>"
primary prevention - situational crises-poverty<br>-high rates of life change events<br>-environmental condition<br>-trauma
situational crisis -&nbsp;when crisis intervention at the primary level fails<br>-exacerbatio of mental illness s/s
"<div><span style=""color: rgb(86, 86, 86); font-weight: bold;"">Based on the public health model of primary <br>
level of prevention, which services would the community nurse provide?&nbsp;</span></div>""<div><span style=""mso-special-format:&quot;numbullet1\,1&quot;;
color:#28805C;font-family:+mj-lt"">A.</span><span style=""color: rgb(86, 86, 86);"">Teaching parenting skills and child development to prospective new
parents</span></div>"
"<font color=""#565656"">tertairy care with severe and persistent mental illness</font>"-homeless population
dorothea dix -began personal crusade on behalf of institutionalized individuals with MI
mental illness and homelessness -28% of homeless population have mental illness - schizo is most common<br>-alcoholism<br>-STIs&nbsp;
RECOVERY MODEL - 2Qs
the recovery model works WITHTHE MEDICAL MODEL
recovery is a ____process!
recovery is changes of:"<div><span style=""color: rgb(0, 0, 0);"">•Individuals improve their health and wellness.</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Live a self-directed life.</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Strive to reach their full potential.</span></div>"
"<span style=""color: rgb(0, 0, 0);"">4 Major Dimensions&nbsp;of Recovery</span>""<div><span style=""color: rgb(0, 0, 0);"">•Health&nbsp;‒Overcoming one’s disease
and living in a healthy way</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Home‒Stable and safe place to
live</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Purpose‒Meaningful daily activities</span></div><span style=""color: rgb(0, 0, 0);"">
</span><div><span style=""color: rgb(0, 0, 0);"">•Community‒Relationships and social
networks that provide support, friendship, love and hope.</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">1.Which of the following is a true statement about mental health
recovery? (Select all that apply.)</span></div>""<div><span style=""color: rgb(0, 0, 0);"">A.Mental health recovery serves to provide empowerment to the
consumer.</span></div><div><div><span style=""color: rgb(0, 0, 0);"">A.Mental health recovery is a collaborative process.</span></div></div>"
"<div><span style=""color: rgb(0, 0, 0);"">1.A client approaches the nurse and states, “I don’t want to go to
outpatient group therapy. I don’t like groups.” Which of these responses by the
nurse supports a recovery model focus?</span></div>""<div><span style=""color: rgb(0, 0, 0);"">A.“Let’s discuss some options for follow-up care and explore the
advantages and disadvantages.”</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">1.Which of the following is NOT one of the four dimensions that
supports life in recovery?</span></div>""<div><span style=""color: rgb(0, 0, 0);"">A.Relapse</span></div>"
trauma - informed care:-assume everyone has been through trauma<br>-go in with compassion and nonjudgement
the tidal model"<div>•The metaphor of water describes how individuals in
distress become emotionally, physically, and spiritually shipwrecked.</div><div>*<span style=""color: rgb(86, 86, 86);"">Uses a person-centered
approach to help people deal with their problems of human living</span></div>"
tidal model - ____ centeredperson centered -&gt; based on their story
"<div><span style=""color: rgb(0, 0, 0);"">1.A nurse is assisting an individual with mental illness recovery
using the Tidal model. Which of the following is a component of this model?</span></div>""<div><span style=""color: rgb(0, 0, 0);"">A.The individual’s personal story</span></div>"
**four dimensions of recovery-home<br>-health<br>-purpose<br>-recovery
**goal of recoveryempower the patient to make their own decisions