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NSG 211 Mental Health Study Guide
Health Care Concepts II (NSG 211)
Germanna Community College
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NSG 211 Mental Health Study Guide Anxiety, Mood and Affect, Psychosis, Cognition Foundational Information: decrease leads to depression and commonly seen with Increase leads to anxiety states decrease leads to and increase leads to schizophrenia and mania High levels associated with anxiety and depression decrease leads to increase leads to anxiety states Butyric Acid decrease leads to anxiety disorders, schizophrenia, mania, Huntington Increase leads to reduced anxiety, schizophrenia, and mania increase leads to decrease leads to Alzheimer disease, Huntington chorea, and Parkinson disease Legal HIPPA exception: duty to allowance of warning people who a homicidal person indicates as a subject to kill Cannot confirm or deny a patient is at the hospital or facility Behavioral restraints (ABSOLUTE LAST are never PRN 4hours, 2 hours, 1 hour temporary detaining order for 72 hours and a hearing is evaluated Criteria for admission Danger to Unable to protect self from harm Levels of Anxiety: only expanded perceptual field, cognition increases ex. Test taking physical heart racing ability to talk down Severe and keep them medicate (benzo), help bring dilated pupils, rapid speech Personality has three parts: immediate, pleasure principle, avoiding pain based in reality, controls and rational thinking, serves as balance between self and environment unconscious and conscious, uncompromising, basis of shame and guilt, morals of psychosocial development throughout life Each stage represents developmental milestones or tasks. Completion of task in each stage is necessary to resolve developmental and for psychosocial developmental growth to occur. Importance is result for individual when task is not fully mastered for feelings, behaviors reflect lack of completion Trust vs. Mistrust years Autonomy vs Shame and Doubt years Initiative vs Guilt years Industry vs Inferiority years Identity vs Role confusion years Intimacy vs Isolation years Generativity vs Stagnation years Integrity vs Despair 65 to death Maslow identified: A of as fulfillment of highest potential Seen as founder of mental health nursing as a science The art of nursing Provide care, compassion, and advocacy Enhance comfort and The science of nursing Application of knowledge to Understand a broad range of human problems and psychosocial phenomena Intervene in relieving suffering and promote growth Major paradigm shift in nursing Levels of Moderate, Severe, Panic Focus on interpersonal relationships and stages of relationship Preintroduction, Orientation, Working, Termination scientific structuring of the environment to effect behavioral changes and to improve the psychological health and functioning of the The client is expected to learn adaptive coping and interaction and relationship skills that can be generalized to other aspects of his or her life. Current focus of care is on short stays and is often more biologically based. decision caused unconscious impulses. 10. Engaging in behavior that is opposite of true desire. Unaccepted impulses are repressed, denied and reacted to opposite overt behavior. 11. Regression Behavior that reflects an earlier level of development. 12. Repression Unable to have conscious awareness of conflicts that are sources of anxiety. Thoughts or emotions are thrust out of consciousness. 13. Sublimation Anxiety channeled into socially dependable behaviors. Substituting unacceptable sexual or aggressive drives or impulses with socially acceptable behavior. 14. Symbolization idea which Representing an idea or object a substitute object or comes to stand for another through some quality they have in common. 15. Undoing 16. Suppression Behaviors that is opposite of earlier unacceptable behavior or thought. A specific action is taken which neutralizes a previous unacceptable action. Consciously putting a thought out of awareness. Choosing not to think about something. Anxiety Mood and Affect Generalized Anxiety Disorder Psychological Responses: Impending doom, panic, uncertainty, irritability, insomnia Physiological Responses: High degree of alertness, in restlessness, sleep disturbances, irritability, muscle tension, easily fatigued, sweating Risk Factors: Higher among females, Caucasians, and persons aged 30s to 50s. Possible genetic link. Impairments in Self Care: Inability to focus or concentrate, possible thoughts or actions related to Medications to Treat: Anxiolytics: Buspirone Paroxetine, Citalopram, Duloxetine Benzodiazepines prn (Xanax, Ativan, Valium, Klonopin) Diazepam, Lorazepam, Alprazolam How can these Meds Kill? Benzos: Highly addictive, mix, overdose, mix with alcohol, may cause SI Buspirone: mix with grapefruit juice Alternative Treatments: Relaxation techniques, yoga, exercise, cognitive behavioral therapy. Additional Notes: Buspirone used daily GAD must be present for months to be diagnosed Some of these meds (particularly lorazepam) can be used to treat alcohol withdrawal Psychological Responses: are related to thought processes Physiological Responses: are related to physical processes (actions). May complete the same actions dozens of times or more each day Risk Factors: Existing mental illness, substance abuse, ADHD, stress Impairments in Self Care: Time consuming and impact day to day activities, person is usually aware of the condition which can lead to anxiety, depression, rage, and potential destructive disorders Medications to Treat: SSRIs, tricyclics How can these Meds Kill? Tricyclics are very easy to overdose on. Alternative Treatments: triggers Setting goals Low stress Healthy coping Psychotherapy Transcranial magnetic stimulation Additional Notes: Difference between Obsession vs. Compulsion: Obsession is the thought (ex. Fear of germs), Compulsion is the act carried out (ex. Washing hands) You do not have to have both the obsession and compulsion to be diagnosed as OCD Panic Disorders Psychological Responses: Feeling a loss of control, fear of dying Physiological Responses: Sympathetic nervous system activation: racing heart, respirations increased, pupil dilation, lightheadedness, dizziness, Risk Factors: Trauma, family history Impairments in Self Care: Effects role Medications to Treat: Alprazolam, Ativan, Diazepam How can these Meds Kill? Overdose, withdrawal Respiratory depression Alternative Treatments: Breathing techniques Behavioral therapy Additional Notes: anxiety in which you fear and avoid situations or places that might cause you to pain and make you feel trapped, helpless, or embarrassed. They fear an actual or anticipated situation, such as public transportation, open or enclosed spaces, or being in a crowd. Stress Disorder Psychological Responses: Difficulty concentrating, hypervigilance, inability to control emotions, nightmares, flashbacks, intrusive memories, numbing Physiological Responses: Potentially violent outbursts, pain, arthritis, hypertension and other cardiovascular maladies Psychological Responses: Catatonia, melancholy, powerlessness, low selfesteem Physiological Responses: Anergia, risk of events due to inactivity and poor diet, increased pain sensitivity, weakened immune system Risk Factors: Women more predisposed than men, lower socioeconomic status, seasonality (worse in the winter) status, medication side effects, hormonal disorders, personal Race is not considered a risk factor. DSM5 criteria for Major Depression Symptoms occurring during same period: Depressed mood, loss of interest, insomnia or hypersomnia, fatigue, feeling worthless or excessive guilt, decreased concentration, thoughts of suicide Impairments in Self Care: Extreme lethargy and demotivation may make even the most basic tasks indifference may affect regression may occur especially in youth Medications to Treat: SSRIs, MAOIs, Tricyclics How can these Meds Kill? SSRIs: This is not directly caused the drug itself, but because the drug can increase energy levels before it actually builds up therapeutic levels in the body, it can put suicidal patients at increased risk giving them the energy needed to carry out a suicide plan Serotonin syndrome is possible if used with MAOIs MAOIs: hypertensive crisis (avoid tyramine), contraindicated with other antidepressants. Tyramine also is found in beer, wine, aged cheese, organ meats, avocadoes, and other foods Tricyclics: Deadly in overdose. No alcohol. Orthostatic hypotension, cardiac issues Atypical antidepressants: Alternative Treatments: Electroconvulsive therapy Additional Notes: Dysthymic Disorder (Persistent Depressive Disorder): Mild but form of depression years) All antidepressants carry a black box warning for increased SI in adolescents Postpartum Depression Psychological Responses: Irritability, loss of libido, sleep disturbances, fear of being unable to provide for infant Physiological Responses: Fatigue, loss of appetite, Risk Factors: Hormonal changes tryptophan metabolism, cellular alterations, can lead to psychosis Impairments in Self Care: Unable to care for self and ba Medications to Treat: antipsychotics How can these Meds Kill? Serotonin syndrome Overdose Possible transference to breast milk Alternative Treatments: Support groups Additional Notes: Can happen for up to a year after childbirth, protect the kid from harm Psychological Responses: Suicidal ideation, anhedonia (inability to feel anxiety, feelings of irritability or anger Physiological Responses: Insomnia or hypersomnia, anergia (lack of Risk Factors: Mental illness, terminal diagnosis, status, substance abuse, history of abuse, family history of suicide, personal loss, perception of failure, white male status. Older adults: senescence (bereavement overload), neurocognitive disorders Impairments in Self Care: S Sex: 1 if 0 if (more females attempt, more males succeed) A Age: 1 if 20 or 44 D Depression: 1 if depression is present P Previous attempt: 1 if present E abuse: 1 if present R Rational thinking loss: 1 if present S Social Supports Lacking: 1 if present O Organized Plan: 1 if plan is made and lethal N No Spouse: 1 if divorced, widowed, separated, or single stated future intent Medications to meds and antidepressants Treat: How can these Meds Kill? See previous Alternative Treatments: Support groups Additional Notes: of people who attempt or commit suicide have been diagnosed with an existing mental illness of these are depressive illnesses If the patient has a plan for suicide, is the mechanism both lethal and available? Individuals who lost a parent to suicide are 3x more likely to carry it out themselves Actively suicidal patients are only prescribed enough medication for 1 to 3 days, in order to prevent intentional ingestion of a lethal dose neuromessenger released at the end of a neuron, too much or too little can cause problems (deficient release or deficient receptors) Test review: putting it on another person Hopelessness symptom for suicide risk Situational someone being there during difficult times Dysthymic disorder is for at least 2 years Cutting (superficial) is not an indication for signs of depression is because of risk of harm to self or ba Thought like a radio, everyone knows what thinking Thought someone putting random thought inside you (the telling you what to think) Thought stolen thought Bizarre speech o Associative thinking is haphazard, illogical, and confused o made up words o Echolalia and mimic language and movement o Clang meaningless rhyming of words o Word jumble of words random sentences that make sense o persistent word repetition Personal boundary difficulties o feeling that person is unreal o feeling that environment has changed Bizarre behaviors o Extreme motor ex. pacing o Stereotyped ex. constantly sweeping the floor o Automatic obedience o Waxy ex. put arm down after taking can lead to not can kill! state of near unconsciousness Negativism Negative taking away from baseline Changes in affect o Flat affect o Inappropriate emotional response incongruent to situation o Blunted affect o Bizarre grimacing, giggling, mumbling Apathy Anhedonia Poor social functioning Poverty of thought Increased risk of violence: self or Extreme suspiciousness Panic anxiety Catatonic extreme restlessness motor movement Rage reactions Command find out who is telling them this and who they are telling them to hurt Communication guidelines: not touch, do not Dealing with schizophrenia o Lower anxiety o Decrease defensive patterns o Encourage participation o Raise feelings of o Increase medication compliance Dealing with hallucinations and delusions o Approach in nonthreatening, nonjudgmental manner o Clarify reality o Identify feelings o Lower pts. anxiety o Avoid arguing Dealing with paranoia o Be honest and consistent o Avoid talking, laughing, whispering Dealing with associative looseness o Do not pretend to understand o Tell pt. you are having difficulty understanding o Look for recurring topics o Emphasize what is going on in the and Nursing Considerations: The patient must get adequate nutrition. If they have hallucinations or delusions of someone telling them the food is poisoned and will not eat, try unopened packages, and asking them what is okay for them to eat. 1. 2. 3. 4. 5. 6. 7. 8. Keep patient safe Keep others safe Reorient patient, decrease stimuli, grounding techniques Patient teaching: change positions slowly as medications cause orthostatic hypotension Assess nutritional status, provide adequate nutrition Promote compliance and monitor drug therapy Be aware of and monitor for Tardive dyskinesia Establish trust with therapeutic communication Other psychotic disorders: Brief psychotic presence of one or more psychotic symptoms with a sudden onset and full remission within one month Symptom duration is one factor distinguishing brief psychotic disorder from schizophreniform disorder (one to six months) and schizophrenia (at least six months) Last less than 1 month Return to full premorbid level of functioning One or more of the following symptoms presents, delusions, hallucinations, disorganized speech, grossly disordered or catatonic behavior psychotic Presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal Psychotic associated with another medical condition: Hallucinations and delusions directly attributable to a general medical condition Catatonic associated with another medical condition: Catatonic symptoms are directly attributable to the physiological consequences of a general medical condition The catatonic features specifier: Catatonic features associated with other psychotic disorders Symptoms: stupor and muscle rigidity or excessive, purposeless motor activity, waxy flexibility, negativism, echolalia, and echopraxia blend of schizophrenia symptoms and affective symptoms Acute dystonia: muscle cramps of head and neck (like a stone) MEDICAL EMERGENCY Akathisia: internal and external restlessness Pseudo parkinsonism: stiffened extremities, fine motor tremors, shuffling gate Oculogyric crisis: eyes stuck up and rolled back Treatment of EPS Give Benztropine mesylate (Cogentin) or Diphenhydramine hydrochloride (Benadryl) Lower dose of antipsychotic or prescribe an antiparkinsonian drug Major side effects cont. Neuroleptic malignant syndrome (NMS): decreased LOC, muscle rigidity, high fever, HTN, sweating, tachycardia, drooling messed up infection can fever, malaise, flu like symptoms Orthostasis Use Abnormal involuntary movement scale (AIMS) for early recognition of EPS Atypical antipsychotics: treats positive and negative symptoms Clozapine can cause agranulocytosis Aripiprazole (Abilify) Risperidone can cause gynecomastia Advantages Minimal EPS Positive and negative symptoms Help improve cognitive deficits, decrease anxiety and depression, and decrease suicidal behavior Disadvantages Metabolic syndrome o Weight gain o Dyslipidemia o Altered glucose o Diabetes o Hypertension o Atherosclerosis o Increase in heart disease o Kills slowly More expensive Education Do not stop abruptly Do not drink alcohol Do not take other drugs without PCP permission Use sunscreens and protective clothing Weekly blood levels if taking Clozapine Awareness of possible risks during pregnancy Cognitive Disorders in the Child Genetic factors Biochemical factors Environmental factors Resilient vulnerable child who does not develop psychiatric disorder has resiliency characteristics of o Adapts to change o Ability to form relationships o Distance self from emotional chaos in family o Social intelligence Use problem solving skills mental health assessment child with a mental disorder is at risk for Intellectual Developmental Disorder: Onset prior to age 18 and measured intellectual performance and adaptive skills IQ of 100 is below 70 is some below 49 is serious problems and need of special care Predisposing factors: o Genetics o Disruptions in embryonic development (toxicity, maternal complications) o Pregnancy and perinatal factors (fetal malnutrition, trauma, O2 deprivation, premature birth) o General medical conditions (infections, poisonings, physical trauma) o Sociocultural (deprived nurturance and social stimulation, impoverished environment, poor nutrition, severe mental disorders) IQ is culturally based, not used anymore little support but fully independent more support extensive support care Autism Spectrum Disorder (ADD) Withdrawal of the child into the self and into a fantasy world of his or her own creation Overstimulation to different senses Changes in the way of filtering stimuli and connecting socially Huge spectrum LACK OF EYE CONTACT, HAND FLAPPING, TOE WALKING, PARALLEL PLAY Pharmacological atypical antipsychotics Risperidone: side drowsiness, weight gain, increased appetite, nasal congestion, fatigue, gynecomastia and lactation Aripiprazole: side sedation, fatigue, weight gain, vomiting, somnolence, tremors ADHD Difficult to diagnose before age 4 Inattention Hyperactivity Impulsivity Pharmacological interventions Adderall, Concerta, Ritalin, Daytrana o Decreases appetite and rate of growth and development o Take in the morning after breakfast and weigh child weekly Atomoxetine (Strattera) Bupropion (Wellbutrin) Clonidine (Catapres) Drug holiday: stops medication for a short time to ensure it is working Interventions:
NSG 211 Mental Health Study Guide
Course: Health Care Concepts II (NSG 211)
University: Germanna Community College
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