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NSG 221 HESI Exam - Hesi Study Guide
Mental Health Nursing (NSG221)
Herzing University
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● Crisis Intervention - Empathy ○ Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information. ○ In therapeutic communication, the nurse must ask specific questions to get the entire story from the client’s perspective, clarify assumptions, and develop empathy with the client. ■ Empathy is the ability to place oneself into the experience of another for a moment in time. ■ Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. ■ The nurse asks as many questions as needed to gain a clear understanding of the client’s perceptions of an event or issue.
○ Crises occur in response to a variety of life situations and events and fall into three categories: ■ Maturational crisis, sometimes called developmental crises, are predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career. ■ Situational crises are unanticipated or sudden events that threaten the individual’s integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member. ■ Adventitious crises, sometimes called social crises, include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or murder.
○ Goals of Crisis Intervention ■ Relieve current symptoms ■ Help identify factors that led to crisis ■ Use remedial measures/resources to restore pre-crisis level of functioning ■ Help develop adaptive coping strategies for current and future situations
● Lithium - Creatinine ○ Lithium not only competes for salt receptor sites but also affects calcium, potassium, and magnesium ions as well as glucose metabolism ■ In addition to treating the range of bipolar behaviors, lithium can also stabilize bipolar disorder by reducing the degree and frequency of cycling or eliminating manic episodes ■ Lithium is effective in about 75% of people with bipolar illness, both adults and children ■ Lithium’s action peaks in 30 minutes to 4 hours for regular forms and in 4 to 6 hours for the slow-release form ○ Lithium is the most established mood stabilizer ■ Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine. ■ Common side effects of lithium therapy include mild nausea or diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, a metallic taste in the mouth, and fatigue or lethargy. Weight gain and acne are side effects that occur later in lithium therapy ■ Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination. Untreated, these symptoms worsen and can lead to renal failure, coma, and death ■ Teaching ● Take with milk or food ● Do not decrease salt intake ● drink 8-12 glasses of water daily ● Daily monitoring of serum lithium levels ○ Adequate renal function is a prerequisite for lithium therapy. ■ Lithium is excreted by kidneys
■ Administration of naloxone (Narcan), an opioid antagonist, is the treatment of choice because it reverses all signs of opioid toxicity. ○ Inhalants → ■ Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus (Howard, Bowen, & Garland, 2017). ■ Treatment consists of supporting respiratory and cardiac functioning until the substance is removed from the body. ■ There are no antidotes or specific medications to treat inhalant toxicity.
DOSE CALC
● IV - mL remaining ● IV - mL/hr ● IV - volume to be infused ● IV bolus - mL ○ Weight (kg) x Dosage Ordered (per kg) = Required Dose ○ medictests/units/weight-based-iv-bolus-and-drip-calculations
● Civil Rights - psychiatric clients ○ Clients receiving mental health care retain all civil rights afforded to all people except the right to leave the hospital in the case of involuntary commitment. ■ A person can be detained in a psychiatric facility for 48 to 72 hours on an emergency basis until a hearing can be conducted to determine whether or not he or she should be committed to a facility for treatment for a specified period. ■ They have the right to: ● refuse treatment ● to send and receive sealed mail ● to have or refuse visitors ■ Any restrictions (e., mail, visitors, clothing) must be made for a verifiable, documented reason. ■ These decisions can be made by a court or a designated decision-making person or persons, for example, a primary nurse or treatment team, depending on local laws or regulations. ■ Examples include: ● A suicidal client may not be permitted to keep a belt, shoelaces, or scissors because he or she may use these items for self-harm. ● A client who becomes aggressive after having a particular visitor may have that person restricted from visiting for a period of time. ● A client making threatening phone calls to others outside the hospital may be permitted only supervised phone calls until his or her condition improves.
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● Alcohol Abuse - Codependent Factors ○ An overdose, or excessive alcohol intake in a short period, can result in vomiting, unconsciousness, and respiratory depression. ■ This combination can cause aspiration pneumonia or pulmonary obstruction. ■ Alcohol-induced hypotension can lead to cardiovascular shock and death. ○ Children of alcoholics are four times more likely than the general population to develop problems with alcohol. ■ Many adult people in treatment programs report having had their first drink of alcohol as a young child when they were younger than 10 years of age. ■ This first drink was often a taste of the drink of a parent or family member ○ Codependency may play a role in substance or alcohol abuse. Even if the codependent individual enables the addict, it's likely that they'll use drugs or other substances with the person on whom they're dependent to feel linked. ○ Risk Factors: ■ Family history of addiction. Drug addiction is more common in some families and likely involves genetic predisposition. If you have a blood relative, such as a parent or sibling, with alcohol or drug addiction, you're at greater risk of developing a drug addiction. ■ Mental health disorder. If you have a mental health disorder such as depression, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder, you're more likely to become addicted to drugs. Using drugs can become a way of coping with painful feelings, such as anxiety, depression and loneliness, and can make these problems even worse. ■ Peer pressure. Peer pressure is a strong factor in starting to use and misuse drugs, particularly for young people. ■ Lack of family involvement. Difficult family situations or lack of a bond with your parents or siblings may increase the risk of addiction, as can a lack of parental supervision. ■ Early use. Using drugs at an early age can cause changes in the developing brain and increase the likelihood of progressing to drug addiction.
● Alcohol withdrawal is usually managed with a benzodiazepine anxiolytic agent, which is used to suppress the symptoms of abstinence ● Most commonly used benzodiazepines: lorazepam, chlordiazepoxide, and diazepam ● Can be administered on a fixed schedule around the clock during withdrawal
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○ Disulfiram ■ A BENZODIAZEPINE ■ If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result. ■ Avoid a wide variety of products that contain alcohol, such as cough syrup, lotions, mouthwash, perfume, aftershave, vinegar, and vanilla and other extracts. ■ Read labels carefully to avoid any alcohols
● Alcohol withdrawal - hospitalization ○ Referral to 12 Step AA upon discharge ○ Because alcohol withdrawal can be life-threatening, detoxification needs to be accomplished under medical supervision. ■ If the client’s withdrawal symptoms are mild and he or she can abstain from alcohol, he or she can be treated safely at home. ■ For more severe withdrawal or for clients who cannot abstain during detoxification, a short admission of 3 to 5 days is the most common setting.
● Anorexia ○ Anorexia: ■ life-threatening eating disorder characterized by the client’s restriction of nutritional intake necessary to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. ■ weight that is less than the minimum expected weight considering age, height, and overall physical health ■ preoccupation with food and food-related activities
■ Clients with the restricting subtype lose weight primarily through dieting, fasting, or excessive exercising. ■ Those with the binge eating and purging subtype engage regularly in binge eating followed by purging ■ They still experience hunger but ignore it and also ignore the signs of physical weakness and fatigue; they often believe that if they eat anything, they will not be able to stop eating and will become fat. ■ Excessive exercise is common; it may occupy several hours a day. ■ Perfectionism, obsessive–compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder.
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○ Anorexia Treatment: ■ difficult to treat because they are often resistant, appear uninterested, and deny their problems. ■ The choice of setting depends on the severity of the illness, such as weight loss, physical symptoms, duration of binging and purging, drive for thinness, body dissatisfaction, and comorbid psychiatric conditions. ■ Short hospital stays are most effective for clients who are amenable to weight gain and who gain weight rapidly while hospitalized. ■ Longer inpatient stays are required for those who gain weight more slowly and are more resistant to gaining additional weight. ■ Outpatient therapy has the best success with clients who have been ill for fewer than 6 months, are not binging and purging, and have parents likely to participate effectively in family therapy. ■ Cognitive–behavioral therapy (CBT) can also be effective in preventing relapse and improving overall outcomes
● Bulimia priority ○ Bulimia Nervosa ■ an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. ■ The amount of food consumed during a binge episode is much larger than a person would normally eat. ■ Between binges, the client may eat low-calorie foods or fast.
● The nurse explains that purging is an ineffective means of weight control and only disrupts the neuroendocrine system. ● In addition, purging promotes binge eating by decreasing the anxiety that follows the binge. ● The nurse explains that if clients can avoid purging, they may be less likely to engage in binge eating. ● The nurse also teaches the techniques of distraction and delay because they are useful against both binging and purging. ● The longer clients can delay either binging or purging, the less likely they are to carry out the behavior.
○ Establish Nutritional Eating Patterns ■ Typically, inpatient treatment is for clients with anorexia nervosa who are severely malnourished and for clients with bulimia whose binge eating and purging behaviors are out of control. ■ implement and supervise the regimen for nutritional rehabilitation. Total parenteral nutrition or enteral feedings may be prescribed initially when a client’s health status is severely compromised. ■ The nurse must be alert for any attempts by clients to hide or to discard food. ■ monitoring meals and snacks and often initially will sit with a client during eating at a table away from other clients.
○ Identifying Emotions and Developing Coping Strategies ■ The nurse can help clients begin to recognize emotions such as anxiety or guilt by asking them to describe how they are feeling and allowing adequate time for response. ● The nurse should not ask, “Are you sad?” or “Are you anxious?” because a client may quickly agree rather than struggle for an answer. ■ The nurse encourages the client to describe his or her feelings. This approach can eventually help clients recognize their emotions and connect them to their eating behaviors. ○ Dealing with Body Image Issues: ■ The nurse can help clients accept a more normal body image. This may involve clients agreeing to weigh more than they would like, to be healthy, and to stay out of the hospital. ■ help clients view themselves in terms other than weight, size, shape, and satisfaction with body image. ○ Providing client and family education ■ provides extensive teaching about basic nutritional needs and the effects of restrictive eating, dieting, and the binge-and-purge cycle ■ Clients need encouragement to set realistic goals for eating throughout the day ■ Teaching should include information about the harmful effects of purging by vomiting and laxative abuse ■ teaches the techniques of distraction and delay because they are useful against both binging and purging.
● Rape 14. ○ May be associated with PTSD ■ Fears—may be displaced or generalized (as in fear of men by survivors who have been raped by men) ○ Especially encourage the expression of anger, guilt, and rage. ○ Rape is the perpetration of an act of sexual intercourse with a person against his or her will and without their consent, whether that will is overcome by force, fear of force, drugs, or intoxicants. ○ Rape is a crime of violence and humiliation of the victim expressed through sexual means. ○ It is also considered rape if the victim is incapable of exercising rational judgment because of mental deficiency or because he or she is younger than the age of consent ○ Only 28% of rapes are committed by strangers, 7% for child victims ○ Related medical problems can include acute injury, sexually transmitted diseases, pregnancy, and lingering medical complaints. ○ Many victims of rape experience fear, helplessness, shock, disbelief, guilt, humiliation, and embarrassment. ■ They may also avoid the place or circumstances of the rape; give up previously pleasurable activities; experience depression, anxiety, PTSD, sexual dysfunction, insomnia, and impaired memory; or contemplate suicide. ○ Assessment ■ To preserve possible evidence, the physical examination should occur before the victim has showered, brushed teeth, douched, changed clothes, or had anything to drink. ■ This may not be possible because the victim may have done some of these things before seeking care. If there is no report of oral sex, then rinsing the mouth or drinking fluids can be permitted immediately. ■ To assess the patient’s physical status, the nurse asks the victim to describe what happened. If he or she cannot do so, the nurse may ask needed questions gently and with care. ■ Rape kits and rape protocols are available in most emergency department settings and provide the equipment and instructions needed to collect physical evidence. ■ The physician or a specially trained sexual assault nurse examiner is primarily responsible for this step of the examination. ○ Tx and Intervention ■ Victims of rape fare best when they receive immediate support and can express fear and rage to family members, nurses, physicians, and law enforcement officials who believe them. ■ Education about rape and the needs of victims is an ongoing requirement for health care professionals, law enforcement officers, and the general public. ■ Giving as much control as possible back to the victim is important. ■ Prophylactic treatment for sexually transmitted diseases is offered. ● Doing so is cost-effective; many victims of rape will not return to get definitive test results for these diseases.
● Adult - generativity (s/o Google on this one) ○ Generativity is the propensity and willingness to engage in acts that promote the wellbeing of younger generations as a way of ensuring the long-term survival of the species. ○ Generativity is a concept that was introduced by Erikson (1950) over 60 years ago. He defined it as “an interest in establishing and guiding the next generation”, concluding ○ that this was typically achieved through biological parenthood.
● Anxiety - panic ○ Mild Anxiety ■ Physical Characteristics: ● Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect him or herself. ● Mild anxiety often motivates people to make changes or engage in goal-directed activity. ■ Nursing Interventions: ● Teaching can be effective when the client is mildly anxious.
○ Moderate Anxiety ■ Physical Characteristics: ● the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. ● the person can still process information, solve problems, and learn new things with assistance from others ● difficulty concentrating independently but can be redirected to the topic ■ Nursing Interventions: ● Speaking in short, simple, and easy-to-understand sentences is effective ● the nurse must stop to ensure that the client is still taking in information correctly. ● The nurse may need to redirect the client back to the topic if the client goes off on a tangent.
○ Severe/Panic Anxiety ■ Physical Characteristics: ● more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly. ● Muscles tighten, and vital signs increase. ● The person paces; is restless, irritable, and angry; or uses other similar emotional–psychomotor means to release tension ■ Nursing Interventions: ● The nurse’s goal must be to lower the person’s anxiety level to moderate or mild before proceeding with anything else. ● remain with the person because anxiety is likely to worsen if he or she is left alone. ● Talking to the client in a low, calm, and soothing voice can help.
● If the person cannot sit still, walking with him or her while talking can be effective.
○ Panic ● The emotional–psychomotor realm predominates with accompanying fight, flight, or freeze responses. ● Adrenaline surge greatly increases vital signs.
● Pupils enlarge to let in more light, and the only cognitive process focuses
on the person’s defense.
■ Nursing Interventions: ● Safety is the primary concern ● The nurse must keep talking to the person in a comforting manner, even though the client cannot process what the nurse is saying ● The nurse must keep talking to the person in a comforting manner, even though the client cannot process what the nurse is saying. ● The nurse can reassure the person that this is anxiety, it will pass, and he or she is in a safe place. ● The nurse should remain with the client until the panic recedes. ● The nurse must be aware of his or her own anxiety level.
● Anxiety - intervention ○ Managing the effects of stress and anxiety in one’s life is important to being healthy ■ Learning to heed this warning (anxiety) and to make needed changes is a healthy way to deal with the stress of daily events ○ Panic disorder is treated with CBTs, deep breathing and relaxation, and medications such as benzodiazepines, SSRI antidepressants, tricyclic antidepressants, and antihypertensives such as clonidine (Catapres) and propranolol (Inderal).
○ SEE ABOVE FOR INTERVENTIONS RELATING TO EACH STAGE OF ANXIETY
○ Teaching ■ Remember that everyone occasionally suffers from stress and anxiety that can interfere with daily life and work. ■ Avoid falling into the pitfall of trying to “fix” the client’s problems. ■ Discuss any uncomfortable feelings with a more experienced nurse for suggestions on how to deal with your feelings toward these clients. ■ Remember to practice techniques to manage stress and anxiety in your own life.
● Anxiety - cognitive behavioral techniques ○ CBTs used to treat clients with anxiety disorders include positive reframing, decatastrophizing, thought-stopping, and distraction. ○ Cognitive–behavioral therapy (CBT) is used successfully to treat anxiety disorders. ■ Positive reframing means turning negative messages into positive messages. ● The therapist teaches the client to create positive messages for use during panic episodes. ● For example, instead of thinking, “My heart is pounding. I think I’m going to die,” the client thinks, “I can stand this. This is just anxiety. It
■ Keep a regular schedule. ● Stick to a routine to help control mood swings. ● Bipolar people don't do well with lots of changes ■ Practice healthy sleep habits. ● Being overtired can trigger mania in some bipolar people. ● Relax before bed by listening to soothing music, reading, or taking a warm bath. ● Experts also recommend that you make your bedroom a calming place and use it only for sleep and sex. ■ Get moving. ● Studies show that regular exercise can help improve mood. ● Start slowly by taking a walk around the neighborhood. ● Gradually work up to exercising on most days of the week. ■ Avoid caffeine, alcohol, and drugs. ● Caffeine is a stimulant, which can keep you up at night and exacerbate manic episodes. ● Cut back on coffee and soda, especially at night. ● Alcohol and drugs can affect how your medications work and possibly trigger a mood episode. ■ Write it down. ● Keep a journal that makes note of big events, stresses, how much sleep you're getting, and what you're eating and drinking. ● Over time, you may see patterns emerging. ● By knowing what your triggers are, you may be able to prepare for times when you might be most vulnerable to mood swings.
● Clarification-communication ○ Seeking clarification is a therapeutic communication technique used to validate findings. ○ To clarify context, the nurse must gather information from verbal and nonverbal sources and validate findings with the client. ■ For example, if a client says, “I collapsed,” she may mean she fainted or felt weak and had to sit down, or she could mean she was tired and went to bed. ● To clarify these terms and view them in the context of the action, the nurse would say, “What do you mean collapsed?” (seeking clarification)
● Countertransference ○ Freud developed the concepts of transference and countertransference. ■ Transference occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships ■ Countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past. ● EX. a female nurse who has teenage children and who is experiencing extreme frustration with an adolescent client may respond by adopting a parental or chastising tone.
● EX. A clinician offers advice versus listening to the client's experience. A clinician inappropriately discloses personal experiences during the session. A clinician doesn't have boundaries with a client. ○ Nurses can deal with countertransference by examining their own feelings and responses, using self-awareness, and talking with colleagues.
● Defense mechanism ○ Behavior Motivated by Subconscious Thoughts and Feelings → Freud believed that the human personality functions at three levels of awareness: conscious, preconscious, and unconscious ■ Conscious refers to the perceptions, thoughts, and emotions that exist in the person’s awareness, such as being aware of happy feelings or thinking about a loved one. ■ Preconscious thoughts and emotions are not currently in the person’s awareness, but he or she can recall them with some effort—for example, an adult remembering what he or she did, thought, or felt as a child. ■ The unconscious is the realm of thoughts and feelings that motivates a person even though he or she is totally unaware of them. ● This realm includes most defense mechanisms ○ Freud believed that the self, or ego, uses ego defense mechanisms, which are methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events ■ SEE BELOW
■ The nurse should assess the client’s behavior to determine which phase of the aggression cycle he or she is in so that appropriate interventions can be implemented. ■ The five phases of aggression:
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■ In the triggering phase, ● Nursing interventions include speaking calmly and non threateningly, conveying empathy, listening, offering PRN medication, and suggesting retreat to a quiet area. ■ In the escalation phase, ● Interventions include using a directive approach; taking control of the situation; using a calm, firm voice for giving directions; directing the client to take a time-out in a quiet place; offering PRN medication; and making a “show of force.” ■ In the crisis phase, ● Experienced, trained staff can use the techniques of seclusion or restraint to deal quickly with the client’s aggression. ■ During the recovery phase, ● Interventions include helping clients relax, assisting them to regain self-control, and discussing the aggressive event rationally. ■ In the post-crisis phase, ● The client is reintegrated into the milieu.
■ Assessment of clients must take place at a safe distance. ● The nurse can approach the client while maintaining an adequate distance so that the client does not feel trapped or threatened. ● To ensure staff safety and exhibit teamwork, it may be prudent for two staff members to approach the client.
● Group treatment ○ A group is a number of persons who gather in a face-to-face setting to accomplish tasks that require cooperation, collaboration, or working together. ■ Each person in a group is in a position to influence and to be influenced by other group members. ○ Types of Group Treatment ■ Group Therapy- number of persons who gather in a face-to-face setting to accomplish a task ■ Group leadership- designated leader that leads the group ■ Psychotherapy groups- members to learn about their behavior and to make positive changes in their behavior by interacting with others as a group
● Psychotherapy groups are often formal in structure, with one or two therapists as the group leaders.
■ Family Therapy- client AND family members participate
■ Family Education- family-to-family education course ■ Education Group- provide information to members on a specific issue such as stress management ■ Self-help groups- members share a common experience but group is not formal or structured ○ Groups may be organized around a specific medical diagnosis, such as depression, or a particular issue, such as improving interpersonal skills or managing anxiety. ○ Group techniques and processes are used to help group members learn about their behavior with other people and how it relates to core personality traits. ○ Members also learn they have responsibilities to others and can help other members achieve their goals. ○ Stages ■ The beginning stage of group development, or the initial stage, commences as soon as the group begins to meet ■ The working stage of group development begins as members begin to focus their attention on the purpose or task the group is trying to accomplish. ■ The final stage, or termination, of the group occurs before the group separates. ● The work of the group is reviewed, with the focus on group accomplishments or growth of group members or both, depending on the purpose of the group.
NSG 221 HESI Exam - Hesi Study Guide
Course: Mental Health Nursing (NSG221)
University: Herzing University
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