Mental Health ATI Study guide
Legal and Ethical Issues: Ch 2
• Legal rights of pt’s in a mental health setting
o Same civil rights as any other
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o Human tx, vote, granting/ forfeiture of drivers license, press charges
o Informed consent, confidentiality, written plan of care, communication with others, respect, freedom from restraints (use least restrictive option 1st)
• Tort: a wrongful act on another person
• Ethical principles:
o Beneficence: doing good (help pt feel safe on a unit)
o Autonomy: pt makes own decision (helps pt explore all options)
o Justice: fair and equal treatment (two pt’s broke a rule were tx the same)
o Fidelity: loyalty and fairness (nurse stays with pt during a difficult time for support)
o Veracity: honesty (tells the pt what she and another nurse were discussing about that pt’s care)
• Types of admissions
o Voluntary admission: right to apply for release at any time, the right to refuse medication
o Temporary emergency admission: d/t inability to make decision regarding care (15 days or less)
o Involuntary admission: against her will~ the risk of harm to self or others or inability to provide self care
Can request legal review of the admission at any time
60 days or less
Still considered competent and have the right to refuse treatment
o Long term involuntary admission: imposed by courts (60-180 days)
• Seclusion and restraints
o Use least restrictive and the least amount of time
Less restrictive measures: verbal interventions, distractions, calm environment, PRN meds
o Never a punishment
o CI: medically unstable pt, psychotically unstable, can’t tolerate low stimulation
o Time limits: adult 4hr, child 2hrs
Food, fluids, bathroom, vitals, pain
Complete documentation q 15- 30 minutes
If emergency get MD sign within 30 minutes
• Torts
o False imprisonment: seclusion
o Assault: threat and battery: harming another
Effective Communication Ch 3
o Therapeutic communication: attend to the pt's thoughts, feelings, concerns and needs~ expresses empathy and concern
o Silence: meaningful reflection
o Active listening: the nurse is able to understand what the pt is communicating and provide feedback
o Questions
o Open ended: facilitates spontaneous response
o Closed ended: used sparingly for data collection
o Projective question: what if… helps the pt explore feeling and gain greater insight
o Presupposition questions: explores pt’s life goals and motivation
o Clarifying tech:
o Restating: uses exact words
o Reflecting: directs focus back to pt to examine his feelings
o Paraphrasing: restates the pt’s feelings to confirm
o Exploring: gathering more information
o Barriers to communication
o Asking irrelevant personal question, personal opinion, advice, false reassurance, minimize feelings, change the topic, ask why, judgments, excessive questioning, approving or disapproving
Group and Family Therapies Ch 8
o Individual focus: pt’s needs and problems
o Goal: strong sense of self
o Family focus: needs and problems and family functioning
o Goal: improve understanding, maximize positive interactions
o Group: focus: develop functional and satisfying relationships
o Goal: common feelings, experiences and thoughts, positive behavior changes
o Boundaries of dysfunctional families
o Enmeshed: thoughts, role and feelings so blended that there is no individual roles
o Rigid: members isolate themselves, roles and rules are so flexible
Brain stimulation Therapies Ch 10
o Electroconvulsive therapies: seizure effects enhance NT activity
o Use: depression, schizophrenia, manic episodes
o CI: CVD, cerebrovascular disorders
o During procedure: monitor HTN, dysrhythmias, 100% O2 before and after procedure
o After procedure: monitor ECG, O2, cardiac (HTN)
o Adverse reaction: memory loss, cardiovascular changes, HA, muscle soreness, nausea
o Transcrainial magnetic stimulation
o Use: depression
o Proceedure: pt is alert, noninvasive, may feel knocking/tapping and tightening jaw muscles
o Complications: light headness, seizures
o Vagus Nerve stimulation
o Use: depression, anxiety, obesity, pain
o Complications: hoarseness, dysphagia (improve with time)
Depressive disorders Ch 13
o Comorbidities: anxiety disorders, schizophrenia, substance use disorders, eating disorders, personality disorders
o Major depressive disorder: change in normal functioning (2 weeks min)
o Depressed, sleeping, indecisiveness, decreased ability to concentrate, suicide, motor activity, inability to feel pleasure
o Psychotic features: depression with auditory hallucinations
o Post partum: with in 4 week of child birth
o SAD: light therapy 1st line tx
o Dysthymic disorder: mild form of depression, early onset and last for at least 2 yrs
o Substance induced depressive disorder: with the use of or withdrawal of a substance
o Phases of depression
o Acute: reduction of depression (goal) 6-12 weeks
o Continuations: increased ability to function, relapse prevention
o Maintenance phase: prevention of depressive episodes (years long)
o Risk factor: family hx, personal hx, females between 15-40 yrs and 65+, NT imbalance, stress, postpartum, poor social support, substance abuse, unmarried, trauma
o Expected findings: anergic, anhedonia, anxiety, sluggish, veggie, somatic
o Interventions: Suicide risk, ADLs, spend time with pt, increase coping skills, self esteem, assertiveness
o MEDs
o SSRI: HA, insomnia, anxiety, sweat, tremor, diarrhea, sex
o TCA: antichol, sedation, hypotension, dysrhythmias, tremors, impotence, wt gain, little EPS
o MAOI: no ssri, cough med, sedation, anesthesia, stimulants, narcotics, thyramine
o Bupripion
o St. John’s wort: herb: watch for rash, itchy, photosensitivity, tachy, GI
Anxiety Ch 11
o Separation anxiety disorder: distress with separation and anticipation
o Fear of tragidity resulting in permanent separation
o Agoraphobia: extreme fear in certain situations/places
o Inability to hold job and ADLs
o Social anxiety: fear of social or performance situation
o Panic disorder: recurrent panic attacks
o Last 15-30 mins: palpitation, SOB, chocking, chest pain, depersonalization, fear of dying, chills/hot flashes
o GAD: 6 months of excessive worry
o Restless, muscle tension, avoidance of situation, increased time for activities
o Hoarding: resulting in extreme stress and functioning impairment
o Body dysmorphic disorder: perceived flaws in physical appearance
o Reoccurring mirror checking and comparing self
o Risk factors: women > men (except hoarding), genetic, hyperthyroid, resp
o MEDS: SSRI (1st) Benzo, buspirone, beta blockers, antihistamine, anticonvulsants
o Therapies: relaxation, modeling, systematic desensitation, flooding, response prevention, thought stopping
Substance Abuse Ch 18
Drug intoxication Withdrawal meds
Alcohol Excessive use: slurred speech, memory impairment, altered judgement, decreased motor skills, decreased LOC
Chronic use: CV and liver damage, erosive gastritis, GI bleeding
Ab cramping, tremors, restless, sleep, hallucinations, tonic-clonic siezures
Tachy, HTN, increase RR, temp W/D: Diazepam
Carbamazepam
Chlordiazepoxide
Phenobarbital
Naltrexone
Maintain
Disulfiram
Naltrexone
Acomprosate
Benzo Drowsy, sedation, agitation, slurred speech, incoordination, N/V disorientation
Resp depress
Antidote for flumazenil (date rape) none for barbs Anxiety, insomnia, sweat, psychosis, tremors, hallucinations, seizure, agitation
HTN, resp depression
Cannabis High dose: paranoia, delusions and hallucination
Chronic use: lung CA, chronic bronchitis, resp effects
Hunger, dry mouth, tachy Irritable, aggression, anxiety, insomnia, restless
Depression, ab pain, tremors, sweat, lack of appetite, fever and HA
Cocaine (CNS stim) Mild: dizzy, irritable, tremor, blurred vision
Severe: hallucinations, seizures, ches pain, CV collapse~ HTN, tachy, high fever
Depression, craving, fatigue, nightmares, agitation
Amphet
amines Impaired judgement, psychomotor agitation, hypervigilance, irritability
Acute CV effects: HTN and tachy (deadly) Craving, depression, sleep
Tobacco High toxicity: seen in children
Chronic use: CVD, HTN, CVA, Resp diseases
Chew: oral mucosa Irritable, crave, nervous, anxiety, insomnia, increase appetite
Opoids Slurred speech, impaired memory, pin point pupils, impaired judgment
Resp depression
Antidote: Narcan Sweat, rhinorrhea, goosebumps, weakness, pupil dilation, tremors
Fever, N/V Methadone
Clonidine
Buprenorphrine
Naltrexo
Hallucinogen Anxiety, depression, impaired judgement, impaired social functioning, pupil dilation, tachy, sweat, palpations, panic attacks Flashbacks
Caffeine Tachy, arrhythmias, flushed, twitching, restles, diuresis, anxiety, insomnia HA. N/V, muscle pain, irritability, drowsy
o Risk factors: family hx, socioeconomic, abuse, low self esteem, few successes and meaningful relationships
o Sociocultural theories: peer pressure, older adult stressors, isolation
o Young users: higher incidence of developing a substance disorder
o Older adult: prone to falls, memory loss, somatic reports, lower doses
o Screenings
o CAGE: change, annoyed, guilt, eyeopener
o CIWA: clinical institute withdrawal alcohol
Eating disorders: ch 19
o Comorbidities: depression, anxiety, personality disorder, substance abuse
o Anorexia nervosa:
o Restriction low body wt, extreme fear of gaining wt, disturbances with self preception
o Characteristics:
Preoccupied with food, women, adolescence to young adulthood, onset with stress
o Types: restricting and binge/purging
o Bulimia nervosa:
o Binge eating followed by compensatory behaviors (vomiting)
Usually less than 2 hrs~ 1x/week for 3 months
o BMI: 18.5-25 WNL to higher, late adolescence or early adult, female
o Types: purging and nonpurging
o Binge eating disorder
o Large quanities of food over short time w/o compensatory behavior
o Lack of control
o 1x/week for 3 months
o Women 45-55 yrs
o Increases risk for HTN, DM, CA
o Risk factors: picky eater, athlete, model, hx of obesity, gentic
o Epidemiology:
o Bio: hippocampus, serotonin and cortisol
o Psycho: relationships, helplessness, loss of control
o Expected findings:
o Low vitals, fine, dull hair, lanugo, yellowed skin, irregular heart rate, weakness, decrease energy, amenorrhea
o Bulimia: Russel sign, enlarged parotid glands, dental erosions
Mental health Issues of Children and Adolescents: ch 28
o Factors impeding dx:
o Children may not be able to describe what is happening
o The child’s normal is always changing
o Behavioral or emotional problem
o Etiology and risk factors:
o Genetics: schizo, bipolar, autism, ADHD, intellectual d/o
o Biochem: NE, serotonin, dopamine
o Environmental: socioeconomic status, SA, crime, parental mental ill
o resiliency ability to adapt to changes in the environment from relationships
o Depressive d/o: risk factors: family hx, abuse, bullied, high risk behaviors
o Anxiety d/o: stress interferes with normal growth and development
o Separation anxiety: excessive distress with anticipation or separation panic disorder
o PTSD: aggression with family and friends, poor grades, somatic reports, difficulty sleeping (use therapy and work through event)
o Interventions: support during panic, increase pt’s self esteem
o Oppositional defiant disorder
o Antisocial behaviors: negative, disobedience, hostility, defiant, argumentative conduct
o Disruptive mood dysregulation disorder:
o Recurrent temper outburst disproportionate with situation 3+/week
In two settings (6-18 yrs)
Behaviors not d/t another mental illness
o Conduct disorder:
o Violates the rights of other: aggression towards people, property, theft, violation of rules with Lack of remorse
o Onset before 10 males are more prevalent
o Contributing factors: SA Dad, sexual abuse, abuse, parental rejection
o Attention deficit disorder
o Inattention: difficulty listening, focusing
o Hyperactivity: intrusive, talking excessively, fidgeting
o Impulsivity: evidence by difficulty waiting for turn, interrupting
o Interventions: calm, firm, respectful, model behavior, clear limits, outlet for energy, behavior modification
o Autism spectrum
o Genetic, abilities varies
o Need structure, consistency is keep, behavior modification, give plenty of notice before changing plans
o Intellectual development disorder
o Inability to maintain independence, responsibility, ADLs, need support at school
o Pharmacology
o ADHD: CNS stimulants, Wellbutrin, atomoxetine (SSRI)
o Austism: SSRI, antipsychotic med (2nd gen)
o Intermittent explosive d/o: SSRI, mood stabilizer, lithium, antipsychotics, beta blockers
o OOD: no meds
o Conduct: TCA, antipsychotics, antianxiety, mood stabilizers
o Anxiety: SSRI ~ not FDA approved
o Disruptive mood dysregulation disorder: antidepressant therapy
Suicide: ch 30:
o Suicide idealation: pt is having thoughts of suicide
o Risk factors elderly: untx depression, loss of employment and finances, isolation, SA, loss of loved ones
o Other risk factors: family hx, chronic diseases, hopeless, intense emotions, poor relationships, stress, American Indian and Alaskan
o Protective factor: children, pregnant, satisfaction, support system, adequate medical care
o Suicide precautions:
o 1;1 supervision
o document q15 minutes
o remove pt’s belongings with glass metal, electrical cords, belts, shoe laces, tweezers, shampoo, perfume, plastic bags
o free environment for hazards
o keep hands wear they are visible
o door always open
o MEDS: SSRI, benzo, mood stabilizers (lithium) 2nd gen: antipsychotics
o Electroconvulsive therapy: loss of memory (no HA)
Anger management: ch 31
o Anger: an emotional response to frustration as perceived by the person
o Becomes negative when suppressed, denied, expressed inappropriately
o Aggression: intent of harming a specific person or object (physical and verbal)
o Comorbidities: depressive disorders, PTSD, alzheimers, personality and psychotic disorders
o Seclusion and restraints: used last, don’t have a positive behavior change but help keep people involved safe
o Interventions
o Safe environment
o Respond quickly, calmly and in control ask to verbalize feelings allow personal space maintain eye contact clearly describe choices set limits (inform of consequences, “I need to you to stop yelling and walk with me”, 4-6 staff members)
Never threat or accuse
o Following event: discuss ways to control anger, what triggered, document
o Meds: olanzapine, haldol [Show Less]