Rasmussen College: NUR 2459 Mental Health Final Exam Blueprint_ LATEST 2021/2022
Mental Health Final Exam Blueprint
• Obsessive-Compulsive
... [Show More] Disorder
o Types
▪ Checking
▪ Contamination/mental contamination
▪ Symmetry and ordering
▪ Ruminations/intrusive thoughts
▪ Hoarding
o Schedule changes may make them more anxious
o Difficulty getting rid of things
o Trouble relaxing
• Borderline Personality Disorder
o Staff splitting
o Staff make sure to be consistent with these patient’s
o Ensure safety!
o Afraid of being alone
o Personality disorders and medications (quick treatment? no!)
o Borderline Personality Disorder patient’s trying to pin staff against each other “the other nurse said you don’t know what you’re doing” let the patient know you and the other nurse talk directly to one another
• Dependent Personality Disorder
o Are they afraid of being alone?
o Helpless
o Submissive or incapable of taking care of themselves
o Trouble making simple decisions
• Histrionic
o Maladaptive behaviors
o Self-esteem depends on approval of others
o Overwhelming desire to be noticed
o Behave dramatically or inappropriately to get attention
• Antisocial Personality Disorder
o Limit setting- clarify the rules and expectations
o Ensuring safety
o Try to understand where they are coming from/what they’re experiencing
• Somatic Symptom Disorder
o Nursing interventions
▪ Education
▪ Assist client to express emotions
▪ Teach coping strategies
o Let them talk about their pain, but then refocus to discussing coping skills to dealing with their stress
• Somatization Disorder
o Extreme focus on physical symptoms
o Causes major emotional distress and problems functioning
• ADHD
o Strategies
▪ Therapy
• Behavioral psychotherapy
• Psychosocial interventions
• Cognitive therapy for adults with ADHD
▪ Pharmacologic
• Stimulants
• Atomoxetine (nonstimulant)
• Tricyclics
▪ Use simple and direct instructions
▪ Implement scheduled routine everyday
▪ Avoid stimulating/distracting settings
▪ Positive reinforcement
▪ Encourage physical activity
• Oppositional Defiant Disorder – characterized by a pattern of anger and defiant behavior. Typically begins by age 8 and usually not later than early adolescence.
o Therapy
▪ Parent training
▪ Parent-child interaction therapy
▪ Family therapy
▪ Anger management
o Depakote: shown to reduce aggression and irritability
▪ Sodium valproate
▪ Anticonvulsant
• Conduct disorder – more severe in children/adolescents. They violate rights of others.
o 18 or older = antisocial personality disorder
o Overall outcomes
▪ Help control thoughts and behaviors
▪ Assist families to function more adaptively
o Multi-systemic therapy is most extensive and effective
▪ Intensive family and community-based program
▪ Healthy activities like sports and recreational
• Eating Disorders: want patient input to aid in setting outcomes
o Anorexia Nervosa
▪ Interventions
• Provide highly structured milieu
• Develop/maintain trusting relationship
• Positive approach and reinforcement
• Encourage participation in plan of care
• Promote cognitive-behavioral therapies
o Cognitive reframing
o Relaxation techniques
o Journal writing
o Desensitization exercises
• Monitor vitals, I&Os, weight
o 2-3 lbs./week medically acceptable
• Behavioral contracts
• Monitor during and after meals
o Bulimia Nervosa
▪ Good sign when they can discuss their feelings
• PTSD vs. Acute Stress Disorder
o Acute Stress: stress response begins to resolve after the traumatic event
o Acute Stress Disorder (ASD) – exposure to traumatic events manifestations for at least 3 days but for not more than 1 month following the event.
o PTSD – exposure to traumatic events manifestations longer than 1 month. Can last for years.
• Panic Attacks vs. Dissociative Disorders
o Panic attacks
▪ Last 15-30 minutes
▪ 4 or more manifestations are present
• Palpitations
• SOB
• Choking or smothering sensation
• Chest pain
• Nausea
• Feelings of depersonalization
• Fear of dying or insanity
• Chills or hot flashes
▪ Behavior changes or persistent worries about next attack
o Dissociative disorders
▪ Disconnection and lack of continuity between thoughts, memories, surroundings, actions, and identity.
▪ Develops as reaction to trauma and difficult memories.
• Conversion Disorder
o Mental condition in which a person has blindness, paralysis, or other neurologic symptoms that cannot be explained by medical evaluation.
• Factitious Disorder Imposed on another
o When someone falsely claims that another person has physical or psychological signs or symptoms of illness or causes injury or disease in another person with the intention of deceiving others.
• Erikson’s Theory of Psychological Adjustment and stages
o Trust vs. Mistrust - Poor relationships and suspicious of others
▪ Psychosocial Stage 1
▪ Begins at birth and last until child is 18 months old
▪ Shapes their view of the world as well as their overall personality
▪ Trust
• Believing in caregivers
• Trusting that the world is safe
• Knowing that needs will be met
▪ Mistrust
• Distrusting caregivers
• Fearing the world
• Unsure that needs will be met
• Group therapy: Listening to other’s experiences is good!
o When is it used?
▪ For specific problems
• Depression
• Obesity
• Panic disorder
• Social anxiety
• Chronic pain
• Substance abuse
▪ For general problems
• Improving social skills
• Anger management
• Shyness, loneliness, and low self-esteem
o What are the benefits?
▪ Support network
▪ Hold you accountable
▪ Other members can help with specific ideas for improving a difficult decision or life challenge
▪ Diversity
▪ Realizing you are not alone
• Nursing interventions with sexual assault
o Safety!
• Abuse:
o Elder
o Intimate Partner
▪ Screening tools
▪ Universal questions
• Has your partner or anyone close to you ever threatened to harm you?
• Have you ever been hit, slapped, kicked, or choked or physically hurt by anyone? If yes, by whom? How many times?
• Has anyone, including your partner, ever force you to have sex?
• Are you afraid of anyone?
o Mandated Reporting
o Cycle of battery(abuse)
▪ Tension building phase: begins with minor incidents such as pushing, shoving, and verbal abuse
• Abuser may rationale the behavior is acceptable
▪ Acute battering stage: occurs when tension peaks
▪ Honeymoon or contrition stage: after the abuse occurs, there is a period of calm
o Child Abuse
• Diazepam (Valium): do not give to those with addiction
o Anxiolytic and sedative
• Zoloft: mood instability and anger control
o Sertraline
o SSRI
o Treat
▪ OCD
▪ PTSD
▪ Premenstrual dysphoric disorder
▪ Social anxiety
▪ Panic disorder
• Grieving Process
o Anticipatory Grief
▪ Future loss is being mourned in advance
• Therapeutic responses to adolescent patients Terms to understand:
• Anhedonia – inability to feel pleasure
• Acrophobia – extreme or irrational fear of heights
• Agoraphobia- may be caused from a traumatic childhood event
o Fear of places or situations that might cause panic, feeling trapped,
helpless, or embarrassed.
• Fugue state
o Type of dissociative amnesia in which the client travels to a new area and is unable to remember one’s own identity and at least some of one’s past. Can last weeks to months and usually follows a traumatic event.
• Desensitization – treatment process that diminishes emotional responsiveness to a negative, aversive, or positive stimulus after repeated exposure.
• Sublimation – mature type of defense mechanism, in which socially unacceptable impulses or idealizations are transformed into socially acceptable actions or behavior. Ex: playing sports to put your aggression into something more
constructive.
• Bereavement overload – grieving individual confronts multiple losses simultaneously or in rapid succession, such that one loss cannot be accommodated before another occurs.
• Depersonalization – persistent feeling of observing oneself from outside one’s body or having a sense that one’s surroundings are not real.
Substance Use recommend group therapy
Beneficial to hear from others with similar experiences
Sexual Assault Patients want to provide safe environment
If an elderly client shares that his child hits him. Are we required to report to proper agency? Yes, nurses and healthcare workers are mandated reporters.
Patient’s may feel it is okay when their partners apologize and buy them gifts
Important to teach about the cycle of abuse
Abuse power and control
Priority action for patient having aggressive outburst make sure all other patient’s are removed from the area to keep them safe [Show Less]