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NSG 2320 --------Comprehensive Final Exam Study Guide Chapters 1-3, 5-10, 12, 18, 21-23, 25-28, 30-32 Morrison-Valfre Chapters 1-3, 5, 7, 10-11, 13-16, 18-24, 26, 30, 32 ATI Chapter 1- The History of Mental Health Care Definition of Mental Healththe ability to cope with and adjust to the recurrent stresses of living in an acceptable way. 1. Inherited traits 2. Childhood nurturing 3. Life circumstances P Risk for Developing Ineffective Coping Behaviors Inherited traits (family members with mental illness), childhood nurturing or lack thereof, and life events that can be stressful or emotionally disturbing etc. Ineffective coping is when behaviors interfere with ADLs, impair judgement, or alter reality. P 1. Chapter 2- Current Mental Health Care Systems Purpose and characteristics of Case Management System of interventions. Psychosocial rehabilitation (decision-making), consultation, resource linkage (periodic monitoring) referral, advocacy, therapy, & crisis intervention (focuses in solving the immediate problem). Based on 1. Severity of illness 2. Level of dysfunction 3. The right fit for the type of illness 4. How much client cooperates 5. & client ability to pay ::: Inpatient safe environment 24/7 & focused therapeutic. Outpatient is services provided while in home setting. Recidivism or the “Revolving door ” and/or waiting until a huge problem happens “Band-Aid approach.” P11-12 (Who, when, why, for how long) Conditions that require emergency committal Danger to self or others Populations at risk for Mental Health Disorders Children, elderly, people in crisis situation, homeless, veterans, clients w/ HIV/AIDS, clients living in rural areas. Chapter 3- Ethical and Legal Issues Non-maleficence DO NO HARM (Most important ethical principle) Voluntary admission vs Involuntary/commitment CH 2 & 3Voluntary admissions are active participants that have a low potential for violence. May legally discharge themselves at any time. Involuntary admission is when a person engages in behavior that is harmful to themselves or others. 1953 Act Governing Hospitalizations—says involuntary admission is a process initiated by someone other than the client. Provide a PROTECTED, therapeutic environment, necessary for safety reasons. False Imprisonment Detaining a competent person against his or her will constitutes false imprisonment. P 26 Chapter 5- Theories and Therapies Maslow’s Hierarchy of Needs Level 1 (base of pyramid):Physiological needs (air, food, shelter, sleep) Level 2 : Need for safety & security-physical & psychological, Level 3 : Love & belonging Level 4: Esteem (self-respect) Level 5: Self- actualization (achieve full potential). P Purpose of Inpatient Care Provide a safe environment where patient cannot harm themselves or others, ideally. When patient is unable to provide self-care and manage symptoms.
Chapter 6- Complementary and Alternative Therapies Characteristics of Body Based CAM These therapies focus on working with the body’s natural abilities to help it heal itself. Veritable (mechanical vibration, electromagnetic forces, can be measured, & uses wavelengths & frequencies) & putative (Humans infused w/ a form of energy, cannot be measured, readjusts the energy flow to treat patients) Qi-Life force energy Reiki-God is wisdom Differentiate between allopathic, complementary and alternative medicine Allopathic use medical & surgical methods to treat disease, find what’s wrongs & fix it (This is what we do, most common). Complementary Practice & treatments that agree or worth with allopathic therapies. Used along w/ common medical treatments. Example: Acupuncture or seeing a chiropractor. Alternative medicine Treatments other than allopathic medicine. Reiki/yoga/herbs examples of alternative therapies. Potential Adverse Effects of CAM therapies Prescriptions drugs can interact w/ herbs**. **Chelation therapy can deplete potassium****. Allergic reactions from inappropriate use of dietary supplements. Chapter 7- Psychotherapeutic Drug Therapy Neuroleptic Malignant Syndrome Life-threatening reaction to antipsychotic drugs. Altered mental status, high fever, muscle rigidity, tachycardia, tachypnea, autonomic nervous dysfunction-- Akathesia Vs. Akinesia Akathisia is the inability to sit still. Akinesia is the absence of physical & mental movement. Table 7-7 P Signs and Symptoms of Serotonin Syndrome 2-72 hours after starting treatment. Ataxia, hyperreflexia, tremor, restlessness--Tachycardia , hallucinations, confused, seizures leading to status epilepticus, fever, diaphoresis, NVD, abdominal pain, coma—apnea—death. ATI P
MAOI side effects and special considerations/teaching Hypertensive crisis Throbbing, radiating
headache, stiff neck, palpitations, tightness in chest, sweating, dilated pupils, very high blood pressure and pulse rate Meds to avoid OTC: nasal and sinus decongestants ; cold, allergy, and hay fever remedies; inhalants for asthma; weight-loss pills, stimulants; narcotics, local anesthetics. No drugs. Foods to avoid alcohol : beer, ale, red wines, sherry wines, liqueurs. Dairy products : aged cheese, sour cream. Fruits and vegetables : avocados, bananas, fava and broad beans, canned figs, any overripe fruit. Meats : pickled or smoked, bologna, chicken or beef liver, dried fish, meat tenderizer, salami, sausage. Other foods: large amounts of caffeinated coffee, tea, or cola; chocolate; licorice; soy sauce; yeast ((Anticholinergic reactionsDry mouth, decreased tearing, blurred vision, constipation, urinary hesitancy or retention, excessive sweating. CNS depressionChanges in level of consciousness; sedation, increasing lethargy, disorientation, confusion, agitation, hallucinations, lower seizure threshold)) Older adults and meds Increased risk for developing drug interactions. P Treatment for panic attacks CH 18 & 7 Benzodiazepines—diazepam, lorazepam, alprazolam, clonazepam—anxiolytics: Buspirone. Interactions----erythromycin, ketoconazole , St John’s wort, GRAPEJUICE. Extrapyramidal Side Effects Akathisia (cant sit still) akinesia (no physical/mental movements) drug- induced parkinsonism, dyskinesia (inability to move voluntarily), dystonia (rigidity in muscles that
Clarification Attempting to put into words, vague ideas or unclear thoughts of client. “I am not sure what you mean. Could you tell me about that again?” Nontherapeutic Communication Techniques Giving advice, reassuring, disapproving, judgmental, inappropriate timing, being vague, stereotyping, belittling, assume. Types of Therapeutic Communication Techniques Active listening , maintaining eye contact, broad openings, restating, clarification, reflection, humor, informing, focusing, sharing perceptions, theme identification, silence , & suggesting. Chapter 12- The Therapeutic Environment Discharge Planning Begins upon admission Crisis Stabilization Interventions are provided by placing clients in 1 or 2-day treatment settings in which balance can be reestablished. Clients undergo intensive counseling designed to solve their immediate problems. Medications, such as antidepressants or sedatives, may be prescribed. P Chapter 18- Anxiety Levels of Anxiety Mild (vitals normal, minimal muscle tension, looks relaxed & calm on outside), Moderate (vitals slightly elevated, tense, attentive, alert perception narrowed, competitive activity, look of concern) Severe (fight or flight, sweating, elevated vitals, muscles rigid, feels threatened) & Panic (Escalating symptoms, pale, muscle coordination poor, scatter brained, helpless). P Treatment for Anxiety and Panic Disorders Benzodiazepines, antidepressants, antihistamines, and a anxiolytic drug called Buspirone (Bu-Spar). Cognitive behavioral therapy helps replace ineffective coping mechanism w/ one that work better for coping w/ anxiety. Systemic desensitization clients learn to cope with one stimulus at a time. Step-by-step method. Flooding is the opposite of desensitization; this is used for treating phobias-rapidly & repeatedly exposes clients to the feared object or situation. Acute Panic attacks CH 18 & 7 A panic attack is a period of intense fear or discomfort in which at least four of the following symptoms develop abruptly and reach a peak within 10 minutes: 1. Palpitations, pounding heart 2.Sweating 3.Trembling 4. Feeling short of breath, smothering 5. Feeling of choking 6.Chest pain or discomfort 7.Nausea or abdominal distress 8.Feeling dizzy, unsteady, lightheaded 9.Derealization (feelings of unreality) or depersonalization (being detached from oneself) 10.Fear of losing control or going crazy 11.Fear of dying 12.Paresthesias (numbness, tingling sensations) 13.Chills/hot flushes P Trichotillomania Pulling out hair- obsessive compulsive disorder Chapter 21- Depression and Other Mood Disorders Major Depressive Episode depression is severe and lasts more than 2 weeks. Feelings of worthlessness, guilt, and despair w/ physical appearance decline. Eating & sleeping patterns are disrupted. Poor concentration, inability to follow through on tasks, powerlessness and helplessness. P
Characteristics of Mania Refers to an emotional state in which a person has an elevated, expansive, and irritable mood accompanied by a loss of identity, increased activity, and grandiose thoughts and actions. Depression Risk Factors- Box 21-2 Adults at Risk for Depression • Women• People between the ages of 35 and 44 years• Whites and Hispanics• Individuals with fewer than 12 years of school• People who live in major urban areas• People with physical illnesses• Recently widowed older adults• People who live in the western United States Read “Emotions throughout the lifecycle” p 238-240 Toddlers-temper tantrums, children depressed about specific event (situational depression). Depression in adolescence is usually related to 4 factors: self-esteem, loneliness, family strengths, and parent-teen communication. Depression not normal sign of aging, elderly woman, medically ill, and people receiving long-term care are high rates in Americans. Characteristics of Hypomania Exaggerated sense of cheerfulness, begins the cycle. Progresses to the unstable “high” of mania. Behaviors become impaired; this phase can last as long as 3 months. Outgoing, happy-go-lucky, free of worry; catchy euphoria, confident, uninhibited; unconcerned about feelings of others; excessive involvement in activities; increased motor activity, sexual drives, distractibility, sense of importance; decreased ability to concentrate; moves quickly from one topic to another (flight of ideas); becomes easily irritated; decreased need for sleep. SSRI Side effects- uses CH 21 & 7 Dry mouth, nausea, diarrhea, drowsy, dizzy, nervous, sweating, headache, insomnia. P242 (((elderly males should be monitored for urinary retention when taking antidepressants))) Nursing Interventions for Bipolar Disorder Psychotherapy, Electroconvulsive therapy, transcranial direct current stimulation, antidepressants and antimanic (mood stabilizers).SSRIs first choice, less side effects, last choice MAOIs potentially severe/fatal side effects. Acute treatment phase 6-12 weeks reduce symptoms & inappropriate behaviors. Continuation phase is to prevent relapse into distressing emotional states. Last 4-9 months, outpatient. Maintenance treatment phase concentrates on preventing reoccurrences in clients w/ prior episodes of depression & mania & prevent new episodes. Treatment Goals for Pts with Depressive Disorders Establishment of effective coping mechanisms, and an elevated sense of well-being. Chapter 22- Physical Problems, Psychological Sources Primary vs Secondary Gains Primary gain is the to reduce anxiety. Secondar y gains are the results from assuming a sick role-- avoiding responsibilities, receiving special attention from people, having dependency needs met. P Conversion Disorder Most are women, low socio-economic class, rural areas, little health care knowledge. Clients with a conversion disorder present with problems related to sensory or motor functions. Four criteria 1 S/S involving voluntary motor or sensory system that suggest a neurological issue, s/s worsened by conflict/stress, S/S not intentional, S/S cause distress & impairment of ADLs, s/s cannot be explained by pathological condition or effects of a substance. Goal - Eliminate the possibility of a physical cause.
individual seclusions, restraints, and intramuscular injections (Haldol). Stage 4: Recovery Stage : Cooling down period Characteristics- Person slowly starts to calm down and return to normal behavior. Interventions-Assessing for injuries during this time & providing a safe, quiet, environment. Stage 5: Depression Stage : Last stage, guilt reconcile or make up attempt Characteristics-Vicious cycle of feeling bad and apologizing and trying to give gifts or make up for what they did wrong Intermittent Explosive Disorder Acts resulting in assaultive/destructive behavior. Chapter 26- Outward-Focused Emotions: Violence Priority Assessment for Victims of Abuse The first priority of care for every victim of violence is to ensure safety & security. Do not leave client alone. Abuse assessment screening Signs and Symptoms of Child Abuse Bruises w/ different patterns different stages of healing, welts, burns, fractures, lacerations, bite marks, consistently dirty, without supervision, constantly tired, torn, stained clothing, wary of physical contact w/ adults. Chapter 27- Inward-Focused Emotions: Suicide Eating Disorders and Suicide CH 27 & 23 “Adolescents with anorexia nervosa have higher rates of suicide. In fact, many theorists believe that anorexia is a slow attempt at suicide.” P Risk Factors for Suicide in Children Have existing mental health problems, such as conduct disorders, attention-deficit/hyperactivity disorders, or psychoses , are at a greater risk for committing suicide than other children, family conflict/disruption, CHANGE IN BEHAVIOR. Assessment of Suicide Potential- Box 27-3, Table 27-3 Have you thought about harming or killing yourself? Do you have a plan? (Do they have the reasonable means to achieve this plan, how soon… assess). Chapter 28- Substance-Related Disorders Signs and Symptoms of alcohol withdrawal N&V, tremors, restlessness, inability to sleep, irritable, elevated HR, BP, respiratory rate, temperature, diaphoresis, tonic-clonic seizures. P159 ATI BOOK Prevention for substance abuse Educate client & family on the risks and dangers of substance abuse, treat underlying problems. Priority Treatment for Substance Abuse- know each drug class Detoxification… Opiates-methadone, Alcohol—disulfiram (Antabuse). Act as a therapeutic agent. Characteristics of Drug addicted newborn CH 28 & 7 High pitched cry, eat & sleep problems—cocaine Delirium Tremens (DTs) a severe form of alcohol withdrawal that involves sudden and severe physical, mental, behavioral, and nervous system changes. 48 hrs-- 10 days after last drink. Medical emergency. Changes in mental function, delirium hallucinations, and seizures Side Effects of Inhalant Use great well-being (euphoria), excitement, sexual aggressiveness, a lessened sense of right and wrong, and loss of judgment, & Significant complications include cardiac dysrhythmia or respiratory depression. Toxicity: hallucinations, anxiety, and confusion. No withdrawals, but repeated use of inhalants can result in profound physical and psychosocial harm****.
Chapter 30- Personality Disorders Characteristics of Personality Disorders Maladaptive patterns of behaving and relating to others, characterized by continual difficulties with interpersonal relations. Distorted picture of self, concrete thinking, poor attention span, impaired judgement, unable to regulate sensory stimuli, easily excited, agitated, rigid & inflexible patterns.
Know the defining characteristics of each The Eccentrics Paranoid (Delusions,
persecution of grandeur, mistrust, thinks people are out to get them or do harm to them, minor events can arouse hostility & aggression). Schizoid ( lack or desire or willingness to become involved w/ people/relationships, prefer solitary activities, they are societies “loners,” emotionally detached, cold, no pleasure in any activities ), Schizotypal (acute discomfort w/ close relationships, odd behavior, odd dressing thinking, speech, EXTREME anxiety in social situations) Schizotypal is often suspiciousness & paranoid ideation , ideas of reference, believe in the paranormal, people are out to get them, loose & vague speech.
The Erratic’s A ntisocial= A sshole ( they are NOT actually antisocial --- Disregards/violates the
rights of others , asshat, ignores rules, belligerent, no remorse), Borderline (relationships issues, self-
destructive, impulsive, unstable emotions & moods, unpredictable), Histrionic (Excessive emotional
expressions, dramatic, drag queen, attention seeking behavior), Narcissistic (no empathy, or concern
for people or animals, needs constant attention & admiration, exploits interpersonal relationships, exaggerated sense of self-importance)
FEARFUL Avoidant (Social distress, feelings of not being good enough, sensitive, does not
want to be involved with others). Dependent (excessive need to be cared for, clingy,
submissive, wants others to call the shots, needs to be reassured, uncomfortable when alone).
Obsessive-compulsive (Preoccupied w/ control, order, & perfection…but all in an attempt
to reduce anxiety or a situation they cannot face, emotions under strict control, never satisfied,
not flexible).
Nursing Interventions for Patients with Personality Disorders Antianxiety agents (Ativan, Valium, Bu- spar), Antidepressants (Elavil, Prozac), Anticonvulsants (Dilantin, phenobarbital, Tegretol), Antipsychotics (Haldol, Thorazine), Lithium. Table 30-2 P Chapter 31- Schizophrenia and Other Psychoses Characteristics of Psychotic Disorders All involve the individual’s perception of reality. Inability to recognize reality, relate to others, & cope w/ life’s demands. Know the defining characteristics of each Schizoaffective is the same as schizophrenia but mania is also present—mood disorder+schizophrenia. Delusional disorder more than 1 month of non-bizarre (reality-based) FIXED ideas. Being followed, poisoned, or having thoughts controlled. Treatment and Diagnostic Criteria for Schizophrenia Stabilize the client, prevent further decline in functioning, and assist the client in coping with the disorder. Long-term goals include psychosocial and vocational rehabilitation. **** Cognitive behavioral therapy (CBT) to identify and change ineffective
SPEECH PROBLEM DESCRIPTION Clang associations Repeating words or phrases that sound alike or substituting a word that sounds like the appropriate word Example: “Honey, money, sunny” or “I need some honey to buy the paper” Concrete thinking Inability to consider the abstract meaning of a phrase; frequently tested by having clients interpret proverbs Example: “A stitch in time saves nine” may mean “sew the holes in your clothes” to a person with schizophrenia Echolalia Repeating words of another after one has stopped talking Example: Nurse: “How is your day going?” Client: “Day going, day going, day going.” Flight of ideas Rapid change in topics with a rapid flow of speech Example: “The sky is blue. The dog is dead, and I have two eyes.” Ideas of reference The belief that some events have special personal meaning Example: “The United States is sending satellites into space so that they can spy on me.” Loose associations Thinking characterized by speech that moves from one unrelated idea to another Example: “I’m hungry, but the desert has no rain so it’s cold outside.” Mutism Refusal to speak Neologisms Words or expression invented by the individual Example: “The ispy is not happy when the fulgari is green.” Verbigeration Purposeless repetition of phrases Example: Client repeats for days: “Prepare to launch the orbiter.” Pressured speech Rapid, forced speech Example: “I must prepare. There’s no time to waste. Can’t talk now.” Word salad A random, jumbled set of words that have no connection or relationship to one another Example: “Hot happies are spying on me but no men love short feet.”
