RASMUSSEN MENTAL HEALTH FINAL EXAM LATEST 2023-2024 REAL EXAM ALL 100+ QUESTIONS AND CORRECT ANSWERS|AGRADE

· Terror of gaining weight
· Preoccupation with thoughts of food
· View of self as fat even when emaciated
· Peculiar handling of food: cutting into tiny bits, pushing pieces around plate
· Possible development of rigorous exercise regimen
· Possible self-induced vomiting, use of laxatives, use of diuretics
· Self-worth judged by their weight
· Controls eating to feel powerful or to overcome feeling helpless

under weight
strict upbringing

signs and symptoms of bulimia

· Binge eating behavior
· Self-induced vomiting, laxative, or diuretic use after bingeing
· History of anorexia nervosa
· Depression
· Problems with interpersonal relationships, self-concept
· Increased anxiety and compulsivity
· Controls/undoes weight after bingeing

normal weight or slightly over weight

signs and symptoms of binge eating

· Frequent episodes of eating more than what may be considered a normal amount of food
· Rapid eating
· Eating until uncomfortably full
· Eating large amounts of food without being physically hungry
· Eating with excessive discretion due to feelings of embarrassment at the quantity of food being consumed
· Feelings of guilt after overeating
· Weight fluctuation, usually gain
· Feelings of low self-esteem
· Loss of sexual desire
· Frequent dieting
· Variant of compulsive overeating
· Similar to bulimia but no compensatory mechanisms used
· Usually associated with bipolar, depressive disorder, anxiety, substance use

Dissociative Disorder examples

conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception.

A sort of defense mechanism

Narcissistic personality disorder

an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others

Avoidant personality disorder

-social discomfort and avoidance of interpersonal contact
-may be extremely shy, fear ridicule, and be overly concerned with looking foolish

Antisocial personality disorder

disregard for other people

tend to lie, break laws, act impulsively, and lack regard for their own safety or the safety of others.

Histrionic personality disorder

characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive desire for approval.

Dependent personality disorder

is described as the need to be cared for by others.

results in submissive and clingy behavior, a fear of separation, and difficulty making decisions without reassurance from others

Paranoid personality disorder

Cluster A

Characterized by a pervasive pattern of unwarranted distrust and suspicion of others that involves interpreting their motives as hostile or harmful.

types of dissociative disorders

o Dissociative identity disorder
o Dissociative amnesia
o Depersonalization/derealization disorder

Assessment of someone with Bulimia- what would you find?

· Routine labs: CBC with differential, serum chemistry and thyroid profiles, and urine chemistry microscopy testing.
· Episodic binge eating
· Use of diuretics, laxatives, vomiting, and exercise.
· Abdominal and epigastric, Amenorrhea
· Painless swelling of the salivary glands, hoarseness, throat irritation or lacerations, and dental erosion.
· calluses of the knuckles or abrasions and scars on the dorsum of the hand, resulting from tooth injury during self-induced vomiting
· The patient’s psychosocial history may reveal an exaggerated sense of guilt, symptoms of depression, childhood trauma (especially sexual abuse), parental obesity, or a history of unsatisfactory sexual relationships.

Cluster A

· Odd or eccentric behavior, suspicious, cold, withdrawn, irrational
· They include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

Cluster B

· Dramatic, emotional behavior, attention-seeking, labile, shallow, increased rates of substance use and suicide.
· They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.

Cluster C

· Anxious, fearful behavior, tense, overcontrolled, depressed
· They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

Signs of opiate overdose

Respiratory failure, slow breathing, small pupils, unresponsiveness, or blue skin from poor circulation

Alcohol withdrawal symptoms and treatment

· Mild symptoms usually show up as early as 6 hours after you put down your glass. They can include: Anxiety, shaky hands, headache, nausea, vomiting, insomnia, sweating.
· More serious problems range from hallucinations about 12 to 24 hours after that last drink to seizures within the first 2 days after you stop. You can see, feel, or hear things that aren’t there.

Types of Child Abuse and Physical and Behavioral Indicators

· Physical abuse
· Physical neglect
Sexual abuse

Behavioral Indicators of child abuse

· Fear of going home.
· Extreme apprehensiveness or vigilance.
· Pronounced aggression or passivity.
· Flinching easily or avoiding touch.
· Abusive behavior or talk during play.
· Unable to recall how injuries occurred.
Account of injuries is inconsistent with the nature of the injuries

Nurse’s responsibility regarding suspected child abuse

Mandatory reporting

Disulfiram (Antabuse)

used to treat chronic alcoholism.

Causes unpleasant effects:
flushing of the face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety.

These effects begin about 10 minutes after alcohol enters the body and last for 1 hour or more.

Patient teaching for disulfiram

· Keep all appointments with your doctor
· Carry an ID card stating that you are taking it
· Do not come in contact with or breathe the fumes of paint, paint thinner, varnish, shellac, and other products containing alcohol.

Exercise caution when applying alcohol-containing products (e.g., aftershave lotions, colognes, and rubbing alcohol) to your skin. These products, in combination with disulfiram, may cause side effects

Naltrexone (ReVia)

is a special narcotic drug that blocks the effects of other narcotic medicines and alcohol used to treat narcotic drug or alcohol addiction and is taken orally in tablet form.

Naltrexone (ReVia) – patient teaching

· Advise patients that if they previously used opioids, they may be more sensitive to lower doses of opioids and at risk of accidental overdose
· Advise patients will not perceive any effect if they attempt to self-administer heroin
· Emphasize that administration of large doses of heroin or any other opioid to try to bypass the blockade and get high while on REVIA may lead to serious injury, coma, or death.
· Patients should be off all opioids, including opioid-containing medicines, for a minimum of 7 to 10 days before starting REVIA in order to avoid precipitation of opioid withdrawal.
· Advise patients that they should not take REVIA if they have any symptoms of opioid withdrawal.
· Advise patients that they may experience depression while taking REVIA Advise patients that dizziness may occur with REVIA treatment, and they should avoid driving or operating heavy machinery until they have determined how REVIA affects them.

Elder abuse

Elder abuse is “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.”

Types of elder abuse

Physical abuse, emotional abuse, neglect, abandonment, sexual abuse, financial abuse

interventions for agnosia

Agnosia is a rare disorder whereby a patient is unable to recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses.

Nursing Intervention: Correct misconceptions

Confabulation

Confabulation is the creation of false memories in the absence of intentions of deception

Ageism

Ageism is stereotyping and/or discrimination against individuals or groups on the basis of their age.

Trust vs. Mistrust

birth to 18m

Identity vs Role Confusion

12 – 20y

Autonomy vs Shame/Doubt

18m – 3y

Intimacy vs Isolation

20 – 30y

Initiative vs Guilt

3 – 6y

Generatively vs Stagnation

30 -65y

Industry vs Inferiority

6 – 12y

Ego Integrity vs Despair

65y +

Autism Spectrum Disorder

This is a complex neurobiological, developmental disorder. It generally appears during the first 3 years of life and affects the normal development of social interaction and social skills. Children with ASD should be referred to early intervention programs so communication and behavioral symptoms are identified. Often treatment includes a behavior management with positive reinforcement. The family’s strengths and needs must be identified and supported.

It is Classified According to Three Levels Depending on the Degree of Assistance and support Needed

Level 1: requires support

Level 2: requires substantial support

Level 3: requires very substantial support

Symptoms

Deficits in social relatedness

Disturbances in developing and maintaining relationships

Stereotypical, repetitive speech

Obsessive thoughts on specific objects or adherence to routines/rituals

Hyperactivity or hypo activity to sensory input

Extreme resistance to change

Dissociative symptoms

symptoms include the experience of detachment or feeling as if one is outside one’s body, and loss of memory or amnesia.

are frequently associated with previous experience of trauma.

orientation

what phase?
atmospere established, nurse role is defined, contract containing date, time, place of meeting, confidentiliaty is discussed. terms of termination discussed, atmosphere of trust

maslows hierarchy of needs

cannot be on a level higher than a level that you have not completed

working

what phase?
maintain relationship, gather more data, promote problem solving skills, facilitate behavior change, evaluate problems and goals

termination

what phase?
summarizes goals and objectives achieved, how to incorperate into daily life, echanging memories, by sharing this phase with patient is shows you care

negligence

ethical principle- act or omission of an act that breaches the duty of due care and results in injury

autonomy

ethical principle- respecting the rights of others to make own decisions, such as the right to refuse medications

justice

ethical principle- duty to distribute resources and care equally, spending time with each patient equally

beneficence

ethical principle- the duty to act as to benefit or promote the good of others such as spending extra time with a highly anxious patient

fidelity

ethical principle- maintaining loyalty and commitment to the patient and doing no wrong, maintaining expertise in nursing cares through education demonstrates fidelity

veracity

ethical principle- duty to communicate truthfully describing medications in a truthful and non misleading way for example

committed

rights for what kind of patient?

freedom from unreasonable restraints
right to informed consent
right to refuse medication

SSRI

what kind of antidepressant?

Fluoxetine (Prozac) Sertaline (Zoloft) Paroxetine (paxil)
serotonin syndrome citalopram (celexa) Escitalopram (lexapro) fluvoxamine (luvox)
side effects: increased serotonin nausea, vomiting

MAOI

what kind of antidepressant?
Phenelzine (nardil) Tranycryomine (parnate)
hypertensive crisis with tyramine foods
hypertensive crisis if ingested with tyramine (beer, wine, aged cheese, organ meat, avacados

TCA

what kind of antidepressant?
Amitriplytene (Elavil) Imipramine (Tofanil)
Cardiotoxic clomipramine (anafranil) desipramine (norpramin) doxepin (sinequan) maprotiline (ludiomil)
increased norephinephrine anticholinergic effects

mental illness

low self esteen and self concept
unable to relate to others
incapable to relate to others
unable to distinguish between reality, fantasy and imagination

mental health

being comfortable with yourself
feeling good about relationships with others
being able to meet the demands of life

0.4-1

therapeutic level of lithium
signs
slight hand tremor
mild thirst
weight gain
nausea

early

early, advanced or severe lithium toxicity?
above 1.5 mEq/L
nausea
vomiting
diarrhea
thirst
poly urea
slurred speech muscle weakness
*hold meds, draw lithium level and adjust dose

advanced

early, advanced or severe lithium toxicity?
1.5-2 mEq/L
course hand tremor
persistant GI upset
mental confusion
muscle hyper irritability
EEG changes
incoordination

hold meds, Blood level drawn, adjust dose, administer emetic ,gastric lavage, mannitol, aminophylline hasten lithium excretion

severe

early, advanced or severe lithium toxicity?
2-2.5+
ataxia
serious EEG changes
blurred vision
clonic movements
large urine output
tinnitus
blurred vision
seizures
stupor
Hypotension
coma
death usually by pulmonary complications

hold meds, Blood level drawn, adjust dose, administer emetic ,gastric lavage, mannitol, aminophylline hasten lithium excretion hemodyalisis

mild

mild, moderate, severe or panic anxiety?
heightened perceptual fields
alerd and see hear and grasp what is happening in the environment
able to identify issues that are disturbing and producing anxiety
able to work effectively towards a goal

moderate

mild, moderate, severe or panic anxiety?
has narrow perceptual field
grasps less of what is happening
can attend to more if pointed out by another
able to solve problems but not at optimal ability
benefits from guidance of others

severe

mild, moderate, severe or panic anxiety?

has greatly reduced visual field
focuses on details or one specific details
attention scattered
completely absorbed with self
may not be able to attend to events in the environment even when pointed by others
unable to see connections between events or details
has distorted perceptions

panic

mild, moderate, severe or panic anxiety?
unable to focus on the environment
experiences the utmost state of terror and emotional paralysis fells like they “cease to exist”
may have hallucinations or deslusions that take place of reality
may be mute or have psychomotor agitation leading to exhaustion
shows disorganized or irrational reasoning

repression

defense mechanism
man forgets wife birthday after a marital fight
maladaptive
women is unable to enjoy sex after having pushed out of awareness sex abuse as a child

sublimation

defense mechanism
women who is angry with her boss rights a story about a heroic woman (almost always is constructive)
no maladaptive behaviors

regression

defense mechanism
four year old boy with a new brother starts sucking his thumb and wanting a bottle
maladaptive
man who losses promotion starts complaining to others, does sloppy work misses appointments and is late for meetings

displacement

defense mechanism
patient criticizes a nurse after their family didn’t visit
maladaptive
child who cannot acknowledge fear of father becomes fearful of animals

projection

defense mechanism
man who is unconsciously attracted to other women teases his wife about flirting
maladaptive
woman who has repressed an attraction for other woman refuses to socialize for fear of being hit on

compensation

defense mechanism
short man becomes assertive and verally loud and accelerates in business
maladaptive
someone drinks alcohol when self esteem is low

reaction formation

defense mechanism
recovering alcoholic constantly preaches about the evils of alcohol
maladaptive
mother who is unconsciously hostile towards daughter is overprotective and interferes with the daughters normal growth and development.

denial

defense mechanism
man reacts to death “no! I don’t believe it, the doctor said she was fine.”
maladaptive
a woman whos husband died 3 years ago still keeps his clothes in the closet and speaks about him in present tense.

conversion

defense mechanism
student is unable to take a final due to a terrible headache
maladaptive
man becomes blind after seeing his wife flirt with other men

undoing

defense mechanism
after flirting with her male secretary a woman brings her husband tickets to a show.
maladaptive
man with ridged belief’s and repressed sexuality is driven to wash his hands when around attractive women

rationalization

defense mechanism
“I didn’t get this raise because the boss doesn’t like me.”
maladaptive
father things his son was fathered by another man and excuses his malicious acts by saying he is lazy and disobedient which is not the case.

identification

defense mechanism
five year old girl wears moms dress and shoes and meets dad at the door.
maladaptive
young boy thinks the town pimp with money is someone to emulate

introjection

defense mechanism
after his wifes death husband complains of chest pains and difficulty breathing, the same symptoms his wife had before she died.
maladaptive
young child whos parents were overcritical and belittling grow up thinking she is inferior.

suppression

defense mechanism
business man faces divorce in morning, and gives a good speech in the afternoon with total concentration
maladaptive
a woman who feels a lump in her breast shortly before vacation puts the info in the back of her mind until after returning from vacation

positive

positive or negative schizophrenia symptoms?

hallucinations
delusions
disorganized speech
bizarre behavior

negative

positive or negative schizophrenia symptoms?
blunted affect
poverty of thought
avolition (decreased motivation)
anhedonia (unable to experience joy)

NMS

extrapyramidal symptoms (EPS) or Neuroleptic malignant syndrome (NMS)?
severe muscle rigidity, oculogyric crisis (eyes rolled up in the head) flexor-extensor posturing, hyperpyrexia of above 103 degrees. autonomic dysfunction HTN, tachy, diaphoresis, incontinence
treatment
stop neuroleptic, transfer to medical unit, administer dantrolene, cool body to reduce fever maintain hydration, correct electrolyte imbalance

EPS

extrapyramidal symptoms (EPS) or Neuroleptic malignant syndrome (NMS)?
pseudoparkinsonsim stiff and stooped posture, shuffling gait, drooling tremor, acute dystonic reactions: contractions of tongue, face, neck and back (tongue and jaw first)
akathisia (restlessness)
Tardive Dyskinesia-rolling tongue blowing, smacking, licking, spastic facial distortion

treatment: trihexyphendyl (artane) benxzotropine (Cogentin)
benedryl, DC of neuroleptic
no known treatment for tardive dyskinesia, screening every three months.

conversion disorder

marked by symptoms or deficits that affect voluntary motor or sensory functions and that suggest a medical condition

However, the dysfunction does not correspond to current scientific understanding of known neurological and medical illnesses. The symptoms are neither voluntarily controlled nor culturally sanctioned. Many patients show a lack of emotional concern about the symptoms

symptoms are involuntary movements, seizures, paralysis, abnormal gait, anesthesia, blindness, and deafness.

personality disorder

describes what condition?

•Inflexible and maladaptive responses to stress. Individuals have difficulty responding flexibly and adaptively to the environment and to the changing demands of life. They often are unable to cope with stress and react by using maladaptive behaviors, which exposes the disorder.
•Disability in work and personal relationships, which is generally more serious and pervasive than the similar disability found in other disorders.

Individuals with PDs assume that everyone thinks and functions as they do; therefore, within relationships they do not view their behavior as a problem; they do not see a need to make changes or accommodate others. They believe that they are normal and that others have a problem

•Avoidance and fear of rejection
•Blurring of boundaries between the self and others so that closeness seems to lead to fusion, which may terrify both parties
•Insensitivity to the needs of others
•Demanding and fault finding
•Inability to trust
•Lack of individual accountability
•Passive-aggressive traits
•Tendency to evoke intense interpersonal conflict: People with PDs fail to see themselves objectively, and they lack the desire to alter aspects of their behavior to enrich or maintain important relationships. Relationships are often marked by intense emotional upheavals and hostility that lead to serious interpersonal conflict, and in some cases violence (self-violence or violence toward others).
•Capacity to “get under the skin” of others: People with PDs often have an uncanny ability to merge personal boundaries with others, which has an intense and undesirable effect on others.

alcohol

early signs of withdrawal develop within a few hours after cessation they peak after 24 to 48 hours and then rapidly and dramatically disappear
the person may appear hyperalert, manifest jerky movements and irritability, startle easily, and experience subjective distress often described as “shaking inside.” Grand mal seizures may appear 7 to 48 hours after cessation

•Autonomic hyperactivity (e.g., tachycardia, diaphoresis, elevated blood pressure)
•Severe disturbance in sensorium (e.g., disorientation, clouding of consciousness)
•Perceptual disturbances (e.g., visual or tactile hallucinations)
•Fluctuating levels of consciousness (e.g., ranging from hyperexcitability to lethargy)
•Delusions (paranoid), agitated behaviors, and fever (temperatures of 100° to 103° F)

bulemia

interventions for?

1. Assess mood and presence of suicidal thoughts/behaviors.
2. Monitor physiological parameters (vital signs, electrolyte levels) as needed.
3. Explore dysfunctional thoughts that maintain the binge/purge cycle
4. Educate the patient that fasting can lead to continuation of bingeing and the binge/purge cycle, emphasizing its self-perpetuating nature.
5. Monitor patient during and after meals to prevent throwing away food and/or purging.
6. Acknowledge the patient’s overvalued ideas of body shape and size without minimizing or challenging patient’s perceptions.
7. Encourage patient to keep a journal of thoughts and feelings

anorexia

engage in self-starvation, express intense fear of gaining weight, and have a disturbance in self-evaluation of weight and its importance.

often experience amenorrhea

• Weight loss more than 30% over 6 months • Rapid decline in weight • Inability to gain weight with outpatient treatment • Severe hypothermia caused by loss of subcutaneous tissue or dehydration (body temperature lower than 36° C or 96.8° F) • Heart rate less than 40 beats per minute • Systolic blood pressure less than 70 mm Hg • Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances not corrected by oral supplementation • Electrocardiographic changes (especially dysrhythmias)

Milelu therapy:
These modalities are designed to normalize eating patterns and to begin to address the issues raised by the illness. The milieu of an eating disorder unit is purposefully organized to assist the patient in establishing more adaptive behavioral patterns, including normalization of eating.

milieu therapy

is an extremely important consideration for the nurse working with a patient who should feel comfortable and safe. Milieu management includes orienting patients to their rights and responsibilities, selecting specific activities that meet patients’ physical and mental health needs, and ensuring that patients are maintained in the least restrictive environment. Among other things, it also includes that patients are informed in a culturally competent manner about the need for limits and the conditions necessary to remove them.

depression

A thorough medical and neurological examination helps determine if the depression is primary or secondary to another disorder. Depression can be secondary to a host of medical or other psychiatric disorders, as well as medications. Essentially, evaluate the following:

•If the patient is psychotic
•If the patient has used drugs or alcohol
•If comorbid medical conditions are present
•If the patient has a history of a comorbid psychiatric disorder (e.g., eating disorder, borderline personality disorder, anxiety disorder)

hypothalamus

part of the brain that maintains homeostasis. It regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms, such as sleep and wakefulness.

brain stem

Basic vital life functions occur through the here composed of the midbrain, pons, and medulla

cerebellum

part of brain that mainly a coordinator of motor function. However, it also interacts with the cerebrum in higher cognitive functions such as speech memory, facial recognition, visual attention, and awareness

thalamus

Located above the brainstem, the blank serves as a major relay station for sensory impulses on their way to the cerebral cortex.

fight or flight

a survival mechanism by which our body and mind become immediately ready to meet a threat or stress. sends signals to the adrenal glands, releasing epinephrine (or adrenaline). The circulating adrenaline increases heart rate, elevates blood pressure, increases blood flow to the skeletal muscles, and increases muscle tension. Respirations also increase, bringing more oxygen to the lungs, which is then sent to the brain, increasing alertness.

reframing

technique to reduce stress

1. Changes the way we look at and feel about things.
2. There are many ways to interpret the same reality (e.g., seeing the glass as half full rather than half empty).
3. Reassess the situation. We can learn from most situations by asking some of the following questions:

•”What positive thing came out of the situation/experience?”
•”What did you learn in this situation?”
•”What would you do differently next time?”

4. Considering life from another person’s point of view can help dissipate tension and develop empathy. We might even feel some compassion toward the person.

•”What might be going on with your (spouse, boss, teacher, friend) that would cause him/her to say/do that?”
•”Is he/she having problems? Feeling insecure? Under pressure”?

sleep

stress reduction tecnique
1. Chronically stressed people are often fatigued.
2. Go to sleep 30 to 60 minutes earlier each night for a few weeks.
3. If still fatigued, try going to bed another 30 minutes earlier.
4. Sleeping later in the morning is not helpful and can disrupt body rhythms

sleep

stress reduction technique

1. Exercise can dissipate chronic and acute stress.
2. It is recommended for at least 30 minutes, three times a week.

no coffee

1. Such a simple measure can lead to more energy, fewer muscle aches, and greater relaxation.
2. Wean yourself off coffee, tea, colas, and chocolate drinks.

stress

ways to reduce?

1. Engage in meaningful, satisfying work.
2. Live with and/or love whom you choose.
3. Associate yourself with gentle people who affirm your personhood.
4. Guard your personal freedom, especially your freedom to:

•Choose your friends.
•Live with and/or love whom you choose.
•Think and believe as you choose.
•Structure your time as you desire.
•Set your own life goals.

roberts seven stage

situational

what kind of crisis

arises from an external rather than an internal source. Often the crisis is unanticipated. Examples of external situations that can precipitate a crisis include loss of a job, death of a loved one, unwanted pregnancy, a move, change of job, change in financial status, divorce, and severe physical or mental illness.

environmental

what kind of crisis?

may result from (1) a natural disaster (e.g., floods, fires, tornadoes, earthquakes), (2) a national disaster (e.g., war, riots, airplane crashes), or (3) a crime of violence (e.g., rape, assault, murder in the workplace or school, bombings, or spousal or child abuse). Every disaster is a unique challenge.

crisis

assessment for what?

1. Identify whether the patient’s response to the crisis warrants psychiatric treatment or hospitalization to minimize decompensation (suicidal behavior, psychotic thinking, and violent behavior).
2. Determine if the patient is able to identify the precipitating event.
3. Assess the patient’s understanding of his or her present situational supports.
4. Identify the patient’s usual coping skills and determine what coping mechanisms may help the present situation.
5. Determine whether there are certain religious or cultural beliefs that need to be considered in assessing and intervening in this person’s crisis.
6. Assess whether this situation is one in which the patient needs primary intervention (education, environmental manipulation, or new coping skills), secondary intervention (crisis intervention), or tertiary intervention (rehabilitation).

crisis

interventions for?

1. Assess for any suicidal or homicidal thoughts or plans.
1. Safety is always the first consideration.
2. Take initial steps to make patient feel safe and to lower anxiety.
2. When a person feels safe and anxiety decreases, the individual is able to problem solve solutions with the nurse.
3. Listen carefully (e.g., make eye contact, give frequent feedback to make sure you understand, summarize what patient says at the end).
3. When a person believes that someone is really listening, this can translate into the belief that someone cares about the person’s situation and that help may be available. This offers hope.
4. Crisis intervention calls for directive and creative approaches. Initially the nurse may make phone calls (arrange babysitters, schedule a visiting nurse, find shelter, contact a social worker).
4. Initially a person may be so confused and frightened that performing usual tasks is not possible at that moment.
5. Assess patient’s support systems. Rally existing supports (with patient’s permission) if patient is overwhelmed.
5. People are often overwhelmed and nurses need to take an active role.
6. Identify needed social supports (with patient’s input) and mobilize the most needed first.
6. Patient’s needs for shelter help with care for children or elders, medical workup, emergency medical attention, hospitalization, food, safe housing, and a self-help group are determined.
7. Identify needed coping skills (problem solving, relaxation, assertiveness, job training, newborn care, improving self-esteem).
7. Increasing coping skills and learning new ones can help with current crisis and assist with minimizing future crises.
8. Plan with patient interventions acceptable to both counselor and patient.
8. Patient’s sense of control, self-esteem, and compliance with plan are increased.
9. Plan regular follow-up to assess patient’s progress (e.g., phone calls, clinic visits, home visits as appropriate).
9. Plan is evaluated to see what works and what does not work.

primary

primary, secondary or tertiary care in a crisis?

promotes mental health and reduces mental illness to decrease the incidence of crisis. On this level, the nurse can:

•Work with an individual to recognize potential problems by evaluating the stressful life events the person is experiencing.
•Teach individual specific coping skills, such as decision making, problem solving, assertiveness skills, meditation, and relaxation skills, to handle stressful events.
•Assist an individual in evaluating the timing or reduction of life changes to decrease the negative effects of stress as much as possible. This may involve working with a patient to plan environmental changes, make important interpersonal decisions, and rethink changes in occupational roles.

secondary

primary, secondary or tertiary care in a crisis?

establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization. The nurse’s primary focus is to ensure the safety of the patient. After safety issues are addressed, the nurse works with the patient to assess the patient’s problem, support systems, and coping styles. Desired goals are explored and interventions planned. Secondary care lessens the time a person is mentally disabled during a crisis. Secondary-level care occurs in hospital units, emergency departments, clinics, or mental health centers, usually during daytime hours.

tertiary

primary, secondary or tertiary care in a crisis?

provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state. Social and community facilities that offer tertiary intervention include rehabilitation centers, sheltered workshops, day hospitals, and outpatient clinics. Primary goals are to facilitate optimal levels of functioning and prevent further emotional disruptions. People with severe and persistent mental problems are often extremely susceptible to crisis, and community facilities provide the structured environment that can help prevent problem situations

grief

nursing interventions for?

1. Use methods that can facilitate the grieving process (Robinson, 1997).
a.Give your full presence: use appropriate eye contact, attentive listening, and appropriate touch.
b.Be patient with the bereaved in times of silence. Do not fill silence with empty chatter.
a. Talking is one of the most important ways of dealing with acute grief. Listening patiently helps the bereaved express all feelings, even ones he or she feels are “negative.” Appropriate eye contact helps to convey the awareness that you are there and are sharing the person’s sadness. Suitable human touch can express warmth and nurture healing. Inappropriate touch can leave a person confused and uncomfortable.
b. Sharing painful feelings during periods of silence is healing and conveys your concern.
2. Know about and share with the bereaved information about the phenomena that occur during the normal mourning process, because they may concern some people (intense anger at the deceased, guilt, symptoms the deceased had before death, unbidden floods of memories). Give the bereaved support during the occurrence of these phenomena and a written handout for reference.
2. Although the knowledge will not eliminate the emotions, it can greatly relieve a person who is thinking there is something wrong with having these feelings.
3. Encourage the support of family and friends. If no supports are available, refer the patient to a community bereavement group. (Bereavement groups are helpful even when a person has many friends or much family support.)
3. Friends can help with routine matters. For example:
•Getting food into the house
•Making phone calls
•Driving to the mortuary
•Taking care of the kids or other family members
4. Offer spiritual support and referrals when needed.
4. Dealing with an illness or catastrophic loss can cause the most profound spiritual anguish.
5. When intense emotions are in evidence, show understanding and support (see Table 25-4).
5. Empathic words that reflect acceptance of a bereaved individual’s feelings are healing (Robinson, 1997).

grief

stages of what?

denial, anger, bargaining, depression, and acceptance

1.Shock and disbelief
2.Denial
3.Sensation of somatic distress
4.Preoccupation with the image of the deceased
5.Guilt
6.Anger
7.Change in behavior (e.g., depression, disorganization, or restlessness)
8.Reorganization of behavior directed toward a new object or activity

alzheimers meds

galantamine hydrobromide (Razadyne), rivastigmine tartrate (Exelon), and donepezil hydrochloride (Aricept)

These are called cholinesterase inhibitors that help dely the progression of the disease in the mild to moderate stage

alzheimers meds

Memantine hydrochloride (Namenda), an N-methyl-d-aspartate (NMDA), is an antagonist at the NMDA-glutamatergic ion channels. This drug works by blocking the toxic effects associated with excess glutamate and regulates glutamate activation. It is the first drug to target symptoms of AD during the moderate to severe stages of the disorder

alzheimers

a complex disease that begins to damage the brain long before the symptoms appear. AD affects processes that keep the neurons healthy, such as (1) communication, (2) metabolism, and (3) repair. In a healthy brain neurons are supported by microtubules, which guide nutrients and molecules between the cell body and the axon terminals. A special protein called tau protein is responsible for the stability of the microtubules. In AD tau protein is subjected to chemical changes, which result in neurofibrillary tangles and cause disintegration of the microtubules, thus collapsing the neuron’s transport system. This disintegration of the neuron transport system results in malfunction of communication between neurons, and eventually leads to neural cell death. It is the destruction and death of the cells that causes memory failure, personality changes, problems in carrying out daily activities, and other features of the disease

dementia

interventions for?

1. Always identify yourself and call the person by name at each meeting.
1. Patient’s short-term memory is impaired—requires frequent orientation to time and environment.
2. Speak slowly.
2. Patient needs time to process information.
3. Use short, simple words and phrases.
3. Patient may not be able to understand complex statements or abstract ideas.
4. Maintain face-to-face contact.
4. Verbal and nonverbal clues are maximized.
5. Be near patient when talking, one or two arm-lengths away.
5. This distance can help patient focus on speaker as well as maintain personal space.
6. Focus on one piece of information at a time.
6. Attention span of patient is poor and patient is easily distracted—helps patient focus. Too much data can be overwhelming and can increase anxiety.
7. Talk with patient about familiar and meaningful things.
7. Self-expression is promoted and reality is reinforced.
8. Encourage reminiscing about happy times in life.
8. Remembering accomplishments and shared joys helps distract patient from deficit and gives meaning to existence.
9. When patient is delusional, acknowledge patient’s feelings and reinforce reality. Do not argue or refute delusions.
9. Acknowledging feelings helps patient feel understood. Pointing out realities may help patient focus on realities. Arguing can enhance adherence to false beliefs.
10. If a patient gets into an argument with another patient, stop the argument and separate individuals. After a short while (5 minutes), explain straightforwardly to each patient why you had to intervene.
10. Escalation to physical acting out is prevented. Patient’s right to know is respected. Explaining in an adult manner helps maintain self-esteem.
11. When patient becomes verbally aggressive, acknowledge patient’s feelings and shift topic to more familiar ground (e.g., “I know this is upsetting for you, because you always cared for others. Tell me about your children.”).
11. Confusion and disorientation easily increase anxiety. Acknowledging feelings makes patient feel more understood and less alone. Topics patient has mastery over can remind him or her of areas of competent functioning and can increase self-esteem.
12. Have patient wear prescription eyeglasses or hearing aid.
12. Environmental awareness, orientation, and comprehension are increased, which in turn increases awareness of personal needs and the presence of others.
13. Keep patient’s room well lit.
13. Environmental clues are maximized.
14. Have clocks, calendars, and personal items (e.g., family pictures or Bible) in clear view of patient while he or she is in bed.
14. These objects assist in maintaining personal identity.
15. Reinforce patient’s pictures, nonverbal gestures, X’s on calendars, and other methods used to anchor patient in reality.
15. When aphasia starts to hinder communication, alternate methods of communication need to be instituted.

Hypothalamus
Maintains homeostasis: regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms (sleep and wakefulness)

Neurons
Initiate signals and conduct electrical impulses

Synapse
where electrical impulses pass from presynaptic neuron to the postsynaptic neuron

Milieu Therapy
-Structuring the daily routine to offer physical safety and predictability, thus reducing anxiety over the the unknown
-Providing daily activities to promote sharing and cooperation
-Providing therapeutic interactions, including one-on-one nursing care and behavior contracts
-Including the patient in decisions about his or her own care

Mental health vs. mental illness
Exist on a continuum- dynamic, shifting, ranging from mild to moderate to severe
Health= successful performance of mental functions, resulting in ability, to engage in productive activities and enjoy fulfilling relationships, adapt to change, and cope with adversity
Illness= medical conditions that effect a person’s thinking, feeling, mood, ability to relate to others, and daily functioning

Maslow’s hierarchy of needs
Physiological needs- food, O2, water, sleep, sex and temp
Safety needs- security, protection, freedom from fear, anxiety and chaos, need for law order and limits
Belonging and love needs- intimate relationships
Esteem needs-
Self-actualization

Peplau’s theory of interpersonal relations
AKA Psychodynamic nursing
Nature of nurse-patient relationship strongly influence the outcome for the patient

Erikson’s stages of development
Trust vs mistrust
Autonomy vs shame/doubt
Initiative vs guilt
Industry vs inferiority
Identity vs role confusion
intimacy vs isolation
Generativity vs self-absorption
Integrity vs despair

Non-verbal behaviors
body behaviors
facial expressions
eye cast
voice-related behaviors
observable autonomic physiological responses
personal appearance
physical characteristics

Techniques that Enhance Communication
Using silence
accepting
giving recognition
offering self
offering general leads
giving broad openings
placing the events in time or sequence
making observations
encouraging description of perception
encouraging comparison
restating
reflecting
focusing
exploring
giving information
seeking clarification
presenting reality
voicing doubt
seeking consensual validation
verbalizing the implied
encouraging evaluation
attempting to translate into feelings
suggesting collaboration
summarizing
encouraging formulation of a plan of action

Nontherapeutic Techniques
Giving premature advice
Minimizing feelings
Falsely reassuring
Making value judgments
Asking “why” questions
Asking excessive questions
Giving approval; agreeing
Disapproving; disagreeing
Changing the subject

Boundaries
Signs: overhelping, controlling, narcissism
Transference and countertransferance

Orientation phase
Establish rapport
Parameters of relationship
Formal/informal contract
Confidentiality
Termination begins (time-frame set)

Working phase
Maintain relationship
Gather further data
Promote patient’s problem-solving skills, self-esteem, and use of language
Facilitate behavioral change
Overcome resistance behaviors
Evaluate problems and goals-redefine as needed
Promote practice and expression of adaptive behaviors

Termination phase
Summarizing goals and objectives achieved
Discuss patient how patient can incorporate
Review situation

Autonomy
Respecting the rights of others to make their own decisions
Ex. ackowledging the patient’s right to refuse medication

Justice
Ethical principle- duty to distribute resources and care equally- spending equal time with patient
Ex. ICU nurse spending equal time with suicidal patient and patient with a brain aneurysm

Beneficence
The duty to act so as to benefit or promote the good of others
Ex. spending extra time to help calm an extremely anxious patient

Fidelity
(Nonmalficence) Maintaining loyalty an commitment to the patient and doing no wrong to patient
Ex. Maintaining expertise in nursing skill through nursing education demonstrates fidelity to patient care

Veracity
One’ duty to communicate truthfully
Ex. Describing the purpose and side effects of psychotropic medications in a truthful non-misleading way

Negligence
Failure to act
Carelessness, forseeability of harm

Involuntary admission rights
patient retains freedom from unreasonable bodily restraints, right to informed consent, right to refuse medication

Rights of voluntary admission
the right to demand and obtain release

Psychiatric Nursing Assessment
Establish rapport
Obtain an understanding of the current problem or chief complaint
Review physical status and obtain baseline vitals
Assess for risk factors affecting the safety of the patient or others
Perform a mental status examination
Assess psychosocial status
Identify mutual goals for treatment
Formulate a plan of care that prioritizes the patient’s immediate conditions and needs
Document data in a retrievable format

Neuroleptic Malignant Syndrome
Fever
Severe Muscle rigidity
Confusion
Agitation
Increase pulse and blood pressure
Life threatening

Key symptoms of schizophrenia

Positive symptoms: Psychotic symptoms are the most obvious (e.g., delusions, hallucinations, and perceptions that are not based on reality).∗
Negative symptoms: Include poverty of thought, loss of motivation, inability to experience pleasure or joy, feelings of emptiness, and blunted affect.∗
Cognitive symptoms: Include the inability to understand and process information, trouble focusing attention, and problems with working memory. The cognitive disturbances also account for the inability to use language appropriately (which is manifested by speech; e.g., looseness of association). These are the symptoms that most profoundly affect the individual’s ability to engage in normal social/occupational experiences.∗
Mood symptoms: Depression, anxiety, dysphoria, suicide, and demoralization.∗
Grossly disorganized or catatonic behavior
Characterological symptoms: Most often people with schizophrenia are isolated or alienated from others. These patients have deep feelings of inadequacy and poorly developed social skills.

Positive schizophrenia symptoms
Hallucinations
Delusions
Bizarre Behavior
Positive formal thought disorder and speech patterns

Negative Schizophrenia Symptoms
Affective Flattening
Alogia
Avolition, Apathy
Anhedonia, Asociality
Attention Deficits

Second Generation Antipsychotics
Clozapine- Schizophrenia
Risperdone- Schizophrenia
Paliperidone- Schizophrenia and schizoaffective disorder
Olanzapine- Schizophrenia and agitaition
Quetiapine- Schizophrenia
Ziprasidone- Schizophrenia and acute agitation
Iloperidone
Asenapine- Schizophrenia
Lurasidone
Brexipiprazole

First- Generation Antipsychotics
Haloperidol- Schizophrenia and acute agitation
Trifluoperazine- Schizophrenia
Fluphenazine- Schizophrenia and other psychotic disorders
Loxapine- Only schizophrenia
Perphenazine- Schizophrenia
Chlorpromazine- Schizophrenia, other psychotic disorder
Thioridazine- treatment resistant schizophrenia only

Personality Disorders
Personality traits tend to be inflexible and unpredictable
Coping strategies tend to be primitive and immature
Have difficulty perceiving and interpreting the world and others around them
Inappropriate emotional response and impulse control

Conversion Disorder
One or more symptoms of impaired motor sensory function. Findings are incompatible with or an exaggeration of recognized neurological conditions not better explained by another mental or medical disorder.

Conduct Disorder
Childhood/Adolescent Disorder
Bullies or intimidates others
Initiates physical fights
Has used a weapon
Physically cruel to people or animals
Steals
Forced sexual activity
Deliberate fire-setting
Destruction of property

Signs and Symptoms of Anorexia

Terror of gaining weight
Preoccupation with thoughts of food
View of self as fat even when emaciated
Peculiar handling of food:
Cutting food into small bits
Pushing pieces of food around plate
Possible development of rigorous exercise regimen
Possible self-induced vomiting; use of laxatives and diuretics
Cognition is so disturbed that the individual judges self-worth by his or her weight
Controls what he or she eats to feel powerful to overcome feelings of helplessness

Signs and Symptoms of Bulimia

Binge eating behaviors
Often self-induced vomiting (or laxative or diuretic use) after bingeing
History of anorexia nervosa in one fourth to one third of individuals
Depressive signs and symptoms
Problems with:
Interpersonal relationships
Self-concept
Impulsive behaviors
Increased levels of anxiety and compulsivity
Possible chemical dependency
Possible impulsive stealing
Controls/undoes weight after bingeing, which is motivated by feelings of emptiness

Complications of Anorexia

Bradycardia
Orthostatic changes in pulse rate or blood pressure
Cardiac murmur—one third with mitral valve prolapse
Sudden cardiac arrest caused by profound electrolyte disturbances
Prolonged QT interval on electrocardiogram
Acrocyanosis
Symptomatic hypotension
Leukopenia
Lymphocytosis
Carotenemia (elevated carotene levels in blood), which produces skin with yellow pallor
Hypokalemic alkalosis (with self-induced vomiting or use of laxatives and diuretics)
Elevated serum bicarbonate levels, hypochloremia, and hypokalemia
Electrolyte imbalances, which lead to fatigue, weakness, and lethargy
Osteoporosis, indicated by low bone density
Fatty degeneration of liver, indicated by elevation of serum enzyme levels
Elevated cholesterol levels
Amenorrhea
Abnormal thyroid functioning
Hematuria
Proteinuria

Complications of Bulimia

Cardiomyopathy (rare occurrence due to diminished protein synthesis, malnutrition)
Cardiac dysrhythmias
Sinus bradycardia
Sudden cardiac arrest as a result of profound electrolyte disturbances
Orthostatic changes in pulse rate or blood pressure
Cardiac murmur; mitral valve prolapse
Electrolyte imbalances
Elevated serum bicarbonate levels (although can be low, which indicates metabolic acidosis)
Hypochloremia
Hypokalemia
Dehydration, which results in volume depletion, leading to stimulation of aldosterone production, which in turn stimulates further potassium excretion from kidneys; thus there can be an indirect renal loss of potassium as well as a direct loss through self-induced vomiting
Severe attrition and erosion of teeth producing irritating sensitivity and exposing the pulp of the teeth
Loss of dental arch
Diminished chewing ability
Parotid gland enlargement associated with elevated serum amylase levels
Esophageal tears caused by self-induced vomiting
Severe abdominal pain indicative of gastric dilation
Russell’s sign (callus on knuckles from self-induced vomiting)

Eating disorder Hospital Admission Criteria
Physical Criteria

Weight loss more than 30% over 6 months
Rapid decline in weight
Inability to gain weight with outpatient treatment
Severe hypothermia caused by loss of subcutaneous tissue or dehydration (body temperature lower than 36° C or 96.8° F)
Heart rate less than 40 beats per minute
Systolic blood pressure less than 70 mm Hg
Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances not corrected by oral supplementation
Electrocardiographic changes (especially dysrhythmias)
Psychiatric Criteria
Suicidal or severely irrepressible, self-mutilating behaviors
Uncontrollable use of laxatives, emetics, diuretics, or street drugs
Failure to comply with treatment contract
Severe depression
Psychosis
Family crisis or dysfunction

Nursing Diagnosis for Somatic Symptom Disorders
Inability to meet occupational, family, or social responsibilities because of symptoms

Inability to participate in usual community activities or friendships because of psychogenic symptoms

Ineffective coping

Ineffective role performance

Impaired social interaction

Ineffective relationship
Dependence on pain relievers; distortion of body functions and symptoms; presence of secondary gains by adoption of sick role
Powerlessness

Disturbed body image

Pain (acute or chronic)
Inability to meet family role function and need for family to assume role function of the somatic individual
Interrupted family processes

Ineffective sexuality pattern
Assumption of some of the roles of the somatic parent by the childrenImpaired parentingShifting of the sexual partner’s role to that of caregiver or parent and of the patient’s role to that of recipient of careRisk for caregiver role strainFeeling of inability to control symptoms or understand why he or she cannot find help
Chronic low self-esteem

Spiritual distress
Development of negative self-evaluation related to losing body function, feeling useless, or not feeling valued by significant othersInability to take care of basic self-care needs related to conversion symptom (paralysis, seizures, pain, fatigue)Focus on self-care deficit (hygiene, dressing, feeding, toileting)Inability to sleep related to psychogenic pain Disturbed sleep pattern

Alcohol Withdrawal
Early signs in a few hours
Peaks within 24 to 48 hours
Rapidly and dramatically disappears unless it progresses to delirium
Irritability and “shaking inside”
Grand mal seizures possible in 7 to 48 hours after cessation
Illusions
^BP, ^HR, jerky movements, small pupils, irritable

TABLE 19-4
Alcohol Withdrawal Delirium ∗
Drug/Purpose
Sedatives :
Benzodiazepines †
Chlordiazepoxide (Librium)/
Provides safe withdrawal and has anticonvulsant effects; chlordiazepoxide and diazepam are cross-addicting
Diazepam (Valium) /
Has anticonvulsant qualities
Not metabolized in the liver Seizure Control:
Carbamazepine (Tegretol), or valproic acid (Depakote)/
Helps reduce withdrawal symptoms and the risk of seizures
Magnesium sulfate /
Increases effectiveness of vitamin B1 and helps reduce postwithdrawal seizures
Thiamine (vitamin B1 ) /
Given intramuscularly or intravenously before glucose loading to prevent Wernicke’s encephalopathy
Alleviation of Autonomic Nervous System Symptoms (ANS):
Beta blockers (propranolol) or alpha blockers (clonidine) /
May help reduce ANS hyperactivity (e.g., tremor, tachycardia, elevated blood pressure, diaphoresis) but should only be used with benzodiazepine
Most effective in short time

Inhalants
Volatile solvents (e.g., paint thinners, glues, gasoline, dry cleaner fluid)
Gases (e.g., butane, propane, nitrous oxide)
Nitrates (e.g., isoamyl, isobutyl, commonly known as “poppers”)
Aerosols (e.g., spray paint, hair or deodorant sprays, fabric protector sprays, vegetable oil sprays)

Inhalant Intoxication Effects
Similar to alcohol: Slurred speech, lack of inhibitions, euphoria, dizziness, drunkenness, violent behavior

Overdose Effects of Inhalants
Liver and brain damage, heart failure, respiratory arrest, suffocation, coma, death
Capable of interfering with oxygen supply to vital organs by destroying oxygen-carrying ability of red blood cells; associated with fatal cardiac rhythm
Long-term use can lead to deterioration of myelin sheath of nerve fibers, resulting in muscle spasms and tremors, or even permanent difficulty with basic movements such as walking, bending, and talking

Treatment for Inhalants
Support affected systems
Neurological symptoms may respond to vitamin B12 and folate

Interventions for Impulse Control Disorders

Guide the person to understand and practice tension reduction and stress control strategies such as stress avoidance, correction of negative self-talk, and breathing control exercises.
Promote the progressive substitution of alternate, less maladaptive responses to tension, such as applying pressure to one’s scalp with a thumb rather than pulling out one’s hair.
Assist the person to explore feelings associated with the impulses, such as shame, fear, or guilt, and to manage these feelings adaptively.
Assist the person to identify the consequences of his or her actions (e.g., “How do other people respond when you _?” “Tell me what things are like the day after you’ve set a fire,” “Imagine you set the fire: what do you think will happen in the days and weeks that follow?” [anticipatory fantasy])
Educate the person that drugs and alcohol may increase impulsiveness through disinhibition or impairment of judgment; educate the person regarding the effect of “triggers,” that is, circumstances that evoke tension or impulses (e.g., going to bars).
Pathological gamblers may respond well to group therapy; organizations such as Gamblers Anonymous (www.gamblersanonymous.org) provide significant assistance through support, education, and practical tips on managing gambling impulses and other concerns.
Persons with trichotillomania can benefit from special hair styling, hair weaves, or other cosmetology assistance; they may require considerable support in order to access such resources, however, because of embarrassment.

Impulse Control Disorders
A decreased ability to resist an impulse to perform certain acts
Intermittent explosive disorder, kleptomania, pyromania, gambling disorder, trichotillomania

Primary Crisis Care
Promotes mental health and reduces mental illness to decrease the incidence of crisis

Secondary Crisis Care
Establishes the intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization

Tertiary Crisis Care
Provides support for those who have experienced a severe crisis and are now recovering from a disabled mental state

Situational Crisis
Arises from an external source, frequently unanticipated
Ex. job loss, death of a loved one, move, divorce

Adventitious (Disasters) Crisis
Catastrophic violent event not a part of every day life
Ex. natural disasters, national disasters, crimes of violence

Interventions for People in Grief

Use methods that can facilitate the grieving process (Robinson, 1997).
a. Give your full presence: use appropriate eye contact, attentive listening, and appropriate touch.
b. Be patient with the bereaved in times of silence. Do not fill silence with empty chatter.
Know about and share with the bereaved information about the phenomena that occur during the normal mourning process, because they may concern some people (intense anger at the deceased, guilt, symptoms the deceased had before death, unbidden floods of memories). Give the bereaved support during the occurrence of these phenomena and a written handout for reference.
Encourage the support of family and friends. If no supports are available, refer the patient to a community bereavement group. (Bereavement groups are helpful even when a person has many friends or much family support.)
Offer spiritual support and referrals when needed.
When intense emotions are in evidence, show understanding and support

what does the amygdala control?
fight or flight response processes fear and amxiety

frontal lobe
controls thought process, reasoning, decision making, voluntary movement

primary depression
due to family history, female gender, 40+, posrpartum, chronic illness, stressful life events

secondary depression
resulted from another mental health disorder or debilitating chronic illness (person is depressed because of their decline in physical or mental function)

nursing interventions and assessment tools for alcohol adiction
risk for suicide
keep them safe
blood alcohol level
seizure precautions

meds:
disulfiram, naltroxone, chloroliazepoxide

Hippocampus
a neural center located in the limbic system; helps process explicit memories for storage

Busipirone (Buspar)
SARI
Tx anxiety
side effects: anxiety, nausea, HA, dizziness, tardive dyskinesia
not habit forming

Lithium levels
maintainence: 0.4-1.3
toxic: ^ 1.5
signs and symptoms: slurred speech, course tremor, thirsty, nausea, vomiting

Neuroleptic Malignant Syndrome
muscle rigidity
confusion
agitation
^temp
^pulse
^BP

Patient teaching nortriptyline
dry mouth
constipation
drowsiness
blurred vision

Comorbidities with anorexia/bulimia
depression
OCD
Social phobia
anxiety

Effective Therapeutic Communication
Silence
Active listening
Open-ended questions
Clarifying
Offering general leads/broad opening statements
Showing acceptance and recognition
Focusing
Asking questions
Giving information
Presenting information

Psych nurse assessment
Establish rapport
Obtain an understanding of current problem

Involuntary admission
Must be a danger to self or others or unable to meet basic needs
Still obtain basic rights
Lose right to leave

Involuntary suicide admission
Lose right to privacy

Beneficence
duty to promote good

Autonomy
respecting rights of others to make their own decisions

Justice
equal care

Fidelity
do no wrong

Veracity
truthfulness

Antidepressant drugs
SSRI

Antidepressants
First-line therapy
Can affect sexual performance, dry mouth, mild nausea, loose bowel movements

Serotonin syndrome
Abdominal pain, diarrhea, sweating, fever, tachycardia, low blood pressure, altered mental state

Tricyclic antidepressants
Inhibits the reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS increasing the

MAOIs
Treat depression

Bipolar I disorder
at least 1 week long manic episode that results in excessive activity and energy

Bipolar II disorder
low-level mania alternates with profound depression
social and occupational impairment
euphoric and dysphoric episodes

Cyclothymia
symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 yrs in adults and 1 yr in children
social and occupational impairment

First-line for bipolar
Lithium carbonate

Lithium therapuetic level
0.4-1.3 mEq/L
pt must be able to follow up for blood testing

Lithium toxicity
1.5 mEq/L
diaphoresis, weakness, nausea, diarrhea

Defense Mechanisms
compensation
conversion
denial
displacement

Buspiron
only antianxiety that isn’t addicting

PTSD symptoms
intrusive thoughts
nightmares
flashbacks
efforts to avoid thoughts and feelings
feeling detached
depression
feelings of guilt
irritability or angry outbursts
hypervigilance
hypersensitivity
headache
disrupted sleep, insomnia

PTSD medications
sertraline (Zoloft)
paroxetine (Paxil)
both SSRIs

PTSD nursing interventions
counseling
support services

Hypothalmus controls what?
heart rate
breathing

Who first identified anxiety as an important concept and developed the anxiety model?
Hildegard Peplau

Levels of anxiety
mild
moderate
severe
panic

Positive Schizophrenia symptoms
something that is not normally there

Negative Schizophrenia symptoms
something you should have that’s missing

Neuroleptic malignant syndrome
combination of hyperthermia, rigidity, and autonomy dysregulation

Akasthia
psychomotor restlessness evident in pacing or fidgeting

Pseudoparkinsonism
medication induced tremor,

When did conventional antipsychotics become available?
1950s

Atypical antipsychotics
tendency to cause significant weight ga

Serotonin-dopamine antagonists
Abilify (Apiprazole)
Clozaril (Clozapine)
Zyprexa

Personality disorders
pathological personality characteristics
exhibits impairment in self-identity or self-direction and interpersonal functioning
maladaptive behaviors

Cluster A disorders
odd/eccentric
paranoid
schizoid
schiotypal

Cluster B disorders
set limits and boundaries
consistent

Cluster C disorders
anxious/fearful
avoidant personality disorders
dependent personality disorder
obsessive-compulsive

Eating disorders
anorexia
bulimia
binge eating
priority is to identify triggers

Anorexia symptoms

30% of body weight within 6 months
temperature below 36 degree C (98.6 degree F)
lenuga
refuse to maintain a minimally normal weight for height
express intense fear of gaining weight
loss of appetite is rare

Bulimia symptoms
hypokalemia
Russel’s sign
engage in repeated episodes of binge eating followed by inappropriate compensatory behaviors
self-induce vomiting

Binge eating
feel ashamed after binging
feeling of being out-of-control

Somatoform disorders
somatic symptom disorder
illness anxiety disorder
conversion disorder
factitious disorder

Assessment guidelines for the chemically impaired
withdrawal syndrome
overdose that warrants medical attention
suicidal thoughts or other self-destructive behaviors
physical complications related to drug abuse
explore interests in doing something about drug or alchol

Nursing diagnoses
risk for suicide
risk for other-directed violence
imbalanced nutrition: less than body requirements
disturbed thought processes
disturbed sleep patterns
ineffective health maintenance
hopelessness
ineffective airway clearance
ineffective breathing pattern

Central Nervous System depressants
alcohol
opioids

Alcohol withdrawal
develop within a few hours after cessation or reduction of intake, peak after 24-48 hrs

Illusion
misinterpretation of reality

Delusion
not based on reality

Pharmacological interventions treatment of alcoholism
Naltrexone (ReVia)
Acamprosate (Campral)
Topiramate (Topamax)
Disulfiram (Antabuse)

Cognitive and degenerative disorders
dementia/Alzheimers

Etiology of Alzheimer’s disease
Neuronal degeneration
starts in hippocampus – short term memory

Alzheimer’s pharmacology
cholinesterase inhibitors
donepezil
galantamine
rivastigmine

Delirium
Fast onset
Caused by a medical problem
Fluctuating levels of consciousness

Four cardinal features of delirium
abrupt onset
s/s fluctuate
disorganized thinking and poor executive functioning
altered awareness, inability to focus, sustain or shift attention
disorientation, delusional thinking, and hallucinations
anxiety and agitation

Features of dementia
slow onset
short term memory deficit
difficulty finding words or communicating
difficulty reasoning or problem-solving

Crisis
normal coping mechanisms fail
profound disruption of normal psychological homeostasis
results in inability to function as usual

Types of crisis
maturational
situational
adventitious

Crisis nursing interventions
Patient safety
Reduction of anxiety

Age related disorders
conduct disorder
impulse control disorder

Suicide
Modified Sad Persons Scale

Suicidal assessment
lethality of suicide plan
do they have access to means

Prioritizing suicide risk
how quickly would they die

Suicide risk factors
psych disorders accompany 90% of suicides
50x higher for schizophrenics
alcohol or substance abuse
increasing age
race (white=2/3)
religion (Catholics are less likely)
marriage (divorced are higher risk)
profession (professionals higher risk)
physical health

Suicide interventions
teamwork and safety
counseling
health teaching and health promotion
case management
pharmacological interventions (SSRI-less issues with OD)
post-vention for survivors of completed suicides

What is the most predictive feeling of increased suicide risk?
hopelessness

Cycle of violence
tension building stage
acute battering stage
honeymoon stage

Id
pleasure principle
reflex action
primary process
preconscious

Ego
problem solver
reality tester
conscious

Superego
moral component
unconscious

Erikson’s ego theory
trust vs mistrust
autonomy vs shame-doubt
initiative vs guilt
industry vs inferiority
integrity vs despair

transference
client views nurse as having characteristics of another person in the client’s life

countertransference
nurse displaces characteristics on the client from another person in his/her past

compensation
makes up for perceived deficiencies and cover up shortcomings to protect the mind from recognizing them

conversion
unconscious transformation of anxiety to a physical symptoms

denial
escaping unpleasantness by ignoring its existence

displacement
transference of emotions to a nonthreatening person, object, or situation

dissociation
disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment

identification
attributing to oneself the characteristics of another

intellectualization
process in which events are analyzed based on remote cold facts and without passion, rather than incorporate feelings or emotions in the process

introjection
process by which the outside world is incorporated into a person’s view of the self

projection
unconscious rejection of emotionally unacceptable features and attributing them to other people, objects, or situations

rationalization
justifying illogical or unreasonable justifying ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener

reaction formation
unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion

repression
first line psychological defense against anxiety-temporary or long term exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness

splitting
inability to integrate the positive and negative qualities of oneself into a cohesive image

sublimation
unconscious process of substituting mature, constructive, and socially acceptable activity for immature, destructive, and unacceptable impulses

undoing
most commonly seen in children
a person makes up for an act fro or feeling

suppression
conscious denial of a disturbing situation or feeling

regression
reverting to an earlier pattern of behavior

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