Mental Health-FINAL EXAM Rasmussen

What type of patients go to memory care? - Dementia or Alzheimer’s What type of environment is a memory care unit? - Locked unit, 24-7 supervision. What type of activities do you implement to interact with memory care patients? - Activities that help them to recall their past-show old photos, ask questions like what was your first job? where did you grow up? what was your parents names? If a patient is not engaged in a group of people sharing photos what might they be feeling? - Depressed, Isolated, Angry Can a social worker make a decision about placement for an elderly person if that person has living family members, a POA? - No, they cannot make the decision. Nurses must educate family about decisions. What does agnosia mean? - Inability to interpret sensations and hence to recognize things, typically as a result of brain damage. Example of something that could cause agnosia? - TBI, vascular dementia. Characteristics of delirium. - Rapid in onset, 24-72 hours, related to infection, NOT common with aging. What is an important intervention for patients with delirium? - Reorient them. What are the primary characteristics of borderline personality disorder? - splitting people (Pitting a group against each other). Self-defeating cycle of behavior. What do you give a patient who has overdosed on PCP? - Benzodiazepine Example of a benzodiazpine antidote? - Flumazenil What type of personality disorder might a patient who still lives at home at 30 and depends on their mother for everything, have? - dependent personality disorder Give an example of a positive statement made by a recovering alcohol that made signal that they are getting better? - I will identify things that trigger my cravings Symptoms of patient with suspected opioid abuse/overdose? - Contracted pupils, increased HR, shallow Resp., increased temp (but not always). What do you give a opioid overdose patient? - Narcan (Naloxone) S/S of acute alcohol withdrawal? - Everything is increased! RR, BP, Temp, HR, delerium Characteristics of histrionic personality disorder? - Mania, melodramatic, manipulative, emotional attention seeking behavior, often seductive and flirtatious. Interventions for histrionic personality disorder patient - They are very manipulative. Set fine lines, do not offer relationship advice, avoid situations where they are the center of attention. Possible fatal complications of patient withdrawing from CNS stimulant - Respiratory failure, suicide, and depression. What is a hypochondriac? - Someone who thinks that everything is wrong with them. Ex. their acute headache is caused by a brain tumor. How does cocaine stimulate the body? What do cocaine users use to combat these effects? - It is an upper. Alcohol-allows them to sleep. Characteristics of borderline personality disorder - Split people apart and are very manipulative. Interventions for nurses dealing with borderline personality disorder patients - Keep all the staff on the same page. Set limits and rules. What is a personality disorder in general? What type of issues do these patients have? - When people rely on others to make decisions. They have difficulties in their social life, work, relationships, family problems. Place the blame on others. Many go undiagnosed. What is conversion disorder?` - Something psychological happens and it then manifests somatically. Ex. Someone has fake blindness What is the difference between objective and subjective data? - Subjective is what the patient tells you, objective is what you see and obtain from the physical assessment of the patient. What is somatoform disorder? - A mental illness that causes bodily symptoms that cannot be tracked back to any specific cause. Are the symptoms real for a patient with somatoform disorder? - Yes, the symptoms are real. It is frustrating because many doctors will perform tests but find nothing. Many go undiagnosed. What are younger patients with body image problems at risk for? - Suicide A nurse caring for a patient with borderline personality disorder should try to find out what? - What the patients secondary gains are. What are they trying to get? Attention? Money? Pain pills? Characteristics of an antisocial personality disorder patient in a locked setting with other clients? - Manipulative, aggressive, angry, yelling. What is a main cause of death for anorexia nervosa patients? - Cardiac problems d/t potassium imbalances *hypokalemia What is re-feeding syndrome? - Occurs when malnourished patient begins to receive nourishment again. Severe change in intake and electrolyte increases cause heart to work harder and can cause dysrhythmias. What is the difference between bulimia and anorexia? - Bulimia is the binging of food and then purging. Anorexia is starving self from food. If you're throwing up and or taking a laxative? What electrolyte might be out of balance? - Potassium What are hallucinations? - Experiences that are real to the patient but are not actually real., What should you do for a patient that is having hallucinations? - Make sure they have everything they need (Glasses, hearing aid etc), keep lights on in room, do not place large clocks or calendars on the walls. What type of med would a dr. give a cognitive impaired elderly client who pulled out all of her tubes? - Atypical antipsychotic How long til we see complications with patients withdrawing from alcohol? - 24 to 48 hours. When giving narcan, what should you monitor closely? - VS, at least every 15 min. Stay with patient! What would you give a patient with a heroin overdose? What would we expect to improve? - Narcan. HR and Resp OD heroin patient receives narcan, 1 hr. later present with abd cramps, goose bumps. What is going on? - Symptom of narcotic absence. "withdrawal" What should the nurse do for a sexual assault victim? - Make sure counseling is available for them, set up an appointment Who is at the highest risk for physically abusing a nurse? - A patient with dementia or a delusional patient What type of meds do ADHD patients receive? - CNS stimulant Early signs of autism in kids? - Isolation, not loving towards people, nonverbal, doesn't like to be touched, difficult relationship with parents Can restraints be PRN? - NO!! Must clarify with doctor. What is lorazepam (Ativan) used for? - Anxiety disorder or preop sedation. Side effects of lorazepam (Ativan) - Drowsiness, respiratory depression, dizziness, lethargy, physical dependence Contraindications of lorazepam (Ativan) - Angle closure glaucoma, hx of drug dependence, pre-existing CNS depression, severe hypotension, and sleep apnea Lithium therapeutic range - 0.5-1.5 Levels of maslow hierarchy of needs? - Physiological needs, safety, love & belonging, self-esteem, self-actualization. Rights of voluntary and involuntary admission patients to mental health? - Have the right to refuse meds, refuse treatments, and the right to informed consent. What vitamin isn't absorbed when taking an MAOI? - Tyramine Characteristic of patient with body dysmorphic disorder? - Preoccupied with an image of a defective body part resulting in obsessional thinking and compulsive behavior, such as mirror checking and camouflaging. Theraputic Communication Technique (TCT) Silence: - using silence allows for meaningful relfection (TCT) accepting: - conveys an attitude of reception and regard (TCT) Giving recognition: - Acknowledging indicates awareness (TCT) Offering self: - Making oneself available on an unconditional basis, increasing the clients feeling of self-worth (TCT) offering general leads: - Allows the person to take direction in the discussion indicates that the nurse is interested in what comes next. ("go on", "and then?") (TCT) giving broad openings: - clarifies that the lead is to be taken by the patient ("Where would you like to begin?") (TCT) Making observations: - Calls attention to the person's behavior, encourages the person to notice behavior and to describe thoughts and feelings for mutual understanding. Helpful for mute or withdrawn people. (TCT) Encouraging description of perception: - Increase the nurse's understanding of the patient's perceptions. Talking about feelings and difficulties can lessen the need to act them out inappropriately Non-therapeutic communication (NTC) Giving premature advice - Assumes the nurse knows best and the patient cannot think for self. (NTC) Minimizing feelings: - Indicates the nurse is unable to understand or empathize with the patient. The patient's feelings or experiences are being belittled. What is beneficence? - The duty to act as a benefit or to promote the good of others. What is autonomy? - Respecting the rights of others to make their own decisions What is justice? - The duty to distribute resource or care equally, regardless of personal attribtutes. What is fidelity (nonmaleficence) - Maintaining loyalty and commitment to the patient and doing no wrong to the patient What is veracity? - One's duty to communicate truthfully. What does a patient lose when they are admitted d/t suicide attempt/ideation? - Right to privacy. What are negative symptoms? - A lack of feelings or behaviors that are usually present. Losing interest in daily activities, lack of feeling or emotion, having little emotion or inappropriate feelings in certain situations, agnosia. What are positive symptoms? - Feelings or behavior that are not usually present. Delusions, hallucinations, disorganized speech and behavior. What do atypical antipsychotics treat? - Negative symptoms. Examples of atypical antipsychotics - Clozapine, risperidone, olanzapine, aripiprazole, ziprasidone, and quetiapine. SE of atypical antipsychotics - fewer EPS symptoms, temp, increased wt, glucose, and triglycerides Three types of crisises? - Situational/external, maturational/internal, and adventitious What is a situational .external crisis? - Often unanticipated loss or change. What is maturational/internal crisis? - Achieving new developmental stages, which requires learning additional coping mechanisms.