Rasmussen: Mental Health: Exam 3,2023 with 100% correct questions and answers

Somatoform Disorders A mental disorder marked by physical symptoms for which there is no apparent physical cause is a ___ disorder. Experiencing physical symptoms as a result of psychological stress Common in patients with: - depression, anxiety, drug abuse Factitious disorders needed to be ruled out Benefits the patient receives because of their symptoms: - Extra attention - freedom from responsibilities - financial rewards (disability) Benefits derived from the symptoms alone like for example in the sick role, the patient is not able to perform normal family, work, and social functions and receives extra attention from loved ones (positive external motivations) Secondary Gains (Associated with Somatoform Disorders) Hypochondriasis (signs and symptoms) (exacerbated during stress) - Person sincerely believes they have a devastating health condition ("headaches must be terminal brain cancer") - Anxiety and depression symptoms - Severe distress/preoccupation with health causes issues with life - May or may not have somatic symptoms Conversion disorder A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found. - most common somatic symptom disorder - symptoms are due to stress, insomnia, loss of control/ loss of grip on their lives - a mental condition where a person has blindness, paralysis, can't move limbs, deafness, anesthesia that cannot be explained by medical evaluation Conversion Disorder (signs/symptoms) - motor/sensory deficits, but no medical illness to prove why EX: blindness, abnormal gait, seizures, paralysis, deafness, anesthesia - The patient may show lack of emotional concern: "La Belle Indifference" - Patient wants medical care, but not really concerned about their symptoms Dissociative Amnesia - Inability to recall important personal information (DOB, SSN, Name, Etc) - Veterans most commonly have this. - "Baby Brain": postpartum (Can't remember things due to stress) Derealization - Walking into your own home, yet everything looks distorted, strange and dreamlike - Persistent and Recurrent Depersonalization - Time moves slow, in a dream/fog, detachment from body. - Usually preceded by severe stress Dissociative Fugue disorder in which one travels away from home and is unable to remember details of his past, including often his identity (Amnesia) - Unconscious defense mechanism: trauma and anxiety are overwhelming and they dissociate to get away. Interventions: - Basic Needs and Safety are #1 (Maslow) - #1 effect treatment is psychotherapy - Allow the person to progress at their own pace until memory is back - Don't Overwhelm them with data about their past - Provide simple routines Body Dysmorphic Disorder Definition: - Person has an unrealistic negative evaluation of his or her personal appearance and attractiveness - They feel defective and causes severe distress - Nose and Breasts are most common appendage worried over Symptoms: - May camouflage the body part, check the mirror frequently, feel shame/guilt about the body part - Multiple cosmetic surgeries but no relief of the obsessive thinking Nursing Interventions: - Assess for suicide - Safety is #1 Priority Treatment: - SSRI's, TCA's (clomipramine), Cognitive Behavioural Therapy Personality Disorder - Personality traits that are exaggerated to the point in which they cause severe dysfunction in people's relationships - they often have difficulty working and loving Nursing Assessment: - Assess for suicidal & Homicidal thoughts #1 - Rule out medical diagnosis vs. Mental diagnosis - Any recent losses/ crisis? - Any drug or alcohol use? Nursing Rationals: Helpful Items: - Have frequent staff meeting (stay on the same page) - Set limits on patient's behavior and be consistent (Ongoing nurse priority) - Rotate nursing staff if one nurse is overwhelmed with a patient - Assess your own reactions toward the patient Two common characteristics of PERSONALITY DISORDER 1. Inflexible (difficult to the changing demands of life) 2. Serious issues with work and relationship Dependent Personality Symptoms: - Believe they are incapable of surviving if left alone - Can't work alone, function alone - Will stay in abusive relationships so they aren't alone - When patient breaks up, the patient will jumpt right into another relationship - High anxiety: can't make decisions unless there is excesssvie reassurance from another person. Histrionic Personality (ex: Mean girls = Regina George) Symptoms: - Manipulate others through their dramatic, rapidly shifting, and charming, flamboyant, and sexually seductive behaviors. - Center of attention. - May act out with displays of temper, tears, and accusations when they are not getting the attention or praise they believe they deserve. Nursing Interventions - Assess your own reactions toward the patient - Assess patient's interactions for a short period before labeling as manipulative - Set limits on any manipulative behaviors - Intervene in manipulative behavior - Be vigilant Nursing Interventions for Manipulating - Set limits on behaviors (arguing, flattery, seductiveness, clinginess) - Set clear rules and follow through with consequences - DONT MAKE PROMISES - DONT ACCEPT GIFTS FROM PT - DONT DO "SPECIAL FAVORS" FOR PT Nursing interventions for Impulsive Behavior: - What precedes the event? (find the trigger) - Teach patient coping skills - Discuss alternative behaviors Anorexia - Signs and Symptoms - Fear of gaining weight, views self of being fat (even if skinny), cuts food into tiny pieces, moves food around during dinner time, chews one piece of food for a long period of time, rigorous exercise pattern, judges self by their current weight, control what they eat to overcome feeling of helplessness - Patient might wear baggy clothing to conceal weightloss, sunken eyes, protruding bones - Athletes, wrestlers, ballerinas, females at the highest risk Physical/ Medical Complications: - Cardiac arrest, amenorrhea, lanugo (fine hair on the body), osteoporosis, hematuria, proteinuria, bradycardia Anorexia (assessment/interventions) Assessment: - Patient's perception of the problem, eating habits, suicide/self-harm, history of dieting, methods used to lose weight. Nursing Interventions: - Weigh patient in bra/underwear at the same time each day (after voiding, but before eating) - Weight patient with their back to the scale - #1 Priority = establish alliance by acknowledging the difficulty - DON'T be authoritative or take a "parental role" with your patient Milieu Management of Anorexia: - Set PRECISE meal times - Observation BEFORE and AFTER meals - Regularly scheduled weights - Monitor patient in the bathroom to ensure no laxatives/diuretics are taken All-or-Nothing Thinking the tendency to believe that one's performance must be perfect or the result will be a total failure - The reasoning is Absolute or Extreme Example: - "If I one Popsicle, I must eat 5" - "If I allow myself to eat, I will blow up like a balloon" Refeeding Syndrome metabolic alterations that may occur during nutritional repletion of starved patient - When the heart muscle has been nutritionally depleted for so long and how the re-fed body needs increased demands -- the heart cannot keep up and can result in CV collapse Bulimia (Signs and Symptoms) - Binge/ purge cycles, Self-induced vomiting, controls weight by bingeing, feeling of emptiness, the person feels shame after binge/purge cycles - easier to treat than anorexia. Bulimia (Nursing interventions) #1 priority = stabilization of HEART and ELECTROLYTES!!! - Labs: CBC, glucose, ECG, electrolytes, thyroid, etc. - Assess mood & suicidal thoughts - Monitor patient before and after meals so they cannot purge - Have the patient keep a journal of thoughts and feelings. Health Teaching: - Meal planning, healthy exercise regimen. Once this is established, the patient can go out on a "Pass", have a meal and come back to the unit to discuss their experience Prescription Medication for Eating Disorders - SSRI's: (Fluoxetine/ Prozac) is the #1 FIRST medication used to maintain weight and prevent relapse. - 2nd generation antipsychotics: (Olanzapine/ Zyprexa) used to help patients gain weight Memory care - Reminiscing (Table 18-5) The nurse should: - encourage reminiscing about Happy Times - Rational: remembering accomplishments and shared joys help distract patient from deficit and gives meaning to existence Dementia: Alzheimer's Disease Permanent - NOT REVERSIBLE - Develops more slowly and is characterized by multiple cognitize deficits that include impairmentin memore without impairment in consciousness 4 A's of Dementia - Amnesia: memory impairment - Agnosia: Loss of ability to recognize objects - Apraxia: loss of purposeful movements - Aphasia: Loss of language Stages of Dementia Stage 1: mild/ forgetfullness Stage 2: Moderate/confusion Stage 3: Severe/ unable to identify objects/ people Stage 4: Late/end-stage Dementia: Defense mechanisms Confabulation: - Making up stories or ansers to maintain self-esteem when they do not rememebr Perseveration: - Repetition of phrases or behavior Dementia: Nursing Interventions - Always introduce yourself - Call the patient by name with every contact - Expectations should be clear and explained in simple, step-by-step instructions - Simple, appropriate choices Dementia: Family Teaching/Education - Nurses need to teach families about dementia, where to get help, community resources, etc. - Gradually take the care away - No throw rugs, tape cords to the floors, mattress on the floor/bed alarms, keep it simple & familiar as possible . Delerium NOT PERMANENT (Can be reversed) - is a syndrome that is always secondary to another condition such as a general medical condition, substance use, medication, toxin exposure, or it may have multiple ideologies. - Speak calmly in a clear low voice, allow adequate time for response, use orienting verbal cues, supportive touch. Keep environmental noise to a minimum. Monitor sleep and void pattern. Monitor intake, discourage daytime napping, encourage some exercise. - Common causes of delirium - Surgery, drugs, UTIs, pneumonia, cerebrovascular disease, and congestive heart failure. - Glasses and hearing aids - Provide when client is misinterpreting reality. - Redirect, reorient them to time/place and let them know they are safe - Patient demands to leave because they need to get home for an appointment. - Risk for injury - priority nursing diagnosis (falls due to confusion) - Antipsychotics and benzodiazepines (start low and go slow) - Use judiciously to help with behavioral problems. Use carefully Delerium (Signs and Symptoms) - sudden onset - disorganized thinking - disturbances in cognition, attention, and memory, disoriented and incoherent. - the patient may wander off - ideas of reference are common. Is always secondary to another condition. If secondary condition resolves, so does delirium. Delerium: Nursing Interventions - use clocks, calendars, familiar picture/objects, talk about familiar history, use natural lighting. - speak in slow, simple statements - keep head of bed elevated & room lighted sufficiently Delerium: Visual (see) & Tactile (feel) Hallucinations - Physical safety is the nurse's highest priority - Clarify reality Nursing Diagnosis: - Impaired environmental interpretation - powerlessness - Fear Delerium: Visual and Auditory Illusions - Are errors in the perception of sensory stimuli. - A stimulus is a real object in the environment; however, it is misinterpreted, and the patient becomes fearful - Clarify reality Delerium: Medications given for Behavioural symptoms/ combativeness in Alzheimer's patients - "Start low and go slow" - Aricept: Helps brain function longer - Atypical Antipsychotics: Risperidone, Olanzapine, Quetiapine -- effective for the short-term only. Taper off Caregiver Fatigue: Nursing Interventions Stress reducing techniques include: - Having a realistic understanding of the disease - Establishing realistic outcomes - Maintaining good self-care such as adequate sleep and rest, eating a nutritious diet, exercising, engaging in relaxing activities, and addressing their own spiritual needs. alcohol dependence Relapse prevention plan: - The goal of relapse prevention is to help the individual identify their "trigger situations" Phencyclidine Piperidine (PCP) or Angel Dust OVERDOSE Signs and Symptoms of Overdose: - psychosis, possible hypertensive crisis, CVA, respiratory arrest, hyperthermia - Pupils = rapid Nursing Interventions: - Give cranberry juice, ascorbic acid or ammonium chloride to acidify urine to help the drug excrete from the body - put in a room with minimal stimuli - do not attempt to talk down the patient!! - speak with a clear/soft voice and in a low tone. Opioid overdose Opioids: - Oxycodone, Heroin, Morphine, Methadone, Codeine Signs and Symptoms: - Triad of symptoms (pinpoint pupils, respiratory depression/ arrest, coma). Cardiac arrest/death ,shock, convulsions. - Pupils: Pinpoint Heroin Overdose Signs and Symptoms: - Triad of Symptoms (Pinpoint pupils, respiratory depression/ arrest, coma). Cardiac arrest/death, shock, convulsions - Pupils = pinpoint Antidote for opioid overdose Antidote: - Narcan (Naloxone): - short-acting: must be readministered every few hours until opioid levels are nontoxic Side effects after administration: - reverse analgesia - s/sx of withdrawal can include: muscle aches, abdominal cramps, insomnia, irritability, diaphoresis Nursing interventions: - monitor pt closely - monitor vital signs every 15 minutes (especially respirations) - Keep resuscitation equipment close Alcohol Withdrawal Delirium Peaks 2 to 3 days (48 to 72 hours) after cessations or reduction of alcohol intake Signs and Symptoms: - hallucinations, delusions, insomnia, tachycardia, diaphoresis, elevated BP, disorientation CNS stimulants withdrawl CNS stimulants produce an imbalance of dopamine and norepinephrine. S/S of Withdrawl: - depression - paranoia - lethargy - anxiety - insomnia - nausea, vomiting, diaphoresis, chills Naltrexone: opioid antagonist - Helps with alcohol cravings and block effects of opiates by reducing the "high" feelings - free from opiates 7-10 days before taking medication. Disulfiram (Antabuse): - helps prevent relapse - Will produce nausea and vomiting, headache, and flushing if a person drinks alcohol while on the medication Vivitrol (naltrexone for extended-release) used for alcohol abuse only - do not use if patient has opioid depedence Acamprosate (Campral) - Helps client abstain from alcohol - reduce alcohol cravings by reducing the intensity of prolonged withdrawal syndrome. - benefits are seen 30 to 90 days later Buprenorphine Hydrochloride - Can prevent symptoms of withdrawal in patients addicted to opiates - is an alternative to methadone Domestic Violence S/S: - recurrent visits to the ED for being "clumsy" or "accident prone" - Story doesn't match up with the injury - Bruises in various stages of healing - Panic attacks, anxiety, depression, GI issues, Hypertension, Insomnia Violence is a LEARNED behavior used by a person to CONTROL others Patient teaching for patient experiencing domestic violence - move to a room with more than 1 exit (preferably a room w/o weapons) - Know the quickest route out of the house - Have safe words to use with children so that they can get out of the house immediately and get help. - Have a safe house/ place to go to - Keep a packed bag hidden with essentials for emergencies emotional abuse - Belittling, criticizes, insults, name calls, and undermines. - Humiliation and threatening - The abused/patient starts to believe the words their abusers say to them - Destroy's a person's spirit and ability to succeed in life Child Abuse: Physical symptoms - At greatest risk 4 yo - Nursing Priority: child safety and well being Physical Symptoms: - bruising in different stages of healing - bite marks, welts, scratches, broken bones - Poor hygiene, malnourished, school problems, missing school, UTI's, bloody clothing or underwear, can't sit/ walk due to abuse, lag in development Child Abuse: Behavioural Symptoms - excessively scared/ fearful of parents or authoritative figures - Consistent efforts to please - truancy, distorted views of sex, begging/ stealing of food - inappropriate behavior (too adult/childlike) - Mistrusts adults/ hides bruises Child Abuse: Nursing Assessment - DO: private interview, sit NEXT to the child, tell them it is confidential, use language they can understand. - Use dolls/ puppets to have the child reenact the situation (great for preschoolers). - Use the body map to indicate areas of abuse. - Kids may not want to "betray" their parents -- even when abused **DO NOT press/poke for answers, let them feel "at fault", group interview, have them remove clothing, display emotions of shock** Child Abuse: Nursing Responsibilities - Nurse has a legal responsibility to report abuse/neglect when proven or suspected. Reports are confidential & vary by state. - SAFETY of the child is your FIRST and most IMPORTANT priority!!! - Safety, risk for injury, & injury are the primary nursing diagnosis Sexual Violence Nursing Interventions (table 22-2) - NEVER leave the patient alone (have someone stay with them) - remain emotionally Neutral -- VERY IMPORTANT-- don't judge them - confidentiality is crucial - DO NOT USE THE WORDS: alleged, refused, intercourse (they minimize the devastation of the event - USE THE WORDS: reported, declined, penetration - Assess s/sx of abuse - Ask for permission to take specimens and photos - Explain ALL procedures - Test for HIV, Hep B, and syphilis Physical Aggression (Signs and Symptoms) RED FLAGS: - setting fires, animal cruelty during childhood, conduct disorder - Has a history of violence (#1 predictor), impulsive behavior, ETOH Violent Behavior Highest Risk (Box 24-1) Highest risk: - irritability, pacing around the room, slamming doors, clenching fists, tense facial expression, mumbles to self, uses profanity, loud voice, suspiciousness, ETOH, possession of a weapon The nurse should ask the patient: "What will help now?" Restraints & seclusion - Each member of the team is assigned to limb or function to stabilize and hold down Chemical restraint: - Atypical antipsychotics and Benzodiazepines: used in acute rage and aggression Seclusion or restraint: used in the following situations: - the patient presents a clear and present danger to self or others. - the patient has been legally detained for involuntary treatment and is thought to pose an escape risk - the patient requests to be secluded or restrained ADHD Medications - Ritalin (methylphenidate) - stimulant, most commonly used. - Available PO and transdermal Patch only ADHD Medications: Concerta - Is extended release Ritalin - (used for 1 time/day dosing) - Good for kids that have a hard time remembering to take pills BID ADHD Medications: Adderall Calms the patient and comes in extended release form Passive developmental disorders/ autism (Signs and symptoms) - decreased social skills (avoids eye contact, plays alone, doesn't share interests with others, doesn't respond to name by 12 months. - delayed speech (echolalia, robot-like voice, doesn't understand jokes, few/no gestures, can't name objects the nurse points to) - Repeated behaviors/ routines (rock body, flaps hands, spins in circles, turns lights on/off, when routine changes -- throws tantrums - Unusual eating habits, aggression, unusual reactions to the way things smell, sounds, look, feel. Cannot pretend play, doesn't like to be cuddled, lacks friends. Facts about Aging - vision, hearing, touch, taste, smell decline with age - muscle strength decreases with age - 50% of restorative sleep is lost with age - increased depression is common Older Adults: Nursing Assessment - Call the patient by formal name (Mrs. Jones, Mr. Smith) - Private interview, sit at same level as patient, low noise, good lighting. - DON'T use "Elderspeak" (talking to them like they are children. Example, "Did WE want a bath today?" Medications and the Elderly - Anticholinergics found to correlate with reduced brain function and early death - Nurse should assess any medications and OTC items - "Start low and go slow" - TCA's #1 drug of choice, then SSRI's (due to increased bone fracture risk.) Depression in Older Adults - Forgetful, agitated, chronic aches/pains, fatigue, paranoia, anxiety without cause - Nurse should assess for suicide! Restraints in Older Adults - Shouldn't be used unless absolutely neccessary (risk of harm to self or others) Other Options Are: - door alarms - bed alarms - making the environment safer - Better lighting - lower beds to floor - keep furniture in same place - increase hearing aids and visual devices The older adult may have ognitive issues or problems with senses which make them wander or be frightened. Somatoform Disorders (symptoms/ interventions) Common Symptoms: - TMJ, teeth grinding @ night, HTN, Tension Heart Attack Nursing Interventions - Goal: to get the feelings out, so the symptoms aren't there anymore - Never state that the symptoms are not real Borderline Personality - unstable and intense relationship and instability of affect, marked by unstable and frequent mood changes. - Poor impulse control is evidenced by recurrent suicide attempts, self-mutilation, and self-destructive behaviors. Interventions - Identify the needs and feelings preceding the impulsive acts - Discuss current and previous impulsive acts - Explore the effects of such acts on self and others - Recognize cues of impulsive behaviors that may injure others - Identify situation that trigger impulsivity, and discuss alternative behaviors - Teach or refer patient to appropriate place to learn needed coping skills (anger management, assertive skills)