NUR 256 Exam One Study Guide for mental health Final Exam

NUR 256 Exam One Study Guide for mental health Final Exam NUR 256 Exam One Study Guide for mental health Final Exam NUR 256 Exam One Study Guide for mental health Final Exam Exam One Study Guide Mental Health and Mental Illness – Chapter One Mental health – recognize potental, cope, productve, ratonal, resilience Mental illness – defnable diagnosis, signifcant dysfuncton in mental functoning Resilience – able to support well-being Optmism, competence, sense of mastery Diathesis – biological predispositon Stress – environmental stress or trauma Diathesis – stress model – more accepted explanaton for mental illness DSM-5 – diagnostc and statstcal manual for mental disorders Mental health nurses – employ purposeful use of self, use evidence based research Basic level – coordinaton of care, health teaching, milieu therapy, pharm/biological/integratve therapies Advanced practce – medicaton prescriptons, treatment, psychotherapy, consultaton Challenges – aging, cultural diversity, expanding technology, patent advocacy, legislatve involvement Setngs For Psychiatric Care – Chapter Four 1950s – Thorazine 1960s – community mental health centers act – deinsttutonalizaton 1980s – carter’s commission of mental health – community based care Primary preventon – occurs before a problem, reduce the incidence, spread the word, educaton Secondary – early identfcaton, screening, doesn’t prevent but may delay progression Tertary – seeks to prevent the progression to a severe course, disability, or death Outpatent care – primary care providers, specialty psych care providers, patent-centered health homes, community clinics, psychiatric home care, assertve community treatment, partal hospitalizaton programs Nursing roles – assessment, case management, promotng contnued treatment, teamwork Comprehensive emergency service model – dedicated space and specialty stafng Hospital based consultant model – no dedicated space/stafng, psychiatric on call Mobile crisis team model – stabilizaton in feld Observaton units – 1-3 days, patents with symptoms Inpatent – suicidal, homicidal, extremely disables Admission optons – direct admission, hospital emergency department Criteria – danger to self/others, unable to fulfll needs Voluntary and involuntary 72 hours – doesn’t include weekends or holidays, assessed for discharge, can be sent home early if ordered Patent refuses to stay afer 72 hours there is a hearing Patent rights – patents retain their rights as citzens, safety must be balanced against rightsRefusal, medicatons, visitaton, informed consents, confdentality Always go with least restrictve Nursing care – safety, initate, therapeutc relatonship, helps develop plan of care, therapeutc groups, assessment, documentaton, medicaton management, medical emergencies Cultural Implicatons – Chapter fve Culture – groups with shared beliefs, values, and practces Influences their thinking and behavior Cultural norms – defne what is normal or abnormal within a culture Ethnic groups – common heritage and history, share worldview for thinking Western – autonomy, independence, self-reliance Mind and body are separate enttes Disease – has a cause and treatment is aimed at the cause Time – linear Success – obtained in preparing for the future Eastern – family is basis for identty Mind-body-spirit are one entty Time – circular and recurring Born into fate, duty to comply Disease – caused by fluctuatons in opposing forces Indigenous – places signifcance on place of humans in natural world Basis of identty is the tribe Person is an entty only in relaton to others Disease – lack of harmony between individual and environment Enculturaton – process in which a culture’s worldview, beliefs, values, and practces are transmited to its members Deviance – can be defned as illness by other members of the group Ethnocentrism – the universal tendency of humans to think their way of thinking and behaving is the only correct and natural way Barriers – communicaton barriers, stgma of mental illness, misdiagnosis (culture-bound syndromes), genetc variatons in pharmacodynamics Populatons at risk for mental illness and inadequate care – immigrants, refugees, cultural minorites Cultural competence – awareness, knowledge, encounters, skill, desire Cultural awareness – examine own culture, recognize that during a cultural encounter, three cultures are intersectng Patent, nurse, and setngCultural knowledge – learn by atending cultural events and programs, forge friendships, learn by studying, ask culturally relevant questons Cultural encounters – deter nurse from stereotyping, help nurse gain confdence in crosscultural interactons, help nurses avoid or reduce cultural pain Cultural skill – ability to perform cultural assessments in a sensitve way, use professional medical interpreter to ensure meaningful communicaton, use culturally sensitve assessment tools Goal – a mutually agreeable therapeutc plan that is culturally acceptable and capable of producing positve outcomes Cultural desire – genuine concern for patent’s welfare, willingness to listen untl patent’s viewpoint is understood, patence, consideraton, and empathy Legal and Ethical Guidelines – Chapter six Ethics – study of philosophical beliefs about what is right/wrong Bioethics – ethical dilemmas in healthcare Benefcence – duty to promote good Autonomy – right to make own’s decisions Justce – distribute resources/care equally Fidelity – maintain loyalty and commitment, doing no wrong Veracity – always communicate truthfully Civil rights – guaranteed the same rights Writ of habeas corpus – formal writen order to free the person, challenge unlawful detenton Informal admission – sought by patent, least restrictve Voluntary admission – sought by patent or guardian, have the right to request and obtain release Temporary admission/emergency commitment – confused or demented, so ill they need emergency admission, need for admission must be confrmed by provider Involuntary – without consent, danger to self or others Long-term involuntary admission – medical certfcaton, judicial review, administratve acton Involuntary outpatent admission – alternatve to forced inpatent treatment, can be preventatve, may face inpatent admission for failing to partcipate Conditonal release – requires outpatent treatment for a period of tme, crimes commited Unconditonal release – terminaton of a patent, insttuton relatonship Release against medical advice – treatment seems benefcial, but there is no compelling reason to seek an involuntary contnuance of stay Restraints – least restrictve for shortest duraton Emergency situatons – least restrictve can be seen as ineffectve in staff’s professional judgement Sleeping – take out of restraints No PRN orders for restraints or emergency injectons Exceptons to confdentality – duty to warn and protect third partes, child/elder abuse Tort – a civil wrong for which money damages may be collected by the injured party from the responsible party Intentonal tort – willful or intentonal acts that violate another person’s rights or propertyAssault – intentonal threat Batery – actual harm or offensive touching False imprisonment Invasion of privacy Defamaton of character – slander Unintentonal tort – unintended acts against another that produce injury or harm Negligence – most common, failure to use care Malpractce – special types of professional negligence Five elements to prove negligence/malpractce – duty, breach of duty, cause in fact, proximate cause, damages Duty – the nurse had a duty to complete Breach of duty – does not meet the standard of care that other nurses would provide under similar circumstances Cause in fact – were it not for the nurse’s actons, the injury would not have occurred Proximate cause – prove that there was no other intervening actons or people Damages – what the person is trying to collect, amount that describes the actual damages Student Theories and Therapies- Chapter two Psychological therapies – treatments based on psychological theories Freud – based theories on three levels of conscious Id – reflex acton Ego – problem solver Superego – seeks perfecton Defense mechanism – deny, distort, reality to make less threatening Freudian theory and nursing – formaton of personality, conscious and unconscious influences, importance of individual talk sessions, transference, countertransference Freud believed transference was healthy and countertransference was not Erkisons – eight stages of developmentPeplau – the act of nursing vs. the science of nursing Relatonship between patent and nurse Developed frst systematc theoretcal framework for psychiatric nursing Interventons to lower anxiety Behavioral therapy – not what caused behavior but how to change it Pavlov – classical conditoning theory, dog Watson – albert and the rat, personality traits are socially learned through classical conditoning Skinner – rewards vs. punishments Cognitve-behavioral therapy – change ways of thinking, reduce symptoms Milieu Therapy – use of total environment The Nursing Process – Chapter Seven Standard one – assessment Difference between children and adolescents and older adults Language barriers – might have kid draw a picture Older adults – read/write, educaton level, stmulaton, alert orientated, respect Access to interpreter right away Gathering data – review of systems, lab data, mental status, examinaton, psychosocial assessment, religious, culture, social ratng scales Diagnosis – standard two Problem – unmet need Etology – probable cause Supportng data – signs and symptoms Outcomes – what is expected Planning – safety, compatble, appropriate, realistc, individualized, evidence-based, what we want to accomplish Implementaton – coordinaton of care, health teaching and promoton, milieu therapy Advanced practces – psychotherapy, pharmacological, consultatonEvaluaton – systemic, ongoing, criteria-based Psychiatric Disorders and Treatments – Chapter Three Brain – regulates stmuli, maintenance of homeostasis, control of biological drives and behaviors, cycle of sleep and awakeness Circadian rhythm – regulates wake/sleep cycle Releases chemicals – neurotransmiters Presynaptc neurons – release neuron to synapse, goes to postsynaptc neuron Neuropeptdes – long-term change in cells Brain stem – regulates internal organs Cerebellum – skeletal muscle coordinaton Cerebrum – mental actvitesBrainstem: Core – regulates internal organs Hypothalamus – link between thoughts and emotons and functon of internal organs Brainstem – processing center for sensory informaton Environment – drugs, steroids, hormones, infecton Genetcs – biological predispositon Altered neurons Antanxiety: Benzodiazepines – controlled, act fast, risk for sedaton, promote gaba, danger is mixing with other CNS depressants, use cauton in older people because falls, risk for abuse, risk for dependency, usually prescribed short term, good for panic atacks When used alone rarely act on the brain, danger is mixing with opioids, alcohol, etc. Older adults – get a tny dose of benzodiazepines compared to younger adults Xanax – shortest half-life, greatest risk of abuse, overdose related deaths Atypical anxiolytc: Buspirone - not as fast actng, very effectve, several weeks, headache, nausea, not sedatve, not for someone having a panic atack, Tylenol should kick the headache, if more severe something else is going on, less sedatve effect, less likely to abuseAnxiolytc/antanxiety: Diphenhydramine – drowsy, nonaddictve, could have opposite effect, might make anxiety worse Hydroxyzine – drowsiness, take as needed, sometme might prescribe this as needed to get through untl buspirone kicks in Propranolol – contraindicated in respiratory issues, beta blocker Clonidine – withdraws, can decrease blood pressure than rebound, sleep for ADHD Sedatve/Hypnotc/sleep aids Trazodone – sleep and sedaton, antdepressant but not a great one Melatonin – OTC Doxepin – TCA, low doses, for staying asleep, not with MAOIS or urinary retenton, avoid sedatves, avoid CNS depressants Amitriptyline – TCA, sedatve side effect Zolpidem/Ambien – controlled, fast onset, take right before bed Quetapine/Seroguel – 2nd generaton antpsychotc, treatment for insomnia, not just for psychosis SSRIS – selectve serotonin reuptake inhibitor, makes more serotonin available, frst line treatment with depression, low side effects, takes 4-6 weeks to notce full effects Side effects – sexual dysfuncton, low libido, appears before mood improves, GI disturbances Might notce side effects before depression gets beter Wont experience all side effects with all medicatons in a class Don’t just stop the medicaton abruptly Serotonin Syndrome – too much serotonin, fever, tachycardia, confusion, increased blood pressure, irritability, nausea, restlessness, can be life threatening, stop the medicaton Might use cooling blankets, person might be hospitalized depending on how severe Increased risk for suicidal ideaton with 25 and under bc of side effects before mood (increased energy) SNRIs – work on serotonin, norepinephrine, increases energy Venlafaxine/effexor – increased BP with higher doses Duloxetne/Cymbalta – helps with diabetc neuropathy, anxiety, depression, fbromyalgia, chronic musculoskeletal pain Prestq – rabdo myalisis which is muscle breaking down, can be dangerous Novel/Atypical Antdepressants: Vilazodone/Vibryd – take with food, don’t take at night because of energy increase Mirtazapine – minimal sexual side effects, increased appettes, helps anxiety and depression, sedaton effect, given to patents who have trouble sleeping and are underweight Wellbutrin/Bupropion – no sexual dysfuncton, anorexia, insomnia, lower seizure threshold, contraindicatve in bulimia, anorexia, and seizure disorders Trazodone – treats insomnia beter, orthostatc hypotension, not a great antdepressant TCAS: Takes longer to work, more lethal Side Effects – cardiac toxicity, not for atempted suicide, antcholinergic, not for glaucoma Amitriptyline – used for pain (migraines and neuropathy), and sleepMAOIS – lots of restrictons, not prescribed very ofen Side effects – not for tyramine bc it can induce hypertension crisis (aged cheeses, smoked fsh, some beer, wine, some chocolate) 1st gen Antpsychotcs – only treat certain symptoms, positve/added symptoms, delusions or hallucinatons 2nd Generaton – treat more symptoms, negatve symptoms that should be there but are taken away 1st gen – eminaria, galactarate, monitor liver functon, menstrual cycle stops, lactaton, dry eyes, decreased blood pressure, sedaton, antcholinergic, memory loss, sedaton, weight gain A lot of patent experience nonadherence bc of side effects Monitor liver functon (LFT) EPS Symptoms – rigid muscles, tardive dyskinesia, parkinsonism, rare in 2nd generaton NMS – medical emergency, rare in 2nd generaton, excessive dopamine, increased heart rate rigid muscles, kidney failure, rabdo myalasis, reduced consciousness, unresponsive, high fever, sweatng Haldol/Haloperidol – can be a long actng shot, 1st generaton Risperidone – long actng injectable, possibility of prolonged qt interval, get baseline and watch EKG Olanzapine/Zyprexa – especially associated with weight gain, sedaton Quetapine – antpsychotc, sedatng effect, prolonged qt interval Ziprasidone – weight neutral, only 2nd gen that is weight neutral, take with food Asenapine – prolonged qt interval Clozapine – risk of agranulocytosis, low WBC count, will take patent off of medicaton, can lower seizure threshold 3rd generaton: Abilify/Aripriprazole – bipolar disorder, treatment resistant depression, can’t sit stll, long actng injectable Benztropine – treats EPS symptoms Mood Stabilizers: Lithium – older medicaton, two-three tmes a day doses, mood stabilizer, mania, 0.5-1.5, kidneys, thyroid, drowsiness in beginning, fne tremor, weight gain especially in females, lithium toxicity, levels checked once per week for frst 6 months, be consistent with fluid and sodium intake (don’t decrease or increase) Lithium toxicity – mental status change, nausea, vomitng, diarrhea, coarse notceable tremor, seizures, coma Don’t double up doses if missed Valproic acid – 50-125, monitor platelets, Alzheimer’s, anger, chance of birth defects, use proper birth control, hepatc failure Carbamazepine/Tegretol – Asians at higher risk for Steven Johnson syndrome, monitor CBC Lamotrigine – start low, go slow, risk for Steven Johnson syndrome Topiramate – migraines, mood stabilizaton Gabapentn – nerve pain, abused ADHD – short atenton span, overactvity Psychostmulants – main treatment, work within 30-45 minutesMethylphenidate and dextroamphetamine – frst choice, agitaton, exacerbaton of psychotc thought processes, growth suppression, suppressed appette, hypertension, risk for abuse, drug screens at least once every 3 months Atomoxetne/intuniv/kapvay – decreased appette, weight loss, fatgue, dizziness, contraindicated with cardiac disease Atomoxetne – antdepressant, increased risk for suicide in ages 25 and younger Alzheimer’s: Donepezil/Galantamine/rivastgmine – cholinesterase inhibitor, don’t work as well as disease progresses Memantne – works on glutamate, plays a role in memory functon, can be taken with the other medicatons, usually not prescribed frst Student Therapeutc Groups – Chapter 34 Group influences – size, defned purpose, degree of similarity, rules, boundaries, content, process Therapeutc factors – instllaton of hope, universality, impartng of informaton, altruism, interpersonal learning, group cohesiveness Orientaton phase – rules purpose, expectatons, dates Working phase – problem solving, conflict resoluton Terminaton phase – summarize, discharge Task roles – get the work accomplished Maintenance roles – keep group together Individual role – focus on themselves RN groups – psychoeducatonal, medicaton educaton, health educaton, dual-diagnosis, symptom management, stress-managementChallenging members – monopolizing, complaining, demoralizing, silent member Stress Management – chapter 10 Walter Cannon – fght or flight Hans Selye – three stages Alarm stage – inital stage Adaptaton stage – overcome usually Exhauston – resources used Stress response – serotonin synthesis is more actve, lower available levels Stressors – physical vs. psychological Percepton and individual temperament Social supports – support groups, culture, religious beliefs Anxiety and OCD – chapter 15 Levels – mild, moderate, severe, panic Separaton anxiety – normal part of childhood Panic disorder – panic atacks Agoraphobia – fear of places Social anxiety – performance/social performance Generalized anxiety disorder – excessive worry that lasts for months Obsessions – cannot be dismissed, intrusive thoughts Compulsions – ritualistc, behaviors OCD – body dysmorphia, hoarding, hair pulling, skin pickingAnxiety disorders – most common form of mental health issues in the U.S., 40 million adults Anxiety and depression run hand and hand Freud – unconscious emotons push through Sullivan – early needs go unmet, anxiety is contagious Behavior theories – anxiety is learned Cognitve theories – individual percepton Cultural consideratons – latn American and northern American =choking Assessment – lab values, level of anxiety (1-10), psychosocial Outcomes identfcaton – what do they want afer? Teaching – not effectve during severe and panic levels of anxiety Benzodiazepines – good for anxiety, short term use Cognitve therapy - tapping into positve thoughts Behavioral – unhealthy coping mechanisms Therapeutc Relatonships – chapter 8 Therapeutc relatonships – safe, confdental, reliable, consistent Relatonship with clear boundaries Goals – facilitate communicaton of distressing thoughts and feelings, assist with problem solving Social relatonships – friendships, mutual needs met Therapeutc relatonships – patent is identfed and explored, about the patent, clear boundaries Necessary nursing behaviors – accountability (don’t lie), focus on patent’s needs, clinical competence, delay judgment, supervision Establishing boundaries – physical boundaries and emotonal boundaries Blurrying boundaries – relatonship slips into social Transference – patent inappropriately displaces onto nurse feelings related to past fgures Countertransference – nurse displays feelings related to people in nurse’s past Patent’s transference ofen leads to countertransference Peplau’s Model: Preorientaton – before frst meetng patent, baseline informaton Orientaton – form relatonship, setng boundaries, educaton, terms of terminaton, assessment Working phase – maintain relatonship, gather further data, behavioral changes, evaluaton Terminaton phase – summarize goals and objectves, discuss ways to incorporate new coping strategies Factors that help relatonships – consistency, pacing, listening, promotng comfort and control Promote patent growth – empathy, genuineness, positve regard, atending Therapeutc Communicaton – Chapter 9 Communicaton – stmuli for informaton, comfort, or advice Sender – initals contactMessage – sent or expressed Factors that affect communicaton: Personal factors – emotonal, social, cognitve Environmental – social determinants Physical – lack of privacy, noise, comfort Relatonship factors – social standing, power, age Nonverbal – tone, appearance, emphasize on certain words, facial expressions, body posture, eye contact, hand gestures Enhancing communicaton – silence, actve listening, empathyOpen ended questons – therapeutc Closed ended questons – yes and no Nontherapeutc techniques – excessive questoning, giving approval/disapproval, giving advice, why questons Cultural consideratons – communicaton style, eye contact, touch Preparing for interview – pace, setng, seatng, introductons, initatng the interview Neurocognitve Disorders – Chapter 23 Delirium – alteraton in level of consciousness, disorientaton, anxiety, agitaton, poor memory, hallucinatons, delusions Medical emergency!! Sudden onset Reversible, treat cause fast Four features: Acute onset and fluctuatng course Reduced ability to direct, focus, shif, and sustain atenton Disorganized thinking Disturbance of consciousness Cognitve disturbances – illusions and hallucinatons Physical – fall precautons, identfy medical cause Implementaton – prevent physical harm, supportve measures Dementa – progressive deterioraton of cognitve functoningAlzheimer’s – form of dementa, neuronal degeneraton Risks – cardiovascular disease, social engagement, diet, trauma to head and brain Defense mechanisms – denial, confabulaton, perseveraton, avoidance of questons Symptoms of Alzheimer’s – memory impairment, disturbance in executve functoning Aphasia – loss of language ability Apraxia – loss of purposeful movement Agnosia – loss of sensory ability to recognize objects Mild stage – short term memory loss Moderate and severe stage – Maslow’s psychological needs Diagnosis:Outcomes:Neurotransmiter – acetylcholine Medicatons – aim to block breakdown of neurotransmiters Suicide and Self Injury – chapter 25 Suicide – intentonal act of killing oneself by any means Tenth leading cause of deathSuicidal behaviors – run in families Freud – aggression turned inward Menninger – wish to kill, wish to be killed, wish to die Beck – central emoton is hopelessness Recent theories – suicidal fantasies, copycat suicide, diathesis-stress model Protectve Factors: African American – religion, extended family Hispanic Americans – roman catholic, extended familyAssessment – direct queston, how they will do it Which patent is the biggest priority Assessment tool – SAD PERSON’S scaleDiagnosis – risk for suicide, ineffectve coping, hopelessness, chronic low self esteem Implementaton – primary, secondary, tertary Primary – educaton to prevent suicide Secondary – treatment of the suicidal crisis Tertary – circle of survivors lef by individuals who completed suicide to reduce the traumatc afereffects Interventons – teamwork, safety, counseling, health teaching, health promoton, case management, pharmacological interventons, post-venton Self-injury – 20-29 years of age Comorbidity – depression, anxiety, eatng disorders, substance abuse Cultural factors – Midwest Crisis and Disaster – Chapter 26 Crisis – disrupton of normal homeostasis Coping mechanisms fail Results in inability to functon as usual Acute and tme limitedOutcomes of crisis – depend on… realistc percepton of event, adequate situatonal support, crisis interventon, adequate coping mechanisms Crisis interventon – safety is a priority Erich Lindemann – seven stage crisis model Maturatonal – new developmental stage is reached, old coping skills are no longer effectve and new coping mechanisms have yet to be developed, leads to increased tension and anxiety EX. maturing and growing, living on own for the frst tme Situatonal – arise from events that are extraordinary, external, and unantcipated Depend on the degree of support available, general emotonal and physical status Adventtous – unplanned and accidental EX. natural disaster, natonal disaster, crime, violence