Mental Health Nursing Test Blueprint #4

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Cognitive behavior therapy

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has been found effective for bipolar, depression, anxiety disorders, and prevention and treatment of traumatic stress. It is based on the premise that distorted or dysfunctional thinking causes psychologic disturbances in mood and behavior. The goal of therapy is to assist the pt. to identify automatic thoughts and connecting these thoughts to feelings and behaviors. Involves cognitive appraisal which means that emotions and behaviors are influenced by perceptions and interpretation of events. THere are many cognitive errors among the depressed patients such as overgeneralization, mental filtering, catastophizing, minimization, magnification, dichotomoization, arbitrary inference or fortune telling, and personalization.

Front 2

Culture and violence

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the way a culture or ethnicity define gender roles may affect how rape is perceived. cultural symbols help to form attitudes and beliefs that re then further translated into laws, court proceedings, police behavior, education curricula, and social service programs. cultural values are the underpinnings of beliefs and attitudes and they assist the civilians, family, police, and any other affected individuals with deriving meaning from the experience. Sexual abuse and rape by an intimate partner is not considered a crime in many countries around the world, and women do not consider forced sex by a known partner to be rape.

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Battered Women

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services for battered women began back in 1885, but by the 1940's almost nothing was being done to help battered women. female murder victims were substantially more likely than man to be killed by an intimate partner. There are 1.8 million wives in the U.S that are abused every year by their husbands, 25-30% of all women are abused by their intimate partner at least once, 20-25% of women how seek treatment in the ER are there as a result of battering injuries, 2-8% of these women identified abuse as the cause of their injuries, 7-17% of pregnant women experience physical abuse by their partners. Assessment- Ask We often see women who have been hurt by their partners. Is your partner responsible for your injury? Has your partner ever hurt you? Have you noticed any pattern to this behavior, such as an increase in the frequency and severity? Does he threaten to se or has he ever used a weapon to hurt you? Accurately document all statements, use direct quotes, assure confidentiality and safety, assess own thoughts and feelings, use supportive statements. may need to help create an emergency exit plan. empower the individual. start with primary prevention, secondary prevention followed by tertiary prevention.

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Family violence

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includes spouse assault, physical and sexual assault of children, sibling assault, and physical and sexual assault of other relatives who reside in the household, and is defined as behaviors which threaten, attempt, or actually inflict physical harm and thereby expanded violence to include more than just the actual physical abuse. Family violence often occurs in private places, can be invisible to others and are less likely to be discovered or reported to police.

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Child abuse statistics

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2 million children are seriously abused by their parents and caregivers each year. Of these children 1000 will die as a result of these injuries. 25% of the 2 million abused are physically abused, 20% are sexually abused, and 55% are neglected. 25% of the 2 million abused are younger than 5 and 60% are between and 14 years of age. children younger than 3 are at a greater risk for fatal abuse than older children, abused and neglected children are at greater risk for later delinquency, adult criminality, and violent crimes that those nonabused/nonneglected.

Front 6

Child abuse

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the physical, psychologic, or sexual victimization of a minor. Psychologic abuse is the most difficult to detect and treat, and it is more long lasting than physical abuse. Review boxes 23-7 and 23-8 which list indicators of abuse and neglect and sexual abuse.

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Nursing Interventions for violence

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review table 23-1 page 534, 23-2, 23-3 page 541, 23-4 page 546

Front 8

Neuroleptic Malignant Syndrom (NMS)

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a medical emergency with symptoms that include a decreased level of consciousness, greatly increased muscle tone (rigidity), and autonomic functioning (hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, and drooling) Muscle necrosis aka rhabodmolysis can be so severe that is causes myoglobinuric renal failure. Potentially fatal reaction with a mortality rate of 10% and occurs in appx. 1% of pt. on antipsychotics and young males are most often those affected. will see lab abnormalities of leukocytosis (15-30K cells/mm), elevated creatine phosphokinase levels (more than 3000) and myoglobinuria. Treatment includes: discontinue antipsychotic medications, increase hydration, administer acetaminophen and cooling blankets for hyperthermia, iv heparin infusion to reduce the risk of pulmonary emboli, manage arrhythmias, monitor renal function, iv infusion of Dantrolene (dantrium) a muscle relaxant to help reduce the amount of muscle breakdown occurring as a result of hypertonicity, and consider dopaminergic drugs like mocriptine (parlodel, amantadine, or anticholinergic drugs.

Front 9

Haloperidol (haldol)
Pregnancy Class C
PO and IM

Back 9

used for psychotic disorders, control of tics, vocal utterances of of tourettes syndrome, short term tx of hyperactive children showing excessive motor activity, schizophrenia, organic mental syndrome with psychotic features and emergency sedation of severely agitated or delirious patients, schizophrenia affective disorders and delusional disorders. Dose ranges from 5-20 mg/day.
Adverse effects- EPS, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, headache, seizures, NMS, orthostatitic hypotension, anticholinergic effects, rash, and risk of death with dementia.
Avoid alcohol, carbamazapine, epinephrine, levodopa, and lithium, phenobarbitol. Also herbals of chamomiles, hops, nutmeg, betel palm, kava.
Monitor billirubin, and serum levels. need good oral hygiene, aboid hazarous activiites, , use sunscreen (photosensitive). May be gien with benztropine (cogentin) or diphenhydramine to reduce chance of dystonia and EPS.

Front 10

fluphenazine (prolixin)
Pregnancy C
PO, IM, SubQ

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used for psychotic disorders, schizophrenia
Outcome- reduced signs and symptoms of psychosis.
Dose 5-20 mg/day
Adverse Effects- EPS, NMS, akathisia, dystonia tardive dyskinesia, drowsiness, headache, seizures, tachycardia, anticholinergic effects, pseudoparkinsonism, orthostatic hypotension, paralytic ileum, hepatitis, aplastic anemia, thrombocytopenia,
Avoid with patients with bone marrow suppression, closed-angle glaucoma, liver damage, coronary disease.
Do not take with Betel palm, kava-increased risk of EPS,
Teach-good oral hygiene, change positions slowly, avoid abrupt withdrawal, avoid OTC products, uses sunscreen (photosensitivity), teach about signs of EPS, avoid antacids take at least 2 hours before or after this drug, report sore throat, malaise, fever, bleeding, mouth sores as may be a sign of blood dyscrasis.

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MAOI's

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used for the treatment of atypical (novel) depression, major depression without melancholia, or depressive disorders that are resistant to TCAs. Hypersomnia, hyperphagia, anxiety, and the absesnce of vegetative symptoms classify atypical depression, and may also be helpful for anxiety disorders, eating disorders, and some pain syndromes. These drugs are rapidly absorbed and have an average half life of 24 hours, dose begins with 10-15 mg.
Contraindications- cerebrovascular defects, adrenal medulla tumors, older pt do not tolerate them well, and may worsen symptoms of parkinsons disease, may exacerbate psychotic symptoms of those with schizophrenia.
Teach patients about food and drug restrictions which will cause a hypertensive reaction if take with the MAOI. Patient must avoid aged cheeses, ripe avacado, ripe figs, anchovies, bean curd and fermented beans, yeast extracts, liver, deli meats, pickled herring, meat extracts, fermented foods, chianti and sherry, beer and ale, wine, cottage and cream cheese, soy sauce.
Avoid drugs that contain epinecphrin or beta agonists, methyldopa, guanethidine, and reserpine, decongestants, diet pills, buspirone (BuSpar), SSRI, and Yohimbine (yocon)

Front 12

Alprazolam/Xanax
Pregnancy D
Controlled Substance IV
PO

Back 12

a benzodiazepine which is used to decrease anxiety for those suffering from anxiety, panic disorders, anxiety with depressive symptoms and works by depressing the subcortical levels of CNS including the limbic system and reticular formation. Dose ranges from 0.75-4 mg/day.
Adverse- dizziness, drowsiness confuson, headache, anxiety, tremores, orthostatic hypotensio, blurred vision, anticholinergic effects, decreased libido, rash
contraindicated for those with closed-angle glaucoma, psychosis, addiction, hypersensitivity, and pregnancy or breastfeeding.
Assess mental status, monitor BP, monitor blood studies AST,ALT,
Give with food to avoid GI upset,
Teach do not take for everyday stress ro longer than 4 months, may be habit forming, avoid OTC and alcohol, avoid hazardous activities, do not discontinue abruptly,
Can give flumazenil for OD

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Trihexphenidyl/Artane
Pregnancy C
PO

Back 13

Used to decrease involuntary movement for those suffering from parkinsonian symptoms, or product induced EPS. can also be used for hypersalivation.
Adverse effects- anticholinergic effects, confusion, anxiety, restlessness, irritability, delusions, hallucinations, headache, sedation, depression, palpitations, tachycardia, paralytic ileus.
Monitor for urinary retention, and tolerance which may occur after prolonged treatment, assess mental status.
Give with food to prevent GI upset, take at night to avoid daytime sleepiness
Teach-use caution in heat, do not abruptly discontinue, avoid hazardous activities, avoid OTC products, slowly change positions, do not double the dose

Front 14

Clozipine/Clozaril
Pregnancy B
Tricyclic dibenzodiazepine- antipsychotic
PO

Back 14

decreases psychotic behavior for those suffering with schizophrenia (other antipsychotics have failed), recurrent suicidal behavior, and can be used for those with agitation, bipolar disorder, dementia, and tremor in Parkinson's disease and works by interfering with the dopamine receptors binding with lack of EPS and tardive dyskinesia.
Take the drug at bedtime
Adverse effects- sedation, salivation dizziness, headache, tremors, sleep problems, akinesia, fever, seizures, sweating, akathisia, confusion, fatigue, slurred speech, NMS, tachycardia
Assess mental status, monitor I & O, check laps, and BP,

Front 15

Benztropine/Cogentin
Pregnancy C
Antiparkinson agent-Cholinergic blocker
PO, IM,IV

Back 15

used to decrease involuntary movement for those with parkinsonian symptoms, EPS associated with neuroleptic products, acute dystonia, and hyper-salivation and works by blocking acetylcholine receptors to balance neurotransmitters.
Adverse-confusion, anxiety, restlessness, irritability, delusions, hallucinations, headache, sedation, palpitations, tachycardia, hypotension, hyperthermia, heat stroke, muscular weakness,

Front 16

Valproate/depacon,
Preg. D.

Back 16

an anticonvulsant that is effective for the treatment of manic episodes, and is the first-line treatment for rapid-cycling bipolar disorder. It is more effective than lithium for bipolar with prominent depressive symptoms and is also used for adjunct tx of schizoaffective disorder.
Rapidly absorbs and peaks within 4 hours, dose to start with 20-30 mg/kg day
Side effects-sedation and GI distress which normally resolves after the first few weeks of treatment, may cause tremor, sedation, hematologic effects.
Teach-management of side effects, and signs and symptoms of hepatotoxicity and hematologic side effects
Other uses-effective in seizures, and can be used as prophylaxis of migraine headaches and as an adjunct for pain management.

Front 17

ECT-Electroconvulsive therapy

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results in a change in brain chemistry that results in an improved mood states.
considered a safe and effective treatment for major depression.
Involves sending an electrical current through the brain of an anesthetized patient to induce a grand mal seizure.. Candidates include those with a major mood disorder, melancholic, delusional, and psychotic depression also tend to respond well.
may be used in the first trimester of pregnancy when pharmacotherapy is contraindicated.
Contraindications include pt with space occupying lesions int he brain that cause increased intracranial pressire. Risk factors include myocardial infarction, aneurysms, acute respiratory infection, cardiac arrhythmias, organic syndromes, thrombophlebitis, and narrow-angle glaucoma. Not used for drug dependence, personality disorders, reactive depresison and paranoid schizophrenia. Treatment usually occurs 3 times a week and lasts 8-12 sessions.
Must have informed consent.
Before take a CBC, metabolic profile, urine analysis and elecrocardiogram, and physical exam. Can be in/outpatient. Pt must fast overnight, and prepared like routine operative procedure. 30 min before treatment pt receives IM injection of atropine 0.5 mg.
During procedure pt vitals are monitors and an electroencephalogram monitors vitals. crash cart is available, and minimum staff include psychiatrist, anesthesiologist and nurse.
A-gives short acting anesthetic and muscle relaxant IV, mouth guard placed, and 100% oxygen is given. ECT electrodes are placed, brief electrical stimulus (no more than 2 seconds) is applied. Pt monitored for respiratory distress or excess secretions.
After pt stays in recovery room about 1-3 hours, until vitals are stable, is alert and able to walk. side effects include headache and memory loss.