1813 Objectives Chap 93 Psych Nursing

Front 1

Define the most important terms and acronyms relating to mental health and its deviations.

Back 1

psychiatrist is a physician who specializes in the treatment of mental disordrs.
paranoia is mental disorder in which one has delusions of persecution or things others will harm him/her.

Front 2

Explain the normal role of defense mechanisms and the results when they are overused.

Back 2

Defense mechanisms are reactions to stress that help individuals resolve mental conflicts, reduce anxiety, protect self-esteem and maintain a sense of security. SUPPRESSION, REPRESSION, REATION-FORMATION, REATIONALIZATION, DISPLACEMENT, SUBLIMATION, INTELLECTUALIZATION; i.e.,Example: DENIAL, disavowing the existane of unpleasant realities. PROJECTION attributing to another person one's unacceptable thoughts or feelings. If you start to do one of these actions excessively then you are on the verge of mental illness

When defense mechanisms are over used then a deviation from NORMAL mental health occurs. Which means it is NORMAL to protect yourself by using one of these but when you loose touch with reality and over use any one of these you are experiencing mental illness.

Front 3

Differentiate between functional and organic mental illnesses.

Back 3

Functional Mental Illness is type of disorder that has no organic cause or no SPECIFIC causative agent; doctor can't pin point the cause. Organic Mental Illness is mental illness that is caused by an actual physical disorder such as AIDS, drug overdose, Huntington's Disease or a CVA 'cerebrovasculaar disease'. When a causative agent is identified as in an Organic mental illness treatment of the cause can derail or alleviate the mental illness.

Front 4

List at least five organic causes of mental illness.

Back 4

motor vehicle accident, CVA, Huntington's Disease, drug overdose, hypoglycemia, brian lesion, AIDS, Endocrine 'thyroid' Disorder

Front 5

Describe the role of neuropsychological and neurodiagnostic testing in diagnosing mental illness.

Back 5

Neuropsychiatric testing includes an in-depth interview and various tests: BPRS=brief psychiatric rating scale MMSE=mini mental status exam. The results are charted in terms of appearance, mood, senorsium, intelligence, and thought process (AMSIT) A&Ox3. ADL assistance with daily activities; Used to rule out a client who is MALINGERING which is feigning or faking symptoms.

Neurodiagnositc Testing are used to rule out organic cuase of psychiatric disorder. Tests are CT 'computed tomography scan', MRI, PET 'positron emission tomography' These test are used for sleep studies and metabolic disorders also.

Front 6

List at least five general symptoms of a mental disorder.

Back 6

Not eating, sleeping; noticeable behavioral changes such as unexplained drepression; sudden lack of concern about physical appearance; physical symptoms without apparent medical cause; overuse of defense mechanisms; loss of contact with reality; cognitive confusion, morbid fascination with death, catatonia 'total immobility'

Front 7

Describe the diagnostic criteria for a mood disorder.

Back 7

Mood disorders are a group of clinical conditions characterized by disturbance of mood (internal, subjective emotional state) along with loss of control and a subjective feeling of distress. SUBJECTIVE is not SEEN but is spoken by the client--the client's opinion and feelings.

At least five symptoms must be present frequently during the same 2-week period and must represent a change from previous functional levels. SYMPTOMS: Depressed mood for most of the day or markedly diminished/loss of interest or pleasure in all or most activites along with FOUR others: weight or appetite changes: sleep disturbance: psychomotor regardation 'very slow movements': fatigue: feelings of worthlessness: recurrent thoughts of death or suicide

Front 8

Explain the differences between a major depressive episode and dysthymia.

Back 8

MDE is most common and must possess five symptoms the number one being depressed mood and the symptoms must last for 2-week period and represent a change from previous functional levels. Not as long lasting.

DYSTHYMIA is depressed mood for most of the day, MOST DAYS and be present for TWO years. Symptoms decreased appetite, sleep disturbance, low self-esteem. Dysthymia is less severe and longer lasting.

Front 9

Describe some of the typical behavioral characteristics of the person with bipolar disorder.

Back 9

broad mood variations from mania to major depression are symptoms; such as:agitation, elation, hyperacitvity, hyperexcitability which is mania. Along with accelarated thinking and speaking, grandiosity, excessive involvement in pleasurable activities with high potential for painful or underisable consequences.

Front 10

List and describe at least four personality disorders. Describe in detail common behaviors of people with borderline personality disorder.

Back 10

1. Paranoid Personality Disorder: pervasive distrust and suspiciousness of others, marked hyperviligance.
2. Schizoid Personality Disorder: pattern of detachment from social relationships and restricted range of emotions in interpersonal settings.
3. Antisocial Personality Disorder: pattern of disregard for and violation of the rights of others, with no remorse for actions.
4. Narcissistic Personality Disorder: pattern of grandiosity, need for admiration, lack of empathy.
5. Dependent Personality Disorder: a pervasive and excessive need to be taken care of, leading to submissive, clingy behavior.
BORDERLINE PERSONALITY DISORDER: unstable personal relationships, low self esteem, self-destructive or self-injurious behavior (SIB), self-inflicted wounds (SIW) and suicide gestures. These ppl have history of sexual abuse and are often female or lesbian; are frequently hospitalized and complain of physical symptoms; obesity and take alot of prescribed medications.

Front 11

Define psychosis and list its most common symptoms.

Back 11

Psychosis mental disturbance in which personality disintegrates and the person escapes into unreality. SYMPTOMS: delusions, hallucinations, impaired reality testing (inable to differentiate between the internal and external environment). Behavior is unusual and noticeable in most cases.

Front 12

Describe the relationships between substance abuse and mental illness.

Back 12

MI/CD (mental illness/chemical dependency or substance abuse); it is hard to determine which came first as this is a dual diagnosis. Chemical abuse often aggravates mental illness such as alcohol is a depressant and when combined with underlying depression symptoms worsen. Long-term chemical abuse can cause organic psychosis. Each diagnosis plays off or worsens symptoms of the other.

Front 13

Identify key members of the mental healthcare team and describe their roles.

Back 13

Psychiatrist is a physician who has received advanced education in the treatment of mental disorders.
NURSE creates a therapeutic environment and assist people to return to as normal functioning as possible in shortest time. A registered nurse can become specialized in psychatric nurisng
PSYCHATRIC TECH provide a large portion of care or assitance in daily activites.
PSYCHOLOGIST have either a Master's degree or a doctorate in psychology and provide testing, counseling and therapy; PSYCHOMETRISTS administer psychological tests
RECREATION THERAPIST and MUSIC THERAPIST provide diversional and personal growth activities and often take clients on outings.
SOCIAL WORKER prepare clients for and assit with discharge acting as a liaison among clients and family members.

Front 14

Describe outpatient services commonly available for people with mental illnesses.

Back 14

Social workers may help a client find a safe place to live, obtain financial assistance or access to community resources. Outpatient Mental Health Clinic provides ongoing therapy and counseling for people who do not require hospitalization. Client visit daily or weekly. Psychiatric Home Care provides a nurse to visit the client regularly to help manage his disorder. Note that many challenges are involved in delivering care to mentally ill clients. Care focuses on largely on rehabilitation and teaching.

Front 15

Identify at least three types of structured living available to clients with mental disorders.

Back 15

Board-and-Care or Licenses Group Home. A B&C home will provide meals and other services with minimal supervision. Licensed Group Home provide some more structure by supervisiong medication and offering group activities.
Halfway House which provides a buffer between the hospital and the community.
Adult Foster Care where the mentally ill lives with a foster family.

Front 16

Discuss the legal categories of admission to the acute mental healthcare setting.

Back 16

Voluntary Admission is when person comes of own free will.
EMERGENCY HOLD is when place by a physician usually 72 hours to be evaluated.
TRANSPORTATION HOLD is when placed by the police and brought to the hospital for an emergency.
DISTRICT CCOURT HOLD is when place by a Judge before a preliminary committment hearing.
ASSESSMENT HOLD is when placed by the court to assess a person to detemrine if he/she is mentally competent to stand trial.
COURT COMMITTMENT for treatment.
MENTALLY ILL/CHEMICALLY DEPENDENT is when there is a dual diagnosis and both need treatment.
MI&D=mentally ill and dangerous is when placed in a secured hospital.

Front 17

Discuss therapies available to clients with mental illness.

Back 17

Individual PSYCHOTHERAPY is a personal relationship between the client and therapist; aim is to relieve symptoms and eventually resolve the disabling conflicts.
GROUP PSYCHOTHERAPY involves several clients and provides an opportunity for each to participate by discussing individual problems and get feedback.
VERBAL AND OTHER THERAPIES
Behavior Modification is method used to primarily deal with emotionally disturbed, mentally ill and intellectually challenged people; people are rewarded for positive behavior--positive reinforcement. However, negative reinforcement or punishment is usually ineffective because it does not promote and teach positive behavior. DO NOT USE FOOD. When using behavior modification (1) show the person what you want (2) helpt the person accomplish it (3) then reward for job well done.
REMOTIVATION a/k/a reality orientation. Groups are structured so that participating clients can discuss things that are meaningful to them. Scrapbooks or current news is used for topics.
REALITY TH

Front 18

Describe electroconvulsive therapy, indications for its use, and associated nursing implications.

Back 18

Electroconvulsive Therapy causes a seizure by sending a small amount of electricity through the brain.Theorist believe that the seizure affects the brain's level of neurotransmitters, which can radically improve the person's mood. It is used to treat middle-aged to older adults who are non-responsivie to antidepressant medications. Disadvantages are person's anxiety before treatment and short-term memory loss in some clients. Nursing implications are to withhold valium or any benzodiazepine or anti-seizure medication prior to ECT. No gum and NPO after midnight. The nurse will check short term memory loss during and right afer.

Front 19

Identify the most commonly used classifications of medications in psychiatry. Give at least three examples of each classification. Describe the undesirable side effects of neuroleptic therapy, including neuroleptic malignant syndrome.

Back 19

Classification is Benzodiazepine; example is Ativan, Valium, Klonopin or Xanax. Undesirable side effects are drowiness and lethargy. Classification is Miscellaneous/AntiAnxiety and example is Buspar and Vistaril. Negative side effects are drowiness and headache.
Antipsyshotic Drugs. Examples are Thorazine, Modecate Decanoate and the long acting is Prolixin Decanoate, Seroquel. Negative Side Effects are weight gain and dizziness.
Antidepressants. Examples are Elavil, Wellbutrin, celexa, Cymbalta. Negative Side Effects are suicidal thoughts and constipation.
Mood Stabilizers. Examples are Lithium, depakote, Tegretol. Negative Side Effects are fatigue and headache and polyuria.

Front 20

Target approaches for dealing with aggressive or assaultive persons.

Back 20

The nurse working with mental health that are assertive will carry an electrical monitor to summons for assistance, if needed. The staff will also need to set limits of inappropriate behavior as quickly as possible. You do not corner them or suffocate them. You may walk with them as they are expressing their concerns or ranting but do not get too close.
Restraints may be used to keep clients from hurting themself or others and to keep client from destroying property. Seculsion is another option, if they are uncooperative, the client can be seculded in a room alone.

Front 21

State the people most likely to attempt suicide and describe suicide precautions in the acute mental healthcare setting.

Back 21

Women are more likely to attempt than men, but men are more likley to complete and do suicide. People most likely to attempt suicide are newly admitted, have low self-esteem, low motivation, poor support system, homelessness, unemployed and are having withdrawals from alcohol abuse. Terminally ill and confused clients may also attempt suicide. Precautions are to know where everyone is at all times. 15 minutes checks at minimum. Make sure the client is breathing. One on one meetings with the nurse at each shift change is necessary and grant a meeting when requested. Keep all meds under lock and key--OTC and prescription. Remove sharp objects and keep doors closed. There are contracts for safety signed by clients stating they willnot hurt themselves and to let staff know if they feel like hurting themself.

Front 22

Discuss nursing responsibilities when working with each of the following: overactive, withdrawn, depressed, hypomanic, regressive, or self-injuring clients.

Back 22

OVERACTIVE. A nursing responsiblity is provide a calm atmosphere and use a calm voice; in general nursing care varies from client to client and is adjusted accordingly but talk calmly and do not use long discussions or force issues or get into power struggles.
WITHDRAWN. A nursing responsiblity is talk calm and encourage client to eat and monitor I&O. Encourage to spend time out of bed and out of room.
DEPRESSED. same as with withdrawn but also do not put in groups of happy people as it emphasis how unhappy the depressed person is. HYPOMANIC. Nursing care is to be firm but kind and do not argue; control behavior and try to keep the client from irriating others. suggest writing or crafts. REGRESSIVE. Remotivation and behavior modification are useful; direct nursing care is helping client focus on reality and keeping client in focus with reality. SELF-INJURIED. nursing care is keep sharp objects away and keep watch on person.

Front 23

Other Therapies for treatment are

Back 23

REALITY THERAPY does not take a traditonal approach to mental illness. Belief that all people need to love and be loved and to feel worthwhile as human beings; self-esteem and acceptance. If person is unable to meet needs they act out. The goal of REALITY THERAPY is to help people face reality, reject irresponsible behavior and learn new and more socially acceptable ways of behaving.
RATIONAL EMOTIVE BEHAVIOR THERAPY (REBT). Belief that members of the group can relate to each other because they share simlar concerns. People are accepted unconditionally, but this approach is less effective if clientis out of control with reality.
TRANSACTIONAL ANALYSIS. Belief that all interations among people have meaning and are based on the way people feel at the moment. The goal of TA is to teach ppl to react in ways that produce positive responses. Based on concept ppl react at different times as either an adult, child or parent. The goal is react as reasonable adult.
One-to-One Therapy, Psychodrama, Occupational