3 Critical Points RN Mental Health Online Practice

Three Critical Points for Remediation RN Mental Health Online Practice 2019 B MANAGEMENT OF CARE Diverse Practice Settings: Planning Discharge Teaching for a Client Who Has Schizoaffective Disorder • ACT helps to reduces recurrences of hospitalizations and provides crisis intervention, assistance with independent living, and information regarding resources for necessary support services. • ACT teams work with clients in their homes, in agencies, hospitals, and cities. • This includes nontraditional case management and treatment by an interprofessional team for clients who have severe mental illness and are noncompliant with traditional treatment Legal and Ethical Issues: Teaching About Plan of Care • Nurses do ongoing planning throughout the provision of care • While obtaining new information and evaluating responses to care, they modify and individualize the initial plan of care • Discharge planning is a process of anticipating and planning for clients’ needs after discharge Psychotic Disorders: Prioritizing Client Care • A client who has an acute problem takes over priority over a client who has a chronic problem • A client who has an urgent need takes over priority over a client who has a nonurgent need • A client who has an unstable finding takes over priority over a client who has a stable finding Legal and Ethical Issues: Identifying Ethical Principles • Justice: fairness in care delivery and use of resources • Veracity: a commitment to tell the truth • Fidelity: fulfillment of promises Legal and Ethical Issues: Determining Client Ability to Give Informed Consent • Give it voluntarily • Be competent and of legal age • Receive sufficient information to make a decision based on an informed understanding of what is expected Suicide: Community Referrals • Specialized equipment (cane, walker, wheelchair, grab bars in bathroom) • Specialized therapist (physical, occupational, speech) • Care providers (home health nurse, hospice nurse, home health aid) Legal and Ethical Issues: Interventions for a Client Who Is in Seclusion • Age 18 years and older: 4 hours • Age 9 to 17 years: 2 hours • Age 8 years and younger: 1 hour HEALTH PROMOTION & MAINTENANCE Mental Health Issues of Children and Adolescents: Identifying Manifestations of Autism Spectrum Disorder • Delayed or absent language development • Lack of empathy • Withdrawn from physical contact BASIC CARE & COMFORT Trauma- and Stressor-Related Disorders: Intervention to Reduce Anxiety • Use multiple strategies to decrease anxiety (music therapy, guided imagery, massage, relaxation therapy, and breathing techniques) • If the client is a child, involve caregivers in treatment if possible, and use play, art and other ageappropriate strategies to decrease stress • Assess clients for suicidal ideation, and take precautions as needed PHYSIOLOGICAL INTEGRITY Family and Community Violence: Identifying Secondary Prevention Strategies • Identify and screen those at risk for abuse and individuals who are potential abusers • Assess and evaluate any unexplained bruises or injuries of any individual • Screen all pregnant women for potential abuse Family and Community Violence: Priority When Developing a Safety Plan • Help client develop a safety plan, identify behaviors and situations that might trigger violence, and provide information regarding safe places to live • Provide basic care to treat injuries • Make appropriate referrals Group and Family Therapy: Identifying Boundary Issues • Enmeshed boundaries: thoughts, roles, and feelings blend so much that individual roles are unclear • Rigid boundaries: rules and roles are completely inflexible • These families tend to have members that isolate themselves and communication is minimal. Group and Family Therapy: Facilitating a Community Meeting • Members take informal roles within the group, which can interfere with, or favor, group progress toward goals • The group leader uses therapeutic communication to encourage group work toward meeting goals • Members take informal roles within the group, which can interfere with, or favor, group progress toward goals Trauma- and Stressor-Related Disorders: Teaching About Posttraumatic Stress Disorder • Detachment from others, including friends and family members • Inability to experience positive emotional experiences, such as love and tenderness • Dissociative manifestations (amnesia, derealization, depersonalization) Anxiety Disorders: Teaching a Client About Relaxation Techniques • Use active listening to demonstrate willingness to help, and use specific communication techniques • Encourage the client to express feelings, develop trust, and identify the source of the anxiety • Assists the client to focus and to begin to problem solve Effective Communication: Counseling a Client Who Has an Eating Disorder • Summarizing: The emphasizes important points and reviews what the nurse and the client have discussed • Giving information: This provides factual details that the client might need for decision-making • Focusing: This helps the client concentrate on what is important PHARMACOLOGICAL & PARENTERAL THERAPIES Medications for Children and Adolescents Who Have Mental Health Issues: Adverse Effects of Methylphenidate • Dysrhythmias, chest pain, high blood pressure • Can increase the risk of sudden death in clients who have heart abnormalities • Eat at regular mealtimes and avoid unhealthy food choices. Medications for Depressive Disorders: Over-the-Counter Medications and Potential Adverse Interactions • Concurrent use with indirect-acting sympathomimetic medications (ephedrine, amphetamine) can promote the release of norepinephrine and lead to hypertensive crises • Over-the-counter decongestants and cold remedies. Frequently contain medications with sympathomimetic action and therefore should be avoided • Avoid concurrent use of MAOIs and TCAs Medications for Psychotic Disorders: Interventions for Adverse Effects of Chlorpromazine • Treat with an antiparkinsonian agents such as benztropine • IM or IV administration diphenhydramine can also be beneficial • Stay with the client and monitor the airway until spasms subside (usually 5-15 mins) REDUCTION OF RISK POTENTIAL Substance Use and Addictive Disorders: Caring for a Client Who Has Alcoholic Cardiomyopathy • Creating kinase MB isoenzyme more sensitive to myocardium • Fasting for 12 to 14 hr is recommended prior to lipid profile sampling. • Cardiac enzymes are released into the blood stream when the heart muscle suffers ischemia Neurocognitive Disorders: Distinguishing Delirium and Dementia • Impairments in memory, judgement, ability to focus, and ability to calculate, which can fluctuate throughout the day • Disorientation and confusion are often worse at night and in the early mornings • Level of consciousness is usually altered and can rapidly fluctuate Brain Stimulation Therapies: Planning Care for a Client Who Is Scheduled for Electroconvulsive Therapy • Ongoing cardiac monitoring is provided, including blood pressure, ECG, and oxygen saturation. • Clients are expected to become alert about 15 mins following ECT • Vital signs should be monitored before and after the ECT procedure