ATI Exam Study Guide Mental Health

Mental Health  Overview ● Abstract thinking ○ The ability to conceptualize and interpret meaning ○ A higher level of intellectual functioning than concrete thinking ● Concrete thinking ○ The inability to conceptualize and comprehend abstract meaning ● Tangential thinking ○ Scattered, not goal-directed, difficult to follow ○ Long story with lots of detail, never gets to the end ■ Seen in people with schizophrenia and delirium ● Circumstantial thinking ○ Describes a patient who talks around the subject and includes unnecessary information ● Flight of ideas ○ Describes the salt pattern in which the client moves rapidly from one topic to the next with loose connections ○ “Flying from one idea to the next without any associations” ○ “The sky is blue, I went to the store yesterday, my dinner tasted good” ● Looseness of an association ○ Describes a pattern in which ideas Lac and apparent logical connection to one another ○ “Derailment” ○ Seen in schizophrenia ● Insight ○ The degreetowhichthepatientunderstandsthesituationorproblemanditseffect on their life ● Judgement ○ The ability to make decisions and behave in an appropriate manner ● Affect ○ A person's mood, feelings, or tone that is observable an outward manifestation ○ May be referred to as inappropriate, flat, or blunted ● Mood ○ Prolonged emotional state that is expressed by the affect ○ Typically a subjective finding ● Delusions ● ● ● ● ● ● ● ● ● ○ False, fixed beliefs ○ Can be delusions of grandeur, persecutions, erotic, jealous, and religious ○ Never refute delusional thoughts, this can increase anxiety and reinforced delusions ○ Never ask the patient to elaborate on the delusion Hallucinations ○ Sensory perceptions that can be auditory, visual, tactile, or olfactory ○ Patient appears to be listening to someone that no one else can hear or see ○ Encouragethepatientwhowashallucinatingtoengageinactivitiesthatdiverttheir attention away, such as watching TV or listening to music with headphones ○ When the patient is experiencing hallucinations, it is important to convey an acceptance of the behavior however let the patient know that we do not see the same things Paranoia ○ Psychosis that is characterized by systematized delusions of persecution or grandeur without hallucinations ○ Never challenge these patients, as this can lead to increased anger and anxiety ○ These patients are easily threatened, avoid touching them or getting to close Nurse to Patient relationship ○ Pre interaction, introduction/orientation, working, termination phase ○ Preparation for ending the relationship will start at the beginning ○ Always remember that nonverbal behavior is more precise indicator of feelings ○ Close ended questions are considered non-therapeutic ○ NO “Why” questions, as they require analysis of the problem and often produce anxiety Paralanguage ○ The use of vocal effects, such as tone and Tempo to convey a message Adaptive Use of Defense Mechanisms ○ Good, will help ease anxiety Maladaptive Use of Defense Mechanisms ○ Bad, will disallow goals to be achieved Proxemics ○ The use of spatial relationships during interaction to communicate meaning Regression ○ An adult who throws temper tantrums, considered maladaptive ○ A 5 year old who begins sucking their thumb again after their brother was born- adaptive ○ A young woman might go stay with her parents after her first fight with her husband Projection ○ When a patient blames someone or something else other than the source ○ “I got in trouble by my boss because he was having a bad day” ● Reaction formation ○ When the patient acts in opposition to their feelings ○ Treating someone you strongly dislike in a kind way to hide the way you actually feel ● Sublimation ○ Turning anxiety into something good ○ Ex; having a bad day at work but then going to exercise to decrease anxiety ● Intellectualization ○ When the patient over uses rational explanations or abstract thinking to decrease the significance of a feeling or event ○ A woman who was raped takes self defense classes” Disorders ● Depression ○ Patient may require assistance to perform activities of daily living ○ Patient should not be allowed to isolate themselves, and may have a diminished ability to concentrate, which suggests a decrease in overall cognitive functioning ○ Provide structured activities for these patients, as well as small groups to provide social contacts without being too ● ECT (electroconvulsive therapy) ○ Most effective in treating patients with severe depression over a total of 6 to 12 treatments ■ 2-3 treatments are given per week ■ requires preoperative care including consent and NPO status ○ Short term memory loss is the most common complication ○ Succinylcholine → drug to minimize muscle movement during therapy ● Alzheimer's disease ○ Early stages ■ The patient will experience forgetfulness, especially short-term and recent memory loss ■ Nursing care includes maintaining a familiar surrounding and a predictable routine ○ Middle stage ■ Personality changes occur here ■ A calm person may become moody and irritable, as well as agitated ■ Problems with speech and language may appearhere,especiallyAphasiaand anomia ● Expressive aphasia: you know what you want to say but can’t get it out ■ Nursing care includes less concentration required activities ○ Final stages ■ Total memory loss, decreased mobility, incontinence of bowel and bladder ○ Typically these patients die from complications of immobility,  such as sepsis or pneumonia Schizophrenia ○ Marked by disturbances in affect, perception, thought content, and form ■ Hallucinations ○ Generally characterized by delusions, whether grandiose, religious, paranoid, nihilistic, or delusions of reference and confusion ■ Word salad, echolalia (repeating what someone says), clang associations (rhyming) ○ Most important nursing care includes maintaining a consistent, predictable environment and preventing sensory overload ○ Medications ■ “Pines”- clozapine, loxapine, olanzapine ■ Haloperidol, risperidone ● Eating disorders ○ Patient will believe that they are grossly obese and commonly uses manipulative ploys to resist weight gain ○ Bulimia ■ Patients are at risk for developing electrolyte imbalances and cardiac arrhythmias ○ Anorexia ■ Patients typically come from families who are controlling and overprotective ■ They use eating as a way of getting control of their lives ■ Highest priority goal is to establish adequate daily nutritional intake and the establishment of a consistent eating plan and monitoring waking ■ The patient should always be monitored before, during, and after meals ■ Typically, these patients will lose the loss of sexual characteristics ■ The temperature of these patients is decreased because of low metabolism, blood pressure and pulse are also lower ● Delirium ○ Characterized by irritability, hypersensitivity to light and Noise, disorientation ○ Sun-downing in demented patients ○ Acute alcohol withdrawal ● Bipolar disorder: manic phase ○ Characterized by recurrent episodes of a persistently euphoric and expansive or irritable mood ○ Diagnosed if a patient has 4ofthefollowingsymptomsforthetotalof1week:flight of ideas, inflated self-esteem, unusual talkativeness, increase social, occupational, or sexual activity, decreased need for sleep, physical restlessness ○ Nutritional needs can be met by providing finger foods ○ Nursing care includes ensuring safety and food, and rest, these patients are encouraged to perform large muscle activities, such as swimming. These patients are discouraged from activities that are stimulating and competitive ● ● ● ● ● ● ○ Seclusion is only appropriate when the patient is engaged in frantic, aimless physical activity, and is at risk for injury ■ Limits should be placed on settingsbecausetheyhavetroubledistinguishing boundaries ○ Medications ■ Lithium, risperidone, valproic acid, clonazepam Borderline personality disorder ○ Patients have an intense fear of abandonment, severe body image issues, and impulsivity ■ Most at risk for self-mutilation ○ Nursing care should include firm and consistency in rules ■ Refrain from engaging in third-party conversations ■ Rotate staff members, which will reduce the incidence of splitting ■ Set limits on unacceptable behavior Antisocial Behavior ○ Common response is the lack of concern about their situation as well as the absence of sensitivity to the feelings of persons they have harmed or will harm ○ Set limits on inappropriate behavior ■ Be cautious of manipulative behavior Narcissistic personality disorder ○ Lack of empathy is one of the main characteristics Suicide ○ Those at highest risk usually have a plan, a means of carrying out the plan, and a history of previous attempts ○ Signs of potential suicide ■ Symptoms of depression, patient gives away their possessions, gets their finances in order, makes direct or indirect statements, leaves notes, has an increase in energy ■ As patients improve, their risk for suicide is greater because they're able to mobilize more energy to plan and execute suicide ○ Predisposing factors ■ Males over the age of 50, ages 15 to 19 years ofage,poorsocialattachments, previous attempts, auditory hallucinations overwhelming precipitatingevent such as the death of a loved one, losing a job, or terminal disease ■ Psychosocial factors include bereavement, retirement, or do social support ○ Suspect suicide risk when patients report that life is not worth living because of unrelieved pain, depression, and poor quality of life Anxiety disorder ○ Patients worry about anything and everything ○ Nursing interventions should be used when patients are experiencing mild to moderate levels of anxiety ● ● ● ● ● ■ Include helping the client recognize sources of anxiety and teaching aclient effective coping mechanisms ○ Anxiety attack nursing care ■ Stay with the patient, decrease stimuli, remain calm, medication as necessary ■ Offer large muscle activities that help drain off excessenergy,thusreducing anxiety ○ Panic anxiety ■ Patient will experience severe anxiety resulting in feelings of impending doom or death Post-traumatic stress disorder ○ Etiology involves a life-threatening or catastrophic event ○ Treatment ■ Exposure therapy Phobic disorder ○ Characterized by a persistent fear of an object or situation that presents no real Danger ■ These are commonly viewed as a learned response to anxiety ○ Treatment ○ Exposuretherapy-includessystematicdesensitizationthroughgradualexposureto the stimuli that causes anxiety Obsessive compulsive disorder ○ Manifested by repetitive thoughts or recurring impulses to perform certain acts ○ Patients have an inability to control intrusive thoughts that repeat over and over, patients are usually aware oftheirrationalityoftheiractionsbuttheyareunableto stop then ■ Rituals are an attempt to avoid increasing anxiety to a severe level ○ Nursing care ■ Allow the patient to complete their behavior, but set time limits Crisis Intervention ○ Brief, time-limited treatment that focuses on the current situation ○ Purpose is to prevent the development of future mental health problems ○ Family Violence ■ Considered a learned behavior and will typically lead to further violence in offspring ○ Rape survivors ■ May experience the hospital and policy procedures as further violation of their privacy and integrity Substance abuse ○ Denial ■ Typically the common defense mechanism ○ Alcohol withdrawal ■ Appears within 8 to 12 hours ■ Includes tremors, anorexia, diaphoresis, irritability, shaky hands ■ Librium will be given to treat the symptoms, works as an anti-anxiety drug ■ Disulfiram is used as a deterrent to compulsive drinking, however, it is contraindicated if the patient drinks alcohol intheprevious12hourspriorto medication administration ■ Klonopin (clonazepam) used to prevent seizures ○ Heroin withdrawal ■ Runny nose, diaphoresis, dilated pupils ○ PCP overdose ■ Patients can be medically treated by acidifying the urine with cranberry juice or NH4Cl, as well as giving a benzodiazepine, and we're straying the patient ○ Methadone ■ Opioid analgesic used to treat narcotic withdrawal syndrome ○ Naloxone (Narcan) ■ Narcotic antagonist used to reverse narcotic induced respiratory depression Extrapyramidal Symptoms and Medications ● Extrapyramidal symptoms ○ Disabling, distressing movement disorders that are associated with antipsychotic medications ○ Akathisia ■ Frequent movements such as pacing, rocking, shifting from one foot to the other, inability to sit still ■ Patient feels in a restlessness, nervousness, feeling unstable ○ Dystonia ■ Involuntary muscle spasms of the tongue, face, neck, and back ■ Patient feels a frightening sudden spasm that may be painful ○ Parkinsonism ■ Shaking of the hands and arms while at rest, stiff posture, muscle rigidity, slow movement, shuffling gait, no swinging of the arms while walking, an  expressive face, slowed thoughts ○ Tardive dyskinesia ■ Protrusion or twisting of the tongue, smacking, person, sucking movements of the lips, puffing of the cheeks, chewing movements of the jaw, jerking movements, shoulder shrugging ■ Patient usually feels anxious and nervous ● Haldol/Prolixin ○ Are considered antipsychotic medications ○ Can cause extrapyramidal symptoms that affect voluntary movement ■ Shuffling gait, tremors, restlessness, pill rolling, drooling, uncoordinated jerky movement, dry mouth, and blurred vision ● ● ● ● ● ● ● ■ Most common is akathisia, a form of psychomotor restlessness that can be relieved by pacing Neuroleptic malignant syndrome ○ Life-threatening EPS effect of antipsychotic medications ○ Associated with the rapid increase in temperature Artane/cogentin ○ Anticholinergic medications that may be given to control EPS symptoms ○ Can result in dry mouth ○ Provide the client with hard candy or encourage increased fluid intake Selective serotonin reuptake inhibitors ○ Prozac, Zoloft ■ Onset of a fact within 7 to 21 days Lithium ○ Narrow therapeutic range of 0.5 to 1.5 ○ Blood levels will be monitored ○ Encourage adequate fluid and salt intake ○ Toxicity ■ Vomiting, diarrhea, muscle twitching, ataxia, slurred speech, coma, seizures, and possible cardiac arrest (hyponatremia) MAOI inhibitors ○ Dangerous drug-food, drug-drug interactions ○ Teach patients to avoid foods high in tyramine ■ Aged cheeses, fermented foods, chocolate, vermouth wine ○ Teach patients to avoid over the counter drugs for cough and cold Clozaril ○ Used as an atypical antipsychotic ○ Monitor patient for agranulocytosis, white blood cell levels should be monitored weekly ■ Sore throat, fever, sudden onset of flu like symptoms Disulfiram (antabuse) ○ Teach patient to avoid drinking for two weeks after the last dose ○ Alcohol is present in cough medicine, vinegar, after shave lotion, and some mouthwashes, teach patient to avoid these 