NURSING 504 04-Review for NCLEX RN®-MENTAL HEALTH & CRISIS INTERVENTION

Mental Health



Depressive Disorders

KEY FEATURES OF DEPRESSION

 Depressed mood

 Anhedonia

 Appetite disturbance/weight change

 Sleep disturbance

 Psychomotor disturbance

 Fatigue or loss of energy

 Worthlessness/guilt

 Indecision/poor concentration

 Recurrent thoughts of death/suicide

TYPES OF DEPRESSIVE DISORDERS

 Major depressive disorder

 Disruptive mood dysregulation disorder

 Persistent depressive disorder (dysthymia)

 Premenstrual dysphoric disorder

,BEHAVIOR SYMPTOMATIC OF DEPRESSION

 Objective signs
 Alterations in activity

 Altered social interactions

 Subjective signs
 Alterations of mood

 Alterations of affect

 Alterations of cognition

 Alterations of physical nature

 Alterations of perception

NURSE–PATIENT INTERVENTIONS

 Demonstrate respect and rapport with patient.
 Accept patient and focus on strengths.
 Develop trust through direct, honest interactions.
 Acknowledge emotional pain and offer to help work through pain.
 Point out accomplishments and strengths.
 Re-program patient’s negative thoughts through cognitive-behavioral therapy.
 Reinforce efforts to make decisions that promote health and wellness.
 Do not reinforce hallucinations or delusions (point out reality without challenging patient’s
perceptions).
 Accept patient’s anger and negativity without reinforcing them.
 Spend time with withdrawn patient, according to the patient’s level of comfort.
MILIEU INTERVENTIONS

 Opportunity to experience accomplishments and receive positive feedback
 Assertiveness training
 Help avoid embarrassment
 Supportive group activities
 Assist with grooming and hygiene
 Brief and frequent interpersonal contacts
 Assist with nutrition and adequate fluids
 Protect from suicidal intent
 Prevent constipation
 Monitor and promote nighttime sleep

,  Discourage daytime sleep
SUICIDAL BEHAVIOR

 Suicidal clients characteristically have feelings of worthlessness, guilt, and hopelessness so
overwhelming that they feel unfit to live and unable to go on with life.

 The nurse caring for a depressed client must always consider the possibility of suicide.

High-Risk Groups

 People with a history of previous suicide attempts

 People with a family history of suicide attempts

 Those with a history of psychiatric hospitalizations or disorders

 Socially isolated individuals

 People who abuse drugs or alcohol

 Those exposed to violence in the home or social environment

 People with access to loaded firearms in the home.

 Teenagers, males, and older clients

 Disabled or terminally ill adults

 Professional persons (e.g., lawyers, dentists, physicians, members of the military)

Clues

 Client statements indicating the intent to attempt suicide

 Preoccupation with death and dying

 Giving away personal, special, and prized possessions

 Sudden calmness or improvement in a depressed client

 Writing farewell notes

 Taking care of unfinished business (e.g., making out or changing a will or taking out or changing
insurance policies)

 Loss of interest in usual activities

 Canceling social engagements

 Poor appetite

 Sleep difficulties

 Excessive risk-taking

 Questions about poisons, guns, or other lethal objects

 Increased use of alcohol or drugs

The Plan

,  Does the client have a plan?

 What is the plan and how lethal is the plan?

 Does the client have the means to carry out the plan?

 Client History of Suicide Attempts
 Is there any history of suicide attempts? What were the outcomes?

 Was the client accidentally rescued?

 Have past attempts and methods been the same, or have methods increased in their potential
for lethality?

Psychosocial Factors

 Is the client alone or alienated from others?

 Is the client hostile or depressed?

 Is the client having hallucinations?

 Is the client using alcohol or drugs?

 Has the client sustained any recent losses or physical illness?

Has the client experienced any environmental or lifestyle changes?




Interventions for the Suicidal Client

 Ensure a safe environment.

 Suicide precautions are implemented when the client is considered suicidal; they include
constant one-on-one monitoring, with the client in view at all times and a distance of one arm's
length between the staff member and the client.

 The client's statements, behavior, and mood are documented in his or her record every 15
minutes.

 Develop a contract: a written, dated, and signed document specifying alternative behavior
when suicidal thoughts occur.