CH. 17, 22, 24-27, 34, 35 NR326
Mental Health
Exam II
CH 17 : THE SUICIDAL CLIENT
SUICIDE IDEATION = thought of ⟹ “I want to kill myself” or “I want to die”
SUICIDE ATTEMPT = trying to ⟹ “I jumped off a bridge, but I lived”
SUICIDE THREAT = indirect or direct way ⟹ “I’m going to kill myself if…”
SUICIDE REHEARSAL = preparing ⟹ writing a note, buying necessary means, creating a plan, etc
o More suicides than homicides
o Second leading cause of death from ages 10 to 14 and 15 to 35
o Suicide risk increases if family member has completed
o 8/10 people who completed gave warning signs
o 6% of suicides occur in hospital setting
Risk factors: HAVING A MENTAL HEALTH DISORDER
HISTORY OF ATTEMPT
INTOXICATION OR SUBSTANCE ABUSE (NOT THINKING CLEARLY)
MALES COMPLETE, FEMALES ATTEMPT
STAYING ISOLATED
YOUNGER AND OLDER AGE
HISTORY OF LOSS OR TRAUMA
EASY ACCESS TO FIREARMS
LOTS OF MEDICAL PROBLEMS
HOW TO ASSESS FOR SUICIDE:
1. Risk factors
2. Suicide thoughts
3. Suicide plans
4. Access to means
5. Lethality
6. Last suicide attempt
7. History of attempts
8. Mitigating factors
A : ASSESSMENT
o Covert – less obvious
“It’s okay now, everything will be fine”
“Things will never work out”
“I won’t be a problem much longer”
“How can I give my body to medical science?”
Sudden brightening in mood
Giving away possessions
Organizing financial affairs
o Overt – very obvious
“I don’t want to live anymore”
“Life isn’t worth living”
“I wish I were dead”
“Everyone would be better off if I died”
, 2
D : DIAGNOSIS
o Risk for self-harm**
o Ineffective coping
o Hopelessness
P / I : PLANNING / IMPLEMENTATION
o Safety
Environment : if at risk, go through belongings for SAFETY reasons (must document)
Observation (behavior) : frequent/constant observations, get a one-to-one
o Therapeutic relationship
“It sounds like you’re depressed”
“It sounds like you’ve been suffering”
“I’m here to listen to you”
“It must be scary to want to end your life”
Be 100% very direct!!!** always ask if they want to kill themselves (no time for rapport)
E : EVALUATION
o Behavior has changed
o Verbalizes no suicidal thoughts
o Expresses feelings for hope
M : MEDICATION AND OTHER TREATMENTS
o No meds for suicide!!!
o Treat underlying issue**
o Therapies – CBT, talk therapy
E : EDUCATION
o APNA.org, suicidology.org, afsp.org, NAMI.org, the National Suicide Prevention Lifeline
CH 22 : NEUROCOGITIVE DISORDERS
DELIRIUM = change in cognition that develops over a SHORT period of time ⟹ reversible
O Causes of delirium: SUBSTANCE INDUCED
SUBSTANCE WITHDRAWAL
INFECTION
DEMENTIA = progressive deterioration in neurocognition over a LONG period of time ⟹ irreversible
7 STAGES OF ALZHEIMER’S DISEASE:
1. No impairment
2. Very mild cognitive decline – forgetfulness of everyday objects
3. Mild cognitive decline – problem w/ memory that may be measurable in testing, decreased
attention span
4. Moderate cognitive decline – clearly detected during medical interview
5. Moderately severe cognitive decline
6. Severe cognitive decline
7. Very severe cognitive decline
A : ASSESSMENT
DELIRIUM DEMENTIA
-poor judgement, insight -aphasia : absence of speech
-impaired memory, inattention -apraxia : inability to move
-hallucinations -agnosia : inability to recognize objects
, 3
-mood swings -anomia : can’t remember names
-fluctuation in vitals -inability to think abstractly (concrete
-altered LOC** thinking)
-no change in LOC
D : DIAGNOSIS
o Risk for injury**
o Confusion
o Fluid volume deficit
P / I : PLANNING / IMPLEMENTATION
o Safety
Quite environment
Reduce agitation
Decrease stimuli
Reality orientation
o Therapeutic relationship
Self-care
Validating therapy : give information, present reality, clarify
“I know things are upsetting and confusing right now”
o Medical concerns
Promote sleep and proper nutrition
Neuro checks
E : EVALUATION
o Remains free from injury
o Is able to do ADLs
o Can retain highest level of functioning
o Verbalize or demonstrate decreased frustration
M : MEDICATION AND OTHER TREATMENTS
o Therapies – reminiscence therapy, structured routine, validation therapy
o Other Tx – cognitive stimulation
o Palliative meds – slow down progression, NOT cure ⟹ Donepezil (Aricept)** | Memantine
(Namenda) | Rivastigmine (Exelon)
E : EDUCATION
o Respite care is adult day for families
o Tell about disease progression
CH 24 : SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS
PSYCHOSIS = symptoms describing disorganization and impaired personality ⟹ affects thinking, behavior,
emotion, and perception
o Schizophrenia – six months or more
Paranoid : intensely guarded and suspicious of others
Catatonia : abnormal motor behavior
Excitement – agitation (negative behavior)
Stupor – sloooooow (positive behavior)
Disorganized : most regressed and socially impaired
o Delusional disorder – one month of delusions
Mental Health
Exam II
CH 17 : THE SUICIDAL CLIENT
SUICIDE IDEATION = thought of ⟹ “I want to kill myself” or “I want to die”
SUICIDE ATTEMPT = trying to ⟹ “I jumped off a bridge, but I lived”
SUICIDE THREAT = indirect or direct way ⟹ “I’m going to kill myself if…”
SUICIDE REHEARSAL = preparing ⟹ writing a note, buying necessary means, creating a plan, etc
o More suicides than homicides
o Second leading cause of death from ages 10 to 14 and 15 to 35
o Suicide risk increases if family member has completed
o 8/10 people who completed gave warning signs
o 6% of suicides occur in hospital setting
Risk factors: HAVING A MENTAL HEALTH DISORDER
HISTORY OF ATTEMPT
INTOXICATION OR SUBSTANCE ABUSE (NOT THINKING CLEARLY)
MALES COMPLETE, FEMALES ATTEMPT
STAYING ISOLATED
YOUNGER AND OLDER AGE
HISTORY OF LOSS OR TRAUMA
EASY ACCESS TO FIREARMS
LOTS OF MEDICAL PROBLEMS
HOW TO ASSESS FOR SUICIDE:
1. Risk factors
2. Suicide thoughts
3. Suicide plans
4. Access to means
5. Lethality
6. Last suicide attempt
7. History of attempts
8. Mitigating factors
A : ASSESSMENT
o Covert – less obvious
“It’s okay now, everything will be fine”
“Things will never work out”
“I won’t be a problem much longer”
“How can I give my body to medical science?”
Sudden brightening in mood
Giving away possessions
Organizing financial affairs
o Overt – very obvious
“I don’t want to live anymore”
“Life isn’t worth living”
“I wish I were dead”
“Everyone would be better off if I died”
, 2
D : DIAGNOSIS
o Risk for self-harm**
o Ineffective coping
o Hopelessness
P / I : PLANNING / IMPLEMENTATION
o Safety
Environment : if at risk, go through belongings for SAFETY reasons (must document)
Observation (behavior) : frequent/constant observations, get a one-to-one
o Therapeutic relationship
“It sounds like you’re depressed”
“It sounds like you’ve been suffering”
“I’m here to listen to you”
“It must be scary to want to end your life”
Be 100% very direct!!!** always ask if they want to kill themselves (no time for rapport)
E : EVALUATION
o Behavior has changed
o Verbalizes no suicidal thoughts
o Expresses feelings for hope
M : MEDICATION AND OTHER TREATMENTS
o No meds for suicide!!!
o Treat underlying issue**
o Therapies – CBT, talk therapy
E : EDUCATION
o APNA.org, suicidology.org, afsp.org, NAMI.org, the National Suicide Prevention Lifeline
CH 22 : NEUROCOGITIVE DISORDERS
DELIRIUM = change in cognition that develops over a SHORT period of time ⟹ reversible
O Causes of delirium: SUBSTANCE INDUCED
SUBSTANCE WITHDRAWAL
INFECTION
DEMENTIA = progressive deterioration in neurocognition over a LONG period of time ⟹ irreversible
7 STAGES OF ALZHEIMER’S DISEASE:
1. No impairment
2. Very mild cognitive decline – forgetfulness of everyday objects
3. Mild cognitive decline – problem w/ memory that may be measurable in testing, decreased
attention span
4. Moderate cognitive decline – clearly detected during medical interview
5. Moderately severe cognitive decline
6. Severe cognitive decline
7. Very severe cognitive decline
A : ASSESSMENT
DELIRIUM DEMENTIA
-poor judgement, insight -aphasia : absence of speech
-impaired memory, inattention -apraxia : inability to move
-hallucinations -agnosia : inability to recognize objects
, 3
-mood swings -anomia : can’t remember names
-fluctuation in vitals -inability to think abstractly (concrete
-altered LOC** thinking)
-no change in LOC
D : DIAGNOSIS
o Risk for injury**
o Confusion
o Fluid volume deficit
P / I : PLANNING / IMPLEMENTATION
o Safety
Quite environment
Reduce agitation
Decrease stimuli
Reality orientation
o Therapeutic relationship
Self-care
Validating therapy : give information, present reality, clarify
“I know things are upsetting and confusing right now”
o Medical concerns
Promote sleep and proper nutrition
Neuro checks
E : EVALUATION
o Remains free from injury
o Is able to do ADLs
o Can retain highest level of functioning
o Verbalize or demonstrate decreased frustration
M : MEDICATION AND OTHER TREATMENTS
o Therapies – reminiscence therapy, structured routine, validation therapy
o Other Tx – cognitive stimulation
o Palliative meds – slow down progression, NOT cure ⟹ Donepezil (Aricept)** | Memantine
(Namenda) | Rivastigmine (Exelon)
E : EDUCATION
o Respite care is adult day for families
o Tell about disease progression
CH 24 : SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS
PSYCHOSIS = symptoms describing disorganization and impaired personality ⟹ affects thinking, behavior,
emotion, and perception
o Schizophrenia – six months or more
Paranoid : intensely guarded and suspicious of others
Catatonia : abnormal motor behavior
Excitement – agitation (negative behavior)
Stupor – sloooooow (positive behavior)
Disorganized : most regressed and socially impaired
o Delusional disorder – one month of delusions
