ATI Capstone Mental Health Study Guide 2023

Mental Status Exam includes: Level of consciousness Physical appearance Behavior Cognitive and intellectual abilities The nurse conducts the MSE as part of his or her routine and ongoing assessment of the client. Changes in Mental Status should be investigated further and the provider notified. 2 types of mental health hospitalizations Voluntary commitment and involuntary or civil commitment. Involuntary commitment is against the client's will. Despite that, unless proven otherwise, clients are still considered competent and have the right to refuse treatment. Communication tips If the client is anxious or depressed - use open-ended, supportive statements If the client is suicidal - use direct, yes or no questions to assess suicide risk If the client is panicked - use gentle guidance and direction If the client is confused - provide reality orientation If the client has delusions / hallucinations / paranoia - acknowledge these, but don't reinforce If the client has obsessive / compulsive behavior - communicate AFTER the compulsive behavior* If the client has a personality or cognitive disorder - be calm and matter-of-fact Treatment for mental health illnesses and disorders can include medications, talk and behavior therapy, and / or brain stimulation. Clients undergoing care for mental health disorders may feel pressure to deny behavior or issues to appear 'normal'. The nurse should always carefully assess each individual to ensure optimal response to therapies. Brain Stimulation Therapy electroconvulsive therapy or ECT. ECT is generally performed for major depressive disorders, schizophrenia, or acute manic disorders. Most clients receive therapy three times a week for two to three weeks. Prior to ECT, carefully screen the client for any home medication use. Lithium, MAOIs, and all seizure threshold medications should be discontinued two weeks prior to ECT. After therapy, reorient the client as short-term memory loss is common. anxiety disorders Anxiety disorders are common mental health disorders. Generalized Anxiety Disorder, Panic Disorder, Phobias, Obsessive Compulsive Disorder, and Posttraumatic stress disorder (PTSD) are all considered types of anxiety disorders. Assess the client for risk factors, triggers, and responses. Depression Symptoms A classic symptom of depression is change in sleep patterns, indecisiveness, decreased concentration, or change in body weight. Any client who shows these signs or symptoms should be asked if they have suicidal ideation. Teach clients to never discontinue antidepressants suddenly. Bipolar Disorders mood disorders with periods of depression and mania. Clients have a high risk for injury during the manic phase related to decreased sleep, feelings of grandiosity, and impulsivity. Hospitalization is often required and nurses should provide for client safety. Types of Abuse physical, sexual, or emotional. Abuse tends to be cyclic, following a pattern of tension building, battering, and honeymoon phase. When test questions appear related to abuse, look for the phase to determine the correct response. Aggressive or violent patient setting boundaries and limits on behavior is important. The nurse should maintain a calm approach and use short, simple sentences. SSRIs: Selective Serotonin Reuptake Inhibitors These medications include Citalopram (Celexa), Fluoxetine (Prozac), or Sertraline (Zoloft). The client should avoid using St. John's Wort with these medications, and should eat a healthy diet while on these medications. TCAs: Tricyclic Antidepressants Amitriptyline (Elavil) is an example. Anticholinergic effects and orthostatic hypotension may occur. MAOIs: Monoamine Oxidase Inhibitors Phenelzine (Nardil) is an example. Hypertensive crisis may occur with tyramine food ingestion, so care must be taken to avoid these substances. Educate the client to avoid all medications until discussed with provider. Atypical antidepressants Bupropion (Wellbutrin) is the most common example. Appetite suppression is a common side-effect. Headache and dry mouth may be severe and client should notify the provider if this occurs. Atypical antidepressants should not be used with clients with seizure disorders. Serotonin Norepinep hrine Reuptake Inhibitors Common SNRIs include Venlafaxine (Effexor) and Duloxetine (Cymbalta). Adverse effects may include nausea, weight gain, and sexual dysfunction.