MENTAL HEALTH GALEN EXAM 1

State of well being - Own Potential Able to work through stress Able to get help when needed Resilience - Ability and capacity to secure resources; where and when to get help Diathesis Stress Model Diathesis - Biological predisposition Diathesis Stress Model Environmental Stress - Natural Disasters Trauma DSM5 - All the different disorders and their criteria Culturally Competent - Educate yourself about different cultures, provide good quality holistic care Western Traditions - Scientific Person finds identity individually Makes own decisions Autonomy Mind and body are separate Easter Traditions - Everything revolves around family mind spirt and body are one entity Indigenous Traditions - Entire Tribe illness contributes to lack of harmony REVIEW TABLE 5.2 IN BOOK - Discusses different traditions Cultural Barriers - Some view mental illness as something negative Communication barriers - Try not to use slang, or verbal sayings, can cause a barrier/confusion REVIEW PAGE 92 IN BOOK - Ethical Concepts Beneficence - Do good for others Autonomy - Respect patients rights, and the right for them to make their own decisions. Justice - Being far amongst patients Fidelity - Commitment to patient care, do no harm. Committed to a life time of education to keep up on best practices. Veracity - Duty to be truthful, do not lie to patients Voluntary Admission - Patient is seeking out treatment , has the right to request to be discharged AMA Doctor still will evaluate . Involuntary Admission - Against the patients will , they do not want treatment. Must meet criteria mentally ill, danger to themselves or someone else, need for treatment is there but the mental illness is stopping them from getting treatment. If they refuse treatment... - File with court to force medication, they judge will come and evaluate to see if there is a danger and it is needed. COURT ORDER IS NEEDED TO FORCE MEDICATION Seclusion/Restraints - Last resort less restrictive interventions first Intentional Tort - Assult: threating harm Batter: Physical Contact False imprisonment: confining someone to a area against their will with no need. Unintentional Tort - negligence: failure to protect and provide care malpractice: professional negligence Five elements requiered to prove negligence are.. - 1: Duty 2: Breach of duty 3: Cause in fact 4: Proximate cause 5: Damages PAGE 100 Treatment Settings Primary Care - Usually step one Treatment Setting Outpatient - Skilled Nursing, Patient medical homes intensive outpatient: partial hospitalization clinics, crisis stabilization units Prevention: Primary - Before any problems have arrived, educate about coping strategies Prevention: Secondary - Early Detection , screenings Prevention: Tertiary - Treatment of the diseases, prevent progression Inpatient: Maintain rights no matter what T/F - TRUE Behavioral Crisis - Physically aggressive to themselves or others Safety is a priority Keep unit safe, less restrictive first Nursing Process First step - Assessments, mental status, history of mental illness for themselves and family history Rating scale for their depression or anxiety ( like pain scale) Nursing Process Diagnosis - Identifying the problem Nursing Process Planning - Education Nursing Process Implement - Therapy Nursing Process Evaluation - Re asses Consideration for kids - Interview child first prior to parent if possible, if abuse is suspected interview separately Observation, play therapy Considerations for adults - No stereotypes Make sure they have glasses or hearing aids if needed If they can not pick up on things help them, do not shame Do not judge Language Barriers, can family translate for them? - No , must use translator Therapeutic Relationships - Clear boundaries between patient and nurse focus on patient needs, boundaries for safe space for patient to voice opinions, Transference - Patient transfers feelings for someone onto the nurse, can turn inappropriate fast . Blurring roles Countertransference - Nurse puts feeling about someone else onto the patient can lead to over involvement, blurring roles Papule Nurse/Patient relationship Pre-orientation - Gathering data before going to see the patient Papule Nurse/Patient relationship Orientation - Meet patient for the first time Assessments Education Get to know each other Figure out problems Develop treatment Papule Nurse/Patient relationship Working Phase - Still gathering data Is the treatment working, or getting worse? Doing interventions Providing Education Papule Nurse/Patient relationship Termination Phase - Patient is leaving Ending the relationship Summarizing goals Praise for goals meet, and encourage them to continue in the outside world Therapeutic communication also included - Facial Expression Body Language Tone of voice Therapeutic communication Silence - Being silent , letting the patient express themselves Therapeutic communication Active listening - Nodding , shaking head, active in the conversation Therapeutic communication Clarifying - Paraphrasing: take their words and say it back in fewer words Restating: saying back a fact that they told you. Therapeutic communication Questions - Projecting- What if? Non Therapeutic - Asking Why Giving advice Neurotransmitters REVIEW IN BOOK - Page 41 Table 3.1 Dopamine - Psychiatric Disorders Decrease = movement disorder & depression Increase= mania schizophrenia Serotonin - Decreases= depression Increased= serotonin syndrome ( REVIEW IN BOOK) life threating , stop medication immediately NE & Serotonin - Depression GABA - Not enough = anxiety calming neurotransmitter increased = decreased anxiety Acetylcholine - Memory Alzheimer's Anti Anxiety Benzo - Controlled Risk for substance abuse Works fast, good for panic attacks Anti Anxiety Buspar - Works without sedative effect takes about 4-6 weeks can cause headache/nausea but will get better Sleep Aids - Cause sedation No driving, operating heavy machinery Sleep Aid Ambien/Zolpidem - Controlled Fast onset Take at bedtime sleepwalking, eating, let patient know Sleep Aid Trazodone - Anti depressant but not the best sedation orthostatic hypotension Sleep Aid Seroquel quetiapine CLASS - anti psychotic sedating effect can help to calm down use at bed time orthostatic hypotension Mood Stabilizers Lithium - Only true one Older Medication Narrow therapeutic range Fine tremor is okay, and nausea and vomiting that subsides is also okay prolonged vomiting and diarrhea , dehydration, bad tremors are signs of toxicity Tell them to be consistent with their water and sodium intake Significant weight gain, educate on exercise and a healthy diet Monitor lithium levels, kidney and hypothyroidism Anticonvulsants Valproic acid/Depakote - Liver failure Thrombocytopenia