MENTAL HEALTH EXAM#1-Rasmussen

What is Art of Nursing: Attending – • An intensity of presence • Listening, touching, or giving attentive physical care What is Art of Nursing: Patient Advocacy – • Being able to speak up for someone, especially when the other person lacks knowledge, skills, ability, or status to speak for themselves • As a nurse it is an ethical responsibility Evidence-based practice (EBP) is... - a process by which the best available research evidence, clinical expertise, and patient preferences are synthesized while making clinical decisions. The 5 A's process of integrating best evidence into clinical practice includes .... - (1) asking, (2) acquiring, (3) appraising, (4) applying, and (5) assessing Application of the recovery model assists people with psychiatric disabilities to.... - -effectively manage symptoms -reduce psychosocial disability -find a meaningful life in a community of their choosing. Three specific areas are inherent within the art of nursing: - (1) caring, (2) attending, and (3) patient advocacy. 1. In which scenario is it most urgent for the nurse to act as a patient advocate? a. An adult cries and experiences anxiety after a near-miss automobile accident on the way to work. b. A homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane. c. A 14-year-old girl's grades decline because she consistently focuses on her appearance and social networking. d. A parent allows the prescription to lapse for 1 day for their 8-year-old child's medication for attention-deficit/hyperactivity disorder. - B. 2. The nurse interacts with a veteran of World War II. The veteran says, "Veterans of modern wars whine and complain all the time. Back when I was in service, you kept your feelings to yourself." Select the nurse's best response. a. "American society in the 1940s expected World War II soldiers to be strong." b. "World War II was fought in a traditional way but the enemy is more difficult to identify in today's wars." c. "We now have a better understanding of how trauma affects people and the importance of research-based, compassionate care." d. "Intermittent explosive devices (IEDs), which were not in use during World War II, produce traumatic brain injuries that must be treated." - C 3. A patient reports to a primary care provider about sleeplessness, constant fatigue, and sadness. In our current health care climate, what is the most likely treatment approach that will be offered to the patient? a. Group therapy b. Individual psychotherapy c. Complementary therapy d. Psychopharmacological treatment - D 4. The nurse prepares outcomes to the plan of care for an adult diagnosed with mental illness. Which strategy recognizes the current focus of treatment services for this population? a. The patient's diagnoses are confirmed using advanced neuroimaging techniques. b. The nurse confers with the treatment team to verify the patient's most significant disability. c. The nurse prioritizes the patient's problems in accordance with Maslow's hierarchy of needs. d. The patient and family participate actively in establishing priorities and selecting interventions. - D 5. Which scenario best demonstrates empathetic caring? a. A nurse provides comfort to a colleague after an error of medication administration. b. A nurse works a fourth extra shift in 1 week to maintain adequate unit staffing. c. A nurse identifies a violation of confidentiality and makes a report to an agency's privacy officer. d. A nurse conscientiously reads current literature to stay aware of new evidencebased practices. - A 1. A mentally ill gunman opens fire in a crowded movie theater, killing six people and injuring others. Which comment about this event by a member of the community most clearly shows the stigma of mental illness? a. "Gun control laws are inadequate in our country." b. "It's frightening to feel that it is not safe to go to a movie theater." c. "All these people with mental illness are violent and should be locked up." d. "These events happen because American families no longer go to church together." - C 2. The nurse presents a class about mental health and mental illness to a group of fourth graders. One student asks, "Why do people get mentally ill?" Select the nurse's best response. a. "There are many reasons why mental illness occurs." b. "The cause of mental illness is complicated and very hard to understand." c. "Sometimes a person's brain does not work correctly because something bad happens or they inherit a brain problem." d. "Most mental illnesses result from genetically transmitted abnormalities in cerebral structure; however, some are a consequence of traumatic life experiences." - C 3. An adult experienced a spinal cord injury resulting in quadriplegia 3 years ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency? a. "I often pray for a miracle that will heal my paralysis so I will be whole again." b. "I don't know what I did to deserve this fate or whether I am tough enough to endure it." c. "My accident was a twist of fate. I suppose there are worse things than being paralyzed." d. "Being paralyzed has taken things from me but it hasn't kept me from being mentally involved in life." - D 4. A nursing assistant says to the nurse, "The schizophrenic in room 226 has been rambling all day." When considering the nurse's responsibility to manage the ancillary staff, which response should the nurse provide? a. "It is more respectful to refer to the patient by name than by diagnosis." b. "Thank you for informing me about that. I will document the behavior." c. "It is not unusual for schizophrenics to do that. It's just part of their illness." d. "You have a difficult job. I'm glad you are so accepting of our patients' behaviors." - A 5. Which scenario meets the criteria for "normal" behavior? a. An 8-year-old child's only verbalization is "No no no." b. A 16-year-old girl usually sleeps for 3 or 4 hours per night. c. A 43-year-old man cries privately for 1 month after the death of his wife. d. A 64-year-old woman has difficulty remembering the names of her grandchildren. - C What was Freud's theory type? - -psychoanalytic- unconscious thoughts -Believes psychological disturbances where related to events of early trauma or events not remembered or recognized Id - • Unconscious, primitive, pleasure principle Superego - Conscience Ego - • Strives for balance • Subject to anxiety Maslow Hierarchy of Needs - 1. Physiological- breathing, food, water, sex, sleep, homeostasis 2.Safety- security of body, finances, home, health 3. Love & Belonging- family, friends, sexual intimacy 4. Esteem- Self confidence 5. Self Actualization- motivation for FULL POTENTIAL Advocate for self. - administration of medications when possible, with appropriate supports in the community Erik Erickson infant stage - (Trust vs. Mistrust) Task—develop a basic sense of trust that leads to hope Trust requires a feeling of physical comfort and a minimal experience of fear or uncertainty; if this occurs, the child will extend trust to the world and self Erik Erickson toddler stage - (Autonomy vs. Shame) Develop confidence in physical and mental abilities that leads to the development of an autonomous will Task—gain self-control of and independence within the environment Erik Erickson preschooler stage - Initiative vs. Guilt Intrusive activity and curiosity and consuming fantasies, which lead to feelings of guilt and anxiety Establishment of conscience Task—achieve a sense of purpose and develop a sense of mastery over tasks Erik Erickson grade school stage - Industry vs. Inferiority In learning to accept instruction and to win recognition by producing "things," the child opens the way for the capacity of work enjoyment Task—gain a sense of self-confidence and recognition through learning, competing, and performing successfully Erik Erickson teenager stage - Identity vs. Role Confusion Differentiation from parents leads to fidelity (sense of self) Physiological revolution that accompanies puberty (rapid body growth and sexual maturity) forces the young person to question beliefs and to refight many of the earlier battles Task—integrate all the tasks previously mastered into a secure sense of self Erik Erickson young adult stage - Intimacy vs. Isolation Maturity and social responsibility result in the ability to love and be loved As people feel more secure in their identity, they are able to establish intimacy with themselves (their inner life) and with others, eventually in a love-based satisfying sexual relationship with a member of the opposite sex Task—form intense long-term relationships and commit to another person, cause, institution, or creative effort Erik Erickson mid- adult stage - Generativity vs. Stagnation Generativity vs. self-absorption Interest in nurturing subsequent generations creates a sense of caring, contributing, and generativity Task—achieve life goals and obtain concern and awareness of future generations Erik Erickson older adult stage - Integrity vs. Despair -Acceptance of mortality and satisfaction with life leads to wisdom -Satisfying intimacy with other human beings and adaptive response to triumphs and disappointments -Marked by a sense of what life is, was, and its place in the flow of history -Task—derive meaning from one's whole life and obtain/maintain a sense of selfworth Group Therapy - A gathering of two or more, who share a common purpose, meet over a substantial amount of time with face to face interactions to achieve a goal Roles of Nurse for Inpatient Psychiatric Care Settings - • Completing comprehensive data collection that includes the patient, family, and other health care workers • Developing, implementing, and evaluating plans of care • Assisting or supervising mental health care workers ( e. g., nursing assistants with or without additional training in working with people who have mental illnesses) • Maintaining a safe and therapeutic environment • Facilitating health promotion through teaching • Monitoring behavior, affect, and mood • Maintaining oversight of restraint and seclusion • Coordinating care by the treatment team DOPAMINE is increased and decreased in what disorders - Decrease: Parkinson disease, depression Increase: Schizophrenia, mania NOREPINEPHRINE is increased and decreased in what disorders - Decrease: Depression Increase: Anxiety states SEROTONIN is increased and decreased in what disorders - Decrease: Depression Increase: Anxiety states HISTAMINE - High levels associated with anxiety and depression GAMMA-AMINO BUTYRIC ACID (GABA) - Decrease: Anxiety disorders, schizophrenia, mania, Huntington chorea Increase: Reduction of anxiety, schizophrenia, mania Acetylcholine - Increase: Depression Decrease: Alzheimer disease, Huntington chorea, Parkinson disease Tricyclics - amitriptylene (Elavil), imipramine (Tofranil), nortriptyline (Pamelor) - Increases norepinephrine. - Side effects include anticholinergic effects. Pharmacokinetics must be considered in TCA overdose fatalities because TCAs are highly lipid soluble and rapidly absorbed. This may result in cardio-toxicity and death before the patient can reach a hospital Selective serotonin reuptake inhibitors (SSRIs): - fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) - Increases serotonin. - Side effects include fewer anticholinergic effects than tricyclic agents and nausea and vomiting (N/V). Examples of SSRI - • Citalopram/Celexa • Escitalopram/ Lexapro • Fluoxetine/Prozac • Fluvoxamine/ Luvox • Paroxetine/ Paxil • Sertaline/ Zoloft Monoamine Oxidase Inhibitors - • phenelzine (Nardil) • tranylcypromine (Parnate) • EMSAM (selegiline transdermal system) delivers monoamine oxidase inhibitors (MAOIs) through the skin. • Hypertensive crisis: Occurs if patient ingests tyramine found in some over-thecounter (OTC) medications, beer, wine, aged cheese, organ meats, avocadoes, and other foods Dietary restriction of tyramine must be maintained for 2 weeks after stopping MAOIs. Foods that contain tyramine - beer wine aged cheese organ meats avocadoes yeast lithium (Eskalith, Lithobid): - Mood Stabilizers: - Stabilizes depression and mania (bipolar disorder). - Narrows the therapeutic index. - Has a potential for toxicity. - Toxic effects can include tremor, ataxia, confusion, convulsions, and N/V Typical Antipsychotic Drugs/ FirstGeneration Agents (FGA) - BLOCK DOPAMINE chlorpromazine (Thorazine) fluphenazine (Prolixin) haloperidol (Haldol) Extrapyramidal Side Effects and Adverse Reaction - • Dystonia (muscle stiffness) • Akathisia (restlessness) • Tardive dyskinesia (TD) • Drug-induced parkinsonism • Neuroleptic malignant syndrome (NMS); rare but life-threatening • Orthostatic hypotension Neuroleptic Malignant Syndrome - • Sudden fever • Rigidity • Tachycardia • Hypertension • Decreased levels of consciousness Atypical Antipsychotic Drug - BLOCK DOPAMINE & SEROTONIN • Produce fewer extrapyramidal side effects (EPS) • Target negative and positive symptoms of schizophrenia • clozapine (Clozaril) • risperadone (Risperdal) • quetiapine (Seroquel) • olanzapine (Zyprexa) • iloperidone (Fanapt) • lurasidone HCl (Latuda) • ziprasidone HCl (Geodon) • aripiprazole (Abilify) • paliperidone (Invega) Positive symptoms of schizophrenia - - Hallucinations, delusions, disorganized thought processes, and paranoia Negative symptoms of schizophrenia - - Withdrawal, lack of initiative, and failure to maintain hygiene Purpose of the MSE - To evaluate the current cognitive processes.