Mental Health Proctored ATI "All or Nothing" Thinking - ✅"If I eat any dessert, I will gain 50 lbs" A client in a true manic state will... - ✅Not stop moving, and does not eat or drink, or sleep. This can become a medical emergency A nurse is planning care for a client who has anorexia nervosa with binge-eating and purging behaviors. What should be included in the plan of care? - ✅Implement one-onone observation during meal time Acute Battering Phase - ✅The tension becomes too much to bear and serious abuse takes place Victim may try to cover up injuries or may get help Acute Main---Priority Goal - ✅Maintain adequate hydration Acute Phase of rape - ✅Occurs immediately following the attack. Lasts for about 2 weeks and consists of initial emotional or impact reaction Emotional outbursts: crying, laughing, hysteria, anger, and incoherence ADHD teaching - ✅Ignore child's attention seeking behaviors that are not dangerous Alcohol withdrawal expected findings - ✅Insomnia and restlessness Alcohol Withdrawal Medication - ✅Disulfram Alogia - ✅Poverty of thought or speech; the client may sit with a visitor but may only mumble or respond vaguely to questions Anorexia - ✅Voluntary refusal to eat Body weight less than 85% of expected normal weight for individual) Restricting Type: individual drastically restricts food intake and does not binge or purge Binge-eating/purging type: engages in binge-eating or purging behaviors Anorexia Reproductive status - ✅Accompanied by amenorrhea for at least 3 consecutive cycles Anorexia Skin, Hair & Nails - ✅Fine, downy hair (lanugo) on the face and back; yellowish skin, mottled, cool extremities and poor skin turgor
Anterograde Amnesia - ✅Difficulty recalling events that occur after dosing Atypical Antipsychotics - ✅Treat BOTH positive and negative symptoms of schizophrenia Abilify Geodon Zyprexa Seroquel Risperdal Clozaril (Clozapine) Autism expected finding - ✅Repetitive counting Avolition - ✅Lack of motivation in activities and hygiene Benzo IV use include: - ✅Diazepam Lorazepam Benzo---finding that would indicate questioning the provider - ✅Hypotension Benzos - ✅Lorazepam (ativan) Clonazepam (Klonopin) Binge Eating Disorder - ✅Client recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa Weight gain increases risk for: -diabetes -HTN -Cancer Binge-eating expected finding - ✅Abdominal pain Bipolar I - ✅Client has at least one episode of mania alternating with major depression More severe Bipolar II - ✅Client has one or more hypomanic episodes alternating with MDD Bipolar Meds - ✅Lithium=mood stabilizer Anticonvulsants such as Valproic Acid (Depakote), Clonazapam, Lamitcal, Gabapentin, and Topiramate Benzos such as Lorazepam used on a short term basis SSRIs such as Prozac
Can give____________with lithium - ✅Valproic Acid Both treat bipolar Catastrophizing - ✅"My life is over if I gain weight" Cluster A Disorders - ✅Odd or eccentric traits Paranoid: characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit or deceive the person Schizoid: characterized by emotional detachment, disinterest in close relationships and indifference to praise or criticism; often uncooperative Schizotypal: characterized by odd beliefs lead to interpersonal difficulties, an eccentric appearance and magical thinking or perceptual distortions that are not clear delusions or hallucinations Cluster B Personality Disorders (Dramatic, Emotional, or Erratic traits) - ✅Antisocial: characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility Borderline: characterized by instability of affect, identity, and relationships as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often tries self-injury and may be suicidal Histrionic: characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious Narcissistic: characterized by arrogance, grandiose views of self-importance, the need for constant admiration Cluster C Personality Disorders (Anxious, fearful, traits. Insecurity and inadequacy) ✅Avoidant: characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations. Fear of abandonment Dependent: characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends Obsessive-Compulsive: characterized by perfectionism with a focus on orderliness and control of the extent that the individual may not be able to accomplish a given task Cocaine intoxication expected finding - ✅Dilated pupils Common adverse effect of Buspirone - ✅Dizziness
Common defense mechanism with substance abuse - ✅Denial Conduct Disorder expected finding - ✅Aggressive behavior toward others Confabulation - ✅Seen with cognitive disorders Client may make up stories when questioned about events or activities that she does not remember Confusion develops...... - ✅SLOWLY with alzheimers Conventional Antipsychotics - ✅Treat positive symptoms of schizo Haloperidol (Haldol) Loxapine Chlorpromazine (Thorazine) Fluphenazine Covert Comment (Suicide) - ✅"Everything is look pretty grim for me" Delirium expected findings - ✅Family report of personality changes Hallucinations Restlessness Delirium Meds - ✅Antipsychotics or antianxiety meds may be used Depersonalization - ✅Nonspecific feeling that a person has lose their identity, self is different or unreal Depressive disorders are most prevalent in... - ✅Adults between ages of 15-40 Derealization - ✅Perception that environment has changed Diet for individuals with eating disorders - ✅Provide small, frequent meals which are better tolerated and will help prevent the client from feeling overwhelmed Provide a diet high in fiber to prevent constipation Provide a diet low in sodium to prevent fluid retention Limit high-fat, gassy foods during the start of treatment Administer a multivitamin and mineral supplement Disenfranchised Grief - ✅Entails an experienced loss that cannot be publicly shared or is not socially acceptable, such as suicide Dysfunctional Grief - ✅Involves difficult progression through the expected stages of the grieving process
Dysthymic Disorder - ✅Mild form of depression that usually has an early onset, such as in childhood and lasts at least 2 years in length Eating Disorder Vitals - ✅Low BP with possible orthostatic hypotension Decreased pulse and body temperature Hypertension may be present in clients who have binge eating disorder ECT expected findings - ✅Memory loss Nausea Tachycardia ECT is given for - ✅Bipolar with rapid cycling ECT Potential Complications - ✅Cardiac arryhthmia Electrolyte Imbalance: Bulimia - ✅Hypokalemia Hyponatremia Hypochloremia Emotional Reasoning - ✅"I know i look bad because I feel bloated" Empathy - ✅UNDERSTANDING of feelings Eye Movement Desentization and Reprocessing (EMDR) - ✅Therapy for clients who have PTSD. Encourages eye focus on a separate stimuli while thinking of or talking about the traumatic event Family violence other name - ✅Maltreatment Flooding - ✅Exposing the client to a great deal of undesirable stimulus in an attempt to turn off anxiety response. Most useful for phobias Flumazenil use - ✅Administered to counteract sedation and reverse the adverse effects of benzos Benzo antidote Global Assessment of Functioning (GAF Scale) - ✅Helps to determine a client's ability to perform ADLs and to function independently Grandeur - ✅Believes that she is all powerful and important, like a god Heroin Intoxication Expected Finding - ✅Respiratory Depression
Heroin withdrawal expected findings - ✅Muscle aches Honeymoon Phase - ✅Abuser becomes loving, promises to change, and is sorry for behavior How is seasonal depression treated? - ✅Light therapy Individuals with highest risk of suicide - ✅Adolescents Native American Clients with depressive disorder Levels of Suicide Nursing Interventions - ✅Primary: prevention strategies that include providing information and education to at-risk populations Secondary: management of the suicide crisis Tertiary: interventions with the family or friends of a person who committed suicide Medication approved for moderate stages of alzheimers - ✅Memantine (Namenda) Medication that is given during alcohol detox - ✅Diazepam Medications for Anger Management - ✅Olanzapine (Zyprexa) Ziprasidone (Geodon) These are atypical antipsychotics used to control aggressive behavior and impulsive behaviors. These are used more commonly than Haloperidol because of the severity of side effects of Haloperidol Haloperidol is often used...just not as often Mematine is used to treat - ✅Severe alzheimers Methadone is indicated for TX of.... - ✅Opiate use disorder Mileu - ✅Safe, structured environment that decreases anxiety and distracts the client from constant thinking and hallucinations Mirtazaprine (Remeron) - ✅This medication increases the release of serotonin and norepinephrine Modeling - ✅Allows client to see a demonstration of appropriate behaviors in a stressful situation. The goal is that the client will imitate the behaviors
Nardil A/E - ✅Orthostatic Hypotension Headache Neurocognitive Disorder Meds - ✅Medications such as Donepezil (Aricept), Rivastigmine (Exelon) and Galantamine (Razadyne) increase actetylcholine at cholinergic synapses by inhbiting its breakdown by acetylcholinterase, which increases the availability of acteylcholine at neurotransmitter receptor sites in the CNS Adverse effects: nausea & diarrhea which in occur in about 10% of patients Bradycardia Nicotine Withdrawal med - ✅Bupropion (Zyban) Overgeneralization - ✅"Other girls don't like me because I'm fat" Overt Comment (Suicide) - ✅"There is just no reason for me to go on" Perseveration: - ✅Client avoids answering questions by repeating phrases or behaviors (Grandpa Mose!) Personalization - ✅"When I walk through the hallways, I know everyone is looking at me" Phenelzine---Finding to report - ✅Elevated BP: increases risk for hypertensive crisis This is an MAOI! Positive Symptoms of Schizo (obvious) - ✅Hallucinations Delusions Use of clang association Constantly waving arms (bizarre movements) Preassaultive Stage of Violence - ✅Defensive responses to questions Rapid breathing Facial grimacing Agitation PTSD expected findings - ✅Hallucinations Recurring nightmares Rape-Trauma Syndrome finding - ✅Report of intense guilt Rapid Cycling - ✅4 or more episodes of acute mania within 1 year
Reaction of Terminal Cancer Diagnosis - ✅Denial Refeeding Syndrome - ✅Potentially fatal complication that can occur when fluids, electrolytes, and carbs are introduced to a severely malnourished client Restricting type anorexia expected finding - ✅Decreased caloric intake due to excessive fear of weight gain Risk factors of family & community violence - ✅Victims are the greatest risk of violence when they try to leave the relationship Pregnancy tends to increase the likelihood of violence toward the intimate partner Child under 3 years of age Serotonin Syndrome - ✅Agitation, confusion, disorientation, anxiety, hallucinations, fever, diaphoresis, tremors Setting limits with aggressive clients - ✅Tell the client calmly and directly what he must do in a particular situation "I need you to stop yelling and walk with me outside where we can talk." Severity Scale for substance use disorder - ✅0-1=no diagnosis of substance abuse 2-3=mild substance abuse 4-5=moderate substance abuse 6 or more= severe substance abuse Shaken Baby Syndrome findings - ✅May cause intercranial hemorrhage Assess for respiratory distress, bulging fontanelles, increase in head circumference Somatic Delusionals - ✅Believes that his body is changing in an unusual way, such as growing a third arm Somatic Reaction of rape - ✅Occurs later and lasts about 2 weeks Bruising and soreness from attack Muscle tension, headaches, sleep disturbances, GI symptoms, genitourinary symptoms, a variety of emotional reactions: embarrassment, guilt, revenge, anger, anxiety, fear. Spitting - ✅Client tends to characterize people or things as all good or all bad at any particular moment For example, client might say, "You are the worse person in the world!" Later that day, she might say, "You are best, but the nurse from the last shift is terrible!" Seen in borderline personality disorder St. John's Wort adverse effects - ✅Photosensitivity Skin rash Rapid heart rate
GI distress Abdominal pain Stage 4 Alzheimers expected finding - ✅Client is able to identify the names of family members Suicide indicator - ✅A sudden change in mood from sad/depressed to happy and peaceful Systemic Desentization - ✅Begins with mastering of relaxation techniques. Then a client is exposed to increasing levels of anxiety-producing stimulus. Tension Phase (Violence) - ✅Abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence Thought Stopping - ✅Teaches a client to say "stop" when a negative thought or compulsive behavior arises and substitute positive thought. The goal is that the client with time will use command silently Transpersonal Communication - ✅Addresses an individual's spiritual needs and providers interventions to meet those needs Vagus Nerve Stimulation adverse effects - ✅Voice changes Dysphagia Neck pain Valproic Acid Teaching - ✅Teach the need to regularly monitor liver function levels due to the risk of hepatotoxicity Wernicke-Korsakoff Expected Finding - ✅Confusion What food type to avoid with Disulfram - ✅Pure vanilla extract When should Donapezil be taken? - ✅Bedtime to reduce the risks for injury due to bradycardia and syncope