Mental Health Nursing ATI.txt

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BSNwannabe
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249752
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Mental Health Nursing ATI.txt
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2013-11-30 01:01:43
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Mental Health Nursing
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psych
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ATI mental health
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  1. Lethargy?
    drowsy but able to open eyes and respond
  2. Stupor?
    need vigorous or painful stimuli to get a brief response - may not be able to respond verbally
  3. 2 stimuli used to get a response from pt with decreased LOC?
    pinching a tendon or rubbing the sternum
  4. Purpose of the mini-mental status exam?

    4 things it assesses?
    • assess pt cognitive status
    • 1. orientation to time & place
    • 2. att span & ability to calculate(count backward by 7's)
    • 3. registration & recalling of objects
    • 4. language, including naming of objects, following commands, & ability to write
  5. A score of ____ or less GCS indicates pt is in coma.
    7
  6. 5 components of a healthy child/adolescent?
    • 1. trust
    • 2. view world as safe
    • 3. accurately interpret env
    • 4. master dev tasks
    • 5. use appro coping
  7. Psychosocial evaluation tool for adolescents?
    HEADSS
  8. 3 extra assessments that may be done for an older adult?
    • 1. functional ability
    • 2. economic and social status
    • 3. env factors:  safety (stairs in home)
  9. 3 standardized assessment tools that are appro for the older adult?
    4 pain assessment scales that may be used?
    • 1. Geriatric Depression Scale (short form)
    • 2. Mini-Mental Status Exam
    • 3. Michigan Alcoholism Screeening Test (geriatric version)
    • pain assessments:  visual analogue scales, Wong-Baker FACES, McGill Pain Questionnaire (MPQ), & Pain Assessment in Advance Dementia (PAINAD)
  10. 8 things to do during mental assessment? (includes elderly)
    • 1. private, quiet space with adequate lighting to accommodate impaired vision and hearing
    • 2. intro self & det pt name preference
    • 3. stand or sit at pt level
    • 4. use touch to comm caring as appro
    • 5. ask about difficulty sleeping, incontinence, falls/injuries, depression, dizziness, & loss of energy
    • 6. include family etc as appro
    • 7. obtain detailed med Hx
    • 8. Summarize & ask for feedback from pt
  11. 4 aspects of counseling?
    • 1. using therapeutic comm
    • 2. assisting with prob solving
    • 3. crisis intervention
    • 4. stress mgmt
  12. 4 aspects of milieu therapy?
    • 1. orienting pt to phys setting
    • 2. ID rules & boundaries of setting
    • 3. ensuring safe env
    • 3. assisting to participate in activities
  13. 3 ways to promote self-care?
    • 1. offer assistance
    • 2. allow time
    • 3. give incentives
  14. 3 Psychobiological interventions?
    • 1. meds
    • 2. teaching pt/family about meds
    • 3. monitoring for AE & effectiveness
  15. 3 cognitive & behavioral therapies?
    • 1. modeling
    • 2. operant conditioning
    • 3. systematic desensitization
  16. Mental health teaching includes _____ & _____ skills.
    social & coping skills
  17. Role of case mgmt?
    coordination holistic care (medical. psych, social)
  18. 3 rights guaranteed to ALL citizens?
    • 1. humane Tx & care
    • 2. right to vote
    • 3. right to due process of law, including right to press legal charges against another person
  19. 8 rights guaranteed to ALL pt including mental health pt?
    • 1. informed consent 7 right to refuse Tx
    • 2. confidentiality
    • 3. written plan of care/Tx including:  d/c follow-up & participation in care plan & its review
    • 4. Comm with ppl outside mental health facility: family, lawyer, health car
    • 5. adequate interpretive services
    • 6. care provided with respect, dignity & without discrimination
    • 7. freedom from harm r/t phys or pharm restraint, seclusion, & phys or mental abuse
    • 8. least restrictive interventions necessary
  20. Tort?
    wrongful act/injury committed by an entity or person against another person or another person's property:  decide liability issues & crimes
  21. 5 ethical issues that must be used to decide ethical issues?
    • 1. beneficence
    • 2. autonomy
    • 3. justice
    • 4. fidelity
    • 5. veracity
  22. Beneficence?
    quality of doing good (charity)

    EX:  nurse helps newly admitted pt feel safe in env
  23. Autonomy?
    right to make own decisions & accept consequences of those decisions

    pt must also respect rights of others

    EX:  RAther than giving advice to a pt, nurse helps the pt explore alternatives & arrive at a choice
  24. Justice?
    fair & equal Tx for all
  25. Fidelity?
    loyalty & faithfulness to pt & one's duty
  26. Veracity?
    being honest with pt
  27. Pt info can be shared with what ppl?
    only with ppl who will carry out pt care plan or with ppl pt has given consent for
  28. Duto to warn & protect 3rd parties?
    have duty to warn 3rd parties if pt is going to harm them & to report child & elder abuse
  29. Voluntary committment?

    Rights?
    pt or pt guardian chooses commitment

    may apply for release at any time & may refuse and med or Tx
  30. Involuntary (civil) commitment?

    Committment is  based on?

    Who decides?

    How many MD's are usually required?
    against will for an indefinite period of time

    based on psych Tx need, risk of harm to self or others. or inability to provide self-care

    judge, court, or other agency

    usually requires 2 MD's
  31. Emergency involuntary committment purpose?

    Lenght of committment?

    Who usually imposes this committment?
    to prevent harm to self or others - usually temporary (may be up to 10 days)

    PCP, mental health provider, or police officer
  32. Observational or temporary involuntary commitment?

    Time?

    4 ppl who can impose?
    pt is in need of observation, Dx, and Tx plan

    time varies  by state

    • 1. family member
    • 2. legal guardian
    • 3. PCP
    • 4. mental health provider
  33. Long-term or formal involuntary commitment?

    Time?
    • similar to temporary commitment ut must be imposed by courts
    • time varies - usually 60 to 180 days  - may not have a release date
  34. Pt admitted under involuntary commitment have the right to refuse Tx?  Why?
    still considered compentent & have right to refuse Tx
  35. When are pt who are involuntarily committed not allowed to refuse TX?

    How will decisions be made regarding this pt?
    if they have been found incompentent at a competency hearing

    temporary or permenant guardian will be appointed & will make decisions based on what they believe pt would want & can sign consent forms
  36. Can a pt request temporary seclusion?
    pt may request if env is disturbing or too stimulating
  37. 5 things that must be done in order to use phys/chem restraints?
    • 1. Tx must be ordered by MD IN WRITING
    • 2. order must specify duration of Tx
    • 3. MD must rewrite order, specifying type of restraint q 24h or the frequency of time specified by facility policy
    • 4. nursing responsibilities must be ID'd in protocol
    • 5. complete documentation
  38. 4 nursing responsibilites to the restrained/chem restrained pt?
    • 1. pt assessment & behavior documented
    • 2. offered food & fluid
    • 3. toileted
    • 4. monitored for VS
  39. Complete documentation of restraints includes what 5 things?
    • 1. precipitating events & prior behavior
    • 2. alternative actionstaken
    • 3. time Tx began
    • 4. pt current behavior, foods/fluids offered, needs provided for, & VS
    • 5. meds admin
  40. Can a nurse admin seclusion or restraints without MD order?
    charge nurse can admin if in emergency situation, but must obtain order within specified time period (usually 15 to 30 min)
  41. Assault?
    threat
  42. Battery?
    touching pt in a harmful or offensive way
  43. 2 things to document regarding violent or unusual episodes?
    • 1. pt behavior - in clear/objective way
    • 2. staff response
  44. Intrapersonal communication?
    "self-talk" - not verbal
  45. interpersonal communication
    b/t 2 or more ppl in a small group
  46. Public communication?
    w/in lg groups of ppl
  47. transpersonal communication?
    addresses individual's spiritual needs & provides interventions to meet those needs
  48. 4 characteristics of therapeutic communication?
    • 1. pt centered
    • 2. purposeful
    • 3. planned
    • 4. goal-directed
  49. 4 alterations in therapeutic communication when talking to a child?
    • 1. simple language
    • 2. be aware of own nonverbal messages
    • 3. be at child's eye level
    • 4. incorporate play
  50. 4 alterations in therapeutic communication for elderly?
    • 1. may require you to speak louder
    • 2. minimize distractions & face pt when speaking
    • 3. allow time for pt to respond
    • 4. if pt has impaired comm:  ask for input from family/CG to det extent of deficits & how best to comm
  51. When are defense mechanisms maladaptive?
    when they interfere with functioning or when same defense mechanism is always used - should use a variety of mechanisms
  52. 2 defense mechanisms that are always healthy?
    altruism & sublimation
  53. Altruism?
    dealing with anxiety by reaching out to others
  54. Sublimation?
    dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
  55. Suppression?
    voluntarily denying unpleasant thoughts & feelings
  56. Repression?
    putting unacceptable stuff out of conscious awareness
  57. Displacement?
    shifting feelings r/t one thing/person onto another less threatening thing/person
  58. Reaction formation?
    overcompensatring or demonstrating opposite behavior of what is felt
  59. Undoing?
    performing an act to make up for prior behavior
  60. Rationalization?
    creating explanations for unacceptable behavior
  61. Dissociation?
    temp blocking memories & perceptions for comsciousness
  62. Splitting?
    inability to reconcile neg & pos attributes of self or others
  63. Projection?
    blaming others for unacceptable thoughts & feelings
  64. Normal anxiety?
    motivates ppl to take action
  65. Acute anxiety?
    precipitated by imminent loss or change that threatens one's sense of security
  66. 3 char of chronic anxiety?

    2 phys s/s that may occur?
    dev over time

    may start in childhood

    may have phys s/s with anxiety:  fatigue, HA
  67. When may mild anxiety occur?
    normal experience of everyday life
  68. Advantage of mild anxiety?
    increases ability to perceive reality
  69. 6 char of mild anxiety?
    • 1. has identifiable cause
    • 2. vague feeling of disomfort
    • 3. restlessness
    • 4. irritability
    • 5. impatience
    • 6. apprehension
  70. 3 physical behaviors that may occur with mild anxiety?
    • 1. finger or foot tapping
    • 2. fidgeting
    • 3. lip-chewing
  71. How does moderate anxiety affect perception, ability to think, & problem solving?
    slightly reduced perception & selective inattention

    decreased ability to think clearly but learning & problem solving may still occur
  72. 7 s/s of moderate anxiety?
    • 1. concentration probs
    • 2. tiredness
    • 3. pacing
    • 4. change in voice ptich
    • 5. voice tremors
    • 6. shakiness
    • 7. increased HR & RR
  73. 4 somatic complaints that may occur with moderate anxiety?
    HA, backache, urinary urgency & frequency, & insomnia
  74. How can others help a person with moderate anxiety?
    direction
  75. Functioning deficits that occur with severe anxiety?
    functioning is ineffective:  perceptual field is greatly reduced, disotroted perceptions,

    learning & prob solving do not occur
  76. 6 char of severe anxiety?
    • confusion
    • feelings of impending doom
    • hyperventilation
    • tachycardia
    • withdrawal
    • loud and rapid speech
    • aimless activity
  77. char of panic-level anxiety?
    • 1. markedly disturbed behavior
    • 2. not able to process what is occurring
    • 3. extreme fright
    • 4. severe hyperactivity or flight
    • 5. immobility can occur
    • 6. dysfunction in speech
    • 7. dilated pupils
    • 8. severe shakiness
    • 9. severe withdrawal
    • 10. inability to sleep
    • 11. delusions
    • 12. hallucinations
  78. 5 nursing interventions for mild-moderate anxiety?
    • 1. active listening & comm techniques
    • 2. be calm & recognize pt distress
    • 3. eval past coping mechanisms
    • 4. explore alternatives to probs
    • 5. encourage participation in activites that may temp relieve feelings of inner tension (exercise)
  79. 6 nursing interventions for severe to panic-level anxiety?
    • 1. env that meets phys & safety needs & remain with pt
    • 2. quiet with low stimulation
    • 3. meds & restraint only after less restricitive
    • 4. encourage gross motor activites:  walking/exercise
    • 5. set limits by using firm, short, & simple statements.  Repetition may be needed
    • 6. direct pt to acknowledge reality & focus on what is present in env
  80. Milieu goals & how are they accomplished?
    learn tools needed to cope adaptively and use them in life

    have community meetings regularly
  81. 5 things that occur during the orientation phase of the therapeutic relationship?
    • 1. intro
    • 2. make contract
    • 3. build trust by est expectations
    • 4. set goals & discuss pt concerns/needs
    • 5. Explore pt thoughts & feelings & meaning of behaviors
  82. 4 things that occur during the working phase of the therapeutic relationship?
    • 1. ongoing assessment to plan/eval care
    • 2. work:  increase SE, autonomy, coping, etc
    • 3. reassess probs, goals, & revise plan prn
    • 4. remind pt about date of termination
  83. 3 things that occur during the termination phase of the therapeutic relationship?
    • 1. discuss loss & previous losses
    • 2. summarize what has occurred & goal achievement
    • 3. discuss how to incorporate what has been learning into life
  84. Transference?
    pt sees healthcare team as being like someone from his/her personal life
  85. When is transference more likely to occur?
    with a person in authority
  86. Countertransference?
    health care team member displaces char of ppl in her past onto a pt
  87. When is countertransference likely to occur?
    in pt who elicit strong personal feelings in the nurse
  88. 3 considerations for room assignments on a 24h care unit?
    • 1. personalities of roomates
    • 2. likelihood of nighttime disruptions for a roommate if 1 pt has difficulty sleeping
    • 3. mental health & medical Dx
  89. 4 criteria to justify admission to an acute care facility?
    • 1. clear risk of pt danger to self or others
    • 2. failure of comm-based Tx
    • 3. dangerous deline in mental health
    • 4. having a medical need in addition to a mental illness
  90. 3 goals of acute mental health Tx?
    • 1. prevention of harm
    • 2. stabilizing mental crisis
    • 3. return to some type of community care
  91. When do discharge plans begin at acute care?
    from time of admission
  92. Primary prevention?
    promotes health & prevents mental health probs from occurring
  93. Secondary prevention?
    focuses on early detection of mental illness
  94. Tertiary prevention?
    focus on rehab & prevention of further probs in pt previously Dx
  95. Partial hospitaliztion programs?
    intense short-term Tx for pt who may go home q night & have a person responsible for them at home
  96. Assertive community treatment (ACT)?
    for pt with severe mental illness & noncompliant with traditional Tx
  97. Community mental health centers?
    provide educational groups, med dispensing, & individual counseling
  98. Psychosocial rehabilitation programs?
    provide structured range of programs:  residential services, day programs for older adults, etc
  99. Psychoanalysis?

    How long does it last?
    therapeutic process of assessing unconscious thoughts & feelings & resolving conflict by talking

    months to years
  100. Common focus of psychoanalysis therapy?
    past relationships
  101. 4 therapeutic tools used in psychoanalysis?
    • 1. free association
    • 2. dream analysis
    • 3. transference
    • 4. defense mechanisms
  102. Free association?
    uncensored verabalization of what come to pt mind
  103. Psychotherapy?
    pt & therapist dev trusting relationship to explore pt probs
  104. Difference b/t psychoanalysis & psychotherapy?
    psychotherapy uses same tools but focuses more on present relationships instead of past
  105. Interpersonal psychotherapy?
    assists pt in addressing specific probs to improve relationships, comm, roles, & bereavement
  106. Cognitive therapy?
    focus on individual thoughts & behaviors to solve current probs
  107. Cognitive therapy may be used to Tx what condiitions?
    anxiety, eating disorders, & others that may be changed by changing pt attitude toward life
  108. What may behavioral therapy be used to Tx?
    phobias, substance use, or addictive disorders
  109. Dialectical behavior therapy?

    Focus & goal?
    cognitive-behavioral therapy for pt with personality disorder & exhibit self-injurious behavior

    focus on gradual behavior changes and provides acceptance and validation for pt
  110. Cognitive reframing?

    Purpose?
    assists pt to ID negative thougths that produce anxiety

    decrease anxiety by changing cognitive distortions
  111. Purpose of monitoring thoughts?
    helps pt to be aware of negative thinking
  112. Modeling?
    pt imitates role model (therapist etc) to improve behavior
  113. Operant conditioning?
    positive reinforcement
  114. Response prevention?
    preventing pt from performing compulsive behavior with the intent that anxiety will diminish
  115. Thought stopping?

    Goal?
    shout stop when negtive thoughts/compulsions occur

    eventually use the command silently
  116. 5 goals of group therapy?
    • 1. sharing common feelings/concerns
    • 2. sharing stories & experiences
    • 3. diminishing feelings of isolation
    • 4. creating a community of healing & restoration
    • 5. less cost than individual therapy
  117. Group therapy for children?
    involves play
  118. Why is group therapy good for adolescents?
    they like their peers a lot
  119. Why is group therapy good for older adults?
    helps with socialization and sharing of memories
  120. 3 phases of group relationship?
    • initial
    • working
    • termination
  121. Primary focus of the initial phase?

    What 3 things occur?
    doefining purpose & goals of the group

    • 1. group leader sets tone of respect/trust
    • 2. members get to know each other
    • 3. discussion about termination
  122. Working phase primary focus?

    What issues may occur in this phase?

    What 2 things occur?
    promote prob-solving skills to facilitate behavioral changes

    power & control issues may occur

    • 1. work toward goals
    • 2. members take informal roles w/in the group (some roles interfere & others help the group)
  123. Maintenance role?
    help maintain purpose & process of the group
  124. Individual roles?
    prevent teamwork & help ind agenda
  125. Scapegoating?
    member of family with little power is blamed for probs w/in family
  126. Triangulation?
    3rd party is drawn into relationship with 2 members whose relationship is unstable
  127. Multigeneratiuonal issues?
    emot issues or themes w/in a family that cont for at least 3 generations
  128. Focus of family therapy?
    focus on family system and not individuals
  129. General Adaptation Syndrome (GAS)?
    body's response to an increased demand
  130. 8 factors that increase person's resilience against stress?
    • 1. phys health
    • 2. strong sense of self
    • 3. religious or spiritual beliefs
    • 4. optimism
    • 5. hobbies
    • 6. satisfying interpersonal relationships
    • 7. strong social support
    • 8. humor
  131. 6 s/s of acute stress (fight or flight)?
    • 1. apprehension
    • 2. unhappiness or sorrow
    • 3. decreased appetite
    • 4. increased RR, HR, cardiac output, & BP
    • 5. increased met & glucose use
    • 6. depressed immune system
  132. 6 s/s of prolonged stress (maladaptive response)?
    • 1. chronic anxiety or panic attacks
    • 2. depression, chronic pain, sleep disturbances
    • 3. weight gain or loss
    • 4. increased risk for MI or stroke
    • 5. poor DM control, HTN, fagiue, irritability, decreased ability to concentrate
    • 6. increased risk for infection
  133. What is involved in most nursing care r/t anxiety?
    teaching stress-reduction strategies to pt
  134. 3 brain stimulation therapies?
    • electroconvulsive therapy (ECT)
    • transcranial magnetic stimulation TMS
    • vagus nerve stimulation VNS
  135. 3 indications for ECT?
    major depressive disorder

    schizophrenia spectrum disorders that are less responsive to neuroleptic meds:  schizoaffective disorder

    acute manic episodes
  136. 4 types of pt with major depressive disorder that may have ECT?
    • 1. s/s not responsive to pharm
    • 2. risks of other Tx are greater
    • 3. actively suicidal or homicidal & need rapid response
    • 4. exp psychotic s/s
  137. What type of manic episodes may be Tx with ECT?

    Why?

    How is their therapy performed?
    used for rapid cycling (more than 4 manic per year) & for manic with destructive behavior

    both have poor response to lithium

    have ECT then get lithium
  138. 5 conditions that place pt at risk with ECT therapy?
    • 1. recent MI
    • 2. Hx of CVA
    • 3. cerebrovascular malformation
    • 4. intracranial mass
    • 5. increased ICP
  139. 3 mental health conditions that ECT has not been found useful for?
    • 1. substance use
    • 2. personality disorders
    • 3. dysthymic disorder
  140. Typical course of ECT Tx?
    3 X per week X 6 to 12 Tx total
  141. Is informed consent needed for ECT?

    If ECT is involuntary who signs informed consent?
    yes

    next of kin or court order
  142. Medication mgmt r/t ECT?
    any meds that affect seizure threshold should be decreased or d/c several days before ECT & MAOIs & lithium should be d/c 2 wks before ECT
  143. 2 conditions that need monitored/Tx before ECT?
    • 1. HTN b/c short period of HTN occurs after ECT
    • 2. cardiac conditions
  144. Nursing assessments before & during ECT?
    VS & mental status before & after

    assess pt & family understanding of procedure & provide teaching
  145. Nursing care during ECT procedure?
    • 1. give IM injection of atropine sulfate or robinul to decrease secretions & counteract vagal stimulation
    • 2. insert IV line & maintain until full recovery
    • 3. bite guard is used to prevent trauma to oral cavity
    • 4. apply scalp electrodes for EEG
  146. Monitoring that occurs during ECT?
    • 1. EEG
    • 2. cardiac monitoring
  147. O2 during ECT?
    mechanically ventilated & receive 100% O2
  148. Anesthesia during ECT?

    EX of muscle relaxant that may be used?
    short-acting anesthetic (brevital etc) IV bolus & muscle relaxant are admin

    muscle relaxant - succinylcholine
  149. What is a cuff place on pt during ECT?  Where is it placed?
    placed on one leg or arm to black muscle relaxant so seizure activity can be monitored in limb distal to the cuff
  150. How long is electrical stimulus typically applied during ECT?

    What is monitored?

    How long does seizure usually last?
    0.2 to 0.8 seconds

    monitor seizure activity

    25 to 60 seconds
  151. What is done after seizure activity ceases during ECT?
    anesthetic is d/c & pt is extubated & assisted to breathe voluntarily
  152. 4 aspects of postprocedure care for ECT?
    • 1. transfer to recovery area to monitor LOC, cardiac status, VS, & O2 sat
    • 2. positioned on side to facilitate drainage & prevent aspiration
    • 3. monitored for ability to swallow & return of gag reflex
    • 4. usually awake & ready for transfer back w/in 30 to 60 min of procedure
  153. 5 complications of ECT?
    • 1. memory loss & confusion
    • 2. reactions to anesthesia
    • 3. ECG changes
    • 4. HA, muscle soreness, & N
    • 5. relapse of depression
  154. What type of memory loss occurs with ECT?
    short-term memory loss
  155. 3 nursing interventions for short-term memory loss r/t ECT?
    • 1. reorient
    • 2. safe env to prevent injury
    • 3. assist with hygiene prn
  156. What should nurse be monitoring for throughout ECT?
    reaction to anesthesia
  157. What will happen to pt HR during ECT & early recovery?
    increase by 25%
  158. What will happen to BP during ECT?

    What happens after?
    BP may initially fall then rise

    should go back to baseline shortly after procedure
  159. 2 interventions for relapse depression r/t ECT?
    • 1. teach that ECT is temp solution
    • 2. weekly ore monthly maintenance ECT can decrease relapse
  160. Transcranial magnetic stimulation?  (TMS)
    noninvasive - uses magnetic pusations to stimulate specific areas of the brain
  161. Indication for TMS?
    major depressive disorder in pt not responsive to pharm
  162. Nursing action for TMS?
    educate pt
  163. Common schedule of Tx with TMS?
    daily for 4 to 6 wks
  164. TMS outpatient or inpatient?
    outpatient usually
  165. How long does TMS last?
    30 to 40 minutes
  166. Procedure for TMS?
    noninvasive electromagnet placed on scalp & pass pulsations through

    pt is alert during procedure
  167. 3 complications of TMS?

    What complications are not associated with TMS?
    • 1. mild discomfort or tingling sensation at site of electromagnet
    • 2. lightheadedness after
    • 3. seizures (rare)

    not asso with systemic AE or neuro deficits
  168. Vagus nerve stimulation (VNS)?
    electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on pt chest
  169. Indications for VNS?
    depression resistant to pharm and/or ECT
  170. 2 nursing actions for VNS?
    • 1. educate about procedure
    • 2. assist MD to obtain informed consent
  171. Is VNS outpatient or inpatient?
    outpatient
  172. When does the VNS deliver pulsations?

    How is it turned off?
    delivers around-the-clock pulsations

    may be turned off at any time by placing special external magnet over the site of implant
  173. 3 complications of VNS?
    • 1. voice changes r/t proximity of implanted lead on vagus nerve to larynx & pharynx
    • 2. hoarseness, throat or neck pain, dysphagia (improve with time)
    • 3. dyspnea, especially with physical exertion
  174. Anesthetic for TMS?
    pt is alert during procedure
  175. Intervention for dyspnea r/t VNS?
    may turn off device when exercising
  176. 4 anxiety disorders recognized & defined by DSM-5?

    Other disorders with similar s/s?
    • 1. separation anxiety disorder
    • 2. panic disorder
    • 3. phobias
    • 4. generalized anxiety disorder GAD

    • 1. OCD & hoarding disorder
    • 2. trauma & stressor-related disorders
  177. Generalized anxiety disorder (GAD)?
    uncontrollable, excessive worry for more than 3 mo
  178. Why do OCD pt do compulsions?
    to relieve obsessive thoughts
  179. Acute stress disorder?
    exposure to traumatic event causes numbing, detachment, & amnesia about event for at least 3 days but no more than 1 mo following the event
  180. Posttraumatic stress disorder (PTSD)?
    exposure to traumatic event causes extreme fear, flashbacks, feelings of detachment & foreboding, restricted affect, & impairment for longer than 2 mo after event - may last for years
  181. Anxiety disorder more likely in ____.
    women
  182. Why do s/s of anxiety need to be assessed well?
    to rule out a physical cause such as hyperthyroidism or pulmonary embolism
  183. Some causes of anxiety?
    • traumatic event
    • genetics & biology
    • acute medical condition
    • some meds & substances
  184. How long do panic attacks typically last?
    15 to 30 min
  185. Dx of a panic attack?
    4 or more of following s/s are present:

    • palpitations
    • SOB
    • choking or smothering sensation
    • chest pain
    • N
    • feelings of depersonalization
    • fear of dying or insanity
    • chills or hot flashes
  186. What may cause anxiety in a pt with panic disorder b/t panic attacks?
    worrying about another panic attack occurring
  187. Agoraphobia?
    avoids being outside & has impaired ability to work or perform duties
  188. 6 s/s of GAD?
    • 1. restlessness
    • 2. muscle tension
    • 3. avoidance of stressful activities or events
    • 4. increased time & effort required to prepare for stressful sit.
    • 5. seeks repeated reassurance
  189. Results of OCD on pt life?
    compulsions are time-consuming & cause impaired social & occupational functioning
  190. Priority consideration in hoarding disorder?
    can lead to unsafe living environment
  191. Manifestations of acute stress disorder & PTSD?
    ASD:  s/s begin immediately & persist for 3d up to 1mo

    PTSD:  s/s any time after & last more than 1 mo
  192. How do ASD pt re-experience traumatic event?

    PTSD pt?
    • ASD:
    • 1. distress when reminded of event
    • 2. dreams/images
    • 3. flashbacks

    • PTSD:
    • 1. recurrent intrusive recollection of event
    • 2. dreams/images
    • 3. flashbacks, illusions, hallucinations
  193. Manifestations of ASD?
    dissociative s/s:  amnesia of the trauma event, absent emot response, decreased awareness of surroudings, depersonalization

    indications of severe anxiety:  irritability, sleep disturbance
  194. S/S of PTSD?
    indications of increased arousal:  irritability, difficulty with concentration, sleep disturbance

    avoidance of stimuli associated with trauma:  avoiding ppl, inability to show feelings
  195. 4 nursing interventions for anxiety disorders during initial assessment/interview?
    • 1. structured interview to keep pt focused on present
    • 2. assess for substance use
    • 3. perform suicide risk assessment
    • 4. instill hope for positive outcomes
  196. 4 interventions for a pt in acute anxiety crisis?
    • 1. provide safety & comfort
    • 2. remain with pt & provide reassurance
    • 3. provide safe env for other pt & staff
    • 4. postpone health teaching until after subsides
  197. Why should teaching be postponed during acute anxiety crisis?
    pt is unable to concentrate, problem solve, or learn
  198. 4 interventions for ongoing assessment & Tx of anxiety?
    • 1. provide milieu therapy
    • 2. use relaxation techniques for pin, muscle tension, & anxiety
    • 3. enhance SE by encouraging positive statements & discussing past achievements
    • 4. assist pt to ID defense mech that interfere with recovery
  199. Env requirements for anxiety disorders?
    structured, predictable, & safe

    monitor for self-harm

    daily activities that promote sharing & cooperation
  200. Cognitive behavioral therapy for anxiety disorders?
    use cognitive reframing to ID negative thoughts that cause anxiety, find cause, & dev new ways
  201. Behavioral therapies for anxiety?
    teach ways to decrease anxiety or avoidant behavior with diff behavioral therapies
  202. Eye movement desensitization & reprocessing (EMDR)?
    therapy for pt with PTSD - pt focus on separate stimuli with eyes while thinking of or talking about the tramatic event
  203. Meds for anxiety disorders? (4)
    • 1. SSRI & other antidepressants
    • 2. sedative hypnotic anxiolytics
    • 3. nonbarbiturate anxiolytics
    • 4. others:  beta blockers, antihistamines, & anticonvulsants may be used
  204. First line of Tx for trauma & stressor-related disorders?
    SSRI
  205. Sedative hypnotics?

    How long are they used in anxiety disorders?
    benzos

    short-term use only
  206. EX of nonbarbiturate anxiolytic?
    buspar/buspirone
  207. What may anticonvulsants be used for in anxiety disorders?
    mood stabilizers
  208. Depression may be comorbid with what 5 conditions?
    • 1. substance abuse
    • 2. anxiety
    • 3. psychotic disorders (schizo)
    • 4 eating disorders
    • 5. personality disorders
  209. Depression = increased risk for suicide especially if have what 6 risk factors?
    • 1. family or personal Hx of attempts
    • 2. comorbid anxiety disorder
    • 3. cormorbid substance use or psychosis
    • 4. poor SE
    • 5. lack of social support
    • 6. chronic medical condition
  210. Major depressive disorder (MDD)?

    8 s/s of MDD?
    single or recurrent episodes of depression (with no mania) that causes change in pt normal functioning accompanied by at least 5 other associated s/s

    • 1 depressed mood
    • 2. difficulty or excessive sleeping
    • 3. indecisiveness
    • 4. decreased ability to concentrate
    • 5. suicidal ideation
    • 6. increase or decrease in motor activity
    • 7. inability to feel pleasure
    • 8. increase or decrease in weight or more than 5% of body weight over 1 month
  211. 3 more specific classifications of MDD?
    • 1. MDD with psychotic features
    • 2. MDD postpartum onset
    • 3. MDD - SAD
  212. Char of MDD with psychotic features?
    MDD with auditory hallucinations or delusions
  213. Char of MDD postpartum onset?

    Risk for ____?
    begins w/in 4 wks of childbirth & may include delusions

    harming newborn r/t delusions
  214. Char of MMD - SAD?
    occurs during winter & may be Tx with light therapy
  215. Dysthymic disorder?
    milder depression that usually has early onset & lasts at least 2 years for adults or 1 year for children

    has at least 3 s/s of depression and may dev into MDD
  216. Premenstrual dysphoric disorder PMDD is asso with the ____ phase of the menstrual cycle.

    Primary s/s (3)?

    3 other s/s?
    asso with luteal phase of the menstrual cycle

    primary:  mood lability, persistent/severe anger, & irritability

    other:  lack of energy, overeating, & difficulty concentrating
  217. Char of acute phase of depression?

    How long does Tx usually last?

    Potential need for _____.

    Goal of Tx?
    6 to 12 wks

    hospitalization

    reduction of depressive manifestations
  218. Interventions for acute phase of depression?
    • assess suicide risk
    • implement safety precautions or one-to-one observation prn
  219. Continuation phase of depression char?

    How long does Tx usually last?

    Goal of Tx?
    increased ability to function

    4 to 9 months

    relapse prevention through education, meds, & psychtherapy
  220. Maintenance phase of depression char?

    How long may this phase last?

    Goal of Tx?
    remission of manifestations

    may last years

    prevention of future episodes
  221. Risk factors for depression?

    Most important risk factor?
    • 1. family Hx & previous personal Hx is most imp risk factor
    • 2. females age 15 to 40
    • 3. pt over age 65
    • 4. pt with NT deficiencies
    • 5. stressful life events
    • 6. presence of med illness
    • 7. postpartum period
    • 8. poor social support
    • 9. comorbid substance use
    • 10. being unmarried
  222. Why is depression harder to recognize in elderly?  Imp intervention?
    may mimic s/s of aging or dementia
  223. S/S of depression that may look like dementia?
    • memory loss
    • confusion
    • behavioral probs (social isolation, agitation)
  224. Pt with depression may seek health care for ____ probs that are s/s of untreated depression.
    somatic
  225. 2 NT deficiencies that may cause depression?

    What do each affect?
    serotonin - mood, sexual behavior, sleep cycles, hunger, & pain perception

    NE - attention & behavior
  226. 6 subjective s/s of depression?
    • 1. anergia - lack of energy
    • 2. anhedonia - lack of pleasure
    • 3. anxiety
    • 4. sluggishness (most common) or unable to relax or sit still
    • 5. vegetative findings:  cahnge in eating patterns, bowel habits, and sleep & decreased interest in sex
    • 6. somatic reports
  227. What eating disturbance usually occurs with MDD?
    anorexia
  228. What eating prob usually occurs with dysthymic disorder and PMDD?
    overeating
  229. What somatic s/s may occur with depression?
    fatigue, GI probs, pain
  230. 5 objective s/s of depression?
    • 1. affect- sad & blunted
    • 2. poor grooming/hygiene
    • 3. psychomotor retardation or agitation
    • 4. socially isolated
    • 5. speech:  slowed, decreased, delayed response:  may seem too tired to speak
  231. 2 important assessments for depressed pt?
    • 1. suicide risk
    • 2. self care abilities
  232. 3 interventions for comm with depressed pt?
    • 1. be with pt even if he does not speak
    • 2. make observations rather than asking direct questions
    • give pt sufficient time to respond - may have delayed response time
  233. Councel depressed pt to assist with what 6 things?
    • 1. prob solving
    • 2. increasing coping
    • 3. changing negative thinking
    • 4. increasing SE
    • 5. assertiveness
    • 6. using avail comm resources
  234. 5 things to teach pt on ANY antidepressant?
    • 1. do not d/c med suddenly
    • 2. ther effects are not immediate - may take several weeks
    • 3. avoid hazardous activities r/t sedation possibility
    • 4. notify provider of any thoughts of suicide
    • 5. avoid alcohol
  235. 6 SSRIs?
    celexa, lexapro, paxil, zoloft, paxil, luvox
  236. 5 AE of SSRIs?
    • 1. N
    • 2. HA
    • 3. CNS stimulation - agitation, insomnia, anxiety
    • 4. sexual dysfunction
    • 5. weight gain with long-term
  237. Important AE to look for r/t SSRIs?

    S/S?
    serotonin syndrome

    usually occurs w/in hours of taking new Rx or increasing dose:  s/s of stimulation CNS

    • 1. increased HR & BP
    • 2. pupil dilation
    • 3. confusion, agitation, restlessness
    • 4. shivering & goose bumps
    • 5. heavy sweating
    • 6. diarrhea
    • 7. HA
  238. What OTC med should be avoided while taking an SSRI?

    Why?
    St John's Wart

    can increase chance of serotonin syndrome
  239. Diet with SSRI?
    need healthy diet r/t possible weight gain with long-term therapy
  240. Tricyclic antidepressants? 6
    all ines or ins (some of these are MAOIs too)

    amitriptyline, imiprimine, clomiprimine, desipramine, doxepin, nortriptyline,
  241. AE of tricyclic antidepressants?
    • 1. orthostatic hypotension
    • 2. tachycardia and dysrrhythmias
    • anticholinergic s/s:
    • 3. dry mouth & nose
    • 4. blurred vision (pupil constriction)
    • 5. slowed GI motility
    • 6. cognitive &/or memory impairment
    • 7. urinary retention
    • 8. increased body temp
  242. Interventions for AE of tricyclic antidepressants?
    • 1. ortho hypotension - change positions slowly
    • 2. dry mouth - chew sugarless gum
    • 3. constipation - fiber & 2 - 3 L fluid/day
  243. MAOIs list?
    • 1. nardil
    • 2. marplan
    • 3. emsam
    • 4. parnate
  244. What will occur if pt on MAOI eats tyramine?

    Foods that contain tyramine?
    hypertensive crisis may occur

    avocados, figs, fermented or smoked meats, liver, dried or cured fish, most cheeses, some beer & wine, & protein dietary supplements
  245. OTC meds that may be taken with MAOIs?
    no new meds should be taken without discussing with MD r/t high risk for interactions
  246. Atypical antidepressant list? 4
    • bupropion - Wellbutrin
    • remeron
    • trazodone
    • nefazodone
  247. 8 AE of atypical antidepressants to educate pt about? 

    When should pt call MD?
    HA, restlessnes, insomnia, dry mouth, GI distress, constipation, increased HR, N

    if AE become unbearable
  248. What needs to monitored if pt is taking atypical antidepressant?
    weight & food intake - can cause decreased appetite
  249. Atypical antidepressants are CI in what pt?
    seizure pt
  250. Serotonin Norepinephrine Reuptake Inhibitors list? (SNRI) 3
    cymbalta, effexor, & pristiq
  251. AE of SNRI?
    N, weight gain, sexual dysfunction
  252. Interpersonal therapy for depression (IPT) focuses on what?
    focus on personaly relationships that contribute to the depressive disorder
  253. 2 alternative therapies for depression?
    • 1. st johns wart
    • 2. light therapy
  254. A of St john's wort? (5)
    • 1. photosensitivity
    • 2. skin rash
    • 3. rapid heart rate
    • 4. GI distress
    • 5. abd pain
  255. Medication interactions with St John's wart?
    may increase or decrease levels of some drugs

    can increase serotonin syndrome with SSRI

    may interact with tyramine
  256. First-line therapy for SAD?

    Effect?
    light therapy

    inhibits nocturnal secretion of melatonin
  257. Who must monitor a pt that undergoes ECT before & after?
    specially trained nurse
  258. Exercise and depression?
    30 min 3-5 X per week can decrease depression
  259. When does bipolar disorder usually get Dx?
    early adulthood/adol

    may be Dx in children but hard to Dx because similar to ADHD
  260. Acute phase of bipolar?

    ____ and/or ____ supervision may be indicated.

    Goals of Tx?

    What is risk that needs assessed?
    acute mania

    hospitalization and/or one to one supervision

    reduction of mania & pt safety

    risk of harm to self or others must be det
  261. Continuation phase of bipolar char?

    Tx duration?

    Goal of Tx?
    remission of s/s

    4 to 9 mo

    relapse prevention
  262. Maintenance Tx for bipolar length?

    Goal of Tx?
    lifetime

    prevent mania episodes
  263. Hypomania?

    Require hospitalization?
    less severe mania episode that lasts at least 4 days accompanied bvy 3 to 4 findings of mania

    no
  264. Char & Tx of mixed episode of bipolar?
    marked impairment in functioning and may require admission to facility
  265. Rapid cycling in bipolar?
    4 or more episodes of acute mania w/in 1 year
  266. Bipolar I?
    at least one episode of mania alternating with major depression
  267. Bipolar II?
    one or more hypomanic episodes alternating with major depressive episodes
  268. Cyclothymia?
    at least 2 years of repeated hypomanic manifestations that do not meet criteria for hypomanic episodes alternating with minor depressive episodes
  269. 4 comorbidities asso with bipolar?
    • 1. substance use
    • 2. anxiety
    • 3. eating disorder
    • 4. ADHD

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