Kaplan mental remediation PDF

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Student Name: Chloe Nakamoto Integrated Test: Psychosocial B

Date: 4/23/19 Course: UNRS 310

Q # 1

Nursing Process Planning

Clinical Concept Health promotion and maintenance

Diagnose

Meeting client needs: psychosocial

2

Level of Difficulty Setting priorities

Understanding Concepts

Remediation Mental Health: Suicide A self-destructive client is the highest priority when protecting clients from inflicting harm on themselves. Indicators include any sudden change in the client’s behavior, becoming energetic after a period of severe depression, or improved mood after taking an antidepressant. This also includes plans, weapons, or giving away possessions. As a nurse, ask the client directly if they are considering suicide and determine appropriate emergency measures. Growth Development: School-Aged Child Some problems are expected as part of normal growth and development. Examples are dishonest behaviors. Interventions include role modeling and honesty by parents. Some problems indicate serious psychiatric disturbances such as fear of using school bathrooms, which leads to new-onset constipation. Encourage children establish a regular toilet time after a meal when the child is not hurried, and encourage diet high in fiber.

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Setting priorities

Assessment

Meeting client needs: physical

6

Making nursing judgments

Planning

Therapeutic procedures

Alzheimer Disease It is a chronic, progressive, degenerative disease resulting in cerebral atrophy, decline in intellectual/cognitive functioning, motor and sensory functioning, and affect Most common after 65 years of age. Indications include changes in personality, motor restlessness, and pacing. Nursing care includes reorient as needed, speak slowly, provide clocks and calendars in room, promote sleep, hygiene, grooming and nutrition, promote safety and protect from self-injury, encourage social interaction, and assist family to understand and cope. Substance Abuse Substance abuse is the overindulgence in or dependence on addictive substance; alcohol, drugs, prescriptions for self or others, over the counter medications, or herbal supplements. Cocaine or Crack Cocaine: stimulant; routes: intravenous, intranasal, smoking, highly addictive, tolerance develops rapidly. Heroin is derived from opioids; obtained from illegal sources; injected IV, snorted/sniffed or smoked; leads to inability to maintain employment, marriage, and

care/responsibility of children. LSD is a hallucinogen, alters perception, cognition, mood in short period; LSD hallucinogenic experience is called "trip"; often referred to as "Acid" Marijuana: indications: injected (reddened) conjunctivae, tachycardia, dry mouth, increased appetite, especially for "junk" food. PCP is Angel dust; developed as animal anesthetic; smoked, taken orally, injected IV; indications: hallucinations, psychotic or violent behavior, hypertension, tachycardia, a blank stare, rigid muscles, ataxia, nystagmus, seizures, respiratory failure and death. 7

Making nursing judgments

Evaluation

Meeting client needs: psychosocial

Alzheimer Disease It is a chronic, progressive, degenerative disease resulting in cerebral atrophy, decline in intellectual/cognitive functioning, motor and sensory functioning, and affect Most common after 65 years of age. Indications include changes in personality, motor restlessness, and pacing. Nursing care includes reorient as needed, speak slowly, provide clocks and calendars in room, promote sleep, hygiene, grooming

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Recalling/recognizing information

Implementation

Communicatio n

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Making nursing judgments

Assessment

Meeting client needs: psychosocial

and nutrition, promote safety and protect from self-injury, encourage social interaction, and assist family to understand and cope. Mental Health: Schizophrenia Spectrum Schizophrenia is a chronic illness resulting in psychotic behavior. This includes hypochondriasis, depersonalization, regression, and an inability to meet basic survival needs. Schizoaffective disorder is the observable bodily expression of emotions of a person; commonly used terms for affect: Flat, blunted, inappropriate, labile. Catatonic Schizophrenia is usually pronounced decrease in amount of movement, client may not move for hours on end; maintain client safety and protect from altered through processes and inappropriate behavior. Mental Health: Personality Disorders This is the one on one interactions between persons; occurs when behaviors become dysfunctional and are unable to be changed; maladaptive behavioral adaptation affecting the way individuals view the world and respond to those around them. Antisocial is pervasive pattern of disregard for and violation

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Setting Priorities

Assessment

Meeting client needs: psychosocial

of the rights of others. Borderline personality disorder is difficulty maintaining interpersonal relationships and selfimage. Dependent is pervasive and excessive need to be taken care of leading to submissive and clinging behavior and fear of separation. Narcissistic is pervasive pattern of grandiosity, need for admiration, lack of empathy. Paranoid are behaviors of mistrust and suspiciousness of others; client holds belief of being singled out for unfair treatment. Manipulative is purposeful behavior directed at getting one's own needs met without regard to needs, feelings and goals of others; treating others as objects; may be part of antisocial personality. Mental Health: Bipolar Disorder It is a mood disorder with swings between mania and depression. Manic episodes usually begin suddenly, with rapid escalation. Treatment includes lithium or anticonvulsants, or lamotrigine. Mania is part of the bipolar disorder with elevated mood and behaviors. Mood disorders are illness in which clients experience wide extremes in change of mood and affect.

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Recalling/Recognizin g information

Diagnose

Meeting client needs: psychosocial

20

Understanding concepts

Planning

Therapeutic procedures

Mental Health: Schizophrenia Spectrum Schizophrenia is a chronic illness resulting in psychotic behavior. This includes hypochondriasis, depersonalization, regression, and an inability to meet basic survival needs. Schizoaffective disorder is the observable bodily expression of emotions of a person; commonly used terms for affect: Flat, blunted, inappropriate, labile. Catatonic Schizophrenia is usually pronounced decrease in amount of movement, client may not move for hours on end; maintain client safety and protect from altered through processes and inappropriate behavior. Mental Health: Anxiety Disorders Displacement is transferring one's feelings from one target to another considered less or not threatening. OCD is repetitive, uncontrollable through and actions. Panic Attacks are sudden onset of extreme apprehension or fear. Phobic disorders are persistent irrational fears of an activity, object, or situation with desire to avoid or escape. Reaction Formation develops behaviors or emotions opposite from current, unacceptable

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Making nursing judgements

Implementation

Critical thinking

27

Setting priorities

Assessment

Therapeutic procedures

emotions or behaviors. Signal Anxiety involves a known stressor and client's related anxiety. Social Anxiety Disorder is severe anxiety or fear when placed in a social or performance situation. Mental Health: Depression This is an abnormal feeling of sadness, low self-esteem, helplessness, obsessive thoughts and fears, and a sense of doom or failure. Somatic indications include gastrointestinal distress, change in appetite, pain, irritability, sleep disturbances, lack of energy, changes in sex drive, palpitations, and dizziness. Nursing responsibilities include being alert for signs of self-destructive behavior, assisting the client in meeting physical needs, and support self-esteem. Screen adolescents for suicidal risk. Persistent depressive disorder is a chronically depressed mood that present smore than 50% of the time for at least 2 years in adults or 1 year for children. It is characterized by feelings of being chronically sad. Medications: Antidepressant: Reuptake Inhibitors They increase or decrease activity of a particular transmitter

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Making nursing judgments

Implementation

Critical thinking

receptor system. They increase serotonin and norepinephrine. Bupropion is an atypical, decreases reuptake of dopamine in CNS; diminishes uptake of serotonin and norepinephrine; used for smoking cessation. Trazodone is an atypical, causes sedation, hypotension, photosensitivity, bone marrow depression, priapism. SSRI inhibits reuptake of serotonin at the 5-HT receptors, potentiates effects of serotonin in CNS; used for depression, OCD, panic, disorder, social phobia, generalized anxiety, PTSD, premenstrual dysphoric disorder, bulimia nervosa. Escitalopram: stops MAOI at least 14 days before starting. Fluvoxamine: SE: Seizures, constipation Sertraline: SE: taste changes, upper respiratory infection, dysmenorrhea, weight loss. SNRI: prevents epinephrine transfer by presynaptic nerve ending. Venlafaxine is SE: diaphoresis; administer with food. Mental Health: Suicide A self-destructive client is the highest priority when protecting clients from inflicting harm on themselves. Indicators include any sudden change in the client’s behavior,

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Setting priorities

Implementation

Critical thinking

30

Making nursing judgments

Implementation

Meeting client needs: psychosocial

becoming energetic after a period of severe depression, or improved mood after taking an antidepressant. This also includes plans, weapons, or giving away possessions. As a nurse, ask the client directly if they are considering suicide and determine appropriate emergency measures. Mental Health: Eating Disorders Anorexia is more common in females 8-18 years; dramatic weight loss, distorted body image, fear of obesity, anemia, amenorrhea, endocrine dysfunction, hypothermia, electrolyte imbalance, gastric complications, denial/fear of sexuality, repression and regression, strained family relationships, feelings of powerlessness, overachievement, and depression. Bulimia is binge eating behaviors frequently followed by self-induced vomiting, and laxative or diuretic use. Mental Health: Schizophrenia Spectrum Schizophrenia is a chronic illness resulting in psychotic behavior. This includes hypochondriasis, depersonalization, regression, and an inability to meet basic survival needs. Schizoaffective

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Recalling/Recognizin g information

Implementation

Therapeutic procedures

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Understanding concepts

Implementation

Meeting client needs: psychosocial

disorder is the observable bodily expression of emotions of a person; commonly used terms for affect: Flat, blunted, inappropriate, labile. Catatonic Schizophrenia is usually pronounced decrease in amount of movement, client may not move for hours on end; maintain client safety and protect from altered through processes and inappropriate behavior. Attention Deficit Hyperactivity Disorder (ADHD) This is an inappropriate degree of inattention, impulsiveness, and hyperactivity. Behaviors include a short attention span, inattention to detail, lack of follow-through, forgetfulness, fidgeting, excessive talking, constant acting out, and interrupting others. General interventions include behavior modification, medication, psychotherapy, and play therapy. Specific interventions include limit setting, here-and-now focus, give feedback, intervene early, and role model appropriate behaviors. Mental Health: Eating Disorders Anorexia is more common in females 8-18 years; dramatic weight loss, distorted body image, fear of obesity, anemia,

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Setting priorities

Planning

Health promotion and maintenance

44

Making nursing judgments

Evaluation

Therapeutic procedures

amenorrhea, endocrine dysfunction, hypothermia, electrolyte imbalance, gastric complications, denial/fear of sexuality, repression and regression, strained family relationships, feelings of powerlessness, overachievement, and depression. Bulimia is binge eating behaviors frequently followed by self-induced vomiting, and laxative or diuretic use. Mental Health: Crisis Dangerous point in disease process of time frame in life. Stages include denial, increased tension, disorganization, attempt to escape problem/pretend problem does not exist, blame others, general reorganization. Crisis management includes intervention during the crisis to solve, correct or treat the problem; focus on clients immediate problems; explore nurse's and client's understanding of the problem; help client become aware of feelings and validating them. Medications: Antipsychotics Broad spectrum antipsychotics are used for many psychiatric disorders. The first generation are used for schizophrenia and other psychiatric disorders.

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Making nursing judgments

Planning

Meeting client needs: psychosocial

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Understanding concepts

Assessment

Meeting client needs: psychosocial

Nurses must watch for blurred vision, GI distress, rash, dizziness, weight gain, and amenorrhea. Second generation need to be monitored for blood pressure, akathisia, and extrapyramidal symptoms. Use with caution is given with antihistamines or antidepressants. First generation chemical categories include phenothiazines and butyrophenones. Mood Stabilizers Lithium is used for controlling manic episodes or bipolar psychosis. Adverse effects are dizziness, hand tremors, and impaired vision. Normal ranges are 1 to 1.5 mEq/L, maintenance 0.8 to 1.2 and toxicity above 1.5 mEq/L. Nursing considerations include monitoring blood levels 2 to 3 times a week when started monthly. Maintain levels below 1.5 mEq/l. Client education includes fluid intake of 2,500 to 3,000 mL/day and adequate salt intake. Mental Health: Anxiety Disorders Displacement is transferring one's feelings from one target to another considered less or not threatening. OCD is repetitive, uncontrollable through and actions. Panic Attacks are sudden onset of extreme

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Understanding concepts

Assessment

Meeting client needs: physical

apprehension or fear. Phobic disorders are persistent irrational fears of an activity, object, or situation with desire to avoid or escape. Reaction Formation develops behaviors or emotions opposite from current, unacceptable emotions or behaviors. Signal Anxiety involves a known stressor and client's related anxiety. Social Anxiety Disorder is severe anxiety or fear when placed in a social or performance situation. Substance Abuse Substance abuse is the overindulgence in or dependence on addictive substance; alcohol, drugs, prescriptions for self or others, over the counter medications, or herbal supplements. Cocaine or Crack Cocaine: stimulant; routes: intravenous, intranasal, smoking, highly addictive, tolerance develops rapidly. Heroin is derived from opioids; obtained from illegal sources; injected IV, snorted/sniffed or smoked; leads to inability to maintain employment, marriage, and care/responsibility of children. LSD is a hallucinogen, alters perception, cognition, mood in short period; LSD hallucinogenic experience is called "trip"; often

referred to as "Acid" Marijuana: indications: injected (reddened) conjunctivae, tachycardia, dry mouth, increased appetite, especially for "junk" food. PCP is Angel dust; developed as animal anesthetic; smoked, taken orally, injected IV; indications: hallucinations, psychotic or violent behavior, hypertension, tachycardia, a blank stare, rigid muscles, ataxia, nystagmus, seizures, respiratory failure and death. 53

Recalling/recognizing information

Diagnose

Meeting client needs: psychosocial

Mental Health: Anxiety Disorders Displacement is transferring one's feelings from one target to another considered less or not threatening. OCD is repetitive, uncontrollable through and actions. Panic Attacks are sudden onset of extreme apprehension or fear. Phobic disorders are persistent irrational fears of an activity, object, or situation with desire to avoid or escape. Reaction Formation develops behaviors or emotions opposite from current, unacceptable emotions or behaviors. Signal Anxiety involves a known stressor and client's related anxiety. Social Anxiety Disorder is severe

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Making nursing judgments

Evaluation

Health promotion and maintenance

58

Making nursing judgments

Implementation

Critical thinking

62

Recalling/recognizing information

Lanning

Meeting client needs: physical

anxiety or fear when placed in a social or performance situation. Setting Limits This is providing boundaries for clients. It is implemented to prevent and/or respond to unclear or inappropriate behaviors and to maximize the therapeutic experience. It clearly conveys expectations, and consequences of not meeting those expectations. It may be verbal, physical, and/or written. Mental Health: Eating Disorders Anorexia is more common in females 8-18 years; dramatic weight loss, distorted body image, fear of obesity, anemia, amenorrhea, endocrine dysfunction, hypothermia, electrolyte imbalance, gastric complications, denial/fear of sexuality, repression and regression, strained family relationships, feelings of powerlessness, overachievement, and depression. Bulimia is binge eating behaviors frequently followed by self-induced vomiting, and laxative or diuretic use. Abuse: Domestic This is manipulation of one’s spouse using emotional abuse, physical abuse, sexual abuse,

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Setting priorities

Planning

Health promotion and maintenance

psychological mistreatment, or financial exploitation. It is punishable by law in all states. An abused partner often acts afraid of the partner and is often afraid to leave the abusive situation. Caregivers need to be aware of potential abuse and ask if any is suspected. Abuse: Child Indications are inconsistency of type or location of injury with the history of the incident; bruises, burns, fractures, especially chip/spiral, severe CNS or abdominal injuries Sexual abuse indications: lacerations, bruises, bleeding, irritations of the genitals, anus, throat or mouth; torn or blood underwear Nursing care: provide for physical needs first, ensure mandatory reporting to supervisor or appropriate agency; engage in nonjudgmental treatment of parents, encourage expression of feelings. Teach growth and development concepts, especially safety, discipline, age-appropriate activities, and nutrition, and support for the child. Engage child in play therapy, do not promise secrecy, do not use leading statements, reassure child that telling was the right

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Making nursing judgments

Assessment

Meeting client needs: psychosocial

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Setting priorities

Implementation

Therapeutic procedures

thing to do. Mental Health: Trauma Related Disorders Dissociation is a defense mechanism that is an altered state of consciousnes...