Mental Health ATI Remediation PDF

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ATI Mental Health Proctored Remediation...

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Stefanie Teyer Spring 2021 Mental Health ATI Remediation 

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Depressive Disorders: Priority Findings to Share with Treatment Team o Depression is a mood affective disorder that is widespread issue, ranking high among causes of disability. o Clients who have a depression have a potential risk for suicide, especially if they have a family or personal history of suicide attempts, comorbid anxiety or panic attacks. o Interprofessional care: psychotherapy by a trained therapist can include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), group therapy and family therapy. CBT assists the client to identify and change negative behavior and thought patterns. IPT encourages the client to focus on personal relationships that contribute to the depressive disorder. Eating Disorders: Manifestations of Anorexia Nervosa o Persistent energy intake restriction leading to significantly low body weight in context of age, sex, development path and physical health. o Fear of gaining weight or becoming fat. o Disturbance in self-perceived weight or shape. o Characteristics: Client is preoccupied with food and rituals of eating, along with voluntary refusal to eat. o Occurs more often in females from adolescence to young adulthood. o Restrictive type: individual drastically restrict food intake. o Binge-eating/purging: individual engages in binge eating or purging behaviors. Higher rates of impulsivity and are more likely to abuse drugs and alcohol. Neurocognitive Disorders: Making Room Assignments o Nursing interventions are focused on protecting the client from injury, as well as promoting client dignity and quality of life. o Provide safe and therapeutic environment.  Assess for potential injury, such as falls or wandering.  Assign the client to a room close to the nurses’ station for observation.  Provide a room with low level of visual and auditory stimuli.  Provide well-lit environment, minimizing contrasts and shadows.  Use monitors and bed alarm as needed.  Use restraints only as an intervention of last resort.  Use caution when administering medications PRN for agitation or anxiety.  Assess the client’s risk for injury and ensure safety in the physical environment, such as a lowered bed. Neurocognitive Disorders: Priority Assessment for a Client Who Has Delirium o Risk factors for delirium:

Delirium has a rapid onset, over short period of time, impairment in memory, judgement, ability to focus, and ability to calculate, which can fluctuate throughout the day. Disorientation and confusion are often worse at night and early morning. Level of consciousness is usually altered and can rapidly fluctuate.  Four types of delirium: hyperactive with agitation and restlessness, hypoactive with apathy and quietness; mixed, having a combination of hyper and hypo manifestations; unclassified for those whose manifestations do not classify into the other categories. Child Safety: Use of Restraints on a Child o Prescriptions allow only 4 hours of restraints on an adult, 2 hours for clients ages 9-17, and 1 hour for children under 9. Neurocognitive Disorders: Risk Factors for Delirium: o Physiological changes, including neurologic (Parkinson’s, Huntington’s), metabolic (hepatic or renal failure, fluid and electrolyte imbalances), and cardiovascular and respiratory diseases, infections, and substance abuse or withdrawal. o Delirium can have similar symptoms to neurocognitive disorders. Anger Management: Intervention for a Client Who is Exhibiting Aggression o Anger is a normal feeling, an emotional response to frustration as perceived by the individual. o Anger becomes negative when it is denied, suppressed, or expressed inappropriately with aggressive behavior. o Steps to handle aggressive behavior:  Respond quickly  Remain calm and in control  Encourage the client to express feelings verbally, using therapeutic communication techniques  Allow the client as much personal space as possible  Maintain eye contact and sit or stand at the same level as the client  Communicate with honesty, sincerity, and nonaggressive stance  Avoid accusatory or threatening statements.  Describe options clearly and offering choices  Setting limits for the client Substance Use and Addictive Disorders: Identifying manifestations of Alcohol Use Withdrawal o Manifestations include abdominal cramping, vomiting, tremors, restlessness and inability to sleep, increased heart rate, transient hallucinations or illusions, anxiety, increased blood pressure, respiratory rate and temperature, and tonicclonic seizures. o Alcohol withdrawal delirium can occur 2-3 days after cessation of alcohol. This is considered a medical emergency. Manifestations include severe disorientation, psychotic manifestations, severe hypertension, cardiac dysrhythmias, and delirium. Alcohol withdrawal delirium can progress to death. 

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Effective Communication: Encouraging Expression of Feelings o Encourage expression of feelings with effective communications skills and techniques therapeutic communication. o The nurse should use interactive, purposeful communication to elicit and attend to the client’s thoughts, feelings, concerns and needs; express empathy and genuine concern for the client’s and family’s issues; obtain information and give feedback about the client’s condition; intervene and promote functional behavior and effective interpersonal relationships. Depressive Disorders: Recommendations to Decrease Social Isolation o Use milieu therapy with depressed patients o Assess client’s risk for suicide and implement suicide precautions o Monitor the client’s ability to perform ADLs and encourage as much as independent as possible. o Make time to be with the client, even if they do not speak. o Give client sufficient time to respond when holding a conversation due to a delayed response time. Medications for Bipolar Disorders: Adverse Effects of Lamotrigine o Adverse effects include double or blurred vision, dizziness, headache, nausea and vomiting. o Activities that require concentration or visual acuity should be avoided. o If a rash occurs, withhold medication and inform provider. o To reduce risk of rash, start with low dose and slowly increase it. Medications for Anxiety and Trauma- and Stressor-Related Disorders: Reportable Laboratory Results o Hyponatremia, especially in older adult clients taking diuretics o Obtain baseline blood sodium, and monitor levels periodically throughout treatment o MAOIs should not be used with warfarin  Monitor PT and INR levels  Assess for indications of bleeding and the need for dosage adjustment....