Mental Health exam 3 study guide PDF

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Exam 3 Mental Health study guide...

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Mental Health Study Guide Exam III (week 8 & 9) Standards Screening Tools CAGE Questionary AUDIT DAST or DAST-A CIWA-Ar)

Ask questions to the client to determine how they perceive they current alcohol use. Alcohol use disorders identification test Drug Abuse screening test (DAST-A adolescent’s version) Clinical institute withdrawal assessment of alcohol scale, revised)

“Overdose & Withdrawal” There are two types of abuse Drugs. Upper Caffeine Cocaine PCP-LST (Hallucinogens) Methamphetamine Adderall Uppers make you go up Overdose (expected findings) Tachycardia Irritability Diarrhea Seizure** (high priority) Restlessness Hyperreflexia Withdrawal (expected Findings) “Too little upper makes everything goes down” Bradycardia Lethargic Respiratory distress Hyporeflexia Coma** (high priority)

Downer CNS Depressants Sedatives, hypnotics, anxiolytics (if is not an upper is a downer) (Alcohol, Cannabis, Tobacco) Downers make you go down Overdose (expected findings) Bradycardia Lethargic Respiratory distress Hyporeflexia Coma** (high priority)

Withdrawal (expected Findings) “Too Little downers makes everything go up” Tachycardia Irritability Diarrhea Seizure** (high priority) Restlessness Hyperreflexia

Nursing Care: Maintain safe environment to prevent falls, seizure precautions, as necessary. Low-stimulation environment. Provide close observations for withdrawal manifestation, possible one-on-one supervision (restrains last resource) Orient client, person, time, and place. Maintain adequate nutrition and fluid balance. Administer medications as prescribed (to treat intoxication or prevent or treat withdrawal) Patient Education: Teach client indicators of relapse, cognitive-behavioral techniques to maintain sobriety and create feelings of pleasure from activities. Assist patient to develop communication skills to communicate with other while sober. Encourage patient and family to attend a 12-step Program (AA)

Alcohol Withdrawal Syndrome (AWS) VS Delirium Tremens (DT) AWS DT Manifestations start 4 to 12hrs of the last intake of alcohol and can continue 5 to 7 days. Every Alcoholic goes through AWS. Is not life threatening. Patients with AWS are not a danger to themselves or others.

Intervention Room Diet Liberty Restrains Antihypertensives Meds Tranquilizers Meds Multi Vit (prevent Wernicke’s)

Nicotine Gum: Chew slow & intermittently over 30 min. Avoid eating/drinking 15 min prior to and while chewing nicotine gum. Not recommended for use longer than 6 months. Nicotine Inhalers: Avoid in asthmatic patients. Gradually taper nicotine inhaler uses over 2 to 3 moths & d/c. Nicotine Spray: One spray in each nostril delivers the amount of nicotine in one cigarette. Follow

Manifestations can occur 2 to 3 days after cessation of alcohol. Only minority get DT. Can kill you. Patients with DT are dangerous to other and themselves.

Nursing Intervention with AWS & DT AWS Semi-Private Room, Any Location Regular Diet Up at Liberty No Restrains Yes Yes Yes

DT

Private Room, closed to nurse station Clear Liquid diet, NPO ***(Risk for aspiration) Restricted to bedrest without bathroom privileges Use Restrains (Vest or 2 points) Yes Yes Yes

Nicotine Patch: Apply in the morning and removed 16hrs later. Avoid using any nicotine product while using the patch. Nightmares and sleep disturbance can occur. Remove patch prior to an MRI. Nicotine lozenges: Avoid eating/drinking 15 min prior to and while nicotine lozenges are use. Allow the lozenges to slowly dissolve in the mouth. (20 to 30 min) Limit use to 5 in 6hrs period time. (max of 20 per Day)

instructions for dosage of nasal frequency.

Medications Medication

Intended Effects

Nursing Action ALCOHOL

Patient Education

***Abstinence Maintenance *Disulfiram

Aversion behavioral therapy Onset of duration of effectiveness ***2 weeks

Monitor LFT

Naltrexone

Suppress craving and pleasurable effects of alcohol. (also use for opioid withdrawal) PO TID. Helps with effect of abstinence.

Concurrent use increases risk for opioid toxicity. Suggest monthly IM injection for pt.’s not compliant with treatment Monitor Fluid/electrolyte imbalances.

Benzo Chlordiazepoxide Phenobarbital Carbamazepine Clonidine Propranolol Atenolol

Decreases risk of seizure. Decreases Withdrawal manifestations. Substitution therapy during alcohol withdrawal. Carbamazepine: *Decreases seizure. Propranolol/atenolol: *Decreases Cravings Propranolol/atenolol/clonidine: *decreases BP & HR

Administer Around-the-clock or PRN Vital signs & neurologic status Seizure precautions Seizure precautions Monitor vital signs. Check HR prior to propranolol administration, withhold if is less than 60/min.

Methadone Substitution

Replaces the opioid to which the pt. has a physical dependence. Prevents abstinence syndrome, used for withdrawal and long-term maintenance. Withdrawal effects related to autonomic hyperactivity (nauseas, vomiting & diarrhea) ***DOES NOT REDUCE CRAVINGS FOR OPIOIDS Decrease cravings. (use for withdrawal & maintenance therapy)

Encourage the pt. to participate in 12-steps program.

Inform the pt. that the medication must be administered by an approved treatment center.

Baseline Vital Signs

Avoid activities that required mental alertness until drowsiness subside. Chew sugarless gum, hard candy, and sip small amounts of water to help with the dry mouth. Administer medication sublingual.

Acamprosate

Wear medical alert bracelet, avoid use or contact with any products that contain alcohol. can cause: (Nauseas, Vomiting & Death) Take it with meals to decrease GI distress. Avoid use during Pregnancy. Diarrhea can result. Maintain adequate fluid intake to prevent dehydration.

***Withdrawal

OPIOIDS

Clonidine Naltrexone

Buprenorphine

Unlike methadone, this drug can be prescribed by Primary care provider.

NICOTINE Bupropion

Decreases cravings & manifestations of withdrawal.

Varenicline

Reduce cravings and withdrawal manifestations. DO NOT USE ON: **Commercial truck or bus drivers **Air traffic Controllers **Airplane Pilots

Alcohol products to avoid: Mouth wash, Cologne or Perfume, Aftershave, OTC Med containing **elixir., Insect repellent, Vanilla extract, Vinaigrettes, Hand sanitizer.

Monitor BP during treatment Monitor pt.’s w/ Diabetes. (loss of glycemic control) Careful titrate minimizing adverse effect. Can cause neuropsychiatric effects. (unpredictable behaviors, mood changes, and thoughts of suicide)

Wernicke’s (Korsakoff’s) Syndrome Psychosis induced by Vit B1 (thiamine) Deficiency.

Avoid CNS stimulants to prevent insomnia. Chew sugarless gum, hard candy, and sip small amounts of water to help with the dry mouth. Take medications after meals. Notify Dr. if: *Nausea *Vomiting *Insomnia *New-onset Depression *Suicidal thoughts

Wernicke’s (Korsakoff’s) Syndrome Characteristics:

Primary Symptoms: Amnesia (memory loss) Confabulation (make up stuff) Therapeutic Communication: “Re-direct” “DO NOT present Reality.”

Preventable: by taking Vit B1 Arrestable: by taking Vit B1. Irreversible: Kill Brain Cells

Somatic Symptom Disorder Form of mental illness where the patient experiences physical manifestations that are the result of psychological factors. ***no underlying physical pathology. Related: “Conversion Disorder” & “Illness Anxiety Disorders” Risk Factors -Female gender, -Teen/young adult -Childhood: *trauma *neglect *abuse -Mental illness *depression *anxiety *personality disorders -Recent stressful event -Learned helplessness

Expected Findings Somatic Manifestations (SM) -SM that disrupts the pt.’s daily life -Excessive Preoccupation about SM Level of anxiety about SM -SM usually present longer than 6 moths. -Remission/Exacerbations of SM -Pt. overmedicated with analgesics & antianxiety Meds. -Common physical somatic symptoms *cramps, backache & pain related symptoms *fatigue *nausea

Factitious Disorder or Munchausen Syndrome Factitious Disorder imposed on another or Munchausen Syndrome Nursing Care: Avoid confrontation. Build rapport/trust with patient. Ensure safety of vulnerable person. Communicate of factitious disorder to the health care team.

Nursing Care -Acknowledge symptoms as being real to the patient. -Reattribution tx: *help pt. find link between psychological factors &physical manifestations. -Assess for suicidal ideation and/or thought of selfharm -Encourage: *Independence in self-care *physical activity *verbalization of feelings **LIMIT AMOUNT OF TIME TALKING ABOUT SM**

Reattribution of Tx. Stage 1: Feeling understood Use therapeutic communication, active listening & empathy to assess the pt. Stage 2 Broadening the Agenda Provide acknowledgement of pt.’s concern & provide feedback about assessment. Stage 3 Making the Link Use therapeutic communication to let the pt. know the lack of physical cause. Stage 4 Negotiating treatment Work with Dr/Pt. to develop tx. Plan. Allows for regular follow-up visits

Form of mental illness that drives an individual to report non-existent physical or psychological symptoms to fill an emotional need for attention. An individual deliberately cause injury/illness to get vulnerable person in other to get attention (or get relief from responsibility) Malingering: Not a mental illness. Exaggeration or lying about symptoms to scape duty/work or collect disability

Anger, Aggression & Hostility Anger *Perceived as a negative feeling. *Feeling anger at appropriate times is normal. *Anger becomes a negative response when denied, suppressed, or expressed. *Anger that is expressed inappropriately can become “Hostility and Aggression”. *Anger can lead to physiologic issues such as CAD & HTN.

Related Disorders Depression Bipolar Schizophrenia Anxiety Intermittent explosive disorder Acting out

Nursing Actions

Anger Management

*Identify how you handle angry feelings: assess your use of assertive communication and conflict resolution. *Increasing your skills in dealing with your angry feelings will help you to work more effectively with patients. *Discuss situation or the care of potentially aggressive patients with experienced nurses. *Do not take the patient’s anger or aggressive behavior personally or as a measure of your effectiveness.

*Provide Safe environment. (for pt. & others) *Encourage pt. to express feeling verbally. *Provide for as much personal space as possible. *Sit/Stand at eye level, maintain eye contact. *Set Limits. Present options clearly and inform pt. of consequences of behavior. *Encourage physical activity to deescalate anger. *Provide meds if limit setting is not effective. *Have 4-6 staff members visible as “show of force” & to assist if is necessary.

Anger phases: Triggering Phase: An incident or situation that precedes or initiates the episode of aggression. Escalation Phase: Response represents escalating behaviors such as clenched fists, threading behaviors, flushed face, yelling & sweating. Crisis Phases: Loss of control. The pt. may throw object, hit, spit, scream or presents as out of control. Recovery Phase: Regain of physical & emotional control. The pt. become calm, voice will lower, communication may become clearer more rational. Post-Crisis Phase: Returns to functional level and attempts reconciliation.

Care Planning Nanda Statement: *Risk for other-directed violence & ineffective coping Expected Outcome: *Pt. will not harm self or others *Pt. will remain free of behaviors that are threatening to self or others. *Pt. will verbalize feelings and concerns without aggression. *Pt. will comply with treatment. Interventions: *Managing the environment and allowing the pt. to openly express feelings in non-threating way. *Managing aggressive behavior by approaching the pt. in a nonthreatening way during the triggering phase. Convey empathy. Assertive communication: *Use “I” statements.

Disorder Conduct Disorder: Persistent behavior in children or adolescents that violates the rights of others and disregards societal norms

Oppositional Defiant Behavior: Disorder in a child or adolescent characterized by defiant behavior against authority figures, such as parents or teachers.

Risk Factors Neglect or abuse by parents Large family size Lack of supervision Difficult temperament as a baby

Treatment

Treatment is aimed at treating the underlying cause of aggression: Bipolar Disorder: Lithium Dementia/Psychosis/Personality Disorder: Carbamazepine & Depakote Mental Retardation/dementia/Brain injury/Personality Disorder: Risperidone Dementia (reduce hostility) Benzodiazepines. Psychosis: Haloperidol & Lorazepam

Manifestations Bullying behaviors Recklessness Volatile temperament Cruelty towards animals or other people Destroys property. Lies and steals. Low self-esteem **Suicide ideation. Disobedience Hostility Stubbornness Argumentative Limit testing Refusal to compromise or take responsibility for misbehavior.

Intervention: Reduce environmental stimuli. Use calm firm approach. Provide short and clear expectations. Set clear limits for behaviors. Incorporate physical activities to help child use energy. Model and reward acceptable behavior....