Mental Health Study Guide 2 Proctored ATI PDF

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Study material and practice questions for the Proctored portion of ATI...

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Mental Health PROCTORED exam Study Guide Chapter 1: Basic Mental Health Mental Status Examination (MSE) 1) Level of consciousness:  Alert  Lethargic: client can open eyes and respond but is drowsy and falls asleep quickly  Stuporous: client requires vigorous and painful stimuli to elicit brief response  Comatose: unconscious – abnormal posturing includes decorticate rigidity and decerebrate rigidity 2) Physical appearance 3) Behavior  Mood: emotion that she is feeling  Affect: objective expression of mood, such as flat affect or lack of facial expression 4) Cognitive and intellectual abilities: orientation, memory, knowledge, calculation, perception of illness, judgment, speech  Immediate memory  Recent memory: visitors from current day, purpose of current appt  Remote memory: fact from past, DOB, mothers name Standardized Screening Tools:  Mini-mental state examination (MMSE): orientation, attention span & count backward by seven, objects, language (naming, commands, writing)  Glascow Coma Scale: baseline LOC – highest score is 15 (awake, alert) or 7 (coma) DSM-5: diagnostic tool to identify mental health diagnoses Chapter 2: Legal and Ethical Issues Beneficence: doing good Autonomy: right to make decisions Justice: fair and equal treatment Fidelity: loyalty and faithfulness Veracity: honesty Restraints: provider must write an order, if renew order they need to rewrite order with type of restraint every 24 hrs  time limits o 18y+: 4hr o 9-17y: 2hr o 8 and younger: 1 hr  complete documentation every 15min; 2 fingers must fit; check circulation; constant one-on-one; NO PRN  NEVER restrain: clients who are extremely physically or mentally unstable or clients who cant tolerate decreased stimulation of seclusion room  assess patient and offer food, fluid, and toilet every 15 min (depends on facility)  monitor vitals, pain  in emergency, get order within 15-30min Assault v Battery – “A before B”  assault: threaten somebody that you will do something  battery: threatening then you actually do it – touching in harmful/offensive way also counts False imprisonment: confining a client to a specific area, such as seclusion room, is false imprisonment if the reason for such confinement is convenience of staff.

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Ch. 3 Effective Communication Intrapersonal communication: “self-talk” Interpersonal communication: one-on-one like nurse asking client Transpersonal communication: spiritual needs such as nurse assisting client with medication for relaxation ADPIE:  Assessment  Diagnose  Planning: identify mutually agreed-upon client outcomes  Implementation: establish a trusting nurse-client relationship  Execute effective:  silence is okay!  okay to used projective questions such as “what if”  okay to use presupposition questions to explore clients life goals and motivations  Clarifying techniques: o restating: uses clients exact words o reflecting: directs focus back to client in order for client to examine feelings o paraphrasing: restates clients feelings and thoughts for client to confirm what has been communicated o exploring: allows nurse to gather more info  offering general leads, broad opening sentences  giving information  presenting reality  touch is ok sometimes some barriers:  no personal opinions  no advice  no false reassurance ex. everything is going to be ok  don’t minimize feelings  don’t change topic  NEVER ASK WHY!!!  no value judgements  no excessive questioning  no closed-ended questions unless its initial interaction to obtain data  don’t respond approvingly or disapprovingly - always stay neutral! Ch 4 Stress and Defense Mechanisms Repression: unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness Displacement: shifting feelings r/t object, person, or situation to another less threatening object, person, or situation Dissociation: creating a temporary compartmentalization or lack of connection between the person’s identity, memory, or how they perceive the environment Projection**: projecting your unacceptable thoughts and feelings on someone else  married woman who is attracted to another man accuses her husband of having affair Denial: pretending the truth is not reality to manage the anxiety of acknowledging what is real Levels of anxiety**  Mild: normal; increase ability to perceive reality*, identifiable cause. Mild discomfort, restlessness, etc. with finger-tapping or foot-tapping, fidgeting, or lip-chewing  Moderate: ability to think clearly is hampered -> difficulty concentrating*, but learning and problem-solving can still occur – increased heart rate, increased respiration rate, change in voice

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o somatic manifestations like headache, body ache, insomnia Severe: perceptual field is greatly reduced (not able to focus on anything except relieving the anxiety) – hyperventilation, tachycardia, loud and rapid speech, aimless activity o not able to take direction from others o ex. sense of impending doom Panic-level: SOB*, markedly disturbed behavior, lose touch with reality, severe hyperactivity or flight, dilated pupils, delusions, hallucinations

Ch 5 Creating and Maintaining Therapeutic and Safe Environment Milieu Therapy: environment that is supportive, therapeutic, and safe Phases and tasks of a therapeutic relationship:  Orientation: set the contract, establish boundaries, discuss confidentiality, build trust, develop/set goals, EXPLORE CLIENTS IDEAS/ISSUES/NEEDS, enforce limits, start the relationship with patient  Working: maintain the relationship, reassess problems and goals and revise plan as necessary  Termination: discussion, summarize goals and achievements Transference*: client views member of health care team as having characteristics of another person who has been significant to the client’s personal life – more likely to occur with a person in authority Countertransference*: health care team displaces characteristics of people in her past onto a client Ch 7 Psychoanalysis, Psychotherapy, and Behavioral Therapies Classical psychoanalysis: therapeutic process of assessing unconscious thoughts and feelings, and resolving conflict by talking to a psychoanalyst – months to years  past relationships are common focus**  help find the CAUSE of the anxiety** Psychoanalysis Therapeutic Tools:  Free association: spontaneous, uncensored verbalization of whatever comes to client’s mind  Dream analysis and interpretation: urges and impulses of the unconscious mind  Transference Cognitive Therapy: focuses on individual thoughts and behaviors to solve current problems (depression, anxiety, eating disorders, other issues that can improve by changing a client’s attitude toward life experiences)  Priority restructuring*  Journal keeping*  Assertiveness training*  Monitoring thoughts* Behavioral Therapy:  Modeling: imitates therapist to improve behavior  Operant Conditioning: positive rewards for positive behavior  Systematic Desensitization**: exposure to events that cause anxiety then practicing RELAXATION techniques  Aversion Therapy**: pairing of a bad behavior with a punishment or unpleasant stimuli to promote change (ex. electric shock, Disulfiram for alcohol use) Biofeedback: behavioral therapy to control pain, tension, and anxiety  uses mechanical device to help gain voluntary control over autonomic such as HR, pulse, BP Flooding: great deal of undesirable stimuli in attempt to turn off anxiety response

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Ch 9 Stress Management Acute Stress (Fight or Flight): apprehension, unhappiness/sorrow, decrease appetite, increase respiratory rate, increase heart rate, increase CO, increase bp, increase metabolism and glucose use, depressed immune system Prolonged Stress (Maladaptive Response): chronic anxiety or panic attacks, depression, chronic pain, sleep disturbances, weight gain or loss, increase risk for MI and stroke, poor diabetes control, hypertension, fatigue, irritability, decrease ability to concentrate, increase risk for infection Ch 10 Brain Stimulation Therapies ECT: Major depressive disorder, Schizo, Acute manic episodes, Bipolar, suicidal THREE TIMES A WEEK, 6-12 treatments meds:  30 min before, give IM of Atropine (antimuscarinic) or Glycopyrrolate to decrease secretions that can cause aspiration and to counteract vagal stimulation (bradycardia)  anesthetic: Methohexital or Propofol via IV bolus  muscle relaxant: Succinylcholine – paralyze muscles/dec injury give oxygen, monitor vitals and mental status before and after, monitor EEG (S/E: cardiac problems), place on side to prevent aspiration – make sure gag reflex is back! S/E: HYPERTENSION, short-term memory loss and confusion, headache, muscle soreness, nausea Education: FASTING bc sedation, will become alert w/n 15min after procedure, not a cure Transcranial magnetic stimulation: noninvasive electromagnetic placed on scalp – alert during procedure  DAILY for 4-6weeks  not associated with systemic adverse effects or neurological deficits Vagus Nerve Stimulation: electrical stimulation through surgically implanted device  S/E: voice changes, hoarseness, throat or neck pain, dysphagia, dyspnea  Education: turn off VNS during exercise or when periods of prolonged speaking Ch 11 Anxiety Generalized Anxiety Disorder: uncontrollable, excessive worry for SIX months  restlessness, muscle tension, avoidance of stressful stuff, increased time and effort required to prepare for stressful stuff, procrastination in decision making, seeks repeated reassurance Panic disorder: attacks last 15-30min  FOUR OR MORE manifestations: palpitations, SOB, choking or smothering sensation, chest pain, nausea, feelings of depersonalization, fear of dying or insanity, chills or hot flashes Ch 12 Trauma and Stressor-Related Disorders Acute Stress Disorder: at least THREE days but not more than ONE month Posttraumatic stress disorder (PTSD): longer than ONE month and can last YEARS Avoid caffeine, alcohol Depersonalization: observe their own body from a distance – detached from own’s body Derealization: disconnected from environment – ex. furniture in room is small and far away Chapter 13 Depressive Disorders Major Depressive Disorder (MDD): at least 5 of the findings + occur almost every day for min 2 weeks and last almost all day  depressed mood, difficulty sleeping or excessive sleeping, indecisiveness, dec ability to concentrate, suicidal ideation, inc or dec in motor activity, inability to feel pleasure (anhedonia), inc or dec in weight of more than 5% of total body weight over 1 month  Acute phase: severe clinical findings of depression & may need hospitalization o treatment: 6-12w

@ShopWithKey on Etsy o goal: reduction of depressive manifestations; assess suicide risk Continuation phase: increased ability to function o treatment: 4-9m o goal: relapse prevention*  Maintenance phase: remission of manifestations o treatment: years o goal: prevention of future episodes Dysthymic Disorder: mild depression, can be early onset (childhood or adolescence); TWO YEARS (adults; 1yr child) + THREE findings; can become MDD Depression more common in females and unmarried people 

Chapter 14 Bipolar Acute phase: acute mania & may need hospitalization  goal: reduction of mania and client safety; assess suicide risk; one-to-one may be required Continuation phase: remission of manifestations  treatment: 4-9m  goal: relapse prevention* Maintenance phase: increased ability to function  treatment: years  goal: prevention of future episodes Mania: abnormally elevated mood and hospitalization required – 1 week+ Hypomania: less severe and lasts 4days+ plus 3+ mania manifestations, less impaired Rapid cycling: four or more episodes within 1 year Bipolar I: at least 1 episode of mania alternation with MDD Bipolar II: 1 or more hypomanic disorder alternating with MDD Cyclothymic: hypomanic manifestations (but not an actual episode) with minor depressive episodes for 2y+ nurse care: frequent rest periods, portable nutritious food (finger foods), high calorie drinks, decrease stimulation, seclusion sometimes necessary, step-by-step reminders for dress and hygiene monitor fluid intake, sleep, nutrition consistent client behavior expectations, offer concise explanations, establish consistent limits use firm, calm, matter of fact, specific approach with communication Chapter 15 Psychotic Disorders (Schizophrenia)      

Schizophrenia: psychotic thinking or behavior present for at least 6 months Schizoaffective: Schizo + Depressive Disorder or Bipolar disorder Positive symptoms: not normally present ex. hallucinations, delusions, alterations in speech, bizarre behavior Negative symptoms: Absence of things that are normally present (more difficult to treat!!!) ex. blunted or flat affect, alogia (poverty of thought or speech), anergia, anhedonia, avolition (lack of motivation) Cognitive symptoms: problems with thinking Affective symptoms: emotions ex. hopelessness and suicidal ideation

Alterations in thoughts (delusions):  Ideas of reference*: occurrences in the environment are about or because of them - misconstrues trivial events and attaches personal significance to them (believing others are talking about him but actually talking about something else)  Persecution: someone or something wants to INTENTIONALLY HURT them - feels singled out for harm by others (being hunted down by FBI)  Grandeur: believes that she is all powerful and important (believes they’re a god)  Somatic delusions*: believes body changing in unusual way (growing third arm)

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 jealousy  being controlled  Thought broadcasting believes their thoughts are heard by others  Thought insertion believes others’ thoughts inserted in their mind  Thought withdrawal believes that their thoughts have been removed from mind by outside agency  Religiosity  Magical thinking*: believes their action or thoughts are able to control a situation or affect others Alterations in speech  Flight of ideas*: associative looseness. sentence after sentence but related to different topics. listener unable to follow client’s thoughts.  Neologisms*: made up words that have meaning only to client ex. I trangled and flittled  Echolalia*: repeat words of someone else = imitation  Clang association*: rhyming  Word salad*: words jumbled together with little meaning or significance AIMS: Abnormal Involuntary Movement Scare – monitor involuntary movements and tardive dyskinesia in pts taking antipsychotics Things you can reply:  “I don’t hear anything, but you seem to be feeling frightened” but DON’T say “the voices are not real, or else we would both hear them”  “I cant imagine that the President would have a reason to kill a citizen, but it must be frightening for you to believe that” Its okay to manage symptoms by interacting with auditory or visual hallucination and telling it to go away or stop

Ch 16 Personality Disorders Defense mechanisms: repression, suppression, regression, undoing, splitting  Splitting*: inability to incorporate positive and negative aspects of oneself or others into a whole image; asso. with Borderline Personality Disorder. o Characterize person as all good or all bad.  Regression*: dysfunctional attempt to reduce anxiety and conflict by returning to less mature behaviors that help the client better tolerate the anxiety. o 5 yr old wetting bed  Repression: unconscious removal of thoughts or memories from one’s awareness Risk factors: substance use disorder, crimes/sex offences, etc Cluster A (odd or eccentric traits)  Paranoid  Schizoid: may isolate themselves  Schizotypal: may isolate themselves but also have magical thinking, ideas of reference, illusions, etc Cluster B (dramatic, emotional, or erratic traits)  Antisocial*: limit setting and consistency (for any manipulative behavior); exploitation and manipulation of others, failure to accept personal responsibility  Borderline: limit setting and consistency  Histrionic: theyre super “extra”, can be flirtatious – use assertiveness training and remodeling  Narcissistic*: indecisiveness, grandiose thinking, lack of empathy, exploits others, self-centered Cluster C (anxious or fearful traits; insecurity or inadequacy)  Avoidant: anxiety in social situations, fear of rejection  Dependent: self-assess frequently for countertransference; use assertiveness training and remodeling  Obsessive-Compulsive Case management:  acute care facility: obtain pertinent history from providers, support reintegration with family, ensure appropriate referrals to outpatient care  long term outpatient facility reducing hospitalization by providing resources for crisis services, enhancing social support system.

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Ch 17 Neurocognitive Disorders Delirium: rapid over short period of time, worse at night/early morning, change in vital signs, secondary to another medical condition (infection, malnutrition, depression, etc), change in LOC – REVERSIBLE  tachycardia, elevated bp, sweating, dilated pupils, electrolyte imbalance Mild Neurocognitive Disorder Major Neurocognitive Disorder (Dementia): gradual over months or years, sundowning may occur - IRREVERSIBLE  Alzheimer’s Disease: neurodegenerative Confabulation: client makes up stories when questioned about events or activities that she doesn’t remember – for selfesteem bc doesn’t remember Perseveration: client avoids answering questions by repeating phrases or behavior – also self-esteem *close to windows and nurses station *clocks, calendars, pictures, familial objects – NO MIRRORS *consistent daily routine *consistent caregivers *reinforce reality, orientation to time and place, limit number of choices, minimize need for decision making and abstract thinking to avoid frustration *caution with PRNs for agitation and anxiety Medications: 1) Cholinesterase inhibitor: Donepezil, Rivastigmine, Galantamine MOA: increase Ach** – slows cognitive deterioration and improve cognitive function in early stages S/E: N/V, diarrhea, bradycardia, syncope, bronchospasm fluid volume deficit, monitor pulse, check for heart disease *titrate dose so start low then gradually increase *taper med *Donepezil: once daily AT BEDTIME * Caution: asthma, COPD C/I: NSAIDs* 2) Memantine: block Ca into nerve cells and slow down brain cell death S/E: dizziness, HA, confusion, constipation *remove rugs, put locks, water heater low, good lighting, mattress on floor, remove clutter, secure electrical cords to baseboards, cleaning supplies stored in locked cupboards, install handrails Ch 18, 19, 20 – Skip Bulimia: enlarged parotid glands, dental erosion, hypokalemia Anorexia: hypokalemia Binge: abdominal pain one-on-one supervision Factitious Disorder (Munchausen Syndrome): client deliberately causes injury or illness to self or vulnerable person for attention or relief of responsibility Ch 21 Meds for Anxiety 1) Benzodiazepines: -AM ex. Lorazepam*, Clonazepam, Alprazolam, Diazepam*, & Chlordiazepoxide*  treat: anxiety, panic disorders, seizures, muscle spasms, alcohol withdraw, anesthesia MOA: increase effects of GABA (reducing neuron activity) S/E: CNS depression (SEDATION**, lightheadedness, ataxia, dec cognitive function), anterograde amnesia (difficulty recalling events after dosing), dizziness  Oral Toxicity: drowsiness, lethargy, CONFUSION

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 IV Toxicity: RESPIRATORY DEPRESSION**, severe HYPOTENSION, cardiac arrest dependency, withdrawal (taper off) Education: only short term use (7-10days), at bedtime, takes 2 nights for effects, do not abruptly discontinue**  avoid alcohol and hazardous activities  do not chew or crush sustained-release tablets (swallow whole)* Antidote - Flumazenil** (= benzodiazepine receptor antagonist. Administer the medication via IV bolus, titrating doses as needed, for a maximum of 3 mg. However, the medication can precipitate seizures and might not reverse respiratory depression, so airway support may be necessary.) 2) Atypical anti-anxiety: Buspirone  treat: anxiety, panic disorder, OCD, PTSD S/E: dizziness, nause...