MH Exam 1 Study Guide - Lecture notes Exam 1 PDF

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Study guide for mental health exam 1...

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Study Guide Exam 1 Chapter 1 

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Mental Health and Mental Illness o Mental health – Ever changing state. Difficult to define. Many factors influence including individual, interpersonal, and social/cultural.  Ex: Moving could cause interpersonal relationships temporarily leaving someone feeling isolated. o Mental Illness – Disorder affecting mood, behavior, thinking, depression, schizophrenia, anxiety disorders.  Difficulties with ADL’s. May be chronic or recurrent.  5 Criteria for diagnosis  Dissatisfaction with characteristics, abilities, and accomplishments  Ineffective or unsatisfying relationships  Dissatisfaction with one’s place in the world  Ineffective coping  Lack of personal growth Global assessment of functioning – tool used by some clinicians, first appeared in DSM3 but most us WHODAS 2.0, which is in DSM 5. WHODAS assess disability across six domains. Deinstitutionalization – Shift from state hospitals to community facilities. Not as many were created which has led to the revolving door effect. Managed Care – designed to control the balance between quality of care and cost of that care. Patients receive care based off need versus request. Health insurance has a specific $ amount they will cover annually. Transitional Care – Patients who were discharged after long hospital stays received intensive services to facilitate their transition to successful community living and functioning. o Peer support and bridging staff. Bridging staff refers to hospital and community care. Clubhouse Model - Community based rehabilitation. Based that both men and women with serious psychiatric disabilities can and will achieve normal life goals when given opportunity, time, support, and fellowship. o 4 rights of membership:  A place to come to  Meaningful work  Meaningful relationships  A place to return to – lifelong membership. Role and life changes o Can be predictable or non.  Predictable: Retirement  Non predictable: Divorce, loss of employment, death, illness or injury o Nurses will do TWO things:  1. Assess the clients ability to adapt and cope  2. Evaluate whether the client has successfully adapted Mental health diagnoses-DSM-5 and serious mental illness

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DSM-5 and use in nursing o DSM5 – Diagnostic and Statistical manual of mental disorders; Edition 5. o Taxonomy published by the APA-American Psychiatric Association o DSM-5 has 3 purposes:  Provides a standardize nomenclature, language for all health care providers Psychotropic drugs were created in 1950’s o Thorazine – antipsychotic o Lithium - antimanic  Present defining characteristics or symptoms that differentiate specific diagnosis  Assist in identifying underlying causes of disorders o DSM-5 allows the practitioner to identify all factors related to patient’s condition:  All major psychiatric disorders  Medical conditions that are potentially relevant to understanding or managing the persons mental disorder  Psychosocial +} environments problems that may affect the diagnosis, tx, and prognosis of the disorder. The world health organization - The World Health Organization defines health as a state of complete physical, mental, and social wellness, not merely the absence of disease or infirmity Trephination – Hole made into patients skull. Insulin coma therapy – Given insulin to make sugars drop and patient would have a seizure. This could make a patient have “wet shock” that made the drool and sweat. This was highly dangerous. “Dry Shock” Would bring on a full brain seizure. Glucose would be given to awake the patient from coma. Metrazol therapy – Given IV Metrazol that produced seizures. ECT – Electroconvulsive therapy – Induces a seizure that is used to “reset.” Patient is given general anesthesia to have one seizure and is monitored through an EEG. Patient is monitored shortly after and discharged same day. This treatment is used after failed medication therapy. Lobotomy – Cut section of the frontal lobe Revolving door – Patient comes in with a psychotic break and we discharge them, tell them how to care for themselves and they do nothing until they have another psychotic break. Dual diagnosis – Mental health disorder + substance abuse disorder o You will treat the substance abuse first. Best person to ask cultural beliefs? The patient Community-based programs are preferable for treating many people with mental illnesses. Psychiatric nursing practice: Pg. 9 Box 1.3 o Basic – level functioning  Counseling:  Interventions and communications techniques  Problem-solving  Crisis intervention  Stress management  Behavior modification  Milieu therapy: Book. ATI.

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 Maintain therapeutic environment  Teach skills  Encourage communication between clients and others  Promote growth through role modeling  Orienting the client to the physical setting  Identifying rules and boundaries for the setting  Ensuring a safe environment for the patient  Assisting the client to participate in appropriate activities  Self-care activities  Encourage independence  Increase self-esteem  Improve function and health  Psychobiologic interventions  Administer medications  Teach  Observe  Health teaching  Teaching social and coping skills  Case management  Health promotion + maintenance  Assist patient smoking cessation o Advanced-Level Functions  Psychotherapy  Prescriptive authority for drugs  Consultation and liaison  Evaluation  Program development and management  Clinical supervision When beginning to talk with a mental health patient begin by building trust and gaining a rapport. Do NOT begin with personal questions.

Chapter 2 

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Neurobiological theories o Genetics and heredity: play a role but not solely genetic.  Twin, adoption, and family studies are used.  Nature vs nurture o Psychoimmunology – HIV can affect the brain. Compromised immune system possibly contributing. o Infections – particularly viruses contracted during fetal development Nurses role in research and education: o Ensure patient + family is well informed o Help distinguish between fact + hypotheses.

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o Explain if or how new research may affect client’s treatment or prognosis. Excitatory and inhibitory neurotransmitters o Excitatory:  Dopamine – “feel good.” Complex movements, motivation, cognition, regulation of emotional response.  Norepinephrine – attention, learning, memory, sleep, wakefulness, mood regulation.  Epinephrine – SNS – fight or flight response  Glutamate – major neurotoxic effects at high levels. Not a lot of meds are given for this. o Inhibitory:  Serotonin – most commom – food intake, wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotion  Women complain of weight gain due to increase eating  Men complain about sexual issues  GABA – modulation of other neurotransmitters o Both excitatory and inhibitory:  Acetylcholine – sleep and wakefulness cycle; signals muscles to become alert o Histamine - neuromodulator Psychopharmacology terms and principles o Terms: o Psychopharmacology – the use of medications to treat mental illnesses o Psychotropic drugs – psychopharmacology that will effect neurotransmitters o Efficacy – maximum therapeutic effect o Potency – amount of drug needed for maximum effect o Half-life – how long for a drug to wear off o Approved use – FDA approved o Off-label use – effective for disease difference from one involved in original testing o Black box warning – serious or life-threatening side effects  Principles  Effect on target symptoms – wanting to effect the targeting symptom  Adequate dosage for sufficient time  Lowest effective dose  Lower doses for older adults  Tapering rather than abrupt cessation to avoid withdrawal or rebound  Follow-up care  Simple regiment to increase compliance Psychopharmacology: use, mechanism of action, side effects, and client teaching for all five categories. o Antipsychotic drugs: neuroleptics  Drugs: Conventional: Chlorpromazine, fluphenazine, thioridazine, haloperidol, loxapine  Second gen: clozapine, risperidone, olanzapine  Third gen: dopamine system stabilizers; aripiprazole

MOA – block receptors for the neurotransmitter dopamine Use – Tx of psychotic symptoms SE – extrapyramidal syndrome (EPS)  Acute dystonia – anticholeretic  Torticollis, opisthotonos, oculogyric crisis  Treatment: anticholinergic drugs or diphenhydramine.  Pseudoparkinsonism – stooped posture, mask-like faces, shuffling gait.  Akathisia – restlessness, anxiety, agitation  #2 SE – neuroleptic malignant syndrome NMS  Tardive dyskinesia – irreversible involuntary movements  Anticholinergic effects – dry mouth, constipation, urinary hesitancy or retention  Other SE – increased prolactin levels patient lactating unwanted)  Weight gain  Prolonged QT intervals  Agranulocytosis – decrease in white blood cell count  Client Teaching – Adherence to regimen, thirsty/dry mouth, constipation, sedation, don’t make important decisions or drive, actions for missed dose (give if within 4 hours of usual time), CBC, ANC with clozapine. Antidepressant drugs:  MOA – interact with monoamine neurotransmitter systems, especially norepinephrine and serotonin.  Preferred drugs for clients at high risk for suicide.  Use – Major depressive illness, anxiety disorder, depressed phase of bipolar disorders, psychotic depression.  Groups:  Tricyclic and related cycle antidepressants (TCA’s): if you OD on this it’s almost always fatal. Typically, only 2 weeks is given at a time.  Selective serotonin reuptake inhibitors (SSRI’s)  MAO inhibitors (MAOI’s) – not used often. Avoid food that contains tyramine. (not as commonly used.)  Others (venlafaxine, bupropion, duloxetine, trazodone, nefazodone)  SE: #1:  SSRIs: anxiety, agitation, akathisia (restless, weight gain, sexual dysfunction), insomnia, sexual dysfunction, weight gain.  TCAs: Anticholinergic effects, orthostatic hypotension, sedation, weight gain, tachycardia, sexual dysfunction.  SE #2:  MAOIs: Daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction, and hypertensive crisis (with foods containing tyramine.)  Drug interactions – Serotonin syndrome: though rare, can be fetal  MAOI + SSRI   

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Agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, coma + death (extreme reactions.)  Client teaching  Time of dosage o SSRI – first thing in the AM o TCAs – at night  Actions for missed dose o SSRI – up to 8 hours after missed dose o TCAs – within 3 hours of missed dose  Safety measures  Dietary restrictions of tyramine if taking MAOIs.  Increase in TCAs can cause disorientation/confusion in elderly. Increased or irregular heart rate. Or seizures. Mood-stabilizing drugs:  Drugs: Lithium (most commonly used), some anticonvulsants, carbamazepine, valproic acid, gabapentin, topiramate, oxcarbazepine, and lamotrigine.  Use: treatment of bipolar disorders  MOA: Normalize reuptake of certain neurotransmitters (lithium)  Increase levels of GABA (valproic acid, topiramate)  Kindling process (valproic acid, carbamazepine)  SE #1:  Lithium – nausea, diarrhea, anorexia, hand tremor, polydipsia, polyuria, metallic taste, fatigue, lethargy, weight gain, acne. o Toxicity – severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination  Carbamazepine + valproic acid – drowsiness, sedation, dry mouth, blurred vision.  SE #2:  Carbamazepine – rash, orthostatic hypotension  Valproic acid – weight gain, alopecia, hand tremor  Topiramate – dizziness, sedation, weight loss  Antianxiety drugs:  Use: Treatment of anxiety and anxiety disorders, insomnia, OCD, depression, posttraumatic stress disorder, alcohol withdrawal.  MOA: mediation of GABA (Benzodiazepines.) Partial agonist activity at serotonin receptors (buspirone)  SE:  Benzodiazepines – physical, psychological dependence, CNS depression, hangover effect, tolerance  Buspirone – nausea is #1 complaint, dizziness, sedation, headache  Client teaching:  Safety measures, avoidance of alcohol (when taking benzos), avoidance of abrupt discontinuation 

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Stimulants:  Use: treatment of ADHD in children and adolescents, residual attention deficit disorder in adults, narcolepsy.  MOA: Cause release of norepinephrine, dopamine, serotonin presynaptically.  Direct agonis against effects postsynaptically  Block reuptake of neurotransmitters  SE: Anorexia, weight loss, nausea, irritability, growth + weight suppression.  Client teaching: Dose after meals, avoid caffeine, sugar and chocolate, keep out of reach of children. o Disulfiram  Use: aversion therapy for alcoholism  MOA: inhibits the enzyme involved with alcohol metabolism  Adverse reaction with alcohol ingestion  SE: fatigue, drowsiness, halitosis, tremor, impotence  Drug interactions: phenytoin, isoniazid, warfarin, barbiturates, long-acting benzo’s.  Client teaching: avoid alcohol and common products that include it  Example: having cream, deodorant, OTC cough preparation. o Methylphenidate – used to treat ADHD. Example know the issues with tyramine and MAOIs (monoamine oxidase inhibitors) and what types of food are high in tyramine. o Tyramine is an amino acid that helps regulate blood pressure. MAIO’s block monoamine oxidase, which breaks down excess tyramine. Blocking monoamine oxidase relieves depression. o Taking an MAOI and eating high-tyramine foods can reach dangerous levels and spike BP and require emergency treatment. o Foods high in tyramine:  Strong or aged cheeses – aged cheddar, swiss, parmesan, blue cheese  Cured meats – dry-type summer sausages, pepperoni, salami  Smoked or processed meats- hot dogs, bologna, bacon, corned beef, or smoked fish  Pickled or fermented foods – sauerkraut, caviar, tofu, pickles  Soy sauce, shrimp sauce, fish sauce, miso, teriyaki sauce  Soybeans and soybean products  Snow peas, broad beans, fava beans  Dried or overripe fruit, raisins, prunes, bananas, avocados  Meat tenderizers  Yeast-extract spreads, marmite, brewer’s yeast or sour dough bread  Alcoholic beverages – tap/homebrewed beer, red wine, sherry, and liqueurs.  Improperly stored foods or spoiled foods – no leftovers or foods past their freshness date. Common barriers to medication management o Long-term, chronic illness requires ongoing treatment. o Symptoms of poor insight + confusion o

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o Faulty thinking o Major side effects/interactions with medications o Stereotyping and discrimination against mental illnesses. CNS = Brain, spinal cord, and nerves that control voluntary acts (neurotransmitters) Brain o Cerebrum o Cerebellum o Brain Stem o Limbic system Cerebrum o Two hemispheres o Four lobes  Frontal Lobe – thought, body movements, memories, emotions, moral behavior  Parietal Lobe – Taste, touch, spatial orientation  Temporal Lobe – Smell, hearing, memory, emotional expression  Occipital Lobe – Language, visual interpretation Cerebellum o Below cerebrum o Center for coordination of movements and postural adjustments o Reception, integration of information from all body areas to coordinate movement and posture. Brain Stem o Midbrain: reticular activating system (motor activity, sleep, consciousness, awareness.) o Pons: Primary motor pathway o Medulla oblongata: Vital centers for cardiac, respiratory function o Nuclei for cranial nerves III through XII o Locus coeruleus: norepinephrine-producing neurons Limbic System: o Above brain stem o Thalamus (activity, sensation, emotion) o Hypothalamus (temperature regulation, appetite control, endocrine function, sexual drive, impulse behavior) o Hippocampus (emotional arousal, memory) o Amygdala (emotional arousal, memory)

Chapter 3 

Humanism o Carl Rogers theory:  Unconditional positive regard—a nonjudgmental caring for the client that is not dependent on the client’s behavior  Genuineness—realness or congruence between what the therapist feels and what he or she says to the client

Empathetic understanding—in which the therapist senses the feelings and personal meaning from the client and communicates this understanding to the client. o Maslow:  Hierarchy of needs:  Self-actualization (self-fulfillment needs)– achieving ones full potential including creative activities  Esteem needs (psychological needs)– prestige and feeling of accomplishment  Belongingness and love needs (psychological needs)– intimate relationships, friend  Safety needs (basic needs) – security, safety  Physiological needs (basic needs) – food, water, warmth, rest Transference and Countertransference o Transference – occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships  Example: teenager is yelling at you to get out of her room, “You’re just like my mom.” o Countertransference – occurs when the therapist displaces onto the client attitude or feelings from his or her past.  Example: Therapist putting ideas on the client. Psychiatric rehabilitation Piaget’s Four Stages of Cognitive Development o Sensorimotor—birth to 2 years: The child develops a sense of self as separate from the environment and the concept of object permanence; that is, tangible objects do not cease to exist just because they are out of sight. He or she begins to form mental images. o Preoperational—2 to 6 years: The child develops the ability to express self with language, understands the meaning of symbolic gestures, and begins to classify objects. o Concrete operations—6 to 12 years: The child begins to apply logic to thinking, understands spatiality and reversibility, and is increasingly social and able to apply rules; however, thinking is still concrete. o Formal operations—12 to 15 years and beyond: The child learns to think and reason in abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity. Milieu therapy/therapeutic milieu o Sullivan is also credited with developing the first therapeutic community or milieu. The concept of milieu therapy, originally developed by Sullivan, involved clients’ interactions with one another, including practicing interpersonal relationship skills, giving one another feedback about behavior, and working cooperatively as a group to solve day-today problems. Milieu therapy was one of the primary modes of treatment in the acute hospital setting. In today’s health-care environment, however, inpatient hospital stays are often too short for clients to develop meaningful relationships with one another. Levels of anxiety 

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Mild anxiety is a positive state of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems. The person can take in all available stimuli (perceptual field). o Moderate anxiety involves a decreased perceptual field (focus on immediate task only); the person can learn new behavior or solve problems only with assistance. Another person can redirect the person to the task. o Severe anxiety involves feelings of dread or terror. The person cannot be redirected to a task; he or she focuses only on scattered details and has physiological symptoms of tachycardia, diaphoresis, and chest pain. A person with severe anxiety may go to an emergency department, believing he or she is having a heart attack. o Panic anxiety can involve loss of rational thought, delusions, hallucinations, and complete physical immobility and muteness. The person may bolt and run aimlessly, often exposing himself or herself to injury. Personality theories: o ID – pleasure seeking, aggression, sexual impulses o Ego – mediating force between the ID & superego o Superego – moral and ethical concepts, values 3 levels of awareness o Conscious – perceptions, thought, emotions in a persons awareness o Preconscious – thought and emotions not currently in a persons awar...