BSN 3084- Midterm

How does the WHO define mental health?

A state of well-being in which an individual is able to realize his or her own potential, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to the community

Public Health Agency define mental health as?

The capacity of each of and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face.

Can a person be healthy without considering mental and physical health? (WHO 2014)

NO

What influences mental health?

Support systems

spirituality, religious influences

family influences

developmental events

personality traits and states

demographics and geographical locations

negative influences

cultural beliefs and values

health practices and beliefs

hormonal influences

biological influences

inherited factors

enviromental experiences

Mental Illness

Refers to all mental disorders with definable diagnoses (definable by DSM-5)

DSM-5

The diagnostic and statistical manual of mental disorders. Classifies disorders people have (Ie. major depressive disorder)

Consequences of mental illness stigma

limiting opportunities (housing, friends, employment, etc), two-thirds of people don’t seek treatment, people often conceal illness, creates barriers to care

Rights of a person with mental illness

Right to medical care

right to be treated with humanity and respect

equal protection right

right to be cared for in the community

right to provide informed consent before recieving any treatment

right to privacy

freedom of communication

right to voluntary admission

What is the aim of the mental health strategy for Canada

the aim of the strategy is to improve the mental health and well-being for all Canadians

Mental health for Canadians striking a balance goals?

Reducing inequalities

increasing prevention

enhancing coping

Where were mentally ill before mid-1800s

at home with family or in jail

1839 legislation of upper canada resolution

authorizing the building of the first asylum, used an old jail abandoned as unfit for prisoners

Why were asylums built?

industrialization increased need for institution

no medications or treatments at this time

mentally ill seen as nuisance

Mental health care spaces today

psych units in community hospitals

4 psych hospitals in Ontario

most MH clients served outside inpatient units

community-based MH services developed what?

day hospitals

crisis management teams

outreach services

primary care psychiatry (ACTT)

Fundamental premise of psychiatric nursing care is?

goal of nursing care is to promote wellness, maximize integrated function. Care is based on determined needs and expected treatment outcomes.

MH in community settings

assessment, case management, promoting continuation of treatment

MH in hospital

Managing behaviroal crisis, safety, suicide risk

Canadian MH act

Law that describes what should happen when someone who is living with a mental illness needs treatment and protection for themselves

Purpose of Canadian MH act

protect clients rights and freedom, keep client free from unlawful detainment, protect the public

Voluntary Patient

person agreed to be admitted to the psychiatric facility for care, observation, and treatment

Involuntary Patient

assessed by a psychiatrist and found to exhibit signs of mental illness and or impaired judgement

Informal patient

has been admitted with the consent of another (POA) who has the legal authority to give this consent

Substitute Decision Maker (POA)

a person who is authorized by law to make decisions on behalf of another (can be for care, property, or finance)

Public Guardian and Trustee (PGT)

an independent agency that can be given responsibility for making decisions on behalf of person who has been declared incapable. ward of the state

Substitute decision maker hierarchy (Highest to lowest)

requirements for admission

going voluntarily, police under MHA (section 17), Form 1, Form 2

grounds for detainment

danger to self

danger to others

displaying impaired judgement likely to result in harm to self

Form 1

By physician

can be held for 72 hours

person will receive a form-42 outlining why

person can refuse treatment *remember involuntary status is separate from treatment decisions

Form 2

an order for examination (signed by justice of peace) to be examined by doctor

Form 2 is based on

sworn statements from loved one

evidence of mental illness

danger to self or others

failure to care for own needs

Form 3

held for 2 weeks minus one day

cannot be initiated by same person as form 1

must be given a form 30 (the why)

patient has right to contest

pt recieves a rights advisor

Rights advisor

consults pt about rights within 24 hours of form 3, pt has right to refuse this

contesting form 3

if contested referred to consent and capacity board

Form 4

Renewal of form 3

first renewel: 30 days

second renewel: 60 days

third: 90 days

Can appeal each one

Form 5

discontinuation of forms or upon discharge

Informed consent

to give a informed consent a person must be capable of making decisions and be given information about their condition, recommended treatment, likely outcomes and risk of either accepting or refusing treatment

Competency

is the capacity to understand the consequences of ones decisions. pt are considered competent until legally declared incompetent

Capacity to consent Form 33

legally declared incapable to make treatment decisions for themselves. SDM will then make treatment decisions until (if) the person becomes capable

Community Treatment Order (CTO)

an order from physician which allows the pt to receive care in the community. it specifies exaxtly what dr, what meds, follows etc

Unintentional Tort

unintended acts that cause harm. Negligence and malpractice

intentional tort

causing harm on purpose

assault, battery, false imprisonment, invasion of privacy, defamation of character

Chemical restraints

antianxiety, antipsycotic, antidepressant, sedative-hypnotic

Physical restraints

hand mitts

lap belts

four side rails

geriatric chair

chest/vest

extremity (ankle or ankle)

Enviromental

seclusion

Physical alternatives to restraints

1:1 supervision

bed alarm

placing the client close nursing station

use of protective equipment or devices for IV sites

Psychosocial alternatives to restraints

reorientation

reassurance

de-esacalation

pet-therapy

distraction

activites

distraction

reducing stimulation

familiar objects

Legalities and ethics with restraints

supervision

documenataion

quick-realease tie to bed frame

2 finger spacing between wrist and extremity

HCP renew prescription Q 12 h

obtaining consent SDM

HCP seeing client to renew

What are the three most common cognitive disorders in adults?

delirium, dementia and depression

What is delirum?

altered LOC

disorientation

anxiety

agitation

poor memory

delusional thinking

hallucinations

is delirum a medical emergency?

yes

Etiology of delirum

always secondary to another condition

if other condition is corrected delirium should correct

Common causes of delrium

post-op

infections (uti)

metabolic disorders

intoxication or withdrawal

nervous system disease

tumor

systemic disease

psychosocial stressors

Four cardinal features of delirium

1. acute onset and fluctuating course

2. reduced ability to direct, focus, shift, and sustain attention

3. disorangized

4. disturbance of consciousness

Nursing implementation delirium

prevent harm from confusion, aggression, or fluid and electrolyte imbalance

Drug therapy delirium

haldol for severe agression

What is dementia?

a collection of symptoms caused by various diseases affected brain

Is dementia a normal part of aging?

no

dementia affects who

mostly older adults, 700000 + canadians

Four most common types of dementia

alzheimer’s disease

vascular dementia

dementia with lewy bodies

frontotemporal dementia

alzheimer disease

cause unknown

age is most important risk fact

changes in brain structure and function amyloid plaques, neurofibrillary tangles, loss connections between cells and cell death

plaques

alzheimers symtoms mild

mild forgetfullness

short-term memory impairment

difficulity recognizing what numbers mean

loss of intiative and intrests

poor judgement

difficulty finding the right word

confusion about location of familiar places

Anxiety

7 a’s of demenita

amnesia: memory issues

aphasia: communication deficient

apraxia: loss of motor skills

agnosia: difficulty cognizing intended use of items

altered perception: can’t judge

apathy: malaise, depression

anosognosia: unaware of neurological deficit

Late stages alzheimers symptoms

long-term memory loss

unable to communicate

cannot perform ADLs

the client may be unresponsive and require total care

Diagnosing Alzheimers

diagnosed by ruling out everything else

through comprehensive analysis

Alzheimers drugs acetylcholinesterase inhibitors

improve or stabilize cognitive decline by blocking cholinesterase from breaking down acetylcholine

donepezil, rivastigmine, galantamine

Alzheimers drugs NMDA

protects nerve cells against excessive amounts of glutamate

mematine

Alzheimers drugs SSRI

treat associated depression

may help with sleep

sertaline, fluvoxamine, citalopram

Alzheimers drugs anticovulsants

maange behaviour, stabilize mood, improve cognition

levetiracetam

Alzheimers behavioural problem

occur in 50-60%

all actions are purposeful expressing a need

Alzheimers sundowning

a specfic type of agitation client becomes more confused and agitated in late afternoon and evening

Alzheimers safety concerns

injury from fall

wandering

injury to others and self

fire or burns

impaired judgement or descion

sundowning interventions

drugs

exposure to daylight

limit naps and caffeine

maintain a quiet calm environment

Alzheimers eating and swallowing (late and middle)

loss of interest in food, decreased ability to self feed

when chewing and swallowing becomes difficult use pureed food, thickening, nutritional supplements

Dementia with lewy bodies

characterized by presence of lewy bodies in brain stem, amygdala, and cortex

Have parkinsons and Alzheimers symptoms

Vasuclar demenita

may have sudden onset after cerebrovascular event

frontotemporal dementia

degeneration of the frontal lobe, temporal lobe or both

nerve cells die because of the accumulation of proteins in neurons

Creutzfeldt-jakob disease

rare and fatal

caused by prions

what is parkinson’s disease

disease of basal ganglia characterized by

slowing down of initation and execution of movement

increased muscle tone

tremor at rest

impair postural reflexes

pathology of parkinson’s disease

degeneration of dopamine-producing neurons, disrupts dopamine-acetylcholine in basal ganglia

Classical triad of parkinson’s disease

tremor

rigidity

bradykinesia

Begining stages vs Later stages of parkinson’s disease

beginning stages involve only mild tremor, slight limp arm swing

later stages may have shuffling, propulsive gait with arms flexed and loss of postural reflexes

what is rigidity parkinson’s disease?

increased resistance to passive motion when limbs are moved

typified by a jerky quality,

cogwheel

caused by sustained muscle contraction (pt may be sore tired and achy)

what is bradykinesia parkinson’s disease?

slowing down inintiation and execution of movement

evident loss of autonomic movements PD (bradykinesia)

blinking

swing arms while wlaking

swallowing of salvia

self-expression

minor movements of postural adjustment

tremor PD

minimal initially

prominent at rest

pill rolling

benign essential tremor (during voluntary movement)

how is PD diagnosed?

no specfic test

diagnosed based on hx and clinical features

diagnosis can be made when two of three of classic triad are present

Levodopa with carbidopa (sinmet)

precursor of dopamine coverted to DA in basal ganglia

carbidopa inhibits enzymes from breaking down levodopa

Anticholinerigics PD

decrease acticity of acetylcholine

Drugs for tremors

antihistamines with anticholinergic or beta blockers

What does entacapone do?

prolonges the effects of sinemet

Sugical care PD

ablation surgery

deep brain situation (electrode in the brain delvers current to specific location)

Nutrition PD

easy to swallow

cut small

several small meals

levodopa can be impaired by protein and B6

Consider mobility PD

remove rugs (shuffling)

back of the chair on blocks

think about stepping over a line on the floor

walk with toes up

What is Multiple Sclerosis (MS)

chronic progressive degenerative disorder of the CNS, demyelination of nerve fibers of the brain and spinal cord, women more than men, onset around 30

Cause of MS

cause unknown, multiple genes confer susceptibility, could be related to external factors

Pathophysiology of MS

characterized by chronic inflammation, demyelination, and gliosis in the CNS, autoimmune by T-cells

Disease process of MS

loss of myelin

disappearance of oligodendrocytes

proliferation of astrocytes

plaques scattered throughout the CNS

myelin replaced by scar tissue

Symptoms of MS

weakness or paralysis of limbs, trunk, and head

diplopia

scanning speech

spasticity of muscles

numbness and tingling

patchy blindness (scotoma)

blurred vision

vertigo and tinnitus

decreased hearing

neuropathic pain

lhermitte’s sign (electric shock down spin moving neck)

nystagmus

ataxia

dysarthria

dysphagia

constipation

spastic bladder

flaccid bladder

sexual dysfunction

anger

depression

euphoria

Diagnosis of MS

Multiple lesions on MRI

CSF analysis