Pysch exam 1

example of inpatient services

crisis stabilization facilities, community-based hospital facilities, state hospital facilities, transitional or respite facilities, and long-term facilities

outpatient service example

primary care provider’s office, mental health clinics, case management, home-based services, mental health crisis teams, day treatment, family services, and peer services

how to know when to put patient inpatient vs outpatien

severity of mental illness, mental health diagnosis, and impact that the mental health disorder has on their daily functioning

five zones of mental health continuum

excelling, thriving, surviving, struggling, crisis

acute stress examples

death of a loved one, divorce, or issues at work

mileu therapy basic principles

indiv client centered care, organzied, theraptuic relationships, mutlidisplinary team, ongoing eval

involuntary admission requirements

consistent history of manifesting symptoms, experiencing severe symptoms, danger to self or others, unable to meet basic care needs, illness prevents from seeking own care

involuntary admission steps

request, get 2 providers to sign off, specific time, voluntary admission or hearing,

seclusion/restraints do NOTS

left alone in a locked room, unsupervised, or left in a prone or supine position

restraint protocols

check at least every 15 min, must be an order, assess integreity and blood flow,

seclusion vs restraint

seclusion should happen first

CSSR scale risk assements components

self injury in past week, sucidice ideation in past week, activating events, treatment history, clinical status, protective factors

SAFE-T 5 components

risk factors, protective facotrs, suicide inquiry, risk level, documentation

sucicide protective factors

physcial activty, social support, healthy eating

SAD PERSONS

male, younger than 19 over 45, depression, previous attempt, ethanol, rational thinking loss, socail support lacking, organized plan, no partner, sickness

risk factors for suicide: indiv

prev attempt, mental illness, lacking social support, legal/fiancial problems, job loss, serious med illness, substance use, impulsive behavior

risk factors for suicide: relationship

hisotry of being abused/neglected, bullied, fam history of suicide, personal relationship problems, sexual violence

risk factors for suicide: community

health care barriers, cultural beleifs, community cluster of suicide

nurse assessment when thinking suicide risk

are you going to kys, preciptiating events, risk factors, MILC

MILC meaning

means, intent, lethal, cues/behavior

suicide warning signs (non obvy ones)

withdrawn social, feel like aburden, giving away loved possesions, arranging affairs, engaging in risky behavior, obessive talking of death, sudden and extreme mood swings, expressing guilt/shame, talk about seeking revenge

major depressive disorder

no mania or hypomania, loss of appetite, sleep distrubances, decreased energy, diffuclty concentrating, may have suicidal ideation

bipolar 1

reoccuring episodes of mania, depression, and hypomania

bipolar II

episodes of hypomania and depression

bipolar manifestations

 pressured speech, circumstantial speech, tangential speech, loose association, flight of ideas, grandiosity/persecutory delusions, decreased need for sleep

bipolar risk factors

genetics, ACEs, biological, brain structure

bipolar: nurse role

calm clear concise speech, act on legitmate complaints, encourage sleep, high protien finger food, decrease stimuli, redirection, store valuables

major depression disorder risk factors

female, ACEs, stress, hormones, inflam, stress, neuroticism, chronic medical conditions

Anhedonia

inability to experience pleasure or a diminished ability to find enjoyment in activities that were once pleasurable

MDD: nursing interventions

small/easy/high protien/high calorie/ snacks, step by step instructions,

ECT: nurse requirements

monitor client stauts, respond to emergency, reorient client

TMS

utilizes magnetic pulses to stimulate focal areas of the cerebral cortex

mild aniexty

visible manifestions: restless, require approval, increase in questioning, function is heightened, more focused

moderate aniexty

increasingly on edge, easily frustrated, increased restlessness, unable to sleep,diff concentrating, increased worry

severe aniexty

overwhelmed, intesne anxiousness, decreased cognition, doesnt respond to others, cant do simple tasks, intense feeling of dread

panic

overwhelmed with error, no longer process stimuli, unable to communicate verbally, detached from reality, risk for self harm

aniexty risk factors

trauma, personality triat, family history, history of illness, genetics, lifestyle

aniexty: physiological manifestations

increase HR, RR, sweating, fatigue, diff concentrating, GI and sleep disturbances

Behaviors seen prior to violence/aggresion

declining to eat/drink, attempting to leave before discharge, verbally antagonistic, harming self, staring, pacing

NSSH signs

unexplained scars, freshs cuts, excessive rubbing, keeping limbs covered, poor interpersonal relationship, personal idneity issue, impuls emotions, feeling worthless

serotonin syndrome symptoms

alterations in mental cognition, tremors, muscle rigidity, diaphoresis, extreme elevation in temperature, tachycardia, hypertension, dilation of the pupils, abdominal pain, and alterations in bowel activity

violence risk factors

history of violence, being a victim, witnessing abuse, poor self esteem, no positive rold models, ACE

constant predictors of violence

inability to control aggressive impulses, cant understand consequences, lack of remorse, substance use

recognize interpersonal violence

afraid to provide events, bruises in various stages of healing, TBI under 1 yo, shaken baby syndrome, unusual brusiing, burns w/gloves and ciggarette shape

nurse role: interpersonal violence

Treat underlying issue, refer victim to a safe house, provide emotional support, collaborative practice referrals, decrease stigma, help client develop a safety plan

Violence Behavior Cues

hyperactivty, hypersensitivty, intense eye contact, aggressive position, intoxication

Violence Verbal Cues

threats of harm, arubt silence, sarcasm, illogical response, statements of fear

De-escalation tricks

respond quickly, stay calm, allow for personal space, mantain eye contact, avoid accusing, set limits

reaction formation

an individual unconsciously expresses the opposite of their true feelings or desires.

pressured speech

rapid, frenzied, and non-stop speech that is difficult to interrupt or slow down. People experiencing pressured speech often talk loudly, rapidly, and in a disjointed manner,

tricyclic antidepressant

amitriptyline, imipramine

SSRI

escitalopram (lexapro), fluoxetine (prozac), sertraline (zoloft)

SNRI

venlafaxine (effexor ER), duloxetine (cymbalata)

MAOIs

phenelzine (nardil), tranylcyropmine (parnate)

benzo

diazepam (valium), lorazepam (ativan)

milieu therapy: nurse role

Monitoring visitors, restricting sexual activity, deterring elopement, deescalating, maintaining seclusion rooms, no access for sharp or harmful roommates, safety training for all staff, and carefully choosing roommates

tricyclic overdose symptoms

 tachycardia, heart block, ventricular fibrillation, and seizures!!!