Mental health, Aggression, depression, RBC disorders

mental health

emotional, psyschological, and social well-being - determines how we handle stress, relate to others and make healthy choices

What are nurses roles in legal aspects of healthcare 

RISK assessments, judgement, daily behaviors indicating ability for self care, insight into illness, aspects of mental status functioning, documentation

mental illness

medical condition that disrupts a persons thinking, feeling, mood, ability to relate to others, and daily functioning

8 dimensions of wellness

social, occupational, intellectual, emotional, spiritual, physical, financial, environmental 

milieu therapy 

assessing environment/vibe of unit, knowing mood/patterns of patients 

mood vs affect

mood - how you feel

affect - observations, what you see 

rights of patients

treatment, participation in treatment planning, refuse treatment, freedom from restraints/seclusion, humane treatment, confidentiality, access to records, state grievances, advocate, referral

what counts as restrictions 

medications (chemical restraint), locked rooms, seclusion, restraints 

emergency holds

officer has good reason to believe that there is a mental illness, developmental disability or are chemically dependent and in danger of causing harm to yourself or others

how long are emergency holds and what happens

up to 72 hours

medical exam within 48 hours of the patients admittance, change from emergency hold to voluntary status, written statement that authorizes the patients confinement, summary hearing regarding the patients release for the emergency hold 

requirements for involuntary hospitalization

must be a danger to self, danger to others, imminent risk to harm b/c of inability to care for oneself 

what is psychiatric nursing committed to and what does it entail

committed to promoting mental health through assessment, diagnosis, treatment of behavioral problems, mental disorders, comorbid conditions across the lifespan

How many people live with a mental health condition

1 in 4 adults

How many people live with a serious mental health condition 

1 in 20 

How many children have a current mental/behavioral health condition

1 in 7

depression criteria 

depressed mood or loss of interest/pleasure in nearly all activities for 2 weeks with 4/7 additional symptoms:

• sleep

• food/weight

• energy

• psychomotor agitation/retardation 

• excessive guilt or feelings of worthlessness 

• suicidal ideation 

depression mood state

feelings of sadness, despair, anxiety, emptiness, discouragement/helplessness, having no feeling/appearing tearful 

prevalence of unipolar major depression plus persistent depressive disorder in developed countries

18 percent

who has higher prevalence of depression

greater prevalence in those with a medical burden, greater in those with less income, hgiher prevalence in divorce/separated/widowed, lifetime prevalence higher in Native Americans'/Asians/Pacific Islanders, 12 months and lifetime prevalence greater in women/men

biological theories for depression

genetic (familial), neurobiological hypotheses (neurotransmitter disruption), neuroendocrine/neuropeptide hypotheses (hypothalamic/growth hormones), psychoneuroimmunology (cytokines and inflammatory reactions)

What does INR stand for

International Normalization Ratio

What is the INR reference range for persons taking anticoagulation

2.0-3.0

What is the INR reference range for persons not taking anticoagulation

0.8-1.1

What is the INR reference range for persons taking anticoagulation for mechanical heart valves

2.5-4.5

what is ect used for

malnutrition, catatonia(abnormal motor/cognitive symptoms), suicidality, refractory disorder

What do SSRIs do 

selectively blocks neuronal reuptake of serotonin 

What are common adverse effects of SSRIs

nausea, agitation, insomnia, sexual dysfunction

What is a pregnancy consideration for SSRIs

withdrawl, persistent pulmonary hypertension in infants Wh

What are uses for SSRIs 

depression, obsessive compulsive disorder, panic disorder 

What is an example of an SSRI

fluoxetine

What do serotonin/norepinephrine reuptake inhibitors (SNRI) do

blocks neuronal reuptake of serotonin and NE with minimal effects on other transmitters or receptors Wh

What are common adverse effects of SNRIs 

nausea, headache, anorexia, nervousness, sweating, insomnia, diastolic hypertension, sexual dysfunction, dilation of pupils 

Uses for SNRIs (serotonin/norepinephrine reuptake inhibitors)

major disorder, panic disorder, social phobia, generalized anxiety disorder

What is an example of an SNRI

venlafaxine

What do tricyclic antidepressants do 

bocks neuronal reuptake of two monoamine transmitters increases the concentration at CNS synapses intensifying their effects 

What is an example of a tricyclic antidepressant 

imipramine 

What are adverse effects of tricyclic antidepressants 

sedation, orthostatic hypotension, anticholinergic effects(fight/flight), lethal cardiac toxicity 

What is an example of monoamine oxidase inhibitors

phenelzine

What do monoamine oxidase inhibitors do

inhibit neuronal breakdown and thereby increase stores of serotonin available for release

What are adverse effects of monoamine oxidase inhibitors (MOI)

hypertensive crises with tyramine, direct CNS simulation anxiety, insomnia, agitation, hypomania, mania, orthostatic hypotension 

What are some uses for monoamine oxidase inhibitors (MOI/phenelzine)

depression, bulimia nervosa, agoraphobia, ADHD, OCD, reduce panic attacks

What are examples of atypical antidepressant 

bupropion, mirtazapine 

What is bupropion

dopamine norepinephrine reuptake inhibitor

What is mirtazapine

antagonizes presynaptic alpha 2 adrenergicWha receptors and postsynaptic serotonin receptors

What are adverse effects of bupropion 

associated with peak plasma concentrations and includes seizures 

What are atypical antidepressants used for

major depression who have inadequate responses or intolerable side effects, generalized anxiety disorder, and tension headaches

pancytopenia

A lower number of red, white blood cells and platelets in the blood

What is the number of circulating red blood cells per 1 microliter of blood

RBC count

Hemoglobin (Hgb)

measures the grams of hemoglobin per deciliter of blood

Hematocrit (Hct)

Measures the volume of packed red blood cells per unit of blood expressed as a percentage 

What is the reticulocyte count

measures the percentage of immature RBCs

What are the laboratory tests most commonly used for red blood cell disorders

Hemoglobin, hematocrit, red blood cell count, reticulocyte count

Red blood cell indices: mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red blood cell distribution

White blood cell count (neutrophils, eosinophils, basophils, monocytes, lymphocytes

What is included in the red blood cell indices 

• Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution (RDW)

What is included in the White Blood cell Differential

• Neutrophils, eosinophils, basophils, monocytes, lymphocytes 

What is a CBC called that includes platelets

CBC-P

What is the mean corpuscular volume (MVC)

Reflects the avg size of circulating RBCs (measured in femtoliters fL)

What is the mean corpuscular hemoglobin (MCH)

reflects the weight of Hgb per RBC (measured in picograms pg)

What does mean corpuscular hemoglobin concentration MCHC measure 

measures the average concentration of hemoglobin in the RBCs MCHC = Hgb/Hct 

How is anemia diagnosed

bone marrow aspiration - cells and fluid are suctioned from the bone marrow

bone marrow biopsy - bone, cells, and fluid are obtained from the bone marrow

What do you do after bone marrow exam and what are you monitoring for

apply firm pressure for 5-10 minutes

cover site with sterile pressure dressing

monitor vital signs, monitor for bleeding/swelling/worsening pain/fever

Soreness lasts 3-4 days after procedure (treat with acetaminophen)

What are some nursing diagnoses for anemia?

Ineffective tissue perfusion, fatigue, risk for injury, activity intolerance, imbalance nutrition - less than body requirements(vit B12, folic acid, iron), readiness for enhanced knowledge

What vitamins/minerals may be imbalanced for someone with anemia

(vit B12, folic acid, iron)

T0 

no evidence of primary tumor 

Tx

primary tumor cannot be assessed

Tis

no evidence of primary tumor

T1 T2 T3 T4

increasing size/local extent of primary tumor 

Nx

regional lymph nodes cannot be assessed

N0

no regional lymph node metastasis

N1 N2 N3

increasing involvement of regional lymph nodes 

Mx

presence of distant metastasis cannot be assessed

M0

no distant metastasis

M1 

distant metastasis 

What are hospital interventions for suicide

therapeutic milieu, frequent checks, proximity (sitter), locked unit, therapeutic use of self, BERT (behavioral emergency response team)

Examples of theraputic techniques

therapeutic listening, seeking clarification, restating, open ended questions/openings, making observations, comparisons/questions about past experiences, encouraging plan of action, presenting reality, presence, collaboration, using silence, accepting/acknowledgement, observing behavior