Psych Exam 2

mental health continuum self check tool

healthy

reacting

injured

ill

mental health continuum self check tool: healthy

occasional mood fluctuations

social

confident

mental health continuum self check tool: reacting

nervous

forgetful

reactive

low energy

sleeplessness

mental health continuum self check tool: injured

angry

anxious

sad

negative

withdrawn

mental health continuum self check tool: ill

easily enraged

panic attacks

constantly tired

depression

numbness

inpatient setting

crisis-stabilization beds

community-based hospital facilities

state hospital facilities

long-term facilities

transitional/respite facilities

substance use disorder treatment centers

outpatient setting

primary care provider

outpatient mental health clinic

case management

home-based services

telehealth

mobile mental health crisis team

day treatment

family services

peer services

Specialty care

military veteran care

pediatric/adolescent care

geriatric care

forensic care

primary prevention

teaching parenting skills to expectant parents

stress awareness education

substance use disorder prevention programs

suicide prevention programs

secondary prevention

mental health self-check screening

counseling services

resources for pregnant teenagers

tertiary prevention

mental illness monitoring

life skill teaching

medication management

support group referrals

home health follow-up visits

discharge education

populations at risk for mental illness

underserved individuals

incarcerated individuals

people experiencing houselessness

underserved individuals

social determinants of health

adverse childhood experiences

geographic or environmental settings

marginalized social or ethnic groups

physical abuse: potential signs

disheveled general appearance

bruising,lacerations, burns, fractures, puncture wounds

wounds in various stages of healing

emotional abuse: potential signs

changes in behavior (withdrawal or non-responsive communication)

loss of self-esteem

anxiety provoked by presence of certain people

sexual abuse: potential signs

sudden changes in behavior (fear of people or places)

sexually explicit behavior or play

regression to younger behaviors

developmentally inappropriate interest in human sexuality

unexplained/recurrent STIs

risk factors for abuse, aggression, and violence

history of violence

history of mental health disorder, including substance use

being the victim of a crime

witness abuse or crime

poor self-esteem

inadequate coping skills

no positive role models throughout childhood

adverse childhood experiences

etiology for abuse, aggression, violence: genetic

MAO gene deficit- x linked recessive

etiology for abuse, aggression, violence: social determinants

cultural

economic

political

etiology for abuse, aggression, violence: medical conditions

damage to the brain’s prefrontal cortex, limbic system, and amygdala

Alzheimer’s

addictive personalities: aggression releases endorphins and adrenaline, mimicking the “high”

Cycle of Violence: Build up

can last days, weeks, or years

breakdown in communication occurs

perpetrator initiates more arguments

environment becomes more tense

abusive incidents begin

Cycle of Violence: acute battering

normally limited to a few hours (up to 24)

abusive acts are filled with rage and intensity

law enforcement may become involved

Cycle of Violence: Honeymoon/ reconciliation

perpetrator becomes affectionate and apologetic toward survivor

regretful of actions and promises to change

will frequently continue to maintain control over survivor through economic and emotional abuse

Abuse, aggression, violence: interview techniques

physical location and who will be present is important

approach should be gradual and nonthreatening

conversational

do not touch survivor without asking permission to do so

trauma effects may be exhibited and should be treated respectfully (memory loss, emotional reactivity, telling several versions of the story)

Abuse, aggression, violence: Nurse’s role

equitable and sensitive care

self-awareness

client-centered care

management and prevention of agitation

Abuse, aggression, violence: Nursing process- assessment/recognizing cues

observe client

careful collection of history

screening tools

Abuse, aggression, violence: Nursing process- analysis/analyze cues/prioritize hypotheses

Link cues to probable causes

Safety and preventing harm to self/others is priority

Therapeutic environment is essential

Clients need to feel safe

Abuse, aggression, violence: Nursing process- planning/ generate solutions

With clients experiencing anger, aggression, abusive tendencies, and risk for violence:

De-escalation: verbal de-escalation should be used first if possible

Pharmaceuticals

Restraint/seclusion

Abuse, aggression, violence: Nursing process- implementation/take action

Physical activity

Contingency management

Seclusion

De-escalation

Restraints- Physical or Chemical (Haloperidol, Midazolam, diazepam)

Abuse, aggression, violence: Nursing process- evaluation/evaluating outcomes

debrief

NSSH: risk factors

ACEs

usually start in adolescents

associated with mental health disorders

NSSH: warning signs

unexplained scars

unexplained fresh wounds

excessive rubbing of skin leading to burns

hiding sharp objects to keep available

covered arms and legs despite weather

poor interpersonal relationships

personal identity issues

unpredictable and impulsive behaviors/actions

feelings of worthlessness, helplessness, and/or hopelessness

NSSH: interventions

reach out immediately to trusted confidant or psychosocial team

explore creative avenues to express emotions

re-center thoughts and emotions by focusing on things that interest client

develop action plan to implement when desirre to engage in NSSH occurs

educate client and family about NSSH thought processes

establish support system

prolonged grief disorder

Symptoms of grief become prolonged,pervasive, and persistent

Preoccupied with the deceased

Experiencing separation distress

Ability to function in daily life is disrupted

anticipatory grief

Experienced in midst of loss or death

Not always related to death (divorce, job change)

Can be prolonged (cancer, dementia)

disenfranchised grief

Outward:

Individual has little or no opportunity to grieve

Not socially, culturally or publicly appropriate

Often related to bias, racism, cultural beliefs

Inward:

Feeling trapped in silence

Isolation

Increased risk for depression and suicidal behaviors

complicated grief

chronic/prolonged

delayed

may have absence of grief symptoms

traumatic grief and loss

all forms of trauma have loss

grief response often intensified

types:

death during military duty

homicide or suicide

accidents or disasters

violent acts

Grief and loss: assessment/recognizing cues

medical and mental health history

physical exam

psychosocial history

culture

mental health exam

Grief and loss: analysis/analyze cues

How much time has passed since the person’s death?

Is there evidence of distress related to the loss?

Is the client able to go to work/school/play?

Can they participate in activities they enjoyed before the loss?

Is the client avoiding talking about their loss?

Grief and loss: analysis/prioritize hypotheses

organization of priorities:

1 safety

2 client need

3 supportive care

Grief and loss: planning/generate solutions

Ongoing bereavement support

Create a safe, confidential, nonjudgmental environment.

Client and family education

Encourage the client

– To talk about their relationship with the deceased

– To share about the loss, death or dying experience

– To describe life since the death of their loved one

grief and loss: implementation/generate outcomes

Therapeutic relationships are foundation

Grief-informed approach to nursing care

Interventions are individualized to meet client need

Ensure culturally and spiritually appropriate care

Consider type of grief client is experiencing

grief and loss: evaluation/evaluate outcomes

was a safe, nonjudgmental environment created/maintained?

what current grief symptoms are being experienced?

impact on daily function?

does client feel supported?

what coping strategies? effectiveness?

levels of anxiety: mild

Perceptual field: May notice increase of awareness to environment possible hypervigilance

Ability to problem solve: Peak functioning

Physical characteristics: Tension-relief is characterized by nail-biting, foot-tapping, or fidgeting.

eustress

“good stress”

histamine

regulates release of:

histamine

glutamate

serotonin

GABA

norepinephrine

learning

sleep

mood

memory

attention

serotonin

emotional regulation

sexual behaviors

temp regulation

sleep

pain management

dopamine

emotional response

pleasure and reward

complex movements

cognition

benzodiazepines

antianxiety

bind to GABA receptors and produce inhibitory effect

increase in dopamine-often addicting

can cause paradoxical symptoms

sedative effects

should be tapered

SSRIs

antidepressants

adverse effects are nausea, agitation, sexual dysfunction

should be watched closely at beginning of therapy for increased risk of suicide-can take a few weeks for therapeutic effects

food interactions

hypertensive crisis from MAOIs and foods with tyramine

OTC interactions

MAOIs should not be taken with OTC containing norepinephrine

drug interactions

MAOIs should not be taken with TCAs

first generation antipsychotic

conventional/typical

block dopamine receptors

for severe manifestations of schizophrenia

second generation antipsychotics

atypical

more subtle dopamine blockers to lesser degree

block serotonin reuptake

more common side effects are metabolic changes

mood stabilizers

lithium- not well understood MOA

important to reduce stress along with medication

check lithium serum concentration levels and drink plenty of water

CNS stimulant

release dopamine, serotonin, and norepinephrine

herbal interactions

st johns wort can increase serotonin syndrome

serotonin syndrome

manifestations: restless, sweating, dilated pupils, high HR and BP, muscle rigidity

activation syndrome

possible increase of suicidal thoughts and aggressive behaviors after staring antidepressants

ADDS: antidepressant discontinuation syndrome

difficulty sleeping

anxiety

depression

flu-like symptoms

electric shock over body

lithium toxicity

early- greater than 1.5 (poor coordination, confusion)

advanced- 2-2.5 (seizure, stupor)

severe- over 2.5 (risk of death, resp distress)