Mental Health Exam 2

rapport

the development of a trusting, therapeutic relationship through warmth, removing biases, and understanding; decreases anxiety and increases recovery

empathy

the ability to understand the patient's perspective and share their feelings

empathetic linkages

feelings, usually anxiety, that the nurse can directly share with the patient and must be aware of

introduction phase of the therapeutic relationship

when the nurse explains their role and task, must put initial bias aside and keep it patient-centered

orientation phase of the therapeutic relationship

the nurse and patient get to know each other, establish trust, set boundaries, get to know problems, and discover themes

first meeting of the orientation phase

nurse and patient set boundaries, outline responsibilities, discuss rules of the unit, address anxieties, and observe problems

confidentiality of treatment in the orientation phase

families may be better historians than patients, but nurses must get permission first

testing the relationship in the orientation phase

patients will test the relationship to gauge if they should trust you: forgetting scheduled session, being late, getting frustrated, making small issues big ones

working phase of the therapeutic relationship

exploring the problem and identifying possible strategies; the patient becomes more trusting and the nurse educates and encourages the patient; phase where transference and countertransference can arise

resolution phase of the therapeutic relationship

problems are resolved and the relationship comes to a close; doesn't mean the problems are gone; ideally the patient takes responsibility, but termination can be stressful

nontherapeutic relationship

nurse and patient both are trying to find a solution but keep failing, thus they get frustrated with each other and can lead to mutural withdrawal

deteriorating relationship

starts with withholding where the patient doesn't feel seen, moves to avoiding and ignoring where the patient avoids the nurse but thinks the nurse is avoiding them and then the nurse starts to ignore, moves to the patient struggling to make sense of the situation which can lead to blaming, taking personally, and internalizing

strategies to support a therapeutic relationship

motivational interviewing, collaboration, client-centered counseling, client change talk, negotiating change plans, empowering goals and decisions

empathy vs sympathy

empathy is feeling with someone and recognizing and not judging their emotion, while sympathy is feeling for someone and feeling bad for them

emotional vs cognitive empathy

emotional is where you absorb emotions as if they were your own and can contribute to compassion fatigue, while cognitive is based on reasoning and keeps you grounded because it is empathy for the purpose of understanding how to help

WBC lab results

decreased from medications like phenothiazine, clozapine, and carbamazepine; increased from lithium and NMS

platelets lab results

decreased from medications such as phenothiazine, clozapine, and carbamazepine

vitamin B12 lab results

deficiency can result in psychosis, paranoia, fatigue, agitation, personality changes, dementia, and delirium

folate lab results

deficiency can be caused by alcohol, phenytoin, oral contraceptives, and estrogens

CK lab results

elevated from muscle injury, drug use, IM injections, NMS, manic episodes, and restraints

sodium lab results

deficiency caused by Addison's, SIADH, polydipsia, and carbamazepine and can increase lithium toxicity

potassium lab results

can lead to weakness, fatigue, and EKG changes

BUN/creatinine lab results

elevated from dehydration or lithium and amantadine toxicity, can cause AMS, lethargy, and delirium

concepts of psychiatric nursing process

assessment, diagnosis, planning, implementation, evaluation

what factors are included in a recovery-oriented assessment?

patient interview, trauma-informed assessment, physical assessment, psychological assessment, self-concept, stress/coping assessment, risk assessment, suicide/homicide assessment, social/cultural/spiritual assessment

what are recovery-oriented nursing interventions?

self-care, activity/exercise, sleep strategies, nutrition, relaxation, hydration, thermoregulation, medications, CBT, conflict resolution, cultural brokering, bibliotherapy/social media, reminiscence, psychoeducation, health teaching, milieu therapy, privilege systems

describe the physical response to stress

increased cortisol, epinephrine, and adrenaline results in hyperglycemia, tachycardia, HTN, and increased blood supply

role of cortisol in stress

fight or flight triggers increased release of stress, the body attempts to adapt, stress continues, leads to burnout, weak immunity, and illness

priorities related to stress

depend on the person but usually entail reestablishing basic functional patterns, addressing psychological issues, and developing coping skills

interventions related to stress

reinstating daily routine, adequate diet education, regular exercise routine, relaxation techniques, problem-solving strategies, reflection of past coping skills, family unit functioning

medications used to treat stress

benzodiazepines, SSRIs, SNRIs, beta-blockers (physical s/s), sedative-hypnotics (stress-related insomnia), buspirone

what is included in the DSM-V criteria for depression?

must include at least one of either depressed mood OR loss of interest or pleasure

additionally, must include 4/7: appetite or weight changes, sleep disturbances, psychomotor changes, fatigue, worthlessness or guilt, concentration problems, suicidal thoughts

neurobiological theory of depression

depression is linked to abnormalities in serotonin, norepinephrine, and dopamine

self-care strategies for depression

stress management, journaling, positive self-talk, goal-setting, contacting friends/family, participating in support groups, prayer, meditation, volunteering, problem-solving skills

family teaching on depression

triggers of depression and steps to take, possibility of depression-related symptoms, stress-management techniques, coping skills, options and support services

patient teaching on depression

illness isn't their fault, full range of tx options, incorporating wellness strategies, pharmacologic agents, risk factors and signs of recurrence, adherence, recovery strategies, nutrition and sleep measures, self-care, goal setting, problem solving, social interaction skills, follow-up, support services

medications used to treat depression

SSRIs, SNRIs, MAOIs, TCAs, NDRIs

nursing priorities for depression

safety from self harm, nutrition, sleep, activity, self-care, social functioning, hopefulness

risk factors for depression

prior episode, family history, lack of social support, lack of coping skills, presence of life stressors, current substance use/abuse, medical and/or mental illness comorbidities

addiction

chronic, relapsing condition which involves compulsive drug seeking and continuation despite the harmful consequences and long-lasting brain changes

abuse

using a substance for intoxication

detoxification

the process of safely withdrawing from a substance under medical supervision

recovery

overall goal, partnership with patient, family, and provider

withdrawal

physical and psychological symptoms that can occur when a substance is no longer used

relapse

using a substance again after time of sobriety, considered part of the disorder

tolerance

needing to ingest an increasing amount of drug to feel intended effects; levels are still the same in the body which can damage organs

DSM-V for SUD

impaired control, social problems, risky use, physical dependence

CAGE questionaire

self-report on alcohol use

C - have u tried to CUT down on your drinking

A- have you ever felt ANNOYED by criticism about drinking

G- have you felt GUILT about your drinking

E- have you ever had an EYE opener

CIWA withdrawal assessment of alcohol

assesses for N/V, tremors, paroxysmal sweats, anxiety, panic, agitation, tactile disturbances, auditory/visual disturbances, headache, and decreased LOC

effect of alcohol

short-term: enhances GABA to relax inhibitions and heighten emotions

withdrawal: enhances glutamate and causes anxiety, tremors, hallucinations, increased bp/HR

what do you give for alcohol withdrawal?

chlordiazepoxide if high CIWA score (done every few hours), lorazepam for older people or those with liver conditions; may also need to give antidepressants, anticonvulsants, and antipsychotics

complications from long-term alcohol use

thiamine/folic acid/magnesium deficiency, Wernicke encephalopathy, Korsakoff Amnestic Syndrome, esophagitis, pancreatitis, cirrhosis, stroke, cardiomyopathy, dysrhythmias

what do you give for alcohol recovery?

naltrexone or disulfiram

cocaine effect on NTs

increases dopamine (euphoria), increases norepinephrine (tachycardia, HTN, dilated pupils, increased temp), and increases serotonin (sleep disturbances and anorexia)

amphetamine effect on NTs

increases dopamine, norepinephrine, and serotonin

methamphetamine effect on NTs

releases excess dopamine

club drugs (MDMA, GHB, ketamine) effect on NTs

increases dopamine, norepinephrine, and serotonin

nicotine effect on NTs

increases release of norepinephrine and acetylcholine

why are opioids so addictive?

they bind to opioid receptors all over the body to block pain and cause a euphoric high; they increase dopamine so the body overcompensates by stopping dopamine production, thus people seek out drugs to go back to a normal dopamine state

what is given for opioid detoxification?

methadone, buprenorphine, or naltrexone

FRAMES model (motivational interviewing technique)

Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy

diathesis-stress model

explains addiction as a result of the interaction between a person's underlying genetic/biologic vulnerability (diathesis) and environmental triggers (stress)

akathisia

inability to sit still, restless, rocking in chair, pacing, marching in place, repetitive motions; can be misdiagnosed as psychiatric symptoms; treatment is to change the antipsychotic

tardive dyskinesia

repetitive movements of mouth, face, and tongue like lip smacking, lip puckering, and chewing; irreversible so the best treatment is to monitor

neuroleptic malignant syndrome

high fever, diaphoresis, unstable BP, muscular rigidity; must monitor temp and vitals

pharmacodynamis

medications act at receptors, ion channels, enzymes, and carrier proteins

why do drugs work?

selectivity - ability of a drug to be specific to a receptor

affinity - degree of strength of the bond

intrinsic activity - ability to produce a response

first-pass effect

metabolized in GI tract or liver before systemic absorption

bioavailability

amount of drug reaching systemic circulation

St. John's Wort

used for anxiety and depression, can contribute to serotonin syndrome

AE: GI upset, dizzy, confusion, sedation

Kava

used for anxiety

AE: liver injury, agranulocytosis, GI upset, drowsy, dizzy

Valerian

used for insomnia and nervousness

AE: headache, GI upset, dizzy, vivid dreams

electroconvulsive therapy (ECT)

used for severe depression, catatonia, and treatment-resistant disorders

a brief electrical current is passed through the brain imitating a seizure

AE: hyper/hypotension, brady/tachycardia, h/a, arrhythmia, nausea, amnesia

light therapy

used for SAD and depression

AE: eye strain, h/a, insomnia

transcranial magnetic stimulation (TMS)

used for depression

magnetic field thought to cause brain activation and brain inhibition in areas

AE: h/a, scalp discomfort

vagus nerve stimulation (VNS)

used for treatment-resistant depression and anxiety

sends electrical impulses to vagus nerve and linked to help changing NT levels

AE: voice changes, throat discomfort

SSRIs

includes Citalopram, Escitalopram, Fluoxetine, and Sertraline

MOA: inhibits reuptake of serotonin - improves mood, emotion, energy

Use: depression, anxiety, eating disorders

AE: sexual dysfunction, diastolic HTN, sedation, serotonin syndrome

serotonin syndrome

Potentially life-threatening condition from excess serotonin; mental status changes, autonomic instability, neuromuscular problems, GI issues

SNRIs

includes duloxetine and venlafaxine

MOA: inhibits reuptake of serotonin and norepinephrine

Use: depression (especially those who sleep excessively), anxiety, insomnia, pain

AE: same as SSRIs with high BP

NDRIs

includes Bupropion

MOA: inhibits reuptake of norepinephrine, serotonin, and dopamine

Use: depression, SAD (higher dose), smoking cessation (lower dose)

AE: seizures, CNS stimulant, dry mouth, h/a, N/V, constipation, low risk for sexual dysfunction

NMDA antagonist

includes esketamine

MOA: psychodelic drug that can cause euphoric effects

Use: nasal spray for resistant depression and Alzheimer's

AE: dizzy, sedation, N/V, headache, nasal discomfort, throat irritation

TCAs

includes Trazodone

MOA: acts on several NTs

Use: depression

AE: sedation, OH, anticholinergic effects, tremors, restlessness, dysrhythmias, weight gain

MAOIs

includes phenelzine

MOA: inhibits breakdown of serotonin, norepinephrine, etc

Use: depression

AE: dysrhythmias, drowsy, dizzy, sexual dysfunction, OH, HTN crisis

atypical antipsychotics

includes aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone

MOA: a bunch of receptor blockers

Use: schizophrenia, mania, autism, Tourette's

AE: EPS, NMS, hypo/hyperglycemia, hyponatremia, bronchospasm, agranulocytosis, anticholinergic effects

- clozapine causes constipation

- olanzapine causes increased prolactin/LFTs and decreased bilirubin

- risperidone causes weight gain in youth

- ziprasidone can cause QT prolongation

- aripiprazole can cause compulsive urges

typical antipsychotics

includes chlorpromazine and haloperidol

MOA: a bunch of receptor blockers, mainly dopamine

Use: schizophrenia, mania

AE: EPS, NMS, hypo/hyperglycemia, hyponatremia, bronchospasm, agranulocytosis, anticholinergic effects, QT prolongation, depressed cough reflex

mood stabilizer

includes lithium

MOA: increases dopamine, norepinephrine, and epinephrine, increases GABA, increases serotonin sensitivity

Use: acute mania in bipolar disorder (depression side too)

AE: severe thirst, metallic taste, polyuria, mild diarrhea, fine hand tremor, drowsy, memory problems, weight gain, hypothyroidism

anticonvulsants

includes valproic acid, carbamazepine, and lamotrigine

MOA: reduces repetitive firing of action potentials

Use: bipolar disorder, mania

AE:

- valproic acid causes GI upset, tremors, lethargy, weight gain, and alopecia

- carbamazepine causes dizzy, drowsy, tremor, N/V, and has several drug interactions with erythromycin, verapamil, and cimetidine

- lamotrigine causes a life threatening rash in kids

benzodiazepines

includes diazepam, lorazepam, and alprazolam

MOA: enhances GABA

Use: anxiety, lorazepam for acute alcohol withdrawal, insomnia

AE: sedation, memory impairment, ataxia, dependence, respiratory depression, confusion, low attention

non-benzodiazepine

includes buspirone

MOA: enhances GABA

Use: anxiety, insomnia, GAD

AE: dizzy, drowsy, nausea

antihistamine

includes hydroxyzine

MOA: crosses BBB to induce sedation and anticholinergic action

Use: anxiety

AE: deep sleep, incoordination, sedation, calmness, dizzy, anticholinergic effects

amphetamines

includes methylphenidate, amphetamine/dextroamphetamine, and dexmethylphenidate

MOA: produce alertness, wakefulness, vasoconstriction, and suppressed appetitie

Use: narcolepsy, ADHD in kids, obesity, adjunct to depression fatigue

AE: appetite suppression, insomnia, irritability, weight loss, nausea, headache, palpitations, blurry vision, constipation, dry mouth, dizzy

iron deficiency

fatigue, low mood, anxiety, irritability, anhedonia, sleep disturbances

folic acid deficiency

depression, irritability, confusion, memory issues, insomnia, psychosis

magnesium deficiency

anxiety, depression, mood instability, irritability, personality changes, mental fatigue

vitamin C deficiency

depression, irritability, fatigue, apathy, cognitive impairment

biotin deficiency

depression, fatigue, irritability, ataxia, hallucinations, cognitive impairment