Mental Health Nursing Review

Flashcards covering key concepts from lecture notes on mental health, including definitions of terms, nursing interventions, medication side effects, and treatment modalities for various disorders.

Why is mental health often considered a 'disease of exclusion'?

Because mental health issues can mimic symptoms of various medical conditions, such as cardiac, thyroid, or brain problems, requiring medical issues to be ruled out first.

What is the number one priority when a patient presents with potential mental illness symptoms?

Always treat any co-occurring medical issues first and rule out medical causes before diagnosing or medicating for a mental illness.

Define 'psychosis'.

A disconnection from reality where an individual experiences hallucinations and delusions.

Define 'delusion'.

False ideas or beliefs accepted by a person as real, often seen in schizophrenic patients (e.g., paranoia).

As a nurse, what is the appropriate response when a patient is experiencing delusions?

Do not argue or agree with the delusion; instead, focus on reality by stating what you observe (e.g., 'I only see you and I in the room').

Define 'hallucination'.

A false sensory perception without a basis in reality, which can be visual, auditory, tactile, olfactory, or gustatory.

What are some natural reasons why someone might exhibit symptoms of mental illness?

High fever, genetics (e.g., autism), injury (e.g., concussion), substance abuse, poor nutrition, sleep deprivation, or brain chemistry imbalances (e.g., serotonin, dopamine levels).

What is a nurse's primary role regarding personal beliefs and values when caring for patients?

To be self-aware of personal beliefs, values, and visible stances, and to maintain a non-biased approach when dealing with patients.

What should a nurse do if they feel biased towards a patient?

Check themselves, try to maintain a professional demeanor, or, if the bias is still high, talk to the charge nurse and request a change in assignment.

How can nurses establish trust and rapport with patients?

By doing what they say they will do, showing respect (e.g., eye contact, addressing them formally), being genuine, asking open-ended questions, and sitting at eye level rather than hovering.

Differentiate between 'empathy' and 'sympathy'.

Empathy is recognizing and understanding another's feelings, often from a similar past experience ('I can empathize with you'). Sympathy is feeling bad for someone without necessarily having a similar experience ('I'm so sorry this happened').

Define 'transference' in a patient-nurse context.

When a patient projects their feelings, emotions, and expressions onto the nurse, often from past experiences with significant figures (e.g., an overbearing parent).

Define 'countertransference' in a nurse-patient context.

When a nurse projects their own beliefs, feelings, emotions, and experiences onto the patient, often from past or current personal experiences (e.g., treating a patient with substance abuse like an addicted parent).

What is the priority in creating a therapeutic environment?

Safety, for both the patient and the nurse.

What measures should be taken to ensure a safe environment for a patient with suicidal thoughts?

Remove sharp objects, keep them close to the nursing station, and conduct regular rounding.

What is the progression of interventions for a combative patient, from least to most restrictive?

Medication (if prescribed), followed by restraints, starting with soft wrist restraints and progressing to two-point or locking key restraints if necessary.

How should a nurse approach a patient experiencing active psychosis, delusions, or hallucinations?

Calmly, ensuring the patient sees you from a non-threatening position (e.g., closest to the door), avoiding physical touch and arguments.

What are key components of therapeutic communication?

Verbal (concrete language, open-ended questions, appropriate vocal cues like volume and tone) and nonverbal (sitting at eye level, open body language, appropriate facial expressions, observing personal boundaries).

Why is it important for nurses to know all medications a patient is taking, especially in mental health?

To understand potential side effects, interactions, and whether the medications are effectively managing their mental health conditions (e.g., anxiety, depression, seizures).

Name three common mental health assessments mentioned in the lecture.

The Mental Status Exam, CAGE (for alcohol use), and GAD-7 (for anxiety).

What principles should guide psychosis care, particularly when approaching patients?

Use a positive, nonjudgmental demeanor; employ respectful communication, active listening, and a supportive presence to build trust, reduce stigma, encourage open communication, and promote emotional safety.

What are some ways to validate a patient's feelings therapeutically?

Using reflective listening (e.g., 'It sounds like you're feeling overwhelmed'), normalizing their feelings ('It's completely understandable to feel sad'), and asking open-ended questions to encourage expression.

Describe the '5-4-3-2-1' physical grounding technique.

Identify five things you see, four things you feel, three things you can hear, two things you can smell, and one thing you can taste, to bring focus to the present moment.

What does 'depression' entail according to the lecture?

Feeling sad for two weeks or greater, inability to perform Activities of Daily Living (ADLs), plus a cluster of five to six symptoms like inability to feel pleasure, changes in weight/appetite/sleep/energy, poor concentration, or low self-esteem.

What is a major priority assessment for all mental health issues, especially depression?

Assessing for suicidal ideations or attempts.

What is a crucial warning sign to be aware of in a patient previously experiencing severe depression?

A sudden and unexpected shift to extreme happiness and enthusiasm, as this might indicate they have finalized a suicide plan and feel relieved.

What are the priority nursing interventions for an actively suicidal patient?

One-to-one sitter, rounding every 15-30 minutes, open-mouth checks after medication administration, and maintaining open lines of communication to build trust.

What are common anticholinergic side effects associated with Tricyclic Antidepressants (TCAs) like amitriptyline?

Dry mouth, increased risk for seizures, decreased urine output, and constipation.

What is Serotonin Syndrome and its key symptoms?

A rare but life-threatening condition caused by too much serotonin, characterized by sweating, high fever (101-105°F), irregular heartbeat, muscle rigidity, and potential loss of consciousness.

What nursing interventions are appropriate for a patient suspected of having Serotonin Syndrome?

Stop the causative medication, notify the physician immediately, provide supportive care such as IV fluids, and monitor vital signs; Tylenol is not effective for the fever caused by muscle activity.

Why are Monoamine Oxidase Inhibitors (MAOIs) less commonly prescribed but frequently tested on exams?

Due to their narrow therapeutic window and high risk of massive hypertension (serotonin syndrome) with specific food and drug interactions.

What specific foods should be avoided when a patient is taking MAOIs?

Fermented foods such as yogurt, sauerkraut, pickles, kefir, sourdough bread, beer, and wine.

Why does starting antidepressant medication sometimes increase the risk of suicide?

As the patient starts to feel better, they may gain enough energy to act on a pre-existing suicidal plan.

What is Electroconvulsive Therapy (ECT) used for?

Severe major depression and bipolar disorder, involving a controlled 30-second to one-minute seizure triggered by electrodes, administered under general anesthesia.

What is the primary characteristic of Bipolar I disorder?

Severe extreme highs of mania (euphoria, agitation, rapid thoughts, decreased need for sleep/food) alternating with extreme lows of depression (sadness, fatigue, hopelessness).

Why can mania in bipolar disorder be considered a medical emergency?

Due to risks of harm to self/others, sleep deprivation, dehydration, and impulsive behaviors that can lead to severe consequences.

What are key nursing interventions for a patient experiencing a manic episode?

Ensuring medication adherence, room safety, promoting hydration and nutrition, maintaining a calm environment, setting realistic behavioral goals, and encouraging short tasks and naps.

What are the three categories of symptoms for schizophrenia?

Positive symptoms (e.g., hallucinations, delusions), negative symptoms (e.g., flattened affect, social withdrawal), and cognitive symptoms (e.g., disorganized thoughts, impaired memory).

What is the primary mood stabilizer discussed for bipolar and schizophrenia?

Lithium.

What are important considerations when administering lithium?

It has a narrow therapeutic range (toxicity above 1.5 mEq/L), requires increased fluids and salt intake to prevent dehydration, and patients should avoid diuretics, caffeine, and NSAIDs.

What is Neuroleptic Malignant Syndrome (NMS)?

A rare but life-threatening reaction to antipsychotic medications (typical and atypical), characterized by high fever, muscle rigidity, blood pressure changes, difficulty swallowing, and elevated white blood cell count/creatinine kinase.

What are the nursing interventions for Neuroleptic Malignant Syndrome (NMS)?

Discontinue the medication, provide cooling measures (ice packs, cooling blankets), administer dantrolene (muscle relaxant), and provide supportive care (e.g., intubation for difficulty swallowing); Tylenol is not effective for the fever.