Exam 2 Mental Health

Sigmund Freud Definition (2)

All human behavior is caused and explainable

Mental illness is caused by early unresolved issues in childhood

Sigmund Freud Personality Components (3)(1st has 4 and a lil sum in (), 2nd has 3 and a lil sum in (), 3rd has 3)

Personality components

-ID- Source of all drives, instincts, reflexes, needs (cannot tolerate frustration)

-Ego-Subjective memories, experiences, and objective reality (controls the ID)

-Super Ego-Morals, ethical values, parental role

3 Level of Awareness

Conscious- Awareness

Preconscious-Can be retrieved easily

Unconscious- Believed memories and emotions associated with trauma

Freudian Slip def

A slip of the tongue is unconsciously saying what you really mean

4 Levels of Anxiety (who created it and what the 4 levels are plus 1 important note)

Hildegard Peplau’s

Mild

Moderate

Severe

Panic

Important: The more anxious a person feels the less likely they are able to engage in the nurse patient relationship

Stages of Cognitive Development (who created it and the 4 stages)

Jean Piaget

1. Sensorimotor (Birth to 2)

2. Preoperational (2-6)

3. Concreate operational (6-12)

4. Formal operational (12-Adulthood)-Abstract thinking ability

Abraham Maslow Theory

Hierarchy of human needs

Theory: Unmet needs are the motivation for behavior. So, physical needs must be met before psychosocial needs can be met

Hildegard Peplau Nurse-Patient Relationship Phases (6)

Nurses role should adapt to meet client’s needs:

Stranger

Resource Person

Teacher

Leader

Surrogate

Counselor (Example: Expression of feelings)

Hildegard Peplau created

Therapeutic nurse-client relationship

Psychoanalysis Def

Focuses on discovering causes of client unconscious, repressed thoughts, feelings, conflicts related to anxiety. Its one on one therapy with a therapist.

Reinforcements Negative and Positive (4)

Positive Reinforcement: Increase frequency of behavior

Removal of Negative Reinforcers: Increased frequency of behavior

Continuous Reinforcement: Fastest way to increase behavior, behavior does not last long after reward ceases

Random intermittent Reinforcement: Increases behavior more slowly but has a longer lasting effect

Erik Erikson Stages of Psychosocial Development (8)

• Initiative vs Guilt

• Intimacy vs Isolation

• Autonomy vs Shame and Doubt

• Identify vs Role Confusion

• Integrity vs Despair

• Generativity vs Self-absorption

• Industry vs Inferiority

• Trust vs Mistrust

0-1.5: Trust vs Mistrust

1.5-3: Autonomy vs Shame and Doubt

3-6: Initiative vs Guilt

6-12: Industry vs Inferiority

12-20: Identify vs Role Confusion

20-35: Intimacy vs Isolation

35-65: Generativity vs Self-absorption

65-Death: Integrity vs Despair

B.F Skinner Def (3)

Theory of operant conditioning

All behavior is learned

Behavior has consequences (reward or punishment)

Transference vs Countertransference

Transference: Client unconsciously redirects feelings onto their therapist (Example: A patient displaces feelings related to people in his past onto the nurse)

Countertransference: Therapist projects their own feelings to client

Conversion Def

Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature

• Teenager forbidden to see X-rated movies is tempted to do so by friends and develops blindness, and the teenager is unconcerned about the loss of sight

Denial Def

Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue

• Person with diabetes eating chocolate candy

• Spending money freely when broke

• Waiting 3 days to seek help for severe abdominal pain

Displacement Def

Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings

• Person who is mad at the boss yells at their spouse

• Child who is harassed by a bully at school mistreats a younger sibling

Intellectualization Def

Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions

• Person shows no emotional expression when discussing serious car accident

Reaction Formation Def

Acting the opposite of what one thinks or feels

• Woman who never wanted to have children becomes a supermom

• Person who despises the boss tells everyone what a great boss they are

Regression Def

Moving back to a previous developmental stage to feel safe or have needs met

• A 5-year-old asks for a bottle when new baby is being fed

• Adult pouts like a 4-year-old if they are not the center of their partner’s attention

Suppression Def

Conscious exclusion of unacceptable thoughts and feelings from conscious awareness

• Student decides not to think about a parent’s illness to study for a test

• Person tells a friend they cannot think about their child’s death right now

Complimentary Medicine

Non mainstream healthcare used with conventional medical treatments

4 Stages of Crisis

Stage 1: Exposure to stressor

Stage 2: Increased anxiety when usual coping are ineffective

Stage 3: Increased efforts to deal with stressor

Stage 4: Disequilibrium, significant distress

Crisis Types (3) (1st with 4, 2nd with 4, 3rd with 4)

Adventitious/Social-Natural disasters, violent crimes, war, riots

Developmental/Maturational-Predictable events, leaving home, marriage, new job

Situational-Unanticipated events, death of loved one, job loss, illness

Crisis Intervention Techniques (2)

Directive interventions: Assess health status, promote problem solving

Supportive Interventions: Deal with person’s needs for empathetic understanding

Individual Psychotherapy

Bringing about change in a person by exploring his or her feelings, attitudes, thinking, behavior

One to one relationship between the therapist and the client

-Progression through stages

-Relationship as key to success

Therapist’s theoretical beliefs strongly influence style of therapy

Psychiatric Rehabilitation

Restoring community functioning and well being for individuals with mental health conditions or psychiatric disabilities

Psychosocial Interventions

Combination of psychological and social elements to support individuals with mental health conditions

Diphenhydramine (Benadryl) (treats 2

Treats extrapyramidal signs (EPS) and neuroleptic malignant syndrome

Ketamine (Ketalar)

Dissociative Anesthetic

Lithium (2 things to do and monitor regularly)

Must draw labs to maintain therapeutic level

Monitor hydration

Post Injection Delirium/Sedation Syndrome (3)

Delirium

Sedation

Extrapyramidal symptoms

TCA 3 vs SSRI 3 vs MAOI 2 Antidepressants

TCA

-Tricyclic/cyclic antidepressants.

-Not first-line antidepressants due to significant side effects.
-Used off label for anxiety

SSRI

-Most commonly prescribed

-Avoid use with bipolar disorder due to potential mania

-Do not abruptly discontinue

MAOI

-Monitor for hypertensive crisis and diet. Avoid tyramine

-Avoid use with bipolar disorder due to potential mania

Antidepressants (warning, 4 kinds)

Patients are at high risk of suicide first 2 weeks after starting drugs

-SSRI

-SNRI

-TCA

-MAOI

Agranulocytosis Def

Decreased WBC

Akathisia Def

An intense need to move about

Dystonia Def

Acute muscular rigidity or cramping

Extrapyramidal Symptoms (6) (EPS) and treatment(2)

S/S:

-Dystonia

-Parkinsonism

-Bradykinesia

-Akathisia

-Neuroleptic Malignant Syndrome (NMS)

-Tardive Dyskinesia (TD)

Treatment:

-Diphenhydramine (Benadryl) – H1 blocker (antihistamine)
-Benztropine (Cogentin) – anticholinergic

Anticonvulsants inhibit what

Kindling process-repeated exposure to certain stimuli, even subthreshold ones, can lead to a progressively stronger and more persistent response, potentially lowering the threshold for future occurrences

Metabolic Syndrome (common side effect of what, its a precursor to 3 things, and s/s of 4)

Common side effect of antipsychotic medication

Its a precursor to heart attack, stroke, and diabetes

S/S:

-Obesity

-Hypertension

-Hyperglycemia

-Hypercholesterolemia

Neuroleptic Malignant Syndrome (NMS) (7)

A potentially fatal reaction to antipsychotic drugs

-Temp higher than 104 F

-Severe EPS symptoms

-unstable blood pressure

-Diaphoresis

-Pallor

-Delirium

-Elevated level of enzymes, specifically creatine phosphokinase

Oculogyric Crisis Def

Eyes rolled back in a locked position

Serotonin Syndrome Def

When an excess of serotonin is in the body

Stevens-Johnson Syndrome Def

Potentially life threatening skin reaction, blistering and peeling of mucous membrane

Tardive Dyskinesia (TD)

Serious side effect of antipsychotics

Abnormal Involuntary Movement Scale )Scale to help notice onset of TD

Permanent involuntary movements

-Protruding and rolling tongue

-Blowing

-Smacking

-Spastic facial distortion

-Smacking movement

Torticollis Def

Painful twisted head and neck

Antipsychotic Medications

Black Box Warning for elongated ST wave

5-Phase Aggression Cycle

Triggering phase

Escalation phase

Crisis phase

Recovery phase

Postcrisis phase

Triggering Phase

Approach in a nonthreatening, calm manner
Convey empathy
Encourage verbal expression of angry feelings
Use clear, simple, short statements
Allow client time for self-expression
Suggest client go to a quieter area
Offer PRN medications if ordered
Suggest physical activity, such as walking

Escalation Phase

Take control
Provide directions in a firm, calm voice
Direct client to time-out in quiet room or area
Communicate that aggressive behavior is not acceptable
Offer medication if refused in triggering phase
Show of force

Crisis Phase

Only staff with training should participate in restraint.

Four to six trained staff members are needed.

Inform client that behavior is out of control and staff is taking measures for safety

Recovery Phase

Talk about situation or trigger
Help client relax or sleep
Help client explore alternatives to aggressive behavior
Assess and document any injuries
Debrief staff
Encourage other clients to talk about feelings - Do not discuss aggressive client with other clients

Postcrisis Phase

Remove patient from restraint or seclusion as soon as criteria met
Calmly discuss behavior (no lecturing or chastising)
Give client feedback for regaining control
Reintegrate client as soon as he or she is able to participate

Types of Abuse

Physical

Sexual

Neglect

Economic

Emotional

Elder

Child Abuse

Clinical picture of patents

-Minimal parenting knowledge and skills

-Emotionally immature

-Frequently view children as property

-Cycle of family violence: Adults raising children in same way they were raised (Adults who were victims frequently abuse their children)

Nurses have a duty to report suspected child abuse

Intentional injury of a child

• Physical abuse or injury

• Neglect or failure to prevent harm

• Failure to provide adequate physical or emotional care or supervision

• Abandonment

• Sexual assault or intrusion

• Overt torture or maiming

Elder Abuse

Maltreatment of older adults

10% of population over age 65 abuser by caregiver

60%-65% are women

The people that abuse are usually in a caretaker role

Bullying between residents

Elders often reluctant to report abuse

Intimate Partner Violence

Emotional abuse

Physical abuse

Sexual

Rate higher among women

Increased rates during pregnancy

Domestic violence occurs in same sex relationships with same statistical frequencies-victims have few protections

JCAHO Standards-Workplace Safety

A standard for healthcare organizations

Managing Aggressive Behavior

Nurse-patient relationship

Use calm reassuring approach

Limit access to frustrating situation

Encourage patient to seek out staff to help with difficult situations

Use of seclusion or restraint

Use of de-escalation techniques

Teach coping skills

Offer PRN meds

Managing the environment

Planned activities

Scheduling one to one interactions

Offer opportunity for problem solving or conflict resolution

Consider safety of other patients and yourself

History of Physical Violence

Is number 1 predictor of future violence

Rape Trauma Syndrome

Begins immediately after assault, lasts for 2-3 weeks

Usually seen in ED by an RN more at this stage

The person may appear self contained/calm however they are dealing with shock, emotional numbness, and disbelief

Cognitive functioning may be impaired

They may be crying hysterical,, restless or even smiling

Physically may be sore with bruises on breast, throat or back, vaginal trauma may have occurred

May be embarrassed and feel shame, guilt, or anger

May have the inability to discuss the event