Mental health

Beneficence

Do good; prevent harm.

Autonomy

Respect the client's right to make decisions.

Nonmaleficence

Do no harm; avoid causing pain.

Justice

Fair, equal treatment for all clients.

Self‑determination

Clients may refuse treatment, including medications

Confidentiality

• Protect client information at all times.

If a client refuses medication what should you do?

Assess decision‑making capacity first.

If refusal places client at risk what actions must you take

notify provider; evaluate for involuntary criteria

when is implied consent used?

only in emergencies;Applies when immediate treatment is needed to preserve life.

Timeout

Client chooses to remove self.

Seclusion

 Locked room; used for danger to self/others.

Restraints

 last resort.

restraint requirements

• Provider order required.

• Continuous monitoring.

• Meet hydration, toileting, nutrition needs.

• Document behavior, interventions attempted, client response.

• Release as soon as client is safe.

what things should you try before using restriction?

verbal de‑escalation → reduce stimuli → PRN meds → seclusion → restraints.

when does debriefing occur?

after crisis event to evaluate response and plan for improvement.

who does debriefing include

staff involved in the crisis, the client, and any relevant support personnel.

what is the purpose of debriefing ?

• prevent future restraint use, improve communication, process emotions.

If client threatens identifiable person what action must be taken?

• MUST notify that person + authorities.

Capacity

 Can client understand, reason, and make decisions?

who is capacity determine by?

the provider

who determines competence of a patient?

a judge

Competence

Legal determination of global decision‑making ability.

who does mandatory reporting protects?

vulnerable population

who does duty to warn protect?

potential victims

do you need proof for suspected abuse?

No, only reasonable suspicion is needed.

Voluntary admission

• Client seeks help.

Involuntary admission

Danger to self/others; unable to meet basic needs.

Emergency admission

temporary; imminent danger

does involuntary client still retain their rights, treatment, informed consent ?

yes, unless danger

how does affirmation therapeutic communication ?

builds confidence

how does open-ended questions help a patient?

encourage expression

what does reflections therapeutic communication?

clarify meaning

what does transition therapeutic communication do?

transitution or close conversation

what is nonvernal communication?

sit squarely

open posture

lean forward

eye contact

relax

T/F you need to clarify nonverbal cues (grimacing, rocking, flushed face) ?

true; clarifying nonverbal cues helps understand the underlying emotions and intentions.

if a patient show autonomic signs ex: sweating, dilated pupils?

assess for anxiety, withdrawal or escalation

who created Transcultural Nursing Theory

Leininger

Maintenance

• Preserve helpful cultural practices.

Negotiation

Adapt practices conflicting with health.

Restructuring

Support healthy cultural change.

motivational interviewing

engage- focus- evoke- plan

what does motivational interview help with?

• Helps clients progress through behavior change.

what do we use Likert scales for

confidence/importance

what must you do with movtivational interviewing

support autonomy

ask permission before giving advice

milieu thearpy

healing environment,

trauma informed

physical + psychosocial environment

Evaluation

• Client response

• Interprofessional feedback

• Resources

• Education

• Medication adherence

•  Evaluate safety + functional recovery.

Implementation

• Build coping skills breathing, grounding, mindfulness).

• Reduce manifestations

• Medication + therapy

• Team collaboration

 Planning

• Client‑centered

• Promote safety

• Reduce barriers

• Collaborate with team

  • Ensure continuity of care after crisis.

 Analysis

Prioritize:

• Self‑harm

• Command hallucinations

• Harm to others

  • Command hallucinations → highest risk.

 Nursing Process: Assessment

Recognize cues:

What happened?

Current manifestations

Life stressors

Functional impairment

Developmental differences
Assess for helplessness + hopelessness.

Trauma Prevention Primary

Wellness, safe environment

Secondary Trauma Prevention

Screen high‑risk individuals

Trauma Prevention Tertiary

Treat existing conditions

secondary prevent for trauma prevention

 early screening for trauma exposure.

Age‑Related Manifestations After Disaster: childern

Regression, sadness, angry outbursts

.Age‑Related Manifestations After Disaster: Adolescents/Adults

Isolation, withdrawal, depression, anxiety

Age‑Related Manifestations After Disaster: all ages

Eating + sleep disturbances

Age‑Related Manifestations After Disaster in children: is regression a normal response

yes, just provide reassurance

what is essential for trauma survivors?

 Tone, eye contact, body language

Universal Trauma Precautions

Assume everyone has trauma.

Use therapeutic communication.

Respect culture, gender, identity.

Create safe environment.

what are the Nursing Role in Trauma?

• Structure care

• Avoid retraumatizing

• Monitor for secondary disorders (PTSD, anxiety, OCD)

what is the PTSD Criteria (Under 6 Years) ?

• Exposure

• Intrusion

• Avoidance

Arousal/reactivity

what is the PTSD Criteria (older 6 Years) ?

• negative mood/cognition changes

Trauma Protective Factors

Secure attachment,

healthy lifestyle,

coping skills,

emotional regulation.

what strengthen proctective factors?

• improves trauma recovery.

Trauma Risk Factors

Family history

poor nutrition

poor sleep

chronic illness

substance use

abuse

violence.

Trauma Types

Acute

• Chronic

• Complex

• System‑induced

• Vicarious

• Historical

Trichotillomania

Hair pulling → relief/gratification

Obsessions

harm,

germs,

deity fear

forgetting

tidiness

Compulsions examples

checking

washing

repeating

counting

hair pulling

Anxiety Disorders: Clinical Manifestations

• Restlessness

• Irritability

• Anticipating worst

• Avoidance

• Tachycardia

• Tachypnea

• GI upset

• Sleep disruption

Agoraphobia

Fear of open/closed spaces, leaving home

what to asses with  Panic disorder?

•  assess for avoidance and anticipatory anxiety.

what should you do with avoidance behaviors?

•  reinforce exposure therapy principles.

Anxiety‑Related Disorders are commonly found in who?

females

what is the most common mental illness in U.S?

Anxiety‑Related Disorders

what age group is Anxiety‑Related Disorders prevalence in ?

13-18

 Levels of Anxiety

• Mild → restless

• Moderate → overwhelmed

• Severe → acting out

• Panic → terror, exhaustion, no response to stimuli

when a patient is at panic level what should you do?

• stay with client, reduce stimuli, model calm breathing.

how to interrupt anxiety cylce?

•  breathing, grounding, cognitive reframing.

 Anxiety Cycle

Stress → catastrophic thoughts

→ fear → anxiety

→ physical symptoms → fight/flight/freeze/fawn

Anxiety becomes a disorder when?

• Occurs at inappropriate times

• Interferes with function

• Prolonged duration

• Excessive intensity

what percentage of adult experience anxiety disorders?

30%

Stress Alleviation Techniques

• Relaxation response

• Deep breathing

• Guided imagery

• Mindfulness

• Biofeedback

• Positive self‑talk

• Meditation

during acute anxiety what techniques should you use?

 breathing + grounding

 DSM‑5‑TR

• Standardized diagnostic criteria.

• Organizes disorders by category.

when does preoperative begin?

begins with the decision to have surgery and ends when the patient is fully healed.

Preoperative

• preparation, optimization, teaching

Intraoperative

 surgical safety, anesthesia, sterile field

Postoperative

recovery, complication prevention, wound healing

Preoperative Management

• Manage chronic diseases

• Medication review

• Blood replacement options (donor, autologous, religious preferences)

• Resources for recovery (rehab, home support)

  • Risk severity + expected recovery

Crystalloids

•  NS, D5, LR

colloids

•  dextran, albumin, gelatin, blood

Preoperative Teaching

• Turn, cough, deep breathe (TCDB) q2h

• Splinting

• Incentive spirometer

• Activity expectations

• Nutrition

• Recovery timeline

• Home support needs

what prevent pneumonia in patients post surgery?

TCDB + incentive spirometer

 Morning of Surgery

• Review morning labs → report abnormalities

• Administer pre‑op meds (antiemetics, PPIs, electrolytes)

• Confirm NPO ≥8 hours

• Confirm signed consent

• Ensure IV access + fluids

• Check allergies (LATEX!)

• Educate about drains, SCDs, TED hose

• Skin prep

• Remove makeup, polish, jewelry, prosthetics, contacts

Pre‑Op Checklist (Critical Items)

• Teaching completed

• Consent signed

• NPO

• Gown on

• Allergy/ID bands

• Jewelry removed

• Void before transfer

• Pre‑op meds

• Contacts/dentures out

• Nail polish removed

• Vitals within 4 hours

• Abnormal labs flagged

• Skin prep

• Side rails up

  • Medication history (aspirin, antidepressants, steroids, NSAIDs)

In the OR

• Site marking

• Anesthesia induction

• Monitoring lines placed

• TIME OUT performed

• Circulating + scrub nurse present

• Family updated periodically

time out

= final safety check → prevents wrong‑site surgery.

Defense Mechanisms Adaptive (mature)

Altruism, sublimation, suppression