Mental Health Review exam 4

what are the cholinesterase inhibitors for dementia

donepezil, rivastigmine (PO or Patch), galantamine

take with food

what is always the first intervention when your patient is a child

role play

what is autism spectrum disorder

A disorder characterized by deficits in social relatedness and communication skills that are often accompanied by repetitive, ritualistic behavior.

-Identified in the first 3 years of life

-impairment with social and language ability

-nonverbal but treat them like normal talk to them on their level

what is attention deficit hyperactivity disorder

Characterized by inattention, hyperactivity, and impulsivity.

want to control the things around them unintentionally (think someone wants to plan or take control of a group project)

difficulty taking turns, poor social boundaries, easily overwhelmed

NEEDS STRUCTURE AND A PLAN!!!!!!!!!!!!!!!!!!!!!!

what are some nursing interventions nurses use when dealing with children

role-playing

modeling

physical distance

touch control

redirection

clarification

restructuring

what is role playing in mental health

a technique where individuals act out real-life situations, often with a therapist or other participants, to practice coping skills, explore emotions, and develop new behaviors in a safe and supportive environment

what is modeling in mental health

a therapeutic technique where clients learn new behaviors or skills by observing and imitating others

what is the last nursing intervention a nurse should use with any patient

restraints or seclusion

what are the treatments for autism

risperidone or aripiprazole

(off label) SSRI like fluoxetine or naltrexone

what are the treatments for ADHD

methylphenidate HCL (look for insomnia and weight loss)

clonidine (monitor blood pressure)

antipsychotics (haladol)

what is anorexia nervosa

Self starvation due to a distorted body image of being overweight while being significantly underweight

S/S

low BMI

cool extremities

constipation

muscle wasting

hypotension

bradycardia

what is bulimia nervosa

binge eating followed by purging (eat then throw-up, pt is a normal weight)

normal weight

look at teeth and hands

S/S

normal weight

dental carries

gastric dilation

edema

calluses on hands

seizures

what is the hospitalization criteria for a nervosa patient

weighs 75% or less of ideal body weight for height and age

less than 10% body fat

HR below 50 resting

systolic BP less than 90

temp below 96F

heart arrythmias

what is the treatment for nervosa

small frequent meals that are high in calorie

monitor during and after meals for purging

strict weighting schedule

SSRI (fluoxetine)

family therapy

LOOK FOR REFEEDING SYNDROME

what is refeeding syndrome

where a patient who has been starving themselves gets too many calories at a time and causes a shift in electrolyte balances

what is delirium

A disoriented reaction with restlessness and confusion that may be associated with fear and hallucinations

CAN BE REVERSED

MOST COMMON CAUSE IS POLYPARMACY

what is dementia

a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.

PROGRESSIVE AND NON REVERSABLE

caregiver support is critical

what is agnosia

inability to recognize objects

looks at hair brush and doesnt know what it is

what is aphasia

loss of ability to understand or express speech, caused by brain damage.

What is Wernikie's Aphasia

primarily involves language comprehension, while speech is fluent but meaningless

"word salad" (random words and phrases)

What is Bronca's aphasia

primarily involves speech production, while comprehension is relatively intact.

slow speech

what is agraphia

inability to write

what is apraxia

Inability to carry out purposeful movements or use objects correctly, despite having the physical ability to do so.

A patient may be physically able to use a spoon but doesn't know how to bring it to their mouth to eat.

what is amnesia

loss of memory

what is confabulation

making up lies to fills gaps in memory loss

what are the nursing interventions with a patient with dementia

help with ADL's but let them do what they can

finger foods

sleep hygiene

avoid restraints and seclusion

give donepezil (take with food)

DO NOT GIVE BENZODIAZEPINES (PAMS)

what are the 3 cluster groups for personality disorders

A- odd or eccentric

B- dramatic or emotional or erratic

C-anxious or fearful

what is paranoid personality disorder

TYPE A

A pervasive sense of mistrust of the motives of other

CAN BE DANGEROUS

let them be alone when the want to be

NURSE WILL

be straightforward, calm, avoid jokes and sarcasm, don't challenge their suspicions just reorientate

what is schizoid personality disorder

TYPE A

Individuals who display a lifelong pattern of social withdrawal. Often seen by others as eccentric, isolated, or lonely

NURSE WILL

respect need for distance, don't force social interaction, slowly build trust

what is schizotypal personality disorder

TYPE A

"Magical thinking", bizarre behavior, inappropriate affect

NURSE WILL

be straightforward, avoid ridicule, encourage reality

what are the key nursing treatments with type A PD

respect need for social isolation

do not be overly friendly

matter-of-fact approach

set limits on threatening behavior

what is borderline personality disorder

TYPE B

unstable relationships and emotion, variable self image/compulsive

look for splitting (seeing all people as all good or all bad)

NURSE WILL

set and limit boundaries

use DBT

USE NALTREXONE (for self injury control)

what is histrionic personality disorder

TYPE B

very attention seeking. display large emotions/wear bright clothes

NURSE WILL

remain professional

help and encourage pt to express feelings

avoid being overly involved

what is antisocial personality disorder

TYPE B

disregards rules/laws, manipulative, aggressive, lacks remorse

HIGH VIOLANCE RISK

NURSE WILL

be firm

maintain safety for patient and self

watch for manipulation

WILL STAFF SPLIT

what is narcissistic personality disorder

TPYE B

ENTITLED, pattern of grandiosity, need for admiration, and lack of empathy, fragile ego

NURSE WILL

avoid power struggles

do not challenge thoughts of power

stay neutral

focus on coping

what are the key nursing treatments with type B PD

be professional

BE NUTRAL

avoid power struggles

weekly staff meetings to prevent splitting

set firm limits

role model behaviors

What is avoidant personality disorder

TYPE C

Socially withdrawn, afraid of rejection but wants to fit in, low self esteem

NIRSE WILL

encourage small social interactions

help build confidence

what is dependent personality disorder

TYPE C

Clingy, submissive, low self-confidence, regression, needs others to make decisions for them

NURSE WILL

encourage autonomy

teach assertiveness

teach decision making

what is obsessive compulsive personality disorder

TYPE C

Perfectionist, doesn't show feelings, detail-oriented, uses isolation

NURSE WILL

avoid power struggles

teach flexibility

stress management

what are the key nursing treatments with type C PD

teach assertiveness

help with coping strategies

teach accepting attitudes

what is clingy

tending to stay very close to someone (such as a parent) for emotional support, protection

needs someone to make decisions for them

who are the vulnerable populations for abuse

children

elderly

dependent populations (financial, physical, mental)

what is physical abuse

intentionally causing physical harm to another person

what is sexual abuse

any sexual act without consent OR OTHER PERSON IS IN A STATE WHERE THEY CANNOT CONSENT

what is emotional abuse

criticize, ridicule, destroy self-esteem of others

what is economic abuse

controlling a person's access to economic resources

what is neglect

the failure to provide needed care that results in physical, mental, or emotional harm to a person

what are the signs of abuse with children

headaches

lots of "accidents"

traumatic alopecia

scars

burns

bruising or wounds in various stages of healing

vaginal discharge

withdrawal from other people

poor hygiene

lack of medical care

What is shaken baby syndrome

A serious brain injury resulting from forcefully shaking an infant or toddler.

what are the signs of abuse in adults

injury to a pregnant women (fractures, bruising in multiple stages of development)

describe partner as jealous, abusive, or frequent substance abuse

miscarriage

covers for partner

makes excuses

frequent ER visits with no real reason

what are signs of abuse in elderly

lack of assistive devices

unclean environment

unsafe living conditions

malnutrition

someone controlling their finances

unexplained bruises

social withdrawal

what should you do when interviewing someone with possible abuse

interview patient privately

be honest about mandatory reporting

assess safety

inform client about child or adult protective services

reduce danger risk

make sure patient understands!!!!!!!

what should you NOT do when interviewing someone with possible abuse

try to force a confession

show shock, anger, or judge the abuser

place blame

allow the client to feel at fault

press for answers

conduct the interview with other people around

what are some anxiety symptoms with abuse

HTN

irritability

GI disturbances

insomnia

what are some coping behaviors symptoms with abuse

withdrawal

blaming themselves

denial

drug or alcohol abuse and increased use

what are some support systems symptoms with abuse

lack of or very few

what are some suicide potential symptoms with abuse

patient expresses feeling trapped

what are some homicide potential symptoms with abuse

feels if they leave they will be in danger so they need to eliminate problem

what are some drug and alcohol abuse symptoms with abuse

limited coping

uses it to escape the situation

what are the important nursing interventions with abuse

REPORTING (CHILD, ADULT, AND ELDERLY)

counseling (tell them there are ways out)

planning a safe way out

therapy