mh midterm

one question on: what is the different BSN and Advanced practice nurse (SATA)

BSN - milieu therapy

two questions on: therapeutic communications part 1 (broad opening and restating)

-"Tell me more about these feelings" -"You must be feeling ashamed"

two questions on: therapeutic communications part 2 (clarity and continuity)

clarity - ensure that meaning of message is accurately understood byy both parties continuity - promotes connections among ideas

one question on: defense mechanism

Relatively unconscious

one question on: models such as biopsychological model

trauma-informed care nursing model

one question on: healthy v unhealthy behaviors (SATA)

one question on: dsm

-Guidelines for identifying and categorizing mental illness -"Framework"

one question on: therapeutic mileus

-Staff creates safe space/environment -Pt oriented to their rights/responsibilities -Nursing staff is a constant -Safety! = promoted when everyone knows roles and responsibilities

one application question on suicide: who will you see first?

one application question on: suicide what would you do when someone was suicidal?

-Risk assessment = ask

one question on: verbal clues that someone may be sucical (SATA)

key warnings: -"They would be better off without me""I'm a burden" -"Things are never going to get better"

•Excessive worrying or fear. •Feeling excessively sad or low. •Confused thinking or problems concentrating and learning. •Extreme mood changes

one question on suicide: how do you know if someone is ready for dicharge?

-Living environment is safe to return (no weapons) -Consistently available support system -Commitment from client to use psychotherapy / suicide hotline

one question on: suicide warning sign (SATA)

-Sex

one question on: what would you put together in a crisis plan (SATA)

•Arrange for the patient needs family or friends •Remove weapons and pills •Encourage patient to talk freely about thoughts and feelings •Contact family members arrange follow-up •Activate resources- self help groups •Referrals to emergency services-988

one question on aggression: what do you do in the moment when the patient becomes aggressive?

-Propper tone/volume/ focus on message -Offer choices / define acceptable behaviors / consequences

one question on: what would you do when someone goes on restraints (SATA)

-Document 3 other avenues attempted / failed before restraints -Inform pt of intended action -Encourage acceptance -Tell pt the conditions Paper scrubs

-Appropriate fit/ good circulation/ hazardous objects are removed from room -Visual observation in case of emergency -1-1 (document every 15) -Check extremities -Offer food/fluid/bathroom

one question on: what is the first thing you would do when aggression starts escalating (SATA)

-Approach calm/ interventions to get them calm -Call person by name/ communicate understanding -Redirection -Using proper tone of voice -Problem solving

one question on: depression tricyclic why are they no longer first line?

-Cardiac problems = death -Cardiac arrhythmias/ anticholinergic effects -Heart block -Need to wean gradually -Confusion

one question on: signs and symptoms of sertonin syndrome (SATA)

-Can occur within min - hours -Change in MS = confusion

one question on mao teaching: what do they need to know

-NO tyramine - causes hypertensive crisis ---Aged cheese

one question on: what is dysthymia

chronically depressed for at least 2 year period (does not affect social or occupational functioning)

one question on: what are you going to teach somebody about ECT?

-Use of electric current passes through brain (0.2 - 8.0 seconds) -Timed motor seizure (@ least 20 seconds) -May alter/increase neurotransmitters (serotonin

one question on: intervention when someone is depressed?

Hospitalization: §Severe depression

Pharmacologic Agents §Tricyclics §Selective Serotonin Reuptake Inhibitors §Monoamine oxidase inhibitors §Newer Antidepressants

ECT Psychotherapy Light Therapy §Changes neurotransmitters §Individual & Group §Seasonal Affective Disorder

Group Intervention: Socialization

one question on: what do you do when someone is withdrawn? (SATA)

Withdrawal Syndrome: if stopped abruptly-nausea

one question on: pick out the anticholinergic side effects (SATA)

-Dry mouth -difficulty voiding -dilated pupils -blurred vision -decreased GI motility -constipation

one question on: major depression disorder symptoms

-Weight loss/gain -Insomnia / hypersomnia -Psychomotor agitation/ retardation -Fatigue / feeling of worthlessness / significant distress

one question on: once you assess someone's depression

what do you do?

one question on: mania symptoms (SATA)

Mania: is an emotional state characterized by elation

one question on: depacot

-Anticonvulsant ---Increases levels of GABA -Side effects = sedation

one question on lithium: what do you need to know before you give it

-Lithium has narrow therapeutic index = levels over 1.5!!!! -Do not limit sodium/water -NO NSAIDs -Treatment of side effects = gastric lavage

one question on lithium: contraindication

pregnancy/ breast feeing/ myasthenia gravis

one question on lithium: teaching

Discuss the Following with Patient/Family: -Side Effects of Lithium based on level -Fine hand tremors and mild nausea common -Early signs of toxicity: vomiting

one question on: what kind of diet would a manic pt have?

High protein/ high calorie finger foods -Juices/ snacks

one question on: intervention for mania (SATA)

´Diffuse conflict & clarify communication ´Decrease Environmental Stimuli ´Gross motor activities ´(Walking

one question on: psychosis or schizophrenia

one question on: what are you going to be concern about catatonia? when someone is catatonic?

-Benzo = lorazepam -Move their body for them?? •Extreme psychomotor disruption •Waxy flexibility •Purposeless movements

•Waxy flexibility: maintaining a fixed position for a long period of time(Catatonia) •Stupor: Motionless for long periods of time (Catatonia) •Catatonia: marked decrease in motion •Motor retardation: slow movements •Posturing: assuming unusual positions

one question on: what do you when someone is paranoid

-Explore voices w pt / Provide distracting activities that focus on here and now / establish trust / approach in non threatening way

one question on: what is anhedonia?

loss of interest or pleasure in usual activities (MDD)

one question on: what is the biggest side effect of Clozapine (Clozaril)?

answer = angraniocytosis -Discontinue if WBC less than 2000

-Monitor sick

•Use: Treat refractory Schizophrenia •Adverse Effects: Agranulocytosis

•Weekly monitoring WBC count required 1st 6 months & bi-weekly

•If WBC's fall below< 2000 cells/mm 3.5 - 10 Normal Range)

Discontinue drug & patient never receive drug again

one question on: positive or negative symptoms of schizophrenia (SATA)

-Positive symptoms = hallucinations / delusions -Negative symptoms = no change in emotional tone

one question about EPS: what it is

Causes: Primarily triggered by antipsychotic medications used to treat schizophrenia

one question about EPS: interventions

Lower Dosage Rx: Anticholinergics •Trihexyphenidyl (Artane) •Benztropine mesylate (Cogentin) •Diphenhydramine hydrochloride (Benadryl) •Amantadine hydrochloride (Symmetrel)

three or four questions on: signs and symptoms of EPS such as acute dystonia

tardic dyskinesia

one question on: why we give them long acting injectable.

-Effects last 2-4 weeks

one question on: how to manage someone who is delusional

Delusions: go to the feeling. Hallucination: assess directly.

one question on: what would you do when someone is having command hallucinations

-Protect from injury

one question on: what type of groups you would have for someone who is schizophrenic

-Psychotherapy

one question on: legal ethical admission criteria

Two types: •Voluntary admission •Involuntary admission (Commitment) -Patient in "Harms Way" (Self or Others) -Judicial determination -Administrative determination -Agency determination -In addition

requires medical certification

judicial

one question on: ethic principles such as justice

automony

one question on: what are the parameters where someone can refuse treatment

-Right to refuse treatment

one question on: confidentiality

-Relaying info to outside parties without consent is breech in confidentiality

one question on: tarasoff act (when to apply)

-Duty to warn and protect third party -Identify specific individual being threatened and apply appropriate actions to protect victim

-Staff should report threats of harm

Protection of patients: legal issues related to failure to protect safety of patients

Protection of self §Nurses must protect themselves in both institutional and community settings §Important for nurses to participate in setting policies that create safe environment

Substandard institutional policies do not absolve the individual nurse of responsibility to practice on the basis of professional standards of nursing care.