final all units

Mental Health vs Mental Illness

Mental health

State of emotional, psychological, and social well-being. It affects how we think, feel, and act, and determines how we handle stress, relate to others, and make choices.

A mentally healthy person can:

• cope with stress

• maintain relationships

• adapt to change

• function in society

Mental illness

A disruption in thinking, mood, behavior, or functioning.

Examples:

• depression

• schizophrenia

• bipolar disorder

Important:
Mental illness affects function.

NCLEX point:
Look at functioning, not just symptoms.

Example:
Sadness alone ≠ depression.

Depression = sadness + impaired function

Risk factors for mental illness

Biological:

• genetics

• neurotransmitter imbalance

• brain injury

Psychological:

• trauma

• poor coping

• abuse history

Social:

• poverty

• isolation

• family dysfunction

Environmental:

• violence

• substance abuse

• chronic stress

DSM-5

Purpose:
Standardized diagnostic criteria.

Used by:
providers

NOT nurses.

NCLEX trap:
DSM diagnosis ≠ nursing diagnosis.

Example:
Medical = Major depressive disorder

Nursing = Risk for self-harm

Major theories

Freud (Psychoanalytic)

ID = pleasure

EGO = reality

SUPEREGO = morals

Defense mechanisms come from Freud.

Erikson

Important for developmental questions.

Trust vs mistrust (0–1)

Autonomy vs shame (1–3)

Initiative vs guilt (3–6)

Industry vs inferiority (6–12)

Identity vs role confusion (12–18)

Intimacy vs isolation (young adult)

Generativity vs stagnation (middle adult)

Integrity vs despair (older adult)

NCLEX:
Failure at stages causes problems later.

Maslow

Priority framework.

Bottom first:
physiological

Then:
safety

Then:
love

Then:
esteem

Then:
self-actualization

NCLEX:
If patient is psychotic AND not eating:
feeding wins.

Bioethics

Autonomy:
patient chooses

Beneficence:
do good

Nonmaleficence:
do no harm

Justice:
fairness

Veracity:
truth

Fidelity:
keep promises

Example:
Patient refuses meds = autonomy

Legal concepts

Voluntary admission

Patient agrees.

Can request discharge.

Involuntary admission

Danger to self or others.

Cannot freely leave.

Requires evaluation.

Duty to warn

If patient threatens someone.

Protect victim.

Tarasoff case.

Confidentiality exceptions

Suicide

Homicide

Child abuse

Elder abuse

Abuse of vulnerable adult

Therapeutic communication

Goal:
help patient explore feelings.

Best techniques:

Broad opening:
Tell me more.

Reflection:
You seem upset.

Clarification:
Can you explain that?

Silence:
Allows processing.

Restating:
Repeat important point.

Validation:
That sounds difficult.

Nontherapeutic:

Why questions

False reassurance

Changing subject

Giving advice

Judging

Minimizing

NCLEX trick:
The correct answer usually explores feelings.

Nurse-patient relationship phases

Preinteraction

Prepare.

Review chart.

Self-reflect.

Orientation

Build trust.

Set boundaries.

Set goals.

Most important:
trust building

Working

Main therapeutic work.

Promote insight.

Behavior change.

Termination

Ends relationship.

Review progress.

Encourage independence.

Boundaries

Maintain professional role.

Bad:
social media
gifts
personal relationships

Transference

Patient projects onto nurse.

Example:
“You remind me of my dad.”

Countertransference

Nurse projects onto patient.

Dangerous:
affects care.

Mental Status Exam (MSE)

Appearance

Behavior

Speech

Mood

Affect

Thought process

Thought content

Memory

Insight

Judgment

Perception

Suicide/homicide

Mood = how patient feels

Affect = what nurse sees

Somatic symptom disorder

Physical symptoms without medical explanation.

Symptoms are real to patient.

Do not say:
It’s all in your head.

Best:
Focus on feelings.

Conversion disorder

Psychological stress becomes physical symptoms.

Examples:
blindness
paralysis

No medical cause.

Dissociative disorders

Disconnection from reality/self.

Types:
DID
amnesia
fugue

Substance use

CAGE

Cut down

Annoyed

Guilty

Eye opener

2+ yes = concern

Alcohol withdrawal

Symptoms:
tremors
anxiety
seizures
hallucinations
agitation

Can be fatal.

Priority:
prevent seizures

Treatment:
benzos

Common meds:
Lorazepam
Diazepam

CIWA

Measures alcohol withdrawal severity.

Higher score = more severe

Opioids

Overdose:
pinpoint pupils
respiratory depression

Treatment:
Naloxone

Withdrawal:
pain
sweating
vomiting
diarrhea

Feels awful
not fatal

UNIT 2

(Anxiety, depression, bipolar, suicide, meds)

Based on Unit 2 outline

Anxiety

Vague feeling of dread.

Can be normal.

Problem when excessive.

Anxiety levels

Mild

Learning improves.

Can focus.

Moderate

Narrow focus.

Needs redirection.

Severe

Poor concentration.

Problem solving impaired.

Panic

Loss of control.

Cannot process.

Priority:
stay with patient

Interventions:

Mild:
problem solving

Moderate:
short directions

Severe:
reduce stimuli

Panic:
stay, protect, calm

Defense mechanisms

Denial:
refuse reality

Projection:
blame others

Regression:
childlike behavior

Displacement:
redirect emotion

Rationalization:
excuses

Suppression:
conscious avoidance

Repression:
unconscious avoidance

Sublimation:
healthy redirection

Reaction formation:
act opposite

Panic disorder

Sudden intense fear.

Symptoms:
chest pain
palpitations
SOB
dizziness

Looks like MI.

Priority:
rule out medical.

Then:
reduce stimuli.

OCD

Obsessions = intrusive thoughts

Compulsions = repeated behaviors

Purpose:
reduce anxiety

Examples:
checking
washing
counting

Treatment:
SSRIs
CBT

Do not stop rituals abruptly.

PTSD

After trauma.

Symptoms:
flashbacks
nightmares
avoidance
hypervigilance

Treatment:
SSRIs
therapy

Priority:
safety

Major depression

Symptoms:
sadness
anhedonia
sleep change
appetite change
hopelessness
fatigue

SIGECAPS

Sleep

Interest

Guilt

Energy

Concentration

Appetite

Psychomotor

Suicide

Priority:
suicide assessment

Suicide assessment

Directly ask.

Do not avoid.

Ask:
Do you have a plan?

Do you have means?

When?

High risk:

Plan

Means

Previous attempt

Male

Hopeless

Isolation

Substance use

Highest risk moment:
when energy returns

(after meds start working)

Suicide precautions

1:1 observation

Remove dangerous items

Close monitoring

Document

No suicide contracts:
not reliable

Bipolar

Mania and depression.

Mania symptoms

DIGFAST

Distractible

Irresponsible

Grandiosity

Flight of ideas

Activity increased

Sleep deficit

Talkative

Priority:
safety

Then:
nutrition

Then:
sleep

Interventions

Low stimulation

Finger foods

Firm limits

Short simple directions

Lithium

Mood stabilizer.

Normal:
0.6–1.2

Toxic:

Symptoms:
nausea
vomiting
diarrhea
tremor
ataxia
confusion

Teaching:

Hydrate

Stable sodium

Avoid dehydration

Blood levels checked

Antidepressants

SSRIs

Examples:
Sertraline
Fluoxetine

Side effects:
sexual dysfunction
GI upset

Watch:
serotonin syndrome

Serotonin syndrome:
fever
agitation
sweating
confusion

Emergency.

MAOI

Avoid tyramine.

Foods:
cheese
wine
aged meats

Risk:
hypertensive crisis

UNIT 3

(Schizophrenia, eating disorders, crisis)

Based on Unit 3 outline

Schizophrenia

Psychotic disorder.

Break from reality.

Positive symptoms

Hallucinations

Delusions

Disorganized speech

Agitation

Paranoia

Negative symptoms

Flat affect

Apathy

Social withdrawal

No motivation

Poor hygiene

Positive = added

Negative = taken away

Hallucinations

Sensory perception without stimulus.

Types:
auditory most common

Priority:
assess command hallucinations

Ask:
What are the voices saying?

Danger if:
voices command harm

Do not:
argue

Do not:
reinforce

Best:
present reality

Delusions

False fixed beliefs.

Types:
persecution
grandiose
religious

Best:
focus feelings

Not content

Paranoia

Patient suspicious.

Interventions:
honest
clear
calm

Avoid whispering.

Avoid touching unexpectedly.

Antipsychotics

First generation

Haloperidol

Higher EPS risk

Second generation

Risperidone

Olanzapine

Lower EPS

Higher metabolic syndrome

Monitor:
weight
glucose
lipids

EPS

Acute dystonia

Akathisia

Parkinsonism

Treatment:
Benztropine

Diphenhydramine

Tardive dyskinesia

Late effect.

Lip smacking

Tongue rolling

Can be permanent.

Use AIMS.

Neuroleptic malignant syndrome

Fever

Rigidity

Confusion

Autonomic instability

Emergency.

Stop medication.

Eating disorders

Anorexia

Restriction

Low weight

Distorted body image

Amenorrhea

Bradycardia

Hypotension

Priority:
nutrition

Monitor:
electrolytes

Refeeding syndrome risk:
electrolyte shifts

Can kill.

Bulimia

Binge/purge

Normal weight often

Signs:
tooth erosion
parotid swelling

Low potassium

Arrhythmias

Crisis

Temporary inability to cope.

Types:
situational
maturational

Goal:
restore baseline

Crisis intervention

Safety

Calm presence

Short-term goals

Problem solving

UNIT 4

(Personality disorders, violence, older adults)

Based on Unit 4 outline

Personality disorders

Enduring maladaptive patterns.

Cluster A

Odd/eccentric

Paranoid

Schizoid

Schizotypal

Cluster B

Dramatic/emotional

Borderline

Antisocial

Histrionic

Narcissistic

Cluster C

Anxious/fearful

Avoidant

Dependent

OCPD

Borderline personality

Unstable relationships

Impulsivity

Splitting

Self-harm

Fear abandonment

Nursing:

Firm boundaries

Consistency

Do not rescue

Antisocial

Manipulative

No remorse

Violates rights

Interventions:
clear limits

Consequences

Schizoid

Detached

No relationships

Emotionally cold

Schizotypal

Odd beliefs

Strange behavior

Social anxiety

Violence cycle

Trigger

Escalation

Crisis

Recovery

Post-crisis

Best time to intervene:
escalation

De-escalation

Calm voice

Simple directions

Space

Reduce stimulation

Escape route

Do not corner patient

Abuse

Physical

Sexual

Emotional

Neglect

Signs:
injuries
fearfulness
inconsistent story

Priority:
safety

Document facts only

Elder abuse

Higher risk:
dependent
isolated
cognitive impairment

Delirium

Acute

Sudden

Reversible

Medical cause

Fluctuates

Treatment:
find cause

Dementia

Gradual

Progressive

Memory decline

Irreversible

Interventions:
routine
simple communication
safety

Depression in elderly

May look like:
confusion

withdrawal

weight loss

Always assess suicide.

MEDICATION MASTER LIST

Antidepressants:
SSRIs
SNRIs
TCAs
MAOIs

Mood stabilizer:
Lithium

Antipsychotics:
Haloperidol
Risperidone
Olanzapine

Anti-anxiety:
Lorazepam

Anti-EPS:
Benztropine

Opioid reversal:
Naloxone

Alcohol deterrent:
Disulfiram

Opioid maintenance:
Methadone

Buprenorphine