CH1 Milieu Therapy= Orienting client to the physical setting, Identifying rules and boundaries of the setting, Ensuring a safe environment for the client. Assisting the client to participate in appropriate activities.Counseling BIG THING IS USING THERAPEUTIC COMMUNICATION problem solving, crisis intervention, stress management. Promotion of self care. (set incentives to promote self care.) Psychobiological= admin meds THERAPEUTIC COMMUNICATION ALWAYS ASK QUESTIONS AND STATE THE FACTS Assessment= Do not forget to ask questions about insomnia, incontinence, Falls/Injuries, Depression, dizziness, and loss of energy. Obtain cultural information about the client and respect the clients cultural needs. Spiritual= a client's view on the purpose of life interval values and sense of molarity. Religion= A client's beliefs according to an organized set of patterns. LOC Alert, Lethargic (drowsy), Stuporous (Painful stimulation needed to arouse), Comatose (Unresponsive). Decorticate= Arms up. Deceberate= elbows extended. Mini mental state examination= Assess orientation to time and place. Attention span and ability to calculate by counting backwards by seven. Registration and recalling of objects. Language, Including naming of objects, following commands, and ability to write

Ch2 Legal rights The right to humane treatment and care The right to vote The rights to related to granting, forfeiture, or denial of a driver’s license The right to due process of law, including the right to press legal charges against another person

Specific rights INFORMED CONSENT (These are not all just the main ones) CONFIDENTIALITY

Ethical issues= Philosophical ideas regarding right from wrong Beneficence: The quality of doing good; can be described as charity Autonomy= RIGHT TO MAKE THEIR OWN DECISION Justice= Fair and equal treatment Fidelity= Loyalty and faithfulness to the client and ones duty Veracity= HONESTY

CONFIDENTIALITY= HIPAA Resources for solving ethical client issues Code of ethics Lawyer Facility policies,

Types of admission Informal admission= LEAST RESTRICTIVE FORM OF ADMISSION does not pose a threat to self or others. FREE TO LEAVE AT ANY TIME EVEN AGAINST MEDICAL ADVICE

Voluntary admission= The client or client’s guardian chooses admission to a mental health facility in order to obtain treatment RIGHT TO REFUSE MEDICATION AND TREATMENT.

Temporary emergency admission= Admitted for emergent mental health care due to the inability to make decisions regarding care. STATES BY LAW NOT TO EXCEED 15 DAYS

Involuntary admission= AGAINST THEIR WILL FOR AN INDEFINITE AMOUNT OF TIME The admission is based on the client’s need for psychiatric treatment, the risk of harm to self or others, or the inability to provide self-care. USUALLY TWO PHYSICIANS NEEDED TO VERIFY

Long term involuntary admission= similar to temporary commitment but MUST BE IMPOSED BY THE COURT 60-180 days

TIME OUT IS DIFFERENT FROM SECLUSION BECAUSE TIME OUT IS BY CLIENT REQUEST. SECLUSION AND RESTRAINT FOR SHORTEST DURATION NECESSARY. LESS RESTRICTIVE MEASURES FIRST ALWAYS. NEVER ABUSE SECLUSION OR RESTRAINTS. LAST CHOICE IS RESTRICTIVE MEASURES (Seclusion and Restraints).

Restraint and seclusion Time frames KNOW THIS COMPLETE DOCUMENTATION 15-30 mins 18 year and older= 4 hours 9-17 = 2hr 8 and younger= 1hr CAN USE IN EMERGENCY BUT TELL PROVIDER within 15-30 MINS MUST BE DISCONTINUED WHEN CLIENT DEMONSTRATES SAFER AND QUIETER BEHAVIOR.

TORTS

Intentional Torts False Imprisonment= HELD AGAINST WILL ASSAULT= THREAT BATTERY= DOING THE THREAT

Unintentional torts Negligence= Failing to provide adequate care in a personal or professional situation when one has an obligation to do so. To be liable for negligence, it must be proven that the professional had a duty to protect, breached the duty, that the action or failure to act caused injury Malpractice= Proven to be on purpose.

Ch3 Notes Intrapersonal communication= Self talk Interpersonal communication = One on one conversation with another individual Small-Group= Two or more individuals Public communication= Large

Verbal communication Vocabulary= Words used to communicate with others Denotative/connotative meaning= Words that have multiple meanings Clarity/Brevity= Shortest simplest communication is usually most effective Timing/relevance= Knowing when to communicate DO NOT COMMUNICATE TO A CLIENT IN PAIN Pacing= Rate of speech Intonation= Tone of voice can communicate a variety of feelings

Non verbal communication= Pay attention to appearance, Posture, gait, Facial expressions, eye contact, gestures, sounds, territoriality, personal space, silence

THERAPEUTIC COMMUNICATION= BUILD AND MAINTAIN HELPING RELATIONSHIPS WITH CLIENTS, FAMILIES, AND SIGNIFICANT OTHERS. Children and older adults frequently require adapted techniques to enhance communication. Components of therapeutic communication Time= Plan for and allow adequate time to communicate. Clients with major depression and schizophrenia may require longer time to respond to questions Attending behaviors or active listening= Eye contact, body language and posture, Vocal quality, Verbal tracking (Restating) Caring attitude= Show concern and facilitate connection. Honesty= Be open direct, truthful, and sincere Trust= Demonstrate reliability without doubt or question Empathy= Convey an objective awareness and understanding of the feelings, emotions and behaviors of others. Nonjudgmental attitude= Acceptance that will encourage open honest communication

With children be simple straightforward, be aware of nonverbal messages as children are sensitive to nonverbal communication, ENHANCE COMMUNICATION BY BEING AT THE CHILD'S EYE LEVEL, Incorporate play in interactions. Be aware of the child's level of development

With adolescents Determine how they perceive the mental health diagnosis. Is the adolescent at risk for refusal of treatment due to a desire to be “normal” How does it affect relationships with peers.

With older clients might need amplification. Minimize distractions, and the face the client when speaking, allow plenty of time for the client to respond, When impaired communication is assed ask for input from caregivers or family to determine the extent of the deficits and how to communicate best

When planning minimize distractions, Provide privacy, Identify mutually agreed upon client outcomes, set priorities according to the clients needs, Plan for adequate time for interventions

Implementation Establishing a trusting relationship provides empathetic responses and explanations to the client by using observations and prodigy hope, humor,and information. Remove distractions

Effective communication skills and techniques Silence= Allows for meaningful reflection Active listening= The nurse is able to hear observe and understand what the client communicates and to provide feedback Open ended questions= Facilitates spontaneous responses and interactive discussion Close-ended questions= Helpful if used sparingly during the initial interaction to obtain specific data. AVOID USING REPEATED CLOSED ENDED QUESTIONS. Projective questions= What if questions to help the client explore feelings and to gain greater understanding of problems and possible solutions Presupposition questions= Explore the clients life goals or motivation by presenting a hypothetical situation in which the client no longer has the mental health disorder.

Clarifying techniques include restating (USE THE CLIENTS EXACT WORDS), reflecting (DIrects focus back to the client), Paraphrasing (restates to confirm what has been communicated), Exploring (Allows the nurse to gather more information regarding important topics mentioned by the client)

Offering general leads, Broad opening statements= Encourages the client to determine where the communication can start and to continue talking.

Showing acceptance and recognition= acknowledges the nurses interest and nonjudgmental attitude

Focusing= Helps client concentrate on what is important

Giving information= provides details that the client might need for decision making

Presenting reality= Helps the client focus on what is actually happening and to dispel delusions, hallucinations, or faulty beauty.

Summarizing= emphasizes the important points and reviews what has been discussed

Offering self= Demonstrates willingness to spend time with the client. INDICATES GENUINE CONCERN

Touch= IF APPROPRIATE Communicates caring and can provide comfort to the client

NEVER DO THESE Barriers to effective communication include asking irrelevant personal questions, Offering personal opinions, Giving advice, giving false reassurance, minimizing feelings, changing the topic, asking why, offering value judgments, excessive questioning, giving approval or disapproval

Ch4 notes

Defense mechanisms Know Altruism, sublimation, repression, displacement, reaction formation, rationalization, dissociation, denial, conversion, splitting, projection Altruism= Dealing with anxiety by reaching out to others (adaptive use= A nurse who lost their family becomes a firefighter) No maladaptive use Sublimation= Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression (Adaptive use= when someone feels angry they go workout at the gym) No maladaptive form Suppression= Voluntarily denying unpleasant thoughts and feelings (adaptive= A student puts off thinking about a fight they had with a friend so they can focus on a test) (Maladaptive= A person who has lost their job says they will worry about paying their bills next week) Repression= Unconsciously putting unacceptable thoughts, ideas, and emotions out of awareness (Adaptive= Someone giving a speech forgets about the time when he was laughed at when speaking) (Maladaptive= A person who is scared of the dentist forgets to go to his dentist appointment) Regression= Sudden use of childlike or primitive behaviors that do not correlate with the person's current developmental level (adaptive= A young child wets the bed when they learn that their pet died) (Maladaptive= A person who has a disagreement with someone throws things) Dissociation= A disruption in consciousness, memory, identity or perception of the environment that results in compartmentalization of uncomfortable or unpleasant aspects of oneself. (Adaptive= a parent blocks out distracting noises from his child to focus on driving) (Maladaptive= A person who forgets who they are following a sexual assault) Displacement= Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation (adaptive= An adolescent angrily punches a punching bag after losing a game) (Maladaptive= A person who is angry about losing a job destroys their child’s toy) Reaction formation= Doing the opposite of what you feel. Overcompensating for the negative feelings you have (Adaptive= A person who wants to quit smoking repeatedly talks to adolescents on the dangers of nicotine) (Maladaptive= A person who resents having to care for an aging person restrict their freedoms) Undoing= Preforming an act to make up for prior behavior (Adaptive= A child does their chores without being told after an argument with their parents) (Maladaptive= An individual buys their significant other flowers and gifts after abuse) Rationalization= Creating reasonable and acceptable explanation for unacceptable behavior (Adaptive= When someone gets rejected they say they must already have a boyfriend) (Maladaptive= a young adult explains they had to drive home from a party after drinking because they had to feed the dog) Denial= Pretending the truth is not reality to manage unpleasant anxiety causing thoughts (Adaptive= Client initially says no that cant be true when told they have cancer) (Maladaptive= A parent whos child died in combat one month later says their child is coming home) Compensation= Emphasizing strengths to make up for weakness (Adaptive= A child unable to play contact sports excels in school) (Maladaptive= A person who is shy learns computer skills to avoid socialization) Identification= assumption of characteristics of another individual or group. (Adaptive= A child who has a chronic illness pretends to be a nurse for their dolls) (Maladaptive= A child who observes his abusive parent becomes a bully) Intellectualization= separation of emotions and logical facts when coping with a situation (Adaptive= A officer blocks out the emotional aspect of a crime to focus on the investigation) Maladaptive= A person who learns they have a terminal illness focuses on their will and financial matters than acknowledging their grief) Conversion= Responding to stress though unconscious development of physical manifestations not caused by a physical illness. No adaptive use (Maladaptive= A person experiences deafness after their partner tells them they want a divorce) Splitting= an inability to reconcile negative and positive attributes of self or others into a cohesive image no adaptive use (Maladaptive= A client tells a nurse that the nurse is the only one who cares about them, yet the next day the client will not talk to the nurse) Projection= Attributing one’s unacceptable thoughts and feelings onto another who does not have them. No adaptive use (Maladaptive= A partner who is attracted to another person accuses their partner of having an affair)

Types of anxiety and interventions KNOW THIS Normal= a healthy amount used in a stressful situation in order to get you to do the things that need to be done in a timely manner. IDENTIFIABLE CAUSE can cause mild symptoms like mild discomfort, restlessness, irritability, impatience and apprehension as well as foot tapping. Acute= State that occurs during an imminent loss or change that threatens one sense of security Chronic= Starts in childhood and develops overtime adults can display physical symptoms (Fatigue, frequent headaches) ALWAYS STAY WITH THE CLIENT Mild= IDENTIFIABLE CAUSE can cause mild symptoms like mild discomfort, restlessness, irritability, impatience and apprehension as well as foot tapping. Use active listening, provide a calm presence, evaluate past coping mechanisms, explore alternatives to problem situations, encourage participation in activities (Exercise) that can relieve stress.Moderate= slightly reduced perception and processing of information occurs, and selective inattention can occur, LEARNING AND PROBLEM SOLVING CAN STILL OCCUR. concentration difficulties, tiredness, pacing, change in voice pitch, voice tremors, shakiness, and increased heart rate and respiratory rate, headaches, backache, urinary urgency and frequency, and insomnia. USUALLY BENEFITS FROM THE DIRECTION OF OTHERS. Interventions same as mild Severe= Perceptual field is greatly reduced with distorted perceptions. LEARNING AND PROBLEM SOLVING DO NOT OCCUR. Functioning is effective;behaviors are automatic. Signs and symptoms include confusion feelings of impending doom, hyperventilation, tachycardia, withdrawal, loud and rapid speech, and aimless activity. NOT ABLE TO TAKE DIRECTION FROM OTHERS same interventions as panic Panic level= characterized by markedly disturbed behavior. Client is not able to process what is occurring in the environment and can lose touch with reality. Extreme fright and horror. experiences severe hyperactivity, flight, or immobility and dysfunction in speech, dilated pupils, severe shakiness, severe withdrawal, inability to sleep, delusions, and hallucinations. FOCUS ON THE PRESENT, SAFE ENVIRONMENT (quiet with minimal stimulation). Use meds and restraint only after less restrictive interventions have failed, encourage walking/exercise set limits by using firm short and simple statements

Ch5 notes Milieu therapy creates an environment that is supportive, therapeutic and safe can also be called therapeutic community or therapeutic environment. The goal is that while the client is in this environment the client will learn how to cope cope, interact and strengthen relationship skills.

Boundaries of the therapeutic relationship social relationship= Primary purpose is for socialization or friendship with a focus on the mutual needs of the individuals involved Therapeutic relationship= Primary purpose is to identify the clients problems or needs and then focus on the assisting the client in meeting or resolving those issues

transference= CLIENT TO NURSE occurs when client views a member of the health care team as having characteristics of another person who has been significant to the clients personal life. (A client can see a nurse as being like their parent and thus can demonstrate some of the same behaviors with the nurse that they demonstrated with their parent.) Countertransference= NURSE TO CLIENT occurs when a health care team member displaces characteristics of people in their past onto a client. (A nurse can feel defensive and angry with a client for no apparent reason if the client reminds them of a friend who often elicited those feelings.)

Activities within the milieu therapy include individual therapy, group therapy, psychoeducational groups (Based off clients level of functioning and personal needs) Recreational activities, unstructured flexible time (Time for staff to observe clients as they interact spontaneously

Ch6 notes Practice settings Acute care= This setting provides intensive treatment and supervision in locked units for clients who have severe mental illness,WHO PRESENT A DANGER TO SELF OR TO OTHERS. Community= Primary care is provided in community-based settings, which include clinics, schools and day-care centers, partial hospitalization programs, substance treatment facilities, forensic settings, psychosocial rehabilitation programs, telephone crisis counseling centers, and home health care. Nursing interventions in community settings provide for primary treatment as well as primary, secondary, and tertiary prevention of mental illness.

Criteria for admission in an acute mental health facility is danger to self or others inability to meet one's own basic needs and a dangerous decline in mental health status of a client undergoing long term treatment.

CH7 Notes Psychoanalysis Classical and transference. Classical Psychoanalysis is a therapeutic process of assessing unconscious thoughts and feelings and resolving conflict by talking to a psychoanalyst. Due to the length and insurance constraints this is not likely the only method used. Past relationships are a common focus therapy to uncover unconscious conflicts.

Transference Feelings that the client has developed towards the therapist in relation to similar feelings towards persons in the clients early childhood. Countertransference, the unconscious feelings that the healthcare worker has toward the client. The client can remind them of a person from their past in a positive or negative manner.

Therapeutic tools Free association= say whatever comes to clients mind. Dream analysis and interpretation. Believed by Frued to be urges and impulses of the unconscious mind that played out through the dreams of clients Use of defense mechanisms

Psychotherapy offers more therapist to client interaction than classic psychoanalysis. Psychodynamic psychotherapy employs the same tools as psychoanalysis, but it focuses more on the current state rather than early life. LASTS LONGER THAN ANY OTHER.

Interpersonal psychotherapy= Addresses specific client problems can improve interpersonal relationships, communication, role-relationship and bereavement, The premise is that many mental health disorders are influenced by interpersonal interactions and the social context

Cognitive therapy focuses on individual THOUGHTS AND PROBLEMS

Behavioral therapy Change in behavior is the key to treating problems (Anxiety or depressive) Abnormal behavior results from an attempt to avoid painful feelings. Change can occur without the underlying cause being identified. Teaches clients way to decrease anxiety or avoidant behavior and give clients an opportunity to practice techniques examples include relaxation training and modeling. Has been used successfully in clients with phobias, substance use or addictive disorders and other issues.

cognitive-Behavioral Therapy is a combination of cognitive and behavioral therapy to assist a client with anxiety management.

Dialectical behavior therapy is a cognitive behavioral therapy for clients with a personality disorder and exhibit self-injurious behavior ACCEPTANCE AND VALIDATION

Cognitive reframing is the changing of thinking in clients. Priority restructuring assists clients with what should come first. Journal keeping, Assertiveness training (SOLVE PROBLEMS AND EXPRESS FEELINGS) Monitoring thoughts helps client to be aware of negative thinking.

Modeling is showing behavior in hopes the client copies that behavior

Operant conditioning Positive rewards for positive behavior

Systematic desensitization Expose the client to anxiety and practice relaxation techniques in attempt to desensitize them to anxiety.

Aversion therapy is the opposite of operant BAD THINGS BAD STIMULI

Meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and bio feedback controls pain tension and anxiety

Flooding exposing a client to a great deal of undesirable stimuli in an attempt to turn off anxiety response in the presence of a therapist

Responsive prevention Preventing the client from preforming a compulsive behavior with the intent that anxiety will diminish

Thought stopping. Shouting stop with negative thoughts and substitute them with positive thoughts

Validation therapy respecting or validating there feelings in a time or place that is real to them (For disoriented older adults)

Ch 8 notes Group therapy Group process is the verbal and nonverbal communication that occurs during sessions

Group norm is the way the group behaves and the structure over time

Hidden agenda Goals held my members or leader that can disrupt the group process

Subgroup Smaller group within a larger group that function separately from the group

Dynamics affected by either being open or closed

Homogenous group a group where all members share a chosen characteristic (Gender/Diagnosis) Hetero is no shared grouping factor

Group therapy goals include diminishing feelings of isolation sharing experiences and stories sharing common feelings and concerns creating community of healing and restoration Providing a more cost effective environment than that of individual therapy

Phases include orientation which is defining the purpose and goals of the group. Working phase which is where they promote problem solving skills to facilitate behavioral changes (power and control issues can dominate this phase)

Termination Phase End of sessions

Roles include maintenance which help to maintain the purpose and process of the group (harmonizer prevents conflict). Task members take on various tasks within the group process example is a recorder who is someone who takes notes during the group. Individual roles Promote their own agenda preventing team work examples include the dominator who tries to control other members

Group characteristics can vary depending on the healthcare setting Acute mental health setting= members can vary on a daily basis and the focus is on relief leader must provide higher level of structure

Outpatient setting members often consistent focus is on growth leader can offer opportunities in determining the groups direction external influences are limited

Types of families Family is the first system to which a person is attached and is the most influential system to which an individual will belong. Nuclear families= Include children who reside with married parents

Single-parent families= Children who live w a single adult who can be related or unrelated to the children

Adoptive families= children whos parents have adopted them

Blended families= children who live w one biological parent and a step parent who is not related

Cohabitating families= Children who live with one biological parent and an unrelated adult who are cohabitating (Roommates?)

Extended families= Children living with one biological or adoptive parent and a related adult who is not their parent

Other families= Children living with grandparents, adult siblings, foster parents

Areas of functioning Communication= clear and understandable messages between family members and each member is encouraged to express individual feelings and thoughts. In dysfunctional families blaming can occur which is used to shift focus away from their own inadequacies. Manipulation is where members use dishonesty for their own agendas. Placating one member takes responsibility for problems to keep peace at all costs. Distracting brings irrelevant information in an attempt to solve a problem. Generalizing ALWAYS AND NEVER in describing family encounters

Management= Adults in a family agree on important issues in dysfunctional families management can be chaotic with a child making management decisions at times.

Boundaries= distinguishable based on family roles clear and understood by all; each family member is able to function properly. IN dysfunctional families enmeshed boundaries are unclear and blend so much that individual roles are lost. Rigid boundaries RULES AND ROLES ARE COMPLETELY INFLEXIBLE

Socialization= healthy ways of coping for all members. Dysfunctional families children do not learn healthy socialization skills within the family and have difficulty adopting to socialization roles of society

Emotional/supportive= Emotional needs of family members are met most of the time and members have concerns about each other CONFLICT AND ANGER DO NOT DOMINATE. In dysfunctional families negative emotions predominate most of the time. MEMBERS ARE ISOLATED AND AFRAID and do not show concern for each other. Scapegoating. A member of the family with little power is blamed for problems

Triangulation. A third party is drawn into a relationship with two members whose relationship is unstable

Multigenerational issues= Emotional issues or themes within a family that occur for at leas three generations or more (a pattern of substance use or addictive behavior, dysfunctional grief patterns, triangulation patterns, divorce).

Disciplining should be consistent, timely, and age appropriate. Parents should administer discipline in private, when they are calm. Caregivers should be in unison on when and how to discipline.

Family therapy focuses on the system rather than each person as an individual. Family assessments include focused interviews and use of various family assessment tools. Nurses that work with families provide teaching also to mobilize family resources to improve communication and to strengthen the family's ability to cope with the illness of one member.

Chapter 9 Factors that help people cope with stress include Physical health, strong sense of health, Religious or spiritual beliefs, Optimism, Hobbies and other outside interests, Satisfying interpersonal relationships, Strong social support systems, Humor

Expected findings Acute stress (Fight or flight) +CNS effects (Increased HR,RR,CO,BP), increased metabolism and glucose use depressed immune system, Apprehension,Unhappiness or sorrow, decreased appetite. Prolonged stress LONG TERM EFFECTS (MALADAPTIVE RESPONSE) Chronic anxiety or panic attacks Depression, chronic pain sleep disturbances weight gain or loss increased risk for MI or CVA Poor diabetes control HTN Fatigue irritability decreased ability to concentrate increased risk for infection standardized screening tools Life changing events questionnaires, perceived stress scale and lazarus's cognitive appraisal. Nursing care involves teaching stress reduction strategies to clients. Cognitive reframing changing the way a pt thinks Behavioral techniques as mentioned earlier (Physical exercise Progressive muscle relaxation breathing exercises) Journal writing. Priority restructuring. Biofeedback a trained professional uses a sensitive mechanical device to assist the client gain voluntary control of such autonomic functions such as HR and BP. Mindfulness. Client is advised to be mindful of their surroundings client learns to restructure negative thoughts to positive ones. Assertiveness training. individual hobbies (fishing, scrapbooking), music therapy, pet therapy, sleep, massage, and aerobic exercise.

Chapter 10 Brain stimulation therapies

Electroconvulsive therapy (ECT) NOT A PERMANENT CURE How it works= Uses electrical current to induce brief seizure activity while the client is anesthetized. The exact mechanism is unknown. One theory suggests that the seizure activity produced by ECT can enhance the effects of neurotransmitters (serotonin, dope, and norepi) in the brain

Indications= Major depressive disorder (clients who are nonresponsive to pharm treatment), Schizo spectrum disorders, Acute manic episodes (unresponsive to lithium and anti psych meds)

Contraindications= Cardiovascular disorders (ECT increases the stress on the heart due to seizure activity that occurs during the treatment.), Cerebrovascular disorders (ECT increases intracranial pressure and blood flow through the brain during treatment.)

Considerations= 2-3 times a week for 6-12 total treatments. Informed consent needed. Pre Ect can include chest X ray blood work Benzos should be discontinued as they interfere with the process. MEds used atropine anesthetic and a muscle relaxant (succ). Short period of htn occurs during the start. Cardiac conditions should be monitored and treated BEFORE the procedure. Monitor vital signs before and after. IV NEEDED 100%oxygen needed. Client expected to become alert after 15 mins following the ECT

Complications= Memory loss and confusion, Reactions to anesthesia, cardiovascular changes,relapse of depression

Transcranial magnetic stimulation (TMS) NONINVASIVE How it works= is a noninvasive therapy that uses magnetic pulsations (MRI strength) to stimulate the cerebral cortex of the brain

Indications= major depressive disorder (Clients non responsive to pharm) Similar to Ect but does not induce seizure activity

Considerations= daily for a period of 4-6 weeks, can be performed as an outpatient procedure. Client is ALERT during procedure. Client might feel a tapping or knocking sensation in the head, scalp skin contraction, and tightening of the jaw muscles during the procedure.

Complications= Mild discomfort (tingling sensation), Monitor for lightheadedness after procedure. SEIZURES ARE RARE BUT POTENTIAL. TMS IS NOT ASSOCIATED WITH SYSTEMIC ADVERSE EFFECTS OR NEURO DEFICITS.

Contraindications= clients who have cochlear implants, brain stimulators, or medication pumps because the metal in the devices can interfere with the treatment.

Vagus nerve stimulation (VNS) How it works= provides electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on the client’s chest similar to a pacemaker device. Believed to result in an increased level of neurotransmitters and enhances the actions of antidepressant medications.

Indications= Depression (resistant to pharm), ongoing research for anxiety obesity and pain

Considerations= Commonly performed as an outpatient surgical procedure. Delivers around the clock programmed pulsations usually every 5 mins for a duration of 30 seconds. Therapeutic antidepressant effects usually takes several weeks to achieve. Can turn off at any time by placing a special external magnet over the site of the implant. Informed consent.

Complications= Voice changes (because of the proximity of the implanted lead to the larynx and pharynx), Hoarseness, throat or neck pain, coughing. These commonly Improve with time. Dyspnea can occur especially with physical exertion ( Client might want to turn off during exercise or during prolonged speaking)