mental health a

  • reorienting a group if a pt is being disruptive by attacking a passive member ~ redivert attention and vocalize that too much pressure is being placed on the target

  • communicating with visibly depressed & withdrawn pt ~ ask what they would like to speak about to promote therapeutic communication (do not ask why questions, or yes/no)

  • alcoholic admitted requiring surgery plan of care nursing intervention ~ promote seizure precautions b/c alcohol withdrawal can start occurring after 2/3 days of not consuming any therefore it would have to be in place bc they are not going to be consuming any of it while hospitalized; iv fluids and sedatives/hynotics can help ease s/s

    • do not admin. disulfiram bc it is not applicable to a pt not consuming alcohol (it functions by making pts that consume alcohol violently ill)

  • anorexia

    • adolescent females most commonly affected

    • highest mortality rate

    • often see themselves as overweight

  • bipolar pt is argumentative and unusually energetic, what is the most important intervention ~ orient them to reality

    • establishing limits and consistency is important too but not immediate need

    • decrease stimulation

  • paranoid shiz pt is alone in hallway, speaking to themselves and gesturing loudly ~ calmly ask if they’re having a hallucination (reinforces reality)

    • do not touch the pt

    • do not ask them to speak about how they feel bc they can’t process info anyways

    • do not leave the pt alone and do not be alone with the pt, therefore do not provide them with privacy

    • do not restrain unless absolute last resort

  • terminal pt refuses to seek medical help and rest ~ should encourage pt to participate in their own care

    • apparent that the pt values their independence and own life, therefore one can encourage them to get help by allowing them to actively make medical decisions and conduct self care

  • pt disorientated to time and place ~ allow them to use their own clothing and care products bc it can create familiarity and help w. anxiety

    • do not sched constant activity or distractions bc it may be overstimulating

    • try to schedule same staff bc consistency and routine is preferred

    • involve family and friends bc the familiarity can make them feel more comfortable

  • catatonic schiz, stands in stupor with mutism and waxy flexibility ~ benzoids (esp. lorazepam) and ECT

    • catatonic pts are typically responsive to benzoids

    • antipsychotics can make catatonia worse and increase risk of developing NMS

    • decrease stimulation

  • recently expired pt, first nursing action ~ allow family to spend time with family and provide privacy

    • everything else can come afterwards

  • stages of group development

    • pre-group; selecting group members and deciding when/where/how often

      • usually first meeting

    • initial; norms are established and and rank/status of members are subconsciously decided

    • working; accomplishing goals

    • termination; goals are accomplished

  • do not teach pt while they are still anxious bc they will not be able to understand or retain info well

  • avoid asking ‘why’ questions bc they can be seen as confrontational

  • when faced with testing behavior, enforce limits to discourage inappropriate behaviors

  • s/s of delirium ~ rapid development

    • secondary to physical illness, meds, dehydration

    • usually reversible within 3 wks

  • play therapy ~ enables pt to express feelings and solve problems

    • esp useful in young children that don’t know how to put their feelings into words therefore, play is the best way for them to express themselves

  • types of anxiety disorders

    • ocd; recurring, unwanted thoughts, ideas or obsessions that make them do something on repeat to gain a sense of control

    • phobic; extreme, irrational fear

    • social anxiety; fear of being judged, neg. evaluated, or rejected in a social or performance situation

    • signal anxiety; internal conflict or emerging impulse and acts as a sign of an impending threat. early defense mechanism to control anxiety

  • maslows hierarchy of needs

    • lowest lvl ~ physiological

    • second lowest ~ safety and security

  • stages of crisis

    • disorganization; pt unable to function and socially isolates, this can develop into depression

    • denial; downplays significance of event that precipitated the crisis

    • blame; determine ‘whos fault’ it is

    • escape; pretend the problem doesn’t exist or downplays its significance as a means of avoiding or minimizing the crisis

  • goal of counseling in alcohol abuse pt ~ help to identify alcohol use triggers

    • pts that abuse substances or alcohol have little ability to tolerate anxiety or other negative emotions

  • pt taking phenelzine sulfate (MAOI) education

    • yogurt is permissible

    • maoi does not cause constipation, therefore laxatives are not needed

  • defense mechanisms

    • substitution; unattainable or unacceptable goal/emotion/object is replaced by an attainable or acceptable one

    • undoing; ‘make up’ for previous action or neglect

    • compensation; attempt to overcome shortcomings, whether they be real or fake

    • denial