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Mental Health Proctored Remediation
Psychiatric Mental Health Nursing (NSG323)
Grand Canyon University
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RN Mental Health 2019 Remediation
Chapter 29: Crisis Management Priority Steps in Critical Incidents Stress Debriefing (Basic Concept)
Underlying Principles:
Crisis intervention is designed to provide rapid assistance for individuals or groups who have an urgent need. Care is directed at the resolution of the immediate problem causing a crisis.
The initial task of the nurse is to promote a sense of safety for the client and protect the client by assessing the clients potential for suicide or homicide.
Nursing interventions: Assist with admission to an impatient facility Prioritize interventions to address the client’s needs first Identify the current problems and direct interventions for resolution Take an active, directive role with the client. Encourage active participation by the client in planning a solution and goal setting Help the client to set realistic and attainable goals Use strategies to decrease anxiety o Develop a therapeutic nurse-client relationship o Remain with the client o Listen and observe o Make eye contact o Ask questions related to client’s feelings o Ask questions related to the event o Demonstrate genuineness and caring o Communicate clearly and with clear directives o Avoid False reassurance Teach relaxation techniques Identify and teach coping skills Assist the client with development types of actions: o Short-term o Focused on the crisis o Realistic and manageable o Self assessment by nurse o Debriefing for staf Critical Incident Stress Debriefing is a group approach that can be used with a group of people who have been exposed to a crisis situation
Chapter 19: Eating Disorders
Manifestations of Anorexia Nervosa (System disorder)
Pathophysiology Related to Client Problem:
Persistent energy intake restriction leading to significantly low body weight in context of age, sex, development path and physical health Fear of gaining weight or becoming fat. Disturbance in self-perceived weight or shape
Health Promotion and Disease Prevention:
Provide highly structed milieu in an acute care unit. Develop and maintain a trusting nurse/client relationship through consistent and therapeutic communication. Use a positive approach and support to promote client self-esteem and positive self-image. Encourage client decision making and participation in the plan of care to allow for a sense of control. Establish realistic goals for weight loss or gain. Promote cognitive- behavior therapies. Reward clients for positive behaviors. Closely monitor the client during and after meals.
Expected Findings:
Body weight that is less than 85% of expected normal weight. Fine, downy hair (Lanugo) on the face and back, yellowed skin, pale, cool extremities and poor skin turgor Irregular HR, HF, cardiomyopathy, peripheral edema, acrocyanosis Acidosis or alkalosis, dehydration and electrolyte imbalances Amenorrhea and menstrual irregularities Exhibit low self-esteem, impulsivity and difficulty with interpersonal relationships, depress mood, social withdrawal, irritability and insomnia
Chapter 24: Medications for Psychotic Disorders Prioritizing Client Care (Basic Concept)
Priority Assessment for a Client Who Has Delirium (System Disorders)
Alterations in Health (Diagnosis): Delirium
Pathophysiology Related to Client Problem:
Short-term reversible, mild neurocognitive disorder may or may not progress to a major disorder. Major disorder are progressive and irreversible
Clients who have NCD can also develop delirium
Health Promotion and Disease Prevention:
Use tools such as:
Confusion assessment method (CAM) Neelon-Champagne (NEECHAM) confusion scale Functional Dementia Scale: Gives nurses information on clients ability to perform self-care, extent of memory loss, mood changes and the degree of danger to self/others. Brief interview for mental status (BIMS): For clients in LTC Mini-mental statue examination (MMSE) Functional assessment screening tool (FAST) Blessed Dementia Scare: Provide client behavior information based on interview with secondary source (family member)
Chapter 12: Client Safety Use of Restraints on a Child (Basic Concept)
Underlying Principles:
Safety is freedom from injury. Providing for safety and preventing injury are major nursing responsibilities.
Many factors afect client’s ability to protect themselves. Those factors include clients, age, young and older at greater risk, mobility, cognitive and sensory awareness, emotional state, ability to communicate, lifestyle and safety awareness
It is the providers responsibility to assess, report and document client’s allergies and to provide care that avoid exposure to allergens.
Nursing interventions:
Time limits for seclusions or restraints are based upon the age of the client o Age 8 years and younger: 1 hour o Age 9-17 years: 2 hours o Age 18 years and older: 4 hours
Explain the need for restraints to the client and family, emphasizing that the restraints keep the client safe and are temporary Ask client or guardian to sign consent form Review manufacturer instructions for correct application Pad bony prominences to prevent skin breakdown Secure restraints to movable part of the bed frame. If restraints with a buckle strap are not available, use a quick release knot to tie the strap Make sure restraints are loose enough for range of motion and that there is enough room for two fingers between restraints and the client Remove and replace restraints frequently to ensure good circulation to the area to allow for full ROM to the limbs Conduct an ongoing evaluation of the client Regularly determine the need to continue using the restraints Never leave client alone without the restraints Check facility policy regarding types of restraints. Many facilities no longer use vest restraints due to the risk for strangulation.
Provider must reassess the client and rewrite the prescription, specifying the type of restraints, every 24hrs or the frequency of time specified by facility policy.
Chapter 2: Legal and Ethical Issues Applying Restraints (Basic Concept)
Alterations in Health (Diagnosis): Conduct Disorder
Pathophysiology Related to Client Problem:
Things such as a traumatic experience, social problems, and biological factors may be involved in conduct disorder. Clients demonstrate a persistent patter of behavior that violate the rights of other or rules and norms of society.
Childhood-onset develops before the age of 10, with males being more prevalent. Adolescent-onset occurs after the age of 10. The ratio of males-to females is equal in the adolescent stage
Health Promotion and Disease Prevention:
Parental rejection and neglect Difficult infant temperament Inconsistent child-rearing practices with hard discipline Physical or sexual abuse Lack of supervision Early institutionalization Frequent changing of caregivers Large family size Associate with delinquent peer groups Parent with a history of psychological illness Chaotic home life Lack of male role model
Chapter 32: Family and Community Violence Priority Nursing Action for Suspected Child Abuse (Basic Concept)
Underlying Principles:
All states have mandatory reporting laws that require nurses to report suspected child or vulnerable adult abuse; there are civil and criminal penalties for not reporting suspicions of abuse.
Document subject and objective data obtained during assessment Provide basic care to treat injuries Make appropriate referrals Help client develop a safety plan, identify behaviors and situations that might trigger violent, and provide information regarding safe places to live Use crisis intervention techniques to help resolve family or community situation where violent has been devastating.
Nursing interventions:
Make sure clients are physically and psychologically safe from harm Provide psychological first aid Reduce stress-related manifestation by using techniques to alleviate a panic attack Provide interventions to restore rest and sleep, and connect the client to social supports and information about critical resources Depending on their level of expertise and training, mental health nurses can provide assessment, consultation, therapeutic communication and support, triage and psychological care.
Chapter 33: Sexual Assault Priority Interventions (Basic Concept)
Underlying Principles:
Pathophysiology Related to Client Problem:
Shortness of breath, heart racing, dizziness, chest pain, sweating, hot flashes, trembling, choking, nausea and numbness. Only three are psychological: feeling of unreality, fear of losing control and fear of dying.
The clients might experience behavior changes and/or persistent worries about when the next attack will occur.
Health Promotion and Disease Prevention:
Provider a structured interview to keep the client focused on the present Assess for comorbid condition of substance use disorder Provide safety and comfort to the client during the crisis period of these disorders, as clients in severe- to panic- level anxiety are unable to problem solve and focus. Remain with the client during the worst of the anxiety to provide reassurance perform a suicide risk assessment Provide a safe environment Use relaxation techniques with the client as needed for the relief of pain, muscle tensions and feelings of anxiety Instill hope for positive outcomes Enhance client self-esteem by encouraging positive statements and discussing past achievements Assist the client to identify defense mechanisms that interfere with recovery Postpone health teaching until after acute anxiety subsides Identify counseling, group therapy and other community resources for the clients
Chapter 5: Creating and Maintaining a Therapeutic and Safe Environment
Orientation Phase (Basic Concept)
Underlying Principles:
Therapeutic encounters can occur in any nursing setting if a nurse is sensitive to a client’s needs and uses efective communication skills
Therapeutic nurse-client relationship is foundational to mental health nursing care
The therapeutic nurse-client relationship difers from social and intimate relationships
Nursing interventions:
Orientation Phase
Nurse: Introduce self to the client and state purpose set the contract: meeting time, place, frequency, duration and date of termination Discuss confidentiality Build trust by establishing expectations and boundaries Set goals with the client Explore the client’s ideas, issues, and needs Explore the meaning of testing behaviors Enforce limits on testing or other inappropriate behaviors
Client: Meet with the nurse Agree to the contract Understand the limits of confidentiality Understand the expectations and limits of the relationship Participate in setting goals Begin to explore own thoughts, experiences and feelings Explore the meaning of own behaviors
Chapter 19: Eating Disorders
Alterations in Health (Diagnosis): Anorexia Nervosa
Pathophysiology Related to Client Problem:
Persistent energy intake restriction leading to significantly low body weight in context of age, sex, development path and physical health
Fear of gaining weight or becoming fat. Disturbance in self-perceived weight or shape
Health Promotion and Disease Prevention:
Clients are preoccupied with food and the rituals of eating, along with a voluntary refusal to eat This condition occurs most often in female clients from adolescence to young adulthood Onset can be associated with a stressful life event, such as college Compared to clients who have a restrictive type, those who have a binge-eating/purging type have higher rates of impulsivity and are more likely to abuse drugs and alcohol
Chapter 19: Eating Disorders Planning Care for a Client Who Has Anorexia Nervosa (System Disorder)
Alterations in Health (Diagnosis): Anorexia Nervosa
Pathophysiology Related to Client Problem:
Persistent energy intake restriction leading to significantly low body weight in context of age, sex, development path and physical health
Fear of gaining weight or becoming fat. Disturbance in self-perceived weight or shape
Health Promotion and Disease Prevention:
A registered dietitian should be involved to provide the client with nutritional and dietary guidance Consistency of care among all staf is important Assist the client to develop an implement a maintenance plan related to weight management Encourage follow-up treatment in an outpatient setting Encourage client participation in a support group Continue individual and family therapy as indicated Provide highly structed milieu in an acute care unit. Develop and maintain a trusting nurse/client relationship through consistent and therapeutic communication. Use a positive approach and support to promote client self-esteem and positive self-image. Encourage client decision making and participation in the plan of care to allow for a sense of control. Establish realistic goals for weight loss or gain. Promote cognitive- behavior therapies. Reward clients for positive behaviors. Closely monitor the client during and after meals.
Chapter 3: Effective Communication Encouraging Expression of Feelings (Basic Concept)
Underlying Principles: Therapeutic communication is the purposeful use of communication to build and maintain helping relationships with clients, families and significant others. Therapeutic communication is essential when
A depletion of the neurotransmitters serotonin, norepinephrine or dopamine in the central nervous system. Serotonin is the most extensively studied neurotransmitter in depression.
Depression is a mood (afective) disorder that is widespread issue, ranking high among causes of disability.
Health Promotion and Disease Prevention:
Recommendations to decrease Social Isolation:
Make time to be with the client, even if they do not speak Make observations rather the asking direction questions, which can cause anxiety in the client Give the client sufficient time to respond when holding a conversation due to a possible delayed response time Encourage daily exercise: 3-5 days each week improves clinical findings of depression and can help prevent relapse and provide social interaction
Chapter 22: Medications for Depressive Disorders Contraindications for Selegiline (Medication)
Drug Class: Antiparkinsons, Monoamine Oxidase Inhibitors
Expected Pharmacological Action: These medications block MAO in the brain, theraby increasing the amount of norepinephrine, dopamine, and serotonin
available for transmission of impulses. An increased amount of these neurotransmitters at nerve endings intensifies responses and relieves depression.
Therapeutic Use:
Depression Bulimia nervosa First-line treatment for atypical depression Panic disorders Social anxiety disorder OCD PTSD
Contraindications:
Children/adolescents (suicide/hypertensive crisis) Hypersensitivity Breastfeeding MAOI’s
Chapter 24: Medications for Psychotic Disorders Contraindications for Aripiprazole (Medication)
Drug Class: Antipsychotic
Expected Pharmacological Action:
Antipsychotic agents work mainly by blocking serotonin, and to lesser degree, dopamine receptors. These medications also block receptors for
Lithium Produces neurochemical changes in the brain, including serotonin receptor blockade. There is evidence that lithium decreases neuronal atrophy and/or increase neuronal growth
Therapeutic Use:
Treatment of bipolar disorders. Lithium controls episodes of acute mania, helps to prevent the return of mania or depression, and decrease the incidence of suicide.
Evaluating medication efectiveness:
Decrease in excitement, manic phase
Chapter 25: Medications for Children and Adolescents Who Have Mental Health Issues Evaluating Client Understanding of Methylphenidate (Medication)
Drug Class: CNS Stimulants
Expected Pharmacological Action:
These medications raise the levels of norepinephrine and dopamine into the CNS
Therapeutic Use:
ADHD in children and adults
Evaluating medication efectiveness:
Decreased hyperactivity (ADHD); increased ability to stay awake (narcolepsy)
Chapter 21: Medications for Anxiety and Trauma- and Stressor- Related Disorders Reportable Laboratory Results (Medication)
Drug Class: Buspirone (Atypical anxiolytic/nonbarbiturate anxiolytics)
Expected Pharmacological Action:
Mental Health Proctored Remediation
Course: Psychiatric Mental Health Nursing (NSG323)
University: Grand Canyon University
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