- Information
- AI Chat
Mental Health Cheat Sheets
NUR203 Psychiatric Nursing (NUR203)
Jersey College Nursing School
Recommended for you
Preview text
Mental Health
Table
of
Contents
Therapeutic Communication
Non-Therapeutic Communication
Defense mechanisms
Legalities and Ethics
In Patient - Out Patient
Restraints and Seclusion
Anxiety
Panic Attacks
OCD
PTSD
Depression
Eating Disorder
Personality Disorders
Dissociative Identity Disorders
Schizophrenia
Schizoaffective
Bipolar Disorder / Manic
Substance Abuse
Alcohol Addiction & Abstinence medication
Dementia
Alzheimer
Delirium
Anti psychotics
Antidepressants
Anxiety medications
Mood stabilizers
ADHD medication
Mental heath - children
Communication with children
Erickson's Stages Of Development
Maslow's hierarchy of Needs
Test Prep and Guide
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
Therapeutic Communication
What is it?
Uses
Parts
What types are there?Techniques
What types are there?By Age group
The use of words and actions that promote a positive response in the client that will allow the Nurse to obtain vital information and develop rapport that facilitates a working relationship.
Gain clients attention Gain Information on patients thoughts, feelings, needs, concerns Information and feedback about the clients condition promotes functional and effective behavior and relationship Client centered, its purposeful, planned, and goal oriented
Time: Dont rush the client, mental health clients will often require more time Active Listening: Nonverbal actions that show the client you're paying attention Eye contact if situation and culturally appropriate Body language comfort and ease, (try not to tense up, or look guarded)
Silence: Allows time for the client to reflect and offer more information Questions: Open-ended, Close-ended, What if, Presupposition - goals assessment Clarifying: Restating, Reflecting, Paraphrasing, Exploring Opening statements: Gives the client a starting point for communication Acceptance and recognition: Nurse demonstrates interest and no judgement Touch: If appropriate can show compassion and care for client Focusing: Keeps the client on topic
Children: simple and straight to the point language, assess developmental level be at eye level, use play during interactions, nonverbal is very important. Adolescents: Assess how the client feels about the diagnosis, may refuse treatment as a desire to feel normal, how with the diagnosis affect relationships with peers Older adult: Minimize distractions, face the client, allow additional time for response, interview family to determine best communication with impaired client
Defense mechanisms
What is it?
Defense mechanisms
Protective behaviors used to protect ones mental state or ego. Can have both adaptive and maladaptive uses.
Altruism: Reaching out for help
Compensation: Focusing on strength to make up for weaknesses Conversion: Physiological symptoms present from mental thoughts
Denial: Refusing to accept the truth Displacement: Shifting feelings towards something or someone less threatening Dissociation: Compartmentalizing of information to ignore or block it out
Projection: Placing ones negative emotions/ actions onto another (cheating spouse accuses the other of cheating)
Rationalization: Making excuses for bad behavior or actions Reaction Formation: Displaying feelings or behavior other than what is felt Regression: Revert to childlike behavior Repression: Unknowingly removing unacceptable feelings from consciousness
Splitting: Lacks ability to reconcile difference between positive and negative emotions Sublimation: Substituting acceptable forms of expressions for unacceptable feelings Suppression: Denying unpleasant thoughts and feelings by choice. Undoing: Performs actions to make up for wrong doings.
Legallities and Ethics
What is it?
Legal Rights in Mental Health
A nurse must know the laws and regulations dealing with clients, protecting their rights, while abiding by local, state, federal laws and within the nurse practice act.
Humane treatment Informed Consent Right to refuse treatment Complete plan of care written out Right to communication - with anybody to include Law, family, legal, medical
Ethical Considerations
Beneficence: The act of goodness Autonomy: Allowing the patient to decide their fate, treatments, actions Justice: Fair and equal treatment: nurses can tend to shy away from MH clients. Fidelity: faithfulness to the client and the nurses duty. Veracity: Honesty - Don't lie to the client: This often happens with diagnosis, simply let the patient know the physician will be the one talking about the diagnosis.
Ethical Resources for decision making
Code of Ethics for nurses: Can be found on the ANA website Nurse Practice Act: Specific to each State / Region Senior Nursing Staff Ethics Department
Torts
Intentional Tort: Acts that are done with conscious thought that damage or violate the client or their rights. False Imprisonment: Confining or Restraining a patient against will w/o orders Assault: Making a threat Battery: Causing Bodily harm Unintentional Tort: Accidental action or inaction that damage or violate the client or their rights. Negligence: Simply failing to provide quality care that could have prevented injury Malpractice: Professional negligence
Restraints and Seclusion
What is it?
Types
Less Restrictive means
What types are there?DO and Do Not
Restraints: Use of Physical or Chemical means that limit the patients ability to function.
Physical: Belts, Cloth Bands, Cloth Vest, Use of physical restraints should be considered only when other methods fail. Medication / Chemical: Benzodiazepines and Anti psychotics (Typical meds, but not the only ones)
Verbal Interventions: encourage client to calm down Diversion and/ or redirection Creating calm / quite environment Offer the clients PRN meds
DO: Use restraints as a last means Only when there is an ORDER Abide by state and local laws Follow Time Limits CHECK ON PATIENT Q15 -30Min and complete documentation
DO NOT use Restraints for: Staff Convenience Intentional Punishment Extreme physically / Mentally unstable
What types are there?Common Rules
Restraints and seclusion are limited by age: 8 years and younger: 1hr 9-17 years: 2 hours 18 years and older: 4 hours Provider must physically assess patient and re-write the prescription Q24 hours Prescription must state the type of restraint to be used
ANXIETY
What is it?
####### Anxiety is the bodies natural response to stress
####### Mild: Restless, increased motivation, and irritability
####### Moderate: Agitation, muscle tightness
####### Severe: Inability to function, ritualistic behavior, unresponsive
####### Panic: Loss of rational thoughts, distorted perceptions, unable to move
####### Separation: Occurs when not around a specific person
####### Phobias: Irrational fears of objects or situation. (Agoraphobia)
####### Social: Fear in social gatherings or when performing/ speaking
####### Panic: Recurrent attacks that immobilize the individual
####### Generalized (GAD): uncontrolled and excessive worry for over 6 months
What levels are there and the assessment findings
What types are there?
What types are there?Risk Factors
####### Anxiety is more common in women than men
####### Family History of Mental disorders / Anxiety
####### Agoraphobia: Extreme fear of being in certain places. Heights, bridges
What types are there?Medication
####### SSRI
####### Antidepressants
####### Benzodiazepines
####### Buspirone
Therapeutic Management- Behavioral Training What types are there?
####### Relaxation: Focus on control and decreasing systemic response
####### Modeling: Attempt to imitate appropriate behaviors
####### Desensitization: Systemically introducing the anxiety inducing trigger
####### Flooding: Used for phobias: Large exposure to stimulus
####### Prevention: Attempt to stop anxiety inducing behaviors like OCD
####### Thought Stop: Client states "STOP" when negative behaviors arise
OCD
What is it?
Assessment findings
Diagnostics
Interventions/ nursing Care
What types are there?Medication
Therapeutic Management- Behavioral Training What types are there?
Cognitive-Behavioral therapy: change negative distorted feelings Exposure/ Flooding: Exposing large amounts of undesired trigger/ stimulus Response prevention: preventing the client from performing the action
Obsessive-Compulsive disorder (OCD) is a recurrent, persistent, unwanted, and actions of a client. Could also be thoughts, urges and images patient is driven to do these actions and if they fail to do them could lead to a panic attack.
Obsessions: are unwanted, intrusive thoughts, urges, or images, the presence of which usually causes marked distress or anxiety. Compulsions: More commonly refereed to as rituals. Washing: can be showering or washing hands to kill germs Checking: May be lights, Stoves, or if doors are locked Counting: Doing a behavior for X times: Switching the lights on/off 3 times Ordering: Everything must be in order / lined up / in its specific place
Hoarding and Body Dysphoric are types of OCD Comorbidity: Other Mental health diagnosis often accompany OCD Anxiety Disorders >70% Depressive or Bipolar > 60% / Major depressive >40% 25-33% estimated have suicidal ideation
A clinical diagnosis will be made based off of observation in accordance with DSM-V
Keep stress levels low Create rigid rules
SSRI - Fluoxetine, Paroxetine, sertraline, fluvoxamine Tricyclic Antidepressant - Clomipramine
Keep the patient accountable
PTSD
What is it?
Post Traumatic Stress Disorder is recurring, intrusive memories of an overwhelming event that occured in the patients life. (Can be direct or indirect)
Reoccurring memories - involuntary intrusive Reoccurring dreams Feeling as if the event is happening again Intense psychological or physiologic distress when the event is remembered Avoidance of thoughts, feelings, memories
DSM 5: Criteria for PTSD Screen for self harm / suicide risk screen for Substance abuse
Assessment findings
Diagnostics
Interventions/ nursing Care What types are there?
Keep a calm environment / Free of extra stimuli assess for memory gaps
What types are there?Medication
SSRI Beta blockers / control physiological reactions
Therapeutic Management- Behavioral Training What types are there?
Cognitive-Behavioral therapy: change negative distorted feelings Prolonged exposure Therapy: Exposure therapy and relaxation techniques Eye movement Desensitization: DO NOT USE IF SUICIDAL Group/ Family therapy: Seek support from those close/ or same experiences Hypnotherapy: used in dissociative disorders Biofeedback: Increases awareness and gain control of triggers and reactions
Avoiding places, things, people Memory loss of the even Persistent negative beliefs about oneself-negative emotional state Trouble sleeping, concentrating Hyper-vigilance, reckless, irritable
Antidepressants Prazosin to reduce hyper vigilance and insomnia
Assess for family and occupational issues barrier Assess for other Psychological conditions
Eating disorder
What is it?
Types / diagnostics
What types are there?Assessment
What types are there?Medication
Therapeutic Management- Behavioral Training What types are there?
RE-FEEDING SYNDROME: fatal complications due to nutritional imbalances that occur after initiating feedings for a severely malnourished client Cognitive-Behavioral therapy: change negative distorted feelings
Serious and sometimes fatal that present as highly abnormal consumption practices that lead to inadequate or excess caloric intake.
Bulimia Nervosa Binge eating the purging (recurrent episodes) Weight within normal BMI Eat low calorie diets between episodes
Anorexia Nervosa Fear of gaining weight Disturbed body image refuse to eat ritualistic eating habits restrictive diet
Binge eating Disorder Often eat large Meals lack of control once per week for 3 months Both men and women 40s-50s most common age
Obsession of food / fat and calories Fatigue with anemic signs Eating in Seclusion Muscle wasting
Brittle nails and hair from poor nutrition excessive wight loss/ gain abnormal dieting / restrictive eating Distorted view of body
SSRI antidepressants Anxiolytics TPN nutrition
Interventions/ nursing Care What types are there?
Assess for food hoarding provide small snacks Routine weights Monitor labs / Vitals / I&Os
Establish goals Encourage Therapy / groups Dietician Consultation Promote self care / education
Personality Disorders
What is it?
10 types in 3 clusters
Assessment - commonalities What types are there?
Nursing Care
Be aware of personal reactions - Physical / Mental Dont let your actions ruin building rapport / caring for patients Milieu management - Orient the client to reality/ safety / appropriate activities Communication: Use firm and supportive approach offer realistic choices consistency in actions and words respect certain clients needs to self isolate when appropriate
Impairments in Self-Identity, Self destruction, and interpersonal functioning
Cluster A (Odd or Eccentric traits) Paranoid: Distrustful, suspicious of others: People want to harm, exploit, or deceive Schizoid: Emotional Detachment, no interest in relationships, indifferent to praise or criticism Schizotypal: Magical thinking or distorted perceptions, may not be clear delusions Cluster B (Dramatic, Emotional, Erratic) Antisocial: Disregard for others feelings / well being, outside of traditional morals and values, will harm, steal, lie and accept no personal responsibility Borderline: instability in identity, relationships, and affect. manipulative, impulsive Histrionic: Attention Seeking, needs to be the center of attention Always. Narcissistic: arrogant, believes self is most important, lack of empathy for others Cluster C (Anxious, fearful, Insecure, and /or inadequate) Avoidant: Actively avoids social events, gatherings, situations of contact / relations Dependent: Always needs a close relationship, finds one immediately as one ends Obsessive-Compulsive: indecisive, perfectionist, need for things to be a specific way which can prevent accomplishing even basic task.
Inflexible/ maladaptive responses Compulsive Lack of Social restraint
Inability to emotionally connect Interpersonal conflict provoking
Schizophrenia
What is it?
Assessment findings
Symptoms by stage
Diagnostic
What types are there?Medication
What types are there?
Therapeutic Management- Behavioral Training
Assess for Suicidal ideations Keep patient oriented to reality Educate on coping skills to recognize and manage delisional states
Mental disorder that limits a persons ability to distinguish between reality and imagination - disruption in how the person thinks, feels, and acts.
Positive Findings: Delusions hallucinations disorganized speech Disorganized Behavior
Negative Findings: Flat affect Decreased emotion expression Loss of interest / activities and relationships Minimal communication
Premorbid Phase: (1) Signs occur prior to diagnosis being very shy / antisocial Prodromal Phase: (2) Clearly manifested signs
Active Psychotic Phase: (3) Psychotic symptoms are prominent Residual Phase: (4) remission period / follows active phase
Minimal one positive symptom and one additional symptom (positive or negative) Present for 6 months or longer with one month of active symptoms Not substance induced
Interventions/ nursing Care
Maintain safe environment and protect client from injury Continuously monitor cognitive state Maintain stable and controlled reactions Dont let patient block the exit/ get inbetween nurse and exit.
Atipical Antipsychotics
Schizoaffective disorder
What is it?
Assessment findings
Diagnostics
Interventions/ nursing Care What types are there?
What types are there?Medication
Therapeutic Management- Behavioral Training What types are there?
Client meets clinical criteria for both Schizophrenia and depression or Bipolar disorder
Psychotic: Delusions hallucinations Altered speech, actions, thoughts
Manic: Agitation, Distracted Insomnia, Self-harm Rapid speech, actions, thoughts
Depressive: Loss of interest poor appetite sleep changes feeling worthless, guilty suicidal ideation
Made according to health history and current symptoms
Maintain a calm supportive environment Assess for suicidal ideation Keep client oriented to reality Allow client to express thoughts, feelings
Antipsychotics Antidepressants
Mood Stabilizers
Cognitive-Behavioral therapy Social Skills training Support groups Family counseling
Healthy consistent diet Avoid stressors Avoid Alcohol / illegal substances Maintain calm environment
Stay with patient during hallucinations identify triggers / avoid triggers Encourage coping skills
Substance Abuse - Addiction
What is it?
Assessment Questions
Diagnostics / Screening
What types are there?Types / side effects
Therapeutic Management- Behavioral Training What types are there?
Maintain safe environment use reversal agent if applicable support patient to maintain vitals Cognitive Behavioral Therapy
Dependence and repeated use on chemical substances to alter mood/ gain a sense of euphoria or escape from reality
Type used Amount used Frequency of use
Age started using changes in performance Precious withdrawal symptoms
Date last used How it affects their daily life and body
Drug Abuse Screening Test CAGE Questionnaire
Alcohol Use Disorder identification test Clinical Opiate withdrawal scale
Opioid: Heroin, Morphine - Slurred speech, respiratory depression, decreased LOC Reversal: Naloxone Alcohol: 0% blood alcohol level is intoxication: Death risk at 0% BAC Sedatives: Benzodiazepines, barbiturates, Club drugs - drowsiness, sedation, respiratory depression, decreased LOC Reversal: Flumazenil (Not for Barbituats) Cannabis: Increased risk of lung cancer, relaxed, euphoric, paranoia w/ high dose CNS stimulant: Cocaine, dizziness, tremors, blurred vision, tachycardia, seizures, cardiovascular collapse, can lead to death Amphetamines: Impaired judgment, hyper vigilant, irritability, tachycardia, elevated blood pressure. Inhalants: Depends on substance inhaled, nystagmus, phych changes, slurred speech, dizziness, muscle weakness Hallucinogens: anxiety, depression, hallucinations, pupil dilation, tremors, panic attacks
Therapy / support groups Client education Provide with resources for quitting 12 - step program encouragement
Alcohol Addiction & Abstinence meds
Withdrawal Medications
Alcohol Abstinence
Withdrawal symptoms by time frame: Within 6 hours: Tremors, anxiety, N/V, Insomnia Peak: 48-72 hours: Hypertension, diaphoresis, hallucinations, seizures 3-10 days after last drink: Withdrawal Delirium: Medical emergency DEADLY Confusion, Disorientation, agitation, autonomic instability, seizures.
Disulfiram (Antabuse): Treat chronic alcoholism Causes unpleasant symptoms / Nausea, Vomiting, chest pain, respiratory issue and makes the client extremely uncomfortable. Medication last up to 2 weeks in system Symptoms occur within 5-10 minutes DON'T GIVE TO AN IMPAIRED CLIENT = Risk of death if enough ETOH is ingested
Acamprosate: Thought to stabilize chemical signaling in the brain that has been disrupted by chronic alcohol use. (Does not reduce craving or cause reduced euphoria if patient continues to drink) Naltrexone: Same as above:
Withdrawal Medications
Diazepam, Chlordiazepoxide, lorazepam are used because they act on the GABA receptors and mimic the effects of alcohol. It takes several days for the neurotransmitters to readjust to normal function without alcohol.
Phenobarbital: Used for severe cases of Alcohol Withdrawal that are suspected to go into Withdrawal Delirium long acting Barbiturate targeting GABA receptors:
Carbamazepine: Outpatient treatment to prevent relapse by decreasing cravings and convulsions Clonidine: used to control Neuroautonomic hyperactivity (decreases SNS side effects of withdrawal) Naltrexone: Suppresses the euphoric effect of alcohol (DOES NOT DECREASE CRAVINGS)
Mental Health Cheat Sheets
Course: NUR203 Psychiatric Nursing (NUR203)
University: Jersey College Nursing School
- Discover more from:
