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• In an emergency, begin with CPR.
• CJAM (Collect data, Action plan, Identify outcomes).
• DSM5 is a resource with clinical manifestations related to mental health disorders, not a nursing plan.
• Suicidal patients must be placed close to the nurse's station.

Neurotransmitters

• Histamine regulates alertness and wakefulness, and regulates glutamate, GABA, and serotonin.
• Serotonin regulates sexual behaviors, temperature, emotional regulation, sleep and pain.
• Dopamine regulates motor, cognitive, and affective functions.
• Catecholamines are hormones produced by the adrenal glands and play an important role in the body's stress response.
• Lithium therapeutic range: 0.6-1.2.
• Sleep hypnotics like Lunesta or Ambien treat insomnia and can cause adverse effects like headaches, fatigue, dizziness, nausea, sleepwalking, and amnesia; these medications do not improve memory or concentration, and can increase the risk of accidents.
• GABA is an inhibitory neurotransmitter that blocks excitatory signals associated with anxiety and panic.
• Glutamate is an excitatory neurotransmitter that stimulates cell activity and is associated with memory and learning.
• A suicide attempt involves intent to die.
• Self-harm involves hurting oneself and creating physical pain, without the intent to die.
• Duty to warn: If a patient threatens to harm another person, the nurse must inform the potential victim.
• Antipsychotic medications include haloperidol and risperidone.
• Signs of psychosis include delusions, hallucinations, alterations in speech, and being out of touch with reality.
• ADHD involves hyperactivity, impulsivity, and inattentiveness.
• ADHD medications include methylphenidate and risperidone.
• Providers discuss treatment plans, side effects, risks, and alternative treatments but nurses witness signing consent, and call the provider to explain further details and answer additional questions.
• Implied consent can be legally assumed in emergency situations, and the client gives nonverbal permission.
• Documentation: Use quotation marks and document the exact statement and nurses should avoid judgment, opinion, and diagnosing the action.

Serotonin Syndrome

• Serotonin syndrome symptoms include shivering, diarrhea, tachycardia, hypertension, muscle rigidity, fever, seizures, restlessness, insomnia, and confusion.
• Serotonin syndrome can be caused by SSRIs, SNRIs, bupropion, tricyclic antidepressants, and MAOIs.
• Serotonin syndrome can also occur when mixing MAOIs and serotonin, with valproic acid.
• Management for serotonin syndrome includes considering the airway, as the patient may have apnea or delirium, being prepared to give an anticonvulsant if seizures occur, padding the side rails, and protecting the head from injury.
• SSRIs are prescribed for suicide ideation to increase interest in suicide and provide energy to the patient, and it is important to provide a watchful eye for mood changes, instruct the ptient ot take with food and avoid tyramine due to risk of hypertensive crisis.
• Neuroleptic malignant syndrome is an adverse effect of antipsychotic medications that changes LOC, causes seizures, stupor, high fever, muscle rigidity, hypertension, and elevated creatine.
• Agranulocytosis can occur as an adverse effect of antipsychotics with flu-like symptoms like fever, chills, tachycardia, tachypnea, fatigue, muscle weakness, sore throat, and mouth sores.

Stages of Stress

• Alarm: fight or flight response.
• Resistance: trying to cope.
• Exhaustion: if the stressor is not relieved, the person can no longer maintain normal function.
• Panic, an anxiety level, has extreme physical symptoms like chest pain, palpitations, and shortness of breath.
• Compassion fatigue: how a nurse feels, and self-care is important to avoid burnout.
• Positive responses to stress include exercise, adequate sleep, a healthy diet, adequate hydration, and spirituality for hope and stress reduction.
• Journaling helps the patient to identify the stressor, but it should not substitute therapy or medications.

Zones of Mental Health Continuum

• Excelling: no concerns.
• Thriving: coping with stressors and minimal concerns.
• Surviving: unhappy, worried about stressors, distracted, angry, and annoyed.
• In crisis: paralyzed with fear and often requires hospitalization.
• Coping with stress involves adequate sleep, a support group, a nutritious diet, spending time with friends, yoga, and meditation
• Ways to avoid stress: daydreaming, pondering the past, revenge, overeating, binge shopping, alcohol, smoking, and drugs.
• Milieu therapy reviews the physical environment and psychosocial factors, as it requires a quiet environment, warm lighting, and the absence of music during the initial interview and should involve a craft and/or exercise room.
• Coordinating care involves including others in the implementation of the best care standards for the patient, and the entire team advocates for the patient.
• Erickson's stages are not really on the test, but the elderly and children will be able to digest medications so well.
• Social determinants include economic status, education, and access to health care.
• Sympathetic response is the flight or fight response, experienced in anxiety, preparation for an exam, or driving.
• Parasympathetic is the relaxation response after a stimulus, causing relaxation, exhaustion, and absence of anxiety.
• Mental health is the state of well-being in which a person can cope with daily stressors.
• Mental illness is a disruption in a person's ability to adapt, leading to a maladaptive stress response.
• Causes of mental illness include stress, genetics, and other non-contagious factors.
• Therapy is a person's right and can be refused. Not everyone needs it, and may not be required by insurance but can be used along with medication.
• Behavioral therapy focuses on modifying maladaptive behaviors, patterns, and responses, learning, and positive rewards to promote desired behaviors.
• Medication administration includes explanation, HOLD med and contact provider for clarification in case patient refuses.
• Cognitive therapy challenges negative thought patterns rooted in the person's past to overcome anxiety-provoking situations and encourages facing problems rather than avoiding negative situations.
• Psychoanalytic therapy studies the unconscious mind, influences thoughts, feelings, and behaviors, and learns adaptive coping skills through one-on-one counseling.
• Group therapy involves a small group that diagnose similarly and has people share insight using coping skills, developing strategies in the mean time, and increasing confidence.
• Nurse leaders facilitate discussion, while group members do most of the talking.
• Family therapy identifies the family's needs, working together, and starting with individual meetings before full family meetings.
• Telehealth therapy is virtually from home via phone or computer.
• Talk therapy is verbalizing feelings and ideas 1 on 1 with a therapist.
• Sigmund Freud advocated psychodynamic theory.
• Abraham Maslow advocated Maslow's hierarchy of needs.
• Erik Erickson advocated psychosocial stages of development.
• John Watson developed behavioral theory.
• Restraints require a provider's prescription, documentation, safety measures, monitoring tightness, time, food, drink, supervision, and therapeutic communication by removing them ASAP.
• Give them “time out” after an outburst, and offer seclusion ( leave room and go to quiet restricted area); physical restraints (last resort) after violence shown.
• Clozapine after violent behavior.

Dangers of Physical Restraints

• Positional asphyxia: slip down and cut off airway.
• Aspiration: issues with swallowing when restraints are applied to torso.
• Cardiac arrest: stress and neurotransmitters, psycho and physio stressor can cause MI.
• Cues of experiencing loss are changed in affect with changed, disinterest in previous activities, notable change in mood and coping, lack/increase of sleep, low appetite, and decreased energy.
• Stages of grief (Kubler-Ross): denial, anger, bargaining, acceptance.
• Complicated prolonged grief requires creating a safe and quiet environment, and conducting a confidential setting to discuss feelings, special education, and support only for certified nurses.
• Bargaining and negotiation should not be tolerated, but redirect and remind boundaries by providing positive rewards.
• MAOIs (phenelzine) should avoid tyramine, pickles, pepperoni, cheese, chocolates, avocados, soybean or fermented.
• Tardive dyskinesia is assessed with the Abnormal involuntary movement scale. (Haloperidol (psycho): tongue thrusting, lip smacking, facial grimacing, eye blinking, hip thrusting, irregular and repetitive.
• Clinical Opiate Withdrawal Scale (COWS): should identify the treatment of opiate withdrawal with benzodiazepine therapy.
• Fluoxetine (SSRI): antidepressant, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder.
• Increases serotonin; do not stop abruptly to avoid antidepressant discontinuation syndrome with flu like ( N/V, difficulty sleeping and achy.
• During initial interviews, introductions are made, boundaries are established, therapeutic milieu is created, and the patient perception of mental status is identified.
• Bias is prejudice is stereotyping.
• Justice involves caring for clients equally.
• Beneficence involves benefitting others, for the good.
• Nonmaleficence involves doing no harm and having a beneficial outcome.
• Autonomy involves allowing the client to make their own decisions.
• Assault involves threatening someone making one fearful of harm.
• Battery involves physical harm.
• False imprisonment requires a patient to be restrained, guarded and imprisoned.
• Negligence is unintentionally causing harm to a patient
• Counting backwards by 5's tests cognitive ability.
• Affects (Facial expressions) Facial appearance, expressions, and reactions.
• Language assessment involves reading and writing an expression from a book.
• Remote memory assessment involves listing 3 objects, and repeating them in 15 min. Give a situation with problem solving" assess abstract thinking.
• Sleep assistance involves a sleep diaries with consistent routines, pattern, and routines by avouidng alcohol.
• If unable to sleep, read or write, keep tv and caffeine drinks to a minmum.
• Lithium therapeutic range: 0.8-1.4.
• Lithium toxicity involves dehydration, thirst, diarrhea, blurry vision, hand tremor, nausea, vomiting, confusion, muscle weakness, slurred speech and ataxia.
• Duty to warn: If a client is threatening them, they should be notified; confidentiality is not required.
• Premenstrual Dysphoric Disorder: week before period, bloated and full, fuzzy brain feeling, moody and sad. SBE after 4th day bc breast is not as tender and masses are easily detected.
• Suicide attempt: caring for physical injuries, medicating for sleep, and giving nutrition and fluids.
• Sudden change in moods requires a visit from a provider - is not normal.

Mood Zones

1. Excelling zone: happiness in life and the hope of the future assists in dealing with stress.
2. Healthy zone: stressor and anxiety, but it is handled.
3. Reacting zone: reversible anxiety and stress, and the person can continue activities.
4. Surviving zone: stress is interfering with life and sleep, but there are boundaries.
5. Struggling zone: insomnia, cannot concentrate, too much to worry.
6. Ill zone: mental paralysis and inability to cope with severe panic attacks and stress, requiring immediate medical attention.

• Norepinephrine regulates learning and memory.
• Naps are recommended to be approximately 20 minutes.
• The root of problems in cognitive therapy: a person's past.
• Epinephrine: adrenaline.
• Postpartum psychosis requires emergency care, and mothers feel hopeless and could hurt their infant.
• Apply oxygen after electroconvulsive therapy.