Blueprint Exam 1 PDF

Antidepressant: SSRI: 2-4 w (1) TCAs (2) MAOIs (3) NDRI (1) SNRI (1) SA/RIs (1): “sex” “TSA= slow” “Selene, the Trani, “No smoking” “So, No; “Trazab...

Antidepressant: SSRI: 2-4 w (1) TCAs (2) MAOIs (3) NDRI (1) SNRI (1) SA/RIs (1): “sex” “TSA= slow” “Selene, the Trani, “No smoking” “So, No; “Trazabone” pheening for acid” Dick/Vagina” ß libido Nerve pain/ Tyramine/ Smoking Chronic pain Ortho SI Ý (young people) insomnia hypertensive cessation BBW: serotonin hypo BBW: serotonin Ortho hypo crisis S/E: seizures syndrome Priapism syndrome (agitation, Dizzy Don’t take with Anticholinergic ß libido Sedative Ý HR, confusion, Anticholinergic food Contraindications: Hypertension effects muscle stiffness Increase risk Don’t take with anorexia, seizure No: St. Wart GI upset Hyponatremia for falls any other Do not cut/ no Educate, No: St. Wart arrythmias antidepressants/ alcohol hydration Take them in am? Not for © pts stimulants Risk: Ý SI Bleed risk? Mood stabilizer/ Antiseizure Med Valproic Acid: 50- 125 Carbamazepine: 4-12 Lamotrigine: 2.5-15 Topiramate: Oxcarbazepine Acute mania, not BBW: agranulocytosis acute mania/ treatment treatment responding to mood (ß WBC) maintenance therapy resistant mania resistant stabilizers Used with lithium steven Johnson weight loss mania Notify provider: Abd. Pain, Labs: WBC, liver, bone syndrome= rash, visual hyponatremia dark urine, Jaundice marrow= routine lab blisters disturbances Liver labs= ALT, AST Hyponatremia/ toxicity fatigue Mood stabilizer Anti-Anxiety Lithium: 0.6-1.2 (1-3w) Benzodiazepines Buspirone Sleep Meds: ZZZ Beta Blockers Hydroxyzine 1st line mood stabilizer Acute anxiety, No effects on Feeling Relieve Used if Eat with food seizure, alcohol GABA drugged, physical (HR, Benzo Drink 1.5-3L/day withdrawal 2-4w (non- daytime tremble, Not Anti-suicidal properties GABA immediate) drowsy sweating) suitable NO NSAIDs S/E: drowsiness, No risk Implications: Short period Sedation Blood draw labs regularly= dizziness, muscle dependence RR, time properties 10-12 hrs after last dose weakness, lack of NOT PRN depressions PRN Caution= BBW: lithium toxicity balance S/E: (zolpidem= S/E: hypo, opiods Early signs: nvd, thirst, No opioids headache, Ý dizzy, pee, slurred speech, PRN dizzy, nausea, depression) weakness, tremors, muscle weakness Monitor: GI upset, Monitor: fatigue dependence, nervous with older Avoid: pts w/ respiratory excited, for asthma/ 2nd Generation: (+,-) depressions, serotonin sensitivity diabetes ß EPS Educate: risk for syndrome Ý Weight Gain Ý Metabolic syndrome (ÝBG, Ý falls, no alcohol, Education: do thirst, Ý pee, fatigue, blurred avoid driving (24- not take w/ vision, obesity, HTN) 48hr) MAOI Labs: Ý TDL, ß HDL Buprenorphine/Naloxone Opioid Maintenance/Detox BBW: no elderly w/ dementia, Stimulants Methadone Opioid Maintenance cardio tox Calming effect, Naltrexone Opioid & Alcohol Maintenance Ý Risk: © disease, stroke, T2 enhancing focus/ Acamprosate Alcohol Maintenance DM concentration Disulfiram Alcohol Maintenance S/E: WG, drooling, sedation, Risk for misuse/ Clonidine/Lofexidine Opioid Withdrawal Detox dependence Flumazenil Benzodiazepine Detox Clozapine: Drug- drug Overdose Frequent Blood draws: WBC interaction Thiamine Alcohol Supportive Drug-drug interactions Symptom-Specific Withdrawal Detox Sedation Medications Symptoms 1st Generation: (+) Anticholinergic Ý EPS (involuntary movement/ tremors) NMS Tardive Dyskinesia (lip smacking, chewing, blinking) Irreversible Anticholinergic NMS (Ý fever, muscle rigidity, altered mental status, autonomic dysfunction) ©: ortho hypo, tachycardia, EKG changes  Cluster A: Cluster B Cluster C odd, eccentric, WEIRD, Suspicious WILD/ dramatic, emotional, impulsive, Worried/ anxious, fearful unpredictable Paranoid: Antisocial: Avoidant: Bad ass kid, reckless, disregard. 15 Alone, lonely, want connection but fearful of distrust, suspicious, perceived attacks it, scared of criticism, negative self-vie people pleaser Schizoid: Pervasive pattern of detachment from social relationships. “Loners”, prefer to be alone, Borderline: Toxic relationships, self-image, impulse, self- harm, avoid abandonment Dependent: Need to be take cared for, fear of separation, indecisive, clinginess, discomfort when alone Schizotypal: Pervasive pattern of social and interpersonal deficits. Histrionic: Attention seeking, shallow, Hoe Obsessive Compulsive Personality Disorder: Perfectionism, detailed, interfering with task completion Narcissistic: Lack of empathy, entitled, need to be special, take advantage of others, try hard, superiority  ADHD Benefits: ODD: 8-12 yrs old improve caregiver- Uncooperative and unhostile behavior S/S: child interaction Usually with other conditions (anxiety, ptsd, Inattentive, hyperactive, impulsivity ß aggressive behavior adhd, autism, etc) Causes: Ý academic Behaviors: Brain injury productivity Anger/ lose temper Environmental factors Risk: Arguing Alcohol/ tobacco during pregnancy Death, stroke, MI Refuse to comply Premature birth S/E: Resentment ß sleep Deliberately annoying others Low birth weight ß appetite/ weight Blaming others Therapy: Stomach pain Preschool (4-5): behavioral therapy before trying Headache Treatments: meds Less common: motor/ Parent behavior management training 6 < = meds verbal tics, personality Individual/ family psychotherapy Psychotherapy = adults changes CBT Medications: Education: Social skills training Stimulants (1st line) Risk for dependence/ Medication for other conditions SNRIs (atomoxetine): Ý SI, not controlled substance abuse Educations: © risk + reinforcement Alpha 2 Adrenergic Agonists (clonidine) Suppress growth Time outs Psychiatric risk Picking battles Priapism Set realistic limits ASD Alcohol Self-care Difficulty w/ communicating interaction with others Collaborate with others Restricted interest & repetitive Separation Anxiety= 8m>preschool yrs Impair pt. ability to function in life areas ODD: 8-12 yrs old S/S: Ongoing pattern of aggression towards others w/ Intense fear Communication/ interaction behaviors: serious rule violations, social norms violations Challenges in sharing enjoyment Physical pain: stomach Examples: aches, headaches, fatigue Slow to response to name calls Running away Enjoy talking about what they love Don’t want to go to school/ Staying out all night\skipping school be away from home Bullying, fighting Treatment: Restricted Interest/ Repetition: Lying stealing CBT Repeating behaviors Damaging property Gradual Exposure Lasting interests Treatments: Routine Family involvement Start early (crucial) Early treatment: enhance Behavioral – younger (for: parents), teens (for: friendships, social, Causes: kid, school, family) academically, and self Siblings’ w/ ASD esteem Older parents Down syndrome (genetic conditions) Separation Anxiety Disorder: Low birth weight Treatment Definition: Fear of Behavioral separation from attachment Developmental figures. Education Symptoms: Fear of harm to Social-Relational loved ones, avoidance, Pharmacology nightmares, physical Psychological symptoms. Complementary/ Alternative treatments Duration: 4+ weeks in children, 6+ months in adults.  Levels of Anxiety Risk Factors for Anxiety Disorders Coping with Anxiety Mild Anxiety Temperamental Traits: Childhood Adaptive Coping Strategies: o Description: Normal and beneficial; enhances focus shyness or behavioral inhibition. o Problem-focused coping: and motivation. Exposure to Trauma: Abuse, loss, or Counseling, cognitive o Symptoms: Restlessness, irritability, mild tension- significant stressors in early life or behavioral therapy (CBT). relieving behaviors (e.g., fidgeting, nail-biting). adulthood. o Emotion-focused coping: Moderate Anxiety Family History: Genetics and familial Mindfulness, yoga, o Description: Narrowed perceptual field with selective predisposition to anxiety or mental meditation, exercise, inattention. health disorders. breathing exercises, social o Symptoms: Increased heart and respiratory rates, support. Medical Conditions: perspiration, headaches, gastric discomfort, urinary o Thyroid problems, COPD, Maladaptive Coping Strategies: urgency, voice tremors, shakiness. angina. o Avoidance, withdrawal, Severe Anxiety o Substance use (e.g., caffeine, substance misuse, o Description: Perceptual field greatly reduced, potential medications, drugs). disengagement. for confusion and automatic behavior. Importance of Physical Exam: Rule Defense Mechanisms: o Symptoms: Hyperventilation, pounding heart, out medical causes of anxiety o Adaptive use helps achieve insomnia, sense of impending doom, impaired symptoms. goals. learning/problem-solving. o Maladaptive/excessive use Panic linked to mental health o Description: Extreme anxiety causing loss of touch disorders. Phobia-Related Disorders: with reality and dysregulated behavior. o Symptoms: Pacing, running, shouting, screaming, withdrawal, hallucinations, acute panic leading to Definition: Intense fear of specific exhaustion. objects or situations. Symptoms: Immediate fear/anxiety, Social Anxiety Disorder: Agoraphobia: avoidance of phobic stimulus. Duration: Persistent for 6+ months. Definition: Fear of scrutiny in Definition: Fear of situations Common Phobias: Social anxiety, social situations. where escape/help is difficult. agoraphobia, separation anxiety. Symptoms: Avoidance, fear of Symptoms: Fear of negative panic-like reactions, housebound in evaluation, avoidance, intense severe cases. Separation Anxiety Disorder: Selective Mutism: anxiety in social settings. Diagnosis: Often comorbid with Duration: Persistent for 6+ panic disorder. months. Definition: Fear of Definition: Inability Impact: Impairs separation from attachment to speak in certain social/occupational functioning Generalized Anxiety Disorder (GAD): figures. social settings despite Symptoms: Fear of harm to normal language loved ones, avoidance, skills. Definition: Excessive worry about Panic Disorder: multiple areas for 6+ months. nightmares, physical Symptoms: Extreme symptoms. shyness, fear of Symptoms: Restlessness, fatigue, Definition: Recurrent, unexpected difficulty concentrating, irritability, Duration: 4+ weeks in embarrassment. children, 6+ months in Associated panic attacks. muscle tension, sleep disturbances. adults. Disorders: Often co- Symptoms: Palpitations, sweating, Impact: Significant distress or occurs with PTSD or shaking, shortness of breath, chest impairment in functioning. pain, dizziness, depersonalization, other anxiety disorders. fear of dying/losing control. Diagnosis: Persistent worry about attacks or behavioral changes to avoid them. Impact: May lead to agoraphobia or significant life disruptions. Therapeutic: Technique Definition Example Acknowledge and affirm the client’s feelings Client: “I hate this medicine.” Nurse: “I Acceptance without agreement. understand how you feel.” Ask the client to explain or define their Client: “I feel useless.” Nurse: “Can you give an Clarification message for better understanding. example of a time you felt that?” Highlight important statements to discuss Client: “I grew up in tough conditions.” Nurse: “It Focusing them further. sounds like you faced stress.” Client: “I hid my sister’s secret.” Nurse: “Can you Exploring Encourage the client to share more details. tell me more about that?” Acknowledge positive behavior without Nurse: “I noticed you took all your medications Giving Recognition giving overt compliments. today.” Open-Ended Encourage clients to lead the conversation Client: “I’m unsure what to do.” Nurse: “Tell me Questions and share more. more about your concerns.” Rephrase the client’s message to clarify and Client: “I’m busy today.” Nurse: “You’ve had a Paraphrasing confirm understanding. lot of activities today, haven’t you?” Correct distorted thoughts with factual Client: “There are spiders on the walls.” Nurse: “I Presenting Reality information. see no spiders here.” Reiterate the client’s message with different Client: “The nurses hate me.” Nurse: “You feel the Restating words to encourage elaboration. nurses dislike you?” Encourage the client to evaluate their own Client: “Should I do this treatment?” Nurse: Reflecting thoughts and actions. “What do you think the pros and cons are?” Nurse: Uses nonverbal cues, like nodding, to show Providing Silence Allow quiet time for reflection. support while remaining silent. Making Comment on the client’s appearance or Nurse: “You look tired today.” Client: “I’ve been Observations behavior to prompt discussion. having trouble sleeping.” Provide presence and emotional support to the Offering Self Nurse: “I can sit with you if you’d like.” client. Encouraging Ask about sensory experiences or Nurse: “What do you see or hear right now?” Perception hallucinations without judgment. Encouraging Help the client reflect on past coping Nurse: “How did you handle stress during your Comparisons strategies. divorce?” Nurse: “You’ve handled tough situations well Offering Hope Reinforce resilience and the client’s strengths. before.” Use light humor to create connection when Offering Humor Nurse: “Orange you glad to see me?” appropriate. Challenge inaccurate assumptions Client: “I don’t drink much.” Nurse: “You Confronting respectfully. mentioned drinking every weekend.” Client: “I don’t like this medication.” Nurse: “The Summarizing Review key points to confirm understanding. side effects concern you, correct?” Nontherapeutic: Nontherapeutic Definition Example Response Nontherapeutic: “Why haven’t you and Mary gotten Asking Personal Asking irrelevant questions out married?” Therapeutic: “How would you describe your Questions of curiosity, not professionalism. relationship with Mary?” Imposing personal views, taking Nontherapeutic: “If I were you, I’d put your father in a Giving Personal decision-making away from the nursing home.” Therapeutic: “Let’s explore options for Opinions client. your father’s care.” Ignoring what the client is Nontherapeutic: “Let’s not talk about insurance. It’s time Changing the Subject sharing and shifting to another for your walk.” Therapeutic: “After your walk, let’s topic. address your insurance concerns.” Nontherapeutic: “Older adults are always confused.” Using stereotypes or blanket Stating Generalizations Therapeutic: “Tell me more about your father’s statements that undermine trust. confusion.” Offering unfounded optimism, Nontherapeutic: “You’ll be fine; don’t worry.” Providing False discouraging expression of Therapeutic: “It must be hard not knowing what will Reassurances feelings. happen. How can I help?” Focusing on pity or the nurse’s Nontherapeutic: “I’m so sorry you lost your leg.” Showing Sympathy feelings instead of supporting the Therapeutic: “Losing your leg is a big adjustment. How do client. you think this will affect your life?” Using "why" questions that may Asking "Why" Nontherapeutic: “Why are you upset?” Therapeutic: come across as accusatory or Questions “You seem upset. Can you tell me more about it?” judgmental. Judging the client’s decisions or Nontherapeutic: “You shouldn’t consider surgery; it’s too Approving or behaviors based on personal risky.” Therapeutic: “You’re considering surgery. What Disapproving beliefs. are the pros and cons?” Nontherapeutic: “No one here would lie to you!” Giving Defensive Denying or dismissing the Therapeutic: “You feel people have been dishonest. Can Responses client’s feelings or concerns. you tell me more?” Providing Nontherapeutic: “It’s your fault you’re sick because you Using avoidance or hostility Passive/Aggressive didn’t take your medicine.” Therapeutic: “Taking your instead of assertiveness. Responses medicine regularly can help prevent symptoms.” Nontherapeutic: “You did sleep; I heard you snoring.” Denying the client’s perspective Arguing Therapeutic: “You don’t feel rested? Let’s discuss ways to or invalidating their feelings. improve your sleep.” 1. Therapeutic Communication Techniques Active Listening and Validation: o Use SOLER framework: § S: Sit squarely facing the client. § O: Maintain an open posture. § L: Lean toward the client. § E: Make eye contact. § R: Stay relaxed. o Example: Reflect on the client’s feelings to demonstrate empathy, e.g., “I hear you’re feeling overwhelmed.” Use of Silence: o Allow space for clients to reflect and share at their own pace. o Combine with nonverbal cues like nodding to show support. Techniques for Effective Communication:  o Clarification: “Can you explain what you mean by that?” o Open-ended questions: “What’s on your mind today?” o Summarizing: “So you’re feeling frustrated because... Is that correct?” Avoiding Barriers: o Refrain from: § Offering personal opinions. § Giving false reassurances. § Interrupting or changing the subject abruptly. 2. Managing Clients with Trauma Histories Trauma-Informed Care Principles: o Emphasize physical and emotional safety. o Foster trust by respecting boundaries and preferences. o Validate trauma without requiring the client to relive it unless clinically necessary. Recognizing Signs of Distress: o Symptoms include hypervigilance, withdrawal, and avoidance. o Monitor nonverbal cues such as tense body language or reluctance to engage. Supportive Techniques: o Use grounding strategies to help clients remain present. o Offer reassurance of safety in the therapeutic environment. Considerations for Touch: o Avoid physical contact unless explicitly permitted, especially in trauma survivors. 3. Building Trust with Clients Developing Rapport: o Introduce yourself and your role clearly using AIDET: § Acknowledge, Introduce, Duration, Explanation, Thank You. o Maintain consistency and reliability in interactions. Respect for Boundaries: o Establish professional limits and avoid overinvolvement. o Example: Redirect personal questions to focus on the client’s needs. Creating a Safe Therapeutic Environment: o Ensure confidentiality and privacy. o Adapt communication style to align with the client’s cultural and developmental needs. 4. Crisis Intervention Suicide Risk Assessment: o Utilize tools like the Patient Safety Screener (PSS-3). o Directly ask about suicidal ideation: “Are you thinking about hurting yourself?” o Look for risk factors such as hopelessness, previous attempts, and substance use. De-escalation Techniques: o Maintain a calm and neutral tone. o Avoid arguing or escalating the situation. o Use short, simple statements to communicate safety and boundaries. Interventions During a Crisis: o Prioritize the client’s immediate needs and safety. o Engage additional support when required, such as rapid response teams or mental health specialists. 5. Comprehensive Assessments in Mental Health Components of Mental Status Examination (MSE): o Assess:  § Appearance, behavior, speech, mood, affect, thought process, and cognition. o Example: Note racing thoughts or flat affect to identify mental health concerns. Psychosocial and Cultural Assessments: o Use tools like the Cultural Formulation Interview (CFI) to explore cultural influences. o Incorporate questions on family dynamics, spiritual beliefs, and coping mechanisms. Holistic Nursing Process (ADOPIE): o Assessment: Gather subjective and objective data (e.g., mood and appearance). o Diagnosis: Identify responses to conditions like anxiety or depression. o Planning and Implementation: Set client-centered goals and implement interventions. o Evaluation: Measure progress against established outcomes. 6. Promoting Resilience and Coping Strategies Fostering Resilience: o Encourage supportive relationships with trusted individuals. o Provide opportunities for clients to practice self-regulation and stress management. Coping Mechanisms: o Validate adaptive behaviors (e.g., journaling or talking to a friend). o Teach relaxation techniques such as deep breathing and mindfulness. Addressing Barriers to Care: o Collaborate with clients to identify challenges, such as financial or cultural obstacles. o Connect them with resources to enhance accessibility. Legal and Ethical Considerations in Mental Health Care Client Rights Informed Consent: Ensures patients are informed about the risks, benefits, and alternatives of treatment. Clients must be legally competent to consent unless overridden in emergencies. Right to Refuse Treatment: Even involuntarily admitted clients can refuse treatments unless deemed a risk to themselves or others. Rights of Involuntarily Committed Clients: Legal protections include the least restrictive environment and access to legal counsel to challenge detention. Confidentiality and HIPAA Protecting Patient Information: Governed by HIPAA, confidentiality applies to all patient information unless reporting is required by law. Duty to Warn: Nurses must notify appropriate parties when a patient poses a danger to themselves or others, superseding confidentiality. Mandatory Reporting: Abuse or neglect of vulnerable populations (e.g., children, adults at risk) must be reported per state law. Restraint and Seclusion Legal Guidelines: Restraints and seclusion are last resort measures and must comply with standards like The Joint Commission's policies. Ethical Considerations: Restraints conflict with nursing values of autonomy and dignity; alternative strategies should be prioritized. Documentation Requirements: Every instance must be documented thoroughly, including rationale, monitoring, and care provided during restraint use. Ethical Decision-Making Impaired Colleagues: Reporting impaired professionals ensures patient safety and adherence to ethical practice. Respecting Patient Autonomy: Balancing autonomy with beneficence involves supporting informed decision-making and respecting choices. Handling Ethical Dilemmas: Nurses should use the ANA Code of Ethics, consult interdisciplinary teams, and employ reflective practices to navigate complex scenarios.