Mental Health Past Paper PDF

CH 1,2,3,4,5,8,11 (Crisis (CH 11) -- LOOK AT THE CHARTS),16 (Schizophrenia -- LOOK AT THE CHARTS) 1. Issues and concerns of Mental Health: Revolving door, 2. Antipsychotic drugs a. Conventional/Typical Antipsychotics b. Atypical Antipsychotics c. Use: treat symptoms of psychosi...

CH 1,2,3,4,5,8,11 (Crisis (CH 11) -- LOOK AT THE CHARTS),16 (Schizophrenia -- LOOK AT THE CHARTS) 1. Issues and concerns of Mental Health: Revolving door, 2. Antipsychotic drugs a. Conventional/Typical Antipsychotics b. Atypical Antipsychotics c. Use: treat symptoms of psychosis d. Mechanism of action: block dopamine receptors e. Side effects i. EPS: Dystonic reactions, Akathisia, Parkinsonism ii. Anticholinergic symptoms (dry mouth, constipation, urinary hesitancy or retention) iii. Weight gain iv. Metabolic syndrome v. Erectile dysfunction f. Client Teaching vi. Adherence to regimen vii. Management of side effects viii. Thirst/dry mouth (sugar-free candy, liquids) ix. Constipation (dietary fiber, exercise) x. Sleepiness/drowsiness (safety measures) xi. Actions for missed dose (take dose if within 4 hours of usual time) 3. Antidepressants g. Tricyclic and cyclic compounds h. Selective serotonin reuptake inhibitors (SSRIs) i. Monoamine oxidase inhibitors (MAOIs) j. Major interaction with other drugs, never administer at the same time with other drugs xii. Serotonin syndrome = MAOI + SSRI xiii. Patient would present with Agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia leading to Coma, death (extreme reactions) k. Side effects xiv. SSRIs: Anxiety, agitation, akathisia, nausea, insomnia, sexual dysfunction, Weight gain xv. Cyclic antidepressants: Anticholinergic effects; Orthostatic hypotension, sedation, weight gain, tachycardia; Sexual dysfunction xvi. MAOIs: Daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction, Hypertensive crisis (with foods containing tyramine) l. Client teaching xvii. Time of dosage 1. SSRI first thing in morning 2. Cyclic compounds at night xviii. Actions for missed dose 3. Take SSRI up to 8 hours after missed dose 4. Take cyclic within 3 hours of missed dose or omit the day's dose xix. Safety measures xx. Dietary restrictions with MAOIs (see Box 2.1) 4. Mood-Stabilizing Drugs m. Lithium, some anticonvulsants (carbamazepine, valproic acid, gabapentin, topiramate, oxcarbazepine, and lamotrigine) n. Use: treatment of bipolar illness o. Mechanism of action xxi. Lithium normalizes reuptake of certain neurotransmitters. xxii. Valproic acid and topiramate increase the levels of GABA. xxiii. Valproic acid and carbamazepine inhibit the kindling process. p. Side effects xxiv. Lithium: Nausea, diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic taste in the mouth, fatigue, lethargy; weight gain, acne (side effects that occur later in therapy) 5. Toxicity: severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination xxv. Carbamazepine and valproic acid: drowsiness, sedation, dry mouth, blurred vision xxvi. Carbamazepine: rash, orthostatic hypotension xxvii. Valproic acid: weight gain, alopecia, hand tremor xxviii. Topiramate: dizziness, sedation, weight loss q. Client Teaching xxix. Periodic monitoring of blood levels xxx. 12 hours after last dose taken xxxi. Taking medication with meals xxxii. Safety measures 5. Antianxiety Drugs r. Use: treatment of anxiety and anxiety disorders, insomnia, obsessive-compulsive disorder (OCD), depression, posttraumatic stress disorder, alcohol withdrawal s. Benzodiazepines, buspirone (see Table 2.6) t. Mechanism of action xxxiii. Mediation of GABA (benzodiazepines) xxxiv. Partial agonist activity at serotonin receptors (buspirone) u. Side Effects xxxv. Benzodiazepines: Physical, psychological dependence, Central nervous system (CNS) depression, Hangover effect, Tolerance xxxvi. Buspirone: Dizziness, sedation, nausea, headache v. Client Teaching xxxvii. Safety measures xxxviii. Avoidance of alcohol xxxix. Avoidance of abrupt discontinuation (taper slowly) 6. Stimulants w. Amphetamines (methylphenidate, amphetamine, dextroamphetamine) x. Use: treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, residual attention-deficit disorder in adults, narcolepsy y. Mechanism of action xl. Cause release of norepinephrine, dopamine, serotonin presynaptically xli. Block reuptake of neurotransmitters z. Side Effects: Anorexia, weight loss, nausea, irritability, Growth and weight suppression a. Client Teaching xlii. Dose after meals xliii. Avoidance of caffeine, sugar, chocolate xliv. Proper storage out of reach of children 7. Disulfiram b. Use: aversion therapy for alcoholism c. Mechanism of action: inhibition of enzyme involved with alcohol metabolism xlv. Adverse reaction with alcohol ingestion d. Side effects: fatigue, drowsiness, halitosis, tremor, impotence e. Drug interactions with phenytoin, isoniazid, warfarin, barbiturates, long-acting benzodiazepines f. Client teaching: avoidance of alcohol, including common products that may contain it such as Shaving cream, deodorant, over-the-counter cough preparations 8. Peplau: therapeutic nurse--client relationship; interpersonal dimension (foundation for current practice g. Four phases: (Table 3.5) xlvi. Orientation 6. Patient's problems & needs are clarified 7. Patient asks questions 8. Hospital routines & explanations are explained 9. Patient harnesses energy towards meeting problems 10. Patients full participation is confidential xlvii. Identification 11. Roles of the patient & nurse are clarified 12. Patient expresses feelings 13. Patient responds to a persons they perceive as helpful 14. Interdependent work with the nurse occurs xlviii. Exploitation 15. Patient makes full use of available services 16. Goals such as going home & returning work emerges xlix. Resolution 17. Patient gives up dependent behavior 18. Services no longer needed by patient 9. Empathy: Ability to perceive client's meanings and feelings, to communicate that understanding h. Client and nurse giving "gift of self" i. Different from sympathy (feelings of concern or compassion; may project nurse's personal feelings) 10. Therapeutic relationship: Focus on needs, experiences, feelings, ideas of client only 11. Peplau's model of three phases (see Table 5.2) j. Orientation: nurse establishes roles, purpose of meeting, identifies client's problems & clarifies expectations l. The nurses needs to get background information before meeting the client & become familiar with the medications the client is taking & arrange a quite, private, setting. li. Trust is built with the client in which the nurse needs to establish that therapeutic environment. k. Working lii. Maintaining the relationship, gathering more data, developing positive coping mechanisms, encouraging the patient to verbalize their feelings, promoting independence liii. Identification: Identifying the problem liv. Exploitation: Creating goals & directing the client. l. Termination: Goals are met with the client & problem is hopefully resolved lv. It is inappropriate for the nurse to agree on seeing the client outside the therapeutic relationship 12. What to avoid in a therapeutic relationship? m. Inappropriate boundaries (relationship becomes social or intimate) lvi. One of the biggest risks is nurse's belief they will not do anything nontherapeutic. n. Feelings of sympathy, encouraging client dependency o. Nonacceptance and avoidance p. Warning signs of abuse of the nurse--client relationship (see Box 5.3) 13. Verbal & nonverbal communication q. Verbal lvii. Content: literal words spoken lviii. Context: environment, circumstances, situation in which communication occurs r. Nonverbal lix. Process: all messages used to give meaning, context to message lx. Congruent or incongruent messages 19. What does that mean? 14. Goals of therapeutic communication s. Establish therapeutic nurse--client relationship. t. Identify the most important client concern; assess client's perceptions. u. Facilitate client's expression of emotions. v. Teach client and family the necessary self-care skills. w. Recognize client's needs. x. Implement interventions to address client's needs. y. Guide client toward acceptable solutions. z. Communication techniques 15. Therapeutic communication is most comfortable when the nurse and the patient are 3 to 6 ft apart 16. In therapeutic communication, the nurse must evaluate the use of touch based on the client's preferences, history, and needs because the nurse may find touch supportive, client may not. 17. Therapeutic communication skills a. Active listening (concentrating exclusively on what patient says); focusing on what the patient says b. These help the nurse: lxi. Recognize the most important issue lxii. Know what questions to ask lxiii. Use therapeutic communication techniques lxiv. Prevent jumping to conclusions; miss key factors in their care lxv. Objectively respond to message 18. Therapeutic Communication Session c. Establishment of contract for relationship d. Learning how client prefers to be addressed e. Identification of major concern lxvi. Nondirective role (broad openings, open-ended questions) lxvii. Directive role (direct yes-or-no questions; usually for clients with suicidal thoughts, in crisis, or who are out of touch with reality) f. Active listening skills, asking many open-ended questions, building on client's responses g. Techniques include clarification and placing an event in time or sequence. 19. Possible responses h. Aggressive i. Passive--aggressive j. Passive k. Assertive 20. **Assertive Communication** l. Calm, specific, factual statements m. Focus on "I" statements 21. What is the purpose of assessing a psych client? Picture of client's current emotional state, mental capacity, behavioral function 22. When interviewing the client n. Environment: is it comfortable? Is it safe (for the client, healthcare team, & other clients)? Is it quiet with little to no distractions? o. Family, friends: Their thoughts about the client? Other information they would like to share about the patient? p. Questions: Always ask open-ended questions to begin the assessment to get the patient talking more & be comfortable. lxviii. Can be focused if the client cannot organize thoughts or has difficulty answering the questions 23. Complete Assessment q. History: Age, Development stage, cultural considerations, Spiritual beliefs, previous history of the disorder r. General appearance/motor behavior lxix. Hygiene/grooming lxx. Appropriate dress lxxi. Posture lxxii. Eye contact lxxiii. Unusual movements/mannerisms: Automatisms, psychomotor retardation, waxy flexibility lxxiv. Speech 20. Neologisms s. Mood/Affect lxxv. Assess for consistency lxxvi. Blunted lxxvii. Broad lxxviii. Flat lxxix. Inappropriate lxxx. Restricted lxxxi. Labile t. Thought process/content lxxxii. Process (how the client thinks) and content (what the client says) lxxxiii. Circumstantial thinking lxxxiv. Delusion lxxxv. Flight of ideas lxxxvi. Ideas of reference: "President Biden told me that I need to serve today." lxxxvii. Loose associations lxxxviii. Tangential thinking lxxxix. Thought broadcasting, insertion, blocking, withdrawal xc. Word salad u. Assessment of suicide or harm toward others (see Box 8.2) xci. Ask client directly xcii. Anger, hostility, or threats toward another person xciii. Specific threats or plans to harm someone 21. Duty to warn v. Intellectual process xciv. Orientation xcv. Memory xcvi. Ability to concentrate xcvii. Abstract thinking and intellectual abilities w. Sensory--perceptual alterations xcviii. Auditory hallucinations xcix. Visual hallucinations x. Judgment and insight c. Ability to interpret environment ci. Ability to understand true nature of one's situation y. Self-concept cii. Personal worth and dignity ciii. Description of physical characteristics/body image civ. Emotions the client frequently experiences z. Roles and relationships cv. Current roles cvi. Ability to fulfill roles cvii. Changes in roles cviii. Satisfaction with relationships cix. Online activity/social media cx. Categories of family assessment (see Box 8.3) a. Physiological and self-care considerations cxi. Eating habits cxii. Sleep patterns cxiii. Major or chronic health problems cxiv. Use of drugs and/or alcohol cxv. Noncompliance with prescribed medications 24. Analysis of Mental Status Exam b. Orientation to person, time, place, date, season, day of the week c. Interpretation of proverbs d. Math calculations e. Memorization, short-term recall f. Identification of common objects g. Ability to follow multistep commands h. Ability to write or copy a simple drawing 25. Anger is a normal human emotion (frustrated, hurt, afraid) i. When handled appropriately, a positive force for resolving conflicts, solving problems, making decisions for that anger to go away towards the person that made the individual angry at that time. j. Inappropriate behavior would have a negative force involving physical or emotional problems & interference with relationships. For instance, an accident occurs and the individual involved in the accident is angry that their car got hit and pulls out a gun on the victim and ends in fatality for the victim at fault of the accident. So that anger isn't well managed & that's when it becomes a problem 26. Phases of Anger table 11.1 k. Triggering phase: incident or situation that initiates the aggressive response cxvi. Restlessness, anxiety (antianxiety medications would be given if needed), rapid breathing, muscle tension, loud voice l. Escalation phase: loss of control cxvii. Pale/flushed face, yelling, swearing, agitated, demanding, clenched fists, threatening gestures, VERY hostile, loss the ability to solve problems or think clearly m. Crisis phase: Client will lose the ability to perceive event accurately (ANYTHING will tick them off), solve problems, express feelings appropriately or control behavior leading to physical aggression cxviii. Total loss of emotional & physical control, throwing objects, kicking, hitting, spitting, biting n. Recovery phase: regaining physical & emotional control cxix. Lowered voice, decreased muscle tension, physical relaxation o. Postcrisis phase: reconciling with others and level of function before aggressive incident. cxx. Remorse, crying, quiet 27. Actions as nurses to handle anger p. Remember that clients exhibiting these behaviors are threatening to other clients, staff or visitors. In psychiatric, engaging the hostile person in dialogue is most important to de-escalate the physical aggression q. Manage the environment r. 28. What is schizophrenia? Brain dysfunction that genetics or environmental factors are involved in causing misleading thoughts, emotions or behaviors. s. Genetics: For example, the client's grandmother had schizophrenia but their mother never had schizophrenia, yet carried a specific gene that cause the client to also have the same schizophrenia as their grandmother or a version of schizophrenia. t. Environmental: Drugs or trauma u. For example, the patient may have an altered sense of things that aren\'t there, such as hearing voices or having a change in their perspective. 29. Symptoms of schizophrenia v. Positive (Hard) Symptoms (apart of the patient) cxxi. **Delusions or a fixed false belief** cxxii. **Hallucinations:** false perception of seeing or feeling things that only the client can see cxxiii. **Flight of ideas:** flow of verbalization where the person jumps rapidly from one topic to another cxxiv. **Echopraxia:** imitation of the movements & gestures of another person whom the client is observing cxxv. **Preservation:** persistently remaining on one topic; repetition of a sentence, word, or phrase & resisting to change the topic w. Negative (Soft) Symptoms (what you, as the nurse, can take away with the patient) cxxvi. **Alogia:** Tendency to speak little substance of meaning cxxvii. **Anhedonia:** feeling no joy or pleasure from life, activities, or relationships cxxviii. **Apathy:** feeling indifferent towards people, activities, or events cxxix. **Blunted affect:** restricted range of emotional feeling, tone, or mood cxxx. **Inattention:** inability to concentrate or focus on a topic or activity, regardless of its importance cxxxi. **Catatonia:** condition in which you may not move or talk much or show unusual behaviors such as holding strange positions or mimicking others; client seems motionless (like in a trance) cxxxii. **Flat affect:** lack of facial expression towards emotions or mood cxxxiii. **Asociality:** social withdrawal 30. Course of schizophrenia x. Onset: Diagnosis of schizophrenia is made when the person begins to display actively positive symptoms of delusions, hallucinations, & disordered thinking (psychosis) y. Immediate Term: After the onset of psychotic symptoms, the client may never fully recover & its ongoing psychosis z. Long Term cxxxiv. **Goal**: Psychosis would hopefully diminish with age & client may regain some degree of social & occupational functioning. Disorder would become less disruptive to the client's life & easier to manage but rarely overcome because of the effects of the years of dysfunction. cxxxv. Unfortunately, with persistent negative symptoms, it can be difficult to function in the community & live independent lives. cxxxvi. Antipsychotic medications are extremely important for these clients so they can live better lives while managing their illness. 31. Nursing Process of Schizophrenia a. Assessment cxxxvii. History of schizophrenia: What age did it begin? cxxxviii. Suicide attempts? cxxxix. Support system? cxl. How are they feeling now? What is stressing them? cxli. Observe the appearance, body language, & speech 22. Hygiene: Are they dressed appropriately? Does the client appear with no concern over their hygiene? 23. **Catatonia:** condition in which you may not move or talk much or show unusual behaviors such as holding strange positions or mimicking others 24. Echopraxia 25. Does the client's speech not make any sense? 26. Hesitation lasting 30-45 seconds when answering questions 27. What is their thought process? How is their mood? How does the patient react to different situations? 32. Risks for Schizophrenic Patients b. Risk for suicide is **MAJOR** issue c. Risk for violence d. Personal identity disturbances e. Impaired verbal communication f. Self-care g. Risk of malnourishment h. Social isolation i. Lack of enjoyment j. Health needs aren't important k. Unable to follow treatment plan 33. Important notice for schizophrenic patients or any psychiatric patient: Providing a **SAFE ENVIRONMENT IS EXTREMELY IMPORTANT** for the client, healthcare team, & other clients 34. Treatment for Schizophrenia: Antipsychotic Medications l. Conventional or Typical (**dopamine antagonist**): Targets the positive signs & symptoms of schizophrenia but not the negative signs & symptoms cxlii. Example: Chlorpromazine (*Thorazine*) *&* Haloperidol (*Halol*) m. Atypical Antipsychotics (**dopamine & serotonin antagonist**): Reduce both positive & negative signs & symptoms of schizophrenia cxliii. Example: Clozapine (*Clozaril*), Risperidone (*Risperdal*) & Olanzapine (*Zyprexa*) n. Side effects cxliv. Extrapyramidal side effects (EPS) 28. Dystonic reactions: muscle spasms in the neck or eyes and is known to be painful for the client 29. Akathisia: restless movement; patient can't be still 30. Parkinsonism: muscle stiffness, shuffling gait cxlv. Weight gain cxlvi. Sedation cxlvii. Photosensitivity cxlviii. Anticholinergic symptoms: Dry mouth, orthostatic hypotension, blurred vision, constipation, urinary retention 35. Other forms of treatment for schizophrenia o. **Individual and group therapy:** The client is able to build connections & relationships with other people p. S**ocial skills training** q. **Cognitive adaptation training** r. **Cognitive enhancement therapy (CET):** Computer-based training that includes group sessions to help the client improve their processing of information & social skills s. **Family education and therapy** 36. **Mood & Affect** t. **Blunted affect:** showing little to a slow response facial expression u. **Broad affect:** displaying a full range of emotional expressions v. **Flat affect:** showing no facial expression or mood w. **Inappropriate affect:** displaying a facial expression that is incongruent with mood or situation; often silly of giddy x. **Restricted affect:** showing one type of expression usually serious 37. Denial, when they use, how, and how nurses address it? **Denial is a defense mechanism where individuals refuse to accept reality or facts, often used when facing stressful or painful situations (death in the family). It can be common in patients coping with illness, loss, or trauma. Nurses address denial by offering support, providing accurate information, encouraging open communication, and helping patients gradually face the situation without forcing them.** 38. Broad openings: "how are you feeling" y. Best way to get a shy patient to open but general for every patient 39. Tangential thinking: a person moves from one topic to another, often related but never directly answering the original question or returning to the main point. This thought process is disorganized, and the person\'s speech may appear scattered or off-topic 40. Laughing? As the nurse asking what is happening, always ask because when in a psych. Setting, 41. Time-out for anger: give individuals a chance to step away from a stressful or triggering situation before reacting impulsively. By temporarily removing themselves from the environment, they can calm down, reflect, and prevent escalation of aggression or violence. This technique helps in regaining self-control and reducing the intensity of emotional reactions. In a healthcare setting, nurses may use time-out strategies to help patients manage anger or agitation by encouraging them to take a break, practice relaxation techniques, or engage in therapeutic activities. It is important to introduce time-out in a non-punitive way to promote its effectiveness. 42. Flight of ideas through broadcasting?? Where the person\'s thoughts rapidly shift from one topic to another, making their speech fragmented and difficult to follow. When combined with \"broadcasting,\" it indicates that the patient may feel their thoughts are being transmitted to others or heard aloud, which is a symptom associated with psychotic disorders like schizophrenia. Nurses address these symptoms by providing a calm environment, using active listening techniques, ensuring the patient\'s safety, and collaborating with mental health professionals for appropriate interventions, such as medication and therapy. 43. Therapeutic goal: to establish relationships 44. Transference: patient to staff & Countertransference: staff to patient 45. Therapeutic communication techniques (CH 6 TABLE 6.1 CHART) z. Accepting a. Broad openings b. Consensual validation c. Encouraging comparison d. Encouraging description of perceptions e. Encouraging expression f. Exploring g. Focusing h. Formulating a plan of action i. General leads j. Giving recognition k. Making observations l. Offering self m. Placing event in time or sequence n. Reflecting o. Restating p. Seeking information q. Silence r. Summarizing s. Suggesting collaboration t. Translating into feelings u. Voicing doubt