Mental Health Review: Anger, PTSD, and Medication PDF

**[Patient Rights]** -Kids need court order/advocate -Can refuse unless incompetent or in emergency situations Psych crisis Immanent harm **[Care for pt w Restraints]** 1. Right to least restrictive environment -- de escalation 2. Least Restrictive -- document Q15min/eyeball/shortest time p...

**[Patient Rights]** -Kids need court order/advocate -Can refuse unless incompetent or in emergency situations Psych crisis Immanent harm **[Care for pt w Restraints]** 1. Right to least restrictive environment -- de escalation 2. Least Restrictive -- document Q15min/eyeball/shortest time possible 3. RN can put restraints in emergency/ must get order within 1hr/debrief ASAP 4. Must be least restrictive and d/c asap 5. Freq assessment q15-30 min = VS, Circulation/skin/mental status/toileting/hydration 6. Order for adults good for 4hrs/teens 2hrs/kids/1hr **[False imprisonment]** No means for using restraints **[Grief and Loss]** 1. Physiological = loss of a limb/hysterectomy/mastectomy 2. Safety Loss = not feeling safe in your environment 3. Loss of security/belonging = security in relationships=losing a loved one/divorce/illness 4. Loss of self-esteem = changes of your own values/self-perception = loss of a job/ lost relationship/ 5. Loss of self/actualization = something that threatens personal goals/fulfillment = external or internal 1. Perception= "Tell me how you feel about...." 2. Support = situational support/ asking patient 3. Coping = sympathizing with presented behavior **[Kubler Ross]** 1.Denial= disbelief/shock 2\. Anger = Expressed towards family/God/providers 3\. Bargaining= asks God/faith for more time 4\. Depression = 5\. Acceptance = coming to terms with death **[Dysfunctional grieving]** -prolonged/unresolved/impairs functioning - **Chronic Grief**: An extended period of intense sorrow that does not seem to lessen over time. - **Delayed Grief**: Grief that is postponed or suppressed, often surfacing later in a more intense form. - **Exaggerated Grief**: An overwhelming reaction to loss that may lead to severe emotional or physical symptoms, such as depression or anxiety. - **Masked Grief**: When individuals do not recognize their grief symptoms, which may manifest in other ways, such as physical illness or behavioral changes. - Encouraging open communication about feelings and providing a supportive environment can help individuals process their grief more healthily. **[Complicated grief]** Affects daily living = multiple deaths **[Disenfranchised Grieving]** -Not accepted by community. = fish died **[Outcomes for grieving client]** -know when to get them professional help -Help support/emotionally/social/coping strategies/functional improvement/exploring what the loss means to pt **[Ineffective Denial]** Not accepting the reality of the death/loss/illness or seeking help = can cause compromised relationship/anxiety/depression/physical illness **[Ch 11]** **[Anger]** -- normal human behavior; physical or emotional; varying from mild to severe; how you express and deal with it determines the problem **Interventions for anger relief** = catharsis= safe release of anger = punching bag, yelling; cognitive behavior therapy. **[Aggression]** = meant to harm/punish another person/force into compliance 1. Verbal 2. Physical **-Recovery** = regains physical and emotional control, lowering of voice, decr muscle tension, more rational communication **-Postcrisis** = reconciliation and return to baseline; remorse, apologies, crying, quiet, withdrawn behavior **[Meds for aggression]** 1. Carbamazepine = BPD, anticonvulsant, monitor CBC, blood dyscrasias (blood disorders) 2. or LITHIUM = -Bipolar/conduct disorder/intellectual disability = Lithium Range = 0.6-1.2 3. [Valproic Acid] = dementia, personality disorders, psychosis; increases GABA, decreases manic episodes, monitor LFT, risk for thrombocytopenia, 4. [Atypical Antipsychotics =] Risperidone, Olanzapine, clozapine = controls + and -- symptoms, serotonin and dopamine antagonist; SE= wt gain, diabetes, agranulocytosis 5. [Benzodiazepines] = lorazepam, diazepam, midazolam, chlordiazepoxide; anxiety, seizures, muscle spasm, enhances GABA, monitor for sedation/RR 6. [Haldol =] Typical antipsych; controls + symptoms (delusions/hallucinations); alters the action of dopamine; SE= EPS, NMS, agranulocytosis, sedation, a. \*\*Benztropene to tx EPS b. \*\*Dantrolene for NMS **[Ch 13 Trauma/PTSD]** **[PTSD]** = patterns of behavior due to traumatic events; -primary response= intense fear; helpless; terror, -Secondary response = re-living the trauma, dreams, intrusive thoughts, reoccurring thoughts, hyper-arousal, being on guard Chronic \>3 mos ; Acute = 3days-1month **[Tx =]** Give meds for anxiety/depression -SSRIs = Fluoxetine, Sertraline (zoloft), Paroxetine (Paxil), Citalopram (Celexa), Escitalopram (Lexapro), Fluvocamine (Luvox) = takes 4-6 weeks to work,monitor serotonin syndrome, do not stop abruptly, do not take with MAOIs, St Johns Wort, suicide risk -SNRIs = Venlaxine (Effexor), Duloxetine (Cymbalta) = takes 4-6 weeks, monitor serotonin syndrome, may incr BP, Avoid alcohol, suicide risk -Most effective = Fluoxetine, Paroxetine, Sertraline, Venlafaxine, ;