Nurs4274 Mental Health Theory Exam 1 Blueprint PDF

Nurs4274 Mental Health Theory Exam 1 Blueprint Module 1 Foundations in Psychiatric Mental Health Nursing Know the difference between risk vs protective factors of mental health. Risk factor increases the chance for developing mental illness; can be external (psychological e.g poor self-concept, dys...

Nurs4274 Mental Health Theory Exam 1 Blueprint Module 1 Foundations in Psychiatric Mental Health Nursing Know the difference between risk vs protective factors of mental health. Risk factor increases the chance for developing mental illness; can be external (psychological e.g poor self-concept, dysfunctional relationship, lack of support, social/cultural factors) or internal (physiological e.g genetics, medical comorbidities, intrapartum complications, traumatic brain injury) Protective factors and resilience (ability to bounce back & overcome stressful barriers) are linked. Protective factors reduce the risk for mental illness; can be internal (healthy lifestyle, high self-esteem, spirituality, motivation, childhood attachments to caregivers, coping skills) or external (safety, caregiver support, group/sport participation, medical care access) Be familiar with risk factors that impact mental health Internal: Physiological (neurotransmitter imbalance), genetics, intrapartum complications (mothers w hx of mental health prior to preganancy are 40% chance of having complications during pregnancy, 50% chance of non-live birth, double risk for low birth weight, social oppression, victimization, lack of support) Be familiar with Hildegard Peplau’s role as the mother of psychiatric nursing and the development of her theory of interpersonal relations. Theory and model of therapeutic nurse-client relationship that focus on the therapeutic use of self in promoting the well-being of individuals, families, groups, and communities. Her theory helped nurses become self-aware in their therapeutic relationships and helped clients build autonomy in problem solving. Her mission was to redefine the scope of pysch nursing as a collaborative part of the team and not just the doctor’s handmaiden Be aware of the variety of assessment tools a registered nurse might use in carrying out a patient assessment. - Mental status exam - Psychosocial assessment - Reviewing pt’s psych meds or other meds that could cause psych side effects - Screening for SI, trauma/violence, substance misuse - Spiritual assessment -> asses pt’s coping skills - Life span, developmental and cultural considerations - Reviewing labs Be familiar with the four types of stigma and be able to recognize examples of each type of stigma. Stigma is negative attitude that motivates general public to fear, reject, avoid and discriminate Affiliated or internalized stigma is related to the caretakers of people with mental illness Be familiar with examples of discrimination that a person with a mental health issue might experience. Implicit bias = prejudice beyond consciousness or control Explicit bias = attitude people are aware of Prejudice is biased thinking ; discrimination is ACTION against groups (can be based on race, ethnicity, age, religion, gender, disability) Module 2 Nurse-Client Relationship and Therapeutic Communication Be familiar with the foundation of client-centered care (hint: it is not therapeutic communication)** Acting professionally, asking questions, listening to answers and setting the tone provides a strong nurse client rapport (pg 171) Be able to define active listening and recognize strategies that demonstrate active listening. Nurse is seeking to capture the meaning, intention and content of the message by facing the pt, with eye contact, focusing on verbal and non verbal cues, and being nonjudgmental Be aware of the importance of self-awareness and its application to the nurse-client relationship. Johari Model of Self Awareness Arena = known to self and others Blind spot = known to others but not self Façade = known to self but NOT others Be able to name the elements that should undergird communication between the client and nurse (e.g., honesty, ethical and legal). Tell the patient that information shared during the assessment WILL be told to the treatment team, especially if SI or HI; there are no secrets Be able to recognize transference vs countertransference during a patient encounter. Transference is when the patient reacts emotionally toward the nurse when triggered by memories of past relationships (e.g nurse resembles someone from the patient’s life and makes the patient feel extra close to that nurse. Counterforce is when the NURSE has these triggers toward the client (e.g the pt reminds the nurse of a previous pt who was angry which can influence her attitude toward the current pt_ Know the difference between objective vs subjective patient data. Be able to recognize the importance of non-verbal communication and cultural sensitivity Be familiar with the importance of non-verbal communication in the nurse-client relationship. Be familiar with barriers to therapeutic communication Inattentive listening, using medical terminology, asking personal questions unrelated to the visit, expressing approval or disapproval, changing the subject, making remarks that are minimizing, providing false assurance, expecting justification, disagreeing with the client. Be familiar with therapeutic nurse-client relationship What is it based on? Mutual trust and respect Remember, that “in the relationship, there is a nurturing of health, hope, wellness, empathy, and therapeutic interventions to help the client through the current encounter.” Be familiar with the four phases of the nurse-client relationship. 1. Pre-orientation phase and its tasks a. Nurse reflects on the feelings on the client and their situation b. Analyzes their own personal/professional strengths/weakens in the context of the patient c. Collect info about the pt and prepare plan of care d. Can occur after bedside report or rounds -> strong element on collaboration with nurse, social worker, mentor, doctor etc 2. Orientation phase and its tasks a. Establish rapport with client, gaining their trust by creating an environment where they feel safe b. Initiate communication and collection of data about the reason why they are seeking treatment c. Identify problem areas and plan protentional interventions  d. Collaborate with the pt to establish goals: what to expect from the nurse and possible discharge or termination 3. Working phase and its tasks a. Therapeutic interventions, promotes healthy coping mechanisms, encourage pt to self-reflect b. Collaboration with the pt to identify stressors and provide insight on the problems. c. Identify and explore protentional solutions and how to implement them d. Data collection continues. e. Encourage the pt to function independently and redefine the problem as needed 4. Termination phase and its tasks a. This critical phase is discussed during the orientation phase b. Focus of the plan is to have pt fix their issues with independence and confidence c. Nurse-patient relationship comes to an end; explore the feelings both the nurse and patient may experience with this termination d. Evaluation of if treatment worked Be familiar with the importance of physical boundaries in a therapeutic relationship. “Proxemic” refers to how much physical distance pt like to have when conversing Be able to discuss the importance of emotional boundaries in the therapeutic relationship. Maintain respect for patient is crucial to being compassionate without getting caught in judging the patient. For example if the pt is depressed they may not answer all questions in one sitting. Be able to discuss the difference of a therapeutic relationship vs a social relationship. Do not share intimate details about their life, do not take work or lunch breaks!! You can make small talk to ease pt into the interview Be able to recognize the importance of client’s beliefs and the stigma engendered by mental illness. What factors influence human perceptions? Culture, spirituality, language Be able to compare a physical head-to-toe nursing assessment to a psychiatric-mental health (PMH) physical nursing assessment Physical: vitals, wt/ht, imaging, neuro assessment Identify characteristics of a psychosocial assessment. Psychosocial: evaluation of pt’s mental health in relation to their social wellbeing - Home environment - Education/employment - Hobbies - Drug/tobacco/alcohol use - Sexuality/gender - Suicide risk - Violence risk Be familiar with tools available for the psychosocial assessment. Mini-Mental Status Exam, Mental Status Exam, Brief Psychiatric Rating Scale (BPRS) etc Module 3 Therapeutic Setting The role of the nurse in milieu management Primary goal is discharge planning ______________________________________ Define least restrictive and recognize examples. Goal is to choose the least restrictive environment with the most effective treatment that places the fewest restrictions in the life Be familiar with the primary goal of inpatient hospitalization. Pt with acute psychiatric symptoms who cannot be managed in an outpatient or home. Can be voluntary OR involuntary. Can be for-profit or non-profit or state owned. Insurance complies limit the # of days approved. Discharge can be frustrating for those who voluntarily sign in Define the goal, purpose of partial hospitalization program “step down” for pt who need high level of care Advantage: client can go home at the end of the day Disadvantage: may not be able to return work full time, dysfunctional home environment can negatively impact An AA meeting is an example of what type of group? Peer support group What is a certified peer specialist? A person who is usually nonclinical who uses their own experience with mental illness and recovery to help others develop goals How would the nurse promote group cohesiveness? Cohesiveness = sense of belonging within group members Nurse cann read a list of expectations prior to the start with the necessity to treat all with respect and possibility of being asked to leave if not followed ; this helps group members feel supported. The nurse also makes sure that everyone who wants to speak gets time to. Be familiar with Prochaska’s Stages of Change tasks Illustrates the cyclical pattern of substance us treatment, recovery and relapse that can become barrier, can be discouraging. The use of telehealth mental health services in managing mental health disorders. Be aware of potential barriers affecting patient use (e.g lack of internet access or lack of support for learning new technologies) along with state and federal policies across state lines. Advantages: safe/familiar environment, connection to serves that would have been unavailable, more cost effective, can eliminate stigma associated w/ psych services Disadvantages: lack of internet access, chaotic home environment, pt who are actively psychotic, suicidal or cognitively impaired are NOT appropriate candidates for telehealth Module 4 Psychobiology and Psychopharmacology Serious Drug Reactions (signs & symptoms, management, associated medications): Neuroleptic malignant syndrome - Rare, progression is RAPID over 24-72 hours -> can lead to coma/death - S/S: severe muscle rigidity, unstable VS with high fever, diaphoresis, AMS/delirium - Treatment: ICU admission, stop offending agent, bromocriptine (dopamine agonist), IV fluids, cooling blankets, benzodiazepines (lorazepam), muscle relaxants Serotonin syndrome - Caused by excessive serotonin - s/s: unstable/elevated VS, AMS, restlessness, agitation, insomnia, myoclonus, hyperreflexia, seizure, coma death - treatment: ICU admit, stop offending med, cyproheptadine (serotonin antagonist & antihistamine), IV fluid, cooling blankets, muscle relaxants (same mmgt as NMS) - anti-depressants and tramadol can cause SS - caused by MAOIs Hypertensive crisis - s/s: severe occipital headache, palpitations, SOB, chest pain, n/v, nuchal ridgitiy, anxiety, confusion, unstable VS, seizure, coma, death - treatment: ICU admit, stop offending med, same mmg as NMS, SS (except no cooling blanket) - caused by MAOIs Lithium toxicity - NARROW THERAPEUTIC INDEX: 0.6 – 1.2 mEq/L -> draw through after 12 hours of administering drug - Monitor KIDNEY and THYROID function; AVOID pregnancy - Serious drug reactions with NSAIDs (take Tylenol instead), ACE inhibitors, and diuretics (dehydration can increase r/f toxicity so maintain hydration) - s/s o mild to mod: N/V/D, tremors, fatigue, drowsiness, weakness o severe: agitation, hyperthermia, tachycardia, hypotension, confusion, slurred speech, renal failure, coma death Stevens-Johnson Syndrome - immune T cell mediated inflammatory reaction - Lamotrigine (mood stabilizer/anticonvulsant) has HIGH risk EPS (esp. tardive dyskinesia) - Highest risk with first gen typical antipsychotics - Akathisia: subjective complaints of movement, rocking, pacing, feeling restless - Dystonia: involuntary contractions of muscles, painful, starts in face, develops within hours - Tardive dyskinesia: involuntary facial movements, sucking, chewing, tongue protruding, lip smacking, blinking, can effect extremities as well. Develops within months – years. Can be permanent. - Pseudo-Parkinson’s: shuffling gait, stiff facial muscles, tremors, bradykinesia, akinesia  Agranulocytosis - Clozapine - Main concern: absolute neutrophil count (ANC) Mechanism of action SSRI’s vs SNRIs vs MAOIs vs TCAs SSRI: block reuptake of serotonin SNRI: block reuptake of serotonin and norepinephrine TCA: block reuptake of serotonin and norepinephrine; STRONG anticholinergic effects MOAIs: inhibit MAO enzyme from oxidizing NTs; can cause serotonin syndrome and hypertensive crisis with food/drug innteractions Antipsychotics (1 st vs 2 nd vs 3 rd generations) Typical - 1st gen: antagonize (block) dopamine receptirs Atypical - 2nd gen: antagonize dopamine receptors and affect various serotonin receptors - 3rd gen: partial dopamine receptor agonist and affect various serotonin receptors Important patient education topics Lithium (hydration, blood work monitoring, lithium toxicity Mood stabilizers (blood work monitoring, potential serious reactions) - Lithium (see lithium toxicity above) - Valproic Acid: monitor liver function, PLT, HcG (DO NOT GET PREGNANT) - Common SE: sedation, dizziness, tremor, GI, weight gain - ADR: SJS (especially with lamotrigine) Antidepressants (Indications, MAOI’s & interactions, potential serious reactions) - Indications: depression, anxiety disorders (OCD, panic, social), PTSD, premenstrual dysphoric disorder, pain disorder (e.g fibromyalgia), insomnia - SE: insomnia or sleepiness, GI upset, HA, weight changes, sexual dysfunction - SE more common in TCAs and MAOI - ADR: RISK FOR INCREASED SI in children-young adults, manic or hypomanic activcationn in bipolar, discontinuation syndrome (with abrupt cessation of med) Benzodiazepines & hypnotics (indications, short- & long-term risks) - Indication: sleep aids - SE: sedation, dizziness, headache, impaired coordination - Serious SE: complex sleep behaviors, amnesia, tolerance, dependence, injury/fall Antipsychotics (monitoring parameters, potential side effects, EPS, metabolic symptoms) - Metabolic SE: weight gain, hyperglycemia, insulin resistance, HTN - EPS - Anticholinergic: sedation, dry mouth, constipation, blurred vision, urinary retention ADHD treatment options (stimulants- monitoring parameters, risks, contraindications, potential side effects - Stimulants: o Potent dopamine & norepinephrine reuptake antagonist o HIGH risk for abuse, tolerance and dependency o SE: insomnia, low appetite, weight loss, HA, anxiety, dry mouth o Monitor BP, HR and growth (can cause suppression in minors) - Non-stimulants: Hydroxyzine (mechanism of action, indication, potential side effects) - Block histamine and acetylcholine  - Take 2-3 times a day PRN - Common SE: sedation, dizziness, anticholinergic SEs - Long term may cause cognitive impairment or pseudodementia - Indication: anti-anxiety Nursing implications related to alternative treatments (see section 4.3 in textbook for important information) TMS Approved for major depressive disorder. Indication: failure of at least one antidepressant and approval by insurance. Prior to treatment assess for risk factors related to seizure, TBI, intracranial masses, neurological disease, metal in the head, withdraw, or meds that lower seizure threshold (bupropion, theophylline and stimulations). Deep TMS indicated for major depression and ocD ECT Use of electrical currents under anesthesia to produce seizure to for tx of resistant depression. Contraindications include CAD, asthma/COPD, poorly controlled HTN, pacemaker, pregnancy. Esketamine ; ketamine Use for treatment resistant depression. Causes increase in brain-derived growth factor. SE: HTN, n/v, anxiety, depersonalization, hallucinations, vertigo, sedation. Contraindications: hypertension, substance disoder, CNSS depression, hepatic impairment) Assess vitals before and after What foods are contra-indicated in treatment with MAOIs? Foods high in tyramine: aged cheese, cured meats, pickled/fermented foods, soybeans, tofu, beer, dried fruit, miso A major side effect for clozapine (Clozaril) agranulocytosis, metabolic syndrome Recognize medications that require periodic blood-level monitoring (hint Bipolar I) Lithium, valproic acid Medication teaching for a patient prescribed Lithium at risk for gaining weight. Why combining medications like SSRIs and MAOIs is contraindicated. Increases r/f serotonin syndrome SSRIs inhibit serotonin reuptake, leading to increased serotonin levels in the synaptic cleft. MAOIs inhibit monoamine oxidase, the enzyme responsible for breaking down serotonin, norepinephrine, and dopamine. This further increases serotonin levels.