Exam+1+Review+September+2024.txt

Ist Exam Review Ist Exam Review September 2024 Just a recap but continue to review Canvas and previous slides Mental illness and Continuum Mental illness refers to all psychiatric disorders that have definable diagnoses. These disorders are manifested in significant dysfunctions that may be related...

Ist Exam Review Ist Exam Review September 2024 Just a recap but continue to review Canvas and previous slides Mental illness and Continuum Mental illness refers to all psychiatric disorders that have definable diagnoses. These disorders are manifested in significant dysfunctions that may be related to developmental, biological, or psychological disturbances in mental functioning. Mental refers to the brain, the most complex part of the body, responsible for the higher thought processes; the workings of the brain—the synaptic connections, the areas of functioning, the spinal innervations and connections—are the physical manifestations. According to the SAMHSA (2012), recovery is “a process of change through which individuals improve their health and wellness, live a self- directed life, and strive to reach their full potential.” Advocates fought for parity,= equivalence or equal treatment. The Mental Health Parity Act was passed in 1996. This legislation required insurers that provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage. Protective factors such as resiliency improve a person’s ability to respond to stress, trauma, and loss. A diathesis-stress model—in which diathesis represents biological predisposition, and stress represents environmental stress or trauma—is the most accepted explanation for mental illness. According to SAMHSA (2020), nearly 52 million adults in the United States experienced a diagnosable mental illness in 2019. Major depressive disorder is the leading cause of disability worldwide, with more than 300 million people affected. Twelve-Month Prevalence of Psychiatric Disorders in the United States Disorder Prevalence 12 Month %|Comments Over 12 Months] Receiving (%) Treatment Schizophrenia |1.1 Major depressive disorder 67 45.8 517 Affects men and women equally Leading cause ofdisability in United States and established economies worldwide Nearly twice as many women (6.5%) as men (3.3%) suffer from major depressive disorder every year Psychiatric-mental health nursing is the nursing specialty that is dedicated to promoting mental health through the assessment, diagnosis, and treatment of behavioral problems, mental disorders, and comorbid conditions across the life span (American Nurses Association [ANA] et al., 2014). cultural competence means that nurses adjust their practices to meet their patients’ cultural beliefs, practices, needs, and preferences. The Psychiatric-Mental Health Nursing: Scope and Standards of Practice defines the specific activities of the psychiatric-mental health nurse. This publication—jointly written in 2014 by the American Nurses Association (ANA), the American Psychiatric Nurses Association (APNA), and the International Society of Psychiatric- Mental Health Nurses (ISPN)—defines the focus of psychiatric-mental health nursing as “promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders” (p. 14). Freud believed that mental disorders resulted from unresolved issues that originated in childhood. 3 levels of psychological awareness in operation: Id, Ego, Superego Psychosexual Stages of Development: Oral, Anal, Phallic, Latency, Genital Psychosexual Stages of Development Personality Development Theory by Sigmund Freud 1. Oral Stage 2. Anal Stage 3. Phallic Stage Birth toLyear —(ie-93years ayenrs byears sen ogee a) Genital Glace L- Latent he herby teAdulthood a @bepsychminded www.simplypsychology.org Defense mechanisms share two common features: (1) they all (except suppression) operate on an unconscious level, and (2) they deny, falsify, or distort reality to make it less threatening. They are automatic coping styles that protect people from anxiety and enable them to maintain their self-image by blocking feelings, conflicts, and memories. Projection: Attributing one’s unacceptable feelings or desires to someone else. For example, if a bully constantly ridicules a peer about insecurities, the bully might be projecting his own struggle with self-esteem onto the other person. Denial: Refusing to recognize or acknowledge real facts or experiences that would lead to anxiety. For instance, someone with substance use disorder might not be able to clearly see his problem. Repression: Blocking difficult thoughts from entering into consciousness, such as a trauma survivor shutting out a tragic experience. Regression: Reverting to the behavior or emotions of an earlier developmental stage. Rationalization: Justifying a mistake or problematic feeling with seemingly logical reasons or explanations. Displacement: Redirecting an emotional reaction from the rightful recipient to another person altogether. For example, if a manager screams at an employee, the employee doesn't scream back—but the employee may yell at her partner later that night. Projection: Attributing one’s unacceptable feelings or desires to someone else. For example, if a bully constantly ridicules a peer about insecurities, the bully might be projecting his own struggle with self- esteem onto the other person. Denial: Refusing to recognize or acknowledge real facts or experiences that would lead to anxiety. For instance, someone with substance use disorder might not be able to clearly see his problem. Repression: Blocking difficult thoughts from entering into consciousness, such as a trauma survivor shutting out a tragic experience. Regression: Reverting to the behavior or emotions of an earlier developmental stage. Rationalization: Justifying a mistake or problematic feeling with seemingly logical reasons or explanations. Displacement: Redirecting an emotional reaction from the rightful recipient to another person altogether. For example, if a manager screams at an employee, the employee doesn't scream back— but the employee may yell at her partner later that night. Reaction Formation: Behaving or expressing the opposite of one’s true feelings. For instance, a man who feels insecure about his masculinity might act overly aggressive. Sublimation: Channeling sexual or unacceptable urges into a productive outlet, such as work or a hobby. Erick Erikson Psychosocial Stages of Development Trust (or mistrust) that basic needs, such as Infancy (0-4 year Early 1-3years Play age 3-6 years School age 7-11 years Adolescence 12-18 years Early adi 19-29 years Middleage 30-64 years Oldage 65 onward vs. mistrust ‘Trust Autonomyvs.shame/doubt Initiative vs.gut Industryvs. inferiority Identity vs. confusion Intimacy vs. isolation Generativity vs. stagnation Integrity vs.despair nourishment andaffection, willbemet Developa sense of independence in many tasks ‘Take initiative on some activities—maydevelopguilt when unsuccessful orboundariesoverstepped Develop self-confidence in abies when competent or sense ofinferiority when Experiment with and develop identity and roles Establish intimacy and relationships with others Contribute to society and be part of a family Assess and make sense oflife and meaning of contributions Failure to complete a stage can result in a reduced ability to complete further stages and, therefore, a more unhealthy personality and sense ofself. These stages, however, canbe resolved successfully at a later time. Jean Piaget’s theory of cognitive development suggests that children move through four different stages of intellectual development which reflect the increasing sophistication of children’s thought Stage Sensorimotor Preoperational Concrete operational Formal operational Piaget's 4 Stages of Cognitive Development ve Birth to 18-24 months 2 to7 years old Ages 7 to 11 years Adolescence toadulthood omen Object permanence Symbolic thought Logical thought Scientific reasoning Peplau's Theory of Interpersonal Relationships Factors influencing orientation phase HILDEGARD PEPLAU Interpersonal Relations Theory Orientation Nurse and patient come together as strangers. meeting initiated bypatient who expresses a “feltneed”: work | together to recognize, clarifyand define tacts related toneed. Identification ‘ Exploitation Bereale ela) CM areas| Vices. f | \ Resolution ') Pationt works collaboratively in goal setting and has feeling of belonging and selectively responds to those who canmeet | his or her needs. Patient activelyseeks anddraws knowledge and expertise of those who can help. The patient's needs have been met by | Patient no longer needs the nurse and gives up their dependency. The patient's needs have been met by collaboration between the ) furse andthepatient "The patientwillmove away and break the bond patient-nurse with a healthy balance, and both willbecome mature individuals,having grown from the interaction. Nurse Roles: Stranger role, Resource role, Teaching role, Counseling role, Surrogate role, Active leadership, and Technical expert role. Interpersonal Relationship: Nurse Roles to Patients Stranger: offering the client the same acceptance and courtesy that the nurse would respond to any stranger Resource person: providing specific answers to questions within a larger context Teacher: helping the client to learn formally or informally Leader: offering direction to the client or group Surrogate: serving as a substitute for another such as a parent or a sibling Counselor: promoting experiences leading to health for the client such as expression of feelings Technical Expert: providing physical care for the patient and operates equipment Visualizing the Brain noninvasive imaging techniques are used to visualize brain structure, functions, and metabolic activity.. There are two types of neuroimaging techniques: structural and functional. Structural imaging techniques (e.g., computed tomography [CT] and magnetic resonance imaging [MRI]) provide overall images of the brain and layers of the brain. Functional imaging techniques (e.g., functional magnetic resonance imaging [fMRI], positron emission tomography [PET], single photon emission computed tomography [SPECT] reveal physiological activity in the brain. Twin studies demonstrate lower brain activity in the frontal lobe of a twin diagnosed with schizophrenia compared with the twin who does not have the diagnosis. The area affected in the frontal cortex of the twin with schizophrenia is an area associated with reasoning skills, which are greatly impaired in people with schizophrenia. Frontal lobe we Parietal lobe Occipital lobe Temporal lobe Schizophrenia At least one must be item 1, 2, or 3: 1. Delusions 80% of the risk of schizophrenia is genetic. 2. Hallucinations 3. Disorganized speech (e.g., frequent derailment or incoherence) 4. Grossly disorganized or catatonic behavior 5. Negative symptoms (i.e., diminished emotional expression or avolition) Continuous signs of the disturbance persist for at least 6 months. nicotine agents with safer delivery systems—such as patches, lozenges, and gums—may be useful adjuncts for treating. People with schizophrenia smoke at much higher rates than the general population: 70% versus 22%. Individuals with schizophrenia also smoke more cigarettes, inhale harder, and obtain more nicotine from each cigarette. Smoking is a significant risk factor for cancers, respiratory disorders, and cardiovascular disease, adding significantly to the already high mortality rates associated with schizophrenia Difference Hallucination and Delusion Hallucinations) are perceptual disturbances; they are sensory experiences that appear real but are created by your mind. They can affect all five of your senses: (i.e., auditory, visual, olfactory, gustatory, tactile) Delusion is a disorder of thinking- thought content; they are false beliefs that aren’t accounted for by cultural or religious background, i.e., persecutory delusions, they believe a person or group wants to hurt them. Delusion of grandeur is a false belief in one’s power or importance. Pharmacotherapy Psychotropic medications block the activity of dopamine-2 (D2) receptors in the brain and reduce symptoms such as hallucinations and delusions Overactive dopamine= too much dopamine Newer antipsychotics block serotonin (5- hydroxytryptamine 2A, or 5-HT2A) and dopamine, which suggests that serotonin may play a role in schizophrenia The first-generation antipsychotics work primarily by reducing positive symptoms (e.g., hallucinations and delusions) but have little effect on negative symptoms. Second-generation antipsychotics treat positive symptoms and can also help negative symptoms (e.g., asociality, blunted affect) First-generation antipsychotics are dopamine (D2) antagonists. Blockage of D2 receptors in motor areas causes extrapyramidal side effects (EPSs), including the following: 1. Acute dystonia—A sudden, sustained contraction of one or several muscle groups, usually of the head and neck. Acute dystonias can be frightening and uncomfortable, may involve muscles affecting the airway, can also cause significant anxiety, and should be treated promptly. 2. Akathisia—A motor restlessness that causes pacing and/or an inability to stay still or remain in one place. It can be severe and distressing to patients and can be mistaken for anxiety or agitation 3. Pseudoparkinsonism—A temporary group of symptoms that resemble Parkinson disease: tremor, reduced accessory movements (e.g., arms swinging when walking), gait impairment, reduced facial expressiveness (mask facies), and slowing of motor behavior (bradykinesia). Treat EPS: trihexyphenidyl (Artane) benztropine (Cogentin) and diphenhydramine (Benadryl), These medications are known to have anticholinergic effects Monitor and assure open airway. Reassure patient that although frightening, dystonias are not dangerous except tor rare airway complications. Steps toAdministeringan Intramuscular Injection Z-Track Method «== ‘We will be using a prepared syringe in this example. ‘Syringes for this procedure can be one to thee milliliter Administer antiparkinsonian agent as above (IM for taster response). Relief usually occurs in5-15 min. Also consider diphenhydramine (Benadryl) 25-50 meIM/TV. Stay with the patient to provide comfort and support. Consider prophylaxis with an oral antiparkinsonian agent. Assist patient to understand the event and avert mistrust ofmedications. Nursing Considerations Tardive dyskinesia is a persistent EPS involving involuntary rhythmic movements. It develops in about 25% of patients on antipsychotics. Tardive dyskinesia is more common with first- generation antipsychotics, usually after prolonged treatment, and usually persists even after the medication has been discontinued Tardive Dyskinesia Symptoms Tongue protrusion Lip smacking Mouth puckering Facial grimacing Excessive eye blinking ta Writhing movements Neuroleptic malignant syndrome (NMS), caused by excessive dopamine receptor blockade, occurs in about 0.2% to 1% of patients who have taken first-generation antipsychotics. It is characterized by reduced consciousness and responsiveness, increased muscle tone (generalized muscular rigidity), and autonomic dysfunction NMS is a life-threatening medical emergency that is fatal in about 6% of cases. Complications of this condition include rhabdomyolysis (protein in the blood from muscle breakdown), which can cause organ failure (30%), acute respiratory failure (16%), acute kidney injury (18%), sepsis (6%), and other systemic infection ABNORMAL INVOLUNTARY MOVEMENT SCALE (AIMS) Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute of Mental Health Name: Date: Prescribing Practitioner: Code: 0 = None Instructions: Complete Examination Procedure before making ratings. Movement ratings: Rate highest severity observed. Rate movements that occur upon activation one /ess than those observed spontaneously. Circle movement as well as code number that applies. Facial and Oral Movements 1. Muscles of facial expression (e.g., movements of forehead, eyebrows, periorbital area, cheeks, including frowning, blinking, smiling, grimacing) Lips and perioral area (e.g., puckering, pouting, smacking). Jaw (e.g., biting, clenching, chewing, mouth opening, lateral movement). Tongue: Rate only increases in movement both in and out of mouth — not inability to sustain movement. Darting in and out of mouth. Extremity Movements. Upper (arms, wrists, hands, fingers): Include choreic movements (i.e., rapid, objectively purposeless, irregular, spontaneous) and athetoid movements (i.e., slow, irregular, complex, serpentine). Do not include tremor (i.e., repetitive, regular, rhythmic). Lower (legs, knees, ankles, toes) (e.g., lateral knee movement, foot tapping, heel dropping, foot squirming, inversion and eversion of foot) Trunk Movements Global Judgments. Neck, shoulder, hips (e.g., rocking, twisting, squirming, pelvic gyrations) Severity of abnormal movements overall. Incapacitation due to abnormal movements 10. Patient's awareness of abnormal movements: Rate only patient's report. No awareness 0 Aware, no distress Aware, mild distress Aware, moderate distress Aware, severe distress 1 2 3 4 Dental Status 11. Current problems with teeth and/or dentures 12. Are dentures usually worn? 13. Edentia 14. Do movements disappear in sleep? No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes 01234 01234 01234 01234 01234 01234 Rater Date 01234 Rater Date 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 01234 © = N > a + o n ¢ Long-Acting Injectable Antipsychotics Generic (Trade) Usual Frequency |Nursing Considerations First-Generation Antipsychotics Haloperidol decanoate|Every 4 weeks (Haldol Decanoate) Fluphenazine decanoate (generic only) Every 2-3 weeks Viscous, deltoid or gluteal site Z-track method Viscous, deltoid or gluteal site Z-track method ¢ ® Second-Generation Antipsychotics Olanzapine pamoate (Zyprexa Relprevv) Every 2-4 weeks Must monitor patient for excess sedation for 3 h postinjection Gluteal site only Shake vigorously just before administering Paliperidone palmitate (Invega Sustenna) Every 4 weeks When initiating, the first two injections must be given deltoid on days 1 and 8. Deltoid or gluteal site afterward. Shake vigorously just before administering Severe neutropenia, most often associated with clozapine (Clozaril). Severe neutropenia is an acute condition involving a dangerously low white blood cell count (neutropenia), which increases the risk of a serious infection. Neutropenia is defined by an ANC (absolute neutrophil count) of less than 500/μL. Left untreated, this life-threatening condition leads to death, most commonly through bacterial infection of the blood or septicemia. Monitoring for neutropenia is done as part of the complete blood count through an ANC. Symptoms of severe neutropenia include signs of infection (e.g., fever, chills, and sore throat) or increased susceptibility to infection. Prolongation of the QT interval is a delay of ventricular repolarization. This condition may result in tachycardia, fainting, seizures, and even sudden death. The second-generation antipsychotic drug ziprasidone (Geodon) is predominantly known. Before being started on any antipsychotic agent, a patient should receive an electrocardiogram to detect preexisting QT prolongation, which magnifies the risk of medication-related prolongation. Psychological Therapies Advanced practice registered nurses may provide diagnostic evaluations, individual and group psychotherapy (e.g., cognitive behavioral therapy [CBT]), psychoeducation, medication prescription and monitoring, health assessment, and family therapy. Cognitive deficits can be addressed with cognitive remediation or enhancement therapy, which enhances recall, attentional, and other skills to reduce cognitive impairment, improving functioning and quality of life. Although these are advance practice roles, components of some, such as helping patients to identify and correct distortions in thinking, can also be implemented by any nurse. CBT treatment usually involves efforts to change thinking patterns. These strategies might include: Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality. Gaining a better understanding of the behavior and motivation of others. Using problem-solving skills to cope with difficult situations. Learning to develop a greater sense of confidence in one’s own abilities. CBT treatment also usually involves efforts to change behavioral patterns. These strategies might include: Facing one’s fears instead of avoiding them. Using role-playing to prepare for potentially problematic interactions with others.