Exam+1+Review+September+2024.pptx

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 Mental refers to the brain, the psychiatric disorders that most complex part of the...

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 Mental refers to the brain, the psychiatric disorders that most complex part of the A diathesis-stress model—in have definable diagnoses. body, responsible for the which diathesis represents These disorders are higher thought processes; the biological predisposition, and manifested in significant workings of the brain—the stress represents dysfunctions that may be synaptic connections, the environmental stress or related to developmental, areas of functioning, the trauma—is the most accepted biological, or psychological spinal innervations and explanation for mental illness. disturbances in mental connections—are the physical functioning. manifestations. Advocates fought for parity,= equivalence or equal According to the SAMHSA treatment. The Mental Health (2012), recovery is “a process Parity Act was passed in 1996. of change through which This legislation required individuals improve their insurers that provide mental health and wellness, live a health coverage to offer self-directed life, and strive to annual and lifetime benefits reach their full potential.” 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. 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 Psychiatric-mental health nursing is the nursing specialty that is dedicated to promoting mental cultural competence means that nurses adjust their health through the assessment, practices to meet their patients’ diagnosis, and treatment of cultural beliefs, practices, behavioral problems, mental needs, and preferences. disorders, and comorbid conditions across the life span (American Nurses Association [ANA] et al., 2014). 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 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  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 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. Erick Erikson Psychosocial Stages of Development 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 Nurse Roles: Stranger role, Resource role, Teaching role, Counseling role, Surrogate role, Active leadership, and Technical expert role.  Stranger: offering the client the same acceptance and courtesy that the nurse would respond to any stranger Interpersonal Resource person: providing specific answers to questions within a larger Relationship: context Teacher: helping the client to learn Nurse Roles to formally or informally Leader: offering direction to the Patients 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. Schizophrenia 80% of the risk of schizophrenia is genetic. At least one must 1. Delusions be item 1, 2, or 3: 3. Disorganized speech (e.g., 2. Hallucinations frequent derailment or incoherence) 5. Negative symptoms (i.e., 4. Grossly diminished disorganized or emotional catatonic behavior expression or avolition) Continuous signs of the disturbance persist for at  People with nicotine agents with safer delivery systems—such as schizophrenia smoke at patches, lozenges, and gums—may be useful much higher rates than adjuncts for treating. 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  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 Overactive dopamine= too much Newer antipsychotics block serotonin (5- activity of dopamine-2 (D2) receptors dopamine hydroxytryptamine 2A, or 5-HT2A) and in the brain and reduce symptoms dopamine, which suggests that serotonin such as hallucinations and delusions may play a role in schizophrenia  The first-generation antipsychotics work Second-generation primarily by reducing antipsychotics treat positive symptoms (e.g., positive symptoms and hallucinations and can also help negative delusions) but have little symptoms (e.g., effect on negative asociality, blunted affect) symptoms.  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 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  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  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, CBTsuch as helping treatment patients usually to identify involves and efforts to correct distortions change in thinking, can also be implemented thinking by anystrategies patterns. These nurse. 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.