Mental Health PDF

Mental Health Pt SAFETY is #1 PRIORITY Delirium Acute confusion or disorientation NI: Reassure pt, stay calm, provide safe environment Dementia Chronic Redirect and orient pt to reality, show familiar objects, set daily schedule Alzheimer’s Disease 5 A’s Amnesia (loss of memories)...

Mental Health Pt SAFETY is #1 PRIORITY Delirium Acute confusion or disorientation NI: Reassure pt, stay calm, provide safe environment Dementia Chronic Redirect and orient pt to reality, show familiar objects, set daily schedule Alzheimer’s Disease 5 A’s Amnesia (loss of memories) Aphasia (impacts ability to communicate) Apraxia (difficulty with skilled movement) Anomia (unable to recall known words) Agnosia (unable to identify objects, sounds, people) Magical Thinking Pt believes their thoughts can control other people and events Schizophrenia Impaired ability to perceive reality S/sx: hallucinations, delusions, disorganized speech and behavior, catatonia, negative symptoms NI: establish trust, provide safe environment, assist with ADL’s and hygiene, sit with mute pt’s, be nonjudgmental, use clear and simple sentences, avoid arguing with pt, praise socially acceptable behaviors Treatment: antipsychotics, individual and family therapy, social skills training Positive Symptoms: Hallucinations Delusions Negative Symptoms: Flat affect Anhedonia (lack of pleasure) Poverty of speech Movement disorders Obsessive-Compulsive Disorders NI: actively listen to pt, acknowledge how the pt feels, provide empathy, avoid judgement Treatment: Antianxiety, SSRI’s, tricyclic antidepressants Post Traumatic Stress Disorder (PTSD) Triggered by traumatic event that can cause anxiety, flashbacks, and nightmares NI: actively listen to pt, assess suicide risk, help pt see the event objectively and identify areas of no control Treatment: antianxiety and antipsychotic meds Personality Disorders Pt displays inappropriate emotional responses to stress, which is shown through anxious and fearful behaviors Includes: antisocial, narcissistic, borderline, schizotypal, avoidant, obsessive-compulsive NI: establish trust, protect pt from injury to self and others, help pt realize manipulative behaviors and set limits, focus on pt’s strengths, encourage socialization Munchausen Syndrome A person who pretends to be ill or inflicts self harm or illness in order to receive medical care or hospitalization  Mental Health Munchausen by Proxy A person (usually a mother) intentionally causes or makes up an illness in another person (usually a child) Tardive Dyskinesia Irreversible, involuntary movements of the tongue, face and extremities Due to prolonged use of antipsychotic meds Depression Always assess pt, especially if they have a sudden increase in energy or mood (might be planning suicide) Symptoms can be manifested in somatic ways (pain, sleep issues, changes in appetite, low energy) NI: Directly ask pt how they feel and if they are suicidal, implement suicide precautions, monitor sleep and nutrition, encourage participation in activities, promote independence, sit quietly with pt if they do not want to talk, spend time with pt and keep your word (if you tell pt you will be back at 5pm, see them at 5pm) Suspect immediate suicide attempt if a depressed pt suddenly feels better → happy affect may imply pt is relieved to have a suicide plan and plans to follow through Signs pt is improving: pt takes interest in appearance, performs self-care activities, Bipolar Disorder Bipolar I - mania with depressive episodes Bipolar II - milder episodes of hypomania that alternate with episodes of severe depression Manic s/sx: increased energy, impulsiveness, talkative, reduced need for sleep, excessive spending, delusions of grandeur or persecution NI: Ensure pt has adequate nutrition and rest, provide safe environment, decrease environmental stimulation, do not give attention to bizarre behavior, provide small frequent snacks/food (finger eating food) Treatment: Lithium, antipsychotics, sedatives, family therapy Phobic Disorders Intense periods of fear and discomfort that can be incapacitating NI: Acknowledge fear, use systematic desensitization (exposure therapy) only AFTER trust is established Anorexia Nervosa 2 Types: restrictive and binge/purging S/sx: weight loss (at least 15% of original body weight), distorted body image, excessive exercise, low self esteem, decreased BP and irregular HR, hair loss, dry skin, dehydration, no menstruation Absence of menstruation can lead to osteoporosis NI: monitor weight, vital signs, and electrolyte levels, provide supportive environment and structured mealtimes, set eating time limits, close assessment to food and fluid intake, watch for discarding of food, use positive reinforcement to build self esteem Treatment: Antidepressants, family therapy Bulimia Nervosa S/sx: dental damage (d/t vomiting), sore throat, concerned with body shape (bulimics are not typically underweight), diarrhea, constipation, bloating NI: monitor weight, vital signs, and electrolyte levels, provide supportive environment and structured mealtimes, monitor for induced vomiting after meals, discuss strategies to stop laxative use and vomiting, provide positive reinforcement for increase self esteem Treatment: Antidepressants, family therapy Alcoholism 5 D’s Denial, destructive, demanding, domineering, dependency  Mental Health Extrapyramidal Side Effects Rigidity, shuffling gait, tremors Administer an anticholinergic (ex: benztropine mesylate) to reverse side effects Neuroleptic Malignant Syndrome (NMS) EMERGENCY caused by a reaction to antipsychotic meds NMS is like S&M: fever, diaphoresis, muscle rigidity, hypertension, tachycardia, tachypnea, drooling Additional Notes: Do not argue with a pt about delusions. State things as a matter of fact and divert delusion to reality Do not tell pt you also hear voices Be supportive and nonjudgmental to all patients Adolescents are at an increased risk for suicide