Mental Wellness Final Exam PDF

NURS 3232 Exam 4 Final Reading Material Mental Health and Mental Wellness 4 1. Discuss the role of nurse in Mental health Co...

NURS 3232 Exam 4 Final Reading Material Mental Health and Mental Wellness 4 1. Discuss the role of nurse in Mental health Coordination of care - coordinates implementation of the nursing care plan and documents coordination of care. Health teaching and health maintenance - Individualized anticipatory guidance to prevent or reduce mental illness or enhance mental health (examples community screenings, parenting classes, stress management) Milieu therapy - Provides, structures, and maintains a safe and therapeutic environment in collaboration with patients, families, and other healthcare clinicians. Pharmacological, biological, and integrative therapies - Applies current knowledge to assessing patient’s response to medication, provides medication teaching and communicates observations to other members of the healthcare team. 2 2. Define mental health and mental illness Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Healthy Mental Health - Think rationally - Communicate appropriately - Listen - Grow Emotionally - Be resilient - Have a healthy self esteem - Realistic goals and reasonable function within the individual Mental illness refers to all psychiatric disorders that have definable diagnoses. Risk Factors for Mental Illness Altered thinking: alzheimer’s Altered emotions: major depression Altered behavior: Schizophrenia  Combination of any above Genetics: plays a huge role, and is present in almost every psych disorder Biological: oxygen deprivation at birth, prenatal alcohol exposure Social: support system, environment Economic: socioeconomic, can they afford healthcare? Cultural beliefs: attitudes Nature vs. Nurture 3 3. Identify Risk factors for mental health Individual attributes and behaviors refers to characteristics that are both inborn and learned that make us who we are. The ability to respond to social cues and participate in social activities influences our view of ourselves and how others view us. Biological and genetic factors also influence mental health, two examples being, prenatal exposure to alcohol and O2 deprivation at birth. A person with resilience is someone who has the ability and capacity for people to secure the resources they need to support their well-being. Social and economic circumstances are immediate social surroundings that impact personal attributes with the family having tremendous effects. They set the stage in promoting confidence and coping skills or for instilling anxiety and feelings of inadequacy. This extends to schools and peer groups. Socioeconomic status dictates the sort of resources available to support mental health and reduce concerns over basic needs such as food, clothing, and shelter. Environmental refers to the overall environment that affects mental health relating to the political climate and cultural considerations. Access and lack of access to basic needs and commodities such as healthcare, water, safety services, and strong highway systems have a profound effect on community mental health. Predominant cultural beliefs, attitudes, and practices influence mental health. There is no standard measure for mental health, partly because it is culturally defined. One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. For example in 1913 hysteria that only thought to affect women. Therapeutic Relationships 1. Analyze the importance of establishing boundaries in nurse-patient relationships. Including the legal and ethical 2 violations in professional boundaries. Boundaries: are the expected and accepted legal, ethical, and professional standards that separates nurses from patients. This provides a safe space for patients to explore feelings and treatment options. The safe space may be threatened by under - involvement and over involvement on the part of the nurse. Under Involved Nurses: least disinterested, neglectful, patient abandonment Over Involved Nurses: boundary crossing, boundary violations, and professional sex misconduct, blurring of roles Blurring of Roles: is often a result of unrecognized transference or countertransference Boundaries> always at risk of becoming blurred When relationship slips into social context When the nurses needs are met at expense of patients needs Nurse may be seeking attention-affection-emotional support in his/her own life 2. Identify the influence of transference and countertransference. 2 Transference: occurs when a patient unconsciously and inappropriately displaces on the nurse feelings and behaviors related to significant figures in the patient's past. Patient, “You remind me of my (mother, sister, father, brother, ect.) Countertransference: is transference in reverse. It occurs when the nurse unconsciously displays feelings related to the nurse's past onto the patient. Patients transference to nurse often results in countertransference in nurses is overidentification with the patient Therapeutic Communication 7 1. Evaluate therapeutic communication techniques to enhance communication. Silence - gives the person time to collect thoughts or think through a point. Indicates that the person has been understood. (Example: encouraging a person to talk by waiting for the answers) Active Listening - Nurses focus, respond, and remember what the patient is saying verbally and nonverbally Clarifying Techniques - Paraphrasing: restating the basic content of a patient’s message in different, usually fewer, words (“You seem to be saying…”) - Restating: an active listening strategy that involves repeating the same key words the patient has just spoken.  - Reflecting: may take the form of a question or a simple statement that conveys the nurse’s observations of the patient when discussing sensitive issues. (“You sound as if you have had many disappointments.”) - Exploring (explain to me what is going on with__ ?) Questions - Open ended: encourages patients to share information about experiences, perceptions, or responses to a situation - Closed ended: yes or no questions when used sparingly can give you specific and needed information. These are most useful during an initial assessment or intake interview or to determine specific results - Projective: Usually start with a “what if” to help people articulate, explore, and identify thoughts and feelings The miracle question: a goal setting question that helps patients to see what the future would look like if a particular problem were to vanish. 2. Evaluate non-therapeutic communication techniques that are barriers to communication. 3 Excessive questioning - asking multiple questions (particularly closed-ended) consecutively or rapidly - casts the RN in the role of interrogator who demands information without respect for the patient's willingness to readiness to respond. (“Why did you leave your wife? Did you feel angry with her? What did she do to you? Are you going back to her?”) ○ More therapeutic approach (“Tell me about the situation between you and your wife.”) Giving approval or disapproval - can lead to a patient attempting to win the approval of a RN instead of being motivated by conviction of change in behavior. (“I am proud of the way you controlled your temper at lunch.” “You really should not cheat on exams even if you think everyone else if doing it.”) ○ More therapeutic approach (“Can you give me two examples of how cheating could negatively affect your goal of graduating?”)  Giving Advice - Doing this as a RN can interfere with the patient’s ability to make personal decisions. Can lead to the pt eventually thinking the RN does not view him or her as capable of making effective decisions. ○ More therapeutic approach (“Have you ever thought of telling your friend about the incident?”) Asking why questions - demands an explanation and implies wrongdoing and can serve to make the pt more defense. ○ More therapeutic approach (Asking who, what, where, and when questions instead.) 3. Differentiate between the types of therapeutic communication 2 8 Eating and Feeding Disorders 1. Compare and contrast the signs and symptoms (Assessment Findings) of eating and feeding disorders (Anorexia, 4 Bulimia, Binging, PICA, Avoidant, Rumination). Pica - ingestion of substances that have no nutritional value (dirt, paint) Eating nonfood items well past toddlerhood Not part of other illness Rumination - food being returned to the mouth Regurgitation with rechewing, re-swallowing, or spitting No medical or mental reason Avoidant/restrictive food intake -mealtime difficulties Starts in childhood. Note: 40% of “picky”eaters resolve on their own Low BMI No distorted body image. Anorexia Nervosa: Monitor vital signs And laboratory results (electrolytes, CBC, etc.) to detect any life-threatening abnormalities. Gradual refeeding: Start with small, frequent meals and slowly increase calorie intake to avoid refeeding syndrome. Provide emotional support: Encourage the patient to express feelings and frustrations in a safe, non-judgmental environment. Promote body acceptance: Focus on health rather than appearance, emphasizing well-being and recovery overweight. Collaborate with a dietitian to create a balanced meal plan that meets nutritional needs. Bulimia Nervosa: Monitor for physical complications of purging (electrolyte imbalance, dehydration, dental issues). Encourage non-purging methods of coping With emotions, such as journaling, breathing exercises, or meditation. Provide cognitive-behavioral therapy (CBT) to help the patient identify triggers for binging and purging and to work on changing negative thought patterns. Normalize eating patterns by helping the patient establish regular meals with no purging afterward. Refer to a psychiatrist or psychologist for deeper emotional issues and comorbid disorders like anxiety or depression Binge Eating Disorder: Monitor weight and encourage healthy eating habits to prevent further weight gain. Promote regular eating patterns with a focus on balanced meals and mindful eating practices to help reduce binge episodes. Provide emotional support to address the feelings of guilt and shame associated with binge eating. Introduce stress-management techniques and coping strategies to handle emotional triggers without resorting to food. Collaborate with a dietitian to create a healthy eating plan and work on portion control. 2. Identify pharmacological interventions/teaching for eating disorders (SSRI) Anorexia Nervosa · Suicidal ideation first · Psychosocial interventions · Pharmacotherapy/medical intervention · Psychotherapy · Nutrition · Health teaching and health promotion · Safety and teamwork Biological Treatments - Pharmacotherapy Integrative Medicine - Yoga, massage, acupuncture, bright light therapy Psychological Therapies - Insight-oriented individual therapy Adolescent-focused therapy (AFT) - self-monitoring of eating and weight gain supported by therapeutic relationship with nurse Family therapy (F-BT) - parents disrupt childs starvation and excessive exercise Cognitive-behavioral therapy (CBT) - challenge negative thoughts Bulimia Nervosa · Inpatient care · Interrupt destructive cycles · Normalize eating habits · Therapy for underlying causes · Treatment of comorbidities · Counseling · Health teaching and health promotion · Teamwork and safety · Advanced practice interventions · Psychotherapy  Binge eating: judgmental language: binge eating is not about food, but about coping with emotion · Help patient track what events triggered an episode · Help patient explore community activities or groups · Use incremental approach in goal setting · Health teaching and health promotion Selective Serotonin Reuptake Inhibitors (SSRIs) Lisdexamfetamine (Vyvanse) · FDA-Approved for BED: Lisdexamfetamine, a stimulant medication, is the first FDA-approved medication specifically for the treatment of binge eating disorder. Ch. 23 & 31 Neurocognitive and Older Adults 1. Explore mental health issues and healthcare concerns related to aging. 3 Depression: not a normal part of aging Aging and suicide risk- white males older than age 75 at highest risk Anxiety disorder Delirium- is an acute cognitive disturbance and often reversible condition that is common in hospitalization patients, especially older patients. It is characterized as a syndrome. Symptoms of delirium are inability to direct focus, anxiety, agitations, poor memory, and delusional thinking. Secondary to general medical condition Neurocognitive disorders Alcohol use disorder Pain 2. Discuss the nurse’s role in caring for older adults. 3  3. Describe mental disorders that may occur in older adults. 3 Older adults can experience a wide range of mental health issues, from cognitive disorders like Alzheimer’s and dementia to mood, anxiety, and psychotic disorders. The complexity of aging means that many of these mental health conditions may overlap with physical health problems, and symptoms may be mistaken for normal aging processes. Early diagnosis and appropriate treatment are essential in managing these conditions, improving quality of life, and supporting the mental and emotional well-being of older adults. 5 Anxiety  1. Identify common assessment findings associated with anxiety disorders 3 Mild Anxiety: occurs in the normal experience of everyday living and allows an individual to perceive reality in sharp focus. A person experiencing a mild level of anxiety sees, hears, and grasps more information, and problem solving becomes effective. - S/S slight discomfort, restlessness, irritability, or mild tension-relieving behaviors (nail biting, foot or finger tapping, fidgeting) Moderate: sees, hears, and grasps less information and may demonstrate selective inattention, where only certain things in the environment are seen or heard unless they are pointed out. The ability to think clearly is hampered, but learning and problem solving can still take place, though not at an optimal level. - S/S tension, a pounding heart, increased pulse and respiratory rates, perspiration, mild somatic symptoms (gastric discomfort, headache, urinary urgency), voice tremors and shaking may be noticed. Severe Anxiety: may focus on one detail or on many scattered details and have difficulty noticing what is going on in the environment, even when another person points it out. Learning and problem solving are not possible on this level, and the person may be dazed and confused. Behavior is automatic and aimed at reducing or relieving anxiety. - S/S somatic symptoms (headache, nausea, dizziness, insomnia), trembling, pounding HR, hyperventilation, and impending doom or dread. Panic: is the most extreme level of anxiety and results in a markedly dysregulated behavior. Someone in a state of panic is unable to process what is going on in the environment and may lose touch with reality. - S/S Pacing, running, shouting, screaming, withdrawals **Individuals with anxiety disorder use rigid, repetitive, and ineffective behaviors to try to control their anxiety - A common example is someone taking to the emergency room to rule out a heart attack when they are actually having a panic attack Assessment · Sound physical and neurological exam · Determine source of anxiety (primary vs. secondary) · Determine current level of anxiety · Assess for potential self-harm · Complete psychosocial assessment · Ask patient about cause they can identify  2. Identify pharmacological interventions in anxiety. 1 Antidepressants Selective Serotonin Inhibitors (SSRIs) are considered the first line of defense in most anxiety related disorders. Antianxiety These are often used to treat the somatic and psychological symptoms of anxiety disorders. When moderate or severe anxiety is reduced, patients are better able to participate in the treatment of their underlying problem. Benzodiazepine are most commonly used because they have a quick onset of action (motor for sedation, ataxia, and decreased cognitive functions) Busprione is an alternative antianxiety medication that does not cause dependency. This takes 2-4 weeks for it to reach its full effect. (side effects include dizziness, nausea, headache, nervousness, lightheadedness,and excitement. Other Medication Classes no Antihistamines: such as Hydroxyzine (Vistaril) Anticonvulsants: such as Gabapentin (Neurontin) or Pregabalin (Lyrica) Antipsychotics Integrative Medicine Complementary practices or integrative therapies that people use to cope with stress in their lives. Herbal Therapy Dietary Supplements Yoga  3. Describe how anxiety result in physical stress 1 Anxiety often triggers the "fight-or-flight" response, a physiological reaction that is meant to prepare the body to deal with perceived threats. When anxiety is chronic or persistent, this response can become overactive, leading to: - Increased heart rate (tachycardia) - Muscle tension (especially in the neck,shoulders, and back) - Digestive issues (e.g., nausea, stomach, cramps, diarrhea, or constipation) - Breathing problems (shallow or rapid breathing) - Sweating or feeling hot - Headaches or migraines - Fatigue, as the body stays in a heightened state of alertness for long periods - Sleep disturbances,due to racing thoughts or an inability to relax - Weakened immune system due to prolonged stress, making the body more susceptible to illness Unit 6: Crisis and Disaster/Standard of care Nursing Process/QPR Ch. 7, Ch. 26. 1. Discuss standard of practice for psychiatric mental health nursing. Ex. Standard of care in Language Barriers. 1 Standard Practice Collect and synthesize pertinent patient data (HIPAA Guidelines) Age considerations: children, adolescents, older adults Language barriers: Interpreter or translator 2. Plan nursing care for psychiatric mental health patients 1 Prescribe strategies to assist patient in attaining expected outcomes Principles to consider when planning care - Safe - Compatible and appropriate - Realistic and individualized - Evidence-based 1. Discuss standards of practice (assessment, intervention, planning, and evaluation on someone in crisis) 2 Situational crisis, Maturational crisis, Crisis management.  What is Crisis and their characteristics? - disturbance caused by a stressful event or threat, disrupts an individual's homeostasis or equilibrium, normal coping mechanisms fail, results in inability to function as usual, equilibrium is displaced with disequilibrium. Maturational: new development stage reached, old coping skills no longer effective, and leads to increased tension and anxiety. Situational: arise from events that are extraordinary, external, often unanticipated. (examples: jobs loss or change, a death, change in financial or material status, psychiatric, or physical illness. Assessment General assessment Perception of precipitating event Situational support Coping skills Self-assessment Nursing Diagnosis Risk for impaired coping Impaired coping Risk for (or actual) impaired family coping Risk for (or actual) impaired community coping Anxiety Planning Implementation Patient safety Anxiety reduction Appropriate level of prevention/debriefing Evaluation 3. QPR-Question, persuade and refer 2