Mental health Flashcards
what is the hallmark of psychiatric nursing?
therapeutic communication
face to face communication involves
verbal and nonverbal expression of the senders thoughts or feelings
What things convey cognitive and and affective messages?
voice inflection, rate of speech and words
how are nonverbal messages communicated?
via body language, eye movements, facial expressions, and gestures.
– nurses should always be aware that their nonverbal communication affects clients
messages are conveyed by the sender by what mediums
sight, sound, touch, smell, non-verbally
what are coping styles?
automatic psychological processes that protect the individual against anxiety and from awareness of internal and external dangers and stressors. The individual may or may not be aware of these processes
what are treatment modalities?
psychiatric and mental health treatment modalities used to promote mental health???
types of treatment modalities
Milieu Treatment
Behavior Modification
Family Therapy
Crisis Intervention
Cognitive Therapy
Electroconvulsive Therapy
Group Intervention
Milieu Treatment
planned use of people, resources, and activities in the environment to assist in improving interpersonal skills, social functioning , and performing the ADLs as well as safety and protection for all clients
Where does milieu treatment occur
in inpatient and outpatient settings where clients are provided an opportunity to actively participate in treatment , decrease social isolation, encourage appropriate social behaviors and educate clients in basic living skills
What do milieu treatments provide
safe places to learn and adopt mature and responsible behavior through through limit setting and client responses to maladaptive social responses
limit setting
a component that requires consistent setting of appropriate limits by all staff, nurses, physicians and health care workers to work with one another via shared communication to maintain and reestablish limit setting
Therapeutic communication techniques
acknowledgement
clarifying
confrontation
focusing
information giving
open-ended questions
reflecting/restating
silence
suggesting
acknowledgement
recognizing the client’s opinions and statements without imposing your own values and judgement
clarifying
process of making sure you have understood the meaning of what was said
confrontation
should be used judiciously calling attention to inconsistent behavior
focusing
assisting the client to explore a specific topic which may include sharing perceptions and theme Identification
information giving
feedback about clients observed behavior
reflecting/restating
paraphrasing or repeating what the client has said (do not overuse as client will feel as though you are not listening)
silence
can be therapeutic or can be used to control interaction; used cautiously with paranoid patient, may support paranoid ideation
suggesting
offering alternatives such as “Have you ever considered…?”
antianxiety drugs categories
benzos
nonbenzos
benzo drugs
chlordiazepoxide HCl
diazepam
Clorazepam
Lorazepam
nonbenzo drugs
busparone
zolpidem
ramelteom
benzo indications
reduce anxiety
induces sedation
treats etoh withrawl
busparone indications
reduces anxiety
helps ctrl symptoms insomina sweating palpitations related to anxiety
zolpidem indications
ST tx for insomina
ramelteon indications
LT tx for insomina
binds melatonin receptors
benzo rxns
sedation
drowsiness
ataxia
dizziness
irritbility
benzo implications
at bedtime to reduce daytime sedation
dont mix with etoh
taper
ST drug
busparone rxn
dizziness
zolpidem rxn
daytime drowsiness
ramelteon rxn
dizziness
busparone NI
takes weeks to become apparent
zolpidem NI
give with food 1-1.5 before bedtime
ramelteon NI
appropriate for clients with delayed sleep onset
tricyclics indications
depression
clients with morbid fanatasiess that do not respond well to these drugs
tricyclic rxns
anticholinergic (dry mouth, blurred vision, consitpation, retention)
CNS sedation
CV TC HoT
GI effects
narrow therapeutic range
tricyclic NI
admin at bed time
2-6 weeks for effects
2-3 weeks from ~ to MAOIs
avoid etoh and antiHT drugs
lethal overdose and eval suicide risk
MAOI indications
depression
phobias
anxiety
MAOI rxn
TC
urinary hesitancy, C
impotence
dizziness
insomnia
dry mouth
retention
HT crisis
confusion
HT crisis
severe HT
severe HA
chest pain/palpitations
fever
sweating
NV
increased BP
MAOI NI
mix with tricyclics for HT crisis
Tyramines can cause HT crisis
do not take with SSRIs
no OTCs
caution with machinery
SSRI indication
depresssion
anxiety
panic
agression
OCD
anorexia
SSRI rxn
drowsiness
lightheadedness
HA
insomnia
depressed appetite
serotonin syndrome
sexual dysfunction
wt gain
SSRI NI
2-6 weeks
HT crisis when with MAOI
14 days from MAOI to fluoxitine - 5 weeks otherway around
bedtime in case of sedation
caution with st johns wart
taper
serotonin syndrome
3> symptoms
rapid onset of altered mental state
agitation
myoclonus
hyperreflexia
fever
shivering
diaphoresis
ataxia
D
atypical - trazodone
indications
depression
insomnia
dementia with agitation
atypical - trazodone
rxn
safer than tricyclics or MAOI
atypical - trazodone
NI
4-6 weeks
SNRI indications
depression
anxiety
panic
agression
anorexia
OCD
DM neuropathic pain
SNRI rxn
N
dry mouth
insomina
HA
fatigue
low appetitie
more sweating
sex dysfunction
withdrawl at cessation
SNRI NI
no with MAOI
14 days from MAOI to SNRI
monitor BP can cause HoT
can worsen pretx symptoms
same as SSRIs
NDRIs
norepi dopamine reuptake inhibs
indications
secondline antiD when SSRI and SNRI not effective enough
anxiety
sleep disturbances
antidepressant drug classes
antiD
SSRI
SNRI
NDRI
MAOI
tricyclics
atypicals
antipsychotic drug classes
antiP
phenothaizines
non-phenothiazines
long-acting drugs
atypicals
phenothiazines indications
to control psychotic behavior, hallu, delu, and bizarre behaviors
phenothiazines rxns
drowsiness
ortho HoT
wt gain
extrapyramindal effects
akathisia
tardive dyskinesia
pseudoparkinsons
phenothiazines NI
extrapyramidal effect (EP effects) are a major concern
monitor older clients
2-3 weeks
avoid etoh sedatives antacids
nonphenothiazines indications
ctrl psychotic behavior
useful in psychomotor agitation associated with thought disorders
nonphenothaizines rxns
severe EP effects
leukocytosis
nonphenothiazines NI (suas haldol)
avoid alcohol
Long acting drugs like
fluphenazine decanoate
haloperidol decanoate
takes months
require supervision
Atypical antipsychotic dugs like
risperidone
abilify
ziprasidone
clozapine
treats SZ +/- without EPS
monoitor WBCs
baseline vitals and ECG
mood stabilizers drugs
lithium carbonate
valproic acid
carbamazepine
lamotrigine
lithium indications
bipolar in mania
lithium rxn
N
fatigue
thirst
polyuria
fine hand tremors
wt gain
hypothyroidism
renal impairment
lithium toxicity
DV
drowziness
muscle weakness
lack of coordination
anticonvulsant mood stabilizers indications
used as with lithium, as alts or for bipolar
anticonvulsant mood stabilizers NI
admin with food and monitor blood leves
valproic acid - 50-125
carbamazepine - 8-12
lamotrigine given in low dose to prevent rash
anticholinergic drugs
EP system effects
relaxes musles
given with antiP drugs
mild anxiety
produces increased levels of sense awareness and alertness
daily living
pt is able to concentrate
moderate anxiety
dulled perception, hesitation
rate of speech and volume increase
restlessness
HA, ND, TC
attentive but less optimal
severe anxiety
fight or flight
disorganized sensory input
distorted perceptions and impaired concetration
selective concentration
severe anxiety SS
increased HR and BP
rapid and shallow resp
dry mouth
muscle tension
anorexia
frequency
panic
grossly distorted perceptions
unable to concentrate or be logical
loss of control
requires intervention
what to do when dealing with anxious client
assess self anxiety
self calmness will help calm client
generalized anxiety disorder (GAD)
excessive persistent anxiety with previous coping mechanisms insuffient
GAD SS
severe anxiety
motor tension (restlessness, quickly fatigued, shakiness, tension)
autonomic hyperactivity (SoB, heart palpitations, dizziness, diaphoresis, frequency)
vigilence and scanning (diff concentrating, sleep disturbance, irritibility, nervousness, low self-esteem)
GAD NI
assess anx and label feelings
help relate stressor to level of anx
encourage coping techniques
decrease environmental stimuli
panic disorders and phobias
periods of intense fear of an external object or activity that is chronic that is unrealistic
common phobias
acrophobia
agoraphobia
claustrophobia
hydrophobia
social anxiety
thanatophobia
heights
crowds or open spaces
tights spaces
water
social situations
death
panic disorder coping styles used
displacement
projection
repression
sublimation
how long do panic attacks last
peak in 10 min but last up to 30 min
what to do when a pt has a phobia
acknoledge the fear and and dont expose them to the fear
gain trust and reduce stimuli
discuss alt coping strategies
after trust discuss desensitization
pair negative with positive
meds
OCD
irresistibe imples to perform an action or repetivie thoughts
hoarding, excoriation (skin picking), trichotillomania (hair pulling)
OCD coping styles
repression
isolation
undoing
OCD assessments
magical thinking (belief that one’s thoughts can ctrl others)
hostile/delu thought content
difff interpersonal relationships
interferes with day to day living
safety issues
intrusive thoughts
repetetive
OCD interventions
listen, acknowledge
