Mental Health Flashcards

Question

which stage of development would a 2-3 year old be in?

Answer 1

Autonomy vs. Shame and Doubt is the typical stage of development for early childhood, which lasts from ages 2 to 3 years. In Autonomy vs. Shame and Doubt, children seek to develop a sense of personal control over physical skills and knowledge of independence. When they are successful, for example, with a task like toilet training, they feel independent, and it leads to a sense of autonomy. When they are not successful, they think they are a failure, and it results in shame and self-doubt.

Answer 2

Trust vs. Mistrust is the typical stage of development for infancy, which lasts from birth to 18 months. In this stage, children develop a sense of confidence when caregivers provide reliability, care, and affection. When infants do not have that, they will build mistrust.

Answer 3

Initiative vs. Guilt is the typical stage of development for preschool children, who are 3 to 5-year-olds. In Initiative vs. Guilt, children start to assert control and power over their environment. Success leads to initiative when they feel a sense of purpose, but children who try to exert too much power and experience disapproval end up feeling guilty.

Answer 4

Methadone is an efficacious medication used in the treatment of opioid use disorder, chronic pain, and in the treatment of neonatal abstinence syndrome. This medication requires close monitoring and counseling for opioid use disorder. Periodic blood tests are required as this medication may be hepatotoxic. This medication has been shown to decrease the transmission of blood-borne pathogens such as HIV and Hepatitis C. This is because the reduction of intravenous drug use decreases the risk of the transmission of these pathogens. Drowsiness is a common side effect of this medication as it is an opioid agonist. Treatment for opioid use disorder includes naltrexone, methadone, or buprenorphine. These medications have proven efficacy in this disorder, and when combined with counseling and appropriate monitoring, they may assist a patient in attaining opioid abstinence.

Answer 5

✓ Positive symptoms include things that add something to the client. They include: Hallucinations: Experiences involving the apparent perception of something not present. They can include any five senses: touch, taste, smell, sight, or hearing. Auditory hallucinations, when the client hears something that is not present, are common in schizophrenia. Delusions: Fixed, false beliefs that conflict with reality. Types of delusions include persecution, grandeur, and jealousy Thought and speech disorganization

Answer 6

✓ Negative symptoms are things that take something away from the client. They include: Apathy: A lack of interest, enthusiasm, or concern. Alogia: Also known as 'poverty of speech,' alogia is difficulty with speaking or the tendency to speak little due to brain impairment. Anhedonia: The inability to feel pleasure. Avolition: A total lack of motivation that makes it hard to get anything done Flattened affect

Answer 7

Foods high in tryptophan, tyramine, and caffeine, such as chocolate and cheese, may precipitate a hypertensive crisis. Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant developed. They ease depression by affecting neurotransmitters in the brain. Although they are active, they've generally been replaced by antidepressants that are safer and cause fewer side effects. MAOIs can cause dangerously high blood pressure when taken with certain foods or medications. Because of this, diet restrictions and avoiding certain other drugs are required while on an MAOI therapy. Despite side effects, these medications are still a good option for some people. In some instances, they relieve depression when other treatments have failed.

Answer 8

✓ Intimate partner violence (IPV) could be a current or previous partner or spouse ✓ IPV occurs in heterosexual and same-sex relationships where intimacy may not be present ✓ Nurses should assess all clients for IPV ✓ IPV may be physical, psychological (emotional), sexual, financial, stalking, neglect, or abandonment ✓ Nurses should inform clients that information regarding IPV will be kept confidential and shared with the treating physician ✓ The nurse should also inform the client that most jurisdictions require reporting of IPV; the nurse should inform the client that any IPV will be reported ✓ Interactions between the victim and the perpetrator may demonstrate the victim seeking approval from the perpetrator, the perpetrator reluctant to leave the victim alone, or frequent interruptions during the assessment ✓ Cases of IPV reported by the nurse are kept anonymous, and that should not dissuade the nurse from reporting ✓ It is not enough for the nurse to report suspicions of abuse to the supervisor; that does not absolve the nurses' legal and ethical responsibility to report the IPV

Answer 9

Spiritual distress should be treated with a referral to the clergy and psychosocial support of the client after assessing the client for the sources of their mental pain rather than diazepam. For example, if the cause of the mental illness is unresolved guilt, the nurse and other members of the healthcare team should educate the client about the purpose of sin, they should facilitate the person’s making amends to others, and also advise the client that all humans have faults; nobody is perfect and without errors.

Answer 10

Antipsychotic agents such as dopamine antagonists (haloperidol) are often used as an initial pharmacological treatment in terminal delirium. Benzodiazepines (lorazepam) are not recommended in treating delirium because they may cause paradoxical excitation that worsens delirium. Benzodiazepines (BZDs) are indicated if the dopamine antagonist fails to relieve agitation or if more sedation is desired. BZDs are also used in treating agitation without delirium.

Answer 11

Delirium is an altered sensorium. It is characterized by acute changes in the patient’s level of consciousness. Hyperactive delirium is characterized by agitation, restlessness, and emotional lability. Hypoactive delirium is characterized by flat affect, apathy, lethargy, or decreased responsiveness. Causes: Many causes of delirium include medications (dexamethasone, opioid toxicity), nicotine withdrawal, dehydration, uncontrolled pain, constipation, urinary retention, infection, hypoxia, renal failure, hyponatremia, hypercalcemia, hypoglycemia, and emotional distress. Management: Initially, non-pharmacological interventions should be attempted to identify and address reversible etiology and relieve terminal agitation/delirium. For example, address the reversible causes such as treating constipation or discontinuing medications such as dexamethasone, modifying precipitating factors such as sensory deprivation or uncontrolled pain, etc. If no rapidly reversible factors are identified or if the patient is terminal, dopamine antagonists must be used.

Answer 12

Severe anxiety causes an individual to experience a narrow perceptual field, an inability to problem-solve, and somatic symptoms such as dizziness, palpitations, diaphoresis, and a feeling of impending doom. Staying with the client provides an assurance and enables the nurse to give the client simple and short directions, if necessary. Severe anxiety is marked by - Greatly reduced and distorted perceptual field Focuses on details or one specific detail Attention is scattered Inability to problem solve A feeling of impending doom Interventions include staying with the client because their behavior may become unpredictable, coaching breathing if the client develops hyperventilation, giving the client short and simple cues, and obtaining prescriptive medication (if necessary). The nurse should ensure that the environment is tranquil and does not have excessive stimuli.

Answer 13

✓ A borderline personality disorder is about five times more common in first-degree biological relatives with the same disorder compared with the general population ✓ This disorder is characterized by the individual having an unstable self-image, fear of rejection, impulsivity, and emotional dysregulation ✓ A key intervention for a client with BPD is to assess for suicidality ✓ Parasuicide is common with this personality disorder; however, it is essential to keep this client safe ✓ Defense mechanisms commonly seen in this personality disorder include splitting, projective identification, and denial ✓ Treatment is therapy, specifically dialectal behavioral therapy, which focuses on emotional regulation and strategies to respond to stressors in a mature way ✓ No medication is approved to treat any personality disorder

Answer 14

Tricyclic antidepressants include nortriptyline, amitriptyline, and imipramine. These medications are utilized in the treatment of depressive and obsessive-compulsive disorders. This class of medications possesses significant anticholinergic effects and, therefore, would not be recommended for older adults. Overdose of a TCA is extremely serious because these medications are cardiotoxic.

Answer 15

Individuals with difficulty obtaining and sustaining housing have high rates of treatment non-adherence. Lack of adequate housing poses a serious threat to treatment adherence because of the lack of privacy, storage of medications, and a sense of detachment from the community. This client should be referred for outpatient services because they are homeless and have a substance use disorder. Both are issues that may be mitigated with community services. An RN may initiate referrals. The nurse should identify clients with the most significant need for community services. Examples of clients needing community services include: Homelessness Complex conditions (HIV, cancer) Insufficient support systems Financial instability

Answer 16

Restraints should be used as a last resort if alternative methods are not effective. A nurse should never threaten a client with restraints. This is considered assault. The nurse may place a client who is violent in restraints without an order from the primary healthcare provider (PHCP). If this was to occur, the nurse has one hour to inform the provider and obtain an order. Restraints are never as needed (PRN). They should be discontinued at the earliest possible time. When restraining a client, the reason for the restraint must be explained to the client and the behavior the client needs to demonstrate for the restraints to be discontinued. The nurse should observe the client at frequent intervals to offer nutrition & toileting, assess their behavioral status, obtain vital signs, and provide range of motion. These intervals are determined by the facility and the type of restraint—the more restrictive the restraint and the younger the client, the more frequent assessment. Restraints must be able to quickly be removed via a quick release buckle (knots are no longer recommended). The nurses’ documentation must be comprehensive, describing the reasoning for the restraints, alternatives utilized, the education provided to the client, the type of restraint utilized, how it was secured, and the ongoing behavior necessary to continue the restraint. The nurse should also document the intervals at which the restraints were released.

Answer 17

Sertraline is a potent, selective serotonin reuptake inhibitor. Sertraline is indicated in treating anxiety, obsessive-compulsive, and depressive disorders. In this client, it is likely the sertraline is being used for the client's anxiety. This medication has a favorable cardiac side-effect profile and is aptly prescribed for this client. SSRIs take four to six weeks to gain efficacy. A new medication may be attempted if no efficacy is observed in twelve weeks. Most SSRIs cause a decrease in libido and sexual performance. This may be a temporary effect. SSRIs typically cause gastrointestinal distress once they are started and may be lessened by taking the medication with food. This effect generally resolves on its own. An example of an atypical antipsychotic would be aripiprazole or ziprasidone. An example of a tricyclic antidepressant would be doxepin or nortriptyline.

Answer 18

Zolpidem is a non-benzodiazepine sedative-hypnotic indicated in the treatment of insomnia. Zolpidem has a rapid onset and should be taken immediately before the planned bedtime. Falls are a significant concern with this medication, especially for older adults. Another consideration is suicidality, as zolpidem has precipitated clients to experience suicidality. This medication should not be taken with alcohol or other CNS depressants because of the risk of respiratory depression. An example of a benzodiazepine would be alprazolam or diazepam. An example of an anticonvulsant would be topiramate or phenytoin. A persistent, painful erection (priapism) should be reported for trazodone - not zolpidem.

Answer 19

Clinical features of schizophrenia include positive and negative symptoms. Anhedonia, avolition, and delusions are all associated with this psychiatric disorder. Schizophrenia symptoms are divided into positive or negative symptoms. Positive symptoms include things that add something to the client. They include: Hallucinations: Experiences involving the apparent perception of something not present. They can include any of the five senses: touch, taste, smell, sight, or hearing. Auditory hallucinations, when the client hears something that is not present, are common in schizophrenia. Delusions: Fixed, false beliefs that conflict with reality. Types of delusions include persecution, grandeur, and jealousy Thought and speech disorganization Negative symptoms are things that take something away from the client. They include: Apathy: A lack of interest, enthusiasm, or concern. Alogia: Also known as 'poverty of speech,' alogia is difficulty with speaking or the tendency to speak little due to brain impairment. Anhedonia: The inability to feel pleasure. Avolition: A total lack of motivation that makes it hard to get anything done Flattened affect