Mental Illness (1 and 2) Flashcards
What is the general assessment that should done for mental illness?
- clinical interview
- signs and symptoms
- MSE
- past medical history
- physical exam
- lab testing
- suicide risk assessment
- substance use
- self-harm assessment
- psychosocial
- spirituality
what does the spiritual assessment include
F - if they consider themselves a spiritual person
I - importance of spirituality
C - are they apart of a community
A - how would they like you to address this issue
what are the main causes of psychosis
- schizophrenia, substance use, mania and major depression
signs and symptoms of psychosis
- disturbed sleep
- neglected personal hygiene
- lack of energy and motivation
- loss of interest in activities
- hallucinations and delusions
- negative symptoms
onset phase of schizophrenia
prodromal symptoms, can last from a few days to 18 months
begins in adolescence and can be confused with moodiness
acute illness phase of schizophrenia
psychosis is present and there is withdrawal from activities, the first episode is 3-5 years following the onset
what is the stabilization phase of schizophrenia
less acute sx.
treatment with increased socialization
adjustment for the family and the individual
maintenance and recovery of schizophrenia
regain previous level of function and improve QoL
continuous medication management
monitor for early signs of relapse
relapse of schizophrenia
can occur at anytime, detrimental successful management
Positive symptoms of schizophrenia
delusions - grandiose, persecutory, somatic
hallucinations
thought disturbances
disorganized speech
what are negative symptoms of schizophrenia
flattened effect
little emotions
strong opposing feelings
withdrawn
lack of pleasure
reduced speech and thought process
motor retardation
what are cognitive symptoms for schizophrenia
decrease process, memory and problem solving
impaired judgement and illogical thinking
what are hallucinations
perceptual experiences that occur without actual external sensory stimuli
delusions
fixed beliefs that are not amenable to change in light of conflicting evidence
what part of the assessment for schizophrenia is the most important
MSE - behaviour, speech and thought processing
suicide risk assessment
self-harm assessment
what types of assessment should be done for hallucinations
observing the behaviours for laughing or talking to themselves
ask about hearing voices and ask what voices are saying
interventions for hallucinations
avoid touching the client
tell the client they are safe and where they are
distraction such as TV and radio
decreased environmental stimuli
interventions for delusions
build a trusting relationship
don’t challenge the delusions
ask further information on when it started
refocus on reality based topics
identify triggers
nursing intervention for acute phases of schizophrenia
- safety is the most important - - overtly ask acute hallucinations and what they are saying
- focus on the reality
- attempt de-escalation before medications (PO before IM)
- low stimulation environmental
- assess level of self-care
- any recent triggers or environmental stimuli, assess medications, family support
what should be focused on in the stabilization phase
- focus on adherence to treatment
- assess caregiver and patient understanding
- assess for EPS and do not minimize discomforts
- community resources - pharmacy, med drop off support group
- assess the need for closer support
what should be focused on during the maintenance phase
- short-term treatment to optimize long term goals
- continue to discuss treatment adherence and pharmacotherapy
- involve family and support system
- health promotion (diet, decrease substance use, stress, self-care)
what are good prognostic factors
- late onset
- acute onset
- good premorbid social, sexual and work histories
- good support systems and
- positive symptoms
- early diagnosis and treatment initiation, maintenance and adherence
what are poor prognostic factors
- early onset
- trauma, financial problems
- frequent relapses
- person with negative symptoms
Bipolar I
one or more epidose of mania with or without an episode of major depressions (lasting at least one week)
Bipolar II
one or more episodes of major depression with one incident of hypomania
signs and symptoms of depression
- decrease motivation and energy
- weight gain and decrease appetite
- difficulty sleeping
- feeling worthless and guilty
- poor concentration thought blocking
- thoughts of suicide
- psychomotor agitation or retardation
signs and symptoms of mania
- euphoria, annoyances and anger
- decreased sleep
- reckless behaviour
- pressure speech and racing thoughts
- grandiosity
- increased energy and sexual drive
- poor judgement
Signs and symptoms of hypomania
- decrease intensity of mania
- may present longer duration
what is important in the acute phase of mood disorders
- injury preventions
- hospitalization is indicated
- medication stabilization
- hydration, sleep
what is important in the continuous phase phase of mood disorders
- prevention of relapse
- psycho-education
- support groups
- communication and problem solving
what is important in the maintenance phase of mood disorders
- medication and treatment adherence
- community services and ongoing psychotherapy
communication durig mania
- firm and calm approach
- short concise explanation
- set limits
- identify expectations
- hear and act on legitimate complaints
communication during depression
- eye contact
- allow time to response
- assess suicide risk
- avoid platitude
what are non-pharmacological interventions for modo disorders
- light and chronotherapy
- trans-cranial magnetic stimulation
- electro-convulsive therapy
- psychotherapy - CBT family therapy
risk factors for depression
- childhood emotional, physical and sexual abuse
- family history
- lack of social support
- stressful live event
- medical co-morbidities
- economic difficulty
what are the main planning goals when it comes to depression
- return to previous level of functions
- returning to work, school and other activities
Nursing interventions for depression
- implement sleep regime
- educate regarding healthy nutrition and physical activity
- watch for high risk suicidality
- behavioural therapy
nutritional therapy for depression
- deficits in iron, folic acid etc can produce depressive symptoms
increase vitamin B complex
ascorbic acid
omega 3 fatty acids
what role does ketamine play in depression
- treatment of resistance depression and off use label of suicidality
- can reshape the brain connections
what does the trauma informed approach
- realize the impact of trauma path of recovery
- recognize the signs and symptoms of trauma
- integrate knowledge about policies and procedure and practice
- refrain from re-traumatization
what is preventative confinement
emergency situation where the person is a danger to themselves or other, up to 72 hours without consent from a judge
what is temporary confinement
hospitalization psychiatric exam, up to 144 hours without permission from judge
court authorized confinement
2 psychiatrists decide a person needs t stay in the hospital, judge decides on how long
what are contributing factors to aggression and violence
overcrowding, space, lack of outside space
long waits
cultural barriers
staffing or staff attitudes
power dynamics
restriction
signs and symptoms of aggression and violence
- increases pulse, BP and RR
- chills and shudders
- warmth
- nausea
- racing thoughts
- fist and jaw clenched
- increased muscle tone
- change in poture
- pacing hands and body shaking
what is the main goals with aggression
- anger management
- emotional regulation
- self-control
- patient safety
- seeking help early on to prevent escalation
interventions with anger management
- quiet room
- staff safety
- environmental safety
- des-escalation
what are pre- ECT nursing management
- NPO
- vital signs and MSE
- insert PIV
- remove jewelry
- hospital gown
- communicate with pre-op team
post-ECT nursing management
- VS
- MSE
- assess adverse side effects
what is CBT
- recommended for first line psychological treatment
- short term and intensive
antidepressants
SSRI (sertraline) first line against depression
mood stabilizers
medication like lithium and treats mania and depression
anxiolytics
benzos (lorazepam, clonazepam)
antipsychotics
first generations (loxapine) vs. 2nd gen. (risperidone)
interventions for NMS
- identifying signs
- stop meds
- treat symptoms, muscle relaxant or dopamines agonist
- manage fluid
most common long-acting injectables
first gen - haldol
second gen - risperidone or paliperidone
when are long-acting injectables administered
non-adherence to oral medications
what causes neuroleptic management
first generation antipsychotics
what are signs and symptoms of NMS
muscle rigidity, elevated temp, HTN. tachycardia, tachypnea, confusion, increase CK, reduce consciousness, fever and DEATH
what causes anticholinergic crisis
first gen antipsychotics, anticholinergics
signs and symptoms of ach crisis
dry mouth, constipation, impaired concentration, confusion, memory impairment, disorientation
delirium
interventions for anti-ach
- stops medss
- emergency cooling
- administer benzos
- physo stigmine IV
how to intervene when patients refuse meds
- address reason why no
- assess level of judgement
- trusting relationship
- check for cheeking
switch to liquid or fast dissolving
what is the nurses role in coping skills
- calm reassuring approach
- acceptance atmosphere
- teaching about diagnosis and management
- encourage patient making decision
risk factors for suicide risk in inuit
- historical trauma
- community distress
- wounded family
- early adversity
- mental distress
- acute loss
protective factors ofr suicide in inuit population
- cultural continuity
- social equity
- family strength
- healthy development
- mental wellness
- coping with acute stress
what is substance used disorder
when experimentation and occasional use turns into misuse when it affect functionality and the person is unable to upkeep their lifestyle
assessment for substance use disorders
- pain
- VS
- observation
- general nutrition
- MSE
- neurological assessment
- pmhx.
- history substance use
- medications
- suicidal ideation or attempts
- trauma
- lab testing
- withdrawal symptoms`
alcohol withdrawal
- coarse tremors of hands, tongue or eyelids
- nausea or vomiting
- weakness
- tachycardia, elevated BP
- delirium tremens
Opioid withdrawal
- nausea or vomiting
- muscle aches
- pupillary dilation
- sweating
- “base case of flu”
assessment of general withdrawal
- decrease communication
- decreased productivity
- change in concentration
- mood changes
- changes in appetite, sleep patterns and routine
- change appearance
- increase high risk behaviour
what is the goal of withdrawal
- maintain treatment retention
- reduce severity and frequency of substance use
- reduce harm caused by substance
- improve patient quality of life
what is the CAGE model for motivational interviewing of clients
C - cut down
A - have you been annoyed by people criticizing you
G - have they felt bad or guilty for drinking
E - have they ever had a drink first thing in the morning
suicidal ideations
reoccurring thoughts of suicide with or without a plan
suicide attempt
action with resulting desire to die
self-harm
intention to injure self without suicidal intent
Assessment for suicidal patients
MSE
level of suicide risk
history of suicide and self-harm
verbal and non-verbal cues
medication effectiveness and adverse effects
medication hoarding or cheeking
what are interventions for mid-mod risk interventions
- distraction, self-soothing strategies
- mindfulness with the body
- breathing exercises
- open communication
- medication management
- safety plan
Acute interventions for suicide
- safe environment
- remove at risk items from patient belonging
- monitor for hazards
- shared room with door open - frequent monitoring
- plastic utensils
- search belonging of visitors
light monitoring
regular monitoring 30min-1 hour passive suicide ideation or low level risk
close observation
every 15 min monitoring of patient location and behaviour present
continuous monitoring
1:1 continous monitoring for patient at high risk of self-harm
anxiety
apprebension, uneasiness, uncertainty or dread from real or percieved threat
fear
reaction to specific danger
worry
thoughts and images that engender negative affect and are uncontrollable
normal anxiety
necessary for survival and a healthy reaction
what assessments should be done for anxiety
- past medical hx.
- MSE
- functionality and triggers
- substance use
- sleep pattern
- nutrition
- vital signs
hows does mild anxiety present
restless irritable and tension relieving behaviour
moderate anxiety presentation
voide tremor with high pitch, somatic behaviour, increase pulse and muscle tension
severe anxiety symptoms
dread, confusion, hyperventilation, withdrawal, tachycardia, dizziness, nausea, headache
panic clinical presentation
immobility, dilated pupils, sleeplessness, inability to speak, hallucinations or delusions
what are interventions for mild anxiety
open ended questions and seek clairifcation
intervention for moderate anxiety
calm environment, open listening
interventions for severe anxiety
safe, medication, distraction techniques
whats are signs and symptoms of anxiety disorder
restlessness
fatigue
impaired concentration
irritable
muscle tension
sleep disturbance
what assessments should be done prior for panic disorder
ECG
trops
chem 7
CBCs
what are signs and symptoms of panic disorder
palpitation
diaphoresis
hyperventilation
tremors
SOB
N/V
chest pain
numbness or tingling sensation
risk factors for panic disorders
previous panic attack
family history
childhood trauma
female gender
history of a mood disorders
what are risk factors for OCD
female
sexual or physical abuse
diagnosis of anxiety
co-morbid conditions
what assessment should be done for people with OCD
asking them how long it takes for morning routine, returning to the house to confirm things are off
nutritional intake
physical injuries from washing hand too muchi
interventions for OCD
SKIN INTEGRITY
LIMIT CHOICES
SIMPLE DIRECTIONS
ASSERTIVE
SCHEDULED BATHROOM USE
SLEEP HYGIENE
NUTRITION
EXPOSURE AND RESPONSE PREVENTION
what are communication interventions for anxiety
teaching family and the patient about the disorder
time management
promote coping with the diagnosis
physiological interventions for anxiety
balanced meals
relaxation with bath
walked and physical activity
non-pharmacological interventions for anxiety
deep brain stimulation
psychotherapy
CBT
self-talk
primary manifestations fo eating disorder
unrestricted eating
watchful eating
increased weight and shape pre-occupation
anorexia nervosa
intense fear of gaining weight resulting in anxiety, panic and depression in relation to eating
risk factors for anorexia
dieting, metabolic rate
ideal of beauty and media
low self-esteem and trauma
signs and symptoms of anorexia
low weight
mottled cool skin
fine hair
loss of menstrual cycle
refusal of food
suicidal thoughts or action
muscle weakness
physical assessment for anorexia
electrolytes and renal function test
vitals signs (FVD)
CBGM hypoglycemia
weight
intake and output
interventions for anorexia
weight increasing program by dietician
counselling
energy conservation
weekly weigh ins
structure meal time and monitored bathroom time
monitor and limit exercise
what is refeeding syndrome
a surge of insulint he body goes through and a fast shift from fat to carb metabolism
can lead to hypophohatemia, kalemia and calcemia
interventions for re-feeding syndrome
electrolyte supplementation
bulimia nervosa
recurrent cycle of binging and purging behaviour
clinical presentation of bulimia
dental erosion and carrie
oesophageal tears
esophagitis
abnormal lab values
callused knuckles
suicide risk
bradycardia and orthostatic changes
medical management for bulimia
electrolyte imbalance
kidney function
re-hydration
weight management for bulimia
preferred foods
daily weight
scheduled eating
observe eating and washroom use
behaviour interventions for bulimia
diary of triggers
log meals
CBT
teaching for bulimia
meal planning
relaxation techniques
impact of binging and purging
effects of laxative use
risk factors for BPD
poor family dynamics
family history
history of childhood trauma
features of BPD
unstable relationship
poor regulation of mood
splitting
cognitive dysfunction
destructive behaviour
chronic suicidal ideations
interventions for BPD
communcation
sleep and nutriton
proper diagnosis and medication
thought stopping
taking a break when the behaviour is notes
visualizing a stop signs
replacing the undesired behaviour with positive ones
communication triad
I statement to identify feeling
nonjudgemental statement of the rigger
what the person wants to feel differently to restore comfort
