MH/CH Final Flashcards
nursing interventions for aggression and violent behaviors- what are priorities?
SAFETY
Engage in a way that will create a calmer environment
Make sure ADL’s met
Role model calm behavior
If upset… engage in de-escalation
E.g. outpatient setting, someone pacing in waiting room or crying
Acknowledge, ask if they want to talk in a quiet area
Recognize people, their feelings and emotions
Are basic needs being met? Are they thirsty?
populations at greatest risk of feeling unheard?
Drugs, alcohol
Psychotic symptoms, paranoia
Feeling unheard
Assess safety first (depression → suicidal thinking)
Voluntary v involuntary commitment(could be angry)
after safety needs are met how do we engage with angry person?
cognitive process/strategies (CBT)
-Person can recognize their emotional reaction, reframe so the resulting behavior isn’t anger but maybe understanding (helping them de-escalate their own thoughts)
Nursing interventions for helping clients with anger to manage emotional responses
CBT, cognitive reframing
comorbidity with PTSD
*substance abuse
Chronic lifelong medical problems
Mental health disorders
how can we help meet emotional needs of someone who is misrepresented by mental illness?
reduce stigma
Atypical antipsychotic medication and risk for agranulocytosis
clozapine
Side effects of clozapine
significant risk for agranulocytosis/ orthostatic hypotension
Needs labs drawn!
- antipsychotic: schizo
what is somatization?
- presentation of physical problems, considered by the client that they can’t do certain things
concern for interacting with someone with somatic disorder
- family strain from taking care of them
- offer “face saving” out
- nursing interventions to disroucage them from resuming behviors
muchausens is what kind of disorder?
fictitious
Benzos: onset/risk/what do we use them for?
anxiety, fast (30-60 minutes), risk for falls/dependence/risk driving
antihistamines: what do we use them for, risk?
(vistaril) anxiety, risk for falls/sedating
antipsychotic meds: onset/ how do they work/ risk
can take a week or so to start working, decrease dopamine to manage sxs
2nd generation like Depakote: less extrapyramidal sxs , risk of metabolic syndrome
Decrease in positive sxs(decrease paranoia, thought processes, think more rationally)
What eval do we use to assess movement disorders that can occur with antipsychotic meds like Depakote?
AIMS
if someone is having acute dystonia/rigid neck/inability to move what do we do?
can treat with benadryl
serotonin drugs: what do they treat/onset/risk
- first line for depression/anxiety, 4-6 weeks to work
- Nauseous, increased risk suicidal thinking (mood not improved but more energy to complete plan)
- Serotonin syndrome risk
drug that works on serotonin but less side effects tan typical =
buspar
lithium- what does it treat/onset/risks
- mood stabilizier
- can decrease dopamine, increases GABA,
- toxicity: vomiting,
- narrow therapeutic window,
- consider salt/hydration/kidney function/thyroid function long term
- 2 or more weeks to notice effect, 4-6 weeks for full effect
risk with tricyclic antidepressants
QT prolongation
onset/duration for stimulant medication
same day/same day
is it lasting long enough to manage sxs?
intevetnion for severe anxiety
Severe anxiety → crisis… not able to engage in problem-solving, cognitive processing
Want to help them feel safe in that moment
Grounding techniques
intervention for mild to moderate anxiety
CBT? Cognitive reframing
speak calmly, clearly
Anticipate client needs to manage milieu and create calm environment
Nursing interventions related to limited progress towards treatment goals (1)
Inpatient, not meeting goals? Need to reassess the situation
nursing priority related to self harm
Always report harm to self or harm to others!
Keep patient safe in that moment
Safety plan : hospitalization, support group → keep it up to date
Gain collaborative information from care team/support people
Focused treatment responses related to severe depression in the in-patient setting
In patient: acute, safety planning, crisis management, reassess goals if not able to meet them
Management of insensitive nursing communication and interactions
Best way to learn about somebody is by asking them/talking to them
Calm approach, present observation
Set boundaries, redirect conversation back to patient
Nursing interventions related to suicidal thoughts and behaviors in the acute care settings
-screening especially for: Anorexia, thought disorders/schizophrenia, bipolar disorder
After confirmed suicidal and/or homicidal ideation → report to care team
Safety plan (working document)…
Gain collateral information from family (with appropriate release of info)
Nursing evaluation and intervention related to dementia and environmental safety
Screen for dementia - change in personality, become forgetful
Identify early and provide support, can slow progression
Safety! Appropriate shoes, rugs, cords, dangers in house that could precipitate fall, medication storage
Losing independence can lead to depression
SUPPORT! (also for family)
Help family understand that it’s a chronic condition…
Education: understand trajectory and medications
Treatment response, expectations (based on symptoms, what to look out for)
Waiting period for medication to work can be challenging
education related to treatment for schizophrenia
risk for genetic component
Risk for substance use
meds take time to work
which gen meds are greatest risk for EPS/tardive dyskinesia
First gen antipsychotic meds
what neurotransmitters do tricyclic antidepressants work on?
serotonin and norepi
2 drugs for bipolar- what do they work on
Lithium - decreases dopamine
Depakote (sodium valproate) - increases GABA
who Distributes federal and state funds to local public health agencies to implement programs at the community level?
state
what level enforces local, state and federal laws related to health code?
local level
what level develops regulations and implements policies that are passed on to state?
federal
Type of Hep transmitted through food handling/poor sanitation (fecal/oral route)
Hep A
How are Hep B and Hep C transmitted? Which one is more associated with drug use?
blood + body fluids
-Hep C = IV drug use
Which Heps have vaccines: A B or C?
Hep A and Hep B have vaccines
Hep C = NO vaccine
*prevention is the best treatment
3 key components of disease surveillance
collect
communicate
collaborate
who exposed you to disease, what was your exposure, COLLECT info about occurrence of disease, COMMUNICATING and COLLABORATING to promote team efforts to address the issue
‣ Example: public health nurse talking to school health nurses about kids exposed at school event
Legally- can you make someone do DOT for TB? (what is DOT)
yep!
DOT = directly observed medication administration
Why? –> To ensure they are treated + to reduce the chances of developing antibiotic resistance from improper adherence to medication regimen
HAI vs community acquired infection (time frame)
◦ HAI: infections that occur in hospital:
MRSA –> now out in community
◦ community acquired infections: occur when no hospital visit within 1 year
3 levels of disaster preparedness
personal, profession, community
interventions for personal disaster preparedness
plan for your family, disaster supply kit
interventions for professional disaster preparedness
be familiar with workplace disaster plan, get training
interventions for community disaster preparedness
coordination between health department, hospitals, emergency services, and other human service agencies
Disaster response chain of command
At local level, then state → national → international
how do we interact with people who have been through a disaster?
◦ meet physical needs and emotional/mental needs–> listen to them, let them tell their story, let them feel heard
4 phases of a disaster
prevention
preparedness
response
recovery
what happens during prevention phase of disaster
any action to make something safer- giving a vaccine, preventing terrorist attack
what happens during preparedness phase of disaster
education, preparing people at home/work, personal disaster kit at home
what happens during response phase of disasters
local/state/national level interventions
what happens during recovery phase of disaster
reconstruction/building back –> risk remains for injuries
Shift from short-term aid to long-term support
Risk in post disaster cleanup
manmade vs natural disasters
◦ natural: hurricane, tornado
◦ manmade: nuclear meltdown, hotel in Florida that collapsed, chemical spills, airplane crash
3 populations most vulnerable during a disaster =
homeless, elderly, children
which triage level:
life threatening injuries + high probability of survival
1st priority (red)
Now sure if we need to know these details :: catastrophic hemorrhage, does not respond to voice - put in recover position, High or low RR, HR >100
which triage level:
injuries with systemic complications + can wait 30-45 mins for tx
2nd triage level (yellow)
which triage level?
local injuries without complications and can wait hours for tx
3rd priority (walking)
emerging vs reemerging disease
Emerging Diseases = outbreaks of previously unknown diseases
Reemerging Diseases = diseases that reappear after a significant decline
Ex: Malaria, Influenza, Tuberculosis
considerations for biological disease surveillance
Ongoing systematic, collection, analysis, interpretation and dissemination of specific health data for use in public health
Who, when, where, and what
Why
Contact Tracing -
- –Looking at who is infected
- –How many people?
- –Where is the area? (specific school/event)
most common communicable disease outbreak =
foodborne
category A biological terrorist agents
Category A → highest priority b/c they are easily transmitted Anthrax Botulism Toxin Bubonic Plague Smallpox Tularemia Viral Hemorrhagic Fever
signs of outbreak
◦ notice a cluster of patients coming through facility with a cluster of illness GEOGRAPHICALLY or with SPECIFIC AGE or UNUSUAL AGE DISTRIBUTION for COMMON Disease
what do occupational health nurses focus on ? example of things they do?
promotion, prevention, and restoration of health in the work place
◦ see a broad spectrum of needs throughout work enviro: diabetic they give insulin too, asthmatic who needs breathing treatments, personal exposure monitoring, physical examinations
3 things faith nurse does
◦ health promotion and disease prevention throughout the life span
- advocating,
- educating
- integrating health with faith
this type of nurse works closely with law enforcement, applies nursing to public or legal proceedings, often seen with collaborative work
forensic nurse
cultural accommodation
◦ accommodation: nurse accidentally interrupts family ritual, recognize cultural belief is valued by patient and accommodate to patient because it does not cause the patient any harm
inhibitors to cultural competence
ack of knowledge, personal bias, stereotyping (especially during report)
parts of cultural assessment
◦ recognize differences/ language barriers and risks associated with their particular population
parts of cultural competence
Awareness + Knowledge + Skills + Encounter + Desire = Cultural Competence
“Knowing, appreciating, and considering the culture of someone else in resolving problems”
Factors that may indicate an increased risk for high risk-taking behavior in adolescents :
Poor academic performance Poor parental role models Low self-esteem Lack of social support Poverty
Leading causes of death in adolescence
Motor vehicle accidents (usually including activity)
Homicide
Suicide
Accidental injuries
primary/secondary/tertiary syphilis
Primary = single painless chancre
Secondary = sore throat, rash, muscle/joint pain, fever, malaise
Tertiary - lesions, CNS/ CV involvement
most common STD?
◦ chlamydia
why is chlamydia so tricky?
can be asxs, cause sterility if untreated
chlamydia sxs in males and female
‣ males: no sxs or report some painful urination
‣ females: asxs or discomfort and vaginal discharge, lower back pain if had a long time
ghonorhrea sxs males/females
males: discharge and urinary frequency with pain,
women : no sxs or lower back pain with PID
chlamydia treatment
5 day z pack
how do we interact with families doing a home visit? what is our goal?
◦ if having issues, help them through motivational interviewing - understand their wants and needs and ideas
during which phase of home visit does this happen:
Clarify sources of referral for visit
Clarify purpose for the home visit
Share information on reason and purpose of home visit with family
Get directions
initiation
during which phase of home visit does this happen:
Establish shared perception of the purpose of the visit
Contact family to establish date/time
Review records/check orders
Take what you will need for the visit
Schedule day around patient’s needs and geography
Pre-visit Phase
during which phase of home visit does this happen:
Interact socially to establish rapport
Establish nurse-client relationship
Implement nursing process
In-home Phase
during which phase of home visit does this happen:
Review visit with family
Establish next visit if necessary
Termination Phase
during which phase of home visit does this happen:
Document the visit
Begin planning for next visit, if needed
Post-visit Phase
when do you hold a vaccine?
- immunocompromised with live vaccine –> refer to physcian and allow input before giving it,
- allergy in past that was anaphylaxis
- acute fever
‣ if just a little itchy/achey/local reaction it is not contraindicated
primary/secondary/tertiary roles of school nurses
Primary: health promotion activities, teaching healthy lifestyles, immunizing children for school entry
Secondary: screening for health problems, caring for ill or injured children and staff
Tertiary: caring for children with chronic problems, health referrals and continuity of care
purpose of school nurses
Eliminate or reduce the health barriers that affect learning
Maximize the amount of in-class time
Advocate for student wellness
Support the learning process
keys areas of health promotion for women
-Reproductive health, menopause
Access and contraceptive counseling
Preconception counseling - folic acid, alcohol use
Menopause - HRT
-Osteoporosis
Foods high in calcium + vitamin D, exercise, limit alcohol, avoid smoking
-Heart Disease + Diabetes
Healthy eating, physical activity, healthy weight, no tobacco use
-Cancer (breast, cervical, ovarian, colorectal)
Screening mammograms, clinical breast exams, and self-breast exams
health promotion intervenrtions for older afults
prevent falls
assess muscle strength
vaccines
medicare guidelines for home health , how long can you have it?
has to be considered intermittent nursing care:
-patient is unable to leave home, need for nursing care in home 7 days/ week in home or less
-will pay for up to 21 days: short term need
hospice provides care during….
last 6 months of life
