Mock Exam Flashcards
Outline four therapeutic communication techniques:
- Listening (being fully present, lets patient be heard, convey interest)
- Silence (gather thoughts)
- Open ended questions (decide on manner of response)
- Restating (repeat main message)
- Reflection (reflect and interpret back)
Name four therapeutic approaches used in mental health setting:
- Psychotherapy
- Pharmacotherapy
- ECT
- CBT
List four reasons for carrying out a risk assessment:
- Part of an overall assessment upon admission to mental health facility
- Major changes in client circumstances
- When moving clients between services
- Prior to granting leave/discharge
State four side effects of atypical antipsychotics:
- Hypotension
- Dizziness
- Fainting
- Sedation
- Weight gain
- Insomnia
- Dry mouth
Define depression and state four signs and symptoms of depression
A mood disorder characterised by depressed mood, pessimism, anhedonia and apathy
Social and emotional withdrawal, Impaired attention and conversation, delusions of guilt and worthlessness, fatigue, weight gain/loss
Briefly describe the powers and responsibilities of a Senior Mental Health Practitioner (SMHP) under the 1996 Mental Health Act.
May detain a voluntary patient at risk in the absence of a doctor for 6 hours
Assessments with substance abuse:
Alcohol and other drug history, physical appearance (general appearance, nutrition, intoxication and withdrawal), breathalyse, drug screening, AUDIT test, mental state examination
Effects of substance abuse on families:
Stress, financial problems, manipulation, lying, distrust
6 nursing management principles:
- Consultation of a GP, counselling service or mental health clinic
- Pharmacotherapy
- AA/NA
- Change peer group
- CBT
- Rehab
- Therapy
- Detox
Nursing diagnosis with anorexia:
Imbalanced Nutrition: less than Body Requirements R/T insufficient intake of nutrients to meet metabolic needs
One expected outcome for diagnosis:
The client will:
increase nutritional intake and increase weight within two weeks
6 nursing interventions:
Establish behaviour modification protocol to provide consistency and decrease power struggle
Provide a structure to mealtimes and state limits. Tell client when it is time to eat and present the food
Do not bribe, coax, or threaten the client to eat food but encourage, withdraw your attention if the client refuses to eat. When the mealtime is over and remove food.
Supervise client during and after meals. Do not allow client to use the bathroom until at least 30 minutes after each meal
Monitor client’s intake and record food intake and food not eaten. Document non-compliant behaviour in the progress notes
Encourage client to seek out for a staff member to talk about feelings of anxiety or fear
Grant and restrict privileges based on weight gain or loss
Weigh client before breakfast and after voiding
Antidepressants:
Treat depression, inhibit neurotransmitter breakdown and release neurotransmitters, increase serotonin levels
Types of antidepressant:
Tricyclic antidepressants (clomipramine), Selective serotonin reuptake inhibitors (sertraline-Zoloft), serotonin noradrenaline reuptake inhibitors (reboxitine), monoamine oxidase inhibitors (phenelzine)
Mood stabiliser:
Lithium carbonate
What is MSE:
Process of obtaining information about specific aspects of individuals mental experience and behaviour
Why we do MSE:
Determine risk and severity, identify signs and symptoms, monitor change and improvement, generate hypothesis, documentation
What done with history:
Individual details, identify present problems, history of illness, personal history, previous medical/surgical history, family history, illicit drug use, MSE
MSE includes (9):
- Appearance and behaviour
- Speech
- Mood and affect
- Form of thought
- Content of thought
- Perceptual disturbances
- Sensorium and cognition
- Insight
- Formulation
Symptoms of alcohol withdrawal:
Sweating, tremors, anxiety, agitation, nausea and vomiting, hallucinations, orientation, headaches, seizure
Principles of nursing care alcohol abuse + substance:
Initial assessment, friendly and calm, seizure precautions, limit environmental stimuli, dim lights, food and nourishing fluids, medication management, assist ADL’s, obtain history, teach about HIV, non-judgemental
Psychosis:
Group of disorders characterised by hallucinations and thought disorder
Schizophrenia:
Most common type of psychosis characterised by psychotic features.
Disturbed thought, perception, volition, emotion with impairment of judgement and behaviour
Subtypes of schizophrenia:
Paranoid (delusions of grandeur)
Disorganised (immature emotionally)
Catatonic (immobility or excited agitation, unusual motor response)
Residual (one episode but no longer shows major symptoms)
Undifferentiated (various symptoms not in one category)
Positive schizophrenic conditions:
Delusions, hallucinations, disorganised thoughts, disturbance in language
Negative schizophrenic conditions:
Blunting effect, anhedonia, sociality, abolition, apathy, poverty of speech
Diagnosing schizophrenia:
At least 2 symptoms in a period of one month:
- delusion
- hallucination
- disorganised speech pattern
- behaviour disturbance
- negative symptoms
Social, occupational, duration (6 months), exclusions (other disorders)
Assessment in schizophrenia:
- Full psychiatric history
- Physical examination
- MSE
- Risk assessment
- Current medications and compliance
- Family response and support
Phases of schizophrenia (4):
- Prodromal phase (initial symptoms identified)
- Acute phase (psychotic symptoms)
- Maintenance phase (less severe symptoms)
- Stabilisation phase (remission of symptoms)
Anxiety VS anxiety disorders:
Anxiety is a normal reaction of alertness and an adaptive response, anxiety disorder is when a client sows exaggerated or excessive anxiety with psychological changes
Types of anxiety disorders:
Panic attack, panic disorder, generalised anxiety disorder, obsessive compulsive disorder, acute stress disorder, PTSD
Symptoms of anxiety disorders:
Panic, fear, stress, worry
Management of anxiety:
Anti-anxiety medication, beta blockers, relaxation and controlled breathing, constructive thoughts, CBT, flooding, thought stopping
Somatoform disorders:
Somatization disorder, conversion disorder, pain disorder, body dysmorphic, undifferentiated somatoform
Dissociative disorders:
Amnesia, fugue, depersonalisation disorder, identity disorder, multiple personality
Cluster A personality disorders:
Paranoid, schizoid, schizotypal
Cluster B personality disorders:
Antisocial, borderline, histrionic, narcissistic
Cluster C personality disorder:
Avoidant, dependent, OCD
Kleptomania:
Theft of worthless objects, relieves tension
Assessments with personality disorders:
Full psychiatric history, history of physical and sexual abuse, history of drug and alcohol use, physical examination, MSE, risk assessment
Managing personality disorders:
Antipsychotics, mood stabilisers, antidepressants, anti-anxiety, CBT, family therapy
Basic counselling skills:
Active listening, attending behaviour
ECT:
Induction of a fit or seizure by passing controlled electric current through the brain via mental electrodes across the temples
Indications of ECT:
Major depression, bi polar, catatonic seizure, puerperal psychosis
Contraindications to ECT:
MI, pulmonary embolism, cerebral tumours, subdural hematoma
Types of risks:
Risk to suicide, risk of deliberate self harm, risk of self neglect, accidental harm, absconding
OTHERS:
Violence, harm to child, deliberate fire setting, sexual abuse, risk of exploitation, elder abuse
Antipsychotics:
Main treatment of psychotic disorders, schizophrenia associated with dopamine overactivity, antipsychotics assist brain to restore chemical balance, subdivided into typical and atypical
TYPICAL:
Older and conventional antipsychotics and AKA as neuroleptics, effective against positive symptoms
Typical drugs include:
Chlorpromazine, haloperidol, thioridazine, trifluoperazine, pericyazine
Effect of typical drugs:
Dopamine antagonist, target positive symptoms, calming effect, less expensive than atypical, do NOT treat negative symptoms or EPSE
EPSE:
Dystonia (stiffness/tonic contraction of muscles)
Oculogyric crisis (rotate eyeballs)
Akathisia (restlessness, agitation)
Parkinsonism (tremor, rigidity, mask-like face)
Tardive dyskinesia (involuntary face movements, tongue and lips)
Neuroleptic malignant syndrome (severe EPS, sweating, muscle rigidity)
Atypical antipsychotics:
Newer antipsychotics, treat both positive and negative symptoms and have less side effects which include (risperidone, olanzapine, clozapine)
Anxiolytics:
Diazepam, clonazepam, lorazepam, buspirone
Sedatives and hypnotics:
Zopiclone, zolpidem, temazepam
Nursing diagnosis of depression:
Risk of suicide, imbalanced nutrition, self care defecit, hopelessness, impaired social interaction, ineffective coping
Nursing diagnosis of mania:
Risk of violence, disturbed sensory perception, disturbed thought processes, impaired verbal communication, ineffective coping, non compliance
MHA:
Police have the power to apprehended any person they suspect has a mental illness. Either a medical practitioner or an authorised mental health practitioner must examine the patient who could be released or referred for further psychiatric examination
MHA legal forms:
Form 1- Referral by MP or AMHP for examination by psychiatrist within 24 hrs
Form 2- Detention of voluntary patient at risk by SMHP in the absence of doctor for 6 hours
Form 3 - Transport Order
Form 4 - Detention for further assessment for 48 hrs
Form 5 - Order for receival into authorised hospital for further assessment for 72 hrs
Form 6 - Involuntary patient order. Patient is detained for 28 days
Form 7 - Transfer between authorised hospitals
Form 8 - No longer involuntary patient
Form 9 - Continuation of involuntary order for up 6 months
Form 10 - Community Treatment Order (CTO)
Form 11 – Revocation of a CTO
Form 12 - Extending or varying a CTO
Form 13 - Breach of CTO
Form 14 - Order to attend treatment
Medication treatment of AWS:
Naltrexone, benzodiazepine, thiamine, acamprosate, methadone
Anorexia nervosa:
Anorexia nervosa is a serious mental disorder characterised by significant weight loss resulting from excessive dieting
Anorexic clients consider themselves to be fat, no matter what their actual weight is
Usually strive for perfection
Set very high standards for themselves and feel they always have to prove their competence
They feel the only control they have in their lives is in the area of food and weight
If they cannot control what is happening around them, they can control their weight
Complications of AN:
Cardiac irregularities due to protein-calorie malnutrition
Electrolyte abnormalities: low potassium and sodium levels
GIT effects: feeling bloated or full even after eating small amounts
Renal dysfunction: Reduced glomerular filtration rate
Neurological changes due to brain atrophy
Cognitive changes: impairment in attention & concentration
Skin changes due to protein-calorie malnutrition
Re-feeding syndrome due to imbalance in electrolytes and fluids
Bulimia nervosa:
Bulimia is mental disorder characterised by a cycle of dieting, binge eating followed by purging to try and lose weight
A binge may range from 1,000 to 10,000 calories
Purging methods usually involve vomiting and laxative abuse Other forms of purging can involve use of diuretics, diet pills and enemas
People with bulimia usually do not feel secure about their own self- worth
They often strive for the approval of others
Food becomes their only source of comfort
Bulimia also serves as a function for blocking or letting out feelings
Unlike anorexia, people with bulimia do realise they have a problem & are more likely to seek help
Potential nursing diagnosis of AN and BN:
Anorexia nervosa Imbalanced Nutrition: Less than Body Requirement Distorted Body Image Ineffective Individual Coping Chronic Low Self-Esteem
Bulimia nervosa and binge eating
Anxiety
Ineffective Individual Coping
Compromised Family Coping
Assessments with ED:
Psychiatric evaluation/ mental state assessment
Body image assessment
Disordered eating behaviours & rituals assessment
Nutritional assessment
Family assessment
Physical examination
Routine laboratory investigations: TFT, FBC, LFT, RFT
Blood chemistry: Electrolytes
Cardiac assessment: ECG
BMI calculation:
Height squared divided by weight
Managing ED:
Psychopharmocotherapy
Antidepressants, anti-anxiety & antipsychotics such as olanzapine to reduce image distortions & severe obsessions
Other medications
Multivitamins, Phosphate Sandoz, Calcitrate Plus Vitamin D
Psychosocial therapy Cognitive behaviour therapy - behaviour modification Motivational enhancement therapy Psycho-education and goal setting Supportive therapy Family support and education Interpersonal relationship therapy Individual & group psychotherapy
Dementia:
Dementia denotes a group cognitive disorders characterised by:
Cognitive impairment
Deterioration of language and motor skills
Disturbance in perception
Mood changes
The distinguishing landmark in dementia is
the significant change in cognitive functions
Causes of dementia:
Some of the causes include:
Infection to the brain (meningitis, encephalitis)
Head injury
Poisons and toxic sprays
Alcohol and drug abuse
Metabolic and endocrine disturbances: myxoedema
Degenerative diseases: parkinson’s disease
Vascular disorders: stroke/CVA
Hereditory
Types of dementia:
Alzheimer's disease AD Huntington Chorea Creutzfeldt-Jakob Disease Dementia with Lewis Bodies Frontal lobe dementia - Pick’s Disease Vascular dementia Wernicke-Korsakoff Syndrome
Assessment with dementia:
Thorough Physical examination
Collateral history
Mini-Mental State Examination (MMSE)
Mental Status Examination (MSE)
Neurological examination
Beck Depression Inventory (R/O depression)
Routine blood checks - FBC TFT, B12, Folate
Blood chemistry - Renal function, metabolic, hepatitis, HIV, VDRL
CT scan- Computerised Tomography
MRI - Magnetic Resonance Imaging test
Treatment of dementia:
Psychopharmacotherapy
Symptomatic treatment with: anti-anxiety, anti-psychotic, anti-depressants and sedatives
Cholinesterase inhibitors are used to treat mild to moderate dementia and include the following drugs: Aricept (donepezil), Galantamine and Rivastigmine - prevent cognitive deterioration
Memantine used to treat mild to moderate dementia to slow memory deterioration
Psychosocial therapies
Cognitive Behaviour Therapy (CBT)
Occupation therapy
Recreational therapy and music therapy
Validation therapy
Reminiscence, reviewing past events using photos albums – by looking at school days, wedding day photos
Delirium:
Delirium is an acute organic mental syndrome characterised by: Cognitive impairment Altered level of consciousness Poor concentration and attention Psychomotor activity Sleep-wake disturbances
Delirium causes:
Any conditions affecting the brain
- Head injury, brain tumour, epilepsy, subdural, CVA
Drug toxicity, interaction or withdrawal
Hypoxia secondary to respiratory or circulatory disorder
Infections: meningitis, encephalitis, sepsis, HIV,
CCF: due to diminished cerebral blood flow
Biochemical disturbances: calcium, sodium, urea
Metabolic and endocrine disorders: thyroid, blood glucose abnormalities
Psychiatric disorders: depression or psychosis
Hyperthermia or hypothermia
Nutritional deficiencies especially B12 and iron
Assessment of delirium:
Routine BLOOD screening: FBC, LFT, TFT, B12 Blood chemistry: drug screening, renal function, hepatitis, HIV, VDRL Neuropsychological testing CT scan - Computerised Tomography MRI - Magnetic Resonance Imaging test Thorough physical assessment Assess medication effects or withdrawal Mini-Mental State Examination (MMSE) Mental Status Examination (MSE)
Nursing care of patient with delirium:
Provide safe and familiar environment to prevent injury
Evaluate the need for one to one to protect patient
Provide non-stimulating environment to promote rest
Provide good nurse patient relationship
Offer continuity of care with familiar faces to alley fear
Communication should be simple, clear, call patient’s name, tell who you are, where she/he is, what time it is
Avoid sudden movement as patient is frightened
Obtain urine, blood and other specimen as ordered by the doctor
Assist with ADL’s: hygiene, bowels, bladder and ensure patients wear glasses or hearing aids if they wear them
Provide adequate light diet and fluids
Restore and maintain fluid and electrolyte balance
Give medication as ordered to treat cause or symptoms
Offer support and reassurance to patient and family
Differentiating the 3 D’s:
Differentiating 3 D’s (depression, delirium and dementia) needs comprehensive assessment including: A complete medical/surgical/psychiatric and collateral history Examine the presenting symptoms A full physical examination Neurological examination Mental State Examination Blood checks and urine test ECG and EEG CT scan and MRI Check support offered to the patient
