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Mental Health > Somatic Therapy > Flashcards

Somatic Therapy Flashcards

1
Q

Somatic Therapy

A

treatment approaches that use physiological or physical intervention to effect behavioural changes

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2
Q

What are the common form of Somatic Therapy?

P.E.R.S. rTMS

A

Common form of Somatic therapy (PERS), rTMS
Psychopharmacology
- Antipsychotics
- Antidepressants
- Mood stabilizers
- Anxiolytics & Hypnotics
ECT
Restraints (Physical, Chemical)
- Physical: Physical Force, Mechanical Force
- Chemical: Drugs (Rapid Tranquilization)
Seclusions (Voluntary, Involuntary)

rTMS

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3
Q

What are the different types of Restraints?

P.M.D.

A

Restraint
Any method of used to restrict a person’s freedom of movement, physical activity & normal access to the body.

Include :
*Physical force
*Mechanical devices
*Drugs (Rapid Tranquilization)

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4
Q

Seclusions

A

*Only used in psychiatric unit
* Placed in a locked padded room alone under constant observation by a video camera

a) Involuntary seclusion:
without their consent,
prevented from leaving or deliberately isolated from others.

This is to be differentiated by patient requested “Time-out”

b) Voluntary selusion (Quiet time)
*Placed in a quiet environment at client’s request
*Client determines the period & whether the door is locked
*Can request that period of seclusion be terminated at any time.

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5
Q

What are the indications/ purposes of
Restraints/ Seclusions?

A

**a) Behavioural reasons: **
- Behaviour is out of control
- Aggressive
e.g. may hurt self or others, aggressive
- Never used as punishment
- Not make it easier for caregivers.

b) Medical or Surgical Reasons
- need wrist / mittens restraints
- prevent client from pulling out tubes.
- Or help client stay still during or after a procedure.

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6
Q

Nursing management for Patients on Restraints

A

Once applied, check every 15mins
*Check aggressive behaviour

  • Till client improves
    – no longer hurting self or others
  • up to 1 to 2 hrs at a time if necessary

1) Elimination Issues (constipation/ incontinent, why?)
2) Injuries (applied wrongly, increased agitation, resistance against restraints)
3) Respiratory issues (pneumonia, aspiration pneumonia)
4) Emotional issues (being punished)
5) Nutritional Issues (loss of appetite, needing assistance)
6) Physical Issues (MSK, DVT)

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7
Q

What should the nurses do before restraining the client?

A
  • Must obtain Doctor’s orders asap for each & every restraint episode

Exception:
- Emergency
- RN may authorize application
- Do get written/ verbal orders immediately following or no later than one hour after the restraint.

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8
Q

What must an order include?
(TRTR)

A
  • What was tried before the restraint
  • Reason for restraint
  • Time Frame
  • Release Criteria
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9
Q

Potential problems after application of restraints

A

1) Elimination Issues (constipation/ incontinent, why?)
2) Injuries (applied wrongly, increased agitation, resistance against restraints)
3) Respiratory issues (pneumonia, aspiration pneumonia)
4) Emotional issues (being punished)
5) Nutritional Issues (loss of appetite, needing assistance)
6) Physical Issues (MSK, DVT)

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10
Q

Nursing care plan after applying restraints

A
  1. Monitor continuously - 1:1 observation
  2. Assess circulation & skin color
  3. every 15 minutes, more often if necessary
  4. Provide opportunity for motion & exercise
  5. at least 5 minutes during every hour in restraint
  6. Assess 2hrly for hydration, nutrition, toileting
  7. Assist in gaining control of behavior to return to milieu
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11
Q

Documentation after applying restraints
(Add on from TRTR)

A
  1. Client’s behaviour leading to need for restraint,
  2. Health problems
  3. Other strategies used to manage challenging behaviours,
  4. Consent to restrain,
  5. Timing & duration ,
  6. Arrangements for protecting safety of client and/or others
  7. Maintenance of confidentiality
  8. Who initiated restraint
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12
Q

ECT

A

ECT causes changes in monoamine neurotransmitter system, similar to the changes caused by antidepressant drugs

  • An electric current (70-150 volts) is passed through the brain for 0.5 to 2 seconds causing a seizure

The seizure from ECT must last approx. 30-60 seconds to be of therapeutic value

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13
Q

Short term side effects of ECT

A

Headaches
Muscle sores/ aches
Nausea
Dizziness

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14
Q

Long term side effects of ECT

A

Long-term Side Effects

**Anterograde **memory impairment
- (can’t form new memories)

Retrograde memory impairment
- (can’t remember things in the past)

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15
Q

Indications for ECT

A
  • Non-response to an adequate trial of antidepressants
  • High suicide potential
  • Depressive stupor
  • Catatonic
  • Delusions
  • Severe manic not controlled by medications
  • Post-partum psychosis after non- response to antidepressants
  • Schizophrenia-catatonic type when non-responsive
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16
Q

Nursing responsibilities
Pre-ECT

A
  • Patient consent should be obtained before ECT (benefits, side effects, other treatment options, written information and support should be given
    to the patient, advocate, family member or friend.
  • Can be given in-patient or day patient,
  • ECT is normally done 1-2 times a week, usually the course of treatment is from 6 – 8 sessions.

Preparation
Sticky tapes, Phy exam, Heart tracing, Blood test
ECG, X-ray, 6 hrs. fasting before procedure
VS monitoring, (esp: BP & spO2, is taken before the procedure)

Sticky leads are placed on the forehead and behind the ears to monitor and support brain waves and seizure activity during the treatment.

Patient Education
Anesthetist will conduct the assessment to see if patient is fit for the procedure.
- - General Anesthetic (Thiopentone) given before procedure
(Explain to the patient that ECT will be conducted while patient is asleep)

Prepare for ambu bag before anesthetic procedure

17
Q

Nursing responsibilities
before ECT

A

Before patient undergo ECT
- to stop any anti-convulsant medications
- to stop benzodiazepines before ECT.

ECT involves the use of mild sedation,
- fast for 8 hours, so that patient will not aspirate on their own gastric content.

18
Q

Nursing responsibilities
during ECT

A

During ECT, prevent patient from severe convulsion.

Short term side effects such as Nausea, headaches, muscle aches and postical state confusion.

Anterograde memory and retrograde impairments can also occur.
2nd injection for muscle relaxants is introduced.

More oxygen might be given to help patient breathe better. Mouth guard may also be given to protect their teeth during the seizure.

19
Q

Nursing responsibilities
after ECT

A

PFCS: Post Fit Confusional state.
(Light headache, confused state)

Prevent patient from having danger to themselves Slowly introduce food and drinks.

Observe tolerance to food and drinks, I/O charting.

After treatment, the patient continues to be monitored and is given more oxygen as they gradually wake up.

After treatment, the patient continues to be monitored and is given more oxygen as they gradually wake up.

Mental state should be assessed following each ECT session.

And treatment should be stopped when symptoms improve, and the patient starts making good recovery from the illness.

Cognitive function should also be monitored on an ongoing basis, but at the end of each course of treatment.

20
Q

Conditions that:
does not respond to ECT

A

Behavioural disorders
Mild depression

Anxiety disorder (AD)
Personality disorders (PD)

Phobic disorders
Somatoform disorders

21
Q

Serious Complications from ECT

A

Serious physical complications are rare.
1 in 50,000 side effects are reported and are comparable to general anesthetics used for minor surgery.

Prepare for ambu bag before anesthetic procedure

22
Q

rTMS

A

Repetitive Transcranial Magnetic Stimulation (rTMS)

23
Q

Repetitive Transcranial Magnetic Stimulation (rTMS)

A

Transcranial magnetic stimulation** (TMS) **:
a non-invasive stimulation of brain tissue through the production of the high or low-intensity magnetic field thought to modulate cortical excitability.

rTMS
applying recurring TMS pulses to a specific brain region.

24
Q

Indications for rTMS
(Only for the severe Ds, except the following:
Panic Disorder,
Personality Disorder,
Eating Disorder)

A

MDD
GAD
OCD
PTSD
Bipolar Disorder
Catatonia

25
Q

Side effects of rTMS

A

Scalp discomfort
Facial twitches
Light Headedness
Mild headaches
Seizure (extreme low risk <0.001)
- For patients with epilepsy or history of seizures (0.03)

26
Q

Before rTMS

A
  • Patient assessment
  • Ensure the consent is signed
  • Ensure there is an order
  • Ensure no contraindications
  • Patient Education
  • Remove metallic objects
  • Baseline vital signs
27
Q

During rTMS

A
  • Time out
  • Positioning
  • Set up rTMS machine with prescribed parameters

- Insert earplugs

  • Assess for adverse reaction
28
Q

After rTMS

A
  • Remove coil & earplugs
  • Assess for adverse reactions
  • Recheck** vital signs**
  • Educate patient to report any delayed or persistent side effects
  • Documentation
  • Follow-up & schedule next session

Mental Health (10 decks)

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