NUR 2488 Mental Health Nursing Final Exam-3 Modules

NUR 2488 Mental Health Nursing Final Exam-3 Modules Cognitive behavior theory- Aaron Beck Introduction to Psychiatric Nursing Basic Brain Anatomy- what do the different part of brain control? Hypothalamus? Neurons/ synapse- pg. 51 Understand milieu therapy- can you describe it in a clinical setting? Describe the difference between mental health and mental illness Maslow’s Hierarchy of needs (pg 31) Know scenarios Safety is #1 in terms of what you are doing as a nurse. Self-actualization Physiological ***What is the highest we want to attain in terms of Maslow? Self-actualization.*** ***You walk into Whispering Oaks and find resident with pee all over herself? Maslow- physiolocial/physical.*** Peplau’s Theory of Interpersonal Relations Mother of psychologic theory Freud- what did he contribute to psychiatric setting? Review table 3-2 (pg 38) Therapeutic Communication Empathy-Put yourself in their shoes. Help them talk about the feeling. Active listening-attending to verbal and non-verbal forms of communication. The way you carry on in front of the patient. Be able to given examples of verbal and non-verbal communication. Know it. Review table 8-1, 8-2, 8-3 Phases of the Nurse-Patient Relationships Describe relationship during each phase Preorientation phase: you have not met them yet Orientation Phase: building rapport Working phase: implementation Termination phase: discharge, evaluation, speak about everything that happened up to this phase. ***There will be a lot of question on termination phase.*** Boundaries Review table 9-1 Legal, Ethical, and Cultural Give examples of Negligence, Autonomy, Justice, Beneficence, Fidelity, and Veracity They will be on the exam. Know examples. Rights for Voluntary and Involuntary Admission Know it. Informed Consent Know it. Confidentiality/HIPAA Know it. Health Information Portability and Accountability Act of 1996. Psychiatric Nursing Assessment – priority interventions, nursing dx, etc. (pg 101) Mood Disorders Primary vs. Secondary Depression Review tables 15-2, 15-8 & 15-9 (Foods that interact) First-line treatment for Depression – Can you name them? Patient teaching for Nortriptyline, TCAs vs. SSRIs vs. MAOIs – know examples from classes of meds/benefits/risks/adverse effects/pt. teaching (Review table 15-7) Review box 15-2 Understand when the question is looking for a response that is asking for low or high tyramine Know the foods low and high in tyramine Know the meds Suicidal Ideation – Assessment, Risk Factors & Interventions (pg 437) Table 23-1, 23-2 We are there to help them get their control back. If they commit suicide, that means someone did not do their job. If the patient has to shit, you are going with them! No more privacy. Lithium Levels & Toxicity Serum level: 0.6-1.2 S/S: nausea Table 15-5 Mr. Jones is on lithium, but he loves his Jamaican food with lots of salt and spice. He comes in and says lithium is not working. He tells you what he loves to eat. High salt intake will decrease its effect. Check serum levels every month, 2 hours after last dose. Anything that will cause dehydration (N/V) will increase the serum lithium level. ***Question may not include the word dehydration in it.*** Review table 16-5 Anxiety Disorders Anxiety Levels & Stages Review table 11-1, 11-2, 11-9 & 11-10 Chronic-generalized anxiety. “I’ve had this feeling for months.” Panic-chest pain, panting Severe- Benzodiazepines – commonly given & teaching needed for patients Table 11-4- Understand and Describe Defense Mechanisms Denial Reaction formation-You just go ahead and do something even if you don’t want to, to cope with your anxiety. Example: you do not like animals, yet you want to be a vet. Example: You hate someone but you bring them donuts every time you see them. Example: You do not like your manager, but you always bring her chocolates. Rationalization-Example: Abuse your spouse because they made you. Example: Someone steals because they say their parents did not feed them when they were young. Discuss the benefits of buspirone For maintenance Thought Disorders Positive and Negative Symptoms of Schizophrenia Negative symptom-flat affect EPS/Tardive Dyskinesia- identify and describe Akathisia Tardive dyskinesia (tongue flapping) Serotonin syndrome-no fever Neuroleptic Malignancy Syndrome- be able to describe ***Fever*** The other conditions do not include fever. Review box 17-2, 17-3 Review table 17-8 & 17-9 Personality, Somatoform, and Eating Disorders Describe personality disorders- Definition: inflexible, unpredictable, difficult with people Narcistic people-arrogant, grandiose, all about themselves, they are never wrong WILL BE ON EXAM Histrionic people-flashy, attention-seeking, showcasing, bright colors WILL BE ON EXAM Dependent behavior Avoidance behavior (Schizophrenia is not a personality disorder) ***Answer the questions in a general context. The response will not focus on the patient in the specific question, but the disorder generally. Review table 13-2 Highest nursing priority with these dx What comorbidities exist with anorexia? With bulimia? Review box 14-1, 14-2 & 14-3 Depression is the big one. Anorexia-they do not want to eat, aggressive exercise (give them something else to do because they can pass out, do not just stop them). Bulimia-they eat, purge. YOU DO NOT RANDOMLY WEIGH THEM. BE CONSISTANT AND STRUCTURED. Conversion Disorder Review table 12-1 Example: The patient says they are blind and they really believe they are, but all tests prove they can. Example: The patient says they are paralyzed and they really believe they are, but you know they are not. Do not feed into it. Do not set limits, do not tell them to stop it. Conversion disorder vs. Hypochondriac Hypochondriac: Example-you got bitten by an ant and go to the doctor and the MD just gives you cream and sends you home. You go see an oncologist the next day because you swear you have cancer now. Conduct Disorder Destructive, bullying, aggressive towards others. They cannot tolerate stress. THIS IS NOT THE SAME AS IMPULSIVE BEHAVIOR. What is the difference between conduct disorder and anti-social disorder? Anti-social may not bully, be aggressive, or destroy people’s objects. Anti-social people are normally nice or charming in public, but serial killers on the down low. Addiction, Abuse and Violence Signs of Alcohol Withdrawal Lots of questions on it. S/S: Know them. Alcohol Dependence – know associated dx Know them. Nursing Interventions & assessment tools Involve the family in the care. ***How do you know that the family members are coping or getting better? They talk about it and how it is impacting the family negatively. Example- Wife says her husband spends all the money on alcohol. ***People abuse cocaine (CNS stimulant) and alcohol (CNS depressant) together. They mellow out. They are in trouble when they cannot have it anymore. *** Peak withdrawal for EtOH-24-48 hours. You need to ask about alcohol use in assessment. In report, pass on alcohol use to next nurse in case the patient withdrawal… no matter how much the patient may drink. Example: Sign of opioid (morphine, heroin) withdrawals-pinpoint pupils. Opioids are CNS depressants Narcan/Naloxone-give within first 15 minutes. Take the patient straight to ICU because you just pulled the opioid out of the patient’s system. They can go into a systemic shock. Do not give naloxone for alcohol abuse. Librium and Ativan are used for alcohol withdrawal. Antabuse/Disulfiram-It is not used to treat alcohol withdrawal, give it after the withdrawal. It is used to repair the alcohol abuse, it will make them suck and throw up when they have alcohol. The patient must be cognitively intact so they understand that they cannot drink alcohol with the medication. Make sure they are cognitively intact before prescribing Antabuse. Review box 19-4 Review table 19-11 Review table 24-1 Cognitive and Degenerative Disorders Alzheimer’s - Understand Pathology Macular degeneration of the brain. Plaque on brain gets degenerate. Agnosia-you do not understand the use of objects anymore (Example-you do not know what a fork is for). Alzheimer’s – Meds used Review table 18-5 & 18-6 Maybe one or two, just know the meds. She will not dig deep into them or trick us. ***What neurotransmitter plays a role is Alzheimer’s? ACETYLCHOLINE*** (ON THE TEST) Nursing Interventions for Alzheimer’s Patients Review box 18-2 Just read the nursing interventions. Very high risk for injury. Impulsive Behaviors- Review table 27-3 Definition-When you do something without thinking it through, you just do it. Impulsive people do not process anything. They do not think about how it will affect something else. DO NOT PICK ANSWER THAT SAYS THE PATIENT IS QUICK TO HIT SOMEBODY. THAT IS NOT IMPULSIVE. Dementia and delirium-Table 18-1. Know the differences. KEY: In delirium, symptoms may fluctuate within 24 hour-period. In dementia, they are consistent with symptoms. Patients in Crisis, Grief, Complementary Therapy Discuss factors that influence the grieving process It is straight forward, read it in the chapter. Describe alarm, exhaustion, fight or flight Alarm-Ex. Walk into your patient’s room, they are having a seizure, how do you respond? Alarm = HR increases. Fight or flight response-ADRENALINE OR NOREPINEPHINE. Identify forms of complementary therapies