NURS3481 Study Helps Exam 1; Psychiatric Mental Health Nursing of Individuals, Families and Groups..

NURS3481 Study Helps Exam 1; Psychiatric Mental Health Nursing of Individuals, Families and Groups. 1. Discuss each of the following major neurotransmitters (GABA, Acetylcholine, Dopamine, and Serotonin) and the role they play in common psychiatric diagnosis. 1. Dopamine-involved with fine muscle movements, integration of emotions, thoughts, & decision making. INCREASED DOPA= schizophrenia & mania; DECREASED DOPA = Parkinson’s & depression. When you think Dopa think schizophrenia pts. 2. Acetylcholine- involved with learning and memory; regulated mood, mania, sexual aggression. Stimulates the PNS. INCREASED ACH= depression; DECREASED ACH= Alzheimer’s dz, Huntington’s & Parkinson dz. When you think of ACH think of memory. 3. GABA- involved with inhibitions, reduces aggression, excitation and anxiety. Also deals with pain perception, anticonvulsant, muscle relaxing properties; can impair cognition and psychomotor.DECREASED GABA= anxiety disorders, mania, Huntington’s INCREASED GABA = reduction of anxiety. When you think GABA think stress & anxiety. a. Glutamate: helps synthesis GABA: the “feel good” elevates mood 4. Serotonin- Plays a role in sleep regulation, hunger, mood states, aggression, pain perception & sexual activity.INCREASED SE = Anxiety; DECREASED SE = depression When you think serotonin think depression. 2. Compare and contrast the impact/effect of psychiatric medications on neurotransmitters in the parasympathetic nervous system and identify resulting side/adverse effects that you may see in your patient (review chapter 4 for specific receptor site impact and related effects).  Ach block- blurred vision, dry mouth, constipation, sinus tachycardia, urinary retention.  NE reuptake inhibition- reduce depression, anxiety, GI disturbances, sexual dysfunction Dopamine reuptake inhibition- decrease depression, psychomotor activation, anti parkinson’s effects.  Serotonin block- reduces depression, reduce suicidal behavior, hypotension and ejaculatory dysfunction. Antidepressants block ACh while increasing NE and SE this can cause blurred vision, dry mouth, constipation, sinus tachycardia, & urinary retention. Second-generation & third-generation antipsychotic meds can also cause a muscarinic cholinergic block while increasing dopa and serotonin leading to dry mouth, blurred vision, tachycardia, urinary retention, constipation. 1 The University of Texas at Arlington College of Nursing Psychiatric Mental Health Nursing of Individuals, Families and Groups - NURS 3481 3. Compare and contrast the muscarinic receptor blockade effects and dopamine-blocking effects of psychotropic drugs and identify important teaching for your patient. ● Dopamine-blocking effects include a decrease in dopamine, decrease in the mania/ schizophrenia characteristics, possible increase in EPS symptoms, gynecomastia, galactorrhea (inappropriate milk production), amenorrhea (absence of menstruation) ○ affect primarily the positive symptoms of schizophrenia: hallucination, delusion, disorganized speech (associative looseness), and bizarre behavior. ● Muscarinic blocking effects include all anticholinergic symptoms (dry mouth, blurry vision, urinary retention, etc.), may affect memory, used to counteract dopamine blocking side effects 4. Discuss cognitive reframing and its impact on negative and irrational thought processes, discuss how reframing distorted thoughts helps with certain anxiety disorders and identify situations where this therapeutic tool might be most useful. 5. Pg 8 Long Review Pg 6 Compare and contrast medications for anxiety disorders including both benzodiazepines and non-benzodiazepines, identifying important teaching, side/adverse effects for each. ● Too much to copy and paste from long review (pg. 6) 6. Compare and contrast therapies for anxiety and stress disorders including cognitive restructuring, flooding techniques, thought stopping, response blocking, relaxation, and desensitization. 7. Compare and contrast Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, Phobia-related disorders, Social anxiety disorder, Specific (Simple) Phobias, Separation anxiety disorder, Agoraphobia and identify best medication for each. 8. Discuss the relationship between the sympathetic and parasympathetic nervous system and how they impact stress reduction and the relaxation response.  The stress response is counteracted by the relaxation response and allows the patient to switch from the sympathetic mode of the autonomic nervous system (fight-or-flight response) to a state of relaxation (the parasympathetic mode).  GAS: general adaption syndrome- 3 stages  Sympathetic Nervous System: Alarm stage o stage is initial, brief, and adaptive response to stressor (fight/flight) o Sympathetic: brain’s cortex and hypothalamus signal adrenals to release catecholamine adrenaline- increase sympathetic activity 2 The University of Texas at Arlington College of Nursing Psychiatric Mental Health Nursing of Individuals, Families and Groups - NURS 3481 o Increase HR, RR, BP to enhance strength/speed. o Pupils dilate to broaden view on environment, blood shunts away from GI tract (dry mouth) and kidneys. o Corticosteroids: hypothalamus sends message to adrenal cortex to produce corticosteroids to increase muscle endurance/stamina and reduce non essential body functions. o These inhibit 3 things: reproduction, growth and immunity o Endorphins: endorphins are released to reduce sensitivity to pain and injury- limit perception of pain.  Acute Stress: uneasiness, concern, sadness, loss of appetite, immunosuppression, Increased metabolism, HTN, infertility, impotence, increased energy mobilization, decreased memory and learning, increased cardiovascular tone, increase risk of blood clots and stroke, increased cardiopulmonary tone  Chronic Stress: anxiety and panic attacks, depression or melancholia, anorexia/overeating,immunosuppression, insulin-resistant diabetes, amenorrhea, loss of libido, increased fatigue and irritability, increased risk for cardiac events, increased respiratory problems.  Parasympathetic Nervous System:  Relaxation Response: counteracts stress response by switching from SNS to PNS.  See BOX 10-4, pg. 176 to see how to activate the Benson-Henry protocol for relaxation.  Phase I: 1. Choose focus breathing, word, phrase, image, or short prayer 2. Sit in comfortable position in a calm place 3. Close your eyes 4. Progressively relax all your muscles, beginning from feet to face 5. Breathe through nose- be aware of breathing, do it naturally and with ease 6. Gently ignore any thoughts that may come to mind 7. Continue for 12-15 minutes, one to twice a day. 8. When finished, sit quietly for few min- w/ eyes open and closed. Don’t stand for while after.  Phase II 3 The University of Texas at Arlington College of Nursing Psychiatric Mental Health Nursing of Individuals, Families and Groups - NURS 3481 ○ For 8 to 10 minutes, focus on imagery of peaceful scene where you are free from whatever stress you are experiencing. Promotes healing expectations, beliefs, and memories. SNS:  Decrease: salivary flow, arterioles, stomach motility and secretion, pancreas, intestinal motility, bladder wall,  Increase: pupil size, lacrimal glands, heart, bronchi, epinephrine PNS:  Decrease: pupil size, lacrimal glands, heart, bronchi,  Increase: salivary flow, arterioles, stomach motility, pancreas, intestinal motility, bladder contraction 9. Discuss the attribute of caring in nursing and give examples. 10. Compare and contrast the art and the science of nursing as described by Peplau and give examples. 11. Describe the most reliable sources of data collection when completing an assessment on your new patient. 12. Compare and contrast the concepts of Mental Health and Mental Illness giving examples and attributes of each. 13. Discuss the role of interpersonal theories (Sullivan, Peplau) as cornerstones of the nurse’s role in helping patients develop effective interpersonal relationships. Sullivan's Interpersonal Theory: A theory where interpersonal processes that could be observed in a social framework and defined personality as a behavior that can be observed within interpersonal relationships. ● Sullivan believed the purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety (defined as any painful feeling or emotion that arises from social insecurity or prevents biological needs from being satisfied). ● Security operation is used to describe measures that the person employs to reduce anxiety and enhance security. Collectively, all of the security operations a person uses to defend against anxiety and ensure self-esteem make up the self-system. Nursing Implications regarding Sullivan's Theory : Foundation of Hildegard Peplau's theory; therapy should educate patients and gain personal insight; nurse should interact (participant/observer) with patients with mutuality, respect, unconditional acceptance, and empathy. 4 The University of Texas at Arlington College of Nursing Psychiatric Mental Health Nursing of Individuals, Families and Groups - NURS 3481 HeldegardPeplau'sTheory:Viewednursingasaneducativeinstrumentdesignedtohelp individuals and communities use their capacities in living more productively; helping patients make positive changes; illness is an opportunity for experiential learning, personal growth, improved coping strategies and psychiatric nurses play a role in facilitating this growth. ● It was Peplau who identified the four stages of the nurse-patient relationship (pre-orientation, orientation, working and termination phase) ● Pre-orientation: Assessment: gathering information; assessing one's feelings, fears, and anxieties about working with a particular client ○ Goal : Explore self-perceptions ● Orientation Phase: Nurse and client become acquainted, rapport is established, roles and responsibilities are clarified, confidentiality is discussed, patient’s problems are articulated, and mutually agreed-upon goals are established. ○ Goal : Establish trust; formulate contract for intervention  Working Phase: maintain the relationship, share information, gather further data,facilitate behavior change, explore areas that are causing problems in patient’s life, promote patient’s problem-solving skills and self esteem, and evaluate progress. ○ Goal : Promote client change  Termination Phase: Summarize goals achieved in the relationship, discuss ways for the patient to incorporate into daily life any new coping strategies. ● Goal: Evaluate goal attainment; Ensure therapeutic closure 14. Compare and contrast Erickson’s developmental tasks and what should occur in each if successfully completed. 15. Name Developmental tasks Successful if: Trust v. mistrust (0- 1.5 yr) Forming attachment to mom Relates, trusts, faith, and hope in other people and future/ environment 5 The University of Texas at Arlington College of Nursing Psychiatric Mental Health Nursing of Individuals, Families and Groups - NURS 3481 Autonomy v. shame/doubt (1.5-3 yr) Basic control of self & environment (ex: toilet training) Self-control and willpower Initiative v. guilt (3-6 yr) Becoming purposeful and directive Initiate one’s own activities, sense of purpose (I like to help mom set the table) Industry v. inferiority (6-12) Social, physical, and school skills Competence and ability to work (ex: I’m getting really good at swimming since taking lessons) Identity v. role confusion (12-20) Transition from childhood to adulthood, develop sense of identity Personal identity, fidelity Intimacy v. isolation (20-35) Develop intimate bonds of love/ friendship Ability to love deeply and commit oneself (ex: getting married) Generativity v. selfabsorption (36-65) Fulfilling life goals involving family, career, and society, develop concerns that embrace future generations Ability to give and care for others Integrity v. despair (65+) Life review and accepting its meaning Integrity and fulfillment, willingness to face death, wisdom 16. Compare and contrast the skill-set and practice of psychiatric nursing and medical-surgical nursing, reflecting on the holistic perspective of psychiatric nursing.  Psychiatric nurses use of self as its art, they work with people throughout the lifespan. They assist healthy people who are in crisis or who are experiencing life problems as well as those with long-term mental illness. They may include people with dual diagnosis such as a mental disorder and coexisting substance disorder, homeless persons and families, people in jail, abused patients, and people in crisis 6 The University of Texas at Arlington College of Nursing Psychiatric Mental Health Nursing of Individuals, Families and Groups - NURS 3481 17. Compare and contrast the concepts of incidence, prevalence, comorbidity as they apply to mental health disorders.  Incidence- number of new cases of mental disorders in a healthy population within a given period of time. (usually annually) ○ Ex: ● Prevalence- TOTAL number of cases, new and existing, in a population within a given period of time ○ Ex: ● Comorbidity- individuals having more than one mental disorder at a time 18. #24 Discuss the steps and process of the nursing process and be able to create a plan for nursing care delivery in which your patient’s primary needs are identified and interventions are planned to assist the patient to help your patient navigate life more successfully. 19. Discuss legal issues related to documentation, confidentiality, patient rights and the concept of least restrictive.  Duty to warn- a psychotherapist has a duty to warn a patient’s potential victim of potential harm  Duty to protect- therapist has a duty to protect the potential victim by assessing and predicting the patient’s danger of violence toward another, identify the specific persons being threatened, and contacting the intended victim, victim’s family, or police, or any other steps that are necessary under the circumstances to protect  Nurses have the duty to report child, elder, and disabled adults abuse  Right to Treatment: requires that psychiatric treatment be provided to all persons admitted to a public hospital and must meet the following criteria ○ The environment must be humane ○ Staff must be qualified and sufficient to provide adequate treatment ○ The plan of care must be individualized  Right to Refuse Treatment: patients have the right to refuse treatment and may withhold consent or withdraw consent at any time, must be honored whether it is a verbal or written retraction 7 The University of Texas at Arlington College of Nursing Psychiatric Mental Health Nursing of Individuals, Families and Groups - NURS 3481 ○ A person may be medicated against their will following a court hearing if they meet all of the following criteria 1. The person has a serious mental illness 2. The person’s ability to function is deteriorating or they are suffering or exhibiting threatening behavior 3. The benefits of treatment outweigh the harm 4. The person lacks the capacity to make a reasoned decision about the treatment 5. Less restrictive services have been found inappropriate.