ATI mental health proctored, ATI CMS EXAM REVIEW

ATI mental health proctored, ATI CMS EXAM REVIEW Lithium levels range 0.5-1.4 Sodium 135-145 potassium 3.5-5 Tricyclic Antidepressants Sedation, urinary retention, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly MAOI inhibits breakdown of amine neurotransmitters, hypertensive crisis. avoid pseudonephrine. Chlorpromazine (thorazine) Anticholinergic side effects constipation, urinary retention, blurred vision, dry mouth. Suck on hard candy. It does not alter skin perfusion. Lithium maintain sodium levels watch for vomiting, diarrhea, sweating Alcohol withdrawal Naltroxone. 2-3 days after can be a seizure risk, hand tremors will occur, monitor bp Difference between alzheimers and dementia Alzheimers is progressive forgetfullness and dementia is rapid Confabulation Filling in gaps in memory bu fabrication Delusion false fixed belief seen in schizos Child abuse pattern inconsistency between history and child's injury Maslow's hierarcy of needs 1. sleep, food 2. safety 3. love and belonging 4. self actualization First priority for alcohol withdrawal rest and nutrition donepezil (aricept) for alzheimers prolong time and functioning of individual in early stages of disease Cocaine signs dilated pupils marijuana signs bloodshot eyes heroin signs pinpoint eyes pcp signs rapid eye movement agoraphobia fear of places or situations that might cause panic such as going outside Conversion physical complaints not true grandiosity "I am grand" narcissistic behavior PTSD nightmares, indecisive, lack of emotion during a event Kubler ross stages of grief 1. denial 2. anger 3. bargaining 4. depression 5. acceptance Alprazolam (xanax) panic disorder med. anticholingeric Benzo side effect dizziness, sedation, drowsiness OCD set time limits , cannot have a pleasant moment Borderline personality disorder a personality disorder characterized by lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures, self mutilation How often should provider renew restraints perscription q4 hrs and follow up withing 1st hour of prescribing Bupropion for quitting nicotine Buprenorphine think phine for opioids withdrawal treatment anorexia An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat. Appearance of lanugo, amenorrhea, intolerance to cold, bradycardia, dry skin, hypotension, occupied thoughts of food Bulimia An eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise. tooth erosion, hand calluses, hypokalemia monitor patient 1 hour after eating Lithium blood testing rules 8 hrs after last dose, 5 days after beginning dose, dosage changes, then testing for 6 months monthly methylphenidate improved attention opioid use disorder impaired coordination, euphoria, decreased respirations, drowsiness. think clumsy sleepy person For schizos what increases hallucinations? anxiety quetiapine schizo med, monitor glucose buspirone antianxiety, GAD, does not cause sedation, does not cause dependence, do not take as PRN, and this med will become effective in 2-4 weeks avolition lack of emotion delirium rapid fluctuations of loc chlordiazepoxide is for alcohol use disorder disulfram alcohol use disorder Amphetamine paranoia AE akathisia-agitation, restlessness Psychosocial History Perception of own health, beliefs about illness and wellness Activity/leisure activities, how the client passes time Use of substances/substance use disorder Stress level and coping abilities - usual coping strategies, support systems Cultural beliefs and practices Spiritual beliefs mental health exam Alert - The client is responsive and able to fully respond by opening her eyes and attending to a normal tone of voice and speech. The client answers questions spontaneously and appropriately. ■■ Lethargy - The client is able to open her eyes and respond but is drowsy and falls asleep readily. ■■ Stupor - The client requires vigorous or painful stimuli (pinching a tendon or rubbing the sternum) to elicit a brief response. She may not be able to respond verbally. ■■ Coma - No response can be achieved from repeated painful stimuli. Alturism Dealing with anxiety by reaching out to others. Person who lost spouse in fire is a firefighter sumblimination hidden feelings about someone and then goes to work out to release the anger orientation phase set boundaries and expectations, determine client's needs operant conditioning positive reinforcement aversion therapy use bad stimuli if patient does something bag like dog chewing on cord and you put bitter apple on the cord and the dog pulls away Cluster A Odd or ecentric. Schizo paranoid Cluster B Dramatic, emotional, erratic. Antisocial-Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility, borderline-Characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment, Cluster C Anxious, fearful. Avoidant, dependent, OCD paradoxical response insomnia, excitation, urgency LOC - ALERT patient is responsive opens eyes spontaneously answers questions appropriately LOC - LETHARGIC patient can open eyes and respond to questions falls asleep easily LOC - OBTUNDED patient responds to light shaking is confused slow to respond LOC - STUPOROUS patient barely responds to painful stimuli example rubbing sternum LOC - COMATOSE patient is unresponsive abnormal posturing may be present DECORTICATE POSTURING arms flexed/internally rotated legs extended/internally rotated DECEREBRATE POSTURING head arched back arms/legs extended AUTONOMY patient has the right to make their own decisions even if not in their best interest BENEFICENCE do what is best for the patient do good FIDELITY keep your promises loyalty/faithfulness JUSTICE provide fairness in care and allocation of resources NONMALEFICENCE do no harm VERACITY tell the truth PATIENT RIGHTS - REFUSAL OF TREATMENT even patients who are involuntarily admitted have the right to refuse treatment PATIENT RIGHTS - CONFIDENTIALITY HIPAA states that health information cannot be released without patient's permission client's right to privacy continues even after death CONFIDENTIALITY - NURSING ACTIONS if someone calls to get an update, suggest they reach out to the patient's family if you overhear a conversation in a public space, take action to stop the violation PATIENT RIGHTS - MANDATORY REPORTING nurses are required to report suspicion of abuse warn/protect third parties who are at risk for harm INFORMED CONSENT - PROVIDER RESPONSIBILITIES communicate purpose of procedure provide a complete description of procedure in patient's primary language (use interpreter if needed) explain risks vs. benefits describe other options to treat condition INFORMED CONSENT - NURSE/RN RESPONSIBILITIES make sure provider gave patient appropriate information regarding procedure ensure that patient is competent to give informed consent have patient sign consent document notify provider if patient has more questions or doesn't understand information provided RESTRAINTS - TYPES Physical - vest - belt - mitten Chemical - sedative Rx - antipsychotic Rx RESTRAINTS - ALTERNATIVES provide verbal interventions diversions calm/quiet environment RESTRAINTS - PRESCRIPTIONS MUST BE IN WRITING prescription must be rewritten every 24 hours in an emergency situation, a nurse may use restraints, but must obtain a written prescription per facility policy (usually within 15-30 minutes) RESTRAINTS - TIME LIMITS Adults 4 hours Ages 9 - 17 2 hours Ages 8 and Under 1 hour RESTRAINTS - DOCUMENTATION complete every 15-30 minutes include the following: - precipitating event - alternative interventions attempted - time treatment began - medication(s) administered - patient assessment (current behavior, VS, pain) - patient care provided (food, toileting) RESTRAINTS - DISCONTINUATION restraints can be discontinued when patient can follow nurse's directions UNINTENTIONAL TORTS Negligence forgetting to set bed alarm for a fall risk patient Malpractice medication error that harms patient INTENTIONAL TORTS Assault nurse threatens patient Battery - nurse hits patient - gives Rx against patient's will False Imprisonment - nurse inappropriately restrains a patient - nurse administers a chemical restraint (Rx) INTRAPERSONAL COMMUNICATION self-talk thinking thoughts, but not verbalizing them INTERPERSONAL COMMUNICATION one-on-one communication with another person OPEN-ENDED QUESTIONS promotes interactive discussion example "tell me more..." CLOSED-ENDED QUESTIONS used to obtain specific data use sparingly as it can block communication *example" questions that can be answered with a "yes" or "no" RESTATING repeat the patient's exact words REFLECTING return focus back to the patient PARAPHRASING restate patient's feelings to confirm understanding of what patient is saying EXPLORING gathering more information about something that patient mentioned GENERAL LEADS allows patient to guide discussion PRESENTING REALITY communicate what is actually happening dispel hallucinations/delusions/disbeliefs OFFERING SELF limited self-disclosure by nurse return focus to the patient ASAP THERAPEUTIC COMMUNICATION - WRONG WAY asking "why" questions offering your opinion giving false reassurance giving advice changing the subject minimizing the patient's feelings THERAPEUTIC COMMUNICATION - RIGHT WAY asking open-ended questions maintaining eye contact to convey interest sitting/standing at eye level therapeutic touch to convey caring/provide comfort THERAPEUTIC COMMUNICATION - BEST PRACTICE FOR OLDER ADULTS minimize distractions discuss health in private setting face patient when speaking use lower pitch voice begin interview by asking the patient to identify their needs/concerns limit number of items on questionnaire when gathering data allow plenty of time for patient to respond DEFENSE MECHANISM - ALTRUISM dealing with stress/anxiety by helping others DEFENSE MECHANISM - SUBLIMATION substitute negative impulses into acceptable forms of expression example working out hard at the gym DEFENSE MECHANISM - SUPRESSION voluntary denial of unpleasant thoughts/feelings DEFENSE MECHANISM - REPRESSION unconscious denial of unpleasant thoughts/feelings DEFENSE MECHANISM - REGRESSION reverting back to childlike behaviors that are inappropriate for current level of development DEFENSE MECHANISM - DISPLACEMENT redirecting feelings about a person/situation towards a less threatening object/person example dad loses job, destroys his child's toy DEFENSE MECHANISM - REACTION FORMATION demonstrated the opposite behavior vs. what is actually felt example "I love nursing exams!" DEFENSE MECHANISM - UNDOING performing an act to make up for prior behavior example bringing home flowers after domestic abuse DEFENSE MECHANISM - RATIONALIZATION creating an acceptable excuse to justify an unacceptable behavior DEFENSE MECHANISM - DISSOCIATION temporary compartmentalization of feelings/thoughts example forgetting who you are during sexual assault DEFENSE MECHANISM - DENIAL pretending truth is not reality DEFENSE MECHANISM - COMPENSATION emphasizing strengths to make up for weaknesses example physically disabled person excel academically DEFENSE MECHANISM - IDENTIFICATION adopting characteristics of another individual or group DEFENSE MECHANISM - INTELLECTUALIZATION separation of feelings/emotions from logistical facts to facilitate coping DEFENSE MECHANISM - CONVERSION unconscious development of physical symptoms as a response to stress DEFENSE MECHANISM - SPLITTING inability to recognize positive AND negative attributes in others or self example "all or nothing" mentality "all good or all bad" DEFENSE MECHANISM - PROJECTION attributing your own thoughts/feelings onto someone else who does not have those thoughts/feelings MILD ANXIETY enhances an individual's perception promotes sharp focus of reality normal experience MILD ANXIETY - SYMPTOMS alert restlessness irritibility fidgeting foot tapping MODERATE ANXIETY slightly reduced perception slightly reduced ability to think MODERATE ANXIETY - SYMPTOMS pacing difficulty concentrating increased RR increased HR SEVERE ANXIETY perception greatly reduced no ability to problem solve SEVERE ANXIETY - SYMPTOMS feeling of doom tachycardia hyperventilation rapid speech PANIC LEVEL ANXIETY