NUR2520Test 1BP

NUR2520Test 1BP What is Mental health and what makes someone have behavior that is equivalent to diagnosed mental illness? ●Mental health and mental illness are not specific entities but rather they exist on a continuum. ●Continuum is dynamic and shifting; ranging from moderate to severe. ●Many biological and environmental factors influence mental health. ●Mental health: a successful performance of mental functions, resulting in the ability to engage in productive activities, enjoy fulfilling relationships, adapt to change, and cope with adversity. ○The successful adaptation to stress from the internal or external environment, evidenced nu thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms. ○The foundation of thinking, communication skills, learning, emotional growth, resilience, and self-esteem throughout the lifespan. ○State of well-being in which individuals are able to realize their abilities as well as contribute to their community within the context of life stressors. ●Mental illnesses: maladaptive responses to stressors rom the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational or physical functioning ○Basically, mental illness can be seen as the result of flawed biological, psychological, or social processes. ○Are treatable, and individuals can experience symptom relief, and complete cure in some cases, with treatment & support. ○Considered When is mental illness considered as a possible diagnosis? ●When there is a dysfunction of the brain or neurotransmitters What assessments do nurses perform? ●They use screening tools to measure conditions including assessing for suicide. ●Mental Status Examination ●MMSE ●Orientation ●Levels of consciousness assessment What are neurotransmitters? How do they work? (6 questions ) ●Neurotransmitter: chemical messenger between neurons by which one neuron triggers another. NEUROTRANSMITTER MENTAL HEALTH DISORDER DOPAMINE (DA): controls emotional responses and the brain’s reward and pleasure centers, stimulates the heart, and increases blood flow to vital organs. HIGH - Schizophrenia, Mania LOW - Parkinson’s, Depression NOREPINEPHRINE (NE): Mood, attention, and arousal. Stimulates sympathetic branch of the autonomic nervous system or “ flight or fight” in response to stress. HIGH - MANIA, ANXIETY, SCHIZOPHRENIA LOW - DEPRESSION SEROTONIN (5-HT): The happy one, the one we want. Found in the brain and spinal cord, helps regulate mood, arousal, attention, behavior, and body temp. HIGH - ANXIETY STATES LOW - DEPRESSION GAMMA AMINOBUTYRIC ACID (GABA) Inhibitory neurotransmitter: controls neuron excitability and is associated with the regulation of anxiety. HIGH- REDUCTION OF ANXIETY LOW- MANIA, SCHIZOPHRENIA, ANXIETY ACETYLCHOLINE (ACH): Cholinergic; plays a role in skeletal muscle movement, arousal, memory, and the sleep/wake cycle. HIGH- DEPRESSION LOW - ALZHEIMER’S, HUNTINGTONS, PARKINSONS GLUTAMATE: Excitatory neurotransmitter; activates NMDA receptors. HIGH- neurotoxicity, neurodegeneration LOW- PSYCHOSIS ●Serotonin: Found in the hypothalamus, thalamus, limbic system, cerebral cortex, cerebellum, and spinal cord. ○Serotonin is derived from the dietary amino acid tryptophan ○It influences sleep and arousal, libido, appetite, mood, aggression, and pain perception. ○Serotonin low → Depression → Give SSRIs (brings it back to synaptic cleft) ●Dopamine: is found in the frontal cortex, limbic system, basal ganglia, thalamus, posterior pituitary, and spinal cord ○It is involved in movement and coordination, emotions, voluntary judgment, and release of prolactin ○(See Saw Effect w/ prolactin) ○Dopamine increased → psychosis (hallucinations & delusions) ●Histamine: found in the hypothalamus. ○The role of histamine in mediating allergic and inflammatory reactions has been well documented ○Its role in the CNS as a neurotransmitter has only recently been confirmed, and only limited information is available ○Its exact function is unclear but may have some influence on mood. ○Histamine low → sedation and weight gain → give Benadryl (antihistaminic) ●GABA: has widespread distribution in the CNS, with high concentrations in the hypothalamus, hippocampus, cortex, cerebellum, basal ganglia, spinal cord, and retina ○GABA is associated with short inhibitory interneurons, although some long-axon pathways within the brain have now been identified. ○GABA increased → to decrease anxiety ●Norepinephrine: is found in the thalamus, hypothalamus, limbic system, hippocampus, cerebellum, and cerebral cortex. It influences mood, cognition, perception, cardiovascular functioning, and sleep and arousal. The neurotransmitter associated with the “fight or flight” syndrome of symptoms that occurs in response to stress. ○NE low → Depression → Give SNRIs What are the medications used for psychotic disorders? Psychopharmacology (Chap 4 page 34) - See chart What are benzodiazepines used for and FDA approved for? ●Antianxiety → promote the activity of GABA by binding to a specific receptor on the GABAA receptor complex Medications (5 questions) CLASSES ●Anxiolytics → ‘PAMS LAMS’ AKA Benzodiazepines for the treatment of anxiety ○Librium-chlordiazepoxide, Lorazepam ○Used for anxiety. Use them short term, they act quick, avoid preg, caffeine, and alcohol. ○Buspirone ■Buspirone used for GAD general anxiety disorder. ●Antidepressants → SSRIs, SNRIs, TCAs, MOAIs for treatment of depression ○SSRI → 1st choice for depression. ■Prozac-fluoxetine, Paroxetine ■Anticholinergic effects ■Give it in the AM ■Takes 6 weeks to work → wait 2 weeks before MOAI ■Do EKG cardiac arrhythmias possible ○SNRI → 2nd generation antidepressant ■Takes 1-3 weeks for effect → 2-3 months for benefit ■Encourage compliance and avoid alcohol. ○TCA → Not the first line of treatment ■Amitriptyline, Desipramine ■Oldest class of antidepressants and are still prescribed ■Not first-line of treatment ■Has adverse reactions ■Use with caution with elderly and take at PM ■Has many interactions with other drugs ○MOAI → Used as a last resort because it has so many adverse effects and strict diet must follow ■No tyramine rich foods, no otc drugs, no caffeine. ●Mood Stabilizers → Lithium and antiepileptic drugs to treatment of bipolar disorder ○Lithium → First line of meds used for long term treatment of Bipolar disorder ■0.5-1.5 range ○Antiepileptic drugs → 2nd choice after lithium may not work ■Monitor liver function and bone marrow suppression. ○Anxiolytics & antipsychotics → may also be used for bipolar disorder ○CBC, liver, and renal tests should be done ●Antipsychotics → Treatment of schizophrenia (hallucinations, delusions, disordered ●thinking, paranoia.) ○Can cause EPS, NMS. (report muscle stiffness, severe side effect) ○1st gen: exerts muscarinic blockade; resulting in dry mouth, blurred vision constipation, and urinary retention. ○2nd gen: often associated with movement disorders, orthostatic hypotension, and sedation. ■Clozaril-clozapine, Risperdone ■Clozaril → common side effect is drooling → assess swallow reflex → sublingual atropine to treat ●Antiparkinson drugs → Anticholinergics ○Used for EPS symptoms and parkinson disease ○Anticholinergic effects ○Cognex-tacrine ■Centrally acting acetylcholinesterase inhibitor and indirect cholinergic agonist Defense mechanisms: Denial, Regression, Projection, Displacement (one question) Denial: ●Arguing against an anxiety provoking stimuli by stating it doesn't exist ○Ex: You have been arrested for drunk driving several times but don't believe you have a problem with alcohol. ●ADAPTIVE USE: A person initially says, “No, that can’t be true” when told they have cancer. ●MALADAPTIVE USE: A parent who is informed that their child was killed in combat tells everyone one month later that the child is coming home for the holidays. Rationalization: ●An ego defense in which apparently logical reasons are given to justify unacceptable behavior that is motivated by unconscious instinctual impulses. Repression: ●The unconscious blocking of unacceptable thoughts, feelings & impulses ●Repressed memories are memories that have been unconsciously blocked from access or view ○Ex: Forgetting sexual abuse from your childhood due to the trauma and anxiety ●ADAPTIVE USE: A young child temporarily wets the bed when they learn that their pet died. ●MALADAPTIVE USE: A person who has a fear of the dentist continually forgets to go to their dental appointments. Progression: ●Attributing your own unacceptable thoughts or feelings to someone or something else ○Ex: You get mad at your husband but scream that he's the one mad at you. Displacement: ●Taking out impulses on a less threatening target ○Ex: Slamming a door instead of hitting as person, yelling at your spouse after an argument with your boss ●ADAPTIVE USE: An adolescent angrily punches a punching bag after losing a game. ●MALADAPTIVE USE: A person who is angry about losing their job destroys their child’s favorite toy. Altruism ●Dealing with anxiety by reaching out to others gaingratificationfromhelping others ●ADAPTIVE USE: A nurse who lost a family member in a fire is a volunteer firefighter. ●MALADAPTIVE USE: n/a Sympathetic nervous system/ parasympathetic nervous system definition Sympathetic ●(Fight or flight) → sends signals to adrenal gland which releases epinephrine (pupil dilation, decreased secretions, increased BP and HR, bronchodilation, decreased peristalsis, decreased bladder, vasoconstriction) Parasympathetic ●(Rest and digest) → helps maintain homeostasis and relaxation, cortisol levels decrease (pupil constriction, increased secretions, decreased BP and HR, increased peristalsis, increased bladder, bronchoconstriction, vasodilation) Different levels of anxiety and symptoms for each one (3 questions) Anxiety: A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. Extremely common in our society. Low levels of anxiety are adaptive and can provide the motivation required for survival. Anxiety becomes problematic when the individual is unable to prevent the anxiety from escalating to a level that interferes with the ability to meet basic needs. ●Mild Anxiety: seldom a problem. energy t focus ●Moderate Anxiety: perceptual field diminishes. troublefocusing but can pay atKalia ●Severe Anxiety: concentration centers on one detail only or on many extraneous details. vscharge ●Panic Anxiety: the most intense state. Unable to focus on even one detail within the environment. doom ** Acute anxiety: decrease anxiety immediately (benzos) Coping mechanisms to deal with stress during mild anxiety: Eating, Drinking, Sleeping, Physical exercise, Smoking, Crying, Yawning, Cursing, Pacing, Laughing, Nail biting, Daydreaming, talking to persons with whom they feel comfortable. Defense mechanisms for protection during mild to moderate level: Compensation, Denial, Displacement, Identification, Intellectualization, Introjection, Isolation, Projection, Rationalization, Reaction formation, Regression, Repression, Sublimation, Suppression, Undoing Moderate to severe coping mechanisms: Migraine headaches, irritable bowel syndrome, and cardiac arrhythmias, and somatoform disorders. Panic level coping mechanisms: Psychotic behavior → for example, schizophrenic, schizoaffective, and delusional disorders. What is an involuntary admission? BA criteria? (4 questions) Involuntary Admission: Made without patient consent. Necessary when a person needs tx, presents anger to self or others, or unable to meet their own basic needs. BA: A Baker Act proceeding is a means of providing an individual with emergency services and temporary detention for mental health evaluation and treatment, either on a voluntary or involuntary basis. Criteria: Harm for yourself or others. ●A physician, clinical psychologist, psychiatric nurse, or clinical social worker may execute a certificate that he or she has examined a person within the preceding 48 hours and finds that the person appears to meet the criteria for involuntary examination ●A law enforcement officer shall take the person named in the certificate to the nearest receiving facility for an examination ●A court may enter an ex parte (on behalf of one party, without notice) order stating that the person appears to meet the criteria for involuntary examination ●A law enforcement officer shall take the person into custody and deliver him or her for an examination. A person may not be held for more than 72 hours. Care Plans to study: Risk for self directed violence, Risk for violence directed towards others (look at ucentral / book) Benzodiazepines: Nursing patient teaching and contraindications ●Contraindicated in pts with sleep apnea, resp depression, glaucoma ●Use with caution in pts w/ liver disease of history of substance abuse(dependency)