ATI Mental Health Review Study Guide

ATI Mental Health Review Study Guide Coordinated Care: Establishing Priorities 1. Managing Client Care: Organizing Client Care on a Mental Health Unit 2. Managing Client Care: Priority Implementation of Care on a Mental Health Unit for a Group of Clients 3. Personality Disorders: Prioritizing Client Care for a Group of Clients Safety and Infection Control 4. Accident/Error/Injury Prevention - Cognitive disorders: family teaching 5. Least Restrictive Restraints and Safety Devices - Anger Management: Least Restrictive Restraint measures 6. Least Restrictive Restraints and Safety Devices - Legal and Ethical issues: Mechanical Restraints Psychosocial integrity 7. Behavioral Management - Anger Management: Anger Control Assistance 8. Behavioral Management - Bipolar Disorders: Goal of Partial Hospitalization Program 9. Chemical and Other Dependencies - Medications for Substance Use Disorders: Reinforcing Discharge Teaching for Heroin Use Disorder 10. Mental health Concepts - Eating disorders: Clinical Findings of Bulimia Nervosa 11. Sensory/Perceptual Alteration - Psychotic Disorders: Auditory Hallucinations 12. Therapeutic Communication - Creating and Maintaining a Therapeutic and Safe Environment: Planning for Therapeutic Relationships Pharmacological Therapies 13. Expected Actions/Outcomes - Medications for Bipolar Disorders: Client Education about Mood Stabilizers Reduction of Risk Potential 14. Potential for Complications of Diagnostic Tests/Treatments/Procedures - Brain Stimulation Therapies: Reinforcing Client Teaching about Electroconvulsive 1. Coordinated Care: Establishing Priorities Managing Client Care: Organizing Client Care on a Mental Health Unit - Clinical reasoning guides the nurse through the process of assessing and compiling data o Nurse must assess first - Prioritize actual problems before potential future problems - One way to set priorities is based upon Maslow’s hierarchy of needs o Focus on physiological (such as food etc) before other needs ▪ Ex: offer high caloric fluids to prevent dehydration and exhaustion **In this question, the nurse prioritized care and chose to first offer high caloric fluids to a constantly pacing client. Other options were a helping a client with anxiety disorder practice relaxation technique, assisting a client w/ a decision re: group activities, or encouraging a client to verbalize feelings of hopelessness. 2. Coordinated Care: Establishing Priorities Managing Client Care: Priority Implementation of Care on a Mental Health Unit for a Group of Clients - When providing care, the nurse should select interventions that are the least restrictive/invasive first. - Use the nursing process to gather information prior to making a decision regarding a plan of action. - Apply clinical knowledge to procedural standards to determine the priority action **In this question, the nurse would have offered the client with dementia, who was increasing agitated, a diversionary activity rather than placing the client in a private room (even though it decreases environmental stimuli and escalation, it’s still shutting them in and that could be restrictive). 3. Coordinated Care: Establishing Priorities Personality Disorders: Prioritizing Client Care for a Group of Clients - Limit-setting and consistency are essential with clients who are manipulative, especially those who have borderline or antisocial personality disorders - Safety is always a priority concern because some clients who have a personality disorder are at risk for self-injury or violence o Give priority to responding to whatever poses the greatest (or most imminent) risk to the client’s physical well-being or that of others. - Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility **In this question, we would have addressed the client with antisocial personality disorder first because his irrational actions could have caused harm to himself or others. 4. Safety and Infection Control Accident/Error/Injury Prevention: Cognitive Disorders: Family Teaching - Nocturnal confusion places the client at greatest risk for injury due to falls and wandering, the nurse should report this to the provider. - Level of consciousness is usually unchanged - Impairments in memory, judgement, speech (aphasia), ability to recognize familiar objects (agnosia), executive functioning (ADLs), and movement (apraxia) do not change throughout the day. Personality changes are gradual. **In this question, the nurse should bring nocturnal confusion to the provider’s attention rather than a demand for constant attention, or personality changes. The others are concerning, but the confusion holds the greatest potential for injury to the client. 5. Safety and Infection Control Least Restrictive Restraints and Safety Devices Anger Management: Least Restrictive Restraint Measures - Seclusion and restraint do not usually lead to positive behavior changes. Seclusion and restraint may keep individuals safe during a violent outburst, but the use of the restraint itself can be dangerous and has, on rare occasions, led to the death of clients due to reasons such as suffocation and strangulation. - When deemed essential to use restraints, remove the client from seclusion or restraint as soon as the crisis is over and when the client attempts reconciliation and is no longer aggressive. - Discuss ways for the client to keep control during the aggression cycle. 6. Safety and Infection Control Least Restrictive Restraints and Safety Devices Legal and Ethical Issues: Mechanical Restraints - When all other avenues have been exhausted, the following must happen in order for the restraint to be used: o Treatment must be ordered by the primary care provider in writing ▪ In emergency situations, the nurse may apply w/o first obtaining the provider’s written order, but it usually must be obtained within 15-30 min. o Order must specify the duration of treatment o Provider must rewrite the order, specifying the type of restraint ever 24 hr or as specified by facility. - Restraints can be either physical or chemical. - Nursing responsibilities must be identified in the protocol, but they should specify monitoring of the patient (for safety and physical needs) and the client’s behavior documented. o The nurse cannot delegate these to assistive personnel. **The Joint Commission requires an in-person evaluation of a client within 1 hr of initiating restraints for safety and protection. 7. Psychosocial Integrity: Behavioral Management Anger Management: Anger Control Assistance - Aggression is typically goal-oriented with the intent of harming a specific person or object. - Use physical activity to de-escalate anger and behaviors. - Discuss ways for the client to keep control during the aggression cycle. **In this question, the nurse was reinforcing teaching with a teen who had a history of aggression. The appropriate therapeutic response is, “have you considered participating in a sport to help control your aggression?” It is appropriate for the nurse to encourage physical activity as an outlet. 8. Psychosocial Integrity: Behavioral Management Bipolar Disorders: Goal of Partial Hospitalization Program - Therapeutic milieu includes providing a safe environment during the acute phase and monitoring the client regularly. Decrease stimulation and provide outlets for physical activity. Follow protocol in regards to safety and restraints and in protecting the client from poor judgement. - Communication with bipolar patients will depend on their state and whether they are in a manic or depressive state. Always use therapeutic communication. The following are other tips: o Use a calm, matter-of-fact, specific approach o Give concise explanations o Provide for consistency with expectations and limit-setting o Avoid power struggles, and do not react personally o Listen to and act on legitimate client grievances o Reinforce nonmanipulative behaviors - Assist the client in maintenance of self-care needs. **In this question, the nurse would have supported the client’s self-administration of medications. This is because nonadherence to the medication regimen places the client at a greater risk for rehospitalization.