mental health review exam 1.docx.pdf - MENTAL\u200b \u200bHEALTH\u200b \u200bTEST\u200b \u200b1\u200b \u200bREVIEW 1 Clozapine\u200b \u200b(Clozaril)\u200b:\u200b \u200bknow\u200b \u200bwhat\u200b

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Unformatted text preview: MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW 1. Clozapine​ ​(Clozaril)​:​ ​know​ ​what​ ​normal​ ​WBC/ANC​ ​(absolute​ ​neutrophil​ ​count)​ ​is a. Normal​ ​Range​ ​ANC​ ​=​ ​1.5​ ​-​ ​8.0​ ​(1,500​ ​to​ ​8,000) b. Normal​ ​Range​ ​for​ ​WBC​ ​=​ ​5k​ ​-​ ​10k c. HOLD​ ​MEDS​ ​IF​ ​ANC​ ​LOW: i. Mild:​ ​1,000​ ​-​ ​1,499​ ​ANC,​ ​blood​ ​drawn​ ​3x,​ ​weekly​ ​until​ ​back​ ​up​ ​to​ ​1,500 ii. Moderate:​ ​going​ ​to​ ​hold​ ​med​ ​and​ ​order​ ​daily​ ​ANC​ ​was​ ​606​ ​and​ ​WBC​ ​was 1,300 iii. Severe:​ ​<​ ​500​ ​ANC,​ ​daily​ ​blood​ ​drawn d. Can​ ​cause​ ​hypersalivation,​ ​lower​ ​sedation​ ​and​ ​weight​ ​gain 2. Know​ ​nurse​ ​patient​ ​relationship​​ ​and​ ​phases​ ​of​ ​it​ ​)​ ​(hildegard​ ​peplau) a. Pre-orientation b. Orientation:​ ​start​ ​termination​ ​or​ ​discharge​ ​plan c. Working d. Termination e. Transference​ ​(Pt​ ​to​ ​RN) i. Patient​ ​unconsciously​​ ​transfers​ ​feelings​ ​toward​ ​the​ ​nurse​ ​that​ ​the​ ​patient has​ ​towards​ ​someone​ ​else f. Countertransference​ ​(RN​ ​to​ ​Pt) i. Nurse​ ​unconsciously​ ​transfers​ ​feelings​ ​onto​ ​the​ ​patient​ ​that​ ​the​ ​nurse has​ ​towards​ ​someone​ ​else 3. Know​ ​side​ ​effects​ ​of​ ​antipsychotic​ ​drugs a. First​ ​Generation i. typical,conventional LOW​ ​potency​ ​ ​(Elixir​ ​and​ ​IM​ ​formulation) Chlorpromazine​ ​(​Thorazine​) >What​ ​labs​ ​need​ ​to​ ​be​ ​checked? Others: Thioridaze​ ​(mellaril) Mesoridazine​ ​(Serentil) Labs:​ ​Check​ ​Fasting​ ​Blood​ ​Sugar​ ​(FBS)​ ​and​ ​Fasting​ ​Lipid​ ​Panel​ ​(FLP) >Common​ ​S/E​ ​of​ ​Low​ ​Potency​ ​Agents ●​ ​ ​ ​ ​ ​Anticholinergic ○​ ​ ​ ​ ​ ​Dry​ ​Mouth ○​ ​ ​ ​ ​ ​Constipation ○​ ​ ​ ​ ​ ​Blurred​ ​Vision​ ​(student​ ​nurse​ ​offer​ ​a​ ​magazine​ ​to​ ​read, student​ ​needs​ ​more​ ​teaching) ○​ ​ ​ ​ ​ ​Urinary​ ​retention ○​ ​ ​ ​ ​ ​Confusion ●​ ​ ​ ​ ​ ​Sedation-Histamine​ ​Blockage ●​ ​ ​ ​ ​ ​Adrenergic​ ​Blockage-​ ​Muscarinic/Hypotension ●​ ​ ​ ​ ​ ​EPS** *​The​ ​Dr.​ ​orders​ ​a​ ​pt.​ ​thorazine.​ ​The​ ​pt.​ ​spits​ ​the​ ​medication​ ​out and​ ​is​ ​noncompliant.​ ​What​ ​action​ ​do​ ​you​ ​take​ ​next? -contact​ ​the​ ​physician​ ​and​ ​recommend​ ​the​ ​medication​ ​in​ ​a​ ​liquid form​ ​(patient​ ​advocate) MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW HIGH​ ​Potency​ ​(Elixir​ ​and​ ​IM​ ​formulation) **Give​ ​Benedryl,​ ​Cogentin,​ ​and​ ​Artane​ ​with​ ​High​ ​Potency​ ​drugs​ ​to reduce​ ​EPS Haloperidol​ ​(Haldol​) Common​ ​S/E: ●​ ​ ​ ​ ​ ​EPS: - Dystonia-​ ​abnormal​ ​muscle​ ​tone​ ​that​ ​causes​ ​spasm Fluphenazine​ ​(Prolixin) - Akathisia-​ ​agitation,​ ​distress,​ ​and​ ​restlessness >If​ ​patient​ ​is​ ​noncompliant​ ​to​ ​taking​ ​the - Pseuodoparkinsonism-​ ​shuffle​ ​gait,​ ​drooling​ ​tremors, medication,​ ​give​ ​Depot​ ​formulation​ ​IM bradykinesia,​ ​rigidity​ ​(Wife​ ​state​ ​husband​ ​shuffling​ ​due​ ​to every​ ​4​ ​weeks​ ​(Haldol)​ ​and​ ​every​ ​2-4 this…​ ​clutter​ ​free​ ​environment) weeks​ ​(Prolixin) - hold​ ​haldol​ ​if​ ​notice​ ​a​ ​twitch​ ​and​ ​assess​ ​for​ ​involuntary movement Others: Primozide​ ​(orap) - tardive​ ​dyskinesia-​ ​difficulty​ ​moving Thiothiexene​ ​(navane) ●​ ​ ​ ​ ​ ​Anticholinergic​ ​SE Trifkuperazine​ ​(Stelazine) ●​ ​ ​ ​ ​ ​Sedation Perphenazine​ ​(Trilafon) ●​ ​ ​ ​ ​ ​**Weight​ ​Gain! Loxapine​ ​(loxitane) b. Atypical​ ​(Second​ ​generation) i. ​ ​effective​ ​for​ ​both​ ​positive​ ​and​ ​negative​ ​symptoms c. MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW Clozapine​ ​(Clozaril) >What​ ​lab​ ​level​ ​do​ ​you​ ​need​ ​to look​ ​at? >​Baseline​ ​CBC​ ​(WBC​ ​count),​ ​also​ ​causes​ ​hypersalivation Risperidone​ ​(Risperdal) >What​ ​symptoms​ ​does​ ​it​ ​treat? >​ ​It’s​ ​an​ ​antipsychotic​ ​and​ ​it​ ​treats​ ​both​ ​positive​ ​and negative​ ​symptoms Ziprasidone​ ​(Geodon) >What​ ​do​ ​you​ ​need​ ​to​ ​check before​ ​starting​ ​Geodon​ ​and throughout​ ​the​ ​treatment? *​*EKG​ ​before​ ​starting​ ​Geodon​ ​(increase​ ​HR) -​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​Take​ ​with​ ​food​ ​or​ ​loses -​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​Less​ ​sedative other: Olanzapine​ ​(zyprexa) Quetiapaine​ ​Fumarate​ ​(seroquel) Lurasidone​ ​HCL​ ​(Latuda) Oral​ ​Disintegrating​ ​Tablets: ​ ​every​ ​2​ ​weeks​ ​IM Common​ ​S/E: ●​ ​ ​ ​ ​ ​Increased​ ​appetite ●​ ​ ​ ​ ​ ​Weight​ ​gain ●​ ​ ​ ​ ​ ​Hyperglycemia ●​ ​ ​ ​ ​ ​Hyperlipidemia-​ ​Also​ ​Monitor​ ​FBS/FLP* Olanzapine​ ​(Zyprexa​ ​Zydis) Risperidone​ ​(Risperdal)​ ​M-Tab c.​ ​Third​ ​Generation-​ ​dopamine​ ​system​ ​stabilizer Aripiprazole-​ ​Abilify​ ​tablet​ ​abilify discmelt​ ​(Oral​ ​tab) Aripiprazole-​ ​Abilify​ ​Maintena​ ​IM​ ​(depot formula Aripiprazole​ ​Lauroxil-​ ​Aristada​ ​(depot injection Common​ ​side​ ​effects: - insomnia - akathsia Safety​ ​considerations - metabolic​ ​changes - ortho​ ​hypotension - neutropenia - neutropenia - dysphagia - dystonia 4. Maslows​ ​and​ ​Ericksons​​ ​stages a. Erikson’s​ ​eight​ ​Stages​​ ​of​ ​development: MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW i. Infancy​ ​(birth-18​ ​mos)​ ​Trust​ ​vs.​ ​mistrust 1. To​ ​develop​ ​a​ ​basic​ ​trust​ ​in​ ​the​ ​mothering​ ​figure​ ​and​ ​learn​ ​to generalize​ ​it​ ​to​ ​others. 2. Non​ ​achievement​ ​results​ ​in​ ​emotional​ ​dissatisfaction​ ​w/​ ​the​ ​self and​ ​others,​ ​suspiciousness,​ ​and​ ​difficulty​ ​w/​ ​interpersonal relationships. ii. Early​ ​childhood​ ​(18​ ​mos-3​ ​yrs)​ ​Autonomy​ ​vs.​ ​shame​ ​and​ ​doubt 1. To​ ​gain​ ​some​ ​self-control​ ​and​ ​independence​ ​within​ ​the environment. 2. Non​ ​achievement​ ​results​ ​in​ ​lack​ ​of​ ​self-confidence,​ ​a​ ​lack​ ​of​ ​pride in​ ​the​ ​ability​ ​to​ ​perform,​ ​a​ ​sense​ ​of​ ​being​ ​controlled​ ​by​ ​others​ ​and a​ ​rage​ ​against​ ​the​ ​self. iii. Late​ ​childhood​ ​(3​ ​-​ ​6​ ​yrs)​​ ​Initiative​ ​vs.​ ​guilt 1. To​ ​develop​ ​a​ ​sense​ ​of​ ​purpose​ ​and​ ​the​ ​ability​ ​to​ ​initiate​ ​and​ ​direct own​ ​activities. 2. Non​ ​achievement​ ​results​ ​in​ ​feelings​ ​of​ ​inadequacy​ and​ ​a​ ​sense​ ​of defeat.​ ​Guilt​ ​experienced​ ​to​ ​excessive​ ​degree.​ ​Child​ ​may​ ​view him/herself​ ​as​ ​evil​ ​and​ ​deserving​ ​of​ ​punishment. iv. School​ ​age​ ​(6​ ​-​ ​12​ ​yrs)​​ ​Industry​ ​vs.​ ​inferiority. 1. To​ ​achieve​ ​a​ ​self​ ​of​ ​self-confidence​ ​by​ ​learning,​ ​competing, performing​ ​successfully​ ​and​ ​receiving​ ​recognition​ ​from​ ​significant others,​ ​peers​ ​and​ ​acquaintance. 2. Non​ ​achievement​ ​results​ ​in​ ​difficulty​ ​in​ ​interpersonal relationships​ ​b/c​ ​of​ ​feelings​ ​of​ ​personal​ ​inadequacy.​ ​Can’t cooperate​ ​or​ ​compromise​ ​with​ ​others​ ​in​ ​group​ ​activities.​ ​May become​ ​passive​ ​and​ ​meek​ ​or​ ​overly​ ​aggressive​ ​to​ ​cover​ ​up​ ​for feelings​ ​of​ ​inadequacy. v. Adolescence​ ​(12​ ​-​ ​20​ ​yrs)​ ​Identity​ ​vs.​ ​role​ ​confusion​.:​ ​a​ ​kid​ ​in​ ​a​ ​gang​ ​** 1. To​ ​integrate​ ​the​ ​tasks​ ​mastered​ ​in​ ​the​ ​previous​ ​stages​ ​into​ ​a secure​ ​sense​ ​of​ ​self. 2. Non​ ​achievement​ ​results​ ​in​ ​sense​ ​of​ ​self-consciousness,​ ​doubt, and​ ​confusion​ ​about​ ​one’s​ ​role​ ​in​ ​life.​ ​Personal​ ​values​ ​or​ ​goals​ ​for one’s​ ​life​ ​are​ ​absent.​ ​Commitments​ ​to​ ​relationships​ ​w/​ ​others​ ​are nonexistent,​ ​but​ ​instead​ ​are​ ​superficial​ ​and​ ​brief.​ ​A​ ​lack​ ​of self-confidence​ ​often​ ​expressed​ ​by​ ​delinquent​ ​and​ ​rebellious behavior. vi. Early​ ​adulthood​ ​(20​ ​-​ ​35​ ​yrs)​ ​Intimacy​ ​vs.​ ​isolation​. 1. To​ ​form​ ​an​ ​intense,​ ​lasting​ ​relationship​ ​or​ ​a​ ​commitment​ ​to another​ ​person,​ ​cause,​ ​institution​ ​or​ ​creative​ ​effort. 2. Non​ ​achievement​ ​results​ ​in​ ​withdrawal,​ ​social​ ​isolation​ ​and aloneness.​ ​Individual​ ​unable​ ​to​ ​form​ ​lasting,​ ​intimate relationships,​ ​often​ ​seeking​ ​intimacy​ ​through​ ​numerous superficial​ ​sexual​ ​contacts. vii. Middle​ ​adulthood​ ​(35-65​ ​yrs)​ ​Generativity​ ​vs.​ ​stagnation​. b. Freud’s​ ​psychosexual:​ ​Anal MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW 1. To​ ​achieve​ ​life​ ​goals​ ​established​ ​for​ ​oneself,​ ​while​ ​also considering​ ​the​ ​welfare​ ​of​ ​future​ ​generations. 2. Non​ ​achievement​ ​results​ ​in​ ​lack​ ​of​ ​concern​ ​for​ ​the​ ​welfare​ ​of others​ ​and​ ​total​ ​preoccupation​ ​with​ ​the​ ​self.​ ​Becomes​ ​withdrawn, isolated​ ​and​ ​highly​ ​self-indulgent​ ​with​ ​no​ ​capacity​ ​for​ ​giving​ ​of​ ​the self​ ​to​ ​others. ii. Later​ ​years​ ​(65​ ​yrs-death)​​ ​Ego​ ​integrity​ ​vs.​ ​despair. 1. To​ ​review​ ​one’s​ ​life​ ​and​ ​derive​ ​meaning​ ​from​ ​both​ ​positive​ ​and negative​ ​events,​ ​while​ ​achieving​ ​a​ ​positive​ ​sense​ ​of​ ​self-worth. 2. Non​ ​achievement​ ​results​ ​in​ ​a​ ​sense​ ​of​ ​self-contempt​ ​and​ ​disgust with​ ​how​ ​life​ ​has​ ​progressed.​ ​Individual​ ​would​ ​like​ ​to​ ​start​ ​over and​ ​have​ ​a​ ​second​ ​chance​ ​at​ ​life.​ ​Feels​ ​worthless​ ​and​ ​helpless​ ​to change.​ ​Anger,​ ​depression​ ​and​ ​loneliness​ ​are​ ​evident. c. Maslow’s​ ​Hierarchy​​ ​of​ ​Needs: 1​ ​-​ ​Biological​ ​&​ ​Physiological​ ​needs​ ​(air,​ ​food,​ ​drink,​ ​shelter,​ ​sex,​ ​sleep) 2​ ​-​ ​Safety​ ​needs​ ​(protection,​ ​security,​ ​order,​ ​law,​ ​limits,​ ​stability) 3​ ​-​ ​Belongingness​ ​and​ ​Love​ ​needs​ ​(family,​ ​relationships,​ ​work​ ​groups) 4​ ​-​ ​Esteem​ ​needs​ ​(achievement,​ ​status,​ ​responsibility,​ ​reputation) 5​ ​-​ ​Self-actualization​ ​(personal​ ​growth,​ ​self-fulfillment) In​ ​a​ ​psych​ ​setting,​ ​pt​ ​complaining​ ​with​ ​SOB,​ ​you​ ​feel​ ​like​ ​they​ ​have​ ​anxiety​ ​and​ ​there​ ​is nothing​ ​wrong​ ​with​ ​them,​ ​but​ ​you​ ​need​ ​to​ ​treat​ ​it​ ​as​ ​an​ ​emergency​ ​because​ ​the​ ​pt​ ​still thinks​ ​that​ ​she​ ​can’t​ ​breath 5. Have​ ​to​ ​identify​ ​what​ ​ego,​ ​superego​ ​and​ ​id​ ​do a. Ego:​ ​within​ ​the​ ​first​ ​few​ ​years​ ​of​ ​life​ ​as​ ​the​ ​child​ ​begins​ ​to​ ​interact​ ​with​ ​others, the​ ​ego​ ​develops i. problem​ ​solver​ ​and​ ​reality​ ​tester 1. “you​ ​have​ ​to​ ​delay​ ​gratification​ ​for​ ​right​ ​now” b. Superego:​ ​last​ ​portion​ ​of​ ​the​ ​personality​ ​to​ ​develop,​ ​represents​ ​the​ ​moral component​ ​of​ ​personality i. represents​ ​the​ ​ideal​ ​rather​ ​than​ ​the​ ​real,​ ​seeks​ ​perfection,​ ​as​ ​opposed​ ​to seeking​ ​pleasure​ ​or​ ​engaging​ ​reason c. Id:​​ ​source​ ​of​ ​all​ ​drives,​ ​instincts,​ ​reflexes,​ ​needs,​ ​genetic​ ​inheritance,​ ​and capacity​ ​to​ ​respond,​ ​as​ ​well​ ​as​ ​the​ ​wishes​ ​that​ ​motivates​ ​us i. lacks​ ​ability​ ​to​ ​problem​ ​solve 1. ex:​ ​hungry,​ ​screaming​ ​infant 2. a​ ​child​ ​is​ ​crying​ ​for​ ​a​ ​toy 6. Conscious​ ​preconscious​ ​subconscious a. conscious​ ​-​ ​our​ ​level​ ​of​ ​awareness​ ​about​ ​ourselves​ ​and​ ​our​ ​environment b. preconscious-​ ​thoughts​ ​that​ ​are​ ​unconscious​ ​at​ ​the​ ​particular​ ​moment​ ​in question,​ ​but​ ​are​ ​not​ ​repressed​ ​and​ ​are​ ​therefore​ ​available​ ​for​ ​recall​ ​and​ ​easily capable​ ​of​ ​become​ ​“conscious” c. subconscious-​ ​information​ ​that​ ​we​ ​are​ ​not​ ​consciously​ ​aware​ ​of​ ​but​ ​we​ ​know must​ ​exist​ ​due​ ​to​ ​behavior 7. Whats​ ​clanging​? a. rhyming​ ​ex:​ ​like​ ​a​ ​rapper​ ​(snoop​ ​dogg) MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW 8. Know​ ​all​ ​the​ ​words​ ​we​ ​talked​ ​about​ ​today…​ ​DA​ ​FUK?!?! 9. Cultural​ ​sensitivity a. ​ ​Nurse​ ​is​ ​still​ ​awareness​ ​of​ ​her​ ​own​ ​beliefs;​ ​but​ ​being​ ​considerate​ ​with​ ​other cultures​ ​and​ ​never​ ​putting​ ​their​ ​own​ ​beliefs​ ​onto​ ​their​ ​patients.​ ​Recognizing​ ​a patient's​ ​beliefs,​ ​practices,​ ​needs​ ​and​ ​preferences. i. eastern​ ​-​ ​balance​ ​(mind​ ​body​ ​spirit​ ​unity) ii. western-​ ​science​ ​(​ ​meds) iii. indigenous-​ ​harmony​ ​(nature) 10. Characteristic​ ​of​ ​nurse ​that​ ​is​ ​culturally​ ​competent a. Cultural​ ​Awareness-​ ​nurses​ ​recognize​ ​that​ ​they​ ​as​ ​well​ ​as​ ​patients,​ ​have​ ​cultural beliefs,​ ​values,​ ​and​ ​practices b. Cultural​ ​Knowledge-​ ​obtained​ ​by​ ​seeking​ ​cultural​ ​information​ ​oneself​ ​in​ ​the culture​ ​or​ ​consulting​ ​print​ ​and​ ​online​ ​resources c. Cultural​ ​Encounters d. Cultural​ ​Skill-​ ​performing​ ​a​ ​culturally​ ​sensitive​ ​assessment​ ​interviews​ ​and adapting​ ​care​ ​to​ ​meet​ ​patient’s​ ​cultural​ ​needs​ ​and​ ​preferences e. Cultural​ ​Desire-​ ​ ​a​ ​general​ ​interest​ ​in​ ​the​ ​patient’s​ ​unique​ ​perspective​ ​enabling nurses​ ​to​ ​provide​ ​considerate,​ ​flexible​ ​and​ ​respectful​ ​care​ ​to​ ​patients​ ​of​ ​all cultures 11. Know​ ​reporting​ ​relationship​​ ​and​ ​what​ ​you​ ​have​ ​to​ ​do a. What​ ​do​ ​you​ ​have​ ​to​ ​do​ ​if​ ​someone​ ​is​ ​homicidal​ ​and​ ​has​ ​specific​ ​victim​ ​in​ ​mind? -Warn​ ​person​ ​and​ ​tell​ ​the​ ​police b. Tarasoff​ ​vs​ ​Regents​ ​of​ ​University​ ​of​ ​California​ ​(1974)​​ ​ruled​ ​that​ ​psychotherapist have​ ​the​ ​duty​ ​to​ ​warn​ ​a​ ​patient’s​ ​potential​ ​victim​ ​of​ ​potential​ ​harm.​ ​The therapist​ ​also​ ​has​ ​the​ ​duty​ ​to​ ​protect​ ​that​ ​other​ ​person. 12. Know​ ​all​ ​about​ ​working​ ​with​ ​a​ ​psychotic​ ​patient​ ​and​ ​with​ ​nursing​ ​assessment,​ ​nursing action​ ​→​ ​Mental​ ​Status​ ​Examination a. appearance-​ ​grooming,​ ​dressed,​ ​level​ ​of​ ​hygiene,​ ​pupil​ ​dilation,​ ​facial expression,​ ​height,​ ​weight,​ ​ect b. behaviors-​ ​excessive​ ​or​ ​reduced​ ​body​ ​movements,​ ​peculiar​ ​body​ ​movements, oto-repetitive​ ​gestures,​ ​LOC,​ ​balance,​ ​gait c. Speech-​ ​rate,​ ​volume,​ ​disturbance,​ ​cluttering d. moodi. affect​ ​(flat,​ ​blunt,​ ​animated,​ ​angry​ ​/​ ​withdrawn) mood​ ​(sad,​ ​liable,​ ​euphoric) e. Disorders​ ​of​ ​the​ ​form​ ​of​ ​thought i. thought​ ​process(​ ​disorganized,​ ​coherent,​ ​flight​ ​of​ ​ideas,​ ​neologism, thought​ ​blocking,​ ​circumstantiality) ii. thought​ ​content​ ​(​ ​delusions​ ​or​ ​obsessions) f. Perceptual​ ​disturbances-​ ​hallucinations​ ​or​ ​delusions g. Cognitioni. LOC-​ ​time,​ ​name​ ​place ii. memory iii. attention iv. abstract​ ​thinking MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW v. insight​ ​and​ ​judgment h. Ideas​ ​of​ ​harming​ ​self​ ​or​ ​others i. suicidal​ ​or​ ​homicidal​ ​thoughts ii. presence​ ​of​ ​a​ ​plan iii. means​ ​of​ ​carrying​ ​plan iv. opportunity​ ​of​ ​carrying​ ​out​ ​the​ ​plan 13. Know​ ​who​ ​needs​ ​to​ ​be​ ​put​ ​in​ ​seclusion​ ​and​ ​who​ ​doesn’t:​ ​someone​ ​who​ ​is​ ​danger​ ​to others a. GOAL:​ ​physical​ ​protection​ ​of​ ​client​ ​and/or​ ​others​ ​and​ ​staff​ ​only​ ​time​ ​seclusions are​ ​used i. the​ ​involuntary​ ​confinement​ ​of​ ​a​ ​patient​ ​alone​ ​in​ ​a​ ​room​ ​or​ ​area​ ​from​ ​which​ ​the patient​ ​is​ ​physically​ ​prevented​ ​from​ ​leaving Patient​ ​is​ ​agitated​ ​(decrease​ ​stimuli,​ ​take​ ​him​ ​out​ ​from​ ​the​ ​situation,​ ​offer 1-on-1,​ ​offer​ ​meds,​ ​offer​ ​seclusion​ ​until​ ​behavior​ ​is​ ​controlled,​ ​then​ ​physical containment​ ​procedure/show​ ​of​ ​force)​ ​(5​ ​people,​ ​each​ ​extremity​ ​and​ ​the torso)​ ​(Can​ ​an​ ​RN​ ​write​ ​a​ ​restraint​ ​order?​ ​YES​ ​if​ ​it​ ​is​ ​an​ ​emergency​ ​but​ ​needs to​ ​be​ ​co-signed​ ​by​ ​an​ ​MD​ ​within​ ​an​ ​hour) 14. Pay​ ​attention​ ​to​ ​competency​ ​café​ ​and​ ​methods​ ​for​ ​times​ ​restraints​ ​and​ ​types​ ​of​ ​knots a. 1st-​ ​decrease​ ​and​ ​remove​ ​from​ ​stimuli b. 2nd-​ ​medication c. 3rd-​ ​seclusion d. 4th-​ ​4​ ​point​ ​restraints i. both​ ​arms​ ​and​ ​both​ ​legs​ ​restrained ii. quick-​ ​release​ ​knot​ ​used iii. 1:1​ ​observation​ ​required iv. check​ ​pt​ ​every​ ​15​ ​mins v. offering​ ​bathroom,​ ​foods,​ ​fluids​ ​every​ ​hour e. Adults​ ​order​ ​is​ ​good​ ​for​ ​4​ ​hours f. Children​ ​good​ ​for​ ​2​ ​hours 15. Therapeutic​ ​communication​ ​(a​ ​lot​ ​of​ ​scenarios) a. Using​ ​Silence b. Active​ ​Listening c. Clarifying​ ​Techniques i. Paraphrasing​ ​-​ ​restating​ ​what​ ​patient​ ​said​ ​using different​ ​shorter​ ​words​ ​validating​ ​the​ ​accuracy of​ ​the​ ​restatement ii. Restating​ ​-​ ​the​ ​nurse​ ​mirrors​ ​the​ ​patient’s​ ​overt and​ ​covert​ ​messages​ ​therefore​ ​echoing​ ​feelings and​ ​content iii. Reflecting​ ​-​ ​assisting​ ​patients​ ​to​ ​better understand​ ​their​ ​own​ ​thoughts​ ​and​ ​feelings​ ​by describing​ ​the​ ​apparent​ ​meaning​ ​of​ ​the emotional​ ​tone​ ​of​ ​the​ ​patient’s​ ​verbal/nonverbal behaviour iv. Exploring o MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW 16. Symptoms​ ​of​ ​a​ ​psychotic​ ​patient a. What​ ​part​ ​of​ ​nursing​ ​process,​ ​and​ ​how​ ​would​ ​you​ ​deal​ ​with​ ​a​ ​schizophrenic patient-​ ​don’t​ ​send​ ​off​ ​to​ ​read​ ​a​ ​book​ ​with​ ​others 17. Erickson’s:​ ​know​ ​the​ ​stages​ ​and​ ​ages​ ​that​ ​go​ ​along​ ​with​ ​that​ ​and​ ​what​ ​the​ ​task​ ​is a. Identity​ ​vs.​ ​isolation i. Intimacy:​ ​Ability​ ​to​ ​love​ ​deeply​ ​and​ ​commit​ ​oneself ii. Isolation:​ ​Emotional​ ​isolation;​ ​egocentricity​ ​“There’s​ ​no​ ​one​ ​out there​ ​for​ ​me” 18. Etiology​ ​of​ ​schizophrenia​​ ​and​ ​physical​ ​changes​ ​in​ ​the​ ​brain.​ ​(Select​ ​ALL) a. Enlarged​ ​lateral​ ​ventricles b. Asymmetry c. Atrophy​ ​of​ ​the​ ​cortex d. Dilated​ ​3rd​ ​ventricle e. Prenatal​ ​exposure​ ​to​ ​influenza *On​ ​test​ ​said​ ​psychosocial,​ ​not​ ​physical​ ​changes.​ ​3​ ​physical​ ​changes.​ ​It​ ​should​ ​be​ ​the​ ​3 psychosocial​ ​changes:​ ​low​ ​income,​ ​move​ ​from​ ​family,​ ​etc 19. Neuroleptic​ ​malignant​ ​syndrome,​ ​Tardive​ ​dyskinesia,​ ​and​ ​what​ ​effects​ ​are a. Neuroleptic​ ​malignant​ ​syndrome:rare​ ​and​ ​sometimes​ ​fatal​ ​reaction​ ​to​ ​a​ ​high potency​ ​neuroleptic​ ​drug i. symptoms: 1. muscle​ ​rigidity​ ​(dystonia,​ ​akinesia,​ ​mutism,​ ​obtundation,​ ​and agitation), 2. fever​ ​(increased​ ​BP​ ​and​ ​sweating), 3. elevated​ ​WBC​ ​(count​ ​and​ ​creatinine​ ​phosphokinase,​ ​liver enzymes,​ ​plasma​ ​myoglobin​ ​and​ ​myoglobinuria=​ ​renal​ ​failure) ii. treatments:​ ​early​ ​detection,​ ​discontinuing​ ​of​ ​the​ ​antipsychotic,​ ​fluid balance,​ ​rapid​ ​temperature​ ​control 1. mild​ ​cases​ ​treated​ ​with:​ ​bromocriptine​ ​(parlodel) 2. severe​ ​cases​ ​treated​ ​with:​ ​IV​ ​dantrolene​ ​(dantrium) b. Tardive​ ​dyskinesia:​ ​difficulty​ ​moving,​ ​stiffness,​ ​jerky​ ​movements,​ ​body​ ​can’t control 20. What​ ​would​ ​you​ ​do​ ​if​ ​found​ ​out​ ​patient​ ​was​ ​not​ ​taking​ ​their​ ​meds​ ​4​ ​days​ ​in​ ​a​ ​row? a. Options​ ​(least​ ​severe​ ​first) i. watch​ ​them​ ​swallow ii. give​ ​them​ ​liquid​ ​form iii. liquid​ ​form​ ​not​ ​available-​ ​give​ ​IM iv. Pt.​ ​has​ ​right​ ​to​ ​refuse​ ​meds​ ​unless​ ​been​ ​through​ ​a​ ​Reise​ ​Hearing 1. if​ ​pt.​ ​is​ ​refusing​ ​but​ ​Dr.​ ​deems​ ​necessary​ ​for​ ​pt​ ​to​ ​take​ ​because either​ ​danger​ ​to​ ​self​ ​or​ ​others 21. 1​st​​ ​generation​ ​like​ ​stelazine,​ ​thorazine a. Causes​ ​photosensitivity i. wear​ ​long​ ​sleeves​ ​and​ ​a​ ​hat ii. Can​ ​damage​ ​the​ ​retina​ ​of​ ​the​ ​eye​ ​and​ ​the​ ​skin st​ 22. S.E.:​ ​of​ ​1​ ​ ​generation​ ​anti-psychotics:​ ​LIST​ ​OF​ ​SYMPTOMS:​ ​SELECT​ ​ALL​ ​THAT​ ​APPLY a. Low​ ​potency​ ​symptoms MENTAL​ ​HEALTH​ ​TEST​ ​1​ ​REVIEW i. Dry​ ​mouth ii. constipation iii. blurred​ ​vision:​ ​do​ ​not​ ​send​ ​patient​ ​to​ ​go​ ​read​ ​a​ ​magazine iv. urinary​ ​retention v. confusion b. High​ ​potency​ ​symptoms i. dystonia ii. Akathisia:​ ​pt​ ​shifting​ ​weight​ ​side​ ​to​ ​side iii. pseudoparkinsonism​ ​“BEDREST” 1. bradykinesia 2. drooling 3. rigidity 4. shuffling​ ​gait 5. tremors iv. Tardive​ ​dyskinesia:​ ​lip​ ​smacking,​ ​tongue​ ​rolling,​ ​pill​ ​rolling​ ​(WHATEVER​ ​IS IN​ ​THE​ ​ATI​ ​BOOK) 23. Fidelity​ ​and​ ​beneficence​ ​:​ ​know​ ​the​ ​definition a. fidelity-​ ​ ​loyalty​ ​and​ ​faithfulness​ ​to​ ​the​ ​client​ ​and​ ​to​ ​one's​ ​duty i. ex:​ ​client​ ​asks​ ​a​ ​nurse​ ​to​ ​be​ ​present​ ​when​ ​he​ ​talks​ ​to​ ​his​ ​mother​ ​for​ ​the first​ ​time​ ​in​ ​a​ ​year.​ ​The​ ​nurse​ ​remains​ ​with​ ​the​ ​client​ ​during​ ​the interaction b. beneficence-​ ​The​ ​quality​ ​of​ ​doing​ ​good;​ ​can​ ​be​ ​described​ ​as​ ​charity i. ex:​ ​a​ ​nurse​ ​helps​ ​a​ ​newly​ ​admitted​ ​client​ ​who​ ​has​ ​a​ ​psychotic​ ​disorder​ ​to feel​ ​safe​ ​in​ ​the​ ​environme...
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