psych notes

Definitions of Mental Health

1) Normality as a statistical concept--those that occur most frequently in the population,
do not take into account community standards and cultural values
2) Normality as ideal mental health--grounded in the belief of universal application,
goals like competence, autonomy, and resistance to stress are White middle class
values
3) Abnormality as the presence of certain behaviors--biases occur with respect to
diagnosis and treatment

Phases of Crisis
precrisis
impact
crisis
adaptive
Postcrisis

Crisis Interventions
1. treatment is immediate, supportive, and directly responsive to the immediate crisis
2. interventions are goal directed
3. feelings of the client are acknowledged
4. intervention provides opportunities for expression and validation of feelings
5. connections are made between the meaning of the event and the crisis
6. client explores alternative coping mechanisms and tries out new behaviors

goals
1. decrease emotional stress and protect the victim
2. assist the victim(s) to organize and mobilize resources
3. return to pre-crisis status or a higher functional level

Aggressive Communication
self-serving communication that does not take a listener's feelings and rights into
account

Goals of Psychotherapy
hope for recovery, gain new perspectives, and providing a caring trusting relationship
Panic Attack Interventions
Stay with patient and acknowledge discomfort.
Maintain a calm style and demeanor.
Speak in short, simple sentences.
Give one direction at a time.
Treat hyperventilation, can provide a brown paper bag, and focus on breathing with the
patient.

psychiatric nurse take assessment?

-establish rapport
-understand current problem
-review physical status/baseline vital signs
-assess risk factors/safety of pt. and others
-perform mental status exam (MSE)
-assess psychosocial status
-identify mutual goals
-formulate plan of care

What is the right to refuse treatment?

-pts. may withhold consent or withdraw consent at any time.
-psychotropic drugs have been debated in courts many times

How does the nurse report child abuse?

-let the child's parents/guardian know that you are filing the report
-it is your legal and ethical responsibility to make a report to your states child welfare
agency

How does the nurse report elderly abuse?

if the nurse suspects abuse, the nurse MUST report it

What can Benzos be used for?

alcohol withdrawal
What are TCA's used for?
suicide

When overdosing TCA's what can it cause?

cardiac dysrhythmias

Compulsion
compelling; strong desire that is difficult to control; irresistible impulse

Stress Management
ways to deal with or overcome the negative effects of stress

CBT (cognitive behavioral therapy)

action therapy in which the goal is to help clients overcome problems by learning to
think more rationally and logically

Restraint devices are

Wrist, ankle, vest, jacket or posey, or other strap to secure a patient in place such as a
lap belt

Application of restraint
Should be fitted properly, so they will not cause accidental injury or harm to patient

Should be able to get two fingers in the restraint

Negative effects of restraints

Increases confusion
Constipation
Incontinence
Pressure sores due to non movement
Decreased inability to perform ADLs or ROM
Monitoring and documenting
Facility will have paperwork to record restraint use
Must assess and record the effects of restraints on
Neurovascular effects distal to the site of restraints every 30-60 minutes

Must document before restraint and after removing restraint

What to do if incident occurs

Check ABCs
Call for help from staff
Assist patient
Notify doctor
Write incident report
Nursing documentation

Remove the restraint

Every two hours to assess skin and circulation, perform ROM, evaluate the continued
need for restraint

PSYCH MEDS

Benzodiazepines
Main type of anti-anxiety medication. Relieves symptoms of anxiety-related disorders
quickly.
Most popular ones:
*Clonazepam (Klonopin)
*Alprazolam (Xanax)
*Diazepam (Valium)
*Lorazepam (Ativan)

All addictive. For short term use only. DO NOT STOP ABRUPTLY, patients must be
weaned off these meds or they will have SEIZURES.

Antidepressants
Not uppers
*6-8 weeks to take effect, continued for 6-12 months (or more)

THREE main groups of antidepressants:

1.Tricyclic
2.Monoamine Oxidase Inhibitors (MAOIs) MY FAVE!!!!!!!!!
3.Selective Serotonin reuptake inhibitors (SSRIs)

Treats Hyperarousal

Anti-Manic Agent (calms patients in manic phase) Episodes of Bipolar 1 Disorder

The Med:
LITHIUM

used for bipolar disorder, calms patient in manic phase

Controls flight of ideas, restlessness, etc

LITIUM IS A SALT, maintain a diet with NORMAL sodium intake, restricting sodium
INCREASES Litium toxicity. Have patients monitor selves for edema, regular weights!

Side effects: Thirst, nausea, vomiting, hair loss, tremors, weight gain, hypothyroidism

NARROW THERAPEUTIC RANGE INCREASES LIKELIHOOD OF TOXICITY!

THERAPEUTIC RANGE OF LITHIUM: .5-1.5 mEq/L

Opioid Addiction
Naloxone (Narcan)
First choice to treat opioid toxicity
Disadvantage: short-acting

Nalmefene (Revex)
Longer half-life, but prolongs withdrawal

Methadone (Dolophine)
Detox tool; synthetic opiate that blocks the craving for and effects of heroin.