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HESI MENTAL HEALTH

#3

QuestionAnswer
Panic Anxiety Interventions Safety is the primary concern. Nurse must keep talking in a comforting manner, even though the client cannot process what is being said. Reassure the patient that it will pass, and they are in a safe place. Remain with the client until panic lessens
Cognitive Behavioral Techniques In Anxiety Includes positive reframing, de-catastrophizing, thought-stopping, and distraction. It is typically successful.
Reframing Turning a negative message into a positive message. May say things like... instead of thinking "I think I'm going to die" you should think "I can stand this, it is just my anxiety"
De-catastrophizing Includes the therapist asking questions to enable the client to think more realistically. Such as "what is the worst that could happen? Could you survive that? Is that as bad as you imagine?"
Thought-Stopping and Distraction Techniques To stop/interfere the client from focusing on negative thoughts. Encouraging the patient to shout, or splash water on their face
Alarm Reaction Stage of Reacting to Stress stress stimulates the body to send messages from the hypothalamus to the glands (such as the adrenal gland, to send out adrenaline and norepinephrine for fuel) and organs (such as the liver, to reconvert glycogen stores to glucose for food) to prepare for potential defense needs.
Resistance Stage of Reacting to Stress the digestive system reduces function to shunt blood to areas needed for defense. The lungs take in more air, and the heart beats faster and harder so that it can circulate this highly oxygenated and highly nourished blood to the muscles to defend the body by fight, flight, or freeze behaviors. If the person adapts to the stress, the body responses relax, and the gland, organ, and systemic responses abate.
Exhaustion Phase of Reacting to Stress occurs when the person has responded negatively to anxiety and stress
Past Success in Coping It is possible that patients found coping strategies in the past that worked for them. However, they may have lost confidence in themselves, or are dealing with new stressors, and coping is no longer successful, or they have forgotten them.
Activity in Depression May experience Anhedonia (loss of any sense of pleasure from any activities that were once enjoyed). Apathetic (not caring about themselves, activities, or much of anything). May have loss interest in sexual activities, may neglect personal hygiene for lack of interest or energy.
Increased Energy in Patients with Depression These changes may indicate that the client has come to a decision to commit suicide.
Plan for Suicide If a client has suicidal ideation or hears voices commanding him or her to commit suicide, measures to provide a safe environment are necessary. If the client has a suicide plan, the nurse asks additional questions to determine the lethality of the intent and plan.
Depression and Suicide Suicidal thoughts are common in mood disorders, especially depression.
Suicidal Ideation Thinking about killing oneself
Active Suicidal Ideation When a person thinks about and seeks ways to commit suicide. They are the more potentially lethal
Passive Suicidal Ideation When a person thinks about wanting to die or wishes they were dead, but no plans to cause their death
Tricyclic Antidepressants Oldest treatment for depression. They relieve symptoms of hopelessness, anhedonia, inappropriate guilt, suicidal ideation, and daily mood variations. They have a lag period of 10-14 days before effectiveness. SHOULD BE ADMINISTERED AT BEDTIME, ensure adequate fluids and nutrition. Assist in rising slowly (orthostatic hypotension)
Lithium Considerations Adequate renal function is required for therapy, as it is excreted by the kidneys. Monitor serum creatinine. Monitor serum drug concentration 2-3 times weekly in the beginning of treatment.
Serum Creatinine Normal Range 0.5-1.3 mg/dL
Serum Lithium Level Normal Range 0.5-1.5 mEq/L
Depakote An effective mood stabilizer. Known to increase the levels of the inhibitory neurotransmitter GABA. MONITOR LIVER FUNCTION BEFORE AND DURING TREATMENT
Assessing for Self-Mutilation Risks Include assessing for behaviors that indicate potential for deliberate physical harm to self, that is not intended to be fatal.
Risk Factors for Self-Mutilation Impulsive, inability to express feelings, attention-seeking behavior, ineffective coping skills
Escalation Phase in Aggressive Patients Include shouting, swearing, agitation, threatening, demanding, clenched fists, threatening gestures, hostility, loss of ability to problem solve or think clearly. The nurse should calmly, suggest retreating to a quiet area, conveying empathy, and offering PRN meds
De-Escalation Techniques in the Escalation Phase Take control. Provide directions in a firm, calm voice. Direct client to time-out in a quiet room or area. Communicate that aggressive behavior is not acceptable. Offer medication if refused in triggering phase. Show of force by calling for assistance.
Communication with Patient's Experiencing Anxiety Get on the Patient's Level. Take Time to Listen, Provide a Clear Summary of the Patient's Situation and Plan. Empathize and Encourage, Circle Back to Important Points, Allow Time for Questions and Clarification. ENSURE THE PATIENT IS NOT EXPERIENCING SEVERE ANXIETY DURING COMMUNICATION. THE PATIENT WILL BE UNABLE TO FOCUS ON THE CONTENT OF THE COMMUNICATION. SIT QUICKLY WITH THE PATIENT UNTIL THEY ARE CALM
Assertive Communication Uses statements with "I"
Anger Management It is not healthy to try to deny or eliminate being angry. It is essential good health to recognize, express, and manage feelings in a positive manor. Anger that tis expressed inappropriately can lead to hostility and aggression. The nurse can help by serving as a role model and by role-playing assertive communication techniques. We do not want to promote catharsis (activities meant to provide release of anger, as they can increase angry feelings).
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