Fundamentals

 How to instill nose drops

o Blow nose before!!
 Tracheostomy care
o Pass 2-3 times and wait 60 seconds between each pass
 Hand hygiene
o Keep hands lower than elbows and using warm water not hot water
HIPAA and Confidentiality
 Client must give verbal or written consent to share info
 Specific mental health issues include disclosing HIV status, the duty to warn and protect
third parties, and the reporting of child and vulnerable adult abuse.
Therapeutic communication – many questions
 Several questions
o Where you pick the best nursing action
 Pick an answer open ended
o Never start with why
 Pick an answer that offers help and allows you to do something for the client
o Make it client centered
 Don’t give false hope
 Clients who have certain mental health disorders may require longer time to respond to
questions
Anxiety
 Signs and Symptoms of Severe Anxiety
o sweating
o heavy and fast breathing
o hot flushes or blushing
o dry mouth
o shaking
o hair loss
o tachycardia
o extreme tiredness or lack of energy
o dizziness and fainting, and
o stomach aches and sickness
o Anxiety can lead to depression if left untreated
Suicide and Depression
 Interventions for a suicidal client
 o Always priority is to keep them safe
o Resources and staff are unlimited
o Anyone suicidal is one on one constant observation
 Depression in teenagers
o Signs and Symptoms
 Somatic complaints and chronic pain
 Stomachaches and headaches
 When you are taking care of people with major depression
o Decision making is hard for them
 If you have a depressed client that doesn’t want to talk some interventions
o We don’t make them talk
o We just sit with them

Borderline personality
 pattern of intense and chaotic relationships
 highly impulsive and Attention seeking
o commit suicide for attention -take it seriously every single time even if it is small
or common
 lack a clear identity
 “think in black or white”
 Manipulative (especially toward health providers)
 Can split very quickly
 Setting boundaries is crucial at the beginning!!
 Borderline between neuroses and psychoses
 Have instable self-image
 Common behaviors
o Chronic depression
o Inability to be alone
o Clinging and distancing behaviors
o Splitting
 Black and white thinking
o Manipulation
o Self-destructive behaviors
o Impulsivity
 Predisposing factors
o Childhood trauma or any trauma
o Fails to achieve autonomy
 Treatment
o Dialectical behavior therapy

Antisocial Personality
 Formally called a sociopath
 Cold blooded criminals
 Exploitive
 CONDUCT DISORDER IS THE PRECURSOR
 Disregards rights to others
 Fail to sustain employment or relationships
 Avoid legal consequences
 Admitted by court sometimes
 LACKS REMORSE
o They can act guilty but not feel it
 Low frustration tolerance

Obsessive Compulsive Disorder

 Want to avoid really strict time frames
o For example you would avoid saying complete activities by day 3 and instead say
before breakfast
 Why do they have their compulsions?
o Performs compulsions because it decreases their anxiety
Bipolar Disorder
 What is an appropriate bipolar room assignment (in patient setting)
o Private if possible
o Quiet
o Far away from nursing station
o The least amount of stimulation
 EPA and tardive dyskinesia
o Dystonia (continuous spasms and muscle contractions), parkinsonism and rigidity
movements, bradykinesia, tremor, and tardive dyskinesia (irregular, jerky
movements).
Mania, Paranoia, and Phobias
 Client in active manic state
o Limit group exposure
 How do you interact with suspicious or paranoid
o Be neutral
 Not to friendly
o Do job as normal even if they are paranoid or guarded
 Agoraphobia pg 57
 o Even though have a great fear of leaving house and their house doesn’t mean they
are afraid of people or therapy
PTSD
 Signs and symptoms
o Hypervigilant (hyper alert to surroundings)
o Nightmares
o Flashbacks
o Avoidance of people and memories of event
o NOT PARANOID FOR THIS TEST
 HAVE TO HAVE SYMPTOMS FOR 30+ DAYS
 Complimentary therapy for PTSD
o Hypnosis
 Other treatment
o SSRIs (fluoxetine and paroxetine

Sexual Assault
 How to care for client after sexual assault
o Taking pictures is not required
o Shower last
 SANE Nurse will complete

Drugs and Alcohol

 Detoxing from drugs and alcohol
o Children playing in room or dogs in room
o Tell them you are not seeing them
o If they have dementia, we will buy in but if any other problem don’t buy in
 Excessive alcohol use makes increased in vitamins
o Which can cause brain damage
 Signs and Symptoms of cocaine intoxication
o Mild: dizziness, irritability, tremor, blurred vision
o Severe: hallucinations, seizures, extreme fever, tachycardia, hypertension, chest
pain, possible cardiovascular collapse, and death

Therapy, Treatments, and Interventions

  Who are good candidates for group therapy?
o Think about people who can participate
 Not confused and diagnoses that have similar prognosis
 Depression and anxiety go good together
 Don’t want to put personality disorders with depression
 Electric convulsive therapy
o Used for
 major depressive disorders
 schizophrenia spectrum disorders
 acute manic episodes
 If unresponsive to treatment with lithium and antipsychotic
medications
o Clients should become alert in 15 minutes following ECT
o Complications
 Memory loss and confusion
 CV changes
 Headache, muscle soreness, and nausea
 Relapse of depression
 Advise client that ECT is not a permanent cure
 Restraints
o They have to be quick release
o 2 fingers under restraint to ensure circulation
o Tie to part of bed that moves
o Remove them every 2 hours

Defense Mechanisms
 Altruism: dealing with anxiety by reaching out to others
o A nurse who lost a family member in a fire becomes a volunteer firefighter
 Sublimation: dealing with unacceptable feeling or impulses by unconsciously substituting
acceptable forms of expression
o Working out anger at the gym
 Suppression: voluntarily denying unpleasant thoughts and feelings
o A person who lost his job states he will worry about paying for his bills next week
 Repression: unconsciously putting unacceptable ideas, thoughts and emotions out of
awareness (forgetting)
o A person who fears the dentist continually forgets to go to his appointments
 Regression: sudden use of childlike or primitive behaviors that do not correlate with the
person’s current developmental level
o Person who has a disagreement with a co-worker starts to throw things
 Displacement: shifting feelings related to an object, person, or situation to another less
threatening object, person, or situation
 o Father mad about losing job destroys his son’s toy
 Reaction Formation: overcompensating or demonstrating the opposite behavior of what is
felt
o A person dislikes their neighbor but then tells others how much they like them
(two-faced)
 Undoing: performing an act to make up for prior behavior
o Honeymoon phase of domestic abuse
 Rationalization: creating reasonable and acceptable explanations for unacceptable
behavior
o Young adult says he drove home drunk because he had to feed his dog
 Dissociation: creating a temporary compartmentalization or lack of connection between
the person’s identity, memory, or how they perceive the environment
o A woman forgets who she is after sexual assault
 Denial: pretending the truth is not reality to manage the anxiety of what is real
o Woman’s son died in war says can't wait for him to come home for Christmas
 Compensation: emphasizing strengths to make up for weaknesses
o Person works on computer skills to avoid socializations
 Identification: conscious of unconscious assumption of the characteristics of another
individual or group
o Child observes abusive father and becomes a bully at school
 Intellectualization: separation of emotions and logical facts when analyzing or coping
with a situation or event
o Person terminally ill focuses on creating a will rather than acknowledging his
grief
 Conversion: unconscious development of physical manifestations not caused by physical
illness
o A person experiences deafness after wife asks for a divorce
 Splitting: inability to reconcile negative and positive attribute of self or others
o Woman saying that the nurse is the only one who cares for her but then the next
day refuses to talk to the nurse
 Projection: projecting unacceptable thoughts or feelings on another who does not
experience these
o Woman cheats and then says her husband is cheating

Pharmacology
 Depakote
o Depakote can cause serious LIVER damage and result into liver failure
 Serious liver damage is most likely to occur within the first six months of
therapy.
 Need to run AST and ALT
 Haldol
o Major adverse effect is ARRYTHMIAS
 Lithium
o Used to treat bipolar disorder
o Controls episodes of acute mania, helps to prevent the return of mania or
depression, and decreases the incidence of suicide.
o Lithium level
 0.8-1.4
o Toxicity
 Early indications (level: <1.5)
 Signs and symptoms: diarrhea, N/V, thirst, polyuria, muscle
weakness, fine hand tremors, slurred speech, lethargy
 Interventions: withhold medication and notify provider, administer
new dose based on lithium and sodium levels
 Advanced indications (level: 1.5-2.0)
 Signs and symptoms: mental confusion, sedation, poor
coordination, coarse tremors, and ongoing GI distress including
N/V/D
 Interventions: withhold medication and notify provider, administer
new dose based on lithium and sodium levels, and excretion needs
to be promoted
 Severe Toxicity (level: 2.0-2.5)
 Signs and symptoms: extreme polyuria of dilute urine, tinnitus,
giddiness, jerking movements, blurred vision, ataxia, seizures,
sever hypotension and stupor leading to coma, and possible death
from respiratory complications
 Interventions: administer an emetic to alert clients, or administer
gastric lavage, use urea, mannitol, or aminophylline to increase
rate of excretion
 Greater than 2. 5
 Signs and symptoms: rapid progression of manifestations leading
to coma and death
 Interventions: hemodialysis
o Interventions and maintenance
 Diet and exercise restrictions
 Too much exercise is bad because you can be dehydrated
o Dehydration is the biggest risk toxicity
 Stress fluid and sodium intake
o Don’t eat too much sodium
 Don’t take NSAIDs (can cause toxicity)
 Monitor levels q2-3d until stable then q1-3months
 Initial treatment levels will be 0.8-1.4 but maintenance range is 0.4-1.0
  Orlistat
o Prescribed for binge eating disorders
o Can cause liver damage
 Client reports dark urine (fist sign)
o Take med 3x/d with meals
 Clozaril
o s/s
 Weight gain, diabetes, dyslipidemia
 Flu like symptoms are urgent
 Agranulocytosis!!

Definitions
 Anhedonia – loss of pleasure
 Dysthymia – mood below baseline
 Anergia- low energy
 Ataxia- physical ability to do movements but brain won't let you
 Neologisms- making up new words that don't make sense to others but make sense to
them
 Magical thinking- believing that you can control outside things with their mind
 Delusions of reference – very similar to magical thinking but actual hallucinations
 Affect vs Mood
o Mood is how I tell you how I feel
o Affect is physical presentation
 Alogia – poverty of thought or speech. The client might sit with a visitor but only
mumbles or responds vaguely to questions
 Avolition – lack of motivation in activities and hygiene
 Ideas of reference – misconstrues trivial events and attaches personal significant to them
such as believing the others who are discussing the next meal are talking about them (aka
being paranoid people are talking about them)
 Persecution – feels singled out for harm by others (being paranoid that they are being
hunted by the FBI)
 Grandeur – believes that they are all powerful and important like God
 Somatic Delusions – believes that their body is changing in an unusual way like growing
a third arm.
 Thought broadcasting – believes thoughts are heard by others
 Thought insertion – believes that others’ thoughts are in their head
 Flight of ideas or Loose associations – the client might say sentence after sentence, but
each sentence can relate to a different topic and the listener is unable to follow the
client’s thoughts
 Echolalia – client repeats words spoken to them
 Clang association – meaningless rhyming of words
 Depersonalization vs derealization
o Depersonalization is nonspecific feeling that a person has lost their identity (self
is different or unreal
o Derealization is the perception that the environment has changed