Therapeutic and Safe Environment
Define 'milieu therapy'
Creating an environment that is supportive, therapeutic, and safe.
Fair and equal treatment for all
Justice
Levels of Anxiety
Mild
Moderate
Severe
Panic-Level
Mood vs Affect
Mood: What the pt tells you; "I feel happy"
Affect: What you see; Pt is smiling
Episodes of eating large amounts of food followed by compensating behaviors (purging/misusing laxatives or diuretics/excessive exercise)
Bulimia Nervosa
Occurs when the pt views a member of the healthcare team as have characteristics of a significant person in the pt's personal life
Transference
The nurse should document the following...
Client behavior, staff response to behavior, time the nurse notified the provider
Major Defense Mechanisms
Denial, Rationalization, Reaction Formation, Suppression, Repression
Define 'anhedonia'
Lack of pleasure in activities the pt typically enjoys
Contains the appetite regulation center in the brain
Hypothalamus
Provisions to prevent client self-harm and harm by others
No access to sharps/harmful objects, restriction to locked areas, monitoring visitors, restrict alcohol and substance access, restrict sexual activity among pts, rapid de-escalation of disruptive or potentially violent behaviors, deterrence of elopment
Define 'false imprisonment'
Confining a client to a specific area(seclusion room) physically, verbally, or using a chemical restraint when it is not part of the patients treatment
Most common anxiety disorder in adults
Phobias
Occurs when adaptation is ineffective
Pathological depression
Medication
fluoxetine(Prozac)
Occurs if the relationship begins to meet the needs of the nurse instead of the patient
Blurred boundaries
Types of Admission to a Mental Health Facility
Informal Admission, Voluntary Admission, Temporary Emergency Admission, Involuntary Admission, Long-term Involuntary Admission
GAD Medications
First-line: SSRIs (paroxetine, escitalopram), SNRIs (duloxetine, ER venlafaxine), buspirone
Other options: off-label use of other medication, including antihistamines, gabapentin, anticonvulsants, atypical antipsychotics
More prevalent in the fall and winter
Affective Disorders
Potentially fatal complication that can occur when fluids, electrolytes, and carbohydrates are introduced to severely malnourished pt
Refeeding syndrome
Phases of therapeutic relationships
Pre-orientation, Orientation, Working, Termination
Criteria for Involuntary Admission
Presence of mental illness, poses a danger to self or others, demonstrates severe disability or inability to meet basic necessities, requires treatment but is unable to seek it voluntarily due to the impact of the mental illness
Nursing Interventions
Provide safety and comfort, use relaxation techniques, remain with pt during worst of anxiety, perform suicide risk assessment, structured interview to keep pt focused on the present
Therapy Options
Individual psychotherapy, group therapy, family therapy, cognitive therapy
What labs/diagnostic tests should be done?
CBC, CMP, Lipid Panel, ECG