Maladaptive Behaviors
Intentional Tort
Willfull actions that cause damage to person or property.
EX. False imprisonment, Battery, Assault
Always ask patients directly about?
Suicide
What are BENZOS and what are they for?
regulate the function of GABA. Used for anxiety! calming effect.
Ex: Lorazepam and Diazepam
What is cognitive behavioral therapy?
psychotherapy that aims to change behaviors and thoughts
What are smart goals?
specific, measurable, attainable, realistic, timely
Battery?
contact without consent that is unwanted and or offensive.
Ex. Touching a client in a harmful or offensive way
What is a Diversion program?
Diversion programs are an example of forensic care. These programs work to promote public safety and connect people who are not receiving adequate mental health care to resources, education, and access to qualified mental health professionals. Participation in diversion programs has also helped to prevent the criminalization of mental illness, thus reducing unnecessary incarceration
Dopamine antagonists?
Antipsychotics used to manage manifestations of psychosis, including hallucinations, and manifestations present in schizophrenia
First-gen antipsychotics: potent dopamine antagonists, block dopamine receptors
-haloperidol, fluphenazine, loxapine, chloropromazine
MOA: dopamine antagonists fit into dopamine receptors but do not activate them, blocking receptor activation, preventing excess dopamine activity and helps relieve symptoms of schizophrenia.
What is psychoanalytic therapy?
talk therapy based on Sigmund Freud’s theories of psychoanalysis, brings unconscious/buried thoughts and feelings to the conscious mind so that repressed experiences/emotions can be brought to the surface and examined
What is the clinical action judgment model? Please describe?
RAFGTE
Recognize Cues: the nurse filters info from variety of sources such as S&S, client hx, and environment
-what matters most?
-assessment
Analyze Cues: nurse links cues to the pt’s clinical presentation and determines needs, concerns, and problems
-what does it mean?
-analysis
Forming and Prioritizing Hypotheses: nurse determines priorities based on pt’s needs, concerns, problems
-where do i start?
-analysis
Generate Solutions: nurse identifies expected outcome and any nursing interventions to meet client needs
-what can i do?
-planning
Take Action: nurse implements appropriate interventions based on priorities of care, nurses knowledge, planned outcomes to promote, restore, and maintain pt’s health
-what will i do?
-implementation
Evaluate Outcomes: nurse evaluates client response to nursing interventions and uses nursing judgment to determine extent the pt’s goal has been met
-did it help?
-evaluation
false imprisonment?
Confining a client to a specific area (a seclusion room) physically, verbally, or using a chemical restraint when it is not part of the clients treatment
Give me 3 ways to prevent self harm?
-no access to sharp harmful objects
-restriction of client access to restricted/locked areas
-monitor visitors
-restrict alcohol/illegal substance use
-restrict sexual activity among pts
-deterrence of elopement from facility
-rapid de-escalation of disruptive and violent behaviors thru planned interventions by
trained staff
Second Gen Antipsychotics
Second-gen antipsychotics: block dopamine receptors to a lesser degree and inhibit reuptake of serotonin
-SGAs, aripiprazole, olanzapine, risperidone, brexpiprazole, cariprazine, clozapine
MOA: block D2 dopamine receptors as well as serotonin receptor antagonist action
SE: high BP, cholesterol, and blood sugar level, weight gain, headache, weakness, vertigo
Teaching:
-agranulocytosis= low WBC caused by clozapine
What are the time restraint limits for physical restraints?
-8 or younger: 1 hr
-9-17: 2 hr
-18+: 4 hr
What is FICA?
faith, importance/influence, community, address
Assault?
Making a threat to a client's person (approaching the client in a threatening manner with a syringe in hand) is considered assault.
-instills fear or apprehension of being touched/harmed, regardless of whether an injury occurred
-intentional tort
What is SAFET?
Suicide Assessment Fivestep Evaluation and Triage
Identify risk factors
Identify protective factors
Conduct suicide inquiry
Determine Risk level/Intervention
Document
SSRIS?
Selective serotonin reuptake inhibitors
ex) fluoxetine, sertraline, escitalopram
MOA:
-Serotonin Reuptake Inhibition: SSRIs bind to and block the serotonin transporters on the neuron’s surface. By doing so, they slow down the reabsorption of serotonin into the neuron. This allows more serotonin to remain in the synapse (the gap between nerve cells) for a longer duration.
-Increased Serotonin Levels: With more serotonin available, the transmission of messages between neurons improves. This can have positive effects on mood, anxiety, and other conditions.
Uses: Used to manage depression such as loss of pleasure in activities, as well as anxiety disorders, PTSD.
Side effects: nausea, agitation, sexual dysfunction, worsening depression, suicide risk
Teaching: Will take 4-6 weeks to experience relief of manifestations.
-herbal supplements, ecstasy/LSD mixed with SSRIs can cause serotonin syndrome
Whats the difference between Eustress and Distress?
Eustress- positive stress
-response to a challenging but beneficial task that may result in developmental growth, mastery, sense of fulfillment
-may bring motivation/enjoyment bc person has positive perception of event (even if process is stressful)
-ex) wedding, family reunion birth, buying home, retirement, starting new job,
vacation, promotion, graduation
Distress- negative stress
-depletion of energy, breakdown of resilience mechanisms
-causes overwhelmed or out of control feelings, impacting physical/psychological
well-being
-ex) loss of employment, death of loved one, divorce, legal problems, high
demand at work/school, abuse, neglect, conflict in relationships,
hospitalization, injury, illness
Don’t delegate a task to the LPN or UAP if the task requires?
TAPE!!!
Teaching
Assessment
Planning
Evaluating
Negligence
Failing to provide adequate care in a personal or professional situation when one has an obligation to do so. To be liable for negligence, it must be proven that the professional had a duty to protect, breached the duty, that the action or failure to act caused injury (proximate cause) and that the injury would not have happened anyway (cause in fact), and that damages occurred.
-unintentional tort
-nurse makes an honest mistake leading to injury
what are the 5 mental health continuum zones and define them?
Crisis
A zone on the mental health continuum that indicates when a person is in a state of emergency with their mental health and they require immediate health. Clients often experience suicidal ideation, severe anxiety, and depression to the point where social isolation and lack of self-care are present.
-pt has extreme depression/anxiety, not performing ADLs, not leaving house
-risk of danger to themselves
-pt will be placed in an inpatient setting (psych hospital)
struggling
The zone that signifies trouble in mental health. The individual may experience anxiety and depression, poor concentration, emotional pain/numbness, low energy, and struggles with work.
-significant risk for further decline in mental wellness
-needs assistance such as meds, partial inpatient hospitalization, or further couseling/therapy
surviving
The zone that refers to an unsettled state of mind and indicates that problems may worsen. Worried, nervous, sad.
-increased stress and disruption in thought process, negative thoughts, problems with sleep/appetitie, difficulty concentrating, feeling on edge
-pt needs to practice self-care, receive support from trusted person, CBT
thriving
A zone on the mental health continuum where an individual has a satisfactory level of mental well-being and is able to function normally.
-healthy coping mechanisms in response to regular stresses of life, no long term concerns
-managing stress with exercise, relaxation, performing fav activity
-may experience stress, illness, trouble at work, financial changes, death of loved one
Excelling
Peak of wellbeing
-experienced during a joyful event like marriage, time during peak performance (career promotion)
How are mood stabilizers used and what is the therapeutic level of lithium?
Ex) Lithium. (primary med)
valproic acid, carbamazepine (anticonvulsants)
Depot injection (SGA aripiprazole)
Uses: Used to treat manifestation of mood dysregulation commonly seen in bipolar disorder. Can help prevent a relapse into a manic or major depressive episode, and decreases suicide incidence.
MOA: lithium = Regulates reuptake of monoamine neurotransmitters (serotonin, norepinephrine, and dopamine).
Side effects: lithium=diarrhea, nausea, fine hand tremors, weight gain, renal toxicity, goiter/hypothyroidism (for long-term use)
anticonvulsants= sedation, dry mouth, weight gain (valproic acid), weight loss (topiramate, lamotrigine), kindling process (valproic acid, carbamazepine) which is a gradual increase in neurological stimulus resulting in seizure activity
Teaching: blood testing Q1-2 weeks at first to monitor level of lithium until therapeutic (between 0.5 and 1.2 mEq/L)
- monitor liver & kidney function
- drink 2-3L water daily
- reduce stress to reduce probability of a relapse
- effect begins at 1 week, max effect at 2-3 weeks
What is intellectualization and splitting?
-intellectualization: concealing or abstractly processing emotions by means of excessive intellectual analysis or activity
Adaptive ex) nurse blocks out feelings while caring for a victim of violence
Maladaptive ex) pt that was sexually assaulted researches about psychological
development of a perpetrator and the victims
the inability to accept that one can be good and bad, someone is only good OR bad
ex) pt talks about nurse that has boundaries as an “awful nurse”
What is motivational interviewing?
a communication strategy that assists pts in developing motivation to resolve insecurities and ambivalent feelings toward behavior change
-involves active listening, open-ended qs, reflective listening back on what the person said to help them explore their own reasons for change, affirmations to affirm pt skills/strengths, summarizing to recap session