- May 7, 2020
Mental Health Therapy
Ch29- Somatic Disorders-
ECTwas discussed in class when talking about Mood Disorders. Review thematerial on ECT if you do not remember this information. NO responseis needed for Ch 29. Need to know this material.
1.Review the two u tube videos on ECT and answer the followingquestions:
Howdo you feel about the use of ECT after watching the videos?
Whattype of peoples are good candidates for ECT?
-People who are going through depression.
-Patients who have acute mania, or are going through psychosis.
-People who have Parkinson’s disease or a neuroleptic malignantsyndrome.
-Elderly people with heart block.
Isthe patient who is getting ECT competent to sign the informed consentfor treatment?
-Yes,but if the patient is suffering from a severe mental illness likepsychosis, s/he does not have the capacity to give informed consent,and informed consent should be given by a legally designated person.
Whatmedications are used in this procedure?
Accordingto Stuart, (2013), the medications include
Listthe most common side effects of ECT? and what nursing interventionsare used to help with these side effects?
-Decreasein blood pressure, pulse or both.
-Disorientation or confusion.
-Nausea and vomiting increase risk of aspiration
Asseen in Stuart (2013), the nursing interventions that can be appliedto reduce these side effects include
Monitoring of the vital signs frequently during the ECT procedure until they return to normal.
Reorienting for longer periods than usual.
Allowing the patient a reasonably lengthy time to rest after treatment.
Observation intensity should be increased to prevent falls.
Access to suctioning equipment should be provided by extending the stay of the patient in the recovery area.
Administration of an analgesic if the headache seems to be a recurring problem. Cryotherapy can also be used to relieve the headache.
2.What are some conditions that would preclude a client from havingECT?
-People with pre-existing cardiac conditions, compromised pulmonaryfunction or patients who have medical complications after receivinganesthesia. Examples of these conditions include: lesions in brain,pheochromocytoma, recently occurring myocardial infraction and highintracranial pressure.
3.TMS can be useful therapy for what type of diagnosis? how would youexplain this procedure to your patient if interested?
-TMS is useful in the therapy of mood disorders. To an interestedpatient, I would tell him/her that TMS is a method of brainstimulation, whereby electromagnetic induction is focused on the partof the brain that is thought to play a part in mood regulation by useof a coil. The coil will generate magnetic pulses, which will passthrough the skull to the target area in the brain painlessly (Stuart,2013).
4.VNS is another therapy that is more invasive. How would be explainthis procedure to your patient and are there any side effects?explain.
-To a patient, I would tell him/her that VNS is a method that is usedto stimulate the left vagus nerve in the neck. Stimulation of thisnerve will lead to the transmission of regular impulses to the brain,preventing seizures. The impulses that will be supplied to the brainwill be generated by a device, which will be inserted inside thepatient’s body, to the left side of the neck. I would also let thepatient know that the method is safe.
Ch27 Therapies- pg ATI 54
1.Beable to compare and contrast Cognitive therapy, behavioral andcognitive behavioral therapy – CBT. These therapies help specificdisorders- Know a few under each therapy. DO NOT respond to thisquestion.
2.Define dialectical behavior therapy and how is it different than CBT?
-Dialectical behavior therapy is a therapy approach that focuses onthe psychosocial facets of treatment (Stuart, 2013). It is a methodwhereby patients are taught skills that will help them deal withsurges of emotion that are intense and sudden. Dialectal behaviortherapy is different from CBT in that dialectal behavior therapy ismore specific and focuses on motional and social aspects, while CBTis broader and focuses on mental and social aspects.
3.List 2 cognitive distortions that you use in your daily life. Howdoes it affect your mood? List several ways that you prevent yourselffrom using cognitive distortions.
Thesecognitive distortions depress my mood, especially if they make medraw negative inferences about myself. To prevent myself from usingcognitive distortions, I can
-Monitoring thoughts and feelings.
-Questioning the evidence.
4.What is the difference between systematic desensitization andaversion therapy? Give examples of each and what type of disorderswould you use these therapies?
-Systematicdesensitization is a cognitive therapy technique whereby a patient isexposed to phobia inflicting or anxiety provoking stimuli and thentaught relaxation techniques simultaneously while aversion therapy isa cognitive therapy technique whereby undesirable behavior in apatient is reduced by coupling the behavior to an undesirablestimulus (Stuart, 2013). An example of systematic desensitization isif a patient has a phobia for scorpions, the patient is shown to adead scorpion, while at the same time taught muscle relaxation andbreathing exercises. An example of aversion therapy is where severealcoholism is treated by mixing alcohol with a drug that causesnausea and giving it to a patient. Systematic desensitization isuseful in treating an anxiety disorder while aversion therapy isappropriate for treating drug addiction.
5.We will discuss motivational interviewing in class and look at thevideo in class. How does MI differ from the other therapies or is itthe same? No response.
Ch22 Cognitive Disorders– Stuart and ATI Ch 16 p 136
1.Review the u tube videos on Alzheimer`s Disease (AD) and and be readyto discuss the changes that you assess in the patient over time. NoResponse needed.
2.What would be a nursing diagnosis, patient goal and 2-3 interventionsyou would use for someone with early onset vs late onset AD?
Nursing diagnosis – Chronic confusion
Patient goal – Patient will have minimal cognitive impairment and confusion
Nursing interventions – Limitation of patient’s sensory stimuli and independent decision making, Utilization of cognitive function testing
-Nursing diagnosis – Impaired physical mobility
-Patient goal – Patient will establish and have a maintainedfunctional mobility.
-Nursing interventions – Assessment of patient’s functionalmobility ability, encourage the patient to avoid using canes andwalkers (Stuart, 2013).
3.Are there any medications that are used to prevent AD? if so what arethey?
-Yes,folic acid supplements can help in lowering the risk of gettingAlzheimer’s disease.
4.What medications are used for this condition to help with mild tomoderate AD? what medications are used for severe AD?
-Medications for mild to moderate AD – galantamine, memantine,rivastigmine (Stuart, 2013).
-Medications for severe AD – donepezil, memantine + donepezil
5.If an AD patient is on Elavil would you give Aricepet also? why orwhy not?
-No,this is because the two drugs are antagonistic, in that Elavildecreases while aricepet increases cholinergic transmission.
6.If a high school boy was playing football and was tackled and hit byanother player in the helmet. The boy continued to play even thoughhe could not remember his name or what happened on the footballfield. You were the team nurse.
a.Describe what you would assess or what questions would you ask,
-I would withdraw the player from the game and assess the severity ofthe injury. This will be done by assessing three aspects of motorfunctioning. These include: verbal response, motor response and eyeopening. I would also assess the player’s orientation for time,place and person and also the time the player takes to return tonormal levels of consciousness.
b.What is your nursing diagnosis based on your assessment of theinformation given? what do you suspect happened and give rational.
-Theplayer has a reduced level of consciousness. The impact of the hitmay have resulted in a concussion. Concussions are associated withtemporary loss of memory.
c.What would be a nursing goal?
-Thepatient to attain normal levels of consciousness.
d.Listtwo interventions that you would do.
-Monitoringand recording the vital signs.
-Assessment for pain
7.What are some causes of delirium?
-Drugtoxicity, alcoholism or drug abuse, metabolic imbalances, acuteinfection, dehydration, malnutrition and exposure to toxins.
8.On pg 410 in Stuart- answer the critical reasoning question:
"Basedon your understanding of sundowning syndrome, describe 2- 3 nursinginterventions that would decrease the severity of this problem inpatients with dementia at home- (1), in the hospital (2) and in thenursing home (3)."
-In the patient’s view, use and place calendars, clocks and familiarpersonal effects.
-Keeping the patient’s home environment well lit.
-As the care provider, identify yourself consistently, addressing theperson by name at each time.
-Identifying and acknowledging the feelings of the patient.
-Assessing and monitoring the ability of the patient to perform ADLs.
-Weighing the patient weekly (Stuart, 2013).
9.Review the table on pseudo depression, delirium and neurocognitivedisorders (ATI ch 16 and textbook) and relate the followingdifferences between them. Onset, causes, and outcome and medications.
Weeks to months
Frontal lobe damage, e.g. trauma, neoplasms, lesions and degenerative diseases.
Patient will establish a touch with reality and have proper cognitive function.
Monoamine oxidase inhibitors, trycyclics, selective serotonin reuptake inhibitors
Hours to days
Drug toxicity, metabolic imbalances, dehydration, malnutrition, acute infection and exposure to toxins.
The patient will establish and maintain psychological and mental function
Antipsychotics, e.g. haloperidol, risperidone, olanzapine and quetiapine.
Memory loss, degenerative illnesses
The patient will establish and maintain psychological and mental function.
Aricept, razadyne, Exelon, memantine and other drugs that increase neurotransmitter levels.
Ch23 in ATI Child and Adolescents meds
What type of patient would not be a candidate for CNS stimulants? Like Ritalin?
-Patients having an attention deficit disorder.
2.What would be some teaching instructions you would give the familyregarding ritalin or Daytrana ? Side effects or food or medinteractions?
-I would tell the family not to give the medicine to their loved oneif they gave them any monoamine oxidase inhibitor over the previous 2weeks. I would also tell them to make sure the patient avoids alcoholover the course of the medication. I would also advise them that thepatient should stop taking the drug if they begin to experiencebreathing problems, hallucinations, convulsions or seizures, muscletwitches, changes in vision or numbness. However, they should expectside effects such as headache, nausea, loss of appetite, sleepproblems and insomnia.
3.What are some reasons that teenagers might benefit from beingprescribed TCA? What is the effect with depression, autism spectrumand ADHD?
– TCAshave been shown to reduce the sex drive (Stuart, (2013). Teenagersare at an age where their reproductive hormones are highly potent,and they are adapting to their new body states. However, with theuse of TCAs, this sexual drive is reduced, and risky sexual behaviorand unwanted outcomes (which the teenagers are very prone to) will bereduced. TCAs also have the effect of elevating the mood and energylevels of individuals. Many teenagers usually go through spells oflowered self-esteem and confidence, and TCAs may well serve torelieve these undesirable attributes. TCAs have also been shown toresolve the symptoms of ADHD, autism spectrum and depression.
4.What are some medication and food interactions that the nurse needsto teach the patient who is prescribed Intuniv?
-Thenurse should let the patient know that intuniv should not be takenconcurrently with a sleeping pill, narcotic, muscle relaxer ormedicine for seizures, depression and anxiety. Vitamins and herbalproducts may also interact with intuniv, and so they should beavoided. The nurse should also let the patient know that s/he shouldavoid taking alcohol while on the medication, as alcohol may increasecertain side effects of the drug (Stuart, 2013).
5.If a teenager is prescribed an atypical antipsychotic and the patientis not psychotic, what are some of the uses for this medication?
-Thismedication is also used to treat agitation associated withanxietydisorder, dementia, obsessive-compulsive disorder and autism spectrumdisorder. The atypical antipsychotic can also be used to treatbipolar disorder.
Ch26 Children and Adolescents ATI pg 270
1.Review the information on oppositional defiant disorder and conductdisorder. Know the differences. NO response needed.
2.List several nursing interventions that would be useful for ateenager with conduct disorder and adhd?
-Acceptthe teenager as s/he is and communicate with him/her as an equal.
-Administration of medications as ordered e.g.stimulants andtranquilizers.
-Implementation of a scheduled routine daily, that is predictable.
-Avoid keeping the teenager in environments and settings that aredistracting or stimulating.
-Praising the teenager for every good deed done.
-Encouragement of physical activity engagement.
3.Other than psychopharmacology, what other types of therapy would behelpful for children and adolescents?
Ch37- Geropsychiatric Nursing Stuart pg 731-
What is the greatest issue with this cohort? and why?
An increased demand for geropsychiatric nurses to take care of people in this cohort is projected. This is because in the United States, people aged 85 years and older constitute the fastest growing age group (Stuart, 2013).
wewill be reviewing much of this material when we discuss Cognitivedisorders.
2.Review the chapter and bring any questions to class.
Ch16 Somatoform and Sleep Disorders Stuart pg 244
Do you believe that physical disorders have a psychological component? Explain your answer.
Yes, this is because psychological studies show that physical and psychological health have a strong link. As one’s mental health declines, the physical health can deteriorate, and if the physical health declines, it can make one feel mentally down.
2.Have you worked with anyone who has physical symptoms without anyorganic impairment? Do you believe them or are they just faking theirillness- (factitious disorder) for attention? How would you determinewhat is happening with the patient?
-No,I have never worked with anyone who has physical symptoms without anyorganic impairment.
3.Explain the difference between primary and secondary gains as itrelates to somatoform disorders.
-Primarygain is a decrease in anxiety, resulting from effort made to reducethe stress while secondary gains are advantages, other than reductionof anxiety, which occur from resolving that sick role (Stuart, 2013).
4.Read the clinical example on pg 255. Using the first nursingdiagnosis – ineffective denial, list a nursing goals for thispatient. List 3 interventions would you use to accomplish this goal?
Acceptance of the patient that she is not blind.
Utilization of all the support systems that are made available to her.
Establishment of patient wellness and ensuring that the patient does not have any destructive behavior towards others or herself.
Actions that reduce anxiety and fear should be performed.
Performance of actions that promote establishment of proper visual functioning.
Administration of medications that reduce and anxiety.
5.It is tempting to inquire about the physical illness – is that themost therapeutic way to help the patient? Use the information on pg252 starting with the paragraph "It is important not…."to help answer this question.
-No,this is because it is important to make sure that the conflict thatis causing anxiety or stress is not directly confronted withoutsufficient coping alternatives. Enquiring about the illness may alsoresult in the patient adopting a less adaptive coping mechanism(Stuart, 2013).
6.If you have family members who do not understand what is happening tothe patient and they are frustrated that he or she does not getbetter as they think it is all in their head. How would you addressthis problem with the family?
-Iwould give the family observations to be on the lookout for in thepatient after given time frames. If those observations are observedin the given timeframe that is provided, then the family can haveconfidence in the fact that the patient is recovering.
7.Do you believe that just stress and anxiety can cause such severephysical reactions in people? Defend your answer.
Yes,this is because studies have shown that psychological and physicalhealth are connected, and so stress and anxiety, which are related topsychological health, can have implications on physical health.
8.Sleep deprivation can cause many problems especially for nursingstudents! List some of the sleep problems that you are experiencing.
-Periods of moodiness
Listsome interventions to help increase your sleep quota.
Discouraging long periods of sleep during daytime.
Encourage participation in relaxing activities during the evening.
Avoiding alcohol in the evening.
Warmth and comfort should be established before sleep.
Foods that contain high levels of caffeine being discouraged before evening sets in.
Stuart,G. (2013). Principlesand Practice of Psychiatric nursing (10thedition),St Louis Missouri: Elsevier and Ati