ECT nursing considerations
6-12 treatments
Painless
Do not smoke the day before
Electrodes on head and chest
Short term memory loss
Confusion
Fatigue
Mood change takes 2-4 treatments
No driving after
Monitor during ECT
BP
O2
Pulse
Monitoring after ECT
Vitals and make sure no decision making after treatment
Life expectancy for those with major mental illness
49-60 yrs
Bronfrenbrenner's ecological model
An individual develops within multiple layers of complex systems. These layers interact and are affected by each of the other systemic layers.
5 Layers include:
1)
the individual
2)
the microsystem
(immediate family)
3)
the mesosystem
(extended family)
4)
parietal lobe
portion of the cerebral cortex lying at the top of the head and toward the rear; receives sensory input for touch and body position
temporal lobe
An area on each hemisphere of the cerebral cortex near the temples that is the primary receiving area for auditory information
Emotion, learning, memory
Wernicke's area
occipital lobe
A region of the cerebral cortex that processes visual information
left hemisphere of brain
controls right side of the body and is logical, contains mathamatics, lauguage, & speech
right hemisphere of brain
controls left side of the body and contains creativity and the arts, facial recognition, emotional content of language, insight, holistic thought
limbic system
A doughnut-shaped system of neural structures at the border of the brainstem and cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for food and sex. Includes the hippocampus, amygdala, and hypothalamus.
Hippocampus
A neural center located in the limbic system that helps process explicit memories for storage.
Amygdala
two lima bean-sized neural clusters in the limbic system; linked to emotion.
Thalamus
the brain's sensory switchboard, located on top of the brainstem; it directs messages to the sensory receiving areas in the cortex and transmits replies to the cerebellum and medulla
Hypothalamus
A neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward.
cingulate gyrus
plays role in expressing emotions via gestures and resolves mental conflict
basal ganglia
structures in the forebrain that help to control movement, many medication side effects occur here
pineal gland
secretes melatonin
ventral tegmental area
a group of dopamine-containing neurons located in the midbrain whose axons project to the forebrain, especially the nucleus accumbens and cortex
reticular formation
a nerve network that travels through the brainstem and thalamus and plays an important role in controlling arousal
locus coeruleus
A small area of the brain that seems to be active in the regulation of emotions. Many of its neurons use norepinephrine.
Norepinephrine
helps control alertness and arousal; undersupply can depress mood (concentration, memory, learning)
Dopamine
influences movement, learning, attention, and emotion
Serotonin
Affects mood, hunger, sleep, and arousal
Acetylcholine
Calm, rest, digest, restore, activates, calm in the parasympathetic nervous system, and anti-excitatory in the SNS
GABA
Calming, guieting relaxing, pain reduction, balances
How many cranial nerves and major spinal nerves?
12 cranial nerves
31 major spinal nerves
Medications to check for therapeutic level in lab test
Lithium, valproic acid, carbamazepine
primary gain
Feeds ego with attention, sympathy
secondary gain
Individual experiences indirect benefit from condition (money)
tertiary gain
What the caretaker gets from the patient's symptoms (like an MD on an interesting case)
biological vulnerability
A specific genetic and neurobiological factor that might predispose someone to develop anxiety disorders.
symptoms of depression
fatigue, difficulty concentration, feelings of guilt, insomnia, and irritability, loss of energy, psychomotor retardation, suicidality
major depressive disorder
A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities. Must have 5 symptoms
seasonal affective disorder
Controversial disorder in which a person experiences depression during winter months and improved mood during spring. Can be treated using phototherapy, using bright light and high levels of negative ions.
persistant depressive disorder
a form of depression that is not severe enough to be diagnosed as major depressive disorder, 2 symptoms for 2 years for adults and 1 year for children
schizoaffective disorder
Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder.
seritonin syndrome
sweating, diarrhea, dialated pupils, increased sympathetic effects, drop in blood suger
SSRIs
Fluoxetine, paroxetine, sertraline, citalopram.
Takes about 3 weeks to work
Withdrawal if sudden
Agitation, sweating, fever, tachycardia, hypotension, muscle rigidity, hyperreflexia
Trycyclics
First-generation antidepressants that work by blocking the reuptake of serotonin and norepinephrine at the neuron's axon terminal, thus allowing these neurotransmitters to "linger" longer at the synapse to enhance their actions.
End with doxipim or ine
MAOIs
monoamine oxidase inhibitors
Hypertensive crisis with tyramine
Sudden pounding headaches and anticholinergic effects
Very rare to prescribe
Lithium
Bipolar disorder
Therapeutic range: 0.5-1.2
Do not give with SSRI
Potential for low potassium, polyuria, polydypsia
Lithium toxicity
-Tremor, hypothyroidism, polyuria (causes nephrogenic diabetes insipidus), teratogenesis.
-Causes Ebstein anomaly in newborn if taken by pregnant mother.
-Narrow therapeutic window requires close monitoring of serum levels.
-Almost exclusively excreted by
symptoms of bipolar disorder
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual
Fight of ideas
Increase in goal directed activity
Excessive involvement in unrestrained buying sprees, poor business investments, or sexual indiscretions due to loss of
Hypomania
A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless.
Cyclothymia
disorder that consists of mood swings from moderate depression to hypomania and lasts two years or more
Johari Window Model
model of self-disclosure that summarizes how self-awareness is influenced by self-disclosure and information about yourself from others
Proxemics
study of personal space
Intimate: 3-18"
Personal: 18"-4'
Social: 4-12'
Public: 10-12'
Erikson stages
Infant(0-1yr)Trust vs. Mistrust"HOPE"
Toddler(1-3yr) Autonomy vs. Shame and doubt"WILL"
Preschool(3-6yr)-Initiative vs. Guilt"Purpose"
School(6-11yr)-Industry vs. Inferiority"Competence"
Adolescent(12-20yr)"Fidelity"
Young Adult(21-40yr)Intimacy vs isolat
Peplau's Theory
develop interaction between nurse and patient. (ex. nurse facilitates interpersonal relationships)
Ida Jean Orlando's Nursing Process Theory
How nurses process their observations of patient behavior and also about how they react to patients on the basis of inferences from patient's behavior. Specific to nurse-patient interactions
Piaget's stages of cognitive development
sensorimotor, preoperational, concrete operational, formal operational
Assimilation
Transforming the environment
accommodation
Changing cognitive structures to be able to work with the environment
Authenticity
Awareness and consistency
Mindfulness
Deliberate action
Presence
Fully present in the moment with the patient
unconditional positive regard
a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance
therapeutic neutrality
maintaining a distant stance toward the patient in order to minimize the therapist's personal influence, no judgement, be aware of bias
Centering
Keeping our emotions in check so we are prepared to be client focused
phases of therapeutic relationship
Pre-interaction
Orientation
Working
Identification
Exploitation
Resolution
Termination
OARS
Open-ended questions
Affirmations
Reflective listening
Summaries
Chief Complaint (CC)
specific symptom or problem for which the patient is seeing the provider today, direct quote from patient
5 P's of case formulation
Presenting issue
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
milieu
A healing, therapeutic environment
defense mechanisms
Denial
Projection
Repression
Rationalization
Displacement
Reaction formulation
Regression
Symbolism
Therapeutic Communication Techniques
1) ACTIVE LISTENING - Shows clients that they have your undivided attention
2) OPEN-ENDED QUESTIONS - Used initially to encourage clients to tell their story in their own way. Ask questions in a language that a client can understand
3) CLARIFYING - Questi
cognitive behavioral therapy
a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)
Beneficence
obligation to do good
Non-maleficence
do no harm
Paternalism
A policy of treating subject people as if they were children, providing for their needs but not giving them rights.
Justice
fairness; rightfulness
veracity
truthfulness
fidelity
faithfulness; loyalty, accountability
Assault
threat or attempt to injure
battery (law)
A criminal offense involving unlawful physical contact
Capacity vs competence
A person is considered incapacitated when the person is no longer able to perform that specific function and incompetent when a court has ruled so.
schizophrenia spectrum
group of disorders that range in severity and that have similar clinical features, including some degree of reality distortion
Schizophrenia symptoms
- Delusions: fixed, false beliefs of grandeur.
- Hallucinations: visual or auditory.
- Perceptions: without environmental stimuli.
- Illusions: misinterpretation of actual stimuli.
- Ideas of Reference: only personalizing environmental stimuli to self.
-
Schizophrenia diagnosis
2+ symptoms (positive, negative, or cognitive) for at least 1 month within a 6 month period, and impaired social function for >6 months
disorganized schizophrenia
disorganized speech or behavior, or flat or inappropriate emotion
catatonic schizophrenia
A type of schizophrenia marked by striking motor disturbances, ranging from muscular rigidity to random motor activity.
paranoid schizophrenia
preoccupation with delusions or hallucinations, often with themes of persecution or grandiosity
undifferentiated schizophrenia
mixture of symptoms and does not meet the diagnostic criteria for any one type of schizophrenia
first generation antipsychotics
a group of medications originally developed to combat psychotic symptoms by reducing dopamine levels in the brain; also called conventional or typical antipsychotics
Risk EPS and NMS
Neuroleptic Malignant Syndrome
Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes
extrapyramidal symptoms
involuntary fine motor tremors, rigidity, uncontrollable retlessness, acute dystonia.
second generation antipsychotics
are associated with metabolic adverse effects (eg. weight gain, dyslipidemia, hyperglycemia, and increased risk of diabetes). As such they should be monitored for changes. Olanzapine and clozapine carry the greatest risk.
Risk of metabolic syndrome and NM
metabolic syndrome
A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascu
insomnia
recurring problems in falling or staying asleep
Hypersomnia
excessive daytime sleepiness
Narcolepsy
A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times.
Nightmares
Anxiety-arousing dreams that lead to awakening, usually from REM sleep.
night terrors
a sleep disorder characterized by high arousal and an appearance of being terrified; unlike nightmares, night terrors occur during Stage 4 sleep, within two or three hours of falling asleep, and are seldom remembered
sleep walking
walking during non-REM sleep
sleep hygiene
nonpharmacologic recommendations like reviewing and changing lifestyles and environment that help an individual get a better night's sleep
anxiety
The condition of feeling uneasy or worried about what may happen, cannot correctly assign risk to situations
generalized anxiety disorder
an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal
panic disorder
An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.
phobic disorder
A type of anxiety disorder marked by a persistent and irrational fear of an object or situation that presents no realistic danger.
Social Anixety
Social context, okay with big spaces but not okay with people
agoraphobia
fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic
obsession
an unwanted thought or image that takes control of the mind
Egodystonic
Phenomena or experiences at odds with an individual's self-perception.
PTSD diagnostic criteria
? Exposure to traumatic event
? Re-experiencing of traumatic event
? Persistent avoidance and numbing
? negative thoughts and mood
? Persistently increased arousal; hyper vigilance
? Causes significant impairment in functioning
Longer than 1 month