Nursing Tips: Psychiatric Mental Health

Phases of a helping/therapeutic relationship: Orientation, Working, and Termination. During Orientation, parameters are established: Goal of relationship; Meeting location, frequency, and length; Confidentiality; Duration of relationship.

Phases of Helping Relationships

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Principles Psychiatric Mental Health

Phases of a helping (therapeutic) relationship with a patient include Orientation, Working, and Termination.

KEY points about Alcoholics Anonymous (AA).

Key Principle from Alcoholics Anonymous

Disorders Psychiatric Mental Health

KEY points about Alcoholics Anonymous (AA).

Major Depressive Disorder (MDD) has 3 phases: Acute, Continuation, Maintenance. Patient is at greatest risk for suicide during the Acute phase of MDD.

Major Depressive Disorder Phases

Disorders Psychiatric Mental Health

Major Depressive Disorder (MDD) has 3 phases: Acute, Continuation, Maintenance. Patient is at greatest risk for suicide during the Acute phase of MDD.

Key nursing interventions for patients with Alzheimer's Disease: Provide frequent reorientation; Provide consistency with caretakers; Keep communication short, simple, and clear.

Alzheimer's Disease Key Interventions

Disorders Psychiatric Mental Health

Key nursing interventions for Alzheimer's Disease: Provide frequent reorientation, consistency with caretakers; Keep communication short, simple, and clear.

Eating Disorders

Disorders Psychiatric Mental Health

Bulimia Nervosa is an eating disorder characterized by binge eating followed by compensatory measures to avoid weight gain (e.g., vomiting, laxative use, extreme exercise).

Anorexia Nervosa is an eating disorder characterized by restriction of caloric intake.

Word Salad

Disorders Psychiatric Mental Health

Word Salad is a type of disorganized speech seen in schizophrenia (e.g., "happy green friendly running monkeys").

Nursing Interventions for the Restrained Patient

Principles Psychiatric Mental Health

The timing of nursing interventions for the restrained patient is crucial! 1) Assess the patient's status every 15 minutes. 2) Offer fluids, ROM exercises, and toileting every 2 hours. 3) Immediately remove restraints once the patient is no longer a danger to themselves or others.

Sublimation

Principles Psychiatric Mental Health

Sublimation is marked by an individual transforming unacceptable impulses into socially acceptable behaviors.

Progressive Relaxation involves tightening and relaxing muscle groups. Guided Imagery helps a patient relax by visualizing detailed images. Meditation can improve health and well-being by helping an individual focus on a word or sensation.

Therapeutic Relaxation Techniques

Therapies Psychiatric Mental Health

Progressive Relaxation involves tightening and relaxing muscle groups. Guided Imagery helps a patient relax by visualizing detailed images. Meditation can improve health and well-being by helping an individual focus on a word or sensation.

Right to Refuse Medication

Principles Psychiatric Mental Health

Patients always have the right to refuse medication, even if they have been involuntarily admitted (except in an emergency)! Support the patient's right to autonomy.

Neuroleptic Malignant Syndrome (NMS)

Therapies Psychiatric Mental Health

Neuroleptic Malignant Syndrome (NMS) is a life-threatening condition by the use or withdrawal of antipsychotic medications.

Complicated Grief

Principles Psychiatric Mental Health

Complicated grief is that which lasts longer than a year and interferes with the individual's daily functioning.

Assertive Community Treatment (ACT)

Disorders Psychiatric Mental Health

Assertive Community Treatment (ACT) is useful for individuals with severe and persistent schizophrenia or major depressive disorder with psychosis.

Bipolar I Disorder is characterized by episodes of severe mania and depression. Bipolar II Disorder is marked by episodes of hypomania (less severe than true mania) and depression.

Bipolar Disorders: I and II

Principles Psychiatric Mental Health

Bipolar I Disorder is characterized by episodes of severe mania and depression. Bipolar II Disorder is marked by episodes of hypomania (less severe than true mania) and depression.

Any patient taking psychiatric medications should avoid St. John's wort, as this increases the risk for serotonin syndrome.

St. John's Wort and Serotonin Syndrome

Therapies Psychiatric Mental Health

Any patient taking psychiatric medications should avoid St. John's wort, as this increases the risk for serotonin syndrome.

How to recognize behaviors that may indicate intention to commit suicide! These include giving away prized possessions, sudden improvement of mood or calmness, and making preparations.

Indications of Intent to Commit Suicide

Principles Psychiatric Mental Health

Recognize behaviors that may indicate an intention to commit suicide . For example: Giving away prized possessions, sudden improvement of mood or calmness, and/or making of final preparations.

Alcohol Withdrawal

Disorders Psychiatric Mental Health

Alcohol withdrawal starts 4-12 hours after last drink and peaks at 24-48 hours. Be sure to ask the patient when they had their last drink!

Electroconvulsive Therapy

Therapies Psychiatric Mental Health

Electroconvulsive therapy (ECT) is used to treat severe depression that is unresponsive to drug therapy.

Bipolar patients & mania

Disorders Psychiatric Mental Health

For bipolar patients experiencing mania: be sure to provide high-calorie portable snacks (finger foods).

Patient at risk for suicide

Principles Psychiatric Mental Health

For a patient at risk for suicide: Do NOT place a patient at risk for suicide in a private room. Provide 1:1 observation at all times.

Duty to Warn

Principles Psychiatric Mental Health

A nurse should always protect patient privacy per HIPAA laws, except when there is a duty to warn!

Criteria for hospitalization of patients with anorexia

Disorders Psychiatric Mental Health

Criteria for hospitalization of patients with Anorexia Nervosa.

Ask your patient directly about hallucinations, including command hallucinations which are when a patient hears a voice instructing them to perform an action.

Patient with hallucinations

Psychiatric Mental Health

Ask your patient directly about hallucinations, including command hallucinations. Implement 1:1 observation if indicated!

Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Dementia vs. delirium

Nervous Med-Surg Psychiatric Mental Health

Dementia vs delirium: Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Key S&S of bulemia nervosa: normal (or slightly higher) body weight, calluses on knuckles, parotid gland enlargement, tooth erosion.

Bulimia Nervosa

Disorders Psychiatric Mental Health

Key S&S of bulimia nervosa: normal (or slightly higher) body weight, calluses on knuckles, parotid gland enlargement, tooth erosion.

POSITIVE symptoms in schizophrenia include the presence of things that are NOT normally present. This includes: Hallucinations, delusions, paranoia, speech alterations, abnormal body movements

Positive Schizophrenia Symptoms

Disorders Psychiatric Mental Health

POSITIVE symptoms in schizophrenia include the presence of things that are NOT normally present.

Donepezil is a KEY medication used for Alzheimer's disease. It does NOT cure the disease, but it may improve memory, cognition, and an individual’s ability to perform ADLs.

Donepezil & Alzheimer's

Nervous Pharmacology Psychiatric Mental Health

Donepezil is a KEY medication used for Alzheimer's disease. It does NOT cure the disease, but it may improve memory, cognition, and an individual’s ability to perform ADLs.

Assault vs. Battery: Remember A before B! Assault is threatening a patient, Battery is following through with that threat.

Assault versus Battery

Principles Psychiatric Mental Health

Assault vs. Battery Remember A before B! Assault is threatening a patient, Battery is following through with that threat.

ADHD medications (e.g. methylphenidate and amphetamine mixtures) cause decreased appetite and weight loss in children. Key Nursing Intervention: Monitor child's weight during therapy!

ADHD Medication and Children's Weight

Nervous Pharmacology Psychiatric Mental Health

ADHD medications cause decreased appetite and weight loss in children.

Splitting Behavior

Disorders Psychiatric Mental Health

A patient with borderline personality disorder exhibits SPLITTING behavior, engages in impulsive behavior, and is at high risk for self-harm.

Antisocial personality

Disorders Psychiatric Mental Health

An antisocial personality disorder does NOT mean an individual doesn't like to be around people.

Suppression is VOLUNTARY denial of thoughts or feelings. Repression is UNCONCIOUS (i.e. involuntary) denial of thoughts or feelings. Both are defense mechanisms used to cope with unpleasant thoughts, feelings, or behaviors.

Suppression and Repression

Psychiatric Mental Health

Suppression is VOLUNTARY denial of thoughts or feelings. Repression is UNCONCIOUS (i.e. involuntary) denial of thoughts or feelings.

Key nursing interventions for patients with Eating Disorders: Supervise patients before and after meals; Set limits on exercise; Restrict caffeine; Provide rewards for calories consumed.

Eating Disorders Key Interventions

Psychiatric Mental Health

Key nursing interventions for patients with Eating Disorders: Supervise before/after meals; Set limits on exercise; Restrict caffeine; Provide rewards for calories consumed.

Patient with mild anxiety, can assist patient with problem-solving/relaxation techniques. Patient with severe anxiety, problem-solving NOT realistic. Provide minimal stimulation, remain with the patient, use simple directions, administer PRN medications.

Mild and Severe Anxiety

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Psychiatric Mental Health

For mild anxiety, you can assist the patient with problem-solving and relaxation techniques. For severe anxiety, problem-solving is NOT realistic.

Obsessive Compulsive Disorder

Psychiatric Mental Health

For Obsessive Compulsive Disorder (OCD): Set time limits. Help the patient identify source of anxiety and provide medications as ordered.

NEGATIVE symptoms in schizophrenia include the absence of things that normally present. Symptoms (5As): Anhedonia (inability to experience pleasure), Anergia (lack of energy), blunt Affect, Alogia (↓ speech), and Avolition (↓ motivation).

Negative Schizophrenia Symptoms

Psychiatric Mental Health

NEGATIVE symptoms in schizophrenia include the absence of things that normally present. Symptoms (5As): Anhedonia (inability to experience pleasure), Anergia (lack of energy), blunt Affect, Alogia (↓ speech), and Avolition (↓ motivation).

Lithium

Nervous Pharmacology Psychiatric Mental Health

Lithium is a mood stabilizer, used for Bipolar Disorder. Patients on lithium need adequate fluid and sodium intake! Diuretics, anticholinergics, NSAIDs are not recommended.

Priority for Patients with Depression

Psychiatric Mental Health

If a patient has depression, your PRIORITY is to assess the patient's risk of suicide and implement 1:1 observation if indicated.

Signs and Symptoms of PTSD

Psychiatric Mental Health

Signs/Symptoms of PTSD: flashbacks, distressing dreams, difficulty concentrating, insomnia, anxiety, irritability, detachment from others, hyper-vigilance, exaggerated startle response, feeling of guilt, and negative self-image.