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HESI MENTAL HEALTH

#4

Question	Answer
Schizophrenia Positive/Hard Symptoms	Delusions, hallucinations, and grossly disorganized thinking, speech, and behavior. Ambivalence, Associative Looseness, Delusions, Echopraxia, Flight of Ideas, Hallucinations, Ideas of Reference, Perseveration, Bizarre Behavior
Schizophrenia Negative/Soft Symptoms	Flat affect, lack of volition, and social withdrawal or discomfort. Alogia, Anhedonia, Apathy, Blunted Effect, Catatonia, Flat Effect, Avolition or Lack of Volition, Inattention
Manifestations	Bizarre thoughts, perceptions, emotions, movements, and behavior
Schizophrenia	Affects thought process and content, perception, emotion, behavior, and social functioning
Clozaril Considerations	produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis (LOW WBC COUNT). This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia
Seclusion	Safety for both the client and the nurse is the priority when providing care for the client with schizophrenia. The nurse must institute interventions to protect the client, nurse, and others in the environment. This may involve administering medication, moving the client to a quiet, less stimulating environment, and in extreme situations, temporarily using seclusion or restraints.
Risperdal Considerations	Watch for tardive dyskinesia. Drink plenty of fluids, especially in hot weather and during exercise. Oral solution should not be mixed with tea or cola. It may be taken with water, coffee, orange juice, or low-fat milk. You should avoid the use of alcohol. Avoid driving or hazardous activity until you know how this medicine will affect you. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.
Geodon Considerations	Some people may develop muscle related side effects. Most commonly tardive dyskinesia. symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.
Tardive Dyskinesia	a syndrome of permanent involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs. It is irreversible, involuntary movements of the tongue, facial and, neck muscles, upper and lower extremities, and truncal musculature.
Neuroleptic Malignant Syndrome	Potentially fatal idiosyncratic reaction to an antipsychotic such as Haloperidol, Fluphenazine, Chlorpromazine, Triflupromazine, Prochlorperazine. Symptoms include rigidity, high fever, autonomic instability (unstable BP), diaphoresis, pallor, and delirium
Auditory Hallucinations	the most common type, involve hearing sounds, most often voices, talking to or about the client. There may be one or multiple voices. A familiar or unfamiliar person's voice may be speaking.
Command Hallucinations	Voices demanding that the client take action, often to harm self, or others. They are considered dangerous
Nurses Response to Delusions	Never convey you accept the delusions as reality, directly interject doubt regarding delusions as soon as the client seems ready to accept this, but do not argue.
Echolalia	Repetition or imitation of what someone else says. Like if the nurse says "can you tell me how you are feeling?" the client would respond "can you tell me how you're feel, how you're feeling?"
Antisocial Personality Disorder	Upright disregard for the rights of others, rules, and laws. Characterized by a disregard for the rights of others, deceit, and manipulation. Very superficial. Aggressive/hostile. Does not follow social norms. Displays false emotions, may exploit those around them.
Nursing Interventions in Antisocial Personality Disorder	Limit setting, confrontation, teach to solve problems effectively and manage emotions of anger or frustration
Psychological Abuse (Emotional Abuse)	Includes name-calling, belittling, screaming, yelling, or destroying property, and making threats as well as more subtle forms such as refusing to speak, or ignoring the victim
Physical Abuse	Ranges from shoving and pushing to severe battering and choking, and may involve broken limbs, ribs, internal bleeding, brain damage, and even homicide
Sexual Abuse	Assaults during sexual relations such as biting nipples, pulling hair, slapping, and hitting, and rape
IPV Abuse	MUST REPORT PARTNER VIOLENCE. Identifying abused women who need assistance is a top priority of the Department of Health and Human Services. The generalist nurse is not expected to deal with this complicated problem alone. He or she can, however, make referrals and contact appropriate health care professionals experienced in working with abused women.
Symptoms of IPV Abuse	unexplained bruising, broken bones, sexual assault, or a psychological/emotional trauma. Stalking is a crime of intimidation in which perpetrators harass and terrorize their victims through behavior that causes fear or substantial emotional distress.
Rape	Perpetration of an act of sexual intercourse with a person against their will and without their consent. Act can be by force, fear of force, drugs, or intoxicants.
Nursing Interventions for Rape Victims	Encourage expression of anger, guilt, rage. Physical exam should occur before they shower, brush teeth, douche, change clothes, or had anything to drink. Ask questions gently, and with care. The victim may suffer from PTSD and it may take 1 year or longer for survivors to regain previous level of functioning
Elder Domestic Abuse	More likely when they have multiple chronic mental and physical health problems, and are dependent on others for food, medical care, and ADLs.
Indicators of Abuse in the Elderly	Hesitant to talk openly. Fearful, withdrawn, depressed, helpless. Injuries that were hidden or untreated, or explanations are incompatible. Often are reluctant to report abuse because it is often done by family members, or they fear of losing their support. SOMETIMES relieving the caregivers stress and providing addition resources may help correct the abusive situation, leaving the relationship intact.
Child Abuse	The nurse does not have to decide with certainty that abuse has occurred. However, nurses are responsible for reporting SUSPECTED child abuse with accurate and thorough documentation of assessment data. All 50 states have mandatory reporting laws.
Child Abuse Interventions	Ensure safety, and well-being, which may be removing them from the home, which can be traumatic. A thorough psychiatric evaluation is needed. It is crucial that a relationship of trust is gained from the child.
Psychological Trauma	Refers to events that were experienced in a person's lifetime that are extraordinary in severity or intensity. Can be from emotional abuse of name calling, belittling, screaming, yellow, destroying property, making threats, and refusing to speak to, or ignoring a person
Patients with PTSD	The clients safety is most important. Continually assess potential for self-harm, increase client's sense of control. Encourage a "safe-place" during moments of destructive thoughts and impulses

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