Mental Health ATI 1 – Flashcards

suicide

ambivalent; intervention can make a difference

is the end of the problem. (Little concern is given to the aftermath and the ramifications to those left behind. Long-term therapy is needed for the survivors).

suicidal ideation

1. People who talk about suicide never commit it. 2. People who are suicidal only want to hurt themselves, not others 3. There is no way to help someone who really wants to kill himself. 4. Mention of the word suicide will cause the suicidal individual to actually commit suicide. 5. Ignoring verbal threats of suicide, or challenging a person to carry out suicide plans, will reduce the individual's use of these behaviors. 6. People who talk about suicide are only trying to get attention.

1. Primary - prevention strategies that include providing information and education to at-risk populations 2. Secondary - management of the suicide crisis 3. Tertiary - interventions with the family or friends of a person who commited suicide

1. Those at highest risk for suicide include adolescent, young adult, and older adult males; Native Americans asa a group; and persons with comorbid mental illness, such as depressive disorders, anxiety disorders, substance use disorder, schizophrenia, eating disorders, bipolar disorder, and personality disorders. 2. Untreated depression increases the risk of suicide in the older adult client. Other risk factors for the older adult client include: loss of employment and finances, feelings of isolation, powerlessness, prior attempts at suicide (older adult clients are more likely to succeed), change inf functional ability, alcohol or other substance dependency, loss of loved ones.

Family history of suicide Physical disorders, such as AIDS, cancer, cardiovascular disease, chronic renal failure, cirrhosis, dementia, epilepsy, head injury, Huntington's disease, and multiple sclerosis

Sense of hopelessness Intense emotions, such as rage, anger, or guilt Poor interpersonal relationships at home, school, and work Developmental stressors, such as those experienced by adolescents

1. Feelings of responsibility towards family 2. Current pregnancy 3. Religious and cultural beliefs 4. Overall satisfaction with life 5. Presence of adequate social support 6. Effective coping and problem-solving skills 7. Access to appropriate medical care

"There is just no reason for me to go on living"

"Everything is looking pretty grim for me"

1. does the client have a plan? 2. How lethal is the plan? 3. Can the client describe the plan exactly? 4. Does the client have access the the intended method? 5. Has the client's mood changed? A sudden change in mood from sad and depressed to happy and peaceful may indicate a client's intention to commit suicide

Lacerations, scratches, and scars that could indicate previous attempts at self-harm

1. The SAD PERSONS scale is a simple and practical tool that assesses 10 major risk factors for suicide and assigns scores for each. 2. It allows the triaging of suicidal clients to determine the necessity of hospitalization. another important area to assess, not included in this tool, is the individual's intake of illicit or prescribed drugs

1. Initiate one-on-one constant supervision around the clock, always having the client in sight and close. 2. Document the client's location, mood, quoted statements, and behavior every 15 min or per facility protocol. 3. Remove all glass, metal silverware, electrical cords, vases, belts, shoelaces, metal nail files, tweezers, matches, razors, perfume, shampoo, and plastic bags from the client's room and vicinity. 4. Allow the client to use only plastic eating utensils 5. Check the environment for possible hazards (such as windows that open, overhead pipes that are easily accessible.) 6. During observation periods, always check the client's hands, especially if they are hidden from sight 7. Do not assign to a private room if possible and keep door open at all times. 8. Ensure that the client swallows all medications 9. Identify whether or not the client's current medications can be lethal with overdose. If so collaborate with the provider to have less dangerous meds substituted if possible. 10. Restrict the visitors from bringing possibly harmful items to the client.

1. When questioning the client about suicide, always use a follow-up question if the first answer is negative. For example: the client says, "I'm feeling completely hopeless.: The nurse says, "Are you thinking of suicide?" Client: "No, I am just sad" Nurse: "I can see you're very sad. Are you thinking about hurting yourself?" Client: "Well, I'v thought about it a lot." 2. Establish a trusting therapeutic relationship 3. Limit the amount of time an at-risk clients spends alone 4. Involve significant others in the treatment plan t. Carry out treatment plans for the client with comorbid disorders, such as a dual diagnosis of substance use disorder.

Celexa, Prozac, Zoloft

Celexa

Zoloft

1. Do not stop taking med suddenly 2. med may take 1 to 3 wks for therapeutic effects for initial response with up to 2 months for maximal response. 3. Avoid hazardous activities (driving, operating heavy equipment/machinery) until med S/Es are known. S/Es may include nausea, H/A, and CNS stimulation (agitation, insomnia, anxiety). 4. Sexual dysfunction may occur. Notify the provider if effects are intolerable 5. Follow a healthy diet, as weight gan can occur with long-term use. 6. Monitor for signs of increased depression and intent of suicide.

Benzodiazepines

1. Observe for CNS depression, such as sedation, lightheadedness, ataxia , and cognitive decreased cognitive function. 2. Avoid the use of other CNS depressants, such as alcohol 3. Avoid hazardous activities (driving, operating heavy equipment/machinery) 4. Caffeine interferes with the desired effects of the medication 5. Advise the client who wants to discontinue a benzodiazepine to seek the advice of a provider. These medications should not be abruptly discontinued. The dosage should be gradually tapered over several weeks.

Lithium carbonate (Lithobid)

1. GI effects may be minimized by taking med with food or milk. 2. Maintain a healthy client, and exercise regularly to minimize wt gain. 3. Maintain fluid intake of 2 to 3 L/day from food and beverage sources. 4. Maintain adequate sodium intake. 5. Encourage the client to comply with lab appts needed to monitor lithium effectiveness and A/Es.

Valproic acid

Valproic acid

Take med with food to minimize GI discomfort

1. Risperdal 2. Zprexa

Risperidone

Zyprexa

Ask the client to agree to a no-suicide contract, which is a verbal or written agreement that the client makes to not harm himself, but instead to seek help.

1. A no-suicide contract is not legally binding and should only be used according to facility policy. 2. A no-suicide contract may be beneficial, but it should not replace other suicide prevention strategies. 3. a no-suicide contract can be used as a tool to develop and maintain trust between the nurse and the client. 4. A no-suicide contract is discouraged for clients who are in crisis, under the influence of substances, psychotic, very impulsive, and/or very angry/agitated. A contract does not take the place of suicide precautions.

Assist the client to develop a support-system list with specific names, agencies, and phone numbers that the client can call in case of an emergency.

1. The right to humane treatment and care, such as medical and dental care. 2. The right to vote. 3. The right to due process of law, including the right to press legal charges against another person

1. Informed consent and the right to refuse treatment 2. Confidentiality 3. A written plan of care/treatment that includes discharge follow-up, as well as participation in the care plan and review of that plan 4. communication with people outside the mental health facility, including family members, attorneys, and other health care professionals 5. Provision of adequate interpretive services if needed 6. Care provided with respect, dignity, and without discrimination 7. Freedom from harm related to physical or pharmacologic restrait, seclusion, and any physical or mental abuse or neglect 8. Provision of care with the least restrictive interventions necessary to meet the client's needs without allowing him to be a threat to himself or others.

Tort (can be used to decide liability issues, as well as intentional issues that may involve criminal penalties, such as abuse)

Ethical issues

Beneficence

Autonomy

Justice

Fidelity

Varacity

Voluntary commitment

Voluntary commitment

Involuntary (civil) committment

Involuntary committment

usually 2

Emergency involuntary commitment

Emergency involuntary commitment

Emergency involuntary commitment

Observation or temporary involuntary commitment

Observational or temporary involuntary commitment

Long-term or formal involuntary commitment (time of commitment varies but is usually 60 to 180 days.)

competent. They have the right to refuse treatment, unless they have gone through a legal competency hearing and have been judged incompetent. The client who has been judged incompetent has a temporary or permanent guardian, usually a familly member if possible, appointed by the court. The guardian can sign informed consent for the client. The guardian is expected to consider what the client would want if he were still competent.

The shortest duration necessary, and only if less restrictive measures are not sufficient. They are for the physical protection of the client and/or the protection of other clients and staff.

seclusion in cases in which the environment is disturbing or seems too stimulating

physical or chemical, such as neuroleptic medication to calm the client.

1. Convenience of the staff 2. Punishment of the client 3. Clients who are extremely physically or mentally unstable 4. Clients who cannot tolerate the decreased stimulation of a seclusion room

1. The treatment must be ordered by the primary care provider in writing. 2. the order must specify the duration of treatment. 3. the provider must rewrite the order, specifying the type of restraint, every 24 hours or the frequency of time specified by facility policy. 4. Nursing responsibilities must be identified in the protocol, including how often the client should be: Assessed, offered food or drink, toileted, monitored for VS 5. Complete documentation includes a description of the precipitating events and behavior of the client prior to seclusion or restraint, alternative actions taken to avoid seclusion or restraint, the time treatment began, the client's current behavior, what foods or fluids were offered and taken, needs provided for, and VS, medication administered

seclusion or restraints without first obtaining a provider's written order. If this treatment is initiated the nurse must obtain consent witing a psecified period of time (usually 15 to 30 mins)