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mental health1 Flashcards

1
Q

types of interventions for ocd address two primary areas of concern

A

The physical consequences of the compulsion

The psychosocial components

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2
Q

maintaining skin integrity with ocd

A 
Use tepid water
Use mild soap
Provide hand cream
Create a schedule for hand washing
For example: 
After specific events
Time-limited
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3
Q

exposure and response prevention with ocd

A

Expose the patient to the situation or object, and have them refrain from the ritualistic behavior
Goals:
Decrease stress related to activity
Identify real outcome

Begin with a very short exposure time and gradually increase the length of time
Observe the patient for signs of distress
Ask the patient to identify how they are feeling and any urges they may have for harm to themselves or others during the exposure
The patient may be uncomfortable during exposure which is okay, but the patient shouldn’t feel intense distress
Important to vocalized that even though the patient felt uncomfortable they were able to remain safe

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4
Q

thought stopping with ocd

A

Interrupt the thought by saying “stop”

Used with obsessive thoughts
Interrupt the autonomic process
This is an outcome associated with mindfulness
Control the downward spiral of obsessional thinking
Delay the response
Creates an opportunity to change the response

The challenge is to recognize the thought in order to interrupt it

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5
Q

relaxation techniques with ocd

A

Benefits of relaxation techniques
Decrease anxiety
However, the symptoms of OCD remain the same
Distraction
Offers an alternative activity, but does not eliminate the existing compulsions
Improve sleep patterns
Can help with insomnia

Examples
Deep breathing
Meditation
Listening to music

*Most relaxation activities have a rhythmical nature

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6
Q

cognitive restructuring with ocd

A

Goal is to alter the individuals dysfunctional appraisal of the situation and his/her perceptions of the consequences.

A combination of mindfulness and cognitive behavior therapy (CBT)
Mindfulness interrupts autonomic processes
CBT tests distorted thoughts with reality/evidence
Examples
cue cards
A pros and cons list

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7
Q

medications for ocd

A 
Common medications
TCA
Clomipramine 
SSRI 
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

Note: antidepressants are given in higher doses for OCD than when given for depression

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8
Q

drug interactions with MAOI

A

Adverse side effects include: Hypertensive crisis and Serotonin syndrome

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9
Q

patient education for ocd medications

A

Educate patient and family about medications
Time to work
May take4-6l weeks to see an initial change
May experience side effects with no improvement during this time
Effectiveness
Medication is only part of the solution
Also need behavioral therapy for lasting change
Side effects
Sedation, toxicity, suicidality

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10
Q

four principles for the patient in acute care

A

Clearly explain unit routines
Decreases fear of the unknown
Initially do not prevent the patient from engaging in rituals
Allow time to settle in without increasing anxiety
Empathize with the individual’s need to perform rituals
Contributes to a positive therapeutic relationship
Balance time between private activities and unit activities

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11
Q

psychoeducation

A 
Educate the patient and family
Diagnosis
Rationale for interventions
Importance of continued behavioral practice
Additional resources
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12
Q

evaluation with ocd

A

Points to consider when evaluating patient progress
Remission of presenting symptoms
Able to complete activities of daily living
Participation in social activities
Absence of self harm behaviors
Knowledge about the disease and treatment
Improved scores on rating scales

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13
Q

purpose of therapeutic relationships

A

The nature of the therapeutic relationship is to
support the goals of therapy
clarify the boundaries related to roles

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14
Q

difficult to develop therapeutic relationships with eating disorders

A

Patients tend to be suspicious and mistrustful (Anorexia)
Intense need to be liked and please others (Bulimia)
Patients can be impatient and irritable
Due to starvation
Result of guilt, shame, and embarrassment about their eating disorder or underlying issues (issues about separation)

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15
Q

nursing approach to developing therapeutic relationships

A

Firm
Accepting
Provide a rationale for interventions (builds trust)
Non-reactive approach (avoids power struggles)

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16
Q

refeeding with anorexia

A

Most important intervention during initial stages of treatment

The nurse will encounter resistance and refusal to eat

Goal is to gain 1 -2 pounds per week
Start with 1500 calories and increase to 3500 calories
There will be several meals per day

Behavioral plan includes both positive and negative reinforcement
Monitor meals, bathroom use
Record “ins and outs” (oral, tube feeds, IV)
Work on cognitive distortions (includes beliefs about their body, food, etc.)
Structure the behavior plan so that is expectations rather than a list of punishments
Need ALL staff to be consistent

May include Nasogastric tube feeds and intravenous replacement of electrolytes

Decreased potassium results from using diuretics and vomiting
Decreased calcium results from large intake of fiber which decreases calcium absorption

17
Q

promotion of sleep with anorexia

A

Patients are hyperkinetic

Hyperactive
Abnormal amount of uncontrolled muscle spasms
Patients with anorexia nervosa may sleep very little and wake up in an energized

Develop a sleep hygiene routine
Conserves energy
Reduces caloric expenditure

May be on bed rest

Exercise is not permitted during the refeeding phase.
The nurse must monitor the patient closely.
Patients may try to exercise in their rooms
For example: running in place, running while laying in bed, calisthenics

18
Q

medications for anorexia

A

. SSRI
fluoxetine (Prozac)
Only approved drug in Canada for the treatment of anorexia nervosa
Take in the morning because it can cause insomnia

2.  Antipsychotics
     chlorpromazine (Thorazine)
Typical antipsychotic
Used for delusions and over activity
Olanzapine (Zyprexa)
Atypical antipsychotic
Used to improve mood, decrease obsessional thinking, side effect is weight gain

Treat co-morbid and concurrent diagnoses
Some medications can cause many of the symptoms an individual with anorexia nervosa is already experiencing (i.e. nausea, vomiting, diarrhea, loss of appetite, weight loss)

19
Q

psychosocial interventions for anorexia

A

Addressing interoceptive awareness
Helping patients understand feelings
Psychoeducation

20
Q

addressing interoceptive awareness with anorexia

A

GOAL: Helping patients acknowledge visceral cues and emotions related to food

Journaling
Identify the emotion behind the somatic concern
For example: “I’m fat” –connected to anger, loneliness, or maybe guilt)
Distinguish between body image distortion and reality
Ask what triggers the distortion (emotions, specific situations)
The underlying principle is to develop an accurate perception of what is going on

21
Q

helping patients understand feelings with anorexia

A

GOAL: To decrease avoidance of conflict

Name the feeling
The patient will want to state thoughts instead of feelings
For example: “I’m too thin” rather than “I feel lonely”

Restructure cognitive distortions
Distinguish fears from reality
Challenge the patient to see the world differently
Use CBT techniques

Example:
Patient: “I’ve gained 2 pounds, so I’ll be up by 100 pounds soon.”
Nurse: “You have never gained 100 pounds, but I understand that gaining even 2 pounds is scary.”

22
Q

psychoeducation with anorexia

A 
Assessment of knowledge
Clarify what the patient knows
For example: role of fats
SMART goals
These should be as small as possible to limit the chance of failure
Goals should set the patient up for success!
Balanced lifestyle
Activity and rest
Healthy relationships
Developing interests
23
Q

physical health with bulimia

A 
Monitor meals
Bathroom visits are monitored
Record intake and output
Encourage regular sleep
Patients with bulimia nervosa may be overcommitted (have difficulties saying no because they want to please others) and the worry about fulfilling their commitments can interfere with sleep and be a trigger to binge.

Develop relaxation strategies
…and practice using them

24
Q

medications for bulimia

A

SSRI
fluoxetine (Prozac)
Only approved drug in Canada for the treatment of bulimia nervosa
Take in the morning because it can cause insomnia
Monitor for cheeking and purging after drug administration

Tri-cyclic antidepressants
Some evidence that these medications reduce binge-eating and purging
Toxicity can be lethal so it is important to complete a risk assessment

Wellbutrin
There is an increase risk of seizures so it is not generally used

Treat co-morbid and concurrent diagnoses
Some medications can cause many of the symptoms an individual with anorexia nervosa is already experiencing (i.e. nausea, vomiting, diarrhea, loss of appetite, weight loss)

25
Q

three psychosocial components with bulimia

A

Behavioral strategies
Group interventions
Psychoeducation

26
Q

behavioural strategies with bulimia

A 
GOAL:  Cue elimination and self-monitoring
Journaling
Binges and purges
Precipitating emotions
Environmental cues
Identify healthy responses
For example: distraction, postponing a binge or purge
Modify responses for specific scenarios
Track successes
27
Q

group interventions with bulimia

A

GOAL: Increases interpersonal learning opportunities

Primarily used after symptoms subside to process
Inadequacy
Low self-esteem
Lack of assertiveness
Opportunity to receive feedback about distorted beliefs

Timing of groups should be considered
Groups with rigid rules can be counterproductive as individuals with bulimia nervosa tend to be rigid and abstain in many ways that lead to binge-eating nutrition (moderation is healthy)

28
Q

psychoeducation with bulimia

A

SMART goals
Learn about setting healthy boundaries and limits
Nutritional concepts
Learn about misconceptions about food and the binge-purge cycle
Distorted thinking
Consider changing thinking pattern from either/or to both/and
Physical harm
Damage to physical systems
Signs of increased risk for suicide and self-harm
Resources
For education and supports

29
Q

evaluation of eating disorders

A

Treatment outcomes exists on a continuum
Discharge when the individual has attained 85% of ideal weight
Treatment is considered successful when the individual has attained 90% of ideal weight and maintained this for 1 year
Thoughts about body image, weight, and food are more closely aligned to reality
Improved scores on rating scales

30
Q

prevention strategies for eating disorders for parents

A 
Education includes
Real vs ideal weight
Ways to increase self-esteem
Reduce the influence of teasing and bullying
Media
Signs and symptoms of OCD and eating disorders
Interventions for obesity
Supervision of eating and exercise
31
Q

prevention strategies for eating disorders for children and adolescents

A 
Education includes
Peer pressure
Pubescent changes
Strategies for obesity
Develop and improve self-esteem
Media
Body image traps
Inactivity
Managing Problems
Coping strategies
Stress reduction
Creative problem solving

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