Psych-Mental Health Concept Map

Psych-Mental Health Concept Map

Medication

Haladol (antipsychotic) 10 mg oral

• Decreases patient’s manic states and controls manifestations of psychosis
• Blocks postsynaptic dopamine receptors (D2) in the mesolimbic system

Artane (anticholinergic) 2 mg oral bid

• Used to decrease adverse side effects of mood stabilizers such as muscle spasms
• Antagonist of acetylcholine and other cholinergic stimuli at muscarinic receptors in the CNS and, in smooth muscle

Lamictal (Anticonvulsant) 50 mg oral bid

• Decreases patient’s manifestations of psychosis
• stabilizes neuronal membranes by acting at voltage-sensitive sodium channels

Zyprexa (antipsychotic) 30 mg oral

• Decreases patient’s manifestations of psychosis
• Antagonist of several receptor sites such as alpha1, dopamine, histamine H1, muscarinic, and serotonin type 2 receptors

Assessment

RJ is a 59-year-old African American male admitted to Austin State Hospital after being arrested for refusing to leave a store and carrying a gun.

Discharge Planning

Gold Standard, Inc. Clinical Pharmacology [database online]. Available at:

http://www.clinicalpharmacology.com. Accessed: March 20, 2015

Patient Triggers: Loud noise (self-identified), homelessness (per social worker)

Coping Mechanisms: Relaxation techniques such as walking or listening to music

• RJ placed at Zoe's Place, a boarding care facility

• Name placed on list for Project Access Program

• Birth certificate issued to receive SSI benefits

• Case worker assigned (LOC 1=higher need)

• Austin Travis County Integral Care

• PATH Program

Bipolar I DSM-V Major Depressive Criteria

Diagnoses

Bipolar I DSM-V Manic Criteria

Pathophysiology

At Least 5 of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure.

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

Symptoms

Patient Symptoms

Axis I- Bipolar I, most recent episode hypomanic

Axis II- personality disorder not otherwise specified

Axis III- unspecified acquired absence of teeth, abnormal ECG, acute hepatitis C, dementia, and hypertension.

Neurotransmitters involved in Bipolar are: norepinephrine, dopamine, and serotonin

Mania is when there is an excessive amount of these neurotransmitters

Depression occurs with too few of these chemical messengers

Brain pathways implicated in Bipolar I are located in the subregions of the prefrontal cortex and medial temporal lobe

Manic Symptoms

• Depressed mood most of the day, nearly every day
• Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
• Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or indecisiveness, nearly every day
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

• Patient did not show significant signs of a depressive state

• Weight loss is a possibility due to patience slender appearance

• Patient denied past or present feelings of suicidal ideations

• Some question as to if this is the proper diagnosis

Patients Symptoms

• Inflated self-esteem or grandiosity

• Decreased need for sleep

• More talkative than usual or pressure to keep talking.

• Flight of ideas or subjective experience that thoughts

are racing.

• Distractibility

• Increase in goal-directed activity or psychomotor

agitation.

• Excessive involvement in activities that have a high

potential for painful consequences

• Grandiosity

• Pressured speech

• Flight of ideas

• Psychomotor agitation

• Religiosity

What I Learned!

Nursing Process

• Feelings elicited...
• Patient's response to me...
• What I learned from the patient...
• Utilization of knowledge gained...

What you learned NCLEX Style!

Goals

Nursing Diagnosis

Highest Priority Diagnosis

Nursing Interventions

The priority nursing diagnosis for a hyperactive manic client during the acute phase is what?

A. risk for injury.

B. ineffective role performance.

C. risk for other-directed violence.

D. impaired verbal communication.

Short-term Goal:

Patient will be free from dangerous levels of hyperactive motor behavior by being medication compliant through the entirety of the shift.

Short-term Goal:

Patient will sleep a minimum of 6 hours through the night

Intervention:

Provide patient with an environment that is conducive to resting and provide PRN medications when necessary.

Intervention:

Teach patient about bipolar disorder and the medications used to manage it. Include medication side-effects in education.

Rationale:

Sleep loss can be the trigger for hypomanic and manic states. It is very important in the management of Bipolar to assure adequate rest. Due to the nature of a manic state, medication may be necessary. (Plante & Winkleman, 2008)

Rationale:

According to Sajatovic, 2014, the more education provided to a patient regarding their disease and medication, the more likely that patient is to be medication compliant.

Implementation:

Although no active intervention was made on my part, providing the patient with a quite room without disturbances from other residents would be ideal. I would also mention to the physician the possibility of sleep medication if necessary.

Implementation: Discussed the various medications RJ was taking and inquired about side-effects the patient was experiencing.

Evaluation: RJ was able to discuss all medications and denied any bothersome side-effects. In the future I would further discuss the need to maintain compliance after discharge and discuss the perceived challenges by patient.

Evaluation:

Patient sleep pattern is documented every night. Patient was currently sleeping approximately 6 to 7 hours a night.

What you learned NCLEX Style!

The priority nursing diagnosis for a hyperactive manic client during the acute phase is what?

A. risk for injury.

B. ineffective role performance.

C. risk for other-directed violence.

D. impaired verbal communication.

Short Term:

• Patient will be free from dangerous levels of hyperactive motor behavior by the end of the shift as desired by patient
• Patient will sleep a minimum of 6 hours through the night
• Patient will demonstrate reality based thought process by the end of each shift

Long Term:

• Patient will sustain optimum physical health while living independently and maintaining medication compliance as desired by patient

1. Risk for injury related to impaired judgment as evidence by patient carrying weapon to public places.

2. Ineffective impulse control related to biochemical changes in the brain as evidence by acting out without thinking, inadequate problem solving and presence of delusions.

3. Self-care deficit related to perceptual or cognitive impairment and poor attention span as evidence by observation of poor grooming, missing teeth, and report of foot fungus.

Maslow's Hierarchy of Needs suggests that the physiological and safety needs come before all others. Without these needs being met, the others would not exist.

Priority: Risk for injury related to impaired judgment as evidence by patient carrying weapon to public places.

Long-term Goal:

Patient will sustain optimum physical health while living independently and maintaining medication compliance after discharge

Short-term Goal:

Patient will demonstrate reality based thought process by the end of each shift

Intervention:

Implement reality based testing such as the 5-4-3-2-1 "test" especially during times of agitation.

Intervention:

Adequate discharge planning will be implemented to find the patient an independent living arrangement to prevent homelessness.

Rationale: Reality based testing can keep a person in the present and may help avoid aggressive behaviors. This technique can be used for de-escalation. (Opotow, 2000)

Rationale:

Homelessness can have major effects on recovery. Homelessness has increased rates of medication non-compliance and heath deterioration. (Henwood, 2014)

Implementation:

RJ was placed on a wait list for an independent living apartment and placed in boarding care until apartment is made available. Patient was provided information as to where he could obtain his medication.

Implementation:

To implement reality based thinking I would asked RJ to name 5 things he can see, 4 things he can hear, etc. until patient's thought process is refocused to the here and now

Evaluation:

RJ is assigned a case work upon discharge to monitor intervention success. To adequately evaluate physical health, patient should be assessed in an outpatient facility regularly.

Evaluation:

I would evaluate this intervention by assessing the patient's mood after reality based thinking is implemented and determine if the patient was able to de-escalate.