Walter Perez Mental Health ATI review Management of Care: Legal and ethical issues: o Information about the

client, verbal and in writing, must only be shared with those who are responsible for implementing the clients treatment plan. Safety and Infection Control: Anger Management o Provide a safe environment not only for the client who is aggressive, but also for the other clients and staff on the unit. Plan for four to six staff members to be available and in sight of the client as a show of force if appropriate. Health Promotion and Maintenance: Stress Management Intervention o Provide a structured interview to keep the client focused on the present. Provide safety and comfort to the client during the crisis period of these disorders, as clients in severeto panic-level anxiety are unable to problem solve and focus. Postpone health teaching until after acute anxiety subsides. Clients experiencing a panic attack or severe anxiety are unable to concentrate or learn. Psychosocial Integrity: Family and Community Violence o Making sure the clients are physically and psychologically safe from harm Anxiety Plan of care o Systematic desensitization begins with mastering of relaxation techniques. Then, a client is exposed to increasing levels of an anxiety-producing stimulus (either imagined or real) and uses relaxation to overcome the resulting anxiety. The goal of therapy is that the client will be able to tolerate a greater and greater level of the stimulus until anxiety no longer interferes with functioning. Bipolar behavior intervention: o Decrease stimulation without isolating the client if possible. Be aware of noise, music, television, and other clients, all of which may lead to anescalation of the clients behavior. In certain cases, seclusion may be the only way to safely decrease stimulation for this client. Group dynamics: o Group therapy goals include: Sharing of common feelings and concerns and sharing of stories and experiences. The objective is the group not just an individual. Codependency: o which is a common behavior demonstrated by the significant other/family/friends of an individual with substance or process dependency, and assists the family to change that behavior. The codependent person reacts in overresponsible ways that actually allow the dependent individual to continue the substance (or process) abuse or dependency. For example, a spouse may call the clients employer with an excuse of illness when the client is actually intoxicated Relaxation Outcome o If the client will verbalize decreased feelings of anxiety and the client will demonstrate appropriate use of relaxation techniques.

Suicide Precaution: o Initiate one-on-one constant supervision around the clock, always having the client in sight and close. Document the clients location, mood, quoted statements, and behavior every 15 min or per facility protocol. PTSD: o Symptoms of increased arousal, such as irritability, difficulty with concentration, sleep disturbance. Also avoidance of stimuli associated with trauma, such as avoiding people, inability to show feelings. Community mental health centers o are there to provide a variety of services for a wide range of community clients. Intensive outpatient programs promote community reintegration for clients. Splitting, o which is the inability to incorporate positive and negative aspects of oneself or others into a whole image, is frequently seen in the inpatient setting. Borderline personality: o Characterized by instability of affect, identity, and relationships; fear of abandonment, splitting behaviors, manipulation, and impulsiveness; often tries self-mutilation and may be suicidal. The nursing role in anxiety disorders is safety first than remain with the client during the worst of the anxiety to provide reassurance. In terms of anger management setting limits for the client if that does not work. Before Plan for four to six staff members to be available and in sight of the client as ashow of force if appropriate. Ineffective communication o Offering value judgments, excessive questioning, or responding approvingly or disapprovingly Alcohol abstinence medications are Disulfiram (Antabuse), naltrexone (Revia), acamprosate(Campral) TCA examples are Imipramine (Tofranil) Doxepin (Sinequan) Nortriptyline (Aventyl) monitor for Anticholinergic effects and Toxicity resulting in cholinergic blockade and cardiac toxicity evidenced by dysrhythmias, mental confusion, and agitation, which are followed by seizures, coma, and possible death For ECT The typical course of ECT treatment is three times a week for a total of six to 12 treatments. MAOIs and lithium should be discontinued 2 weeks before the ECT procedure. Severe hypertension should be controlled, since a short period of hypertension occurs immediately after the ECT procedure. Post Op ECT: The client is usually awake and ready for transfer back to the mental health unit or other facility within 30 to 60 minutes after the procedure. During the recovery phase, the nurse needs to orient the client frequently, because confusion and short-term memory loss are common during this time.