NR 326 Exam 2

NR 326 Exam 2

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Chamberlain University

NR-326: Mental Health Nursing

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NR 326 Mental Health Nursing Exam 2 Overview

Psychotherapy Overview

Psychotherapy is a key intervention in mental health nursing aimed at promoting behavioral and emotional change. Various therapeutic approaches such as cognitive therapy, behavioral therapy, and combined models like cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) are used to help clients manage psychological disorders effectively.

Cognitive Therapy

Cognitive therapy is rooted in the cognitive model, which postulates that an individual’s thoughts directly influence their emotions and actions. The primary aim is to identify and correct distorted thinking patterns that contribute to emotional distress. This approach is widely used for treating depression, anxiety, eating disorders, and other conditions by encouraging clients to reevaluate their interpretations of life events (Beck, 2011).

Behavioral Therapy

Developed in contrast to psychoanalytic theories, behavioral therapy is grounded in the idea that behaviors are learned and can be unlearned or modified through reinforcement techniques. According to theorists like Pavlov, Watson, and Skinner, maladaptive behaviors are responses to painful experiences and can be altered through systematic interventions without exploring underlying causes.

Key techniques include:

Cognitive-Behavioral and Dialectical Behavior Therapy

CBT combines both cognitive and behavioral strategies to help clients better understand the relationship between their thoughts, emotions, and actions. DBT, a subtype of CBT, is effective for clients with personality disorders and focuses on emotional regulation, distress tolerance, and mindfulness.

Dissociative Disorders

Overview

Dissociative disorders emerge when individuals experience disconnection between thoughts, identity, consciousness, and memory due to overwhelming stress or trauma. They include:

Predisposing factors often include psychological trauma, abuse, or overwhelming stress. Treatment goals include enhancing coping strategies and helping clients regain a sense of reality and continuity (APA, 2013).

Somatic Symptom and Related Disorders

Somatic Symptom Disorder

Somatic symptom disorder involves multiple physical symptoms without identifiable medical causes, often accompanied by emotional distress. Clients are preoccupied with their physical symptoms, which significantly impair daily functioning.

Assessment Tool: PHQ-15

The Patient Health Questionnaire 15 assesses the severity of common somatic symptoms:

• Abdominal pain
• Back pain
• Headaches
• Chest pain
• Joint and menstrual issues
• Fatigue and dizziness
• Sleep and gastrointestinal disturbances

Illness Anxiety Disorder

This disorder involves excessive worry about having a serious illness despite medical reassurance. Clients may either obsessively seek medical care (care-seeking type) or avoid it altogether (care-avoidant type). Risk factors include childhood abuse and concurrent mental health conditions.

Conversion Disorder

Conversion disorder presents as neurological symptoms (e.g., blindness, paralysis) without medical explanation. Symptoms often relate to psychological stress and are not feigned. A subtype includes pseudocyesis (false pregnancy), often following emotional trauma.

Factitious Disorder

This disorder is characterized by deliberate fabrication of symptoms for the purpose of assuming a sick role. It can be imposed on oneself or another individual (formerly known as Munchausen syndrome by proxy).

Grief and Maladaptive Grieving

Stages of Grief (Kübler-Ross Model)

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Grief is highly individualized and may be anticipatory (before actual loss) or prolonged. Maladaptive grief responses include:

• Distorted grief: Exaggerated symptoms beyond normal grieving
• Chronic grief: Persisting emotional pain without resolution
• Denial or anger phase stagnation: Hindrance to functional recovery

Neurocognitive Disorders (NCDs)

Overview

NCDs are characterized by cognitive decline that interferes with daily life. They include mild and major types, the latter aligning with the previous term “dementia.”

Delirium vs. Dementia

Common Symptoms

• Impaired judgment and impulse control
• Personality changes
• Wandering and incontinence
• Language and memory deficits

NR 326 Exam 2

Etiological Subtypes

Defense Mechanisms in NCD

• Denial: Resistance to acknowledging memory decline
• Confabulation: Fabricated memories to preserve self-esteem
• Perseveration: Repeating responses to avoid confusion

Suicide in Mental Health

Suicide is a Behavior, Not a Diagnosis

Suicide is the act of intentionally ending one’s life and is most often linked with psychiatric disorders, particularly major depression. Over 90% of individuals who die by suicide have a diagnosable mental disorder.

Theories and Risk Factors

Psychological explanations often include hopelessness, shame, guilt, isolation, and unresolved trauma. Defense mechanisms include:

• Isolation of affect
• Undoing
• Projection

Electroconvulsive Therapy (ECT)

Indications and Procedure

ECT is used when other treatments fail, particularly in severe depression, bipolar mania, or schizophrenia. It involves administering electrical currents under anesthesia to induce seizures, which can improve mood symptoms.

Patient and Family Education

Clients should follow medical guidance pre- and post-procedure. Common side effects include nausea, confusion, headache, and temporary memory loss.

Suicide Prevention and Mental Health Assessment

The Importance of Connectedness in Suicide Prevention

A sense of connectedness plays a critical role in preventing suicidal ideation from escalating. When emotional pain and hopelessness surpass an individual’s sense of belonging or connection, the risk of developing active suicidal thoughts increases significantly. However, suicidal ideation alone does not necessarily lead to an attempt unless the individual possesses the means and psychological capacity to act on those thoughts.

Nursing Process: Assessment

Comprehensive Suicide Risk Assessment

The assessment phase focuses on identifying the presence and severity of suicidal ideation, distinguishing between mere thoughts, concrete plans, and actual attempts. It is crucial to determine whether any self-injurious behavior was intended to result in death or was non-suicidal in nature.

Support Systems and Life Context

An evaluation of the client’s interpersonal support system is vital. Individuals without meaningful relationships are at higher risk, particularly during emotionally turbulent periods. Nurses should explore precipitating factors, significant life events, psychiatric or medical conditions, and past mental health treatment, including for depression or substance use.

Behavioral and Verbal Clues

Patients often exhibit behavioral or verbal indications of suicidal intent. Nurses must determine if there is a specific plan and whether the individual has the means to carry it out. Importantly, seclusion should never be used with suicidal patients.

Planning and Implementation

Short-Term and Long-Term Goals

Planning includes setting goals such as ensuring the client seeks staff support during crises and remains safe from self-harm both in the short and long term.

Interventions

Use of safety contracts (“no harm” or “no-suicide” agreements) is acceptable, although they should not replace active monitoring or interventions. Nurses must also discuss their roles in maintaining safety and facilitating support.

Risk Factors Identified by ATI

Biological and Psychosocial Considerations

Pharmacological Interventions

Therapeutic Communication

Effective communication includes open-ended, empathetic questioning and establishing a trusting relationship. Follow-up questions are vital when clients express hopelessness. Encourage clients to limit isolation and involve significant others in their treatment plans.

Electroconvulsive Therapy (ECT)

ECT is especially beneficial for patients with treatment-resistant depression or active suicidal ideation associated with psychotic disorders.

Client Education and Post-Discharge Planning

Nurses should assist clients in creating a list of emergency contacts and resources. Though not legally binding, no-suicide contracts may build trust when used appropriately.

Depression: Types and Risk Factors

Predisposing factors include physiological imbalances (hormonal, neurological, nutritional), medication side effects, and cognitive distortions such as learned helplessness.

Bipolar Disorders

Manic episodes involve elation, hyperactivity, and impulsive behavior, while depressive episodes include suicidal ideation, hopelessness, and psychomotor changes.

Trauma and Stress-Related Disorders

Nurses must approach trauma survivors with empathy, provide emergency contacts, assess for suicidal risk, and facilitate access to therapy and medications.

Anxiety and Related Disorders

Obsessive-Compulsive Disorder (OCD)

Obsessions are intrusive thoughts, while compulsions are ritualistic behaviors performed to alleviate distress. Therapy and SSRIs are often effective.

Eating Disorders

To be addressed separately, but often coexist with anxiety or body dysmorphia.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author. ATI Nursing Education. (2020). Mental health nursing review module (10th ed.). Assessment Technologies Institute. Townsend, M. C. (2020). Psychiatric mental health nursing: Concepts of care in evidence-based practice (10th ed.). F.A. Davis Company. U.S. Department of Health & Human Services. (2022). Suicide prevention. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/suicide-prevention 

NR 326 Exam 2

Centers for Disease Control and Prevention. (2022). Preventing suicide. https://www.cdc.gov/suicide/index.html

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.

Townsend, M. C. (2020). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis.