Student Name Chamberlain University NR-326: Mental Health Nursing Prof. Name Date Binge Eating Disorder in Adolescence Binge eating disorder (BED) is one of the most prevalent eating disorders affecting teenagers. Many adolescents with BED may not fully recognize the severity of their symptoms, may feel ashamed of their eating behaviors, or wonder why they cannot stop. The constant societal and media pressure to lose weight further complicates this issue. According to Marzilli et al. (2018), binge eating disorder is the most prevalent eating disorder in the United States. Although BED can occur at any age, it often begins in late adolescence or early adulthood. It is important to differentiate between overeating and BED—while overeating can occur occasionally and may be part of normal eating habits, BED is a serious mental disorder that, if left untreated, can result in severe negative consequences. Article Summary Epidemiological research on eating disorders (EDs) in adolescents is still emerging, primarily because EDs have only recently been acknowledged as significant mental health conditions. Marzilli et al. (2018) reviewed 13 studies—five based on DSM-IV criteria and eight on DSM-5 criteria—documenting the prevalence of BED. Prevalence rates ranged from 1% to 5% among adolescents, with a reported rate of 343 per 100,000 in teenage females. The review emphasized that BED increases adolescents’ risks for obesity, substance abuse, suicidal ideation, and other mental health problems. Prevalence and Gender Differences in BED Population Studied Prevalence Rate of BED Notes Adolescent girls 1% – 4% Higher risk compared to boys Adolescent boys 0% – 1.2% BED still most prevalent ED among males Overall adolescent prevalence 1% – 5% Data from 13 reviewed studies Clinical Significance Research shows that BED often peaks between ages 19 and 22 in adolescents and around age 24 in women. Studies over the past decade confirm that BED and subthreshold BED (SBED) are strong predictors of overweight and obesity in both adolescent boys and girls. Given obesity’s severe health risks—including type II diabetes, hypertension, cardiovascular disease, fatty liver disease, and increased mortality—the clinical importance of BED cannot be overstated. NR 326 Binge Eating Disorder In Adolescence Additionally, BED is linked to increased suicidal ideation and attempts in adolescents. Findings indicate: Disorder Type Suicidal Thoughts (%) Suicide Attempts (%) BED 30% 15.1% SBED 20% 5.3% Self-harm behaviors are also more prevalent among adolescents with BED compared to their peers without eating disorders. Etiology of BED The development of BED is influenced by a combination of biological, psychological, and environmental factors: Biological Factors Psychological Factors Environmental Factors Article Critique The study by Marzilli et al. (2018) effectively highlights the long-term consequences of BED and underscores the importance of developing evidence-based prevention programs and treatment approaches. Their review contributes valuable insights for longitudinal studies and randomized controlled trials, reinforcing the need for ongoing research and BED maintenance strategies. Conclusion BED is the most common eating disorder among adolescents and presents significant risks to both physical and mental health. Its complex origins include genetic, psychological, and environmental factors. While BED is more common among girls, it is also the most prevalent ED in adolescent boys. Given the serious health consequences, further research into prevention and treatment tailored to teenagers is essential. NR 326 Binge Eating Disorder In Adolescence References Marzilli, E., Cerniglia, L., & Cimino, S. (2018). A narrative review of binge eating disorder in adolescence: prevalence, impact, and psychological treatment strategies. Adolescent Health, Medicine and Therapeutics, 9, 17–30. https://doi.org/10.2147/ahmt.s148050

Student Name Chamberlain University NR-326: Mental Health Nursing Prof. Name Date RUA: Scholarly Article Review Psychiatric disorders in children are becoming increasingly complex. Approximately 15 million children are estimated to have some form of mental disorder. This rise is attributed to several risk factors, such as genetic predispositions within families and increased bullying in schools or communities by peers. Diagnosing children with mental health disorders is particularly challenging due to the variability in their physical, emotional, and intellectual development. This challenge is especially evident in the case of anxiety, which is considered the most common mental disorder among children. Parents often misinterpret signs of anxiety, sometimes leading to frustration with their children. As children grow and are exposed to more social environments, their awareness of personal differences increases, often resulting in heightened emotional stress (Stewart, 2020). Article Summary According to Stewart (2020), early identification of mental health disorders in children is critically important. Research indicates that 30–50% of children with intellectual disabilities also have a mental disorder. Without early detection, these children may experience adverse outcomes in adulthood. However, in Canada, fewer than 75% of children with mental disorders receive treatment, and wait times for such treatment can range from six months to one year. The difficulty lies in accurately assessing children’s mental health. A newly developed assessment tool, interRAI Child and Youth Instruments, addresses this challenge. It is designed for children from birth to age 18 and uses a dimensional, holistic framework to evaluate mental health. This approach helps healthcare providers understand both the patient and the environmental factors affecting them. NR 326 RUA: Scholarly Article Review A study compared the interRAI instrument with other tools such as CBCL-internalizing. The interRAI anxiety scale includes six items and assesses the frequency of anxiety symptoms. These symptoms include: Higher scores indicate greater anxiety severity. The interRAI system is versatile, used across service sectors, and can follow children’s mental health development longitudinally, aiding in efficient assessment, care planning, and service prioritization (Stewart, 2020). Table 1 Comparison of interRAI Anxiety Scale with Other Tools Feature/Aspect interRAI Anxiety Scale CBCL-Internalizing Scale Target Age Group Birth–18 years 6–18 years Items Measured 6 anxiety-specific items Multiple internalizing symptoms Symptom Examples Anxiety, fears, obsessive and intrusive thoughts, panic, nightmares Depression, anxiety, withdrawal Framework Dimensional & holistic Symptom-based Usage Across Service Sectors Yes Limited Longitudinal Tracking Yes Limited Article Critique The article effectively highlights the major challenges in children’s mental health, offering valuable statistics on the prevalence of mental illness among children who remain untreated. It provides a detailed explanation of the interRAI assessment instrument and its advantages for diagnosing mental disorders. However, one limitation is the geographic scope of the data, which is based solely on Canadian children. While Stewart (2020) states that approximately 15 million children go undiagnosed, U.S. statistics from the CDC provide further perspective: Table 2 U.S. Statistics on Children’s Mental Health (Ages 2–17) Condition Estimated Cases (Millions) ADHD 6.1 Behavior Problems (Ages 3–17) 4.5 Anxiety 4.4 Depression 1.9 (Data source: Centers for Disease Control and Prevention, 2020) The article’s strength lies in its evidence-based support for the interRAI tool. Nonetheless, additional studies using American data would enhance its applicability for U.S. healthcare providers. Conclusion Mental health disorders can begin in early childhood, and their impact can extend into adulthood if left undiagnosed or untreated. Early detection is vital for improving outcomes. The interRAI instruments offer a promising approach by enabling continuous and holistic assessment from birth through adolescence. The tool’s six-item anxiety scale evaluates complaints of anxiety, unrealistic fears, obsessive and intrusive thoughts, panic episodes, and nightmares. Its adaptability across service sectors makes it valuable for both healthcare providers and mental health professionals, improving the accuracy and efficiency of assessments, care plans, and prioritization (Stewart, 2020). References Centers for Disease Control and Prevention. (2020). Children’s Mental Health. https://www.cdc.gov/childrensmentalhealth/data.html NR 326 RUA: Scholarly Article Review Stewart, S. L., et al. (2020). A psychometric evaluation of the interRAI child and youth mental health instruments (ChYMH) anxiety scale in children with and without developmental disabilities. BMC Psychiatry. https://doi.org/10.1186/s12888-020-02785-9

Student Name Chamberlain University NR-326: Mental Health Nursing Prof. Name Date What are safety and nutritional concerns that you would need to consider in regard to caring for a patient suffering from PTSD? Consider safety of both patient(s) and staff? Posttraumatic stress disorder (PTSD) is characterized by symptoms such as re-experiencing a traumatic event, heightened anxiety levels, and emotional numbness (Townsend & Morgan, 2018). When caring for a patient experiencing PTSD, it is crucial to implement safety precautions for both the patient and staff. One important strategy is to minimize exposure to stimuli that could trigger trauma-related memories, as this reduces the risk of re-traumatization and potential aggressive responses. Patients with PTSD may sometimes lash out, often unaware of the harm they could cause, as they might mentally feel they are still in the traumatic situation, such as a war zone. Depression is also common in PTSD, increasing the risk of self-harm or suicide. Therefore, it is essential to assess the patient’s suicide risk regularly. From a nutritional standpoint, depression and anxiety can lead to irregular eating habits, such as decreased appetite or excessive sleep, resulting in inadequate nutritional intake. Nurses should assess the patient’s daily dietary consumption and implement strategies to meet nutritional needs, ensuring the patient maintains physical health despite mental health challenges. Safety Concerns Nutritional Concerns Reduce trauma triggers in the environment Monitor daily nutritional intake Assess suicide risk regularly Address appetite loss due to depression Maintain close supervision during high-anxiety episodes Encourage balanced, nutrient-rich meals Prevent potential harm to patient or staff Develop personalized meal plans What immediate interventions would you carry out for a patient experiencing PTSD? Immediate interventions for a patient experiencing PTSD focus on creating a safe and supportive environment. Establishing a trusting relationship is essential, as PTSD can cause significant difficulty in trusting others. A calm, consistent presence reassures the patient and fosters a sense of security. Remaining physically close during potential flashback episodes allows the nurse to provide rapid emotional support and de-escalation. It also aids in identifying specific triggers so that preventive strategies can be developed. In addition, discussing and teaching coping mechanisms tailored to the patient’s needs can help them manage intrusive thoughts and emotions. Such coping strategies not only provide immediate relief but may also reduce the frequency and severity of future PTSD episodes. NR 326 Pre Simulation Immediate Interventions Purpose Establish trust with the patient Increase comfort and security Stay nearby during flashbacks Provide quick reassurance and de-escalation Identify and manage triggers Reduce recurrence of distress Teach coping strategies Promote self-management of anxiety Describe relaxation techniques or other methods that could be implemented and/or taught to a patient to mitigate/relieve anxiety? Several relaxation techniques can be effective in alleviating anxiety for patients with PTSD. Reducing environmental stimulation—such as dimming bright lights—can help create a calming atmosphere. Breathing exercises, including the Bellows Breath or counting breaths, are useful in helping patients focus and slow their physiological stress responses (Weil, 2018). Imagery techniques involve guiding the patient to visualize calming, positive scenes, such as lying on a peaceful beach, which can divert attention from distressing thoughts. Music therapy is another valuable tool, as it can improve mood and promote emotional stability through soothing auditory stimulation. Relaxation Technique Description Benefit Reduce stimulation Limit bright lights and noise Creates a calming environment Breathing exercises Bellows Breath or counting breaths Focuses attention and lowers anxiety Imagery Visualizing peaceful scenes Distracts from distressing thoughts Music therapy Listening to calming music Improves mood and reduces stress References Weil, A. (2018, September 28). Breathing exercise: Three to try | 4-7-8 breath. Retrieved from https://www.drweil.com/health-wellness/body-mind-spirit/stress-anxiety/breathing-three-exercises/ NR 326 Pre Simulation Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice. Philadelphia, PA: F.A. Davis Company.

Student Name Chamberlain University NR-326: Mental Health Nursing Prof. Name Date Prototype Drug: Risperdal (risperidone) Class Therapeutic: AntipsychoticsPharmacologic: Benzisoxazoles Clinical Indications (Top Three) Risperdal is indicated for schizophrenia, acute mania, and irritability associated with autistic disorder in children. Mechanism of Action It may act by antagonizing dopamine and serotonin in the central nervous system, leading to decreased symptoms of psychosis, bipolar mania, or autism. Side and Adverse Effects Common side effects include aggressive behavior, dizziness, headache, cough, dyspnea, constipation, diarrhea, dry mouth, nausea, and weight gain.Adverse effects include neuroleptic malignant syndrome, suicidal thoughts, agranulocytosis, anaphylaxis, and angioedema. Route and Dosage (Adults) Schizophrenia – PO: 1 mg twice daily; increase by 1–2 mg/day at intervals of at least 24 hours to a maintenance dose of 4–8 mg dailySchizophrenia – IM: 25 mg every 2 weeks; may increase to 37.5 or 50 mg every 2 weeksAcute mania – PO: 2–3 mg/day as a single dose; increase by 1 mg/day at intervals of at least 24 hours (range 1–5 mg/day)Bipolar I maintenance – IM: 25 mg every 2 weeks; may increase to 37.5 or 50 mg every 2 weeks Nursing Implications (Top Three) Monitor mental status (orientation, mood, behavior) before and during therapy.Assess weight, BMI, and monitor for signs of hyperglycemia throughout therapy.Monitor blood pressure and pulse, particularly during initial dose titration, and watch for prolonged QT interval, tachycardia, and orthostatic hypotension. Patient Teaching Take medication exactly as directed. Report extrapyramidal symptoms immediately. Change positions slowly to avoid orthostatic hypotension. Avoid driving or hazardous activities until the drug’s effects are known. Other Considerations Pregnancy Category: CHalf-life in extensive metabolizers – risperidone: 3 hr; 9-hydroxyrisperidone: 21 hrHalf-life in poor metabolizers – risperidone: 20 hr; 9-hydroxyrisperidone: 30 hr Prototype Drug: Ritalin (methylphenidate hydrochloride) Class Therapeutic: Central nervous system stimulants Clinical Indications (Top Three) Ritalin is indicated for the symptomatic treatment of narcolepsy, attention deficit hyperactivity disorder (ADHD), and certain cases of refractory depression. Mechanism of Action Produces central nervous system and respiratory stimulation with weak sympathomimetic activity. Side and Adverse Effects Common side effects include aggressiveness, anxiety, insomnia, restlessness, tremor, hypertension, palpitations, tachycardia, and anorexia.Adverse effects include sudden death, rhabdomyolysis, anaphylaxis, and angioedema. Route and Dosage (Adults) ADHD – PO: 5–20 mg two to three times daily as prompt release tabletsNarcolepsy – PO: 10 mg two to three times daily; maximum 60 mg/day Nursing Implications (Top Three) Monitor blood pressure, pulse, and respiration before and during therapy, and obtain a family history for sudden death or ventricular arrhythmia.Observe for changes in behavior.Monitor for signs of peripheral vasculopathy such as numbness or burning in the fingers. Patient Teaching Take medication as directed; avoid doubling doses. Take the last dose before 6 p.m. Monitor weight regularly. Avoid caffeine-containing beverages. Other Considerations Pregnancy Category: CSchedule II controlled substancePeak plasma concentration: 1–3 hr Prototype Drug: Lithium (Eskalith, Lithobid) Class Therapeutic: Mood stabilizer Clinical Indications (Top Three) Used for manic episodes of bipolar I disorder, management of depression, and adjunct therapy in schizophrenia. Mechanism of Action Alters cation transport in nerve and muscle cells and may influence neurotransmitter reuptake. Side and Adverse Effects Common side effects include fatigue, headache, impaired memory, ECG changes, diarrhea, nausea, muscle weakness, and tremors.Adverse effects include seizures and arrhythmias. Route and Dosage (Adults) Tablets or capsules – 300 to 600 mg three times daily initiallyMaintenance – 300 mg three to four times daily Nursing Implications (Top Three) Assess mental status regularly; initiate suicide precautions if indicated.Monitor for signs of lithium toxicity, including vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness, or twitching.Monitor serum lithium levels twice weekly during initiation and every two months during maintenance. Patient Teaching Take medication as prescribed, even when feeling well. Maintain consistent sodium and fluid intake. Avoid hazardous activities until effects are known. Other Considerations Pregnancy Category: DHalf-life: 20–27 hrOnset: 5–7 days; Peak: 10–21 daysTherapeutic range: 0.5–1.5 mEq/L for acute mania, 0.6–1.2 mEq/L for maintenance; should not exceed 2.0 mEq/L Prototype Drug: Depakote (divalproex sodium) Class Therapeutic: Anticonvulsants, vascular headache suppressantsPharmacologic: Valproates Clinical Indications (Top Three) Indicated for absence seizures, complex partial seizures, and as adjunctive therapy for multiple seizure types. Also used for manic episodes in bipolar disorder and migraine prevention. Mechanism of Action Increases levels of GABA, an inhibitory neurotransmitter, in the central nervous system. Side and Adverse Effects Common side effects include agitation, dizziness, headache, insomnia, sedation, visual disturbance, abdominal pain, anorexia, diarrhea, indigestion, nausea, vomiting, and tremor.Adverse effects include suicidal thoughts, hepatotoxicity, pancreatitis, hyperammonemia, and hypothermia. Route and Dosage (Adults) Single agent therapy – initial dose of 10–15 mg/kg/day in one to four divided doses; increase by 5–10 mg/kg/day weekly until therapeutic response is achieved Nursing Implications (Top Three) Assess seizure activity and initiate seizure precautions.Monitor mood, ideation, and behavior.Assess suicidal tendencies, especially early in therapy. Patient Teaching Take medication as prescribed. Avoid hazardous activities until effects are known. Inform healthcare provider about all concurrent medications before starting new ones. Other Considerations Pregnancy Category: DHalf-life: 9–16 hrPeak: 1–4 hrTherapeutic range: 50–100 mcg/mL for seizures, 50–125 mcg/mL for mania Prototype Drug: Methadone (Dolophine) Class Therapeutic: Opioid analgesicsPharmacologic: Opioid agonist Clinical Indications (Top Three) Used for moderate to severe chronic pain, detoxification and maintenance therapy for opioid dependence, and neonatal abstinence syndrome. Mechanism of Action Binds to opiate receptors in the central nervous system, producing analgesia and suppressing withdrawal symptoms. Side and Adverse Effects Common side effects include confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, and unusual dreams.Adverse effects include hypotension, bradycardia, QT prolongation, constipation, urinary retention, and respiratory depression. Route and Dosage (Adults) Moderate to severe pain – PO: 2.5 mg every 8–12 hrModerate to severe pain – IV, IM, Subcutaneous: 10 mg every 6–8 hr Nursing Implications (Top Three) Notify provider if patient is unconscious or difficult to arouse.Assess for constipation.Use pain scales to evaluate treatment effectiveness. Patient Teaching Take medication exactly as prescribed. Avoid alcohol and CNS depressants. Change positions slowly to prevent dizziness. Avoid hazardous activities until effects are known. Other Considerations Use with caution in structural heart diseaseOnset: 30–60

Student Name Chamberlain University NR-326: Mental Health Nursing Prof. Name Date Clinical Observations and Mental Health Indicators A disheveled appearance, grandiosity, rapid speech patterns, and avoidance of eye contact may indicate worsening mental health conditions. Although an irregular heart rate is clinically significant, it does not directly suggest mental health deterioration. Individuals diagnosed with major depressive disorder often present with self-care deficits—particularly in hygiene—alongside hopelessness and self-esteem issues. They are less likely to exhibit disturbed sensory perception (hallucinations) or thought processes (delusions), or ineffective impulse control, which are more typical in bipolar disorder. Common Assessment Tools in Mental Health The most widely used evaluation tools in mental health nursing are validated survey tools, which help detect changes in behavior, emotional state, and symptom severity. Although tools such as stethoscopes, electrocardiograms, and reflex hammers may be used, they do not yield mental health–specific data. Goals of Nursing in Mental Health Core Objectives Nursing in mental health focuses on enabling clients to adapt to environmental stressors, which may involve modifying thoughts, feelings, and behaviors to align with social and cultural norms. Crisis intervention and management skills are essential, particularly during acute mental health crises. Therapeutic Relationship Establishing a strong nurse-client relationship early promotes safety and trust, enabling effective recovery during vulnerable periods. Nurses aim to restore, promote, and maintain optimal mental health for both themselves and their clients. Professional Identity Professional identity in mental health nursing begins with self-awareness, where nurses understand their own emotions, thoughts, and behaviors and their influence on patient care. Personality assessments are particularly useful in this process, whereas tools like depression scales or lifestyle interventions (exercise, diet) serve different purposes. Clinical Manifestations in Mental Health Mental health assessments prioritize psychosocial, cognitive, emotional, and behavioral symptoms over physical findings. Common assessment cues include: Symptom/Behavior Examples and Notes Perceptual disturbances Hearing voices, visual hallucinations, inability to accept facts Poor hygiene Infrequent bathing, unkempt hair, untreated skin conditions Eye contact Avoidance may indicate disorder or cultural variation Inappropriate behavior Aggression, shouting, sexual innuendos, physical touching Substance misuse Alcohol, illicit drugs, prescription misuse Suicidal ideation Passive or active, with or without a plan Self-harm/violence Cutting, physical aggression toward others Self-defeating behavior Actions leading to repeated negative outcomes Legal issues Frequent law enforcement encounters Survey tool score changes Worsening or improving condition Baseline assessments are essential for identifying changes over time. For example, worsening depression symptoms may present as social withdrawal, neglecting self-care, and reduced food intake. Nursing Diagnoses in Mental Health Nursing diagnoses help establish appropriate interventions, goals, and outcomes, promoting autonomy and professionalism in mental health nursing. Common Nursing Diagnoses Diagnosis Typical Indicators Labile emotional control / Impaired mood regulation Frequent mood changes Ineffective impulse control Risk-taking behavior Hopelessness Depressive symptoms Disturbed personal identity Personality disorder Disturbed body image / Chronic low self-esteem Passive behaviors, anorexia Ineffective/defensive coping Anger, aggression Self-mutilation Cutting Disturbed sensory perception Hallucinations Disturbed thought processes Delusions Self-care deficit Poor hygiene Contributing Environmental Factors Behavioral Causes Survey Tools in Mental Health Measurement tools assist in quantifying subjective client experiences and establishing illness severity. Tool Purpose GAD-7 Generalized anxiety disorder screening SPIN Social phobia assessment ASRM Mania self-rating BEST Borderline symptom severity tracking SBQ-R Suicide risk assessment SAD PERSONS / Adapted Suicide risk screening (adults, children) COWS Opioid withdrawal assessment CAGE / CAGE-AID Alcohol and drug misuse screening Substance Misuse Case Example A client experiencing opioid withdrawal scores 28 on the COWS assessment. The nurse documents: “The client scored 28 on the COWS assessment. Alprazolam administered orally per provider orders.” Nursing Actions in Mental Health Key interventions include: Effective de-escalation often involves relocating the client to their personal space to minimize confrontation. Crisis in Mental Health A crisis is a sudden event that disrupts life balance, overwhelms coping mechanisms, and is typically short-lived. It can result in personal growth or injury. Individuals with mental health vulnerabilities are more susceptible to crises, which may also worsen pre-existing conditions. Phases of Crisis with Client Examples Phase Description Example Phase 1 Event perceived as crisis, anxiety rises, problem-solving begins Evan lost his job, updated his resume, searched job ads Phase 2 Coping fails, anxiety worsens, function declines Rachel’s dog died; she stopped eating, sleeping, and working Phase 3 Seeks external resources, tries new coping Doug, after a tornado loss, asked his brother to help Phase 4 Crisis unresolved, panic, disorientation, possible psychosis Phyllis, homeless and hungry, found confused in grocery store Variables Influencing Crisis Severity References American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis. NR 326 Week 2 Insights and Assessments Varcarolis, E. M. (2021). Foundations of psychiatric mental health nursing: A clinical approach (8th ed.). Elsevier.

Student Name Chamberlain University NR-326: Mental Health Nursing Prof. Name Date Mental Health and Mental Illness The concepts of mental health and mental illness are influenced by cultural definitions. Psychological adaptation to stress can be explained through two primary responses: anxiety and grief. Mental health is defined as “the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms.” Maslow emphasized that individuals are motivated in a continuous quest for self-actualization, described through the hierarchy of needs: physiological/safety, love and belonging, self-esteem, and self-actualization. Mental illness, on the other hand, refers to “maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and that interfere with the individual’s social, occupational, and/or physical functioning.” This is consistent with the transactional model of stress and adaptation. Levels of Anxiety Anxiety is a diffuse, vague apprehension often associated with feelings of uncertainty and helplessness. It becomes problematic when the individual can no longer control it. The four recognized levels of anxiety are presented below: NR 326 Week 1 Level Description Common Symptoms Mild Seldom a problem; anxiety has a clear cause Fidgeting, lip chewing, foot/finger tapping, mild apprehension Moderate Perceptual field narrows; thinking ability is diminished Headache, backache, urinary urgency/frequency, insomnia, difficulty concentrating Severe Greatly diminished perceptual field; learning and problem-solving do not occur; limited connection with reality Confusion, feelings of impending doom, hyperventilation, tachycardia, loud/rapid speech Panic Most intense form; individual loses touch with reality Severe hyperactivity, flight/immobility, disorganized speech, delusions, hallucinations Stages of Grief Grief is a subjective state resulting from a perceived loss, expressed through mourning. According to Kübler-Ross, there are five stages of grief: Stage Description Denial Shock and disbelief regarding the loss Anger Envy and resentment toward those unaffected by the loss Bargaining Attempt to negotiate with a higher power to delay or reverse the loss Depression Intense sadness and despair over the loss Acceptance A sense of peace regarding the loss Legal and Ethical Issues Ethics involves determining what is right or wrong based on moral values, while bioethics applies these principles within medical contexts. A legal right is one established by law, such as freedom of speech. Ethical perspectives include: Perspective Core Principle Utilitarianism Greatest good for the greatest number Kantianism Actions are judged by duty and intention, not outcomes Christian Ethics Follows the Golden Rule Natural Law Humans inherently know right from wrong Ethical Egoism Decisions are based on self-interest An ethical dilemma occurs when a choice must be made between two equally unfavorable outcomes, such as end-of-life decisions for a patient on life support. Key Legal and Ethical Terms Term Meaning Beneficence Promoting good for others Nonmaleficence Doing no harm Justice Ensuring fairness Veracity Being truthful Autonomy Supporting patient’s right to decide Confidentiality Protecting patient privacy (HIPAA) Consent Must be competent, voluntary, and informed Negligence Failure to meet standard care Malpractice Professional negligence causing harm Restraints and Seclusion should only be used as a last resort. Orders for restraint use vary by age: 4 hours for adults, 2 hours for children over 8, and 1 hour for children under 8. Avoiding liability includes effective communication (iBAR, SBAR, AIDET), accurate documentation, compliance with standards of care, understanding the client’s background, and practicing within one’s scope and competence. Relationship Development The nurse–client relationship is central to mental health care, fostering healing, growth, and illness prevention. It should be patient-centered, goal-oriented, and mutually established. Phases of the Therapeutic Relationship Phase Description Pre-interaction Review client information; self-reflection on biases Orientation Introduce, gather data, establish goals, set boundaries Working Maintain trust, implement and evaluate action plans Termination Transition client to next level of care Transference occurs when the patient redirects feelings toward the nurse, while countertransference refers to the nurse’s personal emotional reaction to the patient. Therapeutic Communication Therapeutic communication is a purposeful interaction focusing solely on the patient’s needs. It differs from personal communication because the nurse has no self-interest.Examples of Therapeutic Techniques Technique Definition Example Silence Allows client to gather thoughts Nurse remains quiet after client pauses Accepting Shows positive regard “Yes, I understand what you said.” Offering self Making oneself available “I’ll remain with you for a while.” Broad openings Allows client to direct conversation “What would you like to talk about today?” Making observations Verbalizing perceived behaviors “I noticed you are pacing.” Restating Repeating main idea “You are having trouble concentrating.” Reflecting Referring questions back to client “What do you think you should do?” Focusing Directing attention to key topics “Let us discuss how you are feeling.” Exploring Encouraging deeper discussion “Tell me more about this relationship.” Presenting reality Correcting misperceptions “I understand you hear voices, but I do not hear them.” Voicing doubt Expressing uncertainty “I have trouble believing the FBI is after you.” Nontherapeutic Techniques Technique Definition Example Giving reassurance Minimizes patient’s feelings “Everything will be fine.” Approving/disapproving Passing judgment “That was a bad decision.” Agreeing/disagreeing Taking sides “I think the right thing is to tell your wife.” Giving advice Directing patient’s actions “I think you should…” Probing Forcing uncomfortable discussion “You must tell me more about that breakup.” Defending Protecting someone from criticism “Your doctor knows what he’s doing.” Requesting explanation Asking “Why” questions “Why do you feel this way?” References Kübler-Ross, E. (1969). On death and dying. Macmillan. Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396. NR 326 Week 1 American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA. HIPAA, Pub. L. No. 104–191, 110 Stat. 1936 (1996).

Student Name Chamberlain University NR-326: Mental Health Nursing Prof. Name Date 1. What is the primary neurotransmitter associated with schizophrenia? A. SerotoninB. NorepinephrineC. DopamineD. Acetylcholine 2. Which of the following is considered a positive symptom of schizophrenia? A. Flat affectB. AvolitionC. DelusionsD. Anhedonia 3. What is the priority concern when caring for a patient with schizophrenia? A. Nutritional intakeB. Physical activityC. Risk for suicideD. Cognitive stimulation 4. Which phase of schizophrenia involves prominent psychotic symptoms such as hallucinations and delusions? A. PremorbidB. ProdromalC. Active psychoticD. Residual 5. Which of the following symptoms is categorized as negative in schizophrenia? A. HallucinationsB. Magical thinkingC. Disorganized speechD. Flat affect 6. Which personality disorder is characterized by magical thinking and mild hallucinations without meeting the threshold for schizophrenia? A. SchizoidB. ParanoidC. SchizotypalD. Borderline 7. Which antipsychotic medication is commonly used in treating schizophrenia? A. FluoxetineB. HaloperidolC. LorazepamD. Topiramate 8. What is the appropriate response by the nurse when a patient says, “I hear voices telling me to go outside”? A. Ignore the patientB. Tell them to stop listening to the voicesC. Acknowledge the experience and reassure safetyD. Tell them the voices are real 9. Which term describes the patient’s behavior when they hold a posture for a long time and resist repositioning? A. Loose associationsB. Waxy flexibilityC. AkathisiaD. Echolalia 10. Which medication is used to treat extrapyramidal symptoms (EPS) in schizophrenia? A. BenztropineB. ClozapineC. AripiprazoleD. Disulfiram NR 326 Exam 3 Final Exam Study Guide Eating Disorders 1. Which eating disorder is characterized by recurrent episodes of binge eating followed by purging? A. Anorexia nervosaB. PicaC. Bulimia nervosaD. Rumination disorder 2. A key characteristic of anorexia nervosa is: A. Normal body weightB. Lack of exerciseC. Intense fear of gaining weightD. Excessive appetite 3. Which electrolyte imbalance is common in patients with bulimia nervosa? A. HyperkalemiaB. HypernatremiaC. HypokalemiaD. Hypercalcemia 4. What is the priority nursing diagnosis for a client with anorexia nervosa? A. Chronic low self-esteemB. Disturbed sleep patternC. Imbalanced nutrition: less than body requirementsD. Impaired memory 5. Which behavior is typical in clients with bulimia nervosa? A. Avoidance of foodB. Secretive binge eatingC. Consistent weight gainD. Excessive water consumption only Personality Disorders 1. Which personality disorder is characterized by disregard for others and violation of social norms? A. BorderlineB. NarcissisticC. AntisocialD. Avoidant 2. Which statement best describes borderline personality disorder? A. Social withdrawal and eccentric behaviorsB. Instability in interpersonal relationships, self-image, and moodC. Preoccupation with orderlinessD. Excessive need to be taken care of 3. A patient with histrionic personality disorder will likely exhibit: A. Attention-seeking behaviorB. Avoidance of peopleC. Logical thinkingD. Indifference to compliments 4. What is the best therapeutic approach for a patient with narcissistic personality disorder? A. Ignore their behaviorB. Set firm limits and maintain consistencyC. Encourage dependencyD. Overpraise them 5. Which of the following is a hallmark of avoidant personality disorder? A. GrandiosityB. Fear of rejectionC. SuspiciousnessD. Manipulation Neurocognitive Disorders 1. Which of the following best describes delirium? A. Gradual decline in memoryB. Acute and reversible cognitive disturbanceC. Irreversible progressive memory lossD. Stable cognitive dysfunction 2. Alzheimer’s disease is most associated with: A. Sudden confusionB. Progressive memory impairmentC. HallucinationsD. Seizures 3. What is a priority nursing action for a client with Alzheimer’s disease? A. Force reality orientationB. Maintain a safe environmentC. Restrict fluidsD. Encourage isolation 4. A patient suddenly becomes confused and disoriented. The nurse suspects: A. Alzheimer’s diseaseB. Parkinson’s diseaseC. DeliriumD. Dementia 5. Which medication is commonly used in mild to moderate Alzheimer’s disease? A. HaloperidolB. DonepezilC. RisperidoneD. Lithium Substance Use Disorders 1. Which symptom is most characteristic of alcohol withdrawal? A. Slow pulseB. Tremors and agitationC. EuphoriaD. Decreased blood pressure 2. What is the priority nursing intervention during alcohol withdrawal? A. Encourage group therapyB. Limit fluid intakeC. Prevent seizures and maintain safetyD. Promote exercise 3. Which medication is commonly used to prevent alcohol relapse? A. FluoxetineB. DisulfiramC. DiazepamD. Haloperidol 4. A sign of opioid intoxication includes: A. Pinpoint pupilsB. Dilated pupilsC. AgitationD. Diaphoresis NR 326 Exam 3 Final Exam Study Guide 5. What is the antidote for opioid overdose? A. MethadoneB. NaloxoneC. DiazepamD. Flumazenil

Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date NR 326 Mental Health Nursing Exam 2 Overview Psychotherapy Overview Psychotherapy is an important intervention in mental health nursing, designed to promote behavioral and emotional change. It uses various therapeutic approaches, such as cognitive therapy, behavioral therapy, and integrated models like cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), to help clients manage psychological disorders effectively. Cognitive Therapy Cognitive therapy is founded on the cognitive model, which suggests that an individual’s thoughts have a direct influence on their emotions and behaviors. The goal is to identify and correct distorted thinking patterns that contribute to emotional distress. It is widely applied in the treatment of depression, anxiety, eating disorders, and other mental health conditions, encouraging clients to reassess their interpretations of life events (Beck, 2011). Behavioral Therapy Behavioral therapy, developed in contrast to psychoanalytic theories, is based on the idea that behaviors are learned and can be unlearned or modified through reinforcement. According to theorists such as Pavlov, Watson, and Skinner, maladaptive behaviors are responses to negative experiences and can be changed through structured interventions without examining underlying causes. Key Behavioral Therapy Techniques Technique Description Application in Mental Health Modeling Learning behaviors by imitating role models Improves interpersonal interactions in acute care Systematic Desensitization Gradual exposure to anxiety-provoking stimuli with relaxation techniques Effective for phobias and anxiety disorders Aversion Therapy Pairing undesirable behavior with unpleasant stimuli Applied in substance use, self-harm, or aggressive behaviors Flooding Intense exposure to anxiety-inducing situations Reduces anxiety in conditions such as claustrophobia Response Prevention Blocking compulsive behaviors to reduce anxiety Common in obsessive-compulsive disorder (OCD) Thought Stopping Interrupting negative thought patterns using verbal or behavioral cues Improves self-regulation in intrusive thoughts Time-Out Removing the client temporarily from reinforcing environments Used in behavioral modification for both children and adults Validation Therapy Recognizing and affirming feelings regardless of accuracy Helpful in managing neurocognitive disorders Cognitive-Behavioral and Dialectical Behavior Therapy CBT integrates cognitive and behavioral strategies to help clients understand the connections between their thoughts, emotions, and actions. DBT, a form of CBT, is particularly effective for individuals with personality disorders and emphasizes emotional regulation, distress tolerance, and mindfulness. Dissociative Disorders Dissociative disorders involve a disconnection between thoughts, identity, consciousness, and memory, often resulting from severe stress or trauma. Disorder Characteristics Dissociative Identity Disorder (DID) Presence of two or more distinct personality states, often linked to childhood trauma Depersonalization-Derealization Disorder Feeling detached from oneself or the environment, resulting in altered perception Dissociative Amnesia Inability to recall essential personal information, typically trauma-related Common predisposing factors include psychological trauma, abuse, and overwhelming stress. Treatment aims to strengthen coping skills and restore a sense of continuity and reality (APA, 2013). Somatic Symptom and Related Disorders Somatic Symptom Disorder Somatic symptom disorder involves multiple physical complaints without a medical explanation, accompanied by emotional distress and significant preoccupation with symptoms that impair daily functioning. Assessment Tool: Patient Health Questionnaire 15 (PHQ-15) evaluates severity based on symptoms such as abdominal pain, back pain, headaches, chest pain, joint or menstrual problems, fatigue, dizziness, sleep disturbances, and gastrointestinal issues. Illness Anxiety Disorder This disorder involves persistent worry about having a serious illness despite medical reassurance. Individuals may either seek frequent medical attention (care-seeking type) or avoid it entirely (care-avoidant type). Childhood abuse and comorbid psychiatric disorders are common risk factors. Conversion Disorder Conversion disorder presents with neurological symptoms, such as paralysis or blindness, without a medical cause. Symptoms often follow psychological stress. A subtype, pseudocyesis, involves false pregnancy, usually after emotional trauma. Factitious Disorder Factitious disorder is the deliberate fabrication of symptoms to adopt the sick role, which may be imposed on oneself or another person (formerly called Munchausen syndrome by proxy). Grief and Maladaptive Grieving Grief is an individualized process that may occur before a loss (anticipatory grief) or persist beyond expected patterns. The Kübler-Ross model outlines five stages: denial, anger, bargaining, depression, and acceptance. Maladaptive grief can take the form of exaggerated or prolonged symptoms, stagnation in denial or anger, and emotional pain that prevents recovery. Neurocognitive Disorders (NCDs) NCDs are conditions involving cognitive decline that interfere with daily functioning, categorized as mild or major. Delirium vs. Dementia Feature Delirium Major NCD (Dementia) Onset Sudden Gradual Duration Short-term, reversible Chronic, progressive Causes Infection, dehydration, medications Alzheimer’s disease, vascular pathology Common symptoms include impaired judgment, personality changes, wandering, incontinence, and deficits in language and memory. Etiological Subtypes of NCD Subtype Cause Alzheimer’s Neurodegeneration Vascular NCD Stroke-related damage Lewy Body Dementia Abnormal protein deposits Parkinson’s Disease Dopaminergic degeneration Huntington’s Disease Genetic defect HIV-related NCD Viral neurological involvement Defense mechanisms may include denial of memory loss, confabulation to maintain self-esteem, and perseveration to avoid confusion. Suicide in Mental Health Suicide as a Behavior Suicide is an intentional act of ending one’s life and is most often linked to psychiatric conditions, especially major depression. Over 90% of individuals who die by suicide have a diagnosable mental disorder. Psychological factors include hopelessness, shame, guilt, isolation, and unresolved trauma. Comprehensive Suicide Risk Assessment The nursing assessment identifies the presence and severity of suicidal ideation, distinguishing between thoughts, plans, and attempts. It is important to evaluate the intent behind self-injurious behaviors and to assess the client’s support system, psychiatric history, significant life events, and access to means. Assessment Criteria Key Focus Areas Suicidal Ideation Presence of thoughts, plans, previous attempts Psychiatric/Medical History of depression, substance use, or chronic illness Social Connections Strength and availability of interpersonal support Symptoms and Diagnosis Current psychiatric or medical conditions Risk Indicators Verbal and behavioral warning signs, access to means, concrete plans Risk Factors Identified by ATI Risk Factor Type Examples Gender and Age Males, particularly older adults, have higher completion rates Identity and Occupation LGBTQ+ individuals, military veterans Comorbid Conditions Depression, bipolar disorder, substance use, schizophrenia Life Events Job loss, declining health, bereavement Biological Family history, chronic illness (e.g., cancer, AIDS, MS) Psychosocial Hopelessness, trauma, interpersonal difficulties Cultural Highest rates among American Indian and Alaskan Native populations Environmental Access to firearms, inadequate mental health care, unemployment Pharmacological

Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date Actions the Nurse Should Take to Prevent Lawsuits Nurses can prevent lawsuits by adhering to ethical principles and following legal standards of practice. Ethical principles in nursing include autonomy, beneficence, justice, and nonmaleficence. Autonomy means that each patient has the right to make their own healthcare decisions based on their values and beliefs. Assault is an act that causes genuine fear of being touched without consent, while battery refers to non-consensual touching. Beneficence involves actions guided by compassion, and justice implies that all patients have the right to fair and impartial treatment regardless of insurance status, age, gender, religion, or sexual preference. Nonmaleficence requires selecting interventions that are beneficial and do not cause harm. False imprisonment is the unauthorized confinement of a person using verbal or physical means, such as restraining a voluntary patient against their wishes. Legal Issues in Psychiatric Nursing Confidentiality requires written consent before sharing health information outside the treatment team. In emergencies, if information is released, the following must be documented: date of disclosure, recipient, reason for disclosure, reason written consent could not be obtained, and the specific information disclosed. Medical records play a critical role in malpractice cases. Documentation must be objective, nonjudgmental, and specific, including care plans and descriptions of interventions with evaluations. Duty to warn obligates healthcare workers to report threats of harm to the psychiatrist and team members; failure to do so may be considered negligence or a criminal act. Informed consent preserves patient autonomy. Before procedures, patients must receive written information, have adequate time to weigh risks and benefits, and be informed of alternatives. Consent is not required if the patient is mentally incompetent and treatment is necessary to preserve life, if refusal endangers another person, or if consent is obtained from a legal guardian. Consent may be withdrawn at any time. Restraints and Seclusion Restraints should never be used as punishment or staff convenience. Less restrictive measures, such as verbal de-escalation or chemical restraints, must be tried first. Staff must be trained in their safe use, and restraints or seclusion should be discontinued as soon as possible. Renewal intervals for restraint and seclusion orders are every four hours for adults (18 years and older), every two hours for children aged 9 to 17, and every hour for children under 9. Voluntary and Involuntary Hospitalization Voluntary admission occurs when a patient requests services and remains as long as treatment is necessary. They may leave at will unless deemed a danger to themselves or others, in which case their status may be changed to involuntary. Involuntary commitment must follow state and federal law and is justified if the person is imminently dangerous to themselves (suicidal), to others (violent or homicidal), or unable to care for basic needs (gravely disabled). Emergency commitments are initiated when a person’s behavior is clearly dangerous. These are time-limited, with a court hearing usually scheduled within 72 hours to determine discharge, voluntary admission, or extended involuntary hospitalization. Types of Lawsuits in Psychiatric Nursing Nurses may face lawsuits for breaches of confidentiality, such as revealing case details without consent. If this disclosure causes harm, the nurse may be liable for defamation of character, with libel referring to written statements and slander to spoken statements. Invasion of privacy occurs when a patient is searched without probable cause. Identify and Provide Examples of the Phases of the Nurse-Client Relationship The preinteraction phase involves preparing for the first meeting by obtaining information from medical records or others and reflecting on personal feelings. The orientation phase is when trust and rapport are established, and a contract is formed outlining expectations and responsibilities. The working phase is when therapeutic goals are addressed, patient insight is promoted, and resistance behaviors are managed. The termination phase occurs when goals are achieved or the patient is discharged, and progress is reviewed. Identify the Various Types of Therapeutic Communication and Provide an Example A therapeutic relationship requires rapport, trust, and empathy. Rapport is mutual acceptance and trust; trust is confidence in the nurse’s integrity and reliability; empathy is understanding the patient’s perspective. Sympathy, unlike empathy, involves sharing the patient’s emotions and losing objectivity. Veracity requires honesty in interactions. Manipulation refers to patient efforts to avoid separation or maintain control. Phenothiazines – First Generation Antipsychotics Phenothiazines and haloperidol are used to treat schizophrenia and other psychotic disorders. They relieve psychosis, improve positive symptoms, and may worsen negative symptoms. These medications historically enabled many patients to function more effectively and allowed research into mental illness origins. Stress The autonomic nervous system mediates the stress response, with sympathetic and parasympathetic divisions. The hypothalamic-pituitary axis and sympathetic adrenomedullary systems are key components. Physical stimuli such as temperature extremes, electric shock, or injury trigger the fight-or-flight response, which may include pupil dilation, bladder contraction, and increased cardiac output, blood pressure, and heart rate. Zoloft (Sertraline) Zoloft is an SSRI antidepressant approved for treating OCD. The daily dosage is 50–100 mg, with higher doses sometimes needed for OCD than for depression. Side effects include sleep disturbances, headache, and restlessness. Conversion Disorder (Somatic Symptom Disorder) Conversion disorder involves physical symptoms without organic cause, often resulting from emotional conflict. Symptoms may include aphonia, anosmia, or pseudocyesis and are more common in women and young adults. Many cases resolve when the diagnosis is accepted. Nursing interventions include health teaching, encouraging emotional expression, and teaching coping strategies. Differentiate Anger and Aggression Anger is an automatic response to hurt, frustration, or fear, which can lead to physical health problems or depression if suppressed. Aggression is behavior intended to threaten or injure another’s self-esteem or safety, ranging from self-protective responses to violent acts. Cognitive Therapy Cognitive therapy helps patients change thinking and behavior to improve mood, functioning, and well-being. It is used for depression, anxiety disorders, OCD, PTSD, eating disorders, substance abuse, personality disorders, schizophrenia, bipolar disorder, and somatic symptom disorders. Effectiveness is shown when patients monitor thoughts, recognize connections between thoughts and behaviors, and notice symptom reduction.