General Test-Taking Reminders & Mental Health Care Plans

General Test-Taking Reminders

  1. Exam Content Sources: Textbook readings, PowerPoints, live/prerecorded lectures, and class activities.
  2. Watch Question Wording:
    • Common keywords: “most,” “best,” “next,” “priority,” “least,” etc.
    • Identify what is being asked (e.g., “Which intervention is a priority?” vs. “Which is inappropriate?”)
  3. When in Doubt—Use Maslow (Page 50/51):
    • Physiological Needs → Safety Needs → Psychological/educational needs.
    • Example: A patient who hasn’t eaten in days may need nutrition before lengthy teaching sessions.

1. Eating Disorders (Anorexia Nervosa & Bulimia Nervosa)

Key References: Textbook Pages: 386–387 (lanugo, medical complications), 396–397 (plan of care).
PowerPoint Slide: 55.
Table 20.2 on Page 387: Overview of diagnostic criteria and features.

Plan of Care Highlights

  1. Medical Stabilization
    • Monitor electrolytes (especially potassium, magnesium) and cardiac status (ECGs).
    • Watch for refeeding syndrome in anorexia (shifts in phosphorus, potassium).
  2. Nutritional Rehabilitation
    • Structured meal plans and monitoring of intake.
    • Supervise patients during and after meals to prevent purging.
    • Daily weights at the same time under similar conditions to track changes accurately.
  3. Behavioral & Emotional Support
    • Establish trust; use therapeutic communication to explore underlying body image distortions.
    • For bulimia, help identify triggers to binge-purge cycles; encourage coping skills (journaling, relaxation techniques).
  4. Safety
    • Suicidal ideation screening (eating disorders can co-occur with depression).
    • Monitor for lanugo (fine body hair) and other signs of severe anorexia.

Table 20.2: Effects of Eating Disorders on Body Systems

Body System Related to Weight Loss Symptoms
Musculoskeletal Loss of muscle mass, loss of fat, osteoporosis, pathologic fractures Muscle loss, brittle/fragile bones, risk of fractures
Metabolic Hypothyroidism (cold intolerance, bradycardia), hypoglycemia, ↓ insulin sensitivity Low energy, cold intolerance
Cardiac Bradycardia, hypotension, arrhythmias, sudden death Dizziness, possible arrhythmias
Gastrointestinal Delayed gastric emptying, bloating, constipation GI discomfort, constipation
Reproductive Amenorrhea, low LH/FSH Absent menses, infertility
Dermatologic Dry skin, lanugo, edema, acrocyanosis Fine body hair, poor skin turgor
Hematologic Leukopenia, anemia, thrombocytopenia Fatigue, pallor, immunosuppression
Neuropsychiatric Abnormal taste, mental changes Confusion, irritability
Body System Related to Purging (Vomiting/Laxatives) Symptoms
Metabolic Hypokalemia, alkalosis, hypomagnesemia, ↑ BUN Muscle weakness, cardiac arrhythmias
Gastrointestinal Salivary gland inflammation, esophageal/gastric erosion, possible artery compression Swollen cheeks, GI bleeding
Dental Erosion of enamel (esp. front teeth) Tooth sensitivity, decay
Neuropsychiatric Seizures (fluid/electrolyte shifts), neuropathies, fatigue Confusion, tremors, fainting

Plan of Care for a Client With Anorexia

Problem: Ineffective Coping

  • Assessment Data: Denial of illness, inability to ask for help, social isolation, refusal to eat, dread of certain foods, body image distortion.
  • Expected Outcomes:
    • Immediate: Be free of self-injury, participate in treatment, recognize perceptual distortions.
    • Stabilization: Develop effective interpersonal relationships, more realistic body image.
    • Community: Continue therapy, maintain independence, sustain realistic body image.
  • Implementation:
    • Assess for suicidal intent, maintain consistency, supervise to prevent manipulation.
    • Encourage normal developmental tasks (schoolwork), honest praise for accomplishments.

2. Dementia

Key References: Pages 462–472

Plan of Care Highlights

  1. Safety & Environment
    • Prevent wandering; remove fall risks; keep environment calm & consistent.
  2. Communication
    • Short sentences, one instruction at a time, validate feelings.
  3. Routine & Structure
    • Daily schedules, label doors, use memory aids.
  4. Caregiver Support
    • Respite care, support groups.

3. Bipolar Disorder (Type I) – Mania

Key References: Pages 310–313, 309 Table 17.6

Plan of Care Highlights

  1. Safety
    • Reduce stimuli, 1:1 if severe risk.
  2. Physical Health
    • High-calorie finger foods, rest periods, low stimulation.
  3. Communication & Limit Setting
    • Firm, calm approach, set boundaries.
  4. Medication Management
    • Lithium, mood stabilizers; antipsychotics short-term if needed.

4. Mood Disorders & Depression

Plan of Care Highlights

  1. Safety & Suicide Risk
    • Assess for suicidal ideation, remove lethal means.
  2. Medication Management
    • SSRIs first-line, watch for serotonin syndrome.
    • MAOIs - avoid tyramine, risk of hypertensive crisis.
    • TCAs - risk of cardiac toxicity in overdose.
  3. Psychosocial Interventions
    • Encourage therapy, problem-solving, coping strategies.
  4. ECT
    • For treatment-resistant depression, severe suicidality; monitor confusion post-ECT.

5. Autism Spectrum Disorder

Plan of Care Highlights

  1. Structured environment, minimal changes, visual schedules.
  2. Simple communication, allow time for response.
  3. Short group activities, reinforce positives.
  4. Family support & education.

6. Anxiety & Trauma-Related Disorders

6a. Phobias

Gradual exposure, supportive communication, relaxation.

6b. PTSD

Ensure safety, let client set pace, consider exposure therapy, grounding techniques.

6c. Anxiety (GAD, Panic)

Calm approach, SSRIs/SNRIs first-line, short-term benzos, CBT.

6d. OCD

Allow rituals initially, gradually limit, SSRIs (higher dose), exposure/response prevention.

6e. Somatic Symptom & Related

Rule out medical causes, encourage feelings expression, avoid reinforcing sick role.

6f. Dissociative

Ensure safety, gentle reorientation, trauma-focused therapy, validate confusion.

7. Additional Medication-Specific Tips

  • SSRIs: Watch for suicidal ideation early, risk of Serotonin Syndrome.
  • MAOIs: Avoid tyramine → hypertensive crisis.
  • TCAs: Cardiac toxicity in overdose.
  • Benzos: Short-term only, sedation & dependence risk.

8. Integrating Maslow’s Hierarchy

  • Physiological first: address eating/sleeping issues in mania before teaching.
  • Safety: suicidal risk overrides all.
  • Teaching: once stable, focus on emotional support & coping skills.

9. Practical Exam Tips

  1. Slow Down: Identify exactly what’s asked.
  2. Priority & Safety: Best choice often protects life or stabilizes first.
  3. Therapeutic Communication: If physical needs are met, choose open dialogue or immediate emotional support.
  4. Key Lab Values: Lithium 0.6–1.2 mEq/L. Stay hydrated!

Final Encouragement: Use your textbooks, focus on safety, and you’ve got this!