PMH-BC cheat sheet

Peplau's interpersonal theory defines four phases: orientation, identification, exploitation, and resolution; the nurse role shifts from stranger to resource to counselor.

Hildegard Peplau identified the nurse roles of stranger, teacher, resource person, counselor, surrogate, and technical expert.

Erikson's eight stages pair each psychosocial crisis with a virtue; identity vs. role confusion peaks in adolescence (roughly 12-18 years).

Freud's structural model: id operates on the pleasure principle, ego on the reality principle, superego on internalized morality.

Sullivan's interpersonal theory holds that anxiety arises from interpersonal experience and is relieved through interpersonal security.

Transference is the client's displacement of feelings from past relationships onto the clinician; countertransference is the clinician's reciprocal emotional reaction.

The therapeutic milieu components are safety, structure, norms, limit-setting, and reality confrontation delivered by the whole team.

The nurse-client relationship is goal-directed, time-limited, and governed by professional boundaries rather than friendship.

Mental status exam domains: appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, judgment.

A Mini-Mental State Examination score of 24 or lower (out of 30) generally suggests cognitive impairment and warrants further evaluation.

The CAGE screen flags alcohol problems with any 2 affirmative answers to Cut down, Annoyed, Guilty, Eye-opener.

The PHQ-9 scores 0-27; scores of 5, 10, 15, and 20 mark thresholds for mild, moderate, moderately severe, and severe depression.

The C-SSRS stratifies suicide risk by ideation intensity, intent, plan, and behavior rather than by a single yes/no answer.

The AUDIT-C scores 0-12; 4 or more in men and 3 or more in women suggests hazardous drinking.

Nursing diagnoses follow NANDA-I format: problem statement related to etiology as evidenced by defining characteristics.

Delirium is acute, fluctuating, and attention-predominant; dementia is chronic and progressive with preserved attention early on.

Clozapine requires absolute neutrophil count monitoring weekly for 6 months, then every 2 weeks for 6 months, then every 4 weeks.

Serotonin syndrome triad: mental status change, autonomic instability, and neuromuscular hyperactivity; stop serotonergic agents immediately.

Neuroleptic malignant syndrome presents with rigidity, hyperthermia above 38 C, autonomic instability, and elevated creatine kinase.

Lithium therapeutic range is 0.6-1.2 mEq/L; levels above 1.5 mEq/L raise toxicity risk, and 2.0 mEq/L or higher is severe.

Tardive dyskinesia involves involuntary choreoathetoid movements, often orofacial, after prolonged dopamine antagonist exposure.

SSRIs carry a boxed warning for increased suicidality in patients aged 24 and younger during initial treatment.

Monoamine oxidase inhibitors require a low-tyramine diet; hypertensive crisis is the risk of tyramine interaction.

Electroconvulsive therapy is indicated for treatment-resistant depression, catatonia, and severe depression with psychosis or refusal of food.

Cognitive behavioral therapy targets cognitive distortions and behavioral reinforcement; homework and thought records are core techniques.

Dialectical behavior therapy pairs acceptance with change across four modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.

Motivational interviewing uses open questions, affirmations, reflections, and summaries, with change talk elicited rather than argued.

Active listening skills include reflection, clarification, paraphrasing, and summarizing rather than advising or reassuring.

Therapeutic communication avoids false reassurance, giving advice, and changing the subject, which block client disclosure.

Exposure therapy relies on habituation; the fear hierarchy is graded and response prevention blocks the safety behavior.

Group therapy stages are forming, storming, norming, performing, and adjourning; universality and universality of experience are curative factors.

Psychoeducation is a structured intervention that improves adherence and reduces relapse in schizophrenia and bipolar disorder.

Acute agitation management prioritizes environmental de-escalation, then verbal de-escalation, then medication, then physical restraint as a last resort.

Restraint or seclusion requires a face-to-face evaluation by a licensed practitioner within 1 hour of initiation.

Restraint orders for adults are limited to 4 hours; for ages 9-17, 2 hours; for under 9, 1 hour.

Positive symptoms of psychosis include hallucinations and delusions; negative symptoms include flat affect, alogia, and avolition.

Catatonia signs include stupor, posturing, waxy flexibility, negativism, and mutism; benzodiazepines and ECT are treatments.

Mania features elevated or irritable mood with decreased need for sleep, pressured speech, and grandiosity lasting at least 1 week or requiring hospitalization.

Withdrawal from alcohol can progress to delirium tremens 48-96 hours after the last drink, with seizures and autonomic instability.

Opioid overdose presents with pinpoint pupils, respiratory depression, and unresponsiveness; naloxone reverses it.

A crisis is a time-limited state of disequilibrium in which usual coping fails; intervention aims at restoring equilibrium, not at solving all problems.

Suicide risk factors include prior attempt, access to lethal means, male sex, older age, substance use, and recent loss.

Lethal-means counseling means securing or removing firearms, medications, and other high-lethality methods from the client's environment.

Trauma-informed care rests on safety, trustworthiness, peer support, collaboration, empowerment, and cultural humility.

PTSD criteria require exposure to trauma plus intrusion, avoidance, negative cognition or mood, and arousal lasting over 1 month.

Postvention is support provided after a suicide to survivors, reducing contagion and complicated grief.

The ABC model of psychological first aid is Arousal reduction, Behavior management, and Cognitive restructuring.

Child and elder abuse reporting is mandatory for nurses in all U.S. states and does not require proof, only reasonable suspicion.

The recovery model emphasizes hope, self-determination, peer support, and meaningful community role over symptom elimination.

Assertive community treatment is a team-based model with low caseloads (about 10:1) and 24-hour availability for high-utilization clients.

Supported employment follows the individual placement and support model: competitive jobs, rapid placement, no pre-employment training requirement.

Metabolic monitoring for antipsychotics includes weight, BMI, waist circumference, blood pressure, fasting glucose, and lipids at baseline and follow-up.

Smoking cessation doubles the metabolism of clozapine and olanzapine; dose adjustments are needed on cessation or restart.

Psychiatric rehabilitation emphasizes skills training, supported housing, and family psychoeducation to reduce relapse.

Health promotion for people with serious mental illness targets a 15-20 year mortality gap driven by cardiovascular disease.

Involuntary commitment requires a mental disorder plus danger to self or others or grave disability, defined by state statute.

Informed consent requires capacity, voluntariness, disclosure of risks and benefits, and comprehension of the information.

The four ethical principles are autonomy, beneficence, nonmaleficence, and justice; veracity and fidelity are additional duties.

Confidentiality exceptions include imminent danger to a specific identifiable person, suspected abuse, and court order.

The duty to warn, established by Tarasoff, permits or requires disclosure when a client threatens a specific identifiable victim.

A health care proxy or psychiatric advance directive extends autonomy when the client loses decision-making capacity.

Nurses must report impaired colleagues through the chain of command and, where required, to the board of nursing.

Plan-Do-Study-Act is the standard rapid-cycle improvement model for testing small changes before spread.

Evidence hierarchy ranks systematic reviews and meta-analyses above randomized controlled trials, cohort studies, case reports, and expert opinion.

PICO frames clinical questions as Population, Intervention, Comparison, and Outcome.

Root cause analysis follows a sentinel event and uses cause-and-effect or five-whys methods to find system failures.

A just culture distinguishes human error from at-risk behavior and reckless behavior, responding differently to each.

Structural, process, and outcome measures are the three Donabedian categories of quality indicators.

Handoff communication using SBAR (Situation, Background, Assessment, Recommendation) reduces information loss at transitions.

Peplau's phases are orientation, identification, exploitation, and resolution.

Therapeutic use of self is the planned use of the nurse's personality and communication to promote client growth.

Boundary crossings differ from boundary violations; violations exploit the client for the nurse's gain.

Behavioral theory uses reinforcement, shaping, and extinction to change observable behavior.

Cognitive theory holds that emotional distress follows from appraisals and beliefs rather than events themselves.

Orientation to person, place, time, and situation is tested in the cognitive portion of the mental status exam.

A single suicide question at intake has low sensitivity compared with structured tools like the C-SSRS.

Diagnosis follows DSM-5-TR criteria requiring symptom count, duration, and functional impairment.

Screening tools identify probable cases; they do not establish a diagnosis without clinical evaluation.

A treatment plan documents measurable goals, interventions, responsible parties, and a review date.

Antidepressants take 2-6 weeks for full effect; early improvement in energy may precede mood improvement and raise suicide risk.

Selective serotonin reuptake inhibitors are first-line for most anxiety and depressive disorders due to tolerability.

Benzodiazepines carry dependence risk and are generally limited to short-term use.

Antipsychotic efficacy for positive symptoms reflects roughly 60-70% D2 receptor blockade.

Transcranial magnetic stimulation and ketamine are options for treatment-resistant depression.

The working alliance has three components: goals, tasks, and emotional bond.

Rapport-building and boundary-setting occur in the orientation phase of the nurse-client relationship.

Termination involves summarizing gains, reviewing coping skills, and planning for future stressors.

Silence can be therapeutic when it allows the client to process and continue.

Interpreter use in therapy requires a trained interpreter, not a family member, to protect confidentiality and accuracy.

Suicidal ideation with a plan and intent requires continuous observation and environmental safety measures.

Hallucinations are managed by focusing on the client's feelings and reality testing rather than arguing about the voice.

Clozapine is indicated for treatment-resistant schizophrenia after failure of two other antipsychotics.

Rapid tranquilization commonly uses an antipsychotic with or without a benzodiazepine, with vital sign monitoring.

Relapse warning signs in schizophrenia include insomnia, social withdrawal, and unusual perceptual experiences.

Suicide risk is highest in the period shortly after discharge from inpatient care.

A no-suicide contract is not an evidence-based risk reduction intervention and does not substitute for assessment.

Acute stress disorder occurs 3 days to 1 month after trauma; PTSD requires symptoms beyond 1 month.

Seclusion and restraint require monitoring of circulation, breathing, and hydration at intervals defined by policy and regulation.

Debriefing after critical incidents is offered selectively; single-session mandatory debriefing is not recommended.

Peer specialists are trained individuals with lived experience who provide non-clinical support and role modeling.

Family psychoeducation reduces relapse rates in schizophrenia when it includes problem-solving and communication training.

Shared decision-making improves medication adherence when the client's preferences are documented.

Housing first provides permanent housing without sobriety or treatment preconditions.

Wellness recovery action planning is a self-management tool with daily maintenance, triggers, and crisis plans.

A client who is voluntarily admitted may still be held if criteria for involuntary status are met after evaluation.

The least restrictive alternative doctrine requires using the least intrusive effective intervention.

Documentation should be objective, timely, and specific, recording observed behavior rather than judgments.

Minors' confidentiality is limited by parental consent laws and state reporting requirements.

Nurses are accountable to the board of nursing for practice standards independent of employer policy.

Transformational leadership uses idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.

Failure mode and effects analysis is prospective; root cause analysis is retrospective.

Appraisal of evidence includes validity, reliability, and applicability to the local population.

Nursing-sensitive indicators include falls, pressure injuries, and restraint use.

Interprofessional rounds reduce length of stay and medication errors when structured with a checklist.