Exam 1 Flashcards
(281 cards)
1
Q
Communication
A
a process of interaction between people in which symbols are used to create, exchange, and interpret messages about ideas, emotions, and mind states
2
Q
5 interrelated concepts to Communication
A
- Health care quality
- Culture
- Safety
- Collaboration
- Care coordination
3
Q
Two most important mental health concepts
A
Clear boundaries and safety
4
Q
4 elements of nurse-patient relationship
A
- Dignity and respect (clear boundaries)
- Information sharing
- Mutual participation (patient is full partner in care)
- Collaboration
5
Q
What does the nurse-patient relationship do?
A
Establishes nurse as safe, confidential, reliable, and consistent; clear boundaries!
6
Q
What is best predictor of positive outcome?
A
Positive nurse-patient alliance is best predictor of positive outcome
7
Q
What encompasses therapeutic use of self? (3)
A
-using personality consciously and with full awareness to promote healing
-attempting to establish relatedness
-structured nursing interventions
8
Q
Talk Therapy (2)
A
Formal: psychotherapy w/ APRN
Informal: counseling used by RN to help individuals problem solve, resolve conflicts, and feel supported
9
Q
6 goals of the nurse-patient relationship
A
- Facilitate communication of distressing thoughts and feelings
- Assist with problem solving for ADLs
- Help patient examine self-defeating behaviors and test alternatives
- Promote self-care and independence
- Provide education on condition and management
- Promote recovery
10
Q
3 types of relationships and what they look like
A
- Intimate (emotional commitment; not allowed in nurse-patient)
- Personal (mutual needs met; purpose of friendship)
- Therapeutic (nurse maximizes communication skills, understanding of human behavior, and personal strengths to enhance patient’s growth)
11
Q
Therapeutic encounter
A
Therapeutic relationship that is brief and informal
12
Q
Five steps to establish therapeutic relationship
A
- Needs of patient identified and explored
- Clear boundaries established
- Problem-solving approaches taken
- New coping skills developed
- Behavioral change supported
13
Q
4 Do’s of setting boundaries
A
- Ensure that the focus of the conversation remains on your patients
- Set firm limits and boundaries on negative or inappropriate behavior
- Disclose a small amount of personal information (if it will strengthen the therapeutic relationship)
- Show genuine concern for patients
14
Q
6 Don’ts of setting boundaries
A
- Behave meanly towards your patient
- Become your patients’ friend
- Allow your needs to be met at the expense of your patient
- Accept cash or gifts for you personally (can blur boundaries)
- Excessively touch patients
- Try to influence patients’ beliefs
15
Q
Boundaries: Under-involvement
A
Ranges from disinterested and neglectful to patient abandonment
16
Q
3 levels of Over-involvement Boundaries
A
- Boundary crossings (personal info sharing, nurses needs met @ expense of patient’s needs)
- Boundary violations (ethically wrong; nurses needs put over patient’s)
- Professional sexual misconduct (most extreme, leads to malpractice
17
Q
Transference and when it is intensified
A
The patient unconsciously and inappropriately displaces onto the nurse feelings and behaviors related to significant figures in patient’s past
Intensified in relationships of authority
Can be positive or negative
18
Q
Countertransference, when is it intensified, how to recognize it
A
The nurse unconsciously displaces feelings related to people in his/her past onto patient
Patient’s transference to nurse often results in countertransference in the nurse
Common sign of countertransference in nurse is over-identification with the patient or strong emotions
19
Q
Values vs beliefs
A
- Both stem from religious, cultural and societal factors
- Values: your judgement of what is important in life
- Belief: opinion, confidence, trust, faith, religious tenets
20
Q
Peplau’s Four phases of therapeutic nurse-patient relationship
A
- Preorientation phase
- Orientation Phase
- Working Phase
- Termination Phase
21
Q
Pre-orientation Phase (3)
A
- Obtain information about the client from chart, significant others, or other health-team members
- Research client condition
- Examine one’s own feelings, fears, and anxieties about working with a particular client
22
Q
Orientation Phase (4)
A
- Introductions (name, purpose)
- Patient may discuss feelings, problems, goals
- Establishing rapport
- Specifying a formal/informal contract (including terms of termination; this is with not for patient)
- Establish confidentiality
23
Q
Working Phase (6)
A
- Maintain trust & rapport
- Gather further data
- Promote patient’s problem-solving skills & self-esteem
- Promote symptom management
- Provide education on diagnosis & medication
- Evaluate progress
24
Q
Termination Phase (5)
A
- Summarize goals & objectives achieved
- Review items taught
- Discuss ways to incorporate new coping strategies
- Review situations of nurse-patient relationship
- Exchange memories to facilitate closure
25
What is the greatest trigger for the development of a patient’s nurse- focused transference?
a. The similarity between the nurse and someone the patient already dislikes
b. The nature of the patient’s diagnosed mental illness
c. The history the patient has with the patient’s parents
d. The degree of authority the nurse has over the patient
D
26
3 Roger’s Factors to promote patient’s growth
- Genuineness
- Empathy (not sympathy)
- Positive regard (shown through attitude and actions, view as having strengths and potential)
27
What should nurse do if patient interrupts during time with current patient?
- Let the patient know you will meet with them later, the time contracted for one patient is their time
28
What should nurse do if the Patient threatens suicide? (3)
- Figure out is patient has plan and lethality
- Share with other staff
- Discuss patient feelings and circumstances that lead to this decision
29
What should nurse do if the patient asks the nurse to keep a secret? (2)
- Nurse cannot make such a promise; info may be important to health and safety of others
- Nurse lets patient know then patient decides to share or not share
30
What should nurse do if the patient asks the nurse a personal question? (2)
- Nurse can answer or not answer
- If nurse answers, be short then refocus on patient
31
What should nurse do if patient cries? (3)
- Nurse stays with patient and reinforces that it is alright to cry
- May inquire about reason for crying
- Offer tissues when appropriate
32
What should nurse do if the patient makes sexual advances? (4)
- Nurse sets clear boundaries
- Nurse frequently states nurse role to maintain boundaries
- Nurse leaves to give patient time to regain control
- Reassignment if behavior continues
33
What should nurse do if patient leaves before session is over?
- Check back in with patient later; they may have needed a break
34
What should nurse do if patient gives the nurse a present? (2)
- “If the gift is expensive or money, the only policy is to graciously refuse.
- If it is inexpensive, then (1) if it is given at the end of hospitalization when a relationship has developed, graciously accept; (2) if it is given at the beginning of the relationship, graciously refuse and explore the meaning behind the present
35
What should nurse do if patient does not want to talk? (3)
- Spend short frequent periods with them
- Let them know you do not half to talk, you will just spend time with them
- Both of these establish nurse as reliable
36
Three factors which Affect Communication
- Personal: cognition, culture, values, bias, beliefs, language barriers
- Environmental: background, privacy, uncomfortable accommodations
- Relationship: level of equality (power imbalances)
37
Four benefits of therapeutic communication
- Feelings of safety
- Increased adherence to treatment
- Increased satisfaction with care
- Increased recovery rates
38
What does verbal Communication communicate? (2)
- Beliefs and values
- Perceptions and meaning
39
What does verbal Communication convey? (4)
- Interest and understanding
- Insult and judgment
- Clear or conflicting messages
- Honest or distorted feelings
40
Examples of Nonverbal communication (8)
- Tone of voice
- Emphasis on certain words
- Physical appearance
- Facial expressions
- Body posture and movement
- Amount of eye contact
- Touch
- Hand gestures
41
Double-bind messages
Mutually contradictory messages, usually given by a person in power; no-win
42
How do verbal and nonverbal communication interaction (3)
- Messages can be conflicting or congruent
- Nonverbal messages and behaviors are less obvious.
- Verbal message = content; nonverbal behavior = process
43
Four cultural considerations
- Touch
- Eye contact
- Communication style
- Cultural filers (cultural bias)
44
Therapeutic Group
any group of people who meet for personal development and psychological growth.
45
Autocratic leader
Exerts control over the group and does not encourage much interaction
Production ↑, morale ↓
46
3 styles of leadership
- Autocratic
- Democratic
- Laissez-faire
47
Democratic leader
Supports extensive group interaction in the process of problem solving
- Production somewhat ↓ than with autocratic leadership, morale much ↑
48
Laissez-faire Leader
Allows the group members to behave in any way they choose and does not attempt to control the direction
Productivity and morale ↓
49
Milieu therapy (3)
- a psychiatric philosophy involving a secure environment to support recovery
- uses naturally occurring events as learning opportunity for patients
- Milieu therapy involves consistency and structure (Structured aspects of the milieu include activities, rules, reality orientation practices, and environment)
50
Peplau’s Therapeutic Milieu
- recognizes the people (patients and staff), the setting, the structure, and the emotional climate as important to healing
-offers patients a sense of security and promotes healing.
51
4 steps of Milieu Therapy/Management
1. Orienting patients to rights and responsibilities
2. Providing culturally sensitive care
3. Selecting activities (individual & group) meet patients’ physical and mental health needs
4. Using the least restrictive environment (consistent and routine
52
What does behavioral crisis management consist of?
1. De-escalation and crisis avoidance
2. Hand-on restraints as last resort
53
TJC’s 4 national safety goals in behavioral healthcare
1. Identify patients correctly (2 identifiers)
2. Use medicines safely (7 rights)
3. Prevent infection (hand hygiene)
4. Identify patient safety risk (suicide risk)
54
5 Clarifying Techniques
-paraphrasing
-restating
-reflecting
-exploring
-focusing
55
Paraphrasing (2)
- when you restate the basic content of a patient’s message in different, usually fewer, words.
-Using simple, precise, and culturally relevant terms, the nurse may confirm an interpretation of the patient’s message and patient confirms or denies
56
Restating (2)
-Repeats the main idea expressed. Gives the patient an idea of what has been communicated.
-If the message has been misunderstood, the patient can clarify it
57
Reflecting (3)
-Directs questions, feelings, and ideas back to the patient.
-Encourages the patient to acknowledge and own personal ideas and inner feelings.
-Acknowledges the patient’s right to have opinions and make decisions and encourages the patient to think of oneself as a capable person.
58
Exploring (2)
-Examines certain ideas, experiences, or relationships more fully.
-If the patient chooses not to elaborate by answering no, the nurse does not probe or pry.
59
Using Silence (3)
-gives person time to collect thoughts or think through a point
-some patients have slower thinking process
-avoid with young people
60
Active Listening
-nurses focus, respond, and remember what patient says verbally and nonverbally
61
Clarifying
- Helps patients clarify their own thoughts and maximize mutual understanding between nurse and patient
62
Making Observations (4)
- Calls attention to the person’s behavior
- Encourages patient to notice the behavior and describe thoughts and feelings for mutual understanding.
- Posture change, facial expressions, behavioral change, etc. → what happened?
- Not judgmental
63
Offering self
-offers presence, interest, desire to understand
-not offered to get person to talk or behave in a specific way
64
Offer General leads
-allow patient to choose direction
-indicates nurse is interested in what comes next
65
Paraphrasing Examples (2)
“You seem to be saying…”
“I’m not sure I understand” ”
66
Restating Examples (2)
“My life is empty… it has no meaning,”
“Your life is empty?”
67
Reflecting Examples (3)
“You sound as if you have had many disappointments.”
“You look sad.”
-useful if patient asks for advice
68
Exploring Examples(3)
“Tell me more about your relationship with your wife.”
“Describe your relationship with your wife.”
“Give me an example of how you and your wife don’t get along.”
69
Making Observations Examples(3)
- “You appear tense.”
- “I notice you’re biting your lips.”
- “You seem nervous whenever John enters the room.”
70
Offering self Examples (2)
“I would like to spend time with you.”
“I’ll stay here and sit with you awhile.”
71
Offer General leads Examples (3)
“Go on.”
“And then?”
“Tell me about it.”
72
Open-ended questions (3)
-encourage patients to share information about experiences, perceptions, or responses to a situation.
- not intrusive and do not put the patient on the defensive
- useful in the beginning of an interview or when a patient is guarded or resistant to answering questions.
73
Closed-ending questions (2)
-used sparingly, can give you specific and needed information.
-most useful during an initial assessment, intake interview, or to determine specific results
74
Projective questions
- usually start with a “what if” to help people articulate, explore, and identify thoughts and feelings.
75
Miracle question
A goal-setting question that helps patients to see what the future would look like if a particular problem were to vanish
76
Nontherapeutic communication (10)
-excessive questioning
-Approval/disapproval- value judgement
-giving advice or interpretations
-probing on sensitive topics
-force treatments
-asking why
-minimizing
-false reassurance
-changing subjects
-participate in negative behavior
77
4 Do’s in Client Interview (besides therapeutic communication)
-keep focus on facts and patient perceptions
-pay attention to nonverbal communication
-encourage patient to look at pros and cons of treatment
-if patient makes serious accusations, explore with senior staff and clarify perceptions
78
How to question patient? (3)
Offer general leads, convey acceptance and interest
79
After introductions in the clinical interview, what should you do?
Turn conversation over to patient with an open-ended question
80
How to decide pace, setting, and seating of clinical interview?
Pace-set by patient
Setting-choose one that enhances feelings of security
Seating- seat at same level, no one should block door; preferably no barrier between
81
What does it look like for nurse to be group leader? (4)
-always use therapeutic communication techniques
-model sensitivity and respect to individual and larger cultural differences
-set foundation for open communication
-encourage members to share and explore cultural assumptions
82
Four factors in group work
- Instillation of hope
- Universality
- Altruism
- Catharsis
83
Instillation of Hope
The leader shares optimism about the successes of group treatment, and members share their improvements and gain hope
84
Universality
Members realize that they are not alone with their problems, feelings, or thoughts.
85
Altruism
Members gain or profit from giving support to others, leading to improved self-esteem and growth
-through mutual sharing and concern for each other
86
Catharsis
A genuine expression of feelings that can be interpreted by both the patient and the group.
-Overexpression of feelings can be detrimental to group processes.
87
Therapeutic groups vs. group therapy
• Group therapy has a sound theoretical base, and leaders generally have advanced degrees
• Aims to improve ability of individual group members to function on an interpersonal level
• Therapeutic groups are based to a lesser extent on theory
• Focus is on group relations, interactions between group members, and the consideration of a selected issue
88
Addiction
compulsive, abnormal dependence on a substance or on a behavior. Typically has adverse psychological, physical, economic, social, or legal ramifications.
89
5 interrelated concepts to addiction
- Coping (addiction is maladaptive)
- Cognition (impairs)
- Family Dynamics
- Mood & Affect
- Safety
90
Substance Use Disorder (3)
Pathological use of a substance that leads to disorder of use
-chronic and relapsing
-not illnesses of choice
91
How do SUD change brain structure and function?
Impacts executive function
92
General symptoms of SUD
-social impairment
-risky use
-impaired control
-physical effects (intoxication, tolerance, withdrawal)
93
Process Addictions
Behavioral additions; no physiological signs, but compulsive actions activate reward pathway in brain just like substances
94
National Institute on Drug Abuse (NIDA)—focus and mission
Focus: drug research
Mission: advance science on causes and consequences of drug use and addiction and then apply that knowledge to improve public health
95
Substance Abuse and Mental Health Administration (SAMHSA)-mission
Reduce impact of substance misuse and mental illness on US communities
96
Addiction (4)
Chronic medical conditions with roots in environment, neurotransmission, genetics, and life experiences
-cycles of relapse and remission
-without treatment lead to disability and premature death
- individuals unable to abstain and unable or unwilling to recognize impact of addiction
97
Intoxication (2)
- Process of using substance to excess
- Manifests in many ways depending on body’s physiological response to the substance
98
Tolerance (2)
- Person no longer responds to drug in the way they initially responded
- Higher dose needed for some response
99
Withdrawal (4)
- Physiological symptoms after discontinued usage after regular or prolonged use
- Substance-specific (mild or life-threatening)
- Alleviated w/ same substance or substance with similar
- More intense symptoms = more likely person to use again
100
Withdrawal Symptoms of behavioral addictions (4)
Psychological symptoms including cravings, anxiety, depression, and sleep disruption
101
Opioids Examples
- sedative and an analgesic effect
-Heroin, Percocet, Morphine, Oxycodone, Meperidine, Codeine, Hydrocodone
102
Opioid Use Disorder Addiction
- chronic relapsing
- significant life impairment, interpersonal conflict, physical hazardous situations
103
Prevalence and protective factors of OUD
-Peaks in young adulthood
-Protective factors: female and high education level
104
Opioid Intoxication Physical Symptoms (4)
-decreased bowel sounds
- decreased RR, BP, normal to low HR
- Miosis (pinpoint pupils)
- track marks
105
Opioid Intoxication-Psychological Symptoms (4)
Initial euphoria then slurred speech, impaired memory and attention, drowsiness, psychomotor retardation
106
Opioid Overdose symptoms (6)
coma, pinpoint pupils, respiratory depression
hypothermia, hypotension, bradycardia
107
Opioid Overdose Treatment (2)
-support airway with mechanical ventilation and aspirating secretions
-naloxone (quick reversal of overdose)
108
Naloxone
-specific opioid antagonist given IM, IV, SubQ, or intranasal for overdose
-FDA approved
-fast action but short duration (may need repeated administration)
109
Opioid Withdrawal symptoms (9)
-male-only (2)
Lacrimation (watery eyes), rhinorrhea (runny nose), pupillary dilation, yawning, piloerection, mood dysphoria, muscle aches, fever, insomnia
-also nausea and vomiting
-males may sweat and have spontaneous ejaculation
110
When does opioid withdrawal start?
6-8 hrs for heroin, Morphine, methadone; peaks@ 2-3 days, subsides next week
8-12 hrs for Meperidine lasts 5 days
111
Opioid Withdrawal Drug treatments (5)
Methadone
Clonidine
Lofexidine
Buprenorphine (w/ Naloxone)
Naltrexone
*death unlikely but miscarriage possible
112
Methadone (4 notes, side effects)
- synthetic slow acting agonist opioid (may have withdrawal symptoms), 1x a day
- only dispensed thru SAMHSA
- reduces the high and prevents withdrawal symptoms
- low dose = safest for pregnant women (neonatal withdrawal will be mild and managed w/ paregoric)
- Side effects : shallow or deep breathing, lightheadedness, chest pounding, hives, rashes, swelling of HEENT area
113
Clonidine for OUD(3)
-alpha agonist antihypertensive
-decreases detox time via blocking SNS neurotransmitters
-eases sweating, hot flashes, watery eyes, restlessness, anxiety
114
Lofexidine (3)
- alpha adrenergic agonist
- cost prohibitive
- decreases detox time significantly
115
Buprenorphine (4)
- Opioid partial agonist, Often contained with naloxone
- Only can be given 12-24 hrs of abstaining
- Long acting
- Side effects: constipation, muscle aches, insomnia, irritability, fever (also nausea and vomiting)
116
Opioid maintenance therapy
-goal = continued abstinence
-reduce cravings with methadone or buprenorphine/naloxone
-Naltrexone for long term maintenance
117
Naltrexone for OUD (3)
-opioid antagonist to prevent relapse after detox, 1x a day
-Side effects: GI distress, muscle cramps, dizziness, sedation, appetite disturbances, or injection site reactions
-Vivitrol: injectable, long acting form to prevent relapse
118
Psychological treatments of OUD (3)
- therapies (individual, behavioral, family, CBT)
- support groups (NA)
-residential treatment
119
What is purpose of residential treatment in OUD?
provide confrontation and isolation for highly motivated
120
Abandonment (legal)-3
- When nurse does not safely transfer patient to another health professional OR
- Nurse does not provide accurate, timely, and thorough reporting or follow-though is neglected
Ex: psych-mental health community nurse needs to not abandon anyone who is suicidal
121
Questionable Practices (3)
Negligence, irresponsibility, impairment
122
2 Steps to take to Act on Questionable Practice
1. Document evidence clearly and accurately
2. Communicate concerns to supervisor
123
Nurse’s role per ANA in acting on questionable behavior (2)
- Included in patient advocate professional responsibility
- Intervene and report risks of harm to patients
124
State variations in Acting on questionable practice (5)
- always report criminally unlawful behaviors
- requirement to report incompetent or impaired to state board of nursing
- requirement to report yourself for these behaviors
- requirements to report other nurses (even if they're the patient) if behavior is public danger
- Most don't require nurses to report non nurses whom are impaired on the job
125
Gambling Disorder Addiction and what does looks like ?
-regular or episodic
- compulsive activity which disturbs life
- futile attempts to control, cutback, or stop
- commit illegal acts to finance and rely on others to pay debt
126
Gambling Disorder Symptoms (3)
- Preoccupation with gambling
- Increased desire to gamble
- Lie to conceal extent of gambling problem
Note: early expression in men, rapid progression in females
127
Gambling Disorder Treatment (nondrug)
- Gamblers Anonymous (includes public confession, peer pressure, peer counselor)
- Therapy
128
Gambling Disorder Treatment (drug)-6
- SSRIs (paroxetine, sertraline, etc.)
- Bupropion
- Mood stabilizers (Lithium)
- Anticonvulsants (topiramate)—also reduce alcohol cravings
- SGAs
- Naltrexone (most severe cases)
129
Alcohol Use Disorder (2)
-Mild, moderate, or severe
-comorbid with many psychiatric disorders
130
Alcohol (2)
-Sedative with initial euphoria due to decreased inhibition
-can decrease immune response and predispose to infection
131
AUD epidemiology
Higher in young adults, men, and native Americans
132
Biological risk factors for AUD
-Genetics
-Neurobiological
-Genetics: 40-60% inherited; more likely in twins and children of adolescents; some genes impact alcohol metabolism
-Neurobiological: altered brain areas with family history of AUD can lead to altered inhibition and working memory
133
Environmental risk factors for AUD
-Social
-Cultural
-Social: trauma, peer influences, “Social lubricant”, increases belonging ( low parental supervision correlated with adolescent substance abuse)
-Cultural- acceptability of alcohol varies by culture
134
Types of Problematic drinking
Binge: drinking too much, too quickly (can intoxicate you faster)—4 drinks in 2 hrs for women, 5 for men
Heavy: drinking too much, too often—8 drinks in week for women, 14 for men
135
What determines how many drinks problematic?
-dependent on age, gender, pregnancy
136
Legal BAC in most state
0.08 to 0.10 g/dL
137
0.02 BAC
# of Drinks
Signs and symptoms
# of Drinks: 2
Signs and symptoms: decreased motor performance, ability to multitask; altered mood and thinking ability
138
0.05 BAC
# of Drinks
Signs and symptoms
# of Drinks: 3
Signs and symptoms: impaired judgement, decreased alertness, euphoria, exaggerated behavior
139
0.08 BAC
# of Drinks
Signs and symptoms
# of Drinks: 4
Signs and symptoms: decreased coordination, reasoning; altered speech, hearing; poor self-control and difficulty detecting danger
140
0.10 BAC
# of Drinks
Signs and symptoms
intoxication
# of Drinks: 5
Signs and symptoms: slurred speech, slowed thinking
141
0.15 BAC
# of Drinks
Signs and symptoms
# of Drinks: 6
Signs and symptoms: vomiting (unless high tolerance), major balance loss
142
0.20 BAC
# of Drinks
Signs and symptoms
# of Drinks: 8-10
Signs and symptoms: memory blackouts, nausea, vomiting
143
0.30 BAC
# of Drinks
Signs and symptoms
# of Drinks: >10
Signs and symptoms: decrease temp, BP, RR; amnesia, sleepiness
144
0.40 BAC
Signs and symptoms
Signs and symptoms: impaired vital signs, death possible
145
AUD Withdrawal Symptoms (6-8 hrs)
Tremulousness, agitation, lack of appetite, insomnia, impaired cognition, increased BP, pulse, temp (nausea, vomiting)
146
AUD Withdrawal Symptoms (8-10 hrs)
Treatment
- Psychotic and perceptual symptoms
- Psychosis is a medical emergency due to risk of DT, seizures, unconsciousness
-Treatment: Chlordiazepoxide for tremulousness and mild-to-moderate agitation
147
AUD Withdrawal Symptoms (12-24 hrs)
-Withdrawal seizures: generalized, tonic clonic; treated with diazepam
148
Alcohol Withdrawal Delirium/ Delirium Tremens (DT’s):
- medical emergency 24-72 hrs after discontinuing alcohol use
-Autonomic hyperactivity, delusions, hallucinations, Psychosis
-likelihood increases with physical illnesses
149
DT prevention and treatment
Prevention: chlordiazepoxide and diazepam
Treatment: Lorazepam (preferred), seclusion and restraints
150
Blackouts
Episodes of amnesia caused by excessive consumption of alcohol due to alcohol’s ability to block new memory consolidation in hippocampus
151
Symptoms of Wernicke-Korsakoff Syndrome
altered gait, confusion/memory disturbance, abnormal eye movement, vestibular dysfunction, sluggish reaction to light
152
Wernicke-Korsakoff Syndrome (cause and treatment)
- Wernicke’s encephalopathy: acute and reversible condition (responds rapidly to Thiamine over 1-2 weeks)
- Korsakoff’s syndrome is severe and chronic version of Wernicke’s encephalopathy (treated w/ Thiamine but no full recovery)
- Both due to thiamine deficiency from malnourishment (drinking over eating) or poor nutrition
153
Peripheral neuropathy
-Characterization
-Recovery after abstinence
-systemic effect of alcohol
-Characterization: thiamine deficiency due to drinking rather than eating leads to PNS damage
-Recovery after abstinence: prevents further deterioration
154
Alcoholic myopathy
-Characterization
-Recovery after abstinence
-systemic effect of alcohol
-Characterization: binge drinking causes muscle weakness and myonecrosis
-Recovery after abstinence: varies from days to months depending on if acute or chronic
155
Alcoholic Cardiomyopathy
-Characterization
-Symptoms
-systemic effect of alcohol
-Characterization: Heart failure due to toxic effects of alcohol weakening and thinning heart muscles
-Symptoms: Fatigue, shortness of breath, and edema of the legs and feet
156
Esophagitis
-Characterization
-Symptom
-systemic effect of alcohol
-Characterization: Inflammation of esophagus (esophageal varices) due to toxic effects of alcohol on esophageal mucosa, esophageal varices may burst and equal medical emergency
-Symptom: vomiting
157
Gastritis
-Characterization
-Symptoms
-systemic effect of alcohol
-Characterization: alcohol erodes mucosal stomach lining which may lead to ulcer and bleeding
-Symptoms: nausea, vomiting, loss appetite, belching, bloating
158
Pancreatitis
-Risk factors
-Acute v Chronic Symptoms
-Acute v Chronic Recovery
-systemic effect of alcohol
-Risk factors: excessive drinking over 5 yrs
-Acute symptoms: abdominal pain, nausea, vomiting
-Acute recovery: complete reversal
-Chronic symptoms: malnutrition, weight loss, and diabetes mellitus
-Chronic Recovery: reduce inflammation and better control of diabetes
159
Alcoholic hepatitis
-Characterization
-Symptoms
-Risk factors
-systemic effect of alcohol
-Characterization: highly toxic chemicals of alcohol deteriorate liver
-Symptoms: appetite changes, dry mouth, pain or swelling in the abdomen, jaundice, fever, confusion, and fatigue. (nausea and vomiting)
-Risk Factors: few heavy drinkers, genetics, liver disorders, malnutrition, female
160
Cirrhosis
-Characterization
-Symptoms
-Recovery
-systemic effect of alcohol
-Characterization: healthy liver tissue replaced with scar tissue which blocks blood flow; end stage of alcoholic liver disease
-Symptoms are easy bleeding and bruising, pruritus (itchy), jaundice, ascites and edema, weight loss, confusion, spider-like blood vessels on the skin (petechiae), and testicular atrophy
-Recovery after abstinence: no cure; liver transplant and low-salt diet for maintenance
161
Leukopenia
-Characterization
-Symptoms
-Recovery
-systemic effect of alcohol
-Characterization: liver damage lead to low WBC due to vitamin deficiencies and low protein intake
-Symptoms: periodontitis, weakness, abdominal pain, fever, fatigue)
-Recovery after abstinence: improve nutrition
162
Thrombocytopenia
-Characterization
-Symptoms
-Recovery
-systemic effect of alcohol
-Characterization: complication of liver cirrhosis due to low platelet count
-symptoms: excessive bruising (purpura), petechiae (on lower legs), and prolonged bleeding from cuts
-Recovery after abstinence: Platelet count begins to rise in 3- 5 days
163
Cancer
Alcohol major risk factor for head and neck cancers.
Also risk for liver, breast and colorectal
164
3 things alcohol contributes to:
-harm to others and injury
-increased economic loss and disabilities
- increased mortality and morbidity of diseases
165
AUDIT
-AUD screening tool
-The Alcohol Use Disorders Identification Test
166
CAGE and CAGE-AID -
AUD screening tools
- Have you felt you needed to cut down on your drinking?
-Are people annoyed by your drinking?
-Have you felt guilty about your drinking?
-Have you ever had a drink in the morning (eye-opener)?
CAGE-AID (Questions are the same as CAGE but refers to Adapted to Include Drugs.)
167
T-ACE
-AUD screening tool
Tolerance
Annoyance
Cut down
Eye-opener
168
What does assessment for AUD include? (7)
1. Screening tool (AUDIT, CAGE, T-ACE) and substance use patterns
2. Addiction professional
3. Clinical exam of background (trauma and family history)
4. Mental health systems
5. Individual 's strength and willingness to change
6. Family assessment (note any codependency)
7. Self- assessment ( assess your biases to remain objective)
169
Codependency (4)
- Codependent people sacrifice their own needs for the fulfillment of others to achieve a sense of control.
- Derive self-worth from others
- Feel responsible for the happiness of others
- Commonly deny that problems exist
170
4 characteristics of codependency
- Caretaking
- Perfectionism
- Denial
- Poor communication
171
Clinical Problems/ Diagnosis
- clinical problem is an issue for which nurses commonly assess, analyze, plan, implement, and/or evaluate care.
- may reflect concerns expressed by the patient or caregiver or identified by another health care team member.
172
Nursing Process: Planning for AUD (2)
-set goal and determine intervention to accomplish goal
-dependent on patient’s assessment, clinical problems, outcome identification, and readiness or motivation for change
173
Nursing Process: Implementation for AUD (6 interventions)
- Promoting safety and sleep: first-line interventions
- Reintroduce good nutrition and hydration (gradually) to support body
- Monitor for withdrawal signs
- Support for self-care (hygiene) to increase self-esteem
- Exploring harmful thoughts, hopelessness, anxiety, spiritual distress, and coping skills
- Instill hope and direction with goal setting assistance
174
Health Teaching/ Prevention for AUD (3)
- In schools
- Prevention best answer for alcohol misuse
- Promote classes which develop healthy coping and self-confidence (social activities increase support and decrease stress)
175
Evaluation (3)
-ensure any transference or countertransference is managed and treatment remains patient - centered
-assess effectiveness of treatment plan using objective data
-Measure patient's behavior changes and progress toward goals
176
6 signs of Chemically Impaired nurse
- High absenteeism or no absences (if drugs are at hospital)
- Patient complaints of inadequate pain control; discrepancies in documentation ; Increase in “wasting” of drugs; higher incidences of incorrect narcotic counts; higher record of signing out drugs
- Poor concentration; difficulty meeting deadlines; inappropriate responses; poor memory or recall
- Problems with relationships
- Irritability; isolate; elaborate excuses for behavior
- Unkempt appearance; impaired motor coordination; slurred speech; flushed face
177
State board response to Chemically Impaired Nurse (2)
- May deny, suspend, or revoke a license based on a report of chemical abuse by a nurse
- Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment; Can later return to work with restrictions
178
Purpose of Peer Assistance Programs for Chemically Impaired Nurse (3)
- Recognize their impairment
- Obtain necessary treatment
- Regain accountability within profession
179
SBIRT program
Comprehensive integrated public health approach
Components
Screening: healthcare professional assesses the severity of substance use and identifies the appropriate level of treatment. (clear and nonjudgmental)
Brief Intervention: healthcare professional focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
Referral to Treatment: healthcare professional provides those identified as needing more extensive treatment with access to specialty care.
180
2 Types of Detoxification
-medically managed inpatient w/ 24 hr medical coverage while drug clears body (withdrawal symptoms may be present
-medically monitored w/ 24 hr professional supervision based on comorbidities and symptoms
181
Rehabilitation (3)
- Short or long-term (long-term also has habilitation)
- medically managed and monitored with 24 hr staff who provide intense and special care for those with acute distress and psychiatric comorbidities
- professional treatment and evaluation for those in acute distress or chronic distress
182
Halfway houses (3)
-Residential treatment in substance-free communal or family environment
-continue work started in other treatments
-Focus on: extend sobriety, case management, integrating new life skills
183
Partial Hospitalization (3)
-More intense than IOP for those who don’t need 24 hr care but would benefit from structure
-no previous treatment experience necessary
-medication management available, but not usually done
184
Intensive outpatient
-nonresidential, highly structured and individualized with treatment groups and individual sessions
185
Outpatient treatment (2)
-structured but less intense, drug-free, nonresidential
-mix of individual, educational and psychotherapy groups based on individual needs and treatment goals
186
Alcoholics Anonymous (2)
-structured for confidentiality and anonymity
-learn how to be sober through support of other members
187
Relapse Prevention (4)
-maintain long-term sobriety
-identify triggers to SUD
-learn healthy coping, identity, and stress management skills to regain abstinence in event of use
-focus on cognition and behavioral changes
188
Disulfram
Use in AUD
Effects when alcohol used
Implications
Use: maintenance, relapse prevention, aversion therapy (DOES NOT reduce craving)
Physical effects when alcohol is used: Intense nausea and vomiting, headache, diaphoresis (sweating), flushed skin, dyspnea (respiratory difficulties), increase BP, decrease HR (tachycardia) and confusion.
Implication: Avoid all alcohol and substances such as cough syrup and mouthwash containing alcohol.
189
Naltrexone (vivitrol-injectable, ,Depade-oral)
Use in AUD
When to take
Side effects
Use: Withdrawal, relapse prevention, decreases pleasurable feelings and cravings
When to take: Opiate-free 10 days beforehand; Oral or long-acting (once a month) injectable form.
Side effects: nausea (usually goes away after first month), headache, sedation, pain at injection site,
190
Acamprostate Calcium
Use in AUD
When to take
Side Effects
Use: Relapse Prevention
When to Take: Begin taking on the fifth day of abstinence; 3x a day
Side effects: diarrhea, GI upset, appetite loss, dizziness, anxiety, and difficulty sleeping.
Contraindicated in patients with renal impairment
191
Benzodiazepenes (lorazepam)
Use in AUD
Implications
Use: Withdrawal
Implication: sedation, decreased anxiety, BP
Use CIWA-AR scale to assess dose according to agency policies.
Assess for seizures that could lead to delirium tremens (DTs). If not treated, coma and ultimately death.
192
Anticonvulsants (Tegretol) and Barbiturates (phenobarbital)
Use in AUD
Implications
Use: Withdrawal
Implication: other treatments safer and more effective; be sure to check for seizures that could lead to DT
193
Clonidine
Use in AUD
Side effects
Use: mild to moderate withdrawal
Implication: Alpha-agonist antihypertensive agent.
Give every 4–6 hr PRN.
Side effects: dizziness, hypotension, fatigue, headache
194
Anxiety
Apprehension, uneasiness, uncertainty, or dread due to real or perceived threat
-both a psychological and physiological etiology and expression
195
4 interrelated Anxiety Concepts
IPV
Coping
Stress
Mood and affect
196
5 levels of anxiety
None
Mild
Moderate
Severe
Panic
Note: behaviors can cross lines
197
Normal anxiety
-Necessary for survival and provides energy to carry out tasks; constructive
198
Fear vs Anxiety (3)
-both physiologically the same (increase HR, BP, diaphoresis)
-Fear is a reaction to a specific danger
-Anxiety is a vague sense of dread related to an unspecified or unknown danger. It can erode self-esteem and personal worth
199
Phobias
Persistent irrational fear that leads to desire to avoid or avoidance itself; person is aware that fear is excessive and unreasonable
-compromises daily functioning and people to great lengths to avoid the situation
200
Phobia Treatment
often not treated; some individuals go to healthcare setting to treat comorbidities like depression, anxiety, substance use, etc.
201
Selective Mutism
condition where children do not speak owing to fears of negative responses or evaluations; often speak at home and seem comfortable
202
Mild Anxiety (3)
- Everyday problem-solving leverage to perceive reality in sharp focus
- Grasps more information effectively
- Coping mechanisms used
203
Mild Anxiety symptoms (5)
- Symptoms: slight discomfort, restlessness, irritability, impatience or mild tension-relieving behaviors (nail biting, fidgeting, finger taping)
204
Moderate Anxiety (4)
- Selective inattention unless pointed out
- Clear thinking hampered
- Problem solving can happen, but not optimal
- Defense mechanisms start here
*may indicate danger*
205
Moderate Anxiety symptoms (8)
- SNS symptoms begin
- Symptoms: tension (and more tension relieving behaviors), pounding heart, increase HR and RR, perspiration, mild somatic symptoms (gastric discomfort, headache, urinary urgency, insomnia), voice tremors, shaking
206
Severe level of Anxiety (4)
- Perceptual field greatly reduced
- Difficulty concentrating on environment even if pointed out
- Dazed and Confused ; no problem solving
- automatic behavior(to reduce anxiety)
207
Severe anxiety Physical Symptoms (4)
-Physical symptoms: more intense somatic (chest discomfort, nausea, dizziness, insomnia), hyperventilation, trembling, pounding heart,
*automatic behaviors aimed at reducing anxiety
208
Severe anxiety Psychological Symptoms (6)
sense of impending doom and dread, confusion, purposelessness, withdrawal, loud and rapid speech, threats and demands
209
Panic level of Anxiety (3)
- Markedly disturbed behavior and exhaustion
- Unable to process reality and environment
- life threatening
* Automatic behaviors are used to reduce anxiety; may be ineffective*
210
Panic level of Anxiety Symptoms (8)
erratic, uncoordinated, impulsive ( including pacing, running, shouting, screaming), withdrawal, hallucinations, terror, unintelligible communication
*somatic complaints increase (numbness, shortness of breath, overheating, chills, chest pain)
211
How does anxiety level affect perceptual field?
Mild: heightened
Moderate: narrowed, grasp less of what is going on
Severe: greatly reduced and distorted
Panic: unable to attend to environment
212
How does anxiety level affect focus?
Mild: focus is flexible; aware of anxiety
Moderate: focus on source of anxiety , less able to pay attention
Severe: focuses on details or one specific detail, scattered attention
Panic: focus is lost, may feel depersonalization or derealization
213
How does anxiety level affect problem-solving ability?
Mild: ability to work effectively and examine alternatives
Moderate: possible but not optimal
Severe: feels impossible; unable to connect events and details
Panic: completely unable to process what is happening; disorganized and irrational reasoning
214
Defense Mechanisms
Coping styles that protect people from anxiety and enable them to maintain their self-image by blocking feelings, conflicts, and memories
-often people are not aware they are using them
215
What determines if defense mechanism is adaptive or maladaptive? (4)
-type
-frequency
-intensity
-duration
216
What kind of defense mechanisms do individuals with anxiety usually use?
Rigid, repetitive, ineffective behaviors
217
Denial
escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence
Adaptive Use: A man reacts to the death of a loved one by saying, “No, I don’t believe you,” to initially protect himself from the overwhelming news.
Maladaptive Use: A woman whose husband died 3 years earlier still keeps his clothes in the closet and talks about him in the present tense.
218
Displacement
transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation.
Adaptive Use: A child yells at his teddy bear after being picked on by the school bully.
Maladaptive Use: A child who is unable to acknowledge fear of his father becomes fearful of animals.
219
Identification
attributing to oneself the characteristics of another person or group. This may be done consciously or unconsciously.
Adaptive Use: An 8-year-old girl dresses up like her teacher and puts together a pretend classroom for her friends.
Maladaptive Use: A boy dresses and talks like a neighborhood drug dealer and starts his own “gang.”
220
Projection
Unconscious rejection of emotionally unacceptable features and attributing them to others
Adaptive Use: always immature
Maladaptive Use: A woman who has repressed an attraction toward other women refuses to socialize. She fears that another woman will come on to her.
221
Rationalization
justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.
Adaptive Use: An employee says, “I didn’t get the raise because the boss doesn’t like me.”
Maladaptive Use: A man who believes that his son was fathered by another man excuses his harsh treatment of the boy by saying, “He is lazy and doesn’t listen to me,” when that is not true.
222
Reaction Formation
when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior.
Adaptive Use: A recovering alcoholic constantly talks about the evils of drinking.
Maladaptive Use: A woman who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth and development.
223
Repression
Involuntary/unconscious blocking of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness.
Adaptive Use: After a marital fight, a man forgets his spouse’s birthday.
Maladaptive Use: A woman is unable to enjoy sex after having pushed out of awareness a traumatic sexual incident from childhood.
224
Sublimation
an unconscious process of transforming negative impulses into less damaging and even productive impulses.
Adaptive Use: A woman who is angry with her boss channels her feelings into housework until her house is sparkling clean.
Maladaptive Use: always constructive
225
Suppression
the conscious decision to delay addressing a disturbing situation or feeling.
Adaptive Use: A businessman who is preparing to make an important speech is told by his wife that morning that she wants a divorce. Although visibly upset, he puts the incident aside until after his speech, when he can give the matt er his total attention.
Maladaptive Use: A woman who feels a lump in her breast shortly before leaving for a 3-week vacation puts the information in the back of her mind until after she returns from her vacation.
226
Panic Disorder
recurrent and unpredictable panic attacks leads to fear of the attacks, a preoccupation with possibility of future episodes disrupts life and creates maladaptive behaviors
-comorbid with many conditions
227
Panic Attacks
sudden onset of extreme apprehension or fear; usually associated with feelings of impending doom and terror
-normal functioning is suspended, perceptual field is limited, and misinterpretation of reality may occur
228
Agoraphobia (4)
-excessive fear or anxiety of places/situations; fear help will not be available in those places
-avoidance behaviors can be debilitating and life constricting
-ACEs and stressful life events may increase development; inheritable
-Often Comorbid with other Anxiety disorders; symptoms of panic disorder and anxiety
229
What is priority diagnosis for panic disorder?
Severe anxiety as evidenced by sudden onset of fear of impending doom or dying, increased HR and RR, shortness of breath, possible chest pain, dizziness, and abdominal distress.
230
What is the intervention and rationale for the following PD short-term goal:
Patient anxiety will decrease to moderate by X date
Intervention: Minimal and simple expectations; breathing exercises
Rationale: shift focus away from symptoms
231
What is the intervention and rationale for the following PD short-term goal:
Patient will gain mastery over panic episodes by Y dates
Intervention: Help patient recognize symptoms, teach the patient adaptive coping
Rationale: Cognitive restructuring, breathing exercises, CBT are effective
232
Generalized Anxiety Disorder
Excessive worry that is difficult to control, interferes with function, persists over 6 months
-comorbid with depression
233
5 key symptoms of GAD
-excessive anxiety, fatigue, avoidance, putting things off, sleep disturbances
234
What is priority diagnosis for GAD?
impaired coping related to persistent anxiety, fatigue, difficulty concentrating
235
What is the intervention and rationale for the following GAD short-term goal:
Patient will state immediate distress is relieved by end of session
Intervention: Stay with patient; speak calmly and slowly, offer reassurance
Rationale: Conveys security, acceptance,
236
What is the intervention and rationale for the following GAD short-term goal:
Patient will be able to identify precipitants of anxiety by X date
Intervention: Teach cognitive therapy, encourage patient to discuss events
Rationale: Promotes self-awareness and future change via identifying stressors
237
What is the intervention and rationale for the following GAD short-term goal:
Patient will identify strengths and coping skills by Y date
Intervention: Identify what has worked in the past; strengths,
Rationale: Increases awareness of coping abilities, self-acceptance
238
Assessment for anxiety ( 6)
• DO physical, neurological, and psychosocial exam (use assessment tools)
• Realize patient is expert on their illness
• Determine source of anxiety (primary vs. secondary)-- Ask patient about causes they can identify
• Determine current level of anxiety (
• Assess for potential self-harm
• Self-assessment (recognize your bias and beliefs around locus of control)
239
Priority Order for Problem and Outcome Identification (Analysis and Planning) (4)
1. Self-mutilation
2. Anxiety
3. Ineffective coping
4. Chronic low self-esteem
240
Outcome Identification for Anxiety problem(3)
• Self-monitors intensity
• Uses reduction techniques
• Maintains role performance
241
Outcome Identification for Ineffective coping problem (2)
- Identifies ineffective and effective patterns
- asks for assistance and information; modifies as needed
242
Outcome Identification for Chronic low self-esteem problem (2)
- Verbalizes self-acceptance
- increased confidence
243
Outcome Identification for self-mutilation problem (2)
• Identifies predictive feelings
• practices self-restraint
244
Implementation for Anxiety Disorders (4)
- dependent on anxiety level
- Rare inpatient admission
- Community-based interventions
- Encourage active participation in care
245
Interventions for mild to moderate anxiety
use therapeutic communication and calm presence techniques; closing off topics and bring up irrelevant details can increase anxiety
246
Interventions for severe to panic anxiety
priority interventions are patient safety and meeting physical needs; seclusion and restraints may be necessary
(they are unable to problem solve so therapeutic communication ineffective; focus on reinforcing environment and reality)
247
Purpose of teamwork and safety in anxiety disorders (3)
• Collaboration to multidisciplinary treatment plan
• Evaluating and refining the plan of care at regular intervals
• Documenting the plan and other essential communication
248
If patient is suicidal what should you do?
-notify team
-do one-to-one continuous observation
249
Role of Health promotion in Anxiety Disorders
people with anxiety disorders less likely to seek help; important to teach about disorders and effective treatments such as relaxation responses
250
Role of promotion of self-care activities in anxiety disorders
usually able to meet their basic physical needs but if not you may need to provide matter-of-fact directions; nutrition and fluid intake, hygiene and grooming, sleep
251
Order of Intervention Implementation for Anxiety Disorders
- Determine anxiety level
- Counseling (enhance coping and communication skills)
- Teamwork and safety
- Promotion of self-care activities
252
Evaluation questions for Anxiety (6)
- Is the patient experiencing a reduced level of anxiety?
- Does the patient recognize symptoms as anxiety-related?
- Does the patient continue to display signs and symptoms?
- Is the patient able to use newly learned behaviors to manage anxiety?
- Does the patient adequately perform self-care activities? Is the patient able to assume usual roles?
- Can the patient maintain satisfying interpersonal relations?
253
Antidepressants used for Anxiety disorders (7)
-1st line of defense and treat comorbid depression
SSRIs
-fluoxetine and sertraline are most activating
-paroxetine is more calming
-escitalopram
-Fluvoxamine (for OCD)
SNRIs
Venlafaxine-for anxiety, depression, nerve pain
Duloxetine (GAD)
Tricyclic (clomipramine for OCD)
254
Usage of Benzodiazepines for Anxiety
-antianxiety (treat somatic and psychological symptoms)
-quick onset
-dependence and paradoxical reactions
-not recommended in pregnancy, older adults, comorbid SUD
-Types: clonazepam, diazepam, lorazepam, chlordiazepoxide, Alprazolam (short term for PD and agoraphobia)
255
Usage of antihistamines for Anxiety
Hydroxyzine; safe non addictive alternative to benzodiazepines
256
Usage of Buspirone for anxiety (4)
-drug of choice, antianxiety (treat somatic and psychological symptoms)
-no dependence or CNS depressant
-2-4 weeks for full effect (effects start in 1-2 weeks)
-not recommended for those with impaired hepatic, renal; safe for fetus
257
Usage of anticonvulsants for Anxiety (2)
-for GAD and social anxiety
-gabapentin, pregabalin
258
Usage of antipsychotics for Anxiety
Only for more severe symptoms
259
Usage of noradrenergic drugs for Anxiety (2)
slow HR and BP
Propranolol-short-term relief social anxiety
Clonidine- PD and other anxiety)
260
Intervention for mild to moderate anxiety:
Help the patient identify anxiety. “Are you comfortable right now?”
What is the rationale:
Rationale: It is important to validate observations with the patient, name the anxiety, and start to work with the patient to lower anxiety.
261
Intervention for mild to moderate anxiety:
Use nonverbal language to demonstrate interest
What is the rationale:
Rationale: Verbal and nonverbal messages should be consistent. The presence of an interested person provides a stabilizing focus.
262
Intervention for mild to moderate anxiety:
Encourage the patient to talk about feelings and concerns.
What is the rationale:
Rationale: When concerns are stated aloud, problems can be discussed and feelings of isolation decreased.
263
Intervention for mild to moderate anxiety:
Avoid closing off avenues of communication that are important to the patient. Focus on the patient’s concerns.
What is the rationale:
Rationale: When staff anxiety increases, changing the topic or offering advice is common but leaves the person isolated.
264
Intervention for mild to moderate anxiety:
Help the patient to identify thoughts or feelings before the onset of anxiety. “What were you thinking right before you started to feel anxious?”
What is the rationale:
Rationale: The patient is helped to identify thoughts and feelings, and problem solving is facilitated.
265
Intervention for mild to moderate anxiety:
Help the patient to develop alternative solutions to a problem through role-play or modeling behaviors.
What is the rationale:
Rationale: Encouraging patients to explore alternatives increases their sense of control and decreases anxiety.
266
Intervention for mild to moderate anxiety:
Explore behaviors that have worked to relieve the patient’s anxiety in the past.
What is the rationale:
Rationale: The patient is encouraged to mobilize successful coping mechanisms and strengths
267
Intervention for mild to moderate anxiety:
Provide outlets for working off excess energy
What is the rationale:
Rationale: Physical activity can provide relief of built- up tension, increase muscle tone, and increase endorphin levels.
268
Intervention for mild to moderate anxiety:
Anticipate anxiety-provoking situations.
What is the rationale:
Rationale: “Escalation of anxiety to a more disorganizing level is prevented.”
269
Intervention for severe to panic anxiety:
Use a low-pitched voice; speak slowly.
What is the rationale:
Rationale: A high-pitched voice can convey anxiety. Low pitch can decrease anxiety.
270
Intervention for severe to panic anxiety:
Reinforce reality if distortions occur
What is the rationale:
Rationale: Anxiety can be reduced by focusing on and validating what is going on in the environment.
271
Intervention for severe to panic anxiety:
Listen for themes in communication.
What is the rationale:
Rationale: verbal communication themes may be the only indication of the patient’s thoughts or feelings.
272
Intervention for severe to panic anxiety:
Attend to physical and safety needs when necessary
What is the rationale:
Rationale: High levels of anxiety may obscure the patient’s awareness of physical needs
273
Intervention for severe to panic anxiety:
Physical limits may have to be set. Speak in a firm, authoritative voice
What is the rationale:
Rationale: A person who is out of control is often terrorized. Staff must offer the patient and others protection from destructive and self- destructive impulses.
274
Intervention for severe to panic anxiety:
Provide opportunities for exercise
What is the rationale:
Rationale: Physical activity helps channel and dissipate tension and may temporarily lower anxiety.
275
Intervention for severe to panic anxiety:
When a person is constantly moving or pacing, offer high-calorie fluids.
What is the rationale:
Rationale: Dehydration and exhaustion must be prevented.
276
Intervention for severe to panic anxiety:
Assess need for medication or seclusion after other interventions have been tried and have been unsuccessful..
What is the rationale:
Rationale: Exhaustion and physical harm to self and others must be prevented.
277
Obsessive-Compulsive Disorders
obsessions and compulsions cause distress, interfere with cognition, normal routines and relationships
-comorbid
278
Obsessions
thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
-cause distress
279
Compulsions
Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent imagined calamity
-time-consuming and interfere with function
280
Why should you not stop people doing compulsions? What should you do instead?
Do not stop people while doing obsessions and compulsions because they do it to relieve their anxiety. Stopping them will increase their anxiety. You should wait for them to finish
Nurse should relieve anxiety, not control behavior
281
Outcome identification for OCD (2)
• Reduced fear, self-destructive behavior, anxiety
• Improved coping, self-esteem, body image, socialization, skin integrity
