Final Flashcards
(101 cards)
1
Q
Understand milieu therapy- can you describe it in a clinical setting?- Safe and therapeutic environment for patients
A
- Managing the patients and staff and everyone’s safety.
- Orienting patient in the unit.
- Maintaining least restrictive environment, following policies for procedures and patients have informed consent.
2
Q
Describe the difference between mental health and mental illness- understanding how mental health can be a stigma
A
- Mental health: state of mental well-being in all stages of life.
- Mental Illness: diagnosis and conditions that affect your well-being, how you feel and how you act. Interfere with mental health.
3
Q
Maslow’s Hierarchy of needs (pg 31)- meet bottom need first before progressing to the top
A
- Self-actualization- becoming what you are capable of
- Self-esteem- achievements and self-thoughts
- Love and belonging- relationships, affection, attention
- Safety- shelter, security
- Physiological- food, water, air (comes first)
4
Q
Freud- what did he contribute to psychiatric setting?
A
- ID: primitive, pleasure seeking, unconsciousness
- Ego: unconsciousness, sense of self
- Superego: conscious state influenced by parents, family, caregivers, etc
5
Q
Be able to given examples of verbal and non-verbal communication- Table 8-1, 8-2, 8-3
A
- Verbal: clear, honest, convey interest and understanding
- Nonverbal: body language, facial expressions, tone, pitch, appearance
6
Q
Understanding therapeutic and non-therapeutic techniques of communication
A
- Therapeutic: actively listening, observing, silence, restating, reflecting, exploring, summarizing
- Non-therapeutic: advice, asking why, minimizing their feelings, judging,
7
Q
Phases of the Nurse-Patient Relationships
A
- Preorientation phase: prep working before seeing the pt. Reviewing their chart
- Orientations phase: first time meeting patient
- Working phase: assessment, setting goals, interventions, etc
- Termination phase: when patient is discharged or you are no longer seeing the patient. Reflection is done and looking for resources is done. Setting up patient to feel safe and survive in the outside world.
Describe relationship during each phase
8
Q
prep working before seeing the pt. Reviewing their chart
A
Preorientation
9
Q
: first time meeting patient
A
Orientations phase
10
Q
assessment, setting goals, interventions, etc
A
Working phase
11
Q
when patient is discharged or you are no longer seeing the patient. Reflection is done and looking for resources is done. Setting up patient to feel safe and survive in the outside world.
Describe relationship during each phase
A
Termination phase
12
Q
Boundaries to take with patients?
A
- Always talk about the pt. Not about your personal life
2. No gifts accepted (a picture they drew is ok, but not something that cost money)
13
Q
Describe active listening:
A
observing pt. Nonverbal behaviors.
Understanding them.
Listening for inconsistencies and areas that need further clarification.
Restating and reflecting.
Providing feedback.
14
Q
omitting to act. Malpractice. Harm results to patient.
A
Negligence
15
Q
: making your own decisions.
A
Autonomy
16
Q
: duty to distribute resources and care equally for all patients
A
Justice
17
Q
: duty to act to benefit and promote good for others
A
Beneficence
18
Q
maintaining loyalty and commitment and doing no wrong.
A
Fidelity
19
Q
: speaking the truth.
A
Veracity
20
Q
Rights for Voluntary Admission
A
Voluntary: you go willingly
- Informed consent
- Refuse medication and tx
- Request to be released
21
Q
Rights for Involuntary Admission
A
- Involuntary: you go against your will. It was chosen for them.
1. Informed consent
2. Refuse medication and tx
3. CANNOT LEAVE THE HOSPITAL
22
Q
What is Informed Consent
Who is able to give consent?
Who would need a POA to give consent?
A
making sure that information on procedures and medications is given to the patient beforehand.
Patients with mental illness that are of sound mind and body are able to make consent.
Bipolar or manic phase are not able to..goes to POA or caregiver
23
Q
Extremely important. This is the law for patient confidentiality.
Can only talk to people that patient’s give permission to.
Determines who has visitation rights.
A
Confidentiality/HIPAA
24
Q
Psychiatric Nursing Assessment – priority interventions, nursing dx, etc. (pg 101)
1. Nursing assessment:
A
done in a surg-unit
25
assessment done in mental health unit additional to the nursing assessment
Psychiatric assessment
26
What is always priority intervention in mental health?
Dx in mental health?
. Safety is always priority in mental health: if patient talks about suicide, ask: how they would do it and if they have the means?
4. Nursing dx: anything that has to do with safety is always priority. Make sure it is patient specific to their situation
27
Psychiatric Nursing Assessment – priority interventions, nursing dx, etc. (pg 101)
1. Nursing assessment: done in a surg-unit
2. Psychiatric assessment: done in mental health unit additional to the nursing assessment
3. Safety is always priority in mental health: if patient talks about suicide, ask: how they would do it and if they have the means?
4. Nursing dx: anything that has to do with safety is always priority. Make sure it is patient specific to their situation
28
Mood Disorders
Primary vs. Secondary Depression
1. Primary: no other reason for depression except that you are sad and depressed.
2. Secondary: happens bc of another diagnosis. Ex; cancer diagnosis
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causes HTN crisis (high BP, and toxic effects). HAVE Tyramine free diet (soy sauce, avocado, banana, pepperoni, aged cheese, yogurt).
MAIOs
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S/E of MAOI’s:
ortho hypotension, anxiety, insomnia, n/v, constipation.
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S/E of TCA
blurry vision, drowsiness, ortho hypotension, anticholinergic, increases suicidal ideations, causes withdrawal symptoms.
32
S/E of SSRI:
GI, insomnia, sexual dysfunction, increases suicidal ideation, weight gain.
SEROTONIN SYNDROME: anxiety, confusion, diaphoresis, tachycardia, HTN, tremors, hallucinations.
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SEROTONIN SYNDROME s/s
anxiety, confusion, diaphoresis, tachycardia, HTN, tremors, hallucinations.
34
First-line treatment for Depression – Can you name the drugs?
Which one can be lethal ?
Which one to give first?
1. TCA: 2nd line -Imipramine, amitriptyline, nortriptyline. Causes cardio toxicity. More lethal in overdose.
2. Atypical Antidepressants: buspirone, bupropion
3. SSRI: citalopram, fluoxetine, sertraline. THIS DRUG IS ALWAYS GIVEN FIRST. Cause serotonin syndrome.
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Patient teaching for:
Nortriptyline,
TCAs vs. SSRIs vs. MAOIs – know examples from classes of meds/benefits/risks/adverse effects/pt. teaching (Review table 15-7)-
She said on the video to look at this table and focus on the meds listed above this section.
? SSRI’s– (Ex: fluoxetine, citalopram, sertraline). Black Box Warning: increased suicidal thoughts
are possible. Takes 2-4 weeks to work. Helps treat Depression, ETOH withdrawal, OCD,
Side Effects: Anxiety, tremors, sexual dysfunction, H/A, agitation, sleeplessness. Dry mouth.
S/Sx of Overdose: Serotonin Syndrome (fever, Hyper-Reflexia, sweating, high BP, delirium,
hostility). Wait 2 weeks before starting an MAOI or vice-versa.
Contraindications: Those who have attempted suicide don’t use! Pregnancy, Renal/Liver issues,
Elderly (due to increase of osteoporosis/fractures)
Patient Teaching: OTC drug interactions, slow standing, don’t take w/in 2 weeks of MAOI,
monitor for suicidal ideations
Serotonin Syndrome Treatment:
STOP medication. •Serotonin receptor blockade: cyproheptadine, methysergide,
propranolol •Cooling blankets, chlorpromazine for hyperthermia •Dantrolene, diazepam for muscle rigidity or rigors •Anticonvulsants •Artificial ventilation •Paralysis
Antidepressants
o TCA’s – Used for Depression, anorexia, insomnia, ODC, Panic disorder, and neurogenic pain. Takes 10- 14 days to become effective. Provider will chose this drug if (1) it worked on family member in past and (2) severity of adverse effects. “Start low and go slow”
Side Effects: Anticholinergic effects (urinary retention, dry mouth, blurred vision, dizziness, tachycardia, constipation, reflux), Postural Hypotension.
S/Sx of Overdose: tachycardia, MI, heart block, dysrhythmias
Contraindications: Elderly and those with Cardiac Disease
Patient Teaching: takes 6-8 for full effect, get up slowly from sitting position, take at BEDTIME
to reduce side effects, good mouth care/lozenges for dry mouth, don’t stop cold turkey
o MAOI–. (ex: Phenelzine/Nardil, Isocarboxazid, Parnate)
Side Effects: insomnia, palpitations, H/A, loss of libido, Orthostatic Hypotension
Contraindications: Foods with Tyramine (causes Hypertensive Crisis. Food Ex: avocados, figs,
bananas, smoked meats, organs, lunch meat, yeast, aged cheese, beer/wine, smoked fish, soy
sauce), Pregnancy!!!
Patient Teaching: Hypotension is HUGE – get up slowly from sitting, avoid Tyramine foods, avoid
cold medications, go to ER if pounding H/A, avoid eating at Chinese restaurants.
36
Suicidal Ideation – Assessment, Risk Factors & Interventions (pg 437)-
assess for previous suicidal attempts, current plans and means to carry out the plans.
37
Understand the differences between covert and overt messages
Overt: open to view or knowledge; not concealed or secret. Implied: involved, indicated, or suggested without being directly or explicitly stated.
2. Convert: means hidden, or secret.
38
Table 23-1, 23-2- intervention during a crisis and after a crisis. Review.
Intervention:
#1 is suicide precautions ( 1:1 monitoring, keep an arm’s length from pt, no suicide contract) Make environment safe (remove sharp objects, metal silverware, mirrors, glass, cords, belts)
o After Crisis Period:
Have friend stay the night or have pt stay with family
Remove weapons and pills from the house
Encourage the patient to talk openly about their feelings.
Don’t give person more than 1-3 days supply of a medication due to overdose (SSRI’s are least
lethal)
39
Lithium therapeutic Levels ?
benefits? And what it’s used for
& Toxicity side effects:
treats mania and mood stabilizer.
Normal range 0.4-1.0,
could experience nausea and tremors and it is normal. Early toxic s/e: range is 1.0-1.5: n/v/d, slurred speech, muscle weakness. Advance toxicity is 1.5-2.0. Severe toxicity 2.0-2.5. Coma or death at greater than 2.5
Review table 16-5
Levels & Toxicity –
o Therapeutic Range: 0.8-1.4 (fine hand tremors & mild N/V are normal)
o Maintenance Range: 0.4 – 1.3
o Toxic Range: 1.5 and over
o Toxicity: slurred speech, blurry vision, seizures, coarse tremors, severe N/V, thirst
o Patient Teaching: regular salt diet, doesn’t get dehydrated, stay out of hot climates, avoid excessive
exercise, take with food.
o Lithium toxicity -possible when one becomes dehydrated, nausea or diarrhea.
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Anxiety Levels & Stages
Mild:
Moderate:
Severe:
Panic:
1. Mild: restless, tension, attention seeking, impatient
2. Moderate: change in voice pitch, tremors, can’t concentrate, elevated HR, RR, and pulse
3. Severe: feeling of dread, confusion, hyperventilation, tachycardia
4. Panic: unable to focus. Not a learning opportunity. Hallucinate. Not able to have intelligent conversation. Not much you can do except give medication.
41
How to help control anxiety?
discuss feelings with patient and help them find ways to control anxiety. Can give anxiolytics to calm them down.
Antidepressants are also known as anxiolytics
Benzodiazepines – commonly given & teaching needed for patients
42
For Patients who say they “don’t want to talk”: what to do?
Its alright. I would like to spend time with you. We
don’t have to talk.” Or reapproach at a later time, “Our 5 minutes is up. I will be back at 10am and spend
another 5 minutes with you.”
43
Non verbal communication:
Tone of voice:
Facial expressions:
Posture
Eye contact
Hand gestures
Yawning
Non-Verbal:
Tone of voice (tone, pitch, intensity, stuttering, silence, pausing)
Facial expressions (frown, smile, grimaces, raises eyebrows, licks lips)
Posture (slumps over, puts face in hands, taps feet, fidgets with fingers)
Amount of eye contact (angry, suspicious or accusatory looks, wandering)
Sighs/Hand gestures (fidgeting, snapping fingers)
Yawning
44
Patient teaching for:
| TCAs – know examples from classes of meds/benefits/risks/adverse effects/pt. teaching
o TCA’s – Used for Depression, anorexia, insomnia, ODC, Panic disorder, and neurogenic pain. Takes 10- 14 days to become effective. Provider will chose this drug if (1) it worked on family member in past and (2) severity of adverse effects. “Start low and go slow”
Side Effects: Anticholinergic effects (urinary retention, dry mouth, blurred vision, dizziness, tachycardia, constipation, reflux), Postural Hypotension.
S/Sx of Overdose: tachycardia, MI, heart block, dysrhythmias
Contraindications: Elderly and those with Cardiac Disease
Patient Teaching: takes 6-8 for full effect, get up slowly from sitting position, take at BEDTIME
to reduce side effects, good mouth care/lozenges for dry mouth, don’t stop cold turkey
45
Patient teaching for:
| SSRIs– know examples from classes of meds/benefits/risks/adverse effects/pt. teaching
SSRI’s– (Ex: fluoxetine, citalopram, sertraline). Black Box Warning: increased suicidal thoughts
are possible. Takes 2-4 weeks to work. Helps treat Depression, ETOH withdrawal, OCD,
Side Effects: Anxiety, tremors, sexual dysfunction, H/A, agitation, sleeplessness. Dry mouth.
S/Sx of Overdose: Serotonin Syndrome (fever, Hyper-Reflexia, sweating, high BP, delirium,
hostility). Wait 2 weeks before starting an MAOI or vice-versa.
Contraindications: Those who have attempted suicide don’t use! Pregnancy, Renal/Liver issues,
Elderly (due to increase of osteoporosis/fractures)
Patient Teaching: OTC drug interactions, slow standing, don’t take w/in 2 weeks of MAOI,
monitor for suicidal ideations
Serotonin Syndrome Treatment:
STOP medication. •Serotonin receptor blockade: cyproheptadine, methysergide,
propranolol •Cooling blankets, chlorpromazine for hyperthermia •Dantrolene, diazepam for muscle rigidity or rigors •Anticonvulsants •Artificial ventilation •Paralysis
46
Patient teaching for:
| MAOIs – know examples from classes of meds/benefits/risks/adverse effects/pt. teaching
MAOI–. (ex: Phenelzine/Nardil, Isocarboxazid, Parnate)
Side Effects: insomnia, palpitations, H/A, loss of libido, Orthostatic Hypotension
Contraindications: Foods with Tyramine (causes Hypertensive Crisis. Food Ex: avocados, figs,
bananas, smoked meats, organs, lunch meat, yeast, aged cheese, beer/wine, smoked fish, soy
sauce), Pregnancy!!!
Patient Teaching: Hypotension is HUGE – get up slowly from sitting, avoid Tyramine foods, avoid
cold medications, go to ER if pounding H/A, avoid eating at Chinese restaurants.
47
Defense Mechanisms
– emotional conflict are addressed by meeting the needs of others.
Altruism
48
– substituting something constructive for something they feel they lack or are inadequate
at
Sublimation
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– denial of something disturbing
Suppression
50
– forgetting/excluding unpleasant things from memory (forgetting a death of a parent, etc) o
Repression
51
– transferring feelings from a particular person/event to something non-threatening (Boss
yells at manman yells at wifewife yells at childchild kicks the dog).
Displacement
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compensation for a negative action, common in OCD (Ex: giving a gift to undo an argument.
Washing hands frequently to reduce anxiety about dirty thoughts).
Undoing
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– turning anxiety into physical symptoms
Somatization
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– the pain/anxiety is too much to deal with, so the patient dissociates to get away from it
(an “out of body” experience).
Dissociation
55
blaming another PERSON for your own issues
Projection –
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unacceptable feelings are kept out of awareness by doing the opposite behavior
(Ex: person who doesn’t like children becomes a boy scout leader)
Reaction Formation –
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– aggression towards others is expressed by procrastination, failure, and illness that
affect others more than themselves.
Passive Aggressive
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– qualities of a person are either all good, or all bad – not a healthy mix. (either good, loving,
nurturing or bad, mean, hateful).
Splitting
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emotional issues are dealt with by exaggerated qualities to others (putting someone on a
pedestal, AKA “the perfect man”). When other person doesn’t hold up to their idealization, they are
disappointed.
o Idealization –
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– ignoring the existence of realities (Ex: denying the diagnosis of cancer, even when presented
with the lab work and diagnostics)
Denial
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Benefits of Buspirone
o Less sedating than Benzodiazepines. Takes 3+ weeks to become effective (slow onset).
o No physical dependence (patients who have drug abuse problems can safely take this medication).
Patient Teaching: Taper off the med. Take with or shortly after meals. Don’t take with Antacids, alcohol
or caffeine.
o Side effects - Tardive dyskinesia. (Facial tics, involuntary repetitive body movements, not reversible, lip smacking, eye blinks, etc)
o may be prescribed over diazepam as it does not result in physical dependence
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PTSD s/s
Priority?
Tx options?
highly traumatic event that scars someone emotionally.
1. Symptoms: re-experiencing, avoidance, and heightened arousal. They re-experience the event through distressing images, thoughts, or perceptions and may have recurrent nightmares. In addition, the patient may experience flashbacks and exhibit extreme stress upon extreme stress upon exposure to an event or image that resembles the traumatic event. Patients will avoid discussing the event altogether or avoid people and places that remind them of the traumatic event. Heightened arousal is evidenced by difficulty sleeping, irritability, poor concentration, exaggerated startle response, or hyper-vigilance.
2. Nursing interventions: treat PTSD patients like you would treat patients with anxiety.
63
Seasonal affective disorder tx options?
Light therapy (phototherapy)
Talk therapy
Exercise
Medications such as SSRIs antidepressants
64
Pt teaching for nortriptyline?
TCA
Do not stop abruptly
Monitor heart rate and headache
Start at low dose
Can be lethal
65
Benzodiazepines – commonly given & teaching needed for patients
Understand and Describe Defense Mechanisms: given for an anxiety attack to calm pt down
Given PRN bc they are fast acting. Not given for long periods of time bc they are highly addicting.
1. Valium
2. Xanax
3. Ativan
66
Positive and Negative Symptoms of Schizophrenia
1. Positive or acute onset: hallucinations, delusions, bizarre behaviors
2. Negative or cognitive deficit: flat effect, alogia (unable to speak), anhedonia (losing pleasure in things you once enjoyed)
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EPS- identify and describe
EPS or extra pyramidal side effects: akathisia (fidgeting), acute dystonia (involuntary muscle contractions). Atypical antipsychotics cause these
68
/Tardive Dyskinesia- identify and describe
2. Tardive dyskinesia (lip smacking, tongue rolling, involuntary movement). EPS caused by prolonged use of antipsychotics. This condition is not reversible if the medication is not stopped in time.
69
Neuroleptic Malignancy Syndrome or NMS- be able to describe:
occurs with antipsychotics. Not a common thing. Decreased level of consciousness, increased muscle tone, drooling, hyperlexias. Think anything that is neuro related.
70
Know that antipsychotics (risperidone, clozapine) cause agranulocytosis (low WBC count).
Risperidone also elevates blood glucose levels
Chlorpromazine: photosensitivity, sedation, lowers seizure threshold, NMS and agranulocytosis.
Haloperidol causes shuffling gait and this should be reported to dr right away: high EPS
. Also review box 17-2and 3
71
a maladaptive social response characterized by a person’s grandiose sense of personal achievements. People with this disorder consider themselves special and expect special treatment. Their demeanor is arrogant and haughty and their sense of entitlement is striking. They lack empathy for the needs or feelings of others and in fact exploit others to meet their own needs. If they are at fault in some way, they always blame others for the problems they themselves have caused. At times, people who have narcissistic PD are admired and envied by others for what appears to be a rich and talented life. However, they require this admiration in greater and greater quantities (attention seeking). On the other hand, narcissistic PD patients often envy others’ successes or possessions, believing that they deserve the admiration and privileges more. Because of their fragile self-esteem, they are prone to depression, interpersonal difficulties, occupational problems, and rejection (Sadock et al., 2015). They also use the defense mechanism of splitting, exhibit tantrums, and can be sadistic with paranoid tendencies. Their relationships are shallow and superficial and based on what the other person can do for them. The diagnosis of narcissistic personality is often associated with anorexia nervosa and substance use disorders, with cocaine being highest on the list
personality disorders-
1. Narcistic
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characterized by persistent disregard for and violation of the rights of others with an absence of remorse for hurting others (APA, 2013, p. 659).
People with antisocial PD have a sense of entitlement, which means they believe they have the right to hurt others, take what they want, treat others unfairly, destroy the property of others, and so on (callousness). They do not adhere to traditional values or standards of morality as boundaries for their actions. Therefore, there is no restraint on their behavior, nor do they feel any sense of responsibility for their actions. People who have antisocial personality disorders lack regard for the law and the rights of others and have a history of persistent lying, use of aliases, conning others for personal profit or pleasure, and stealing (deceitfulness). However, they do rely on others to conform to the social norms.
Antisocial
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unstable and intense relationship, and, instability of affect, marked by unstable and frequent mood changes. Feelings of anxiety, dysphonia, and irritability can be intense though short lived (emotional lability). Poor impulse control is evidenced by recurrent suicide attempts, self-mutilation, and other self-destructive behaviors. Chronic depression is common. The use of the primitive defense mechanism of projected identification is common in patients with BPD. This occurs when the person projects on an undesirable aspect of the self. Individuals with BPD often exhibit patterns of high emotional sensitivity, acute responsiveness, and slow return to normal as “emotional dysregulation.” This cycle may lead to feelings of deadness, panic, and fury as well as self-mutilation and suicide-prone behaviors. These are common responses to threats of separation or rejection. People with BPD desperately seek relationships to avoid feelings of abandonment and chronic feelings of emptiness.
Borderline
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interventions for manipulation as a nurse and team
1. Set limits
2. Be consistent
3. Avoid talking about yourself
4. Clear boundaries
5. Force consequences
6. Avoid staff splitting
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Highest nursing priority with these dx: personality disorders
always safety for patient and others
76
What comorbidities exist with anorexia? With bulimia?-
```
**Depression
Anxiety
Borderline
Personality disorders
OCD
```
77
Differences between presentation of clients? Anorexia and bulimia
- Anorexia: muscle wasting, thin, look sick, pale skin from low hemoglobin, low BP, HR and temp, binge and purge quality
- Bulimia: normal or overweight. Do not appear ill
78
Review box 14-1, 14-2 & 14-3: Interventions for eating disorders
1. Assessing mood and suicidal thoughts
2. Monitoring vital signs, electrolytes, and weight
3. Monitoring during and after meals
4. Evaluating dysfunctional thoughts that maintain the binge/purge cycle
5. Educate patient on dangers of fasting and binging
6. Encourage pt to keep journal of thoughts and feelings
79
What would qualify for an admission with eating disorders?
?
80
this disorder presents with one or more symptoms of impaired motor or sensory function. Findings are incompatible with or an exaggeration of recognized neurological conditions and are not better explained by another mental or medical disorder. 155The deficit causes significant distress to the patient and impaired social or occupational functioning. Symptoms are further specified as including weakness or paralysis, abnormal movement, swallowing or speech difficulties, seizures or attacks, sensory loss or anesthesia, or symptoms involving the senses (blindness or loss of smell). Symptoms can also be mixed with elements of more than one specifier. Are among the most common of the somatic symptom disorders; they are more prevalent in women, in the elderly, and among lower educated and rural populations. Comorbidities include childhood abuse, depression, anxiety, and personality disorders.
Review table 12-1
Conversion Disorder:
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Understanding limit setting and boundaries for clients for inappropriate behaviors
1. Clear limits
2. Set boundaries with yourself, the patient, the floor or milieu,
3. Keep them and others safe
Conduct Disorder.
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Addiction, Abuse and Violence
Signs of Alcohol Withdrawal/ priority concerns ?
1. Begins within a few hours after last drink
2. Peaks 24-48 hours
3. Diaphoresis
4. Hallucinations or delirium (emergency and needs to be treated ASAP)
5. Tremors
6. Hyper alertness
7. Jerky movements
8. Irritability
9. Seizures if not properly treated
83
Alcohol Dependence – know associated dx, priority dx
1. Alcohol is usually used with a stimulant drug like, Cocaine
2. Safety is priority
84
Nursing Interventions & assessment tools for alcohol withdrawal
Physical complications of ETOH abuse??
1. Administer sedatives: benzos, diazepam, chlordiazepoxide
2. Seizure control
3. Alleviate autonomic symptoms: tachycardia, tremors, high BP, diaphoresis
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Review box 19-4
Review table 19-11_ meds for treating substance abuse
Cocaine/amphetamines ?
Opiates?
Alcohol withdrawal?
PCP?
1. Cocaine/amphetamines: dopamine agonists and antidepressants
2. Opiates: Naloxone for overdose and methadone for tapering and maintenance therapy
3. Alcohol withdrawal: give benzos to calm patient. Campral helps cravings. Antabuse or disulfiram treats chronic alcoholism. Naltrexone for detox.
4. PCP: reduce stimuli and give benzos
86
Describe nursing interventions for client after traumatic event occurred with drugs
1. Psychotherapy
2. Family therapy
3. Vocational rehab
4. Group therapy
5. Relaxation techniques
6. Learn to control thoughts and feelings
87
Identify intoxication signs of alcohol, opioids
1. Alcohol: slurred speech, incoordination, unsteady gait, low BP, aggression, impaired judgement, impaired attention or memory
2. Opioids: constricted pupils, low RR, drowsiness, low BP, slurred speech, euphoria, impaired attention and memory.
Review table 24-1
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Cognitive and Degenerative Disorders
Alzheimer’s pathology?
Meds?
: damages the brain. Decrease in cells and volume in regions og the brain where memories are stored. Can be seen on MRI’s and CT scans.
```
Alzheimer’s – Meds used- prevent breakdown of acetylcholine in the brain. Just know that you start with low dose and increase slowly to avoid toxicity.
1. Exelon
2. Razadyne
3. Cognex
Review table 18-5 & 18-6
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Nursing Interventions for Alzheimer’s Patients
| Review box 18-2
1. Teach families about caregiver strain.
| 2. Teach them resources and phone numbers
90
Impulsive Behaviors-
Interventions
1. Help understand and practice tension reduction and stress control strategies
2. Promote progressive substitution of alternate, less maladaptive responses to tension, Ex: apply pressure to scalp with thumb instead of pulling hair.
3. Assist in exploring feelings associated with impulses
4. Identify consequences of actions
5. Educate that drug and alcohol may increase impulsive behaviors
6. Group therapies may be good for gamblers
7. Hair styling may benefit those with trichotillomania
Review table 27-3
91
Symptoms associated with delirium and dementia- describe them, understanding the difference between them
1. Delirium: a symptom. Brought on by medications, fever, UTI, etc. Confusion with a decrease in level of consciousness. When the causing agent is removed, the delirium goes away.
2. Dementia: a diagnosis. Develops slower. Confusion which progresses but there is NO change in level of consciousness.
92
Patients in Crisis, Grief, Complementary Therapy
Discuss factors that influence the grieving process?
1. Adequate perception of the situation
2. Adequate situational support
3. Adequate coping
93
Describe alarm, exhaustion, fight or flight: these are the steps in the General Adaptation Syndrome.
1. Alarm: pt experiences response associated with “fight-or-flight”
2. Resistance: the body adapts to stress but functions at a lower than optimal level
3. Exhaustion: negative effects of the stressor spread to the entire organism ensuing illness and ultimately leading to death
94
Identify forms of complementary therapies: therapies that are different from but used in conjunction with traditional or conventional medical treatment.
1. Light therapy
2. St. John’s Wort
3. SAMe
4. Peer support
95
Stress Reduction Techniques
| Review box 10-1 & table 10-1
1. Relaxation
2. Reframing: interpreting reality in a positive way
3. Sleep
4. Exercise
5. Low caffeine intake
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Crisis - Environmental Disasters & Situational Crisis – Know Examples
1. Situational: arises from an external rather than an internal source and is frequently unanticipated. Examples of external situations that can precipitate a crisis include loss of a job, death of a loved one, unwanted pregnancy, a move, change of job, change in financial status, divorce, and severe physical or mental illness
2. Environmental: These types of crises are unplanned and tend to be catastrophic or violent in nature. Adventitious crises may result from natural disasters such as tsunamis, fires (Yarnell, Arizona where 19 firefighters lost their lives), hurricanes, flooding, or earthquakes (Japan); national disasters such as war (Iraq; Afghanistan), terrorist attacks, airplane or train crashes; or crimes of violence such as shootings in a public venue (numerous school shootings, rape, child abduction, or spousal abuse.
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Crisis Nursing Interventions – Highest Priority
1. Initial task is to assess pt’s perception of the event
| 2. Assess their safety and suicidal ideation
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Nursing Assessment Priority during Crisis
1. Safety
2. Self- directed violence
3. Violence towards others
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Review table 20-1, 20-2
Primary, Secondary and Tertiary Nursing Care
1. Primary: teaching coping skills, problem-solving skills. Outpatient care
2. Secondary: ensuring safety, assessing support system, set goals, plan interventions. Inpatient care
3. Tertiary: Support after a crisis. Recovering.
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Nursing Interventions – Grief
Disenfranchised Grief
o Grief experienced by a NURSE regarding a PATIENT who dies (or over an abortion, death from AIDS or
execution, war heroes, divorced spouse, suicides). The nurse cannot openly grieve, it may not be acknowledged by others, so it may be difficult to deal with.
Nursing Interventions for Acute Grief
o **Be present. Listen to them. Sharing painful feelings during periods of silence help with healing and
convey concern.
o **Share information on the Grieving Process (let them know these feelings are normal). Provide handouts
for reference and support information.
o **Encourage support of friends and family or even Bereavement Groups o Spiritual support
o **Empathetic Words are ALWAYS helpful! Examples are:
This must hurt terribly.
I hear anger in your voice. Most people go through periods of anger when their loved one dies.
Are you feeling angry now?
Are you feeling guilty? This is a common reaction many people have. What are some of your
thoughts about this?
This must be very difficult for you.
**Active listening – includes paying attn.. to verbal and non-verbal communication
Miscellaneous
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Caring for a Dying Patient
| Interventions?
1. Be present for patient and family
2. Listen actively
3. Use silence when appropriate
Table 25-3
ng for a Dying Patient
o #1: Assess your own skill level and seek help from other nurses is necessary
o Good Listening Skills & Sensitivity towards patients and family
o Conservation of Dignity (access to wigs, clothing, cosmetics, discussing their legacy, allow patient as
much control over their situation as possible, food/music/friends visiting, and spiritual comfort access)
o Demonstrating care to grieving family
