Flashcards in Psychiatric Deck (25):
1. Loss of interest in life’s activities
2. Negative view of the world
3. Anhedonia, loss of pleasure in usually pleasurable things
4. Usually related to loss - death, job, body part
5. Poor kept appearance.
6. Weight gain in mild depression.
7. Weight loss in severe depression.
8. Crying spells with mild to moderate depression.
9. No more tears with severe depression.
10. Clients may be irritable (due to decreased serotonin)
11. No energy
12. Need self-care help
13. Help experience accomplishments.
14. Careful with compliments, these may make the client feel worse.
15. Prevent isolation.
16. Interacting with others actually makes the client feel better, even if they don’t want to do it. Seek the pt out
17. If severely depressed, sitting with client and making no demands may be the best thing that you can do.
18. Can't make simple decisions
19. Assess suicide risk.
20. As depression lifts, suicide risk goes up cuz more energy
21. A sudden change in mood towards the better may indicate that the client has made
the decision to kill himself.
22. Elderly clients are particularly at risk for suicide; elderly men tend to be very successful by using very lethal methods.
23. They can have delusions/hallucinations
24. Slowed thoughts
25. Can’t concentrate
26. Sleep disturbances common
27. In mild depression, hypersomnia.
28. In moderate depression to severe depression, may have insomnia
29. Generally, depressed clients have difficulty falling asleep, staying asleep, or have early morning awakening.
a. Continuous high
b. Emotions labile
c. Flight of ideas
d. Delusions-false beliefs
• Delusions of grandeur (Example: you think you are Jesus)
• Delusions of persecution
• Don't argue about the belief
• Don't talk a lot about the delusion
• Let the client know you accept that he/she needs the belief, but you do not believe it.
• Look for the underlying need in the delusion; for example, delusions of persecution, the need is to feel safe; delusions of grandeur, the need is to feel good about self or self-esteem needs.
e. Constant motor activity > exhaustion
f. Inappropriate dress
g. Can’t stop to eat
h. Altered sleep patterns
i. Spending sprees
j. Poor judgement
k. No inhibitions
l. Hypersexual, and may exploit other clients.
m. Manipulates→ fails→ they get mad.
• Manipulation makes them feel secure and powerful
n. Set limits; staff must be consistent.
o. Decreased attention span
a. Nursing Considerations:
• Decrease stimuli (tv, radio, activity-quiet and calm)
• Limit group activities.
• Feels most secure in one-on-one relationships
• Remove hazards
• Stay with client as anxiety increases.
* structured schedule
• Provide activity to replace purposeless activity.
• Writing activities provide energy outlet without too much stimulation.
• Brief, frequent contact with the staff. Too much intense conversation stimulates client.
• Finger foods
• Keep snacks available.
• Weigh daily
• Walk with client during meals.
• Don’t argue or try to reason.
• Will try to “charm” you
• Blame everybody.
• Make sure dignity is maintained.
• Client may do things or say things that they wouldn’t normally do.
b. Medications: Common psychotropic drugs are found under medications
a. Focus is inward; they create their own world
b. Inappropriate affect, flat affect, or blunted affect
c. Disorganized thoughts (loose associations: interrupted connections in thought, confused thinking)
d. Rapid thoughts
e. Jump from idea to idea.
g. Neologism making up new words
h. Seek clarification (“I don’t understand”).
i. Dont mean anything
j. Concrete thinking
k. word salad - jumbled
m. Hallucinations, auditory most common; visual next most common.
n. Child-like mannerisms - fetal like
o. Religiosity - preach
Command hallucinations are auditory hallucinations that command the client to hurt themselves or others. Command hallucinations are often frightening for the client and can signal a psychiatric emergency.
a. Nursing Considerations:
• Decrease stimuli
• Observe frequently without looking suspicious
• Orient frequently (important to remember that client may know person, place, and time and still have delusions and hallucinations)
• Keep conversations reality based.
• Make sure personal needs are met.
A. Do they have a plan? What is the plan?
B. How lethal is the plan?Guns,car crashes,hanging,and carbon monoxide are very lethal plans.
C. Do they have access to the plan? Watch for:
• Isolating self
* writing a will
• Collecting harmful objects
• Giving away belongings
D. Elderly men are particularly at risk, and are successful in attempts.
2. Nursing Considerations:
a. Provide safe environment (#1).
b. Safe-proof room
c. Contract to postpone.
d. Direct, closed ended statements appropriate > are you going to kill yourself?
e. Re-channel anger→exercise
f. Stay calm→ anxiety is contagious
1. Check every 15 minutes; remember hydration, nutrition, & elimination.
2. Not used much anymore on psychiatric units
3. Note: On NCLEX®, stay away from restraints as long as possible!
4. Observation at 15 to 30 minutes intervals or one-to-one if the client cannot contract for safety.
a. Always suspicious, but have no reason to be
b. Why? Because they are responding in a way that is consistent with their paranoid
c. Remember, you can’t explain away delusions or false beliefs.
d. Guarded in relationships
e. Pathologic jealousy
g. Can’t relax
h. No humor
j. Craves recognition
k. Life is unfair.
l. Everybody else has the problem
m. Reacts with rage
a. Be reliable.
b. If you say you will do something, you must do it!
c. Brief visits
d. Be careful with touch.
e. Respect personal space.
f. Avoid whispering.
g. Don’t mix meds.
h. Can’t handle overfriendly nurse
i. Be matter-of-fact.
j. Always ID meds.
k. Eating-sealed foods and foods from home
l. Need consistent nurses
m. No competitive activities
n. Be honest.
a. A universal feeling
b. We all have felt anxious
c. It becomes a disorder when it interferes with day to day functioning.
2. General comments
A. It increases performance at mild levels, decreases performance at high levels.
B. Clients may not need the nurse’s presence in mild anxiety; however, the nurse should stay with highly anxious client.
C. The client who is highly anxious needs step-by-step instructions
Generalized anxiety disorder
a. Chronic anxiety
b. Person lives with it daily
c. Fatigued due to constant anxiety and muscle tension
e. Seek help be because of quality of life
a. Short-term use of anxiolytics
b. Relaxation techniques: deep breathing, imagery, deep muscle relaxation
c. Journaling over time to gain insight into anxiety, peaks and valleys, triggers
a. Results from exposure to life-threatening event; severe trauma, natural disasters, war.
b. Relive the experience, nightmares, and flashbacks
c. Emotionally numb and detached (protective)
d. Difficulty with relationships
e. Isolate themselves
a. Support groups .
b. Talk about the experience, but don’t push.
c. Medications may be helpful.
A. Obsession→ recurrent thought
b. Compulsion→ recurrent act
c. Can’t stop
D. Come from an unconscious conflict/anxiety e. Need structured schedule. Give them time for their rituals but decrease it.
F. Can’t perform rituals→ anxiety level goes up.
G. You should never take away the ritual without replacing it with another coping mechanism, such as anxiety reduction techniques.
H. Do not verbalize disapproval.
A. Time delay techniques, relaxation techniques
B. Medications, such as SSRIs (selective serotonin reuptake inhibitors) or TCAs (tricyclic antidepressants)
a. The client uses dissociation as a coping mechanism to protect self from severe physical and or psychological trauma.
b. May see with clients who have history of physical or sexual abuse
c. Not commonly occurring or seen.
d. Client or others may be aware of the problem except that client may have periods of time or events that he cannot remember.
e. Dissociative Identity Disorder (multiple personalities) is extreme example of dissociative disorder.
a. Client must process the trauma over time.
b. Medications may be used to treat co-existing depression, anxiety.
Stages of alcohol withdrawal
Alcohol is a Depressant
1. Stages of Withdrawal:
a. Stage I-Mild tremors, nervous, nausea
b. Stage II-Increased tremors, hyperactive, nightmares, disorientation, hallucinations, increased pulse, increased BP
c. StageIII-Most dangerous, severe hallucinations (visual and kinesthetic(buggy feeling) are most common), grand mal seizures
d. Stage II and III are DT’s (withdrawal delirium)........Keep light on (they are scared)
e. Stage I and II→walk and talk to them. Reorient
Treatment of alcohol withdrawal
a. Anxiolytics: don’t be afraid to give.
Chlordiazepoxide (Librium®) is an anxiolytic that is frequently used for outpatient detox.
• Remember that the client has a tolerance to alcohol, and a cross-tolerance to other CNS depressants.
• He can handle medications every two hours. .
• DTs should be prevented.
• The client is very frightened during the episode.
b. Detox protocol usually includes thiamine injections, multivitamins, and perhaps
a. Chronic problems: (caused by thiamine/niacin deficiencies)
• Korsakoff’s syndrome (disoriented to time; confabulate)
• Wernicke’s syndrome (emotions labile, moody, tire easily)
S/s of alcohol withdrawal
a. Peripheral neuritis cuz low B vitamin
b. Liver and pancreas problems
c. Impotence cuz alcohol kills nerves
e. Mg and K+ loss
f. Major defense mechanisms? Denial and rationalization
a. Antabuse: deterrent to drinking
b. Client has to sign consent form, must stay away from any form of alcohol, including cough syrups, aftershaves, colognes, alcohol preps etc.
C. 12 step program very effective treatment
d. Client must have a relapse prevention plan in place.
• Must have support once detox is over
e. Family issues emerge once the alcoholic is sober.
• All of the dynamics change, and this causes stress.
a. Distorted body image
b. Sees an overweight person when looking in the mirror, even when weight is 75
c. Preoccupied with food, but won’t eat.
• Plans meals for others
d. Periods stop.
e. Decreased sexual development
g. Lose weight
h. Uses intellectualization as defense mechanism
i. High achiever, perfectionistic
a. Increase weight gradually.
b. Monitor exercise routine.
c. Teach healthy eating and exercise.
d. Allow client input into choosing healthy food items for meals.
e. Limit activity and decisions if weight is low enough to be life threatening.
a. Overeat→ vomit
b. Teeth decay
d. Strict dieter; fasts; exercises
e. Binges are alone and secret.
• Out of control when binging (may consume thousands of calories at one sitting, may steal food from grocery or garbage cans)
f Client spends more and more time obtaining food.
• Pleasurable→ intense self-criticism
g. Normal weight
h. With both – feel like they are in control
a Sit with client at meals and observe for 2 hour after.
b. Allow 30 minutes for meals.
c. Take focus off of the food.
d. Angry you’ve taken this control away
e. Family problems usually the cause.
f. Families tend to deny conflict and problems.
g. Self-esteem building is important.
a. Most commonly encountered: borderline personality disorder
b. Clients are intensely emotional.
d. Suicidal gestures
f. May also be depressed or bulimic.
g. May abuse substances
h. Fear of abandonment, many negative relationships.
i. To this person, any relationship is better than no relationship.
j. May be sexually promiscuous.
a. Improve self-esteem.
b. Treat co-diagnoses.
c. relaxation techniques
d. Enforce rules and limits.
e. Don’t reinforce any negative behaviors.
f. Treat self-mutilation and suicide gestures in matter-of-fact way.
1. With a phobia, does the object the person is scared of present danger? Not usually
2. Must have a trusting relationship.
3. Desensitization, must occur over time.
4. Don’t talk about phobia a lot.
5. follow up is the key to successful treatment.
1. Stay 6 feet away.
2. Simple words
3. Have to learn how to stop the anxiety.
4. Teach that symptoms should peak within 10 minutes.
5. Teach journaling to manage anxiety
6. Helps the client gain insight into the peaks and valleys of anxiety and triggers.
7. Relaxation techniques
1. Warn before touching.
2. Don’t say “they”.
3. Let the client know you do not share the perception.
4. Connected with times of anxiety
5. Involve in an activity.
6. Elevate head of bed.
7. Turn off TV.
8. Offer reassurance, the client is frightened.