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Flashcards in psychiatric Deck (41)
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1

depression s/s

loss of interest
negative view on world
anhedonia (loss of pleasure in usually pleasurable things)
poor kept
weight gain in mild
weight loss in severe
crying spells with mild
no more tears with severe
sleep disturbances
slow thoughts: speak slow when talking to them: silence
can have delusions or hallucinations

2

depression treatment/nursing considerations

have them help w/ self care
prevent isolation
help them experience accomplishments
be careful w/ compliments: may feel worse
sit with them
have them describe their feelings
set accomplishable goals
walking, running, weight lifting
assess for suicide: as depression gets better their suicide risk increases r/t high energy
when starting antidepressants suicide risk goes up
a sudden change in mood towards better means that they maid the decision to kill themselves
elderly at risk
ask if they have a plan? what is the plan? how lethal?
do they have access to the plan
assess for:
isolation
writing a will
collecting harmful objects
giving away belongings

suicide interventions:
direct, closed ended statements
safe environment
safe-proof room

3

mania s/s

depression and mania

continuous high
emotions-labile
flight of ideas
delusions are just a false idea
delusions of grandeur (client thinks they're jesus)
delusions of persecution
constant motor activity (exhaustion)
no inhibitions (inappropriate dress, hyper-sexual behaviors)
altered sleep
poor judgement
manipulation makes them feel secure and powerful

4

mania treatment

decrease stimuli
dont argue or try to reason
do not talk about delusions
let them know you accept the delusion but do not believe it
look for underlying need:
delusion of persecution: need to feel safe
delusion of grandeur: need to feel good about self
set limits
be consistent
one on one relationships
remove hazards
stay with them when anxiety goes up
structured schedule
provide activity to replace non-purposeful activity
finger foods- too busy to stop and eat
walk with them during meals
remind them to drink fluids
dignity maintained

ECT treatment

5

ect treatment

induce a tonic clonic seizure
used with severe depression

pre procedure:
NPO
void
atropine (prevent aspiration)
consent
succinylcholine (relax muscles)

series of treatments

post procedure:
position on their side (prevent aspiration)
stay with them
temporary memory loss
reorient them repeatedly

return to activities asap

6

schizophrenia s/s

focus inward
create their own world
inappropriate affect, flat affect, or blunted affect
disorganized thoughts
ineffective communication skills
echolalia: repeat the word
neologism: making up new words-- seek clarification "I don't understand"
word salads: jumble of words
concrete thinking (be specific)
religiosity
delusions
hallucinations (auditory)

7

schizophrenia treatment

decrease stimuli
observe frequently
orient frequently
keep conversations reality based
observe for hallucinations (warn before touching, don't refer to the voices as "they" it makes them seem real)
****let them know that you do not share the perception
hallucinations are connected to times of anxiety
get them involved in activity (out of hallucination and into the real world)
elevate HOB
turn off TV
offer reassurance
command hallucinations

8

command hallucinations

auditory hallucinations
command them to hurt themselves
frightening for client and signal psychiatric emergency

9

paranoid personality disorder s/s

suspicious-- no reason to be
distrust of others
pathologic jealousy
hypersensitive
can't relax
no humor
unemotional
abnormal anger response

10

paranoid personality disorder treatment

****be reliable
build trust
if you say something, do it
be honest
consistent nurses and brief visit
matter of fact
respect personal space
careful with touch
paranoid person cannot handle touchy/feely
don't mix meds
always ID meds
may need to eat sealed foods
restraints are a last resort

11

joint commission restraints

must be evaluations in person by HCP within one hour of restraint

orders renewed
q4 hours for adults
q2hours for ages 9-17
hourly for less than 9

12

anxiety disorders s/s

universal emotion
disorder when it interferes with daily living
increases performance at mild levels
decreases performance at high levels
stay with highly anxious client
step by step instructions if highly anxious

13

GAD s/s

chronic anxiety
"worry" disease
live with it daily
seek help
fatigue r/t constant activity and muscle tension--always uncomfortable

14

GAD treatment

short term use of anxiolytics
relaxation techniques
journaling
rechannel though exercise (pick most exerting activity)
stay calm

15

panic disorder s/s

onset of panic attacks start in late 20s
weekly or monthly
classic symptoms of MI
may think they are dying

16

panic treatment

stay wit them
give them space
be calm
make them feel secure
breathe with them to slow down their hyperventilation
simple words or messages
symptoms should peak within 10 minutes and be gone within 20-30 minutes
journaling
relaxation techniques

17

phobias treatment/considerations

develop trusting relationship
****desensitization (GRADUAL exposure)
don't talk about phobia

18

OCD s/s

obsession: recurrent thought
compulsion: recurrent action
unconscious conflict/anxiety

19

OCD treatment

structured schedule
give time for rituals
decrease amount of time and increase amount of time between the ritual
never take away ritual w/o replacing it with another coping mechanism such as anxiety reduction
provide distraction techniques
teach relaxation techniques

20

anorexia nervosa s/s

distorted body image
always think they're overweight
preoccupied with food
won't eat
menses stop rt malnourishment
may have lanugo
decreased sexual development
lose weight
hypothermia rt loss of subq tissue
dehydration and electrolyte imbalance-- low BP and pulse

21

anorexia nervosa treatment

increase weight gradually
weight them in underwear
monitor exercise routine
acknowledge difficulty of their situation
teach healthy eating and exercise
allow them input into choosing foods
monitor for suicidal ideation

22

bulimia nervosa s/s

overeat then vomit
teeth erosion
laxative use
diuretic use
strict dieters
binges are alone and secret
binges are pleasurable but after consuming lots of calories intense self criticism occurs
normal weight
feel in control as long as they are eating what they want

23

bulimia nervosa treatment

sit with them after meals for 1 hour
allow 30min for meals
take focus away from food
intense family therapy-- family issues is usually the cause
self esteem building

24

ptsd s/s

relives experience, nightmares, and flashbacks
emotionally numb
difficulty w/ relationships
isolate themselves

25

ptsd treatment

establish a sense of safety
engage client in learning new coping skills
support groups

26

alcohol use disorder

use of substance interfere with the ability to fulfill obligations such as work, school, or home
alcohol is a depressant

usually have low thiamine, mg, ca, k, and phosphorous

27

stages of withdrawal

stage 1:
minor
4-12 hours of cessation
mild tremors, nervous, nausea, insomnia, headache, palpitations
orientated to person time and place

stage 2:
moderate to severe
increased tremors
confusion
hyperthermic
hyperactive
nightmares
increased BP
high RR
hallucinations
illusions

stage 3:
delirium tremens (DTs)
medical emergency
kinesthetic DT most common: feel things crawling on them
tonic clonic seizures possible

28

alcohol treatmetn

keep light on
clients are scared
encourage a close friend/family to stay with them
quiet environment
walk and talk to them
orient frequent
clarify illusions
seizure precautions

chlordiazepoxide used for outpatient detox

anxiolytics
sedatives (Benzos, chlordiazepoxide, diazepam, lorazepam)

well hydrated
replace electrolytes
replace with multivitamins, electrolyte solutions, and thiamine injections
thiamine deficiency can lead to wenicke's encephalopathy and korsakoff's psychosis

29

wenicke's encephalopathy

thiamine deficiency
paralysis of ocular muscles
diplopia
ataxia
somnolence
stupor
death will occur with thiamine injections

30

korsakoff's psychosis

confusion and loss of recent memory
often when they are coming out of wenicke's