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Wednesday, August 22, 2007

Psyche Nursing

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For Withdrawn clients
· Allow client to set pace
· Encourage social activities or games

For Depressed client
· Assess suicide potential
· Let client talk about personal problems
· Do not leave alone

For Suicidal clients
Crisis intervention to assess suicide protential.
· Communicate intent “ are you tired of living?”
· Previous attempts
· Specific plan
· Social support system
· DO NOT make “ suicide contract”!

For Anxious clients
· Convey interest and care
· Don’t “force” client
· Help client identify source of anxiety
· Suggest relaxation techniques

For Violent clients
· Remain calm and in control of the situation
· Give client space, avoid sudden movements
· Encourage verbal expression of anger
· Restrain or seclude if necessary

For Compulsive clients
· Allow client to engage in rituals (these are used to cover up anxiety)
· Gradually limit length of time for rituals.

For Manipulative clients
· Set clear limits
· Hold client responsible for behavior

For Dependent clients
· Don’t reward dependent behavior
· Client should share responsibility for treatment

For Paranoid clients
· Don’t argue with client (simply state that you don’t share his beliefs)
· Be reliable and consistent

For Delusional clients
· Stay with client
· Don’t argue about the reality of delusions
· Orient frequently to reality (place, situation)
· Assess potential for self harm

For Somatization clients
· Respect client and his problems (client is not faking)
· Rule out physical basis for symptoms
· Help client express anxiety


DEFENSE MECHANISMS:
1. Conversion: A college student develops diarrhea on day of exam
2. Regression: Returning to immature ways of dealing with stress: crying, tantrums…
3. Repression: Blocking of unacceptable urges and feelings from awareness.
4. Denial: Blocking of unacceptable information or perceptions from awarness.
5. Dissociation of affect: A girl laughs when telling about her failed exam
6. Rationalization: Substituting an acceptable motive for attitudes or behavior for an unacceptable motive
7. Reaction formation: you want to “kick your bosses ass” but end up kissing it.
8. Identification: A teenager dresses like Madonna and mimics her behavior.
9. Projection: “ you are acting like a teenager, not I”
10. Introjection: A boy yells at his dog like his father does him
11. Displacement: Client is upset about disease and yells at nurse. Nurse gets upset and yells at nursing assistant
12. Undoing: “ magic,”

SIGNS AND SYMPTOMS

Aphasia
Receptive (Wernicke =difficulty to comprehend language) or expressive (Broca = difficulty to find “the right word” language disorder

Apraxia
Failure to do, despite intact motor function

Agnosia
Failure to recognize

Dementia
Gradual impairment of cognitive functions, memory
· Alzheimer dementia: early memory loss
· Multi infarct dementia: step like decline

Delirium
Acute, organic, short lasting
Clouded consciousness
Confusion, disorientation, anxiety
Sometimes hallucinations

Delusions
Persistent false belief despite invalidating evidence
Grandeur
Paranoia
Somatic delusions

illusions
Misperception of external stimuli

Hallucinations
Perception without external stimuli


TERMS:
1. Neologisms: invents new words: Schizophrenia
2. Echolalia: echoes words or sentences: Schizophrenia
3. Word Salad: jumble of words without meaning: Schizophrenia
4. Flight of ideas: rapid switching from topic to topic: Mania
5. Confabulation: invents stories to fill memory gaps: Korsakoff encephalopathy.

DELIRIUM
Ø Acute onset
Ø Fluctuating consciousness
Ø Disorientation
Ø Optical hallucinations

DEMENTIA
Ø Gradual onset
Ø No impairment of consciousness
Ø Loss of intellectual functions: memory, orientation, language.


ALZHEIMER’S

ASSESSMENT:
§ Progressive memory loss
§ Declining mental, social, and self care abilities

ANALYSIS:
§ Risk of injury due to cognitive deficits
§ Family/caregiver burnout

IMPLEMENTATION:
§ Support family caregivers
§ Provide safe and familiar environment
§ Support client’s attempts at independence
§ Continually orient client to time, date and person
§ Advance directive should be drafted as early as possible


GRIEF

DEPRESSION

Initial: shock/ denial

Illusions/hallucinations may occur

Low risk of suicide

Feeling of hopelessness

Feeling of worthlessness

High risk of suicide

PERSONALITY DISORDERS:

Ø Behavior is inflexible across a broad range of situations

Ø Behavior is markedly deviant from cultural norms

Ø Significant distress and impairment of functioning

DEPENDENT

Afraid of being helpless

Need to be cared for

COMPULSIVE

Fear of loss of control

Tries to control physician

PASSIVE-AGGRESSIVE

Appears willing but is not compliant

HISTRIONIC

Dramatic, emotional

May display inappropriate sexual behavior

NARCISSISTIC

Feels better than others

Perfect self image is threatened by disease

PARANOID

May blame nurse or others for disease

SCHIZOID

Anxious, withdrawn

(doesn’t want close relationships)

BORDERLINE

Severe disorder!

Intense unstable relationships

Paranoia and suicidal behavior

Features of psychoses

ANXIETY DISORDERS:

Ø Clients are distressed and know that their symptoms are irrational.

PHOBIA

Persistent excessive of specific objects or situations.

Patient knows that his fear is unrealistic

PANIC ATTACK

Abrupt onset, peak within 10 min.

Palpitations, tachycardia

Sweating, trembling, shaking

Fear of dying

Derealization: feeling of unreality of the external world.

Depersonalization: feeling of being detached from oneself

AGORAPHOBIA

Hx of panic attacks

Patient avoids places where panic attack might occur (especially public places)

OBSESSSIVE COMPULSIVE

Obsessions: recurrent thoughts

Compulsions: repetitive behavior

POSTRAUMATIC STRESS DISORDER

Traumatic event in client’s history

May occur any time after event

Persists for > 1 month

HYPOCHONDRIASIS & MALINGERING:

HYPOCHONDRIASIS

Unrealistic interpretation of body signs

Client believes to have serious disease that is unrecognized by family and physicians

FACTITIOUS DISORDER

Intentional feigning of symptoms

Motivation: to assume the sick role: external incentives such as economic gain or avoiding legal responsibilities are absent

MALINGERING

Intentional feigning of symptoms

Motivation: economic gain

Avoiding leagal responsibilities



MAJOR DEPRESSION

ASSESSMENT:

  • Feeling of worthlessness
  • Thoughts of death or suicide
  • Lethargy
  • Slow, muted speech
  • Anorexia, weight loss
  • Early morning awakening

ANALYSIS:

  • Risk of suicide

IMPLEMENTATION:

  • Assess suicidal risk ( ask client directly)
  • Remove potentially harmful objects
  • Encourage verbal expression of feelings
  • Encourage participation in group activities

MEDICATIONS:

  • Antidepressants (require several weeks for full effect)
  • Watch for anticholinergic side effects:

* Blurred vision

* Dry mouth

* Constipation

ü Urinary retention



BIPOLAR DISORDER:
Manic episodes alternate with episodes of major depression.
Some clients have only manic episodes, no depressive episodes.

ASSESSMENT:

  • Euphoria
  • Grandiose ideas
  • Uninhibited sexuality
  • Buying sprees
  • Psychomotor agitation

IMPLEMENTATION:

  • Low stimulus environment
  • Provide frequent small meals, snacks
  • Encourage physical activity as a means to “act out”

MEDICATION:

  • Lithium
  • Watch for signs of toxicity

* Abdominal pain, nausea

* Hand tremor

* Ataxia, nystagmus

* Slurred speech

  • Monitor serum levels closely

* Not to exceed 1 mEq/L




SCHIZOPHRENIA:

ASSESSMENT:

  • Defect in reality testing
  • Affect incongruent ( does not match thoughts)
  • Thought form: tangential, circumstantial, loose associations

“POSITIVE SYMPTOMS”

* Delusions

* Hallucinations

“NEGATIVE SYMPTOMS”

* Flat affect

* Loss of interest

* Ambivalence

* Autism

CATATONIA:

* Waxy rigidity of muscles

* Client maintains bizarre positions

IMPLEMENTAION:

§ Establish trusting, honest relationship

§ Maintain calm, consistent manner

§ Don’t challenge client’s thought content

§ Decrease environmental stimuli

MEDICATION:

  • Neuroleptics: monitor for signs of tardive dyskinesia

* Choreoathetosis

* Lateral movements of jaw

* Tongue protrusion

CLIENT EDUCATION:

§ Stress importance to comply with follow up visits

§ Encourage family support



DRUG ABUSE:

Abuse: recurrent use of drugs resulting in social failures at home, school or work, legal problems or hazardous situations.
Dependence: Tolerance (needs larger doses to achieve effect). Withdrawal symptoms.


INTOXICAITON

WITHDRAWAL

ALCOHOL

Euphoria

Disorientaion

Unsteady gait

Nausea

Delusions, hallucinations

Delirium

Tremor, seizures

BARBITURATES

Sedation

Delirium

Epilepsy

Coma, death

BENZODIAZEPINES

Antianxiety

Sedation

Anxiety

Irritability

insomnia

AMPHETAMINES, COCAINE

Arousal

Euphoria

Fatigue

Dysphoria

OPIOIDS

Euphoria

Apathy

Nausea, vomiting

Sweating, fever

Muscle aches

LSD

Hallucinations

Anxiety

Paranoid ideas

NONE







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1 comments:

Anonymous said...

are you sure that UNDOING is MAGIC


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