ATI #1 Flashcards
Schizophrenic patient with command hallucinations
Priority?
Determining what the ‘voices’ are saying After this, the triggers should be identified,
Schizophrenic patient
Clang association?
Word rthtm
I’m red, in the head and I’m going to bed!
Echolalia
consistent repeating!!
Word salad
A mixture of phrases and words strung together without meaning
質問に答えてるけど、全然話が嚙み合わずにとにかく永遠と話し続ける
Magical thinking
Thoughts or behaviors have control over specific people and situations
Not hallucinations
Anhedonia
Inability to receive pleasure from things
A Hate Doing
Anergia
abnormal lack of energy.
Seen in the depressive stage of bipolar disorder
An energy
Sexual assault pt in ER
Assess self-harm thought
Don’t shower or change clothing until after exam and evidence collection.
Sexual assault is what crisis?
an adventitious crisis
pt reaches new stage of development is what crisis?
Maturation crisis
During mania, pt needs what?
quiet, solitary(孤独な) activities and decreased stimulation
For pt with Obsessive-compulsive disorder (OCD)
schedule time for them to perform rituals
(しばしば同じ形式で繰り返される儀式)
This will decrease anxiety
Negative reinforcement can decrease pt self
-Isolation would inc of a panic attack.
-Keep the environmental stimuli low
What is Obsessive-compulsive disorder (OCD)?
A person has uncontrollable, reoccurring thoughts (“obsessions”) and/or behaviors (“compulsions”) that he or she feels the urge to repeat over and over.
OCD repetitive behaviors relieve what?
Anxiety
They do NOT have hallucinations
Alcohol withdrawal symptoms
Hand tremors
several days after the last intake of alcohol
Seizures
Antisocial characteristic?
Manipulation others
Aggressive
Do not seek isolation
Set realistic limits on the client’s behavior
反社会的人格異常
Dealing with an antisocial pt?
Use clear, calm statements
Limits should also be set
Confronting the patient will escalate the risk of violence
The nurse should stay out of reach of the client
Cognitive behavioral therapy helps?
When experiencing mania, the client tends to view the future unrealistically. CBT assists the client in recognizing and challenging unrealistic or “automatic” thoughts.
Also helps recognize early trends toward mania.
CBT does NOT replace medication. It is an individual therapy, and lifestyle interventions (rest and nutrition) still need to be followed.
Dementia is associated with?
Alzheimer’s disease,
chronic alcohol use disorder
head trauma
Progresses over time!!!
Delirium is?
Reversible
Occurs suddenly over hours or days
Could be caused by a reaction to a new med or a med toxicity
During the orientation phase, nurse should inform?
The client about confidentiality
This helps to establish trust.
Child abuse sing?
Inconsistent stories about a child’s injury
一貫性がない
Delaying medical care
The parent leaving the treatment area, or child showing fear of the parent.
During orientation phase, the nurse should determine?
The rules that apply to the group and ensure that all members understand.
Discuss confidentially and meeting times.