Noncompliant Patient Flashcards
Delirium tremens
. Nightmares, agitation, global confusion, disorientation, visual and auditory hallucinations, tactile hallucinations, fever, high bp, autonomic hyperactivity
. Occurs due to alcohol withdrawal
Alcohol withdrawal timeline
. 1: anxiety, insomnia, nausea, abdominal pain (8hrs)
. 2: high bp, inc. body temp (1-3 days)
. 3: hallucinations, fever, seizures, and agitation (past 1 week)
GI bleed
. Can be from mouth to anus
. Vomiting red blood, bloody stool, or black stool
. Etiology: trauma, erosion/tear, rupture of enlarged vein, inflammation/infection, alcohol and drug consumption (NSAID), vascular disorder, intestinal/anal disorder
Suicidal ideation
. Suicidal thoughts or suicidal ideation, means thinking about or planning suicide
. Must obtain psych evaluation
. Can be medication side effect: SSRIs
Depression
. Medical illness causes a person to have feelings of sadness that do not go away
. Feels hopeless, low energy, and has no interest in activities that he or she may have enjoyed in the past
. Affects thoughts, feelings, behavior, mood, and physical health
Depression screening questions
. Over he past 2 weeks, have you felt down, depressed, or hopeless?
. Over the past 2 weeks have you felt little interest or pleasure in doing things you normally do?
Psychosis
. Loss of contact w/ reality
. Ability to perceive and respond to the environment is significantly disturbed, and the individual’s functioning is impaired
. Symptoms: may include hallucinations, delusion, incoherency and overt agitation
Lack of medical knowledge
. Directly dependent on patient’s background knowledge
Münchausen syndrome
. Fabrication of symptoms to undergo medical tests, hospitalization, surgery, or obtain meds
Non-compliance
Failure or refusal to comply
. Patient doesn’t follow a course of treatment
Characteristics of noncompliant patient
. Low literacy . Language barrier . Angry . Crying patient . Talkative patient . Altered cognition
Addiction
. Primary, chronic, neurobiological disease w/ genetic, psychosocial, and environmental factors inflicting development . Impaired control over drug use . Compulsive use of drugs . Continued use despite harm . Craving
Physical dependence
. Drug-class specific withdrawal symptom produced by: . Abrupt cessation of drug . Rapid dose reduction . Dec. blood level of drug . Administration of antagonist
Tolerance
. State of adaptation in which exposure to a drug induces changes that results in diminution of drug effect over time
Key reasons for non-compliance
. Lack of time . Denial of problem . Cost of treatment . Difficulty of regimen . Side effects of treatment . Lack of patient-physician trust . Apathy . Previous experience
Common triggers of hostile behavior
. Ineffective communication skills . Frustration.overwhelmed . Perceived disrespect or belittlement . Perceived loss of control . Fear
Nonmaleficence
First do no harm
Beneficence
Actions need to be motivated by what is in the patient’s best interest
Autonomy
Patient has the right to determine what is best for them
Tavistock principle
. Rights: people have right to healthcare
. Balance: care of individual patient is central, but the health of population also concern
. Comprehensiveness: in addition to treating illness, we must ease suffering, minimize disability, prevent disease, and promote health
. Cooperation
. Improvement
. Safety
. Openness
Postnatal depression
. Persistent sadness/low mood
. Loss of energy, interest
. Trouble sleeping
. Difficulty bonding with baby
. Problems concentration and making decisions, frightening thoughts about hurting baby
. Treatment: psychological therapy, antidepressants
Risk factors for postnatal depression
. History fo mental health issues
. No close friends or family for support
. Poor relationship w/ partner
. Recent stressful life events
Scale used for postnatal depression
. Edinburgh postnatal depression scale
Adolescent depression screening
. Whole child assessment
. Strengths and difficulties questionnaire
. Pediatric symptoms checklist
. Youth pediatric symptoms checklist
. Clinicians encouraged to seek training for screening tools
. 12+ should be screened
. Patient w/ risk factors to be identified and systematically monitored
Banana bag
. Thiamine
. Folate: 400-1000 mcg, deficiency can cause psychosis, agitation, and sleep disturbances
. Magnesium
. Multivitamin
. Mixed in isotonic saline w/ 5% dextrose
. Corrects electrolyte abnormalities
