Psych Flashcards
Anhedonia
Loss of pleasure in usually pleasurable things
Mild depression weight
Gain
Severe depression weight
Loss
Severe depression crying
No more tears
Mild-moderate depression crying
Crying spells
Why might depressed clients be irritable?
Decreased serotonin
Do you compliment depressed clients?
No, they might make them feel worse
Do you isolate the depressed client?
No, seek them out
How to help the severely depressed client
Sit with them and make no demands, they can’t make simple decisions, they will worry about the decisions they do make
Suicide risk with depressed clients
It increases once the depression lifts, because now they have the energy to do it
Thoughts with depression
Slowed thoughts, use silence and slow speaking to them. They can’t concentrate
Can depressed clients have delusions/hallucinations?
Yes
Sleep with depression
In mild depression, hypersomnia-want to sleep all the time. In moderate to severe, insomnia
S/S of mania
Labile (changing) emotions Flight of ideas Delusions-false ideas Delusions of grandeur Delusions of persecution Inappropriate dress Can't stop to eat-give snacks Spending sprees Poor judgement, no inhibitions (no filter) Hypersexual, exploiting Manipulation-gets mad when they fail Decreased attention span Hallucinations
Delusions of grandeur
You think you’re Jesus
Delusions of persecution
Think someone’s out to get them
How to deal with a delusional client
Make them feel safe, don’t argue, don’t talk about it. Tell them you accept they believe it, but you do not believe it.
How to treat the manic client
Set limits, be consistent Decrease stimuli Limit group activities One on one relationships are the best Remove hazards Stay with them if anxious Structured schedule Writing activities work well Finger foods Weigh daily Walk with them during meals Don't try to argue or reason Brief, frequent contact with staff. Too much conversation stimulates them Maintain their dignity They blame everyone
S/S of schizophrenia
Inward focus on their own world Inappropriate affect Disorganized thoughts Loose associations (interrupted connections in thought and confused thinking) Rapid thoughts, jump from idea to idea Echolalia Neologism (make up new words) Concrete thinking Word salad (jumble of words) Delusions/hallucinations Child-like mannerisms Religiosity
Nu Dx for schizophrenia
Alteration in communication
Most common hallucinations with schizophrenia?
Auditory, then visual
What type of hallucinations with schizophrenia should you assess for?
Command; they’re auditory that tell the client to hurt themselves or others. They scare the client and can signal a psychiatric emergency
As an RN, can you go into a psych client’s room alone?
Yes
How to care for the schizophrenia client
Decrease stimuli Observe frequently-don't look suspicious Orient frequently (they may be oriented x3 but still have delusions/hallucinations) Keep conversations reality based Make sure personal needs are met
What are some of the most lethal methods of suicide?
Guns, car crashes, hanging, carbon monoxide
Contract to postpone suicide
They sign saying they won’t harm themselves or others for 24 hours. Don’t forget to renew the contract
How to you speak to the suicidal client?
Direct, closed ended statements. Ask if they have a plan to hurt themselves.
How to answer exercise questions
Pick the answer that is most exerting that won’t hurt them. Just bc you haven’t seen a punching bag at a hospital doesn’t mean there isn’t one at the NCLEX hospital.
Restraints
Check q 15 minutes
Remember hydration, nutrition, & elimination
Not used much more on psych units
On NCLEX, stay away from restraints as long as possible
Observation at 15 to 30 minutes intervals or one to tone if the client cannot contract for safety
How to answer questions about staying with clients
Don’t act like you have other patients, only worry about the patient on the question
Which client thinks life has been unfair to them?
Paranoia
Which client do you HAVE to be reliable and keep your word with?
Paranoia
Which client thinks everyone else has the problem?
Paranoid
How to treat the paranoid client
Brief visits, careful with touch, don’t mix meds, don’t hide them, be matter of face, always ID meds, they eat sealed foods, they need consistent nurses, no competitive activities, be honest
S/S of generalized anxiety disorder
Chronic anxiety
Fatigue due to constant muscle tension
Uncomfortable
Seek help
Tx for GAD
Short term use of anxiolytics
Relaxation techniques
Journaling over time to gain insight into anxiety, peaks and valleys and triggers
Which client is emotionally numb and detached
PTSD
Which client has difficulty with relationships, isolates themselves
PTSD
Tx for PTSD
Support groups
Talk about it, don’t push
Meds may help
OCD
Comes from an unconscious conflict/anxiety
Need schedule
Give time for their rituals
Do not verbalize disapproval
You should never take away the ritual without replacing it with another coping mechanism, such as anxiety reduction techniques
Obsession
Recurrent thoughts
Compulsion
Recurrent acts
Tx of OCD
Time delay techniques and relaxation
Meds-SSRIs or TCAs
Dissociative disorders s/s
Client uses dissociation as a coping mechanism to protect self from severe physical or psych trauma
Hx of abuse
Not commonly seen
Client or others may be aware of the problem, but may have periods of time or events not remembered
Dissociative identity disorder
Multiple personalities, extreme example of a dissociative disorder
Tx of dissociative disorder
Process trauma over time
Meds may be used to treat co-existing depression or anxiety
Alcohol is what?
A depressant
Stages of alcohol withdrawal
1-mild tremors, nervous, nausea
2-increased tremors, hyperactive, nightmares, disorientation, hallucinations, increased HR/BP
3-most dangerous, severe hallucinations (visual and kinesthetic are most common), grand mal seizures
Stage II and III alcohol withdrawal
DT’s (withdrawal delirium) keep light on
Stage I and II alcohol withdrawal
Walk and talk to them, reorient them a lot
Tx for alcohol withdrawal
Anxiolytics-don’t be afraid to give
- They have a tolerance to alcohol, and a cross-tolerance to other CNS depressants
- They can handle meds every two hours
- DTs should be prevented, don’t let them suffer through
- They will be very frightened
What is an anxiolytic that is frequently given for outpatient alcohol detox?
Chlordiazepoxide
Alcohol detox protocol consists of what?
Thiamine injections, multivitamins, maybe mag
Complications of alcohol withdrawal caused by B vitamin (thiamine) deficiencies
Korsakoff’s syndrome (disorientated to time, confabulate-they don’t mean to lie but they make up things to fill in gaps)
Wernicke’s syndrome (emotions labile, moody, tire easily)
Peripheral neuritis
Nerve problem with alcohol withdrawal, think B vitamin deficit
Other S/S of alcohol withdrawal
Impotence-can’t get an erection
Liver/pancreas problems
Gastritis
Mg and K loss from diuresing
Major defense mechanism used in alcohol withdrawal
Denial and rationalization
Antabuse
Deterrent to drinking alcohol
Before they’re given it, they have to sign consent and say they’ll stay away from ANY for of alcohol: cough syrup, aftershave, perfume, alcohol prep
What must a client have prepared after alcohol detox?
Relapse prevention plan
S/S of anorexia
Lanugo, decreased sexual development, lose weight, exercise, periods stop, plan meals for others, hight achiever, perfectionistic, use intellectualization as defense mechanism
Tx of anorexia
Increase weight gradually
Monitor exercise
Allow their input on choosing healthy foods for meals
Limit activity and decisions if weight is low enough to be life threatening
S/S of bulimia
Teeth decay, laxatives, diuretics, strict dieter: fasts and exercise, binge alone and secret, NORMAL weight, the binge is initially pleasurable but when they’re done they are very self critical
When do bulimia and anorexic pts feel in control?
As long as they can eat and not eat how they want
Tx for bulimia
Sit with them at meals, observe for 1 hour after
Allow 30 minutes for meals
Take focus off of the food, don’t talk about it with them
Self esteem building is important
Causes of bulimia
Usually family problems, they usually deny conflicts
Personality disorder s/s
Intensely emotional Manipulative Suicidal gestures Self mutilation Depressed or bulimic Substance abuse Fear of abandonment, many negative relationships To them, any relationship is better than no relationship
Most common personality disorder
Borderline
Tx of personality disorders
Improve self esteem Treat co diagnoses Enforce rules and limits Don't reinforce negative behaviors Treat self mutilation and suicide gestures in matter of fact way
Phobia s/s
The object they’re scared of doesn’t present danger
Must have trusting relationship
Don’t talk about the phobia a lot
Follow up is the key to successful tx
Desensitization (gradual exposure to the fear) must occur over time
Panic disorder
Stay 6 feet away Simple words Have to learn how to stop the anxiety Teach that symptoms should peak within 10 minutes Teach journaling to manage anxiety
Hallucinations
Warn before touching Don't say "they" Involve in an activity Elevate head of bed Decrease stimuli Offer reassurance, they're scared
Electro-Convulsive Therapy
*Last resort tx* Can induce grand mal seizure For severe depression, manic episodes NPO, void, atropine to dry up secretions Signed permit is necessary Series of tx, depends on client response Very effective, very humane with current meds Succinylcholine chloride-relaxes muscles
Post procedure ECT
Position on side Stay with client Temporary memory loss Reorient Involve in day's activities ASAP Always look for injuries Tell family that the client will be confused for a while, will get better over time
