Psychiatric Flashcards
Mania S/S
a. Continuous high
b. Emotions labile
c. Flight of ideas
d. Delusions-false beliefs
• Delusions of grandeur (Example: you think you are Jesus)
• Delusions of persecution
• Don’t argue about the belief
• Don’t talk a lot about the delusion
• Let the client know you accept that he/she needs the belief, but you do not believe it.
• Look for the underlying need in the delusion; for example, delusions of persecution, the need is to feel safe; delusions of grandeur, the need is to feel good about self or self-esteem needs.
e. Constant motor activity > exhaustion
f. Inappropriate dress
g. Can’t stop to eat
h. Altered sleep patterns
i. Spending sprees
j. Poor judgement
k. No inhibitions
l. Hypersexual, and may exploit other clients.
m. Manipulates→ fails→ they get mad.
• Manipulation makes them feel secure and powerful
n. Set limits; staff must be consistent.
o. Decreased attention span
p. Hallucinations
Depression
- Loss of interest in life’s activities
- Negative view of the world
- Anhedonia, loss of pleasure in usually pleasurable things
- Usually related to loss - death, job, body part
- Poor kept appearance.
- Weight gain in mild depression.
- Weight loss in severe depression.
- Crying spells with mild to moderate depression.
- No more tears with severe depression.
- Clients may be irritable (due to decreased serotonin)
- No energy
- Need self-care help
- Help experience accomplishments.
- Careful with compliments, these may make the client feel worse.
- Prevent isolation.
- Interacting with others actually makes the client feel better, even if they don’t want to do it. Seek the pt out
- If severely depressed, sitting with client and making no demands may be the best thing that you can do.
- Can’t make simple decisions
- Assess suicide risk.
- As depression lifts, suicide risk goes up cuz more energy
- A sudden change in mood towards the better may indicate that the client has made
the decision to kill himself. - Elderly clients are particularly at risk for suicide; elderly men tend to be very successful by using very lethal methods.
- They can have delusions/hallucinations
- Slowed thoughts
- Can’t concentrate
- Sleep disturbances common
- In mild depression, hypersomnia.
- In moderate depression to severe depression, may have insomnia
- Generally, depressed clients have difficulty falling asleep, staying asleep, or have early morning awakening.
Mania treatment
a. Nursing Considerations:
• Decrease stimuli (tv, radio, activity-quiet and calm)
• Limit group activities.
• Feels most secure in one-on-one relationships
• Remove hazards
• Stay with client as anxiety increases.
* structured schedule
• Provide activity to replace purposeless activity.
• Writing activities provide energy outlet without too much stimulation.
• Brief, frequent contact with the staff. Too much intense conversation stimulates client.
• Finger foods
• Keep snacks available.
• Weigh daily
• Walk with client during meals.
• Don’t argue or try to reason.
• Will try to “charm” you
• Blame everybody.
• Make sure dignity is maintained.
• Client may do things or say things that they wouldn’t normally do.
b. Medications: Common psychotropic drugs are found under medications
Schizophrenia S/S
a. Focus is inward; they create their own world
b. Inappropriate affect, flat affect, or blunted affect
c. Disorganized thoughts (loose associations: interrupted connections in thought, confused thinking)
d. Rapid thoughts
e. Jump from idea to idea.
f. Echolalia
g. Neologism making up new words
h. Seek clarification (“I don’t understand”).
i. Dont mean anything
j. Concrete thinking
k. word salad - jumbled
l. Delusions
m. Hallucinations, auditory most common; visual next most common.
n. Child-like mannerisms - fetal like
o. Religiosity - preach
Schizophrenia treatment
Assess for:
Command Hallucinations
Command hallucinations are auditory hallucinations that command the client to hurt themselves or others. Command hallucinations are often frightening for the client and can signal a psychiatric emergency.
a. Nursing Considerations:
• Decrease stimuli
• Observe frequently without looking suspicious
• Orient frequently (important to remember that client may know person, place, and time and still have delusions and hallucinations)
• Keep conversations reality based.
• Make sure personal needs are met.
b. Medications
Suicide
A. Do they have a plan? What is the plan?
B. How lethal is the plan?Guns,car crashes,hanging,and carbon monoxide are very lethal plans.
C. Do they have access to the plan? Watch for:
• Isolating self
* writing a will
• Collecting harmful objects
• Giving away belongings
D. Elderly men are particularly at risk, and are successful in attempts.
2. Nursing Considerations:
a. Provide safe environment (#1).
b. Safe-proof room
c. Contract to postpone.
d. Direct, closed ended statements appropriate > are you going to kill yourself?
e. Re-channel anger→exercise
f. Stay calm→ anxiety is contagious
Restraints
- Check every 15 minutes; remember hydration, nutrition, & elimination.
- Not used much anymore on psychiatric units
- Note: On NCLEX®, stay away from restraints as long as possible!
- Observation at 15 to 30 minutes intervals or one-to-one if the client cannot contract for safety.
Paranoia s/s
a. Always suspicious, but have no reason to be
b. Why? Because they are responding in a way that is consistent with their paranoid
beliefs
c. Remember, you can’t explain away delusions or false beliefs.
d. Guarded in relationships
e. Pathologic jealousy
f. Hypersensitive
g. Can’t relax
h. No humor
i. Unemotional
j. Craves recognition
k. Life is unfair.
l. Everybody else has the problem
m. Reacts with rage
Paranoia treatment
a. Be reliable.
b. If you say you will do something, you must do it!
c. Brief visits
d. Be careful with touch.
e. Respect personal space.
f. Avoid whispering.
g. Don’t mix meds.
h. Can’t handle overfriendly nurse
i. Be matter-of-fact.
j. Always ID meds.
k. Eating-sealed foods and foods from home
l. Need consistent nurses
m. No competitive activities
n. Be honest.
Anxiety
- S/S:
a. A universal feeling
b. We all have felt anxious
c. It becomes a disorder when it interferes with day to day functioning. - General comments
A. It increases performance at mild levels, decreases performance at high levels.
B. Clients may not need the nurse’s presence in mild anxiety; however, the nurse should stay with highly anxious client.
C. The client who is highly anxious needs step-by-step instructions
Generalized anxiety disorder
- S/S:
a. Chronic anxiety
b. Person lives with it daily
c. Fatigued due to constant anxiety and muscle tension
d. Uncomfortable
e. Seek help be because of quality of life - Tx:
a. Short-term use of anxiolytics
b. Relaxation techniques: deep breathing, imagery, deep muscle relaxation
c. Journaling over time to gain insight into anxiety, peaks and valleys, triggers
PTSD
- S/S:
a. Results from exposure to life-threatening event; severe trauma, natural disasters, war.
b. Relive the experience, nightmares, and flashbacks
c. Emotionally numb and detached (protective)
d. Difficulty with relationships
e. Isolate themselves - Tx:
a. Support groups .
b. Talk about the experience, but don’t push.
c. Medications may be helpful.
OCD
A. Obsession→ recurrent thought
b. Compulsion→ recurrent act
c. Can’t stop
D. Come from an unconscious conflict/anxiety e. Need structured schedule. Give them time for their rituals but decrease it.
F. Can’t perform rituals→ anxiety level goes up.
G. You should never take away the ritual without replacing it with another coping mechanism, such as anxiety reduction techniques.
H. Do not verbalize disapproval.
2. Treatment
A. Time delay techniques, relaxation techniques
B. Medications, such as SSRIs (selective serotonin reuptake inhibitors) or TCAs (tricyclic antidepressants)
Dissociative disorder
- S/S:
a. The client uses dissociation as a coping mechanism to protect self from severe physical and or psychological trauma.
b. May see with clients who have history of physical or sexual abuse
c. Not commonly occurring or seen.
d. Client or others may be aware of the problem except that client may have periods of time or events that he cannot remember.
e. Dissociative Identity Disorder (multiple personalities) is extreme example of dissociative disorder. - Tx:
a. Client must process the trauma over time.
b. Medications may be used to treat co-existing depression, anxiety.
Stages of alcohol withdrawal
Alcohol is a Depressant
- Stages of Withdrawal:
a. Stage I-Mild tremors, nervous, nausea
b. Stage II-Increased tremors, hyperactive, nightmares, disorientation, hallucinations, increased pulse, increased BP
c. StageIII-Most dangerous, severe hallucinations (visual and kinesthetic(buggy feeling) are most common), grand mal seizures
d. Stage II and III are DT’s (withdrawal delirium)……..Keep light on (they are scared)
e. Stage I and II→walk and talk to them. Reorient
