Psychiatric Flashcards
Depression
-ve view of world
anhedonia
Mild is weight gain, crying spells
Severe is weight loss, no tears
Sleep problems, slow thoughts, hallucinations and delusions
Txt
Communicate with silence, speak slowly
Help with self care, prevent isolation
No compliments
Workout, Set goals, Provide Encouragement
Careful of SSRI’s because it can give them energy suicide
Sudden change in moods
*Elderly = lethal
Questions to ask if someone is suicidal
Do they want to harm themselves or others?
Do they have a plan?
How lethal - as in are you going to get into an accident? , shoot yourself?
Find out if they have access to do the deed.
What to watch for if they have a plan A will Isolating themselves Collecting harmful objects Giving away belongings
How to do a suicide intervention
Closed statements
safe environment
safe-proof room
What is mania? in bipolar
S/S Continuous high
labile flight of ideas
Delusions of grandeur - need to feel good about themselves, persecution - they are safe
Constant movement/ inappropriate dressing
bad sleeping patters and poor judgement
Manipulation is powerful
KIM
What is the treatment for bipolar?
When you enter the room, have any distractions off, don’t argue. When they tell you about their delusion acknowledge it but don’t agree with it. Don’t talk about it. Set a limit, encourage a schedule and give them activities. When it comes to eating because they move a lot fast foods and walk with the client when eating meals. Don’t forget their drinks need to be given because they can become dehydrated and maintain their dignity.
ECT Treatment for bipolar/depressed pre surgery
Induces a seizure for severely depressed
Preprocedure
NPO, void , atropine - to prevent aspiration
consent
succinylcholine to relax muscle
ECT post surgery
position client to the side
stay with client temporary memory loss and reorient them
resume day to day activities
Schizophrenia
Inappropriate affect / mood with disorganized thoughts
They are difficult to communicate with.
Echolia - use a word too much Neologism make up words - say you don't understand Word Salad - jumble words Concrete thinking - taking it literal Religiosity delusions Hallucinations - Auditory
Treatment for Schizo
When you enter, turn off distractions. Don’t address the voices, instead express the difference in perceptions. Instead continuously reorient them and observe them. Don’t touch them unless they allow you to. Encourage activity and elevate the hob, reassure. Ask if they have command hallucinations (which tell them to hurt themselves or others)
Paranoid Personality Disorder
They are always suspicious and have a jealousy, they are hypersensitive.
Txt: Keep your conversation matter-of-fact, brief conversations established with trust. Don’t touch the pt. Seal their foods if they need it and show their meds in separate containers. Don’t use restraints unless they are a harm to themselves/others.
Restraint Rules
Evaluated q1hr with a primary healthcare provider Orders must be renewed q4hrs adults q2hr 9-17 years every hr for less than 9 years and check client every 15
Remember hydration and basic needs are important, and can lead to harm or death with restraints so accurate monitoring needed
Anxiety
Becomes a disorder when it affects daily living
Highly anxious people need step-by-step instructions
Generalized Anxiety DIsorder
Is chronic and lives with them daily, always have muscle tension and uncomfortable always seek help.
Tx
Short term anxiolytics
CBT
Journaling, rechannel through exercise stay calm
Panic Disorders
S/S - Starts in late 20’s
Frequent and can present to ED with MI but it will be a panic attack
Txt
Stay with client , slow their breathing and communicate using words or messages. Teach them how to cope and tell them it will peak in 10 mins but last only 20-30 minutes. Journaling and CBT
Phobias
Fears that don’t present as danger
Txt:If they are nervous don’t talk about it develop a trusting relationship then slowly desensitize them. give them coping strategies.
OCD
Obsessed with a recurrent though and cannot stop.
Txt
They need a structured schedule but don’t take away their traditions from them. In time it should be decreased and given them strategies to cope with the anxiety such as distraction . The time decreased should be gradual over time.
Anorexia
Distorted body image, menses stop, decreased sexual development, weight loss, hypothermia and low bp/pulse
Tx:
Monitor for sucidal thoughts and try to weigh them only in their underwear. Limit their exercise time, instead focus on increasing their weight. They can help pick healthy foods and acknowledge how they feel.
Bulimia
Overeat and then vomit, same weight, erosion on enamel, diuretic use, strict diets
Tx:
Sit with client and observe for 1hr after and only allow for 30 min for meals. have intense family therapy and build self esteem
PTSD
Recurrent nightmares, emotionally numb, difficulty with relationships, and isolate themselves.
Txt
Establish safety
engage in new learning coping skills
Support groups
Alcohol Disorders
When substance use affects the ability to do work, school, home alcohol is a depressant
Tx: Provide a quite environment with the lights on, frequently orient them, have a friend/family stay and clarify their illusions *seizure * librium. Anxiolytics don’t be afraid
Sedatives benzodiazepine to sedate chlordiazepoxide / diazepam or lorazepam
Well hydrated thiamine, mag, cal, pros, potassium, multivatimains, watch for wernicke and krosakoff
delirium tremens prevented
Nursing Considerations for Alcohol
Observe for denial and rationalization given antabuse and stay away from any form of alcohol must have family support or therapy
Opiod Abuse
Can be through prescription or recreational
most common is heroin, oxycodone and meperidine
S/S need more drugs and drug is a survival Triad symptoms Pinpoint pupils Resp depression Coma
Emergency Treatment for Drug Abuse
Naloxone reveres can be used their multiple ways except PO , short acting and given every few hours till non toxic
Follow up treatment
Must go to hospital - failure to continue dose can lead to death. Intranasal are usually in emergency kits
Opioid Withdrawal
Hours to days
With Heroin its 6-8 hrs, and meperidine users withdraw faster
S/s
Aggitated and anxious pupil dilation everything is up!
Txt
Methadone must be monitored long term.
