psychiatric Flashcards
depression s/s
loss of interest negative view on world anhedonia (loss of pleasure in usually pleasurable things) poor kept weight gain in mild weight loss in severe crying spells with mild no more tears with severe sleep disturbances slow thoughts: speak slow when talking to them: silence can have delusions or hallucinations
depression treatment/nursing considerations
have them help w/ self care
prevent isolation
help them experience accomplishments
be careful w/ compliments: may feel worse
sit with them
have them describe their feelings
set accomplishable goals
walking, running, weight lifting
assess for suicide: as depression gets better their suicide risk increases r/t high energy
when starting antidepressants suicide risk goes up
a sudden change in mood towards better means that they maid the decision to kill themselves
elderly at risk
ask if they have a plan? what is the plan? how lethal?
do they have access to the plan
assess for:
isolation
writing a will
collecting harmful objects
giving away belongings
suicide interventions:
direct, closed ended statements
safe environment
safe-proof room
mania s/s
depression and mania
continuous high
emotions-labile
flight of ideas
delusions are just a false idea
delusions of grandeur (client thinks they’re jesus)
delusions of persecution
constant motor activity (exhaustion)
no inhibitions (inappropriate dress, hyper-sexual behaviors)
altered sleep
poor judgement
manipulation makes them feel secure and powerful
mania treatment
decrease stimuli dont argue or try to reason do not talk about delusions let them know you accept the delusion but do not believe it look for underlying need: delusion of persecution: need to feel safe delusion of grandeur: need to feel good about self set limits be consistent one on one relationships remove hazards stay with them when anxiety goes up structured schedule provide activity to replace non-purposeful activity finger foods- too busy to stop and eat walk with them during meals remind them to drink fluids dignity maintained
ECT treatment
ect treatment
induce a tonic clonic seizure
used with severe depression
pre procedure: NPO void atropine (prevent aspiration) consent succinylcholine (relax muscles)
series of treatments
post procedure: position on their side (prevent aspiration) stay with them temporary memory loss reorient them repeatedly
return to activities asap
schizophrenia s/s
focus inward create their own world inappropriate affect, flat affect, or blunted affect disorganized thoughts ineffective communication skills echolalia: repeat the word neologism: making up new words-- seek clarification "I don't understand" word salads: jumble of words concrete thinking (be specific) religiosity delusions hallucinations (auditory)
schizophrenia treatment
decrease stimuli
observe frequently
orient frequently
keep conversations reality based
observe for hallucinations (warn before touching, don’t refer to the voices as “they” it makes them seem real)
**let them know that you do not share the perception
hallucinations are connected to times of anxiety
get them involved in activity (out of hallucination and into the real world)
elevate HOB
turn off TV
offer reassurance
command hallucinations
command hallucinations
auditory hallucinations
command them to hurt themselves
frightening for client and signal psychiatric emergency
paranoid personality disorder s/s
suspicious-- no reason to be distrust of others pathologic jealousy hypersensitive can't relax no humor unemotional abnormal anger response
paranoid personality disorder treatment
****be reliable build trust if you say something, do it be honest consistent nurses and brief visit matter of fact respect personal space careful with touch paranoid person cannot handle touchy/feely don't mix meds always ID meds may need to eat sealed foods restraints are a last resort
joint commission restraints
must be evaluations in person by HCP within one hour of restraint
orders renewed
q4 hours for adults
q2hours for ages 9-17
hourly for less than 9
anxiety disorders s/s
universal emotion
disorder when it interferes with daily living
increases performance at mild levels
decreases performance at high levels
stay with highly anxious client
step by step instructions if highly anxious
GAD s/s
chronic anxiety "worry" disease live with it daily seek help fatigue r/t constant activity and muscle tension--always uncomfortable
GAD treatment
short term use of anxiolytics relaxation techniques journaling rechannel though exercise (pick most exerting activity) stay calm
panic disorder s/s
onset of panic attacks start in late 20s
weekly or monthly
classic symptoms of MI
may think they are dying
panic treatment
stay wit them give them space be calm make them feel secure breathe with them to slow down their hyperventilation simple words or messages symptoms should peak within 10 minutes and be gone within 20-30 minutes journaling relaxation techniques
phobias treatment/considerations
develop trusting relationship
**desensitization (GRADUAL exposure)
don’t talk about phobia
OCD s/s
obsession: recurrent thought
compulsion: recurrent action
unconscious conflict/anxiety
OCD treatment
structured schedule
give time for rituals
decrease amount of time and increase amount of time between the ritual
never take away ritual w/o replacing it with another coping mechanism such as anxiety reduction
provide distraction techniques
teach relaxation techniques
anorexia nervosa s/s
distorted body image always think they're overweight preoccupied with food won't eat menses stop rt malnourishment may have lanugo decreased sexual development lose weight hypothermia rt loss of subq tissue dehydration and electrolyte imbalance-- low BP and pulse
anorexia nervosa treatment
increase weight gradually weight them in underwear monitor exercise routine acknowledge difficulty of their situation teach healthy eating and exercise allow them input into choosing foods monitor for suicidal ideation
bulimia nervosa s/s
overeat then vomit teeth erosion laxative use diuretic use strict dieters binges are alone and secret binges are pleasurable but after consuming lots of calories intense self criticism occurs normal weight feel in control as long as they are eating what they want
bulimia nervosa treatment
sit with them after meals for 1 hour allow 30min for meals take focus away from food intense family therapy-- family issues is usually the cause self esteem building
ptsd s/s
relives experience, nightmares, and flashbacks
emotionally numb
difficulty w/ relationships
isolate themselves
ptsd treatment
establish a sense of safety
engage client in learning new coping skills
support groups
alcohol use disorder
use of substance interfere with the ability to fulfill obligations such as work, school, or home
alcohol is a depressant
usually have low thiamine, mg, ca, k, and phosphorous
stages of withdrawal
stage 1: minor 4-12 hours of cessation mild tremors, nervous, nausea, insomnia, headache, palpitations orientated to person time and place
stage 2: moderate to severe increased tremors confusion hyperthermic hyperactive nightmares increased BP high RR hallucinations illusions
stage 3: delirium tremens (DTs) medical emergency kinesthetic DT most common: feel things crawling on them tonic clonic seizures possible
alcohol treatmetn
keep light on clients are scared encourage a close friend/family to stay with them quiet environment walk and talk to them orient frequent clarify illusions seizure precautions
chlordiazepoxide used for outpatient detox
anxiolytics
sedatives (Benzos, chlordiazepoxide, diazepam, lorazepam)
well hydrated
replace electrolytes
replace with multivitamins, electrolyte solutions, and thiamine injections
thiamine deficiency can lead to wenicke’s encephalopathy and korsakoff’s psychosis
wenicke’s encephalopathy
thiamine deficiency paralysis of ocular muscles diplopia ataxia somnolence stupor death will occur with thiamine injections
korsakoff’s psychosis
confusion and loss of recent memory
often when they are coming out of wenicke’s
alcohol use nursing considerations
observe defense mechanisms (denial and rationalization)
Disulfiram:
deterrent to drinking
sign consent before given
stay away from any form of alcohol (cough syrup, aftershave, colognes, and chemicals–varnish)
support when detox is over
12 step program
family therapy
opioid abuse
prescription
recreational
common opiates
heroin
oxycodone
meperidine
s/s of addition
more drugs and needs them more often (tolerance)
drug seeking is survival
opiate intoxication s/s
pinpoint pupils
respiratory depression
coma
opiate emergency treatmetn
naloxone:
opiate antagonist
dramatically reverses signs of OD
IM, IV, SQ, or nasal
opiate follow up treatment
given naloxone in field must go to hospital
naloxone is short acting
administered every few hours until opiate levels are non-toxic
failing to continue the dosages can led to death
intranasal is most common
opioid withdrawal
hours to days of stopping
heroin: symptoms 6-8hours after
meperidine users withdrawal faster than heroin users
opioid withdrawal s/s
agitated anxious n/v muscle aches excessive tearing and runny nose sweating pupil dilation
opioid withdrawal treatment
methadone:
long acting opioid substituted for opioid addition
titrated down during rehab to ease symptoms
don’t crave it
have time to do purposeful things
monitored in a clinic long term (adjusted frequently)
alzheimer’s nursing considerations
identify yourself call them by name speak slow use short, simple sentences and words focus on one piece of information at a time communicate face to face 1-2 arm length away talk about meaningful things notice pictures in room and reminisce keep clocks, calendars, and personal items within reach and vision mark days on calendar with a big X identify doors with labels monitor intake glasses and hearing aids within reach weigh weekly group activities of enjoyable things dress themselves calm environment perform all tasks if possible
