psychiatric nursing Flashcards
signs and symptoms of depression
loss of interest in life activities
negative world view
anhedonia (loss of interest in pleasurable things)
usually related to loss
weight gain (mild depression)
weight loss (severe depression)
crying spells with mild to moderate
no more tears (severe)
sleep disturbances
slow thoughts, think slow,
can have delusions and hallucinations
Treatment
may need help with self care
prevent isolation
help them experience accomplishments
be careful with compliments (may make them feel worse)
just sit there
encourage them to describe feelings as they feel better
help them set accomplishable goals
if able walking, weight lifting, running
assess for suicide risk
Suicide risks
as depression lifts suicide risks increase
antidepressants increase suicide risk
American Indians have highest suicide rate and the elderly especial men
a sudden change in mood may indicate they have a plan
ask if they have a plan, what it is, how Lethal
do they have access to plan? watch for isolation, will writing, collecting harmful objects, giving away belongings
suicide prevention
direct, closed ended statements
provide a safe environment
safe-proof the room
signs of mania
continuous high
emotions-labile (extreme depression, manic)
flight of ideas
delusions are just a false idea
delusions of grandeur
delusions of persecution
constant motor activit> exhaustion
no inhibitions, innapropriate
altered sleep patterns
poor judgement
manipulation makes the feel powerful
mania treatment
decrease stimuli
dont argue or try to reason
dont talk about delusion
let them know you accept they need to believe it but you dont
look for the underlying need in delusion
persecution the need to feel safe
grandeur they need to feel good about themselves
set limits and be consistent
feel most secure in one on one relationships
remove hazards
stay with them as anxiety increases
need a structured schedule
provide activity to replace non-purposeful activity
supply finger food
dont forget fluids
maintain dignity
What is ECT treatment
can induce a tonic clonic seizure
used for severe depression
what do you do pre ECT
NPO, Void and give atropine
consent
succinylcholine given to relax muscles
what do yo do post ECT treatment
position on their side to prevent aspiration
stay with client
temporary memory loss expected
reorient them repeatedly
return to daily activities ASAP
schizophrenia symptoms
inward focus/ create their own world
inappropriate affect, flat affect or blunted affect
disorganized thoughts (looseness of asociations
ineffective communication skills (echolalia, neologism, word salads)
concrete thinking
religiosity
delusions
hallucinations (usually auditory)
what is echolalia
repeat what they hear
what is neologism
make up new worlds (seek clarifications)
schizophrenia treatment
decrease stimuli
observe frequently without looking suspicious
orient frequently
keep conversations reality based
observe for hallucinations
warn before you touch them
dont refer to hallucinations as they it makes them seem real
let them know you do not share the perception
hallucination connected to anxiety
get them involved in activity
elevate HOB
turn off TV
offer reassurance
what are command hallucinations
hallucinations that command the client to just themselves or others, can be frightening and can signal a psych emergency
signs and symptoms of paranoid personality disorder
always suspicious, but nor reason to be, distrust of others,
cannot explain away their delusions or false beliefs
pathological jealousy
hypersensitive to comments or actions
can’t relax, no humor, unemotional
abnormal anger response, responds with rage when provoked
treatment of paranoid personality disorder
be reliable
be honest
consistent nurses and brief visits
be matter-of-fact
respect personal space
be careful with touch, dont mix medications (always ID meds)
may need to eat sealed foods
use restraints as last resort
when must a provider evaluate a patient in restraints
within an hour
how often must restraint orders be renewed,
every 4 hours for adults
every 2 hours 9-17
every hour for less than 9 years
check client face to face every 15 min
remember hydration
signs and symptoms of anxiety
a universal emotion
becomes a disorder when interferes with functioning
increased performance at mild levels
decreased performance at high levels
may not need nurse with low anxiety
nurse should stay with high anxiety
highly anxious person needs step by step instructions
signs and symptoms of generalized anxiety disorder
chronic anxiety
fatigued due to constant activity and muscle tension always uncomfortable
always seek help
treatment of generalized anxiety disorders
short-term use of anxiolytics
relaxation techniques, deep breathing, imagery, deep muscle relaxation, or meditatin
journaling over time may help gain insight into anxiety peaks and valleys and triggers
re-channel anxiety through exercise
stay calm, because anxiety is contagious
panic disorders signs and symptoms
onset of panic attacks start in late 20s
they can be as frequent as weakly, or spread out like monthly
may present in ed with symptoms of an MI
treatment of panic disorders
if hyperventilating, slow down their breathing and breath with them
use simple words or messages when talking
teach ways to stop anxiety
symptoms should peak in 10 minutes and be gone in 20-30 minutes
journaling to help manage anxiety
use relaxation techniques
treatment of phobias
must develop a trusting relationship with the client
desensitization is the key to recovery and must occur over time
do not talk about the phobia a lot
unconscious anxiety causes the phobia
normal coping hasn’t worked and fear may help them cope better
OCD signs and symptoms
obsession is a recurrent thought
compulsion is a recurrent act they cannot stop
in comes from an unconscious conflict/anxiety
OCD treatment
need a structured schedule
give time for ritual (increased anxiety if can’t perform) taper off and replace with another coping mechanism
provide distraction techniques
teach relaxation techniques like meditation
anorexia signs and symptoms
distorted body image
preoccupied with food, but won’t eat
menses stop due to malnourishment
may have lanugo
decreased sexual development
lose weight
have hypothermia
dehydration and electrolyte imbalance resulting in low bp and pulse
treatment of anxiety
increase weight gradually, weigh in underwear
monitor exercise routine
acknowledge the difficulty of clients situation
teach healthy eating and exercise
allow clients input into choosing healthy food items for meals
monitor for suicidal thoughts
bulimia signs and symptoms
overeat and vomit
teeth have erosion of enamel
laxative and diuretic use
strict dieters: fasts, exercises and binges
binges are alone and secret
binges are pleasurable initially but after consuming thousands of calories intense self criticism may occur
low end of normal weight
Bulimia treatment
sit with client at meals and observe for 1 hour after eating
allow 30 minutes for meals
take focus away from the food
intense family therapy is usually the cause
self-esteem building is important
PTSD signs and symptoms
relives experience, nightmares, and flashbacks
emotionally numb
difficulty with relationships
isolate themselves
PTSD treatment
establish a sense of safety
engage client in learning new coping skills
support groups
what is considered a substance abuse disorder
when the use of the substance interferes with the ability to fulfill obligations such as work, school, or home
what are the stages of alcohol withdrawl
minor withdrawal
moderate to severe withdrawal
delirium tremens
signs of minor alcohol withdrawal
starts 4-12 hours of cessation of drinking
mild tremors, nervous, nausea, insomnia, headaches and palpitations
oriented to time, place and person
describe moderate to severe withdrawal
increased tremors, confused, hyper-thermic, hyperactive, nightmares, increased BP, increased respirations, hallucinations, illusions
carefully assess and provide treatment to prevent delirium tremers
signs of delirium trements
medical emergency
kinesthetics DT are most common (feel things crawling on them)
tonic clonic seizures possible
treatment of alcohol withdrawal
keep light on (scared)
encourage friend or family to stay with the
provide a quiet environment
walk and talk to them
orient the client to time, place and person,
clarify illusions
seizure precautions
anxiolytics
sedatives
hydration
why are sedatives used in alcohol withdrawal
they sedate
have anticonvulsant qualities
examples of benzodiazepines
chlordiazepoxide
diazepam
lorazepam
what are those in alcohol withdrawal deficient in
thiamine
manesium
calcium
potassium
phosphorous
what can thiamine deficiency lead to
wernickes encephalopathy and korsakoffs psychosis
what is wernickes encephalopathy
most serious form of thiamine deficiency in alcoholics
include paralysis of ocular muscles,
diplopia
ataxia
somnolence and supor
can lead to death
what is korskaoffs psychosis
syndrome of confusion and loss of recent memory
seen when coming out of wernickes
nursing considerations for alcohol withdrawl
observe for defense mechanisms (denial, rationalization)
disulfiram
support
12 step program
things to consider with disulfiram (Antabuse)
connect form must be signed
must stay away from any form of alcohol including , cough syrup, aftershave, colognes and chemicals such as varnish
what are the most common opioids
heroin
oxycodone
meperidine
signs and symptoms of opioid addiction
need more drugs and needs them more often due to build up tolerance
drug seeking is no longer an option , its survival
signs of opioid intoxication
pinpoint pupils
respiratory depression
coma
emergency treatment of opioid use
Narcan (naloxone)
how often must narcan be administered
every few hours until levels are non-toxic
what happens if you do not continue naloxone
can lead to death
when does opioid with draw start
within hours to days of stopping
when do heroin users go through withdrawls
6-8 hours after use is stopped
who goes through withdrawal faster
meperidine useres
signs of opioid withdrawal
agitated and anxious mood,
nausea
vomiting
muscle aches
excessive tearing and running nose
sweating
pupil dilation
treatment of opioid withdrawal
methadone