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Psych - Final Unit

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olanjones's version from 2017-02-21 03:41

Substance Abuse

Question Answer
S/S alcohol withdrawalshaky, sweating, vomiting, tachycardia, mild fever (lasts a few hours, peak at 24-48, then disappear)
S/S deliriumTremors, Change in MS, Agitation & irritability, Confusion, disorientation, Delirium, Oversleeping, Mood Swings, Fatigue, Generalized tonic-clonic seizure
Delirium TremensSevere form of alcohol withdrawal; triggers- abrupt d/c of alcohol intake after heavy drinking; Head injury, infection, & other illness in alcoholics may trigger DTs
Banana bag txThiamine, folic acid, and 3 grams of magnesium sulfate; The typical composition of banana bag is IL of normal saline, Magnesium sulfate 3g, Folic acid 1mg
ETOH w/d Early tx meds Benzodiazepines, barbiturates, Thiamine, Mag sulfate, Pheregen
ETOH Sobriety Maintenance DrugsDisulfiram (Antabuse), Naltrexone (revia), Vivitrol, Acamprosate (campral)
S/S PCP overdoseSx are unpredictable & dose-related. Impulsiveness, impaired judgment or can be calm/comatose
Tx PCP overdoseelimination enhanced by ammonium chloride; When anxiety or panic occur, can give benzos (diazepam or chlordiazepoxide) to prevent harm to client or others; Psychotic rxns can be treated with antipsychotics
Opioid w/dmuscle aches, lacrimation or rhinorrhea, pupillary dilation, n/v, dysphoric mood. Tx is rest, nutritional support & methadone substitution
Opioid w/d txBuprenorphine tx for w/d: less powerful than methadone, but somewhat safer with fewer side effects; Clonidine: used to suppress w/d sx and as monotherapy to provide a bridge to enable client to be opioid free for long enough to end methadone maintenance doses; Intoxication Tx: naloxone, naltrexone, or nalmefene
Why does THC slow everything down acts on presynaptic cells, ‘Dimer switch’, Limits amount of neurotransmitter release (eg: dopamine)
POC for substance abuse disorder-Meds for intoxication & withdrawal, Monitor for covert substance use during detox, Emotional support
-Educate client & family about co-dependency, addiction, initial tx goal of abstinence, removing unused meds from the home
-Develop motivation & commitment for abstinence & recovery, Encourage self-responsibility & emergency plan list/contact info, Encourage attendance at self-help groups
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Neurocognitive

Question Answer
DeliriumRapid over a short period of time (hrs/days); Impairment in memory, judgement, Altered LOC, restlessness, agitation, mood swings; Personality changes, Perceptual disturbance, VS unstable (usu d/t med conditions, substance abuse)
DementiaGradual deterioration (mos/yrs); Impairment in memory, judgement, speech, ability to recognize familiar objects, executive function, movement, (do not change throughout the day), LOC unchanged, Restlessness and agitation are common Sun-downing many occur; Gradual personality changes, VS stable
Therapeutic environmentclose to nurse’s station, low level of visual & auditory stimuli, Well-lit environment, minimize contrasts/shadow, Rooms with windows – promote orientation, ID bracelet
Safety & SecurityMemory aides, eye glasses, consistent routine, adequate food/fluid intake, Allow safe pacing/wandering, cover/remove mirror to decrease fear/agitation
Communicationcalm/reassuring tone, positive worded phrases (do not argue/question hallucinations/delusion), reinforce reality, reinforce orientation to time/place/person, reintroduce each time, Establish eye contact/use short/simple sentences, Focus on one item of information at time
Daily routineEncourage reminiscence about happy times/talk about familiar tings, break instruction/activities into short time frames, limit number of choices when dressing/eating, minimize the need for decision making & abstract thinking to avoid frustration, avoid confrontation, encourage family visitation as appropriate
Home safety measuresRemove rugs; door locks; lock water heater thermostat & turn water temp down; good lighting; handrails; mattress on floor; secure electrical cords to baseboard.
Dementia Meds (CAREN)-Cognex (dropped by FDA d/t hepatotoxicity)
-Aricept (donzepil): cholinesterase inhibitor (↑ Ach in NT’s for people w/ Alzheimer’s dementia) *long half-life, admin. 1x/day @ bedtime, administer with food, monitor client’s ability to swallow
-Razadyne (galantamine): cholinesterase inhibitor
-Exelon (rivastigmine tartrate): cholinesterase inhibitor
-Namenda (memantine): CNS Agent blocks entry of Ca into nerve cells (slows brain death) FDA approval for mod-sev stages of Alz Dementia; can be used with a cholinesterase; w or w/o food; AE: dizziness, h/a, confusion & constipation
Med SECholinergic effects: bradycardia, esp. watch with patients with respiratory or heart issues; teach to monitor pulse rate at home; 10% patients get nausea and diarrhea→ monitor fluids, advocate provider to titrate dosage to reduce GI effects
Med ContraindicationsNSAIDS may cause GI bleed; Antidepressants/TCA/Conventional antipsychotics can reduce therapeutic effect of donepezil (cholinergic receptor blocking medications for clients taking any cholinesterase inhibitor is not recommended)
Depression Risk In Older people~40% of AD pts. suffer with depression; Sx are challenging bc hard to distinguish from NCD (neurocognitive disorders); depression can complicate NCD in these patients; Usually prescribed SSRI because of the few SE
Suicide & RFOf all suicides, More than 15% are 65<; Loss & Grief, Attachment to Others, Maintenance of self-identity, Dealing with death
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Crises & Abuse

Question Answer
Maturational Crisisoccurs across life cycle- events that can precipitate maturational crisis are marriage, leaving home during late adolescence, birth of a child, retirement, death of a parent.
Situational Crisisextraordinary, external rather than internal, often unanticipated. loss of job, death of a loved one, divorce, severe physical or mental illness, change in financial status, change of job, an abortion, severe physical or mental illness
Adventitious CrisisAre either nature or man made. Natural disaster eg. flood, fire, earthquake. A national disaster eg. acts of terrorism, war, riots, airplane crashes, crime
Interventionspt-centered care, rapid assistance for individuals or groups who have an urgent need; initial task of the nurse is to promote SAFETY; initial intervention: ID current problems, take active role with client & help to set realistic/attainable goals
Assessment post sexual assault-Treatment and documentation of injuries
-Maintaining the proper chain of evidence
-Treatment and evaluation of STDs
-Pregnancy risk evaluation and prevention
-Crisis intervention and arrangements for follow-up counseling
Characteristics of intimate partner violence victims >80% are women; low self-esteem; no support system; grew up in abusive homes
Why abused partners staySome women may also believe that they- Deserve the beatings (they did something “wrong”), Can control the beatings (by not upsetting their partners), Need to stay for the sake of the children, Are still positively reinforced by the honeymoon phase of the battering cycle
Rape-trauma Acute phaseshock & disbelief, won’t talk. Numb, don’t believe it happened; Interventions: sit with client, safe env’t, listen, get them what they need.
Rape-trauma Long-term phasebegin to open up and talk, but start to see PTSD symptoms; Interventions: same for PTSD, maybe meds
Cycle of abuseTension-building (abuser–minor explosions, victim–walking on eggshells) -> battering (unbearable tension, victim may provoke to “get it over with”) -> honeymoon (abuser-loving/sorry, victim–trusting/hoping for change)
Indicators of abuseExtremes of behavior, Delayed physical or emotional development, Lack of attachment to parent
Emotional abusea pattern of behavior on the part of the parent or caretaker that results in serious impairment of the child’s social, emotional, or intellectual functioning
Emotional neglectFailure to provide the child with the hope, love, and support necessary for the development of a sound, healthy personality
Physical abuseUnexplained injuries, frightened of adults, reports injury by parent or caregiver, Conflicting or unconvincing explanation for injuries
Physical neglectRefusal of or delay in seeking health care; Abandonment/Expulsion from the home, Refusal to allow a runaway to return home, Inadequate supervision
Sexual abuseDifficulty walking/sitting, Suddenly refuses to change for gym/participate in physical activities, Nightmares/bedwetting, Sudden change in appetite, Demonstrates bizarre/sophisticated/unusual sexual knowledge/behavior, Becomes pregnant/contracts STD
DocumentationNot alleged, use reported, Not refused, use decline, Instead of intercourse, use penetration, Instead of “in no acute distress,” you need to describe what is going on with the client.
Treatment Modalitiescrisis intervention: follow up with client; don’t focus on problems unassociated with rape; help return to previous life before rape, Safe house/shelter to protect women/children, Family therapy to help families develop democratic ways of solving problems.
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Anger & Aggression

Question Answer
AggressionAction or behavior that results in a verbal or physical attack.
Angernormal human emotion that, when handled appropriately and expressed assertively, can provide an individual with a positive force to solve problems and make decisions concerning life situations
Predisposing factors to maladaptive response Client who is angry and aggressive may have underlying feelings of inadequacy, insecurity, guilt, fear, and rejection
Stages of Maladaptive responsePre-assaultive stage- Anger, Increasing anxiety, Hyperactivity, Verbal abuse
Assaultive State- Violence act
Post assaultive stage- Staff review the incident with the client
Interventions for aggressionPreassaultive response: De-escalation approaches
Assaultive stage: Medication, seclusion, restraint
Post assaultive stage: Seclusion and restraint. Debriefing
Provide safe environment, Follow policies, Assess triggers, What are the steps to handling aggression/deescalating, Setting Limits, Follow-up, Discuss ways for the client to keep control during aggression cycle
Meds (most common antipsychotics)olanzapine (Zyprexa), ziprasidone (Geodon), haloperidol; SSRIs, mood stabilizers (lithium), and sedatives/hypnotics (benzodiazepines) are also used
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Neurodevelopmental

Question Answer
ADHD Inattention, impulsiveness, hyperactivity; Areas of brain affected: orbital frontal cortex, basal ganglia, cerebellum, anterior cingulate cortex
ODDRecurrent pattern of Negativity, Disobedience, Hostility, Defiant behaviors ( especially toward authority), Stubbornness, Argumentativeness, Limit testing, Unwillingness to compromise, Refusal to accept responsibility
Conduct DisorderPersistent pattern of behavior that violates the rights of others or rules and norms of society, Aggression to people and animals, Destruction of property, Deceitfulness or theft, Serious violations of rules
InteractionsUse calm, firm, respectful approach with child, Modeling acceptable behavior, Obtain child’s attention before giving direction, Provide short, clear explanations, Set clear limits on unacceptable behaviors (be consistent), Plan physical activities through which child can use energy & obtain success, Provide safe environment for child & others, Provide child with specific positive feedback when expectations are met
Family supportAssist parents to develop a reward system using methods (encourage the child to participate), Focus on the family/child’s strengths, Support parents efforts to remain hopeful, Family Therapy, CBT, Psychoeducation, Grief & trauma intervention
Purpose of ADHD medsIncrease the levels of norepinephrine, dopamine, & serotonin in CNS
Atomoxetineinhibits reuptake of NE
Bupropionblocks neuronal uptake of 5HT, NE, DA
Clonidine & GuafacineStimulate central alpha-adrenoreceptos in the brain
Stimulants for ADHDMethylphenidate (Ritalin, Methylin, concerta, daytrana (transdermal); Dexmethylphenidate (Focalin);Dextroamphetamine (Dexedrine, Dexedrine spansules); Amphetamine Mixture (Adderall, Adderall-XR); Lisdexamfetamine dimesylate (Vyvanse) -Insomnia , restlessness
NIeducate client to observe for side effect & to notify provider, Decrease dosage as prescribed, Administer last dose of day before 4pm (Weight Loss), Monitor weight/compare to baseline, Administer medication right before/after meals, Encourage children to eat at regular meal times & to avoid unhealthy choices
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Grief

Question Answer
Kubler-Ross1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
Engel1. Shock and disbelief 2. Developing awareness 3. Restitution 4. Resolving the loss 5. Idealization 6. Outcome
Worden1. Accepting the reality of loss 2. Working through pain of grief 3. Adjusting to the environment without the deceased 4. Emotionally relocating the deceased and moving on with life
Maladaptive-Prolonged (assoc w/ denial & anger) Mani: disorganization, ↓ functioning
-Delayed/inhibited (assoc w/ denial) Mani: No emotional pain but anxiety, somatic disorders, sleep/eating disorders
-Distorted (assoc w/ anger) Mani: Guilt, Helplessness, Hopelessness, Anger - Pathological depression
Grief & CultureMay determine how death is viewed/how mourners behave, rituals may help legitimize emotional/physical ventilation, provide a focus for managing confusion, disorganization, & loss of control which promoting social interaction
NIExplore & respect cultural, religious, personal values; Teach what to expect; Encourage expression & sharing of grief with support system
Hospice CareWork to help client maintain personal control and accept declining health status (nurse supports the client's will/hope)
Grief across lifespan-Toddlers/preschool may not have concept of death or permanence, don’t want to be separated from parents
-School-age understand permanence but fear separation or abandonment
-Adolescent understand/ may cope well or not cope well
-Adults may become more familiar/accepting of loss
-Older adults have greater risk for Bereavement overload
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