Psychiatric Nursing Kaplan

Unconscious failure to acknowledge an event, thought, or feeling that is too painful for conscious awareness

The transference of feelings to another person or object

Attempt to be like someone or emulate the personality, traits, or behaviors of another person

Using reason to avoid emotional conflicts

Incorporation of values or qualities of an admired person or group into one’s own ego structure

Separation of an unacceptable feeling, idea, or impulse from one’s thought process

Indirectly expressing aggression toward others; a facade of overt compliance masks covert resentment

Attributing one’s own thoughts or impulses to another person

Offering an acceptable, logical explanation to make unacceptable feelings and behavior acceptable

Reaction Formation
Development of conscious attitudes and behaviors that are the opposite of what is really felt.

Reverting to an earlier level of development when anxious or highly stressed

The INVOLUNTARY exclusion of a painful thought or memory from awareness

Substitution of an unacceptable feeling by a more socially acceptable one (a skinny kid that can’t play football becomes a champion swimmer)

The INTENTIONAL exclusion of feelings and ideas (I’ll think about it tomorrow)

Communication or behavior done to negate a previously unacceptable act

Milieu Therapy
Planned use of people, resources and activities in the environment to assist interpersonal skills, social functioning, and performance of ADLs while protecting safety of all clients.
Uses limit setting
Clients make decisions about their care and nurses support privacy and autonomy

Behavioral Therapy

– Positive Reinforcement

– Negative Reinforcement

Process of changing ineffective behavior patterns. Focus on consequences rather than peer pressure. Uses role modeling and teaching new behaviors
Positive Reinforcement – strengthens behavior with praise or reward
Negative Reinforcement – eliminates inappropriate behavior with removing a privilege or ignoring undesirable behavior

Family Therapy
The entire family is the client. Focuses on family interaction and roles of each member. Goal is to decrease conflict and anxiety and develop appropriate role relationships

Crisis Intervention
Focuses on resolving immediate crisis and can be used when the client is disoriented due to a panic state. Helps identify coping mechanisms and a support system. Goal is to return to pre-crisis level of functioning.

Cognitive Therapy
Replaces irrational beliefs and distorted attitudes. Short term. Goal is cognitive restructuring

Electroconvulsive Therapy (ECT)
Electronically induced seizures for clients who do not respond to antidepressants or need immediate intervention (such as for suicide patients).

Nursing Care After ECT
Maintain patent airway: nausea and vomiting after is common
Check vital signs every 15 minutes until consciousness is regained
Reorient client
Common complaints: headache, nausea, muscle soreness, retrograde amnesia

Group Intervention
Development of interactive relationships with patients that have at least one common goal
Can be open or closed, small or large

Phases of a group:
– Orientation: high anxiety, superficial interaction, limit testing of therapist
– Working: problem identification, beginning of problem solving, sense of group belonging
– Termination: evaluation of experience, expression of feelings (could be anger or joy)

– Development of socializing techniques
– Clients don’t feel alone in their situation
– Opportunity to try new behaviors, gain feedback from peers, and look at alternative perspectives of dealing with issues

Anxiety (defined)
Unpleasant feeling that occurs when a person feels a threat to their self. May be real or imagined (subjective experience). It is contagious can can be transferred from client to nurse and vice versa

Mild Anxiety
Required for daily functioning to motivate learning and promote sensory awareness and alertness. Allows for concentration and logical thought.

Moderate Anxiety
Client is still able to function and focus. Speech and volume increase. May lead to nausea, headaches, diarrhea, and tachycardia. Sensory awareness dulled

Severe Anxiety
Stimulate fight or flight. Causes perceptions to be distorted. Impairs concentration and problem solving ability. Results in verbalization of emotional pain. Tremors and increased motor activity

Panic Anxiety
Causes acute psychosis (client cannot tell what is real and unreal). Loss of ability to problem solve or think logically. Can exhibit angry, aggressive, or withdrawn behavior and may lead to crying. Requires immediate intervention

Generalized Anxiety Disorder
– Severe Anxiety
– Motor Tension (restlessness, quickly fatigued, shakiness, tension
– Autonomic Hyperactivity (SOB, palpitations, dizziness, frequency, diaphoresis)
– Difficulty sleeping and concentrating; irritabity
– Nervousness
– Low self-esteem

– Assess anxiety level
– Identify the relationship between the stressor and level of anxiety
– Decrease environmental stimuli
– encourage coping mechanisms

Panic Disorders
– Incapacitating fear or discomfort
– Fear of external subject
– Client knows fear is excessive but “can’t help it”
– Use of coping mechanisms (displacement, projection, repression, sublimation)
– Autonomic Hyperactivity
– Panic Attacks (peak at 10 minutes and last up to 30 with gradual return to normal functioning)
– Disruption of personal life
– Possible self medicating with drugs or alcohol to decrease anxiety

– Acknowledge the fear without exposing the fear to the client
– Establish trust and then start desensitization
– Use positive reinforcement when a decrease in phobic reaction occurs
– Reduce environmental stimuli

Fear of heights

Fear of crowds or open places

Fear of closed-in places

Fear of water

Fear of the dark

Fear of death

Obsessive-Compulsive Disorder
Anxiety Associated with repetitive thoughts (obsessions) or irresistible impulses (compulsions) to perform an action.
Major Symptoms: Fear of losing control
Compulsions are due to anxiety which may or may not be related to the obsession

– Use of defense mechanisms (Repression, Isolation, Undoing)
– Magical Thinking (belief that one’s thoughts or wishes can control other people or events)
– Evidence of delusional thought content
– Difficult with relationships
– Interference with normal activities (excessive washing hands)
– Safety issues related to ritualistic activity
– Recurring intrusive thoughts

– Provide for physical needs
– Allow compulsions but consider safety
– Explore the purpose of the behavior
– Limit the allowed time for compulsions and work to gradually decrease it.
– Administer anti-anxiety medications, SSRIs, and Tricyclic Antidepressants as prescribed
– Best time to educate is at the end of compulsion (anxiety is lowest leading to the highest ability to learn)
– Alleviate anxiety that causes the obsessions and compulsions
Interfering with compulsions can increase anxiety; let them happen as long as they are safe

Post-Traumatic Stress Disorder
Occurs in clients who have experienced or witnessed a highly traumatic event or repeatedly exposed to stories of traumatic events.

Assessment: (Four Symptom Clusters)
1. Avoidance of events or situations that are reminders
2. Persistent negative alterations in cognition and mood
3. Mood including numbing symptoms, as well as persistent negative emotional stress
4. Alterations in arousal and reactivity including irritable or aggressive behavior and reckless or self-destructive behavior (suicidal ideation and substance abuse)

– Provide a consistent, non-threatening environment
– Assess for self-harm and provide precautions
– Help the client regain a sense of control by identifying past situations where they successfully handled something
– Administer anti-anxiety and anti-psychotic medications as prescribed
– Promote rest
– Utilize group therapy with clients who went through a similar event

Antianxiety Medications

Somatic Symptom Disorder
Client turns any symptom into worst case scenario with great anxiety and demands excessive testing from health care professionals.

– Preoccupation with pain or bodily function for at least 6 months.
– “Doctor shopping” – looking for a diagnosis
– No emotional concern regarding the physical impairment
– Elevated vitals (like a panic attack)
– Excessive use of analgesics
– Suicidal thoughts
– Social or occupational impairment

– Record pain duration and severity with attention to factors that cause it.
– Encourage expression of anger
– Focus interactions away from self and pain
– Help client identify the connection between the pain and anxiety
– Increase attention given to client as a reward for the client no focusing on self or physical symptoms
– Reduce anxiety
– Use disorder specific medication for depression/anxiety
– Acknowledge that symptom or complaint/reaffirm that the tests came back negative and reveal no pathology/determine secondary gains acquired by the client (gains for playing the sick role)

Dissociative Disorders
Alteration in function of consciousness, personality, memory, or identity. Handle stress by “splitting” from the situation and going into a fantasy state. This is an unconscious defense mechanisms to protect from overwhelming anxiety:

– Psychogenic Amnesia
– Psychogenic Amnesia with Fugue
– Dissociative Identity Disorder
– Depersonalization including derealization

– Depression, mood swings, insomnia, potential for suicide
– Varying levels of orientation and anxiety
– Impairment of social and occupational function
– Self-medication with alcohol or drugs

– Reduce environmental stimulation
– Stay with client during depersonalization
– Accept client during various experiences and personalities
– Identify stressful situations that cause transition
– Identify coping measures
– Note that all behaviors have meaning
– With amnesia, do not provide too much info at once. The amnesia is there to protect the patient so too much can cause decompensation.

Psychogenic Amnesia
– Sudden inability to recall extensive personal events
– Occurs in a traumatic event (near death, natural disaster, intolerable life situation)

Psychogenic Amnesia with Fugue
– Flight with loss of memory (person leaves home or work with inability to recall identity
– Person may assume new identity
– Excessive alcohol use can lead to fugue state
– Rare

Dissociative Identity Disorder
– Presence of two or more distinct personalities
– Personalities emerge during stress
– Caused by physical, psychological, or sexual child abuse

Depersonalization including Derealization
– Temporary loss of one’s reality and ability to feel ad express emotion
– Express detachment with regard to surroundings (others are unreal or visually distorted)

Cluster A Personality Disorders
Types: Paranoid, Schizoid, and Schizotypal
Description: Suspicious strange behavior that may be odd or eccentric.

– Determine degree of mistrust and anxiety
– Determine if delusions are present (Reference or control, Persecution, Grandeur, or somatic)

– Establish trust
– Avoid confrontation with client over delusions
– Avoid talking or laughing where the client can see but not hear you.
– Engage in noncompetitive activities

Paranoid Personality
– Mistrust in others
– Projection (blame for own problems onto others)
– Can have odd beliefs or magical thinking
– Not in touch with reality
– Can be hostile and use accusatory language that is reality-based

Schizoid Personality
– Socially/emotionally detached
– Avoids relationships
– Withdrawn and seclusive
– Little expression, dull, humorless

Schizotypal Personality
– Interpersonal conflicts
– Socially isolated
– Has eccentricities and odd beliefs

Cluster B Personality Disorders
Types: Antisocial, Borderline, Histrionic, Narcissistic

Antisocial Personality
– Shows aggressive acting out behavior pattern
– Manipulative to meet own needs
– Lacks conscious or remorse
– Difficulty forming relationships

Borderline Personality
– Views others as either good or bad (splitting behavior)
– Impulsive
– Shows intense anger and has difficulty controlling anger
– Makes suicidal gestures
– Has disturbances with self-image and sexual, social, and occupational roles
– Can become verbally abusive

Histrionic Personality
– Seeks attention by overreacting and exhibiting hyper-excitable emotions
– Dramatic, attention-seeking
– Angry outbursts
– Uses physical appearance to draw attention to self

Narcissistic Personality
– Perceives self as all-powerful (arrogant) (preoccupied with power)
– Critical to others
– Needs attention and admiration

Cluster C Personality Disorders
Types: Avoidant, Dependent, Obsessive-compulsive

– Assess degree of social impairment and anxiety
– Determine risk of self-directed violence

– Establish Trust
– Protect from injury
– Set limits on manipulative behaviors
– Reinforce independence
– Encourage socialization

PDs are maladaptive responses to anxiety that cause difficulty in relating to and working with others

Avoidant Personality
– Socially inhibited
– Hypersensitive to negative criticism and rejection
– Longs for relationships
– Feels inadequate

Dependent Personality
– Expresses needs in a demanding way while professing independence and denying dependence
– Passive and does not accept responsibility for behavior
– Negative self-image/difficulty making decisions

Obsessive-compulsive Personality
– Attempts to control self through the control of others or the environment.
– Cold toward others
– Perfectionist
– Acts with blind conformity and obedience to rules
– Preoccupied with lists, rules, details, and orders
– Expresses disapproval of those who are different from their own

Personality Disorders
PDs are maladaptive responses to anxiety that cause difficulty in relating to and working with others

These people are comfortable with their disorders and believe that they are right and the world is wrong (little motivation to change)

Anorexia Nervosa
Distorted body image and intense fear of becoming obese drive excessive dieting and exercise.
15-20% die
More common in females and adolescents/young adults
Results from dependency issues with parents (feel that their body is the only thing they can control)

– Dysfunctional family system
– Unrealistic expectations of perfection
– Ambivalence about maturation and the assumption of independence

– Loss of at least 15% of ideal or original body weight
– Excessive exercise
– Distorted body image (thinks they are fat even when emaciated)
– Dry skin/loss of hair
– Delayed sexual development or disinterest in sex
– Dehydration and electrolyte imbalance (due to diet pill abuse, enema or laxative abuse, diuretic abuse, or self-induced vomiting)

– Monitor weight, vital signs, and electrolytes
– Provide a structured, supportive environment especially during mealtime
– Set a time limit for eating
– Monitor food and fluid intake
– Prevent excessive exercise
– Provide snacks between meals
– Devise a behavior-modification program if indicated (Include weight goal and weigh on regular schedule, Weigh in same clothes with back to scale, Praise weight gain rather than food intake)
– Sudden withdrawal from medications can cause seizures
– Gain pleasure in providing food and watching others eat (do not let them plan or prepare foods)

Bulimia Nervosa
Eating excessive amounts of food followed by self-induced purging (vomiting, laxatives, diuretics, fasting, or exercise)
Report loss of control over eating during the binging

– Diarrhea, constipation, abdominal pain, and bloating
– Dental damage due to vomiting
– Sore throat and chronic inflammation of the esophageal lining with possible ulceration
– Financial stressors related to food budget
– Concerns with body shape and weight; usually not underweight

– Monitor weight, vital signs, and electrolytes
– Provide structures environment around mealtime
– Encourage expression of anger
– Use positive reinforcement to stop vomiting and laxative use
– Administer antidepressants as prescribed
– Family therapy is most effective

Binge Eating Disorder
Eat large amount of foods in short periods of time and report feelings of guilt and shame after binging. Do not purge after nor are they obese. Co-exists with other psychiatric disorders.

Depressive Disorders (Severity)
Pathologic grief reactions ranging from mild to severe states.

– Feelings of sadness
– Difficulty concentrating and performing usual activities
– Difficulty maintaining usual level of activity

– Feelings of helplessness and powerlessness
– Anergia
– Sleep and appetite disturbances
– Slowed speech, thought, and movement
– Rumination on negative feelings

– Feelings of hopelessness, worthlessness, and guilt
– Flat affect
– Indecisiveness
– Anergia, lack of motivation
– Suicidal thoughts
– Delusions or hallucinations
– Sleep and appetite disturbances
– Loss of interest in sex
– Constipation
MOST IMPORTANT SYMPTOM: Loss of interest in the pleasures of life

Depressive Disorders
(Assessment and Interventions)
– Determine type of depression (exogenous [caused by external factors] or endogenous [caused by an internal biologic deficiency])
– Determine degree of depression
– Determine risk for suicide
– Arrange for lab tests (Dexamethasone-suppression test [indirect marker of depression if level greater than 5mg/dL] and Biogenic Amines [Decreased seratonin and norepinephrine are indicative of depression])

– Ask about plans to self-harm
– Monitor sleep and nutrition habits
– Assist with ADLs
– Assess for elevation in mood (increases risk of suicide)
– Insist on participation in activities (do not give a choice)
– Administer antidepressent medication
– Depressed client find it hard to accept compliments –> instead comment on signs of improved behavior (such as doing an ADL)
– Improvement is noted when the client takes an interest in themselves

Care for Suicidal Patients
– Previous attempt is the highest risk factor
– Giving away possessions
– Sudden happiness

– Express concern for the client
– Tell the client that you will share information with the staff
– Offer hope (You’re feeling this way not but there is treatment to help this feeling pass)
– Stay with the client
– Sitting in silence with the client is the best intervention to offer support

Antidepressent Medications
Atypical Antideppresents

Bipolar Disorder (Manic Depressive Illness)
Affective disorder characterized by euphoria, grandiosity, and inflated sense of self-worth. May or may not include sudden swings of depression. Range from mild to severe.

– Feelings of being high, having a sense of well-being, and minor alterations in habits
– Do not seek treatment because they like the pleasurable effect

– Grandiosity, talkativeness, pressured speech, impulsiveness, excessive spending, and bizarre dress and grooming

– Extreme hyperactivity
– Flight of Ideas
– Sexually acting out; explicit language
– Talkativeness
– Over responsiveness to stimuli
– Agitation and explosiveness
– Delusions of Grandeur
– Sleep disturbance

Bipolar Disorder
(Assessment and Intervention)
– Determine level of depression and mania
– Assess nutrition and hydration status
– Assess level of fatigue
– Assess danger to self and other in relation to level of impulse impairment present

– Provide nutrition, rest, and hydration (small frequent meals)
– Provide safe environment (altercations with other clients)
– Decrease environmental stimulation
– Use limit setting
– Avoid giving attention to bizarre behavior
– Engage in simple, active, noncompetitive activities
– Administer lithium, sedatives, and anti-psychotics as prescribed (lithium level is 0.8-1.4)
– Avoid arguing or becoming defensive when a bipolar puts you down (common)
– If patient becomes abusive: (redirect negative behavior or verbal abuse in a calm. firm, nondefensive manner, suggest a walk or other physical activity, set limits for intrusive behavior, seclude or sedate as a last resort)

Mood Stabilizing Drugs
Anticonvulsant Mood Stabilizers:
– Valproic Acid (depakote)
– Carbamazepine (Tegritol)
– Lamotrigene (Lamictal)

Catatonic vs. schizoaffective
Assessment and Interventions
Description: Psychiatric disorder characterized by thought disturbance, altered affect, withdrawal from reality, regressive behavior, difficulty with communication, and impaired interpersonal relationships as well as impaired ability to perceive reality.

Types: Catatonic and Schizoaffective

– Stupor (decrease in reaction to the environment)/mutism
– Rigidity (maintenance of a posture against efforts to be moved
– Posturing (waxy flexibility
– Negativism (resistance to instructions)
– Potential of violence to self or others during stupor or excitement

– Schizophrenia with the presence of a major mood episode for the majority of the disorder’s duration

– Symbolism: meaning given to words by client to screen thoughts and feelings that would be difficult to handle directly
– Delusions: Fixed, false beliefs that may be persecutory, grandiose, religious, or somatic (cannot be change with reason or reality)
– Ideas of Reference: belief that all conversation or actions are in reference to the client (world revolves around them)
– Looseness of Association: Lack of clear connection from one thought to the next
– Tangential or circumstantial speech: failing to address the original point (too many nonessential details
– Echolalia: constantly repeating what is heard
– Neologism: Creating new words
– Preservation: repeating same word or phrase in response to a different questions
– Word Salad: Speaking with a jumbled mixture of real and made-up words
– Blocking: gap or interruption in speech due to absent thoughts
– Concrete thinking: thinking based on facts rather than abstract points (takes everything literally)
– Illusions: Misinterpretation of external environment (can be fixed with reality)
– Hallucinations: false sensory perception
– Depersonalization: perceives self as alienated or detached from real body
– Echopraxia: repeating movements of others
– Difficult to establish trust or intimacy

– Establish trust and provide a safe and secure environment
– Use a matter-of-fact approach
– Assist with ADLs
– Use concrete terms
– Use clarification: accept and support client feelings
– Set limits
– Avoid stresors
– Praise socially acceptable behavior

4 A’s of Schizophrenia:
– Autism (preoccupied with self)
– Affect (flat)
– Associations (Loose)
– Ambivalence (difficulty making decisions)

Delusional Disorders
Suspicious, strange behaviors which can be precipitated by a stressful event and manifest as intense hypochondriasis

– Assess degree of anxiety, insecurity, mistrust
– Assess whether delusions are present (reference or control, persecution, grandeur, somatic, jealousy)

Interventions for Delusional Client:
– Divert focus from the delusion to reality
– Do not agree with or support delusions
– Avoid arguing about the delusion. Be matter-of-fact
– Administer antipsychotic and antiparkinsonian medications
– Avoid touching the client

Interventions for Hallucinating Client:
– Protect from injury and pay attention to content
– May remarks to interrupt the hallucinations
– Discuss observations with client such as looking around as if listening to something)
– Administer anti-psychotic and anti-cholinergic drugs

Know the side effects of drugs to determine if behavior changes are due to schizophrenia or side effects.

Antipsychotic Drugs
Long-acting drugs
Atypical Antipsychotics

Side Effects of Antipsychotic Medications
Extrapyramidal Effects:
– Parkinsonism
– Akathisia
– Dystonia
– Tardive Dyskinesia
Neuroleptic Malignant Syndrome (Fever)
Serotonin Syndrome
Anticholinergic Effects

– Binge drinking
– Morning drinking (eye opener)
– Gastritis
– Poor work ethic and legal problems
– Defense Mechanisms (denial, projection, and rationalization)
– Family history of alcoholism

Withdrawal Symptoms:
– Can occur after 4-6 hours of drinking
– Autonomic hyperactivity (increase in vital signs)
– Delirium tremens (48-72 hours after)
– Grand mal seizures
– Chronic Illnesses (gastritis, cirrhosis and hepatitis, korsakoff syndrome, malnutrition, pancreatitis, peripheral neuropathy)

– Maintain safety, nutrition, hygiene, and rest
– Monitor vital signs, I&O, electrolytes
– Prevent aspiration
– Reduce environmental stimuli
– Provide protein, vitamin supplements (especially B), and antianxiety medications (Librium/Ativan)
– Provide emotional support

– Set limits on behavior
– Help increase self-esteem
– Find alternative coping mechanisms
– Identify a support group (Such as AA)
– Identify activities and relationships not related to drinking

Alcohol Drugs
Alcohol Deterrents

Commonly abused drugs
– Heroin, morphine, codeine, opium, methadone
– Cocaine
– Amphetamines
– Hallucinogenics
Antianxiey Drugs

Drug Abuse
– Pattern of drug use (what and how much)
– Physical evidence of drug usage (needle marks, cellulitis, poor nutrition, inflammation of nasal passages)
– Drug dependency
– Symptoms of withdrawal or overdose for that drug

– Assess LOC and vital signs
– Monitor I&O and electrolytes
– Confront denial
– Identify stressors
– Explore coping strategies

Child Abuse
– Indicators of child abuse (injuries not congruent with developmental age or skills, injuries not correlated with stated cause, delay in seeking medical care)
– Bruises in various stages of healing
– Burns
– Fractures in various stages of healing
– Parent using child to meet own needs
– Parent critical of child; seldom touching or responding to child
– Child frightened in the presence of parent
– Hx of frequent moves, unstable employment, marital discord, or family violence
– Bedwetting, soiling
– Failure to thrive

– Nurses are LEGALLY required to report all cases of suspected child abuse to the appropriate local or state agency
– Take color photographs of injuries
– Establish trust with the child and care for immediate, physical needs of the child
– Recognize feelings of contempt for the parents
– Support family therapy
– Select only one nurse to work with the child. Trust is hard to get from a child, so one nurse helps build that trust.

Intimate-Partner Violence
– Delay between time of injury and time of treatment
– Anxiousness when answering questions about injury
– Abdominal injuries during pregnancy
– Looks to abuser to answer questions about injuries
– Feeling of responsibility for “provoking” partner

– Establish trust
– Treat physical needs first
– Document factual, objective info about the condition of the client, injuries, and interaction with partner or family
– Determine potential for further violence
– Interview when abuser is not present
– Assist with referral to a shelter if necessary
– Assist client with contacting authorities if charges are to be pressed

Elder Abuse
1-10% of the elder population is abused (often by the caregiver)

– Bruises on upper arms, broken bones (from being pushed and falling)
– Dehydration, malnourishment
– Overmedication
– Poor hygiene, improper medical care
– Feelings of hopelessness/helplessness
– Injuries do not correlate with stated cause
– Misuse of money by children or legal guardians

– Establish trust
– Meet physical needs and treat wounds
– Document factual, objective info about the condition of the client, injuries, and interaction with partner or family
– Arrange for “respite care” for the caregiver
– Arrange for visiting nurses, nutrition services, or adult day care if possible
– Report suspected abuse to the authorities
– Older adults often do not report abuse due to fear of abandonment and being put into a nursing home.

Rape and Sexual Assault
– Physical assessment with careful documentation of injuries
– Emotional status (self-blame, anxiety, fear, humiliation, disbelief, anger)
– Coping behaviors
– Identification of support system
– Details of the assault

– Communicate nonjudgmental acceptance
– Provide physical care to injuries
– Tell them what you are doing before you do it
– Document factual, objective statements of physical assessment; record EXACT words of the client
– Notify police and encourage victim to prosecute
– Notify rape crisis team or counselor if available
– Allow discussion of feelings
– Advise potential for venereal disease, pregnancy, and HIV
– Support the client, family, and friends.
– High risk for PTSD

Focus of sexual abuse questions
Physical manifestations of abuse

Client Safety

Legal Responsibilities of the Nurse:
– Required to report child abuse
– Adults decision to report otherwise

Neurocognitive Disorder

Delirium and Dementia

Delirium: Acute impairment of cognitive functioning that is secondary to another ailment
– Infection, Drug Reaction, Substance intoxication/withdrawal, Electrolyte Imbalance, Head Trauma, Sleep Deprivation
– Correct the cause of delirium

Dementia: Chronic, gradual, progressive, and irreversible degeneration of judgement, memory, abstract thinking, social behavior, and other aspects of cognition
– Can develop aphasia, apraxia, and agnosia

– Limited attention span, easily distracted
– Disorientation
– Delusions, illusions, or hallucinations
– Loss of recent or remote memory
– Confabulation
– Impaired coordination
– Day-night reversal/sleep deprivation
– Incontinence, constipation

– Provide safe, consistent environment
– Maintain health, nutrition, hygiene, and rest
– Assist with ADLs
– Reorient client as needed
– Provide a consistent caregiver

Alzheimer’s Drugs
Acetylcholinesterase Inhibitors
N-Methyl D-Aspartate Agonist

Attention-Deficit (Hyperactivity) Disorder
Description: Developmentally inappropriate attention, impulsiveness, and hyperactivity

– More prevalent in boys
– Failure to listen/follow instructions
– Difficulty playing quietly or sitting still
– Disruptive behavior
– Easily distracted by external stimuli
– Excessive talking
– Shifting from task to task without finishing them
– Underachievement in school

– Decrease environmental stimuli
– Set limits on behavior
– Initiate a behavior contract to help the child manage own behavior
– Administer medications as prescribed

ADHD Medications

Disruptive, Impulse-control, and Conduct Disorder
(Oppositional Defiant Disorder)
Callous and unemotional interpersonal relationships. Symptoms cause significant impairment in social, educational, and occupational functioning

Definition: ODD is characterized by behavior that causes problems at school, work, or home

Assessment of Conduct Disorder:
– Physical fighting
– Running from home
– Lying, stealing, vandalism, or arson
– Cruelty to animals
-Use of alcohol or drugs

Assessment of Defiant Disorder:
– Argumentativeness
– Blaming others for own problems
– Defying rules or authority
– Use of obscene language

– Assess verbal and nonverbal cues for escalating behavior to decrease outbursts
– Use “show of force” when the child is out of control
– Use “quiet room” to control external stimuli
– Teach coping skills (punching a pillow or punching bag)
– Role-play coping strategies
– Monitor for fulfilling prophesy (“Mom says I’m a trouble maker so I have to be one”)
– Confront bad behaviors to give a sense of security (such as lying)
– Use consistent interventions to prevent manipulation and help the client develop self-control

Chlordiazepoxide (Librium)
Diazepam (Valium)
Clorazepate Dipotassium (Tranxene)
Lorazepam (Ativan)

Buspirone (BuSpar)
Zolpidem (Ambien)
Ramelteon (Rozerem)

Tricyclic Antidepressants
Amitryptyline (Elavil)
Nortriptyline (Aventyl)
Protriptyline (Vivactil)
Maprotiline (Ludiomil)
Imipramine (Tofranil)
Desipramne (Norpramin)

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Eldepryl)
Tranylcypromine (Parnate)

Fluoxetine (Prozac)
Paroxetine (Paxil)
Escitalopram (Lexapro)
Citalopram (Celexa)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Vilazone (Viibryd)

Atypical Antidepressants
Trazadone (Desyrel)

Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)

Bupropion (Wellbutrin)
Mirtazapine (Remeron)

Chlorpromazine (Thorazine)
Trifluoperazine (Stelazine)
Thioridazine (Mellaril)
Perphenazine (Trilafon)
Triflupromazine (Vesprin)
Loxapine (Loxitane)

Haloperidol (Haldol)
Thiothixene (Navane)
Pimozide (Orap)

Atypical Antipsychotics
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Clozapine (Clozaril)

Trihexypgenidyl (Artane)
Benztropine (Cogentin)
Amantadine (Symmetrel)

Alcohol Deterrents
Disulfram (Antabuse)
Acamprosate (Campral)

Acetylcholinesterase Inhibitors
Tacrine (Cognex)
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)

N-Methyl D-Aspartate Antagonist
Memantine (Nemenda)

Dextroamphetamine (Dexedrine)
Methylphenidate (Ritalin)
Pemoline (Cylert)
Lisdexamfetamine (Vyvanse)
Amphetamine/Dextroamphetamine (Adderall)
Dexmethylphenidate (Focalin)

Maslow’s Hierarchy of Basic Human Needs
Physical Needs – Oxygen, water, food, sleep, sex
Safety Needs – physical, security, order
Love and Belonging – Affection, companionship, identification
Esteem and recognition- Status, success, prestige
Self Actualization – self-fulfillment, creativity

Which nursing approach is best when caring for a client diagnosed with a conversion reaction paralysis? Minimize the sick role and secondary gains. the nurse cares for the client diagnosed with conversion reaction. the nurse identifies that this client utilizes …

One morning at a group therapy session, several clients begin to pick on another client for their passive behavior. The nurse leader says that the client is a very sensitive person who has problems, and they should stop picking on …

A terminal patient dies quietly in his sleep. The nurse should take which of the following actions? Provides a private place family members. Which of the following signs and symptoms would the nurse observe in a patient who has recently …

Which nursing approach is best when caring for a client diagnosed with a conversion reaction paralysis? A. Give special attention to the paralyzed limb. B. Point out to the client that paralysis reflects anxiety. C. Minimize the sick role and …

When intervening with a violent client, the nurse should take which action? 1. Tell the client that they have no control over their behavior. 2. Point out that the client is making others anxious. 3. Identify the nurse to client …

1. Which nursing approach is best when caring for a client diagnosed with conversion reaction paralysis? 1. Give special attention to the paralyze limb. 2. Point out to the client the paralysis reflects anxiety. 3. Minimize the sick role and …

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