Podcast
Questions and Answers
A pregnant woman is experiencing significant anxiety due to fear of not being able to provide for her child. Which nursing intervention would be MOST appropriate to address this psychosocial concern?
A pregnant woman is experiencing significant anxiety due to fear of not being able to provide for her child. Which nursing intervention would be MOST appropriate to address this psychosocial concern?
- Assessing the client's urinary bladder and catheterizing as needed.
- Providing client and family education and connecting them with resources for financial and emotional support. (correct)
- Administering a sedative to promote relaxation and reduce anxiety.
- Monitoring uterine contractions for dysfunctional patterns using an electronic monitor.
A laboring mother is exhibiting signs of ineffective individual coping related to perceived stressors during childbirth. Which nursing diagnosis would be MOST appropriate for this patient?
A laboring mother is exhibiting signs of ineffective individual coping related to perceived stressors during childbirth. Which nursing diagnosis would be MOST appropriate for this patient?
- Disturbed Sleep Pattern related to environmental conditions.
- Risk for Injury related to alteration of muscle tone.
- Risk for Infection related to prolonged labor.
- Ineffective Individual Coping related to inability to appraise stressors. (correct)
During labor, a client reports feeling overwhelmed and detached, displaying poor impulse control. What is the MOST likely underlying psychological factor contributing to these symptoms?
During labor, a client reports feeling overwhelmed and detached, displaying poor impulse control. What is the MOST likely underlying psychological factor contributing to these symptoms?
- Alteration of muscle tone/contractile pattern.
- Mechanical obstruction to fetal descent.
- Posttraumatic stress syndrome. (correct)
- Maternal fatigue.
A laboring patient is diagnosed with 'Risk for Injury related to environmental conditions interacting with the individual's adaptive and defensive resources'. Which of the following nursing interventions is LEAST likely to mitigate this risk?
A laboring patient is diagnosed with 'Risk for Injury related to environmental conditions interacting with the individual's adaptive and defensive resources'. Which of the following nursing interventions is LEAST likely to mitigate this risk?
A new mother is experiencing difficulty bearing down effectively during the second stage of labor. Which combination of factors is MOST likely contributing to this issue?
A new mother is experiencing difficulty bearing down effectively during the second stage of labor. Which combination of factors is MOST likely contributing to this issue?
Which of the following assessment findings would be LEAST likely in a client experiencing post-traumatic stress following a traumatic event?
Which of the following assessment findings would be LEAST likely in a client experiencing post-traumatic stress following a traumatic event?
A client scores a 19 on the Hamilton Rating Scale for Depression (Ham-D). How would this score be interpreted?
A client scores a 19 on the Hamilton Rating Scale for Depression (Ham-D). How would this score be interpreted?
During an interaction, a client becomes increasingly agitated and verbally aggressive. Which nursing intervention is most appropriate FIRST?
During an interaction, a client becomes increasingly agitated and verbally aggressive. Which nursing intervention is most appropriate FIRST?
A client who is a survivor of a traumatic event is experiencing intense feelings of anger. Which of the following nursing interventions would be MOST appropriate to assist the client in managing these emotions?
A client who is a survivor of a traumatic event is experiencing intense feelings of anger. Which of the following nursing interventions would be MOST appropriate to assist the client in managing these emotions?
A rape survivor expresses feelings of shame and withdraws from social interactions. Which nursing diagnosis is MOST appropriate for this client's behavior?
A rape survivor expresses feelings of shame and withdraws from social interactions. Which nursing diagnosis is MOST appropriate for this client's behavior?
Flashcards
Hyperarousal Symptoms
Hyperarousal Symptoms
Increased alertness, easily startled, hyperarousal.
Hamilton Rating Scale for Depression (Ham-D)
Hamilton Rating Scale for Depression (Ham-D)
A questionnaire used to assess the severity of depressive symptoms.
Social Isolation (Trauma-Related)
Social Isolation (Trauma-Related)
Feelings of shame and subsequent withdrawal from social interactions.
Depersonalization
Depersonalization
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Establish Rapport
Establish Rapport
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Posttraumatic Stress Syndrome (PTSD) after childbirth
Posttraumatic Stress Syndrome (PTSD) after childbirth
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Inability to Bear Down Properly (Psychological)
Inability to Bear Down Properly (Psychological)
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Fear/Anxiety (in Pregnant Mothers)
Fear/Anxiety (in Pregnant Mothers)
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Risk for Injury (Related to Stress)
Risk for Injury (Related to Stress)
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Ineffective Individual Coping
Ineffective Individual Coping
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Study Notes
Problems with the Psyche Factor
- Women lacking adequate support may experience significant stress, potentially leading to post-traumatic stress syndrome.
Problems with the Psyche Factors
- Inability to bear down properly can occur when a pregnant mother's psychosocial state changes drastically due to shocking events impacting her capacity to provide care.
- Fear and anxiety can arise from perceived danger or concerns about being inadequate as a caregiver or provider, and/or fear of being alone.
Inability to Bear Down
- Risk for Injury diagnoses can occur due to environmental conditions interacting with adaptive/defensive resources.
- Ineffective Individual Coping: Inability to to assess stressors/available resources.
Risk Factors
- Altered muscle tone
- Maternal fatigue
- Mechanical obstruction to fetal descent
Nursing Management
- Optimize uterine activity by monitoring contractions for dysfunctional patterns using palpation and electronic monitoring.
- Prevent unnecessary fatigue and assess the client's fatigue level, as well as their ability to cope with pain.
- Prevent complications of labor for both the client and infant.
- Assess urinary bladder - catheterize if needed.
- Assess maternal vital signs (temperature, pulse, respiration, blood pressure).
- Check maternal urine for acetone (dehydration/exhaustion).
- Assess the fetus by monitoring FHR, fetal activity, and amniotic fluid color.
- Provide physical and emotional support.
- Promote relaxation through bathing, cleanliness, back rubs, repositioning, walking (if indicated), and maintaining a quiet environment.
- Coach the client in breathing and relaxation.
- Provide client and family education.
Medical Managements
- Narcotic or sedative medications like morphine, pentobarbital (Nembutal), or secobarbital (Seconal) may be administered for sleep.
Anxiety/Fear Signs and Symptoms
- Anger
- Poor impulse control
- Emotional detachment or numbness
- Hyper-alertness, hyperarousal, and exaggerated startle reflex
- Social withdrawal
- Self-destructive behavior
- Survivor's guilt
- Relationship problems
- Avoidance of associated people/places/things from a traumatic experience
- Depersonalization (loss of identity)
- Relationship problems
- Difficulty falling or staying asleep
- Decreased self-esteem
Diagnostic/Lab Test
- A psychiatrist treats the mental health dx.
- Hamilton Rating Scale for Depression (Ham-D): Widely used scale with 17 or 21 items, scored between 0 and 4 points.
- Evaluates depressive symptoms; the extended version measures factors related to depression but not severity.
- Scoring: 0-7 (normal), 8-16 (mild depression), 17-23 (moderate depression), over 24 (severe depression); max score 52.
- Ultrasonography.
Nursing Diagnoses
- Anxiety related to fear of death and health status changes (Domain: Perception/cognition).
- Hopelessness secondary to rape (Domain: Self-perception).
- Risk for compromised human dignity (Domain: Self – perception).
- Social isolation related to shame from rape trauma (Domain: Coping/Stress Tolerance).
- Rape-trauma syndrome (Domain: Coping/Stress Tolerance).
Nursing Management (Fear/Anxiety)
- Establish rapport: important to gain trust; accept current functioning, consistency, positivity, honesty, and non-judgment.
- Provide time: provide time/opportunity to discuss feelings, detect grieving process, and help to find conclusion.
- Manage outbursts of anger: identify sources of emotions, assist in regaining control.
- Assist client: assist in using displacement by providing manipulative items.
- After every outburst: discuss how fear or anxiety escalates.
- Desensitize traumatic event memories.
- Administer prescribed medications and evaluate responses, ensure compliance and no hoarding.
- Remind patients that setbacks are expected.
- Encourage forgiveness of self and others.
- Emphasize the importance of strict adherence to medications.
- Refer client to support resources (organizations, support groups).
- Encourage verbal instead of only physical expression.
Medical Management
- Antidepressants: nortriptyline, desipramine
- Psychotherapy may be beneficial in women who prefer to avoid antidepressant medication.
- Pain Management
- Low-dose antipsychotic agents (Haloperidol).
Treatment
- Position and Posture: can decrease pain/increase comfort, facilitate gravity and descent, change pelvic diameters, and assist cardinal movements.
Trust
- Recognize the clients feelings.
- Honesty
- Respect for the client
- Non-judgmental attitude
Emphasize Positive Results
- Avoid arguing with the client. Recognize the presence of pain without dwelling on it.
Medication prescribed by the Physicians:
- Use Buspirone (Buspar) because it is pregnancy safe.
- Consider Cognitive behavioral therapy (CBT) as an alternate treatment option.
- Use of haloperidol (Haldol) during pregnancy due to safety data without any congenital malformations.
- Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), fluoxetine (Prozac) shown to be safe during pregnancy.
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