exam 2 cont.docx

- Appropriate care for a client with PTSD - Assign same staff - Validate feelings - Encourage client to speak about trauma at own pace - What must a nurse understand for a client with OCD - REDOING THINGS OVER AND OVER HELPS WITH ANXIETY - What may happen if someo...

- Appropriate care for a client with PTSD - Assign same staff - Validate feelings - Encourage client to speak about trauma at own pace - What must a nurse understand for a client with OCD - REDOING THINGS OVER AND OVER HELPS WITH ANXIETY - What may happen if someone saw their parents murder scene - Conversion - Assessing a client who has the illness anxiety disorder, hydrochondriasis, what should a nurse expect - Constantly worrying about undiagnosed illnesses - Discharge instructions, patients have anxiety and phobias what must the nurse include - Encourage the client to explore underlying feelings that are causing the irrational fears - What would be an appropriate response for a patient regarding anxiety - I still have anxiety, but I have found ways to prevent it at a high level - What causes conversion disorders - Trauma and anxiety - What would you do with a patient who tells you they have severe back pain 9/10 and are suspected of having factitious disorder, would you still treat them - Yes, we do not determine pain - Nurse intervention for a patient with generalized anxiety disorder - Provide a place that is quiet, lower stimuli - What would a patient be diagnosed with that has difficulty leaving the house for the past six months due to consistent worrying - Generalized anxiety disorder - Patient with OCD is spending 45 mins washing hands and performing ritualistic tasks, what would be a good intervention - Discuss what is provoking anxiety - Ex. how are you feeling? - Child with OCD is actively performing a convulsive behavior, what should the nurse do - Do NOT interrupt, unless harmful - Difference between panic and crisis - Panic is a clients suddenly reports an onset of doom or terror lasting 6 minutes - Crisis last longer and builds up slowly - Patient has anxiety towards a phobia, what should the nurse do - Remain calm when approaching the client - What would a nurse tell a patient who is suffering from PTSD - Avoid any substances - State of crisis, phase 4 - Possibly threatening violence to staff - Example of somatic symptom - Disproportionate and persistent thoughts about the seriousness of one symptom - Ex. any type of cancer pain - A patient with stage 3 of Alzheimer's: mild cognitive factors - Will have trouble navigating and may get lost when driving a car - Patient dx with neuro-cog disorder has progressive memory loss, diminished cognitive function, verbal aggression, and experiencing frustration, the best nursing intervention is - Schedule structured daily routines, will reduce frustration and verbal aggression - Evidence based interventions to reduce anxiety and agitation while caring for a client with dementia include - Engage in physical activity - Dancing or other rhythmic activity - Delirium is characterized by - Change in cognition that develops rapidly over a short period of time - Know that low dose anti-psychotics, such as Zyprexa are frequently used to treat delirium in nero-cog disease, however - Black box warning relates to an increased risk of death in elderly patients - When a patient with acute confusion is identified as an increased risk for injury, the nurse must - Ensure patient safety by making sure frequently used items are within reach - S/S of apraxia for a patient with Alzheimer's - Is the inability to carry out motor activity despite intact motor function - Onset of symptoms of Alzheimer's - Slow and insidious - Progressive and deteriorating - When caring for a client with stage 2 Alzheimer's, what does maintaining organization with lists do - Provide some compensation to avoid forgetfulness---first stat to experience memory loss - Aricept is used in treatment with patients with - Cognitive impairment assoc. with Alzheimer's - Hamilton depression scale - 0-6= no evidence of depression - 7-17= mild depression - 18-24= moderate depression - Above 24= severe depression - As anti-depressant begin to take affect and mood begins to lift the patient may have increased energy, what must be taken into consideration - Greater risk for suicide - Increase level of suicide precautions - Teaching with patients with major depressive disorder, clients are taking SSRIs, such as Zoloft, what should the nurse include in the symptoms - Serotonin syndrome - Onset=agitation - Rapid HR - Increased temp - Could take up to 6 weeks for an anti-depressant such as Celexa, to take effect nurse should - Encourage patients to keep taking the medication as prescribed - S/S of major depressive disorder - Feelings of hopelessness and worthlessness - Electro-convulsive therapy is commonly used for - Clients with severe depression - Those who are actively suicidal - Client with persistent depressive disorder has a mild form of depression and is more likely to be treated with - Group therapy - Individual psychotherapy - Medications - Cognitive behavioral therapy, a patient is taught how to replace negative thoughts with positive ones, such as - Logical non-biased thoughts - Pre-menstrual dysphoric disorder usually go away within - 2-3 days - Premenstrual dysphoric disorder is a health problem that is like pre-menstrual but - Causes sever irritability - Depression - Anxiety - In the week or 2 before menstrual cycle - The difference between pre-menstrual dysphoric disorder and normal mood changes around menstruation is - The dysphoric disorder has symptoms that interferes with one's own ability - When taking SSRIs, such as Lexapro it is important for the nurse to assess - Thoughts - Intentions - Behaviors - If a patient states "I wish, I wasn't here anymore" - Are you having thoughts of hurting yourself - Do you have a plan - T or F: family and friends should listen attentively and take any hint of suicide and seek help - True - T or F: the highest and lowest social classes have the highest risk of suicide - True - When a mental health client returns from a day leave - Nurse must search the patient's belongings for sharps or potentially harmful items - Decreased serotonin and nor-epinephrine - Contributes to a patient's diagnoses with depression - When a nurse is caring for clients in a psych unit, who would be most appropriately treated with group therapy - Client diagnosed with major depressive disorder one year ago - What is the preferred treatment for SAD (seasonal affect disorder) - Light therapy - What is the purpose of light therapy - Inhibit the nocturnal secretion of melatonin - Can be done in 30 min session or two 15 min doses in total of 30 min in one day - What does light therapy begin working - Some people notice improvement rapidly within a few days - May take several weeks to take effect - Works by exposure to the face by light - T or F: between 50 and 80% of all people who kill themselves have a history or previous attempts - True - A confused patient who presents with restlessness, tachycardia, diaphoresis, and tremors could be suffering from - Serotonin syndrome by possibly ingesting two separate SSRIs - Worry about elderly - Women gets diagnosed with depression and husband is already taking an SSRI for one month, presents with bright affect is more communicative and rates mood 9/10, the nurse should - Increase frequency of client observation due to suicide risk - S/S of major depressive disorder include - Anhedonia (degreased attention to enjoyment of prev. pleasurable activities) - Feelings or worthlessness - Difficulty focusing - Celexa (Citalopram) causes drowsiness, so the nurse must - Instruct client to take medication at night - Patient is on anti-depressant therapy, such as sertraline, the nurse should instruct the client to - Avoid drinking alcohol - Therapeutic comment "tell me about which problems are the most important to you" - Most therapeutic response when counseling a patient with suicidal ideations - Warning signs of suicide include - Giving away possessions - Talking about their own death - Describing themselves as worthless - When educating a patient and family of a new Rx or SSRIs it is important for the nurse to teach - Risk of increased suicidal ideations in the beginning of treatment may increase - Diagnostic criteria for persistent depressive disorder include - Poor appetite/overeating - Low energy/fatigue - Insomnia/hypersomnia - S/S of pre-menstrual dysphoric disorder include - Markedly depressed mood - Excessive anxiety - Mood swings - Suicide risk factors include family Hx of - Suicide - untreated depression - poor interpersonal relationships