PSYCHIATRIC NURSING -Ross, the five stages of death and dying are denial, anger, bargaining, depression, and

acceptance. of ideas is an alteration in thought processes thats characterized by skipping from one topic to another, unrelated topic. may occur in a patient who has a conversion disorder. inattentive (focuses on immediate concerns), and the perceptual field narrows. uses self-protective avoidance as an ego defense mechanism. electrolyte imbalances. nce a month) monitoring of the blood lithium level because the margin between therapeutic and toxic levels is narrow. A normal laboratory value is 0.5 to 1.5 mEq/L. nsomnia. They may begin up to 8 hours after the last alcohol intake. -Anon is a support group for families of alcoholics. because it may cause oversedation and respiratory depression. exists. ng to Erikson, the school-age child (ages 6 to 12) is in the industry-versus-inferiority stage of psychosocial development. suicide. is parrotlike repetition of another persons words or phrases. and interacts with the outside world at the conscious, preconscious, and unconscious levels. values, and ethics. It continually evaluates thoughts and actions, rewarding the good and punishing the bad. (Think of the superego as the supercop of the unconscious.) (Remember i for instinctual and d for drive.) n event. the patient from self-injury or injury to others, and prevent damage to hospital property. Its used for patients who dont respond to less restrictive interventions. Seclusion controls external behavior until the patient can assume self-control and helps the patient to regain self-control. -rich food, such as aged cheese, chicken liver, avocados, bananas, meat tenderizer, salami, bologna, Chianti wine, and beer may cause severe hypertension in a patient who takes a monoamine oxidase inhibitor. suicidal tendencies. kes a monoamine oxidase inhibitor has palpitations, headaches, or severe orthostatic hypotension, the nurse should withhold the drug and notify the physician. of growth and development.

progressive worsening of memory, and the results of a neuropsychological test. lzheimers disease. compulsion is an irresistible urge to perform an irrational act, such as walking in a clockwise circle before leaving a room or washing the hands repeatedly. t high risk for suicide. anxiety-producing stimulus. r prolonged grief. -patient relationship (beginning, or orientation, phase), the nurse obtains an initial history and the nurse and the patient agree to a contract. -patient relationship (middle, or working, phase), the patient discusses his problems, behavioral changes occur, and self-defeating behavior is resolved or reduced. -patient relationship (termination, or resolution, phase), the nurse terminates the therapeutic relationship and gives the patient positive feedback on his accomplishments. independence, has an increased interest in members of the opposite sex, and establishes an identity. -versus-role confusion stage occurs between ages 12 and 20. achieved with lesser amounts. plans.

estment of the self in the interest of the larger community) is expressed through procreation, work, community service, and creative endeavors. -step program to achieve sobriety. osa include amenorrhea, excessive weight loss, lanugo (fine body hair), abdominal distention, and electrolyte disturbances. -247 (Child Abuse and Neglect Act of 1973) requires reporting of suspected cases of child abuse to child protection services. vaginal discharge, genital trauma that isnt readily explained, or a sexually transmitted disease. -ended question is one of the best ways to elicit or clarify information. -producing thoughts from the consciousness. to recreate and enact scenes to gain insight and to practice new skills. th groups to help participants gain new perception and self-awareness by acting out their own or assigned problems. as cough syrup, fruitcake, and sauces and soups made with cooking wine. medical advice.

ss are examples of proverbs used during a psychiatric interview to determine a patients ability to think abstractly. (Schizophrenic patients think in concrete terms and might interpret the glass house proverb as If you throw a stone in a glass house, the house will break.) c cause. relationships and will attempt to split staff by pointing to discrepancies in the treatment plan. ntly with metronidazole (Flagyl) because they may interact and cause a psychotic reaction. midnight to prevent aspiration while under anesthesia. respond to drug therapy. of 2 to 3 per week. after

receives 6 to 12 treatments at a rate

down because the patient may die as a result of self-induced exhaustion or injury. atient with Alzheimers disease, the nursing care plan should focus on safety measures. considerations. abstinence syndrome receive 10 to 40 mg of methadone (Dolophine) in a single daily dose and are monitored to ensure that the drug is ingested. -range goal of psychotherapy. organic brain syndrome is irritability. electroconvulsive therapy. on to use restraints should be based on the patients safety needs. d be checked 8 to 12 hours after the first dose, then two or three times weekly during the first month. Levels should be checked weekly to monthly during maintenance therapy. s, which improves function and increases compliance with therapy. feelings of others. physician. with adequate salt intake. demonstrating dependent behavior. children. hold one dose and call the

r patients is

limits is the most effective way to control manipulative behavior.

s a misinterpretation of an actual environmental stimulus. al exercise program as one of the ways

to ventilate feelings.

dejection, worthlessness, and hopelessness that are inappropriate or out of proportion to reality. -floating anxiety is anxiousness with generalized apprehension and pessimism for unknown reasons. -or-flight reaction (alarm reflex) may take over. use of imaginary experiences or made-up information to fill missing gaps of memory. the therapy is to produce a positive change. of psychoanalytic theory is that all behavior has meaning. regardless of the consequences. A patient who has a conversion disorder resolves a psychological conflict through the loss of a specific physical function (for example, paralysis, blindness, or inability to swallow). This loss of function is involuntary, but diagnostic tests show no organic cause. pressure every 2 hours for the first 12 hours, every 4 hours for the next 24 hours, and every 6 hours thereafter (unless the patients condition becomes unstable). supportive, nonjudgmental staff. rse should follow these guidelines when caring for a patient who is experiencing alcohol withdrawal: Maintain a calm environment, keep intrusions to a minimum, speak slowly and calmly, adjust lighting to prevent shadows and glare, call the patient by name, and have a friend or family member stay with the patient, if possible. supplements as well as adequate food and fluids. ates (drugs derived from poppy seeds, such as heroin and morphine) typically experiences withdrawal symptoms within 12 hours after the last dose. The most severe symptoms occur within 48 hours and decrease over the next 2 weeks. response to a specific life event. nconscious defense mechanism whereby unacceptable or painful thoughts, impulses, memories, or feelings are pushed from the consciousness or forgotten. is morbid anxiety about ones health associated with various symptoms that arent caused by organic disease. consciously intolerable. tion is the avoidance of anxiety through behavior and attitudes that are the opposite of repressed impulses and drives. ntal stage.

despair. reestablish rational communication between family members. impartially, use short sentences, and speak in a firm, quiet voice. ehaviors. They occur during the developmental stage identified by Erikson as autonomy versus shame and doubt. unnecessary, minute details and digresses into inappropriate thoughts that delay communication of central ideas and goal achievement. p member to examine interactions, learn and practice successful interpersonal communication skills, and explore emotional conflicts. hallucinations, confabulation, amnesia, and disturbances of orientation. such as police, parents, and school officials. others. ibits suspicion, hypervigilance, and hostility toward

hypomania, lowered seizure threshold, tremors, weight gain, problems with erections or orgasms, and anxiety. interpret. It assesses personality and detects disorders, such as depression and schizophrenia, in adolescents and adults. -care patient. ic technique thats used to help depressed patients to view a situation in

alternative ways. to treat depression.

isease lasts 2 to 4 years. Patients have inappropriate affect, transient paranoia, disorientation to time, memory loss, careless dressing, and impaired judgment. ality changes, loss of independence, disorientation, confusion, inability to recognize family members, and nocturnal restlessness. facial expression, seizures, loss of appetite, emaciation, irritability, and total dependence. adulthood. syndrome thats characterized by agitation, disorientation, vivid hallucinations, and tremors of the hands, feet, legs, and tongue. a hospitalized alcoholic, alcohol withdrawal delirium most commonly occurs 3 to 4 days after admission. patients words and his nonverbal behaviors. or a patient with substance-induced delirium, the time of drug ingestion can help to determine whether the drug can be evacuated from the body.

fluid containing thiamine and other B vitamins, and antianxiety, antidiarrheal, anticonvulsant, and antiemetic drugs. syndrome. some people. zure activity because alcohol lowers the seizure threshold in formation) to cover memory

lapses or periods of amnesia. -compulsive disorder realize that their behavior is unreasonable, but are powerless to control it. frontation, the nurse should first separate the two individuals. to ensure that they dont purge what they have eaten. were born the wrong gender and may seek hormonal or surgical treatment to change their gender. identity, and has amnesia about his previous identity. (Its also described as flight from himself.) positive attitudes and approaches. -to-one interaction with a patient, the nurse should state how long the conversation will last and then adhere to the time limit. broadcast for the world to hear. e taken with food. A patient who is taking lithium shouldnt restrict his sodium intake. vomiting, drowsiness, or muscle weakness. taking a monoamine oxidase inhibitor for depression can include cottage cheese, cream cheese, yogurt, and sour cream in his diet. process it. ymptoms of sensory overload include a feeling of distress and hyperarousal with impaired thinking and concentration. such as daydreaming, inactivity, sleeping excessively, and reminiscing. onment or from within oneself,

ing excessively. feared stimuli.

ressive disorder include depressed mood, inability to experience pleasure, sleep disturbance, appetite changes, decreased libido, and feelings of worthlessness. too many why questions yields scant information and may overwhelm a psychiatric patient and lead to stress and withdrawal. -IV, bipolar II disorder is characterized by at least one manic episode thats accompanied by hypomania.

diagnosis. medication orders. without any discernible connection.

a dual

-building phase of an abusive relationship, the abused individual feels helpless. tment of an alcohol-intoxicated patient, determining the blood-alcohol level is paramount in determining the amount of medication that the patient needs. oss, and dry mouth. (Anectine) by I.V. administration. the establishment of trust. specified period of time. overwhelmed with too much food. ave schizophrenia. aggressive personality disorder. activities that are focused on the here and now. should administer an antiparkinsonian drug (for example, Cogentin or Artane) as ordered. skalith) therapy should report diarrhea, vomiting, drowsiness, muscular weakness, or lack of coordination to the physician immediately. -compulsive disorder is an anxiety-related disorder. -Anon is a self-help group for families of alcoholics. electroconvulsive therapy, the patient is placed in the lateral position, with the head turned to one side. note or talking about suicide. ollowed by

shouldnt be

stamped, addressed envelope. An appropriate response is that he would mail the envelope. -shock amnesia. cian pronounces a child dead is showing denial. sucking and chewing.

adverse effects. consuming aged cheese, caffeine, beer, yeast, chocolate, liver, processed foods, and monosodium glutamate. dyskinesia. ggests that it resets the brain circuits to allow normal function. -compulsive disorder usually recognizes the senselessness of his behavior but is powerless to stop it (ego-dystonia). used, physical safety is the nurses first priority. granulocytopenia or severe central nervous system depression. used to treat psychogenic amnesia. including nausea and vomiting, and may endanger the patients life. -outs, token economy, or a reward system, is a treatment for attention deficit hyperactivity disorder. r a patient who has anorexia nervosa, the nurse should provide support at mealtime and record the amount the patient eats. (Haldol) administration include drowsiness; insomnia; weakness; headache; and extrapyramidal symptoms, such as akathisia, tardive dyskinesia, and dystonia. child who shows dissociation has probably been abused.

Name Compensation

Description Over-achievement in one area to offset real or perceived deficiencies in another area

Conversion

Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature

Denial

Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue

Displacement

Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings

Dissociation

Dealing with emotional conflict by a temporary alteration in consciousness or identity

Fixation

Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage

Identification

Modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal

Intellectualization

Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions

Introjection

Accepting another persons attitudes, beliefs, and values as ones own

Projection

Unconscious blaming of unacceptable inclinations or thoughts on an external object

Rationalization

Excusing own behavior to avoid guilt, responsibility,

conflict, anxiety, or loss of self-respect Reaction Formation Regression Moving back to a previous developmental stage to feel safe or have needs met Repression Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness Resistance Overt or covert antagonism toward remembering or processing anxiety-producing information Submlimation Substituting a socially acceptable activity for an impulse that is unacceptable Substitution Replacing the desired gratification with one that is more readily available Suppression Conscious exclusion of unacceptable thoughts and feelings from conscious awareness Undoing Exhibiting acceptable behavior to make up for or negate unacceptable behavior Acting the opposite of what one thinks or feels

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful. Nurses have an important role to deliver when a client is to undergo Electroconvulsive Therapy. Find out what are the responsibilities and activities of the nurse during electroconvulsive therapy. 1. Emotional and Educational Support to the Client & Family Encourage the client to discuss feelings, including myths regarding ECT.

Teach the client and the family what to expect with ECT.

2. Pre treatment Protocol for ECT Ascertain if the client and the family have received a full explanation, including the option to withdraw the consent at any time.

Withhold food and fluids for 6 to 8 hours before treatment. Remove dentures, glasses, contact lenses, hearing aids, hair pins and etc. Have client void before the treatment. Give preoperative medications as ordered:

Give either glycopyrrolate (Robinul) or atropine to prevent potential for aspiration and to help minimize brady-arrhythmias in response to electrical stimulants.

3. Nursing Care During the Procedure Place a blood pressure cuff on one of the clients arms.

As the intravenous line is inserted and EEC and ECG electrodes are attached, give a brief explanation to the client. Put on the pulse oximeter to the clients finger. Monitor blood pressure throughout the threatement. Medications to be given:

Short-acting anesthethic (Brevital) Muscle relaxant (Succinylcholine) 100% oxygen by mask via positive pressure

Check if the bite block is placed in prevent biting of the tongue Electrical stimulus given (seizure should last 30 to 60 seconds).

4. Post treatment nursing care Have the client go to a properly staffed recovery room.

Once the client is awake, talk to the client and check the vital signs. Give frequent orientation and reassurance to allay confusion. Check the gag reflex before giving client fluids, medications or breakfast.