TEXT STEP #1 Build a solid foundation. 422
UNIT 3 ■ Care of Patients With Psychiatric Disorders
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■■ Sleeps 6 to 8 hours per night and reports feeling well rested. ■■ Bathes, washes and combs hair, and dresses in
clean clothing without assistance. Planning and Implementation
Communication Exercises 1. Hal, a patient on the psychiatric unit, has a diagnosis of schizophrenia. He lives in a halfway house, where last evening he began yelling that “aliens were on the way to take over our bodies! The message is coming through loud and clear!” The residence supervisor became fright- ened and called 911. As Hal was being admitted to the psychiatric unit, he told the nurse, “I’m special! I get mes- sages from a higher being! We are in for big trouble!” How would the nurse respond appropriately to this statement by Hal? 2. The nurse notices that Hal is sitting off to himself in a cor- The role of patient teacher is important in the psy- chiatric area, as it is in all areas of nursing. A list of topics for patient and family education relevant to depression is presented in Box 16–5. Evaluation of Care for the Depressed Patient ner of the dayroom. He appears to be talking to himself and tilts his head to the side as if listening to something. How would the nurse intervene with Hal in this situation? 3. Hal says to the nurse, “We must choose to take a ride. All alone we slip and slide. Now it’s time to take a bride.” How would the nurse respond appropriately to this statement by Hal? CHAPTER 4 ■ Psychopharmacology Table 16–2 presents a plan of care for the depressed patient. Selected nursing diagnoses are presented, along with outcome criteria, appropriate nursing interventions, and rationales for each. Some institutions use a case management model to coordinate care (see Chapter 6 for more detailed explanation). In case management models, the plan of care may take the form of a critical pathway. Concept Care Mapping Antianxiety Agents Background Assessment Data Indications The concept map care plan is an approach to plan- ning and organizing nursing care (see Chapter 6). It is a diagrammatic teaching and learning strategy that allows visualization of interrelationships between medical diagnoses, nursing diagnoses, assessment data, and treatments. An example of a concept map care plan for a patient with depression is presented in Figure 16–3. Patient and Family Education Relieves anxiety In the final step of the nursing process, a reassess- ment is conducted to determine whether the nursing
TABLE 4–2 Effects of Psychotropic Medications on Neurotransmitters—cont’d ACTION ON NEUROTRANSMITTER EXAMPLE OF MEDICATION AND/OR RECEPTOR DESIRED EFFECTS
CHAPTER 15 ■ Schizophrenia Sp SIDE EFFECTS
Antianxiety: buspirone
5-HT 1A agonist D 2 agonist D 2 antagonist
Nausea, headache, dizziness Restlessness
Communication Exercises let you practice your communication skills with vignettes and questions that prepare you for clinical and practice.
5-HT, 5-hydroxytryptamine (serotonin); ACh, acetylcholine; ADHD, attention deficit-hyperactivity disorder; BZ, benzodiazepine; D, dopamine; EPS, extrapyramidal symptoms; GABA, gamma-aminobutyric acid; H, histamine; MAO, monoamine oxidase; MAO-A, monoamine oxidase A; MAOI, monoamine oxidase inhibitor; NE, norepinephrine; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.
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One of the Quality and Safety in Nursing Educa- tion (QSEN) criteria identified by the Institute of Medicine (IOM) (2003) stresses that the patient must be at the center of decisions about treatment (patient-centered care), and this type of assessment tool provides an opportunity to actively engage the patient in describing what medications have been effective or inef- fective and identifying side effects that may impact will- ingness to adhere to a medication regimen.
AU: Ok to add here?
Antianxiety drugs are also called anxiolytics and his- torically were referred to as minor tranquilizers. They are used in the treatment of anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation. They are most appropriate for
Quality and Safety Education for Nurses (QSEN) activities and content, highlighted with a special icon, help you attain the knowledge, skills, and attitudes required to fulfill the initiative’s quality and safety competencies. BOX 4-1 Medication Assessment Tool Date __________________________ Client’s Name __________________________________ Age ______________________ Marital Status ____________________ Children __________________________ Occupation ___________________________ Presenting Symptoms (subjective & objective) _______________________________________________________________ _____________________________________________________________________________________________________ Diagnosis (DSM-5) _____________________________________________________________________________________ Current Vital Signs: Blood Pressure: Sitting ________/________ ; Standing __________/__________; Pulse____________ ; Respirations ____________ Height ___________________ Weight _______________________ CURRENT/PAST USE OF PRESCRIPTION DRUGS (Indicate with “c” or “p” beside name of drug whether current or past use): Name Dosage How Long Used Why Prescribed By Whom Side Effects/Results ____________ ____________ _______________ _______________ _____________ ___________________ ____________ ____________ _______________ _______________ _____________ ___________________ ____________ ____________ _______________ _______________ _____________ ___________________ MOVIE CONNECTIONs I Never Promised You a Rose Garden (Schizophrenia) • A Beautiful Mind (Schizophrenia) • The Fisher King (Schizophrenia) • Bennie & Joon (Schizophrenia) • Out of Darkness (Schizophrenia) • Conspiracy Theory (Paranoia) • The Fan (Delusional disorder) • The Soloist (Schizophrenia) • Of Two Minds (Schizophrenia) “The anhedonia, psychomotor retardation, and anergia in acute depression can make assessment a challenge. It’s important to offer hope to a client who may be uncer- tain about how to navigate their present state of deep depression and to remain diligent while not making the patient feel pressured to speak. Paraphrasing what the patient has said to you conveys understand- ing and provides validation. Open-ended questions encourage the patient to elaborate rather than just answer ‘yes’ or ‘no.’” —Larry Johnson, RN phren file th ■■ Have som Treatment Interperso Research ha satisfactory a sion with o the lowest q 2013). With ■■ Indiv integ other vidua thera ily th For th ■■ Does the feeling re ■■ Does the grooming Real Nurses, Real Advice shares helpful tips from practicing nurses to help you navigate clinical situations and provide the best possible care to your patients. Real Nurses, Real Advice
Summary and Key Points ■■ Of all of the mental illnesses, schizophrenia un- doubtedly results in the greatest amount of per- sonal, emotional, and social costs. It presents an enormous threat to life and happiness. ■■ For many years, there was little agreement as to a
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CURRENT/PAST USE OF OVER-THE-COUNTER DRUGS (Indicate with “c” or “p” beside name of drug whether current or past use): Name Dosage How Long Used Why Prescribed By Whom Side Effects/Results ____________ ____________ _______________ _______________ _____________ ___________________ ____________ ____________ _______________ _______________ _____________ ___________________ 4576_Ch16_p402-444.indd 422
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