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28985231 Psychiatric File

28985231 Psychiatric File

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02/07/2013

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PSYCHIATRIC BULLETS
 
According to Kübler-Ross
,
the five stages of death and dying
are denial, anger, bargaining,depression, and acceptance.
 
Fl
ight of ideas
is an alteration in thought processes thats characterized by skipping from onetopic to another, unrelated topic.
 
La be
ll
e indifférence
is the lack of concern for a profound disability, such as blindness orparalysis that may occur in a patient who has a conversion disorder.
 
M
oderate anxiety
decreases a persons ability to perceive and concentrate. The person isselectively inattentive (focuses on immediate concerns), and the perceptual field narrows.
 
A patient who has a
p
hobic disorder
uses self-protective avoidance as an ego defensemechanism.
 
I
n a patient who has
anorexia nervosa
, the highest treatment priority is correction of nutritional and electrolyte imbalances.
 
A patient who is taking
l
ithium
must undergo regular (usually once a month) monitoring of theblood lithium level because the margin between therapeutic and toxic levels is narrow. Anormal laboratory value is 0.5 to 1.5 mEq/L.
 
Ear
l
y signs and sym
p
toms of a
l
coho
l
withdrawa
l
include anxiety, anorexia, tremors, andinsomnia. They may begin up to 8 hours after the last alcohol intake.
 
A
l-
Anon
is a support group for families of alcoholics.
 
The nurse shouldnt administer
ch
l
or
p
romazine (Thorazine)
to a patient who has ingestedalcohol because it may cause oversedation and respiratory depression.
 
Lithium toxicity
can occur when sodium and fluid intake are insufficient, causing lithiumretention.
 
 An alcoholic who achieves sobriety 
is called a
recovering a
l
coho
l
ic
because no cure foralcoholism exists.
 
According to Erikson, the
schoo
l-
age chi
l
d (ages 6 to 12)
is in the
industry-versus-inferiority stage of psychosocial development.
 
 
W
hen caring for a depressed patient, the nurses first priority is
safety
because of theincreased risk of suicide.
 
Echo
l
a
l
ia
is parrotlike repetition of another persons words or phrases.
 
According to
 
p
sychoana
l
ytic theory
, the
ego
is the part of the psyche that controls internaldemands and interacts with the outside world at the conscious, preconscious, and unconsciouslevels.
 
According to
 
p
sychoana
l
ytic theory
,
the
su
p
erego
is the part of the psyche thats composed of morals, values, and ethics.
I
t continually evaluates thoughts and actions, rewarding the goodand punishing the bad. (Think of the superego as the supercop of the unconscious.)
 
 
According to
 
p
sychoana
l
ytic theory
, the
id
is the
 part of the psyche that contains instinctual drives
. (Remember i for instinctual and d for drive.)
 
D
enia
l
 
is the defense mechanism used by a patient who denies the reality of an event.
 
I
n a psychiatric setting,
sec
l
usion
is used to reduce overwhelming environmental stimulation,protect the patient from self-injury or injury to others, and prevent damage to hospitalproperty.
I
ts used for patients who dont respond to less restrictive interventions. Seclusioncontrols external behavior until the patient can assume self-control and helps the patient toregain self-control.
 
Tyramine
-
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 takesa monoamine oxidase inhibitor.
 
A patient who takes a
monoamine oxidase inhibitor
should be
weighed biweekly 
and
monitored for suicidal tendencies.
 
 
I
f the patient who takes a
monoamine oxidase inhibitor
has palpitations, headaches, or severeorthostatic hypotension, the nurse should withhold the drug and notify the physician.
 
Common causes of c
hi
l
d abuse
are poor impulse control by the parents and the lack of knowledge of growth and development.
 
The diagnosis of 
A
l
zheimers disease
is based on clinical findings of two or more cognitivedeficits, progressive worsening of memory, and the results of a neuropsychological test.
 
M
emory disturbance
is a classic sign of Alzheimers disease.
 
Thought b
l
ocking
is loss of the train of thought because of a defect in mental processing.
 
A
com
p
u
l
sion
is
an irresistible urge to perform an irrational act 
, such as walking in a clockwisecircle before leaving a room or washing the hands repeatedly.
 
A patient who has a chosen method and a plan to commit suicide in the next 48 to 72 hours isat
high risk for suicide.
 
 
The therapeutic serum level for lithium is
0
.5 to 1.5 mEq/L.
 
 
Phobic disorders
are treated with
desensitization thera
p
y
, which gradually exposes a patientto an anxiety-producing stimulus.
 
D
ysfunctiona
l
grieving
is
absent or prolonged grief.
 
 
D
uring
p
hase I of the nurse
-
p
atient re
l
ationshi
p
 
(beginning
,
or orientation
,
 
p
hase)
, the nurse
 obtains an initial history 
and
the nurse and the patient agree to a contract.
 
 
D
uring
 
p
hase II of the nurse
-
p
atient re
l
ationshi
p
(midd
l
e
,
or working
,
 
p
hase)
, the patientdiscusses his problems, behavioral changes occur, and self-defeating behavior is resolved orreduced.
 
D
uring
p
hase III of the nurse
-
p
atient re
l
ationshi
p
(termination
,
or reso
l
ution
,
 
p
hase)
, thenurse terminates the therapeutic relationship and gives the patient positive feedback on hisaccomplishments.
 
 
According to Freud, a person between ages 12 and 20 is in the
genita
l
stage
, during which helearns independence, has an increased interest in members of the opposite sex, andestablishes an identity.
 
According to Erikson, the identity-versus-role confusion stage occurs between ages 12 and 20.
 
To
l
erance
is the need for increasing amounts of a substance to achieve an effect that formerlywas achieved with lesser amounts.
 
Suicide
is the third leading cause of death among white teenagers.
 
M
ost teenagers
who kill themselves made a previous suicide attempt and left telltale signs of their plans.
 
I
n Eriksons stage of generativity versus despair,
generativity
(investment of the self in theinterest of the larger community) is
expressed through procreation, work, community service,and creative endeavors.
 
 
A
l
coho
l
ics Anonymous
recommends a
12
-step program
to achieve sobriety.
 
Signs and symptoms of 
anorexia nervosa
include amenorrhea, excessive weight loss, lanugo(fine body hair), abdominal distention, and electrolyte disturbances.
 
A serum lithium level that
exceeds 2.
0
mEq/L
is considered
toxic.
 
 
Pub
l
ic Law 94
-
247 (Chi
l
d Abuse and Neg
l
ect Act of 1973)
requires reporting of suspected casesof child abuse to child protection services.
 
The nurse should suspect
sexua
l
abuse
in a young child who has blood in the feces or urine,penile or vaginal discharge, genital trauma that isnt readily explained, or a sexuallytransmitted disease.
 
An
a
l
coho
l
ic
uses alcohol to cope with the stresses of life.
 
The
human
p
ersona
l
ity
operates on
three
l
eve
l
s
:
c
onscious, preconscious, and unconscious.
 
 
Asking a patient an
o
p
en
-
ended question
is one of the
best ways to elicit or clarify information.
 
 
The diagnosis of 
autism
is often made when a child is
between ages
2
and 3.
 
 
D
efense mechanisms
protect the personality by reducing stress and anxiety.
 
Su
pp
ression
is voluntary exclusion of stress-producing thoughts from the consciousness.
 
I
n
p
sychodrama
, life situations are approximated in a structured environment, allowing theparticipant to recreate and enact scenes to gain insight and to practice new skills.
 
Psychodrama
is a
therapeutic technique
thats used with groups to
help participants gain new  perception and self-awareness
by acting out their own or assigned problems.
 
A patient who is taking
disu
l
firam (Antabuse)
must avoid ingesting products that containalcohol, such as cough syrup, fruitcake, and sauces and soups made with cooking wine.
 
A patient who is admitted to a psychiatric hospital involuntarily loses the
right to sign outagainst medica
l
advice.
 
 
People who live in glass houses shouldnt throw stones and A rolling stone gathers no mossare examples of proverbs used during a psychiatric interview to determine a
 patients ability tothink abstractly 
. (
Schizo
p
hrenic
p
atients
think in concrete terms
and might interpret the glasshouse proverb as 
I
f you throw a stone in a glass house, the house will break.)

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