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After the 4th group meeting, the informal leader makes a statement that she believes she can help the group more than the assigned facilitator and has better credentials. Identify the group dynamics and stage of development. The informal leader is “testing,” which is a behavior indicative of a new group trying to establish trust. This group is still in the orientation phase of development. On an in-patient psychiatric unit, clients are expected to get up at a certain time, attend breakfast at a certain time, and come for their medication at the correct time. What form of therapy is incorporated into this unit? - Milieu. The wife of a man killed in a motor vehicle accident has just arrived at the emergency room and is told of her husband’s death. What nursing actions are appropriate for dealing with this crisis? Take woman to a quiet room, ask her if there are family, friends, or clergy you can call for her. Assess her need for medication and discuss with physician. Stay with her, be firm and directive, and assess previous successful coping strategies. A 10 yr. old is admitted to the children’s unit of the psychiatric facility after stabbing his sister. His behavior is extremely aggressive with the other children on the unit. Using a behavior modification approach with positive reinforcement, design a treatment plan for this child. Assess what activities he enjoys. Set up a token system – when he displays non-aggressive behavior, he earns a token good towards participating in the activity selected. He loses a token when he becomes aggressive. The 10 yr. old, his sister, mother, and the mother’s live in boyfriend are asked to attend a therapy meeting. Who is the “client” that will be treated during this session? The entire family. A 66 yr. old woman is admitted to the psychiatric unit with agitated depression. She has not responded to antidepressants in the past. What would be the medical treatment of choice for this client? Electroconvulsive therapy (ECT). Describe the nurse’s role in preparing clients for electroconvulsive therapy (ECT). Give accurate, non-judgmental information about the treatment. Explore client’s concerns. Administer the following as ordered: Atropine sulfate to dry oral secretions, a quick-acting barbiturate to induce anesthesia such as Brevital Sodium, and a muscle relaxant such as Anectine. Check emergency equipment and O2 are available. Describe the nursing interventions used to care for a client during and after electroconvulsive therapy. Maintain patent airway. Check vital signs every 15 minutes until alert. Remain with client following treatment until conscious. Reorient, if confused.
ANXIETY DISORDERS: 1. 2. 3. State 5 autonomic responses to anxiety. Shortness of breath, heart palpitations, dizziness, diaphoresis, frequent urination. Identify the defense mechanism used by a person who feels guilty about masturbating as a child, and develops a hand-washing compulsion as an adult. Undoing. Identify anxiety-reducing strategies the nurse can teach. Deep breathing techniques, visualization, relaxation techniques, exercise, biofeedback.
Look at pictures of planes. which occurs from the sick role. teach relaxation techniques. heart palpitations. Decrease anxiety. If the client is agitated. anxiety. Decreases the anxiety about job. Discuss with the group leader the possibility of allowing the client to enter the group late. What type of disorder is this? What purpose is the blindness serving? What nursing interventions are indicated? Conversion reaction. which would probably be implemented. What type of disorder is this? What nursing actions are indicated? Hypochondriacal disorder. Document duration and intensity of pain. Assist with ADL. - Which levels of anxiety facilitate learning? Mild to moderate. a woman was involved in a motor vehicle accident that killed her friend who was a passenger in the car she was driving. explore relationship between the symptoms and past experiences with heart disease. Assist client to identify precipitating factors related to request for medication. the appropriate nursing interventions.4. Five years ago. A client is in the middle of an extensive ritual. she has been unable to work because of sever back pain. - 5. A 42 yr. A client displays a phobic response to flying. administer anti-anxiety medications as ordered. 6. Protect roommate from harm. Focus interactions away from bodily concerns. old secretary has visited 7 different doctors in the last year with a complaint of chest pain. A psychogenic fugue state is characterized by the individual leaving home and being unable to recall their identity or their past. All physical findings are negative. List. Accompany the client on a short flight while listening to a relaxation tape. Primary gain is a decrease in anxiety. other than reduced anxiety. which is about to start. and assist with the identification of anxiety related to job security and performance. An air traffic controller suddenly suddenly develops blindness. Evaluate pain medication use and/or abuse. She is certain she is having a heart attack in spite of the physician’s reassurance that all tests are normal. Accompany client into a plane. What type of disorder is this? What are the contributing causes? Describe the nursing care. Somatization disorder. in order of priority. which focuses on food during lunch. - 7. which results from some effort made to deal with stress. and shortness of breath. Secondary gain is the advantage. Stay with client. 5. encourage expression of anger. What action should the nurse take? Allow client to complete the ritual. - 3. Unresolved grief. Describe the difference between primary and secondary gains. Somatization is used to describe a person who has many recurrent complaints with no organic basis as opposed to someone with hypochondriasis who has unrealistic or exaggerated that they interfere with social and occupational functioning. Psychogenic amnesia is the sudden inability to recall certain events in one’s life. Arrange for client to begin lunch either so that the ritual can be completed prior to scheduled activities. Talk about planes. Allow the client to board a plane alone. Place client on homicidal precautions at night. . Make plans to accompany client during a visit to airport. A Vietnam veteran is plagued by nightmares and is found trying to strangle his roommate one night. - SOMATOFORM DISORDERS: 1. The pain in unrelieved by prescribed medications. Describe the desensitization process. Arrange for private room. 2. However. the client is scheduled for group therapy. - 4. Explain the difference between somatization and hypochondriasis. Describe the difference between psychogenic amnesia and a psychogenic fugue. The client’s history reveals an increased anxiety about job performance and fear abou t job security. - DISSOCIATIVE DISORDERS: 1. teach relaxation techniques. Since that time.
Anorexia nervosa may be precipitated by what etiologic factors? Mother-daughter conflicts usually focusing on independence/dependence issues. discomfort with maturation. decreased blood pressure. mistrust of others. Anorexia nervosa deals with issues of control and a struggle between dependence and independence. - 3. What nursing intervention is appropriate in addressing this behavior? Discuss activities that don’t involve food. Bulimia deals with loss of control (Binge eating) and guilt (purging). authorities are “out to get them.g. Discuss the cookbooks with the treatment team and. rigid. Describe depersonalization disorder. 3. constipation. - 5. lack of sexual interest. Weight change (loss or gain). has no close friends 10. or a sense of “strangeness” in the surrounding environment. need for control. carefully monitor for evidence of vomiting. An anorectic client has her friend bring her several cookbooks so she can plan a party when she is discharged. splitting behavior 5. self-mutilating. somatic complaints. 3. dry skin. electrolyte imbalance. Maladaptive Personality = Does not think anything he/she does is wrong. shows. hair loss. an intolerable life situation. Identify physiologic changes. if the treatment plan indicates.2. 4. - What is a multiple personality disorder? Presence of two or more distinct personalities within an individual. May exploit others to get own needs met. decreased pulse. allows others to assume responsibility for his/her life. Schizoid Personality = Isolated and introverted. 6. Traumatic event such as a threat of death or injury. which often occur with depression. Paranoid Personality = Suspicious. State 2 psychodynamic differences between anorexia and bulimia. 7. or a natural disaster. and sleep disturbances.” PERSONALITY DISORDERS: 1. . replenish electrolytes and fluids as indicated. Obsessive-Compulsive Personality = Orderliness. weight loss of at least 15% of ideal/original body weight. - AFFECTIVE DISORDERS: 1. These individuals express a fear of “going crazy. unable to sustain relationships. The personalities emerge during stress. is watchful and secretive 9. - 4. e. 2. Amenorrhea. always in a crisis. take books from client. A temporary loss of one’s reality. Histrionic Personality = Dramatic. which may take place after discharge. irregular heart rate.. dehydration.” EATING DISORDERS: 1. needs to be the center of attention 8. Narcissistic Personality = Feelings of self-importance and entitlement. List 3 possible causes of psychogenic amnesia. Dependent Personality = Unable to make decisions for self. 4. flamboyant. Describe the clinical symptoms of anorexia nervosa. fatigue. 2. Passive-Aggressive Personality = Passively resistant Antisocial Personality = Inability to conform to social norms Borderline Personality = Needy. a loss of the ability to feel and express emotions. desire for perfection What might the initial treatment include for a client admitted to the hospital with a diagnosis of bulimia nervosa? Blood work to evaluate electrolyte status.
Remove client and other persons in the vicinity to a safe area and activate hospital fire plan. What assessment data should the nurse obtain? What kind of anticipatory planning should the nurse develop? Obtain a drug and alcohol consumption assessment including type. talking quietly. His BP and pulse rate gradually increased. In order of priority. What type of delusion is this client experiencing? Approach client and offer solitary activity to distract.g.” What type of thinking is this client exhibiting? Concrete. Place on precautions as indicated. - . A client is very agitated. A client is sitting alone. Encourage verbalization of feelings and promote outlet for expression. Assess content of the hallucinations. - 2. be aware of fluid and nutrition needs. There is no one around. identified support system. safe environment. The nurse asks the client. she gave her roommate her favorite necklace. Paranoid disorder with delusions of reference (CIA). A client is standing on a table loudly singing the “Star Spangled Banner” encircled by sheets. Anticipate withdrawal/delirium tremens. In order of priority. This is an example of what type of thought disorder? Delusion of grandeur A client has been sitting in the same position for 2 hours. 2. be alert to potential for violence toward self/others. - 4. availability of method chosen. Call the physician and report findings. and time of last dose/drink. What actions should the nurse take and why? Assess for suicidal ideation. “The bus. He believes that the CIA has tapped the phone. What nursing action should be taken? Quietly approach client and note the behavior. poor nutritional status. Place on seizure precautions. method. - 4. - 5. He is mute. - A client. and that you are an agent who has been planted by the agency. 5. Assess need for medication. do not give client option. lethality of method chosen. which have been set afire. a client was admitted to the medical unit for a GI bleed. “I noticed you talking. Anticipate giving a medication like Librium. and he developed a low-grade fever..2. Three days ago. comes to breakfast one morning smiling and interacting with her peers. Candice Bergen. frequency. 3. place client in quiet environment with low stimulation and medicate as indicated. Are you hearing voices? Can you tell me about the voices you are hearing?” A client dials 222-2222 and asks for his fiance. and history of previous attempts. is sending messages through the television. assist with ADL. describe appropriate nursing actions. “What brought you to the hospital?” The client’s response is. What is the most appropriate nursing interventions? Accompany client to the group. Existence of a plan. A sudden change in mood and giving away possessions are two possible signs that a suicide plan has been developed. plan and means to carry out plan. A client on your unit refuses to go to group therapy. Prior to breakfast. Client needs to be mobilized. What type of schizophrenia is this client experiencing? Describe appropriate nursing interventions for this client? Catatonic: Spend time with client. 3. e. When area is safe. - SUBSTANCE ABUSE: 1. Name the components of a suicide assessment. What physical signs might indicate that a client is abusing intravenous medications? Needle track marks. list the appropriate nursing actions to intervene in this situation. Provide a quiet. cellulitis at puncture site. - SCHIZOPHRENIC/PARANOID DISORDERS: 1. who has been withdrawn and tearful.
or physical neglect. marital discord. 3. What behavior might the nurse observe in a child who is abused? Child may appear frightened and withdrawn in the presence of parent or adult. He is currently undergoing detoxification from alcohol with Librium 25 mg q6h. Parent sees child to meet their own needs. Must report all cases of suspected abuse to appropriate local/state agency. Take color photographs of injuries. . Identify nursing interventions for dealing with an abused child. The nurse notices that he is euphoric and is socializing with the other clients more than he has in the past. A client becomes extremely agitated. increase in absences (especially Monday or Friday). Confront client with observed behavior change. Provide physical care to treat injuries. - 4. exploitive. Collect and label evidence carefully in the presence of a witness. 8. late returning from lunch. Give clear. Document factual. - 6. Recognize own feelings of disgust and contempt for the parents. long breaks. increase in number of times tardy. Family history of frequent moves. Notify Rape Crisis Team or counselor if available in the community. objective statements of child’s physical condition. What types of abuse are seen in the elderly? Abuse can be physical. and very suspicious. Establish trust. Allow discussion of feelings about the assault. - What behaviors would indicate to the nurse manager that an employee has a possible substance abuse problem? Change in work performance. Document factual. Why is elder abuse so under reported? It is difficult for an elderly person to admit abuse for fear of being placed in a nursing home or being abandoned. 2. - 5. so she becomes isolated and dependent upon the abuser. 5. in the third week of cocaine rehabilitation program. encourage victim to prosecute. objective statements of physical condition. concise explanations of all procedures to be performed. unstable employment. calm manner.3. Parent may be very critical of child. She is often embarrassed to tell friends and family. Identify nursing interventions for working with a rape survivor? Communicate non-judgmental acceptance. What dynamics prevent a battered spouse from leaving the battering situation? A woman in a battering relationship usually lacks self-confidence and feels trapped. What nursing actions are indicated? Notify the physician of observed behavior change. verbal. psychosocial. Advise of potential for venereal disease. 4. What family dynamics are often seen in child abuse cases? Parent sees child as “different” from other children. - ORGANIC MENTAL DISEASES: 1. safe environment. A client. child -family interactions. When does battering of women often begin or escalate? During pregnancy. HIV. and family violence. and care for the child’s physical problems. Parent seldom touches or responds to child. What nursing actions are indicated? Notify the physician immediately and anticipate an increase in dose or frequency of Librium. Teach basic child development and parenting skills to family. Provide a quiet. List 5 causes of delirium. returns from an unsupervised pass. These are the PRIMARY and IMMEDIATE needs of these children. abusive. One parent answers all the questions. withdrawal. - ABUSE: 1. Approach in a quiet. Get a urine drug screen as ordered. Avoid touching client. record client’s EXACT WORDS in describing the assault. - 7. and interviews with family. Notify police. or pregnancy and describe medical care available.
Identify 3 or more causes of dementia. Disturbance in self-esteem related to…depending on client. - Infection. Clarify expressions or jargon if meaning is unclear. old boy is threatening to drop out of school.) Stick to routines. (Do not make changes if possible. - 2. disruptive. Ineffective family coping related to…depending on client. brain injury. More prevalent in boys. C. Potential for violence related to…depending on client. D. Parkinson’s disease. say they can’t stop him. difficulty sitting still. B. Conduct disorder. Ritalin. Implement behavior modification therapy if indicated. excessive talking. sleep deprivation.” What is the most probable psychiatric disorder? What are the signs and symptoms of this disorder? What drug is usually prescribed for this disorder? Attention deficit disorder (ADD/ADHD). 3. - CHILDHOOD AND ADOLESCENT DISORDERS: 1. i. Initiate suicide precautions when assessment indicates risk. Redirect angry feelings to “safe” alternative such as pillow or punching bag. make sure they have a nametag. multi-infarcts (brain).2.. Huntington’s chorea. His parents. Use “quiet room” when external contro l is needed. - . Initiate a “show of force” for a child who is out of control. distractibility to external stimuli. subdural hematomas Describe the nursing care for a client with Alzheimer’s disease. Role-play new coping strategies. multiple sclerosis. both alcoholics. alcohol withdrawal. and underachievement in school performance. A. shifts from one unfinished task to another. If client wanders. Alzheimer’s disease.e. old boy is disruptive in the classroom and is described by his parents as “hyperactive. He has just been arrested for stealing a car and breaking into a house. Change increases anxiety and confusion. impulsive behavior. What is the most probable disorder? Develop nursing diagnoses and interventions for this disorder. Assess verbal/nonverbal cues for escalating behavior to decrease outbursts. Avoid asking “why” questions. Use a non-authoritarian approach. failure to listen or follow instructions. electrolyte imbalance. Provide assistance as needed with ADL. Provide a safe. A 7 yr. consistent environment. Make sure bathroom is clearly labeled. A 15 yr. Difficulty playing quietly.
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