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211 Units 1 & 2 - SI notes
Health Care Concepts II (NSG 211)
Germanna Community College
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Diagnostic Criteria
Major Depressive Disorder (MDD) 5 or more symptoms have been present during the same 2 week period and interferes with roles. At least 1 of the symptoms is either depressed mood, or loss of interest or pleasure. (Anodynia) 1. Depressed mood most of the day, nearly every day (Feels sad, empty, or hopeless). 2. Anodynia. 3. Significant weight loss or gain (more than 5% of body weight). Decrease or increase in appetite. 4. Insomnia, hypersomnia nearly everyday. 5. Psychomotor agitation or retardation nearly everyday (restlessness, being slowed down). 6. Fatigue or loss of energy nearly everyday. 7. Feelings of worthlessness, excessive or inappropriate guilt nearly everyday. 8. Diminished ability to think or concentrate, indecisiveness nearly everyday. 9. Recurrent thoughts of death. A. Episodes are not attributable to the physiological effects of a substance or medical condition. B. This occurrence of MD episode cannot be better explained by other psychotic disorder criteria. C. There has never been a manic or hypomanic episode. Persistent Depressive Disorder; Dysthymia Depressed mood for most of the day, for more days than not, for at least 2 years. Presence of 2 or more symptoms. Interferes with roles. 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness. A. During the 2 year period, the individual has never been without symptoms for more than 2 months. B. There has never been a manic episode or a hypomanic episode. C. Episodes are not attributable to the physiological effects of a substance or medical condition. D. This disturbance cannot be better explained by other psychotic disorder criteria. Premenstrual Dysphoric Disorder At least 5 symptoms must be present in the final week before the onset of menses, starts to improve within a few days after onset, becomes minimal or absent in the week postmenses. 1. Marked affective lability (mood swings, feeling suddenly sad or tearful, increased sensitivity to rejection). 2. Marked irritability or anger, increased interpersonal conflicts. 3. Marked depressed mood, feelings of hopelessness, self-deprecating thoughts. A. Episodes are not attributable to the physiological effects of a substance or medical condition. B. This disturbance cannot be better explained by other psychotic disorder criteria. C. There has never been a manic episode or a
Interferes with roles. 4. Marked anxiety, tension, feelings of being keyed up or on edge. 5. Decreased interest in usual activities. 6. Subjective difficulty in concentration. 7. Lethargy, easy fatigability, marked lack of energy. 8. Marked change in appetite, overeating, specific food craving. 9. Insomnia or hypersomnia. 10. Sense of being overwhelmed or out of control. 11. Physical symptoms: breast tenderness, bloating, joint or muscle pain. hypomanic episode. Disruptive Mood Dysregulation Disorder Severe recurrent temper outbursts manifested, verbally, and/or behaviorally. Interferes with roles. 1. Grossly out of proportion to the situation. 2. Inconsistent with developmental level. 3. Outbursts occur 3 or more times per weeks 4. Mood between outbursts persistently irritable or angry most of the day, nearly everyday. A. Criteria has been present for 12 or more months. During the 12 months the individual has not had a period lasting 3 or more consecutive months without all of the symptoms. B. Symptoms have been present in at least 2 or more settings (school, home). C. Diagnosis cannot be made for the first time before the age of 6 or after the age 18. D. Age of onset of criteria is before 10. E. This disturbance cannot be better explained by other psychotic disorder criteria. F. Episodes are not attributable to the physiological effects of a substance or medical condition. Post-Partum Depression Associated with hormonal changes, tryptophan metabolism, or cell alterations. Interferes with 1. May last for a few weeks to several months. 2. Fatigue, irritability. 3. Loss of appetite. 4. Sleep disturbances. 5. Loss of libido. A. Signs and symptoms for at least 2 weeks. B. Prior history of depression increases risk of development. C. This disturbance cannot be better explained by other psychotic disorder criteria.
Diagnosis of this Bipolar Disorder requires at least one Manic or Mixed episode, but there may be episodes of Hypomania or Major Depression as well. (This diagnosis conforms to the classic concept of manic depressive illness.) Interferes with roles. 3. 3 symptoms of mania. criteria. B. Episodes are not attributable to the physiological effects of a substance or medical condition Bipolar 2 Disorder: Diagnosis of this Bipolar Disorder requires neither a Manic nor a Mixed Episode, but does require at least one episode of hypomania in addition to an episode of Major Depression. Interferes with roles. 1. Hypomania and MDD 2. 1 or more symptoms of MDD. 3. 1 or more symptoms of hypomania. A. Has never met criteria for full manic episode. B. This disturbance cannot be better explained by other psychotic disorder criteria. C. Episodes are not attributable to the physiological effects of a substance or medical condition. Generalized Anxiety Disorder Excessive and hard to control worry and anxiety occurring persistently, occurring more days than not for at least 6 months, about a number of events or activities. 3 or more of the 6 symptoms. Interferes with roles. 1. Restlessness or feeling keyed up or on edge. 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep). A. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder. B. Episodes are not attributable to the physiological effects of a substance or medical condition. Obsessive Compulsive Disorder 1. Obsessions- Recurrent and persistent A. Obsessions or compulsions are time
Presence of obsessions, compulsions, or both. Interferes with roles. thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. a. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action. 2. Compulsions- Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly. a. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. consuming, more than 1 hour a day, or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. B. The obsessive compulsive symptoms are not attributable to the direct physiological effects of a substance or a medical condition. C. The disturbance is not better explained by the symptoms of another medical disorder. Posttraumatic Stress Disorder Exposure to actual or threatened death, serious injury, or sexual violence, in 1 or more ways. The presences of 1 or more intrusion symptoms associated with the traumatic event beginning after the traumatic event occurred. Duration of disturbance is more than 1 month. Interferes with roles. 1. Directly experiencing the traumatic events. 2. Witnessing in person the event as it occurred to others. 3. Learning the traumatic event occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event (first responders, police officers). A. Negative alterations on cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred by 2 or more: a. Inability to remember an important aspect of the traumatic event. b. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world. c. Persistent, distorted cognitions
by intense physical discomfort. 4 symptoms must be present. Interferes with roles. 5. Feelings of choking. 6. Chest pain or discomfort. 7. Nausea or abdominal distress. 8. Feeling dizzy, unsteady, lightheaded, or faint. 9. Paresthesias. 10. Derealization, or depersonalization. 11. Fear of losing control or going crazy. 12. Fear of dying. C. Symptoms come on unexpectedly; that is, they do not occur immediately after or on exposure to a situation that usually causes anxiety. D. They are not triggered by situations in which the person is the focus of others’ attention. E. Episodes are not attributable to the physiological effects of a substance or medical condition. Drug/Class Action Side Effects Interactions Disorders Bendzodiazepines Alprazolam (Xanax) Diazepam (Valium) Lorazepam (Ativan) Clonazepam (Klonopin) **Ativan Intermediate-acting benzodiazepine Can be given by IV push; useful in the treatment of an acutely agitated patient Continuous infusion for agitated patients Depress activity in the brainstem and limbic system. Acts at many levels in the CNS to produce anxiolytic effect. May produce CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter. Therapeutic Effects: Relief of Anxiety. Decreased CNS activity, sedation; Hypotension Drowsiness, loss of coordination, dizziness; headaches; Nausea, vomiting, dry mouth, constipation. SUICIDAL THOUGHTS (Klonopin) RESPIRATORY DEPRESSION (valium/diazepam), Ativan(lorazepam)) Xanax confusion, ataxia, headache, and others. Valium headache, confusion, slurred speech, and others. Alcohol and CNS depressants can result in additive CNS depression and even death. More likely to occur in patients with renal or hepatic compromise. Xanax alcohol, oral contraceptives, and others. Valium alcohol, oral contraceptives, and others. Xanax indicated for: GAD, short-term relief of anxiety symptoms, panic disorder, and anxiety associated with depression. Valium Indications: relief of anxiety, management of alcohol withdrawal, reversal of status epilepticus, preoperative sedation, and as an adjunct for the relief of skeletal muscle spasms. Ativan is used to treat or prevent alcohol withdrawal.
who are undergoing mechanical ventilation** SSRIs (2nd gen. Antidepressant) Citalopram (Celexa) Fluoxetine (Prozac) Paroxetine (Paxil) Selectively inhibits the reuptake of serotonin in the CNS. Neuroleptic Malignant syndrome, Seizures, Suicidal thoughts. NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS, TORSADE DE POINTES, SEROTONIN SYNDROME, Seizures (celexa, Fluxetine) Celexa and Prozac Anxiety, dizziness, drowsiness, insomnia and others. Sweating, GI irritation, headache, dry mouth, sexual side effects. Discontinue use of MAO inhibitors for 14 days before Fluoxetine or Citalopram therapy. Combined therapy may result in confusion, agitation, seizures, hypertension, and hyperpyrexia (serotonin syndrome). Celexa: Premenstrual dysphoric disorder PMDD. OCD. Panic disorder. GAD. PTSD and Social anxiety disorder, depression. Prozac: Major depressive disorder. OCD. Bulimia nervosa. Panic disorder. Acute treatment of depressive episodes associated with bipolar 1 disorder (when used with olanzapine). SNRIs (2nd gen. Antidepressant) Duloxetine (Cymbalta) Desvenlafaxine (Pristiq) Vanlafaxine (Effexor) Inhibits serotonin and norepinephrine reuptake in the CNS. Both antidepressant and pain inhibition are centrally mediated. Therapeutic Effect(s): Decreased depressive symptomatology. Decreased neuropathic pain. Decreased symptoms of anxiety. Decreased pain. Cymbalta/Pristiq/Effexor NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, SUICIDAL THOUGHTS, fatigue, drowsiness, insomnia, SEROTONIN SYNDROME, ERYTHEMA MULTIFORME, STEVENS- JOHNSON SYNDROME, ↑ sweating, HEPATOTOXICITY, PANCREATITIS, ↓ appetite, constipation, dry mouth, nausea, dysuria, and increased BP. Concurrent use with MAO inhibitors may result in serious potentially fatal reactions (Do not use within 14 days of discontinuing MAOI. Wait at least 5 days after stopping duloxetine to start MAOI). Cymbalta Major depressive disorder. Diabetic peripheral neuropathic pain. Generalized anxiety disorder. Fibromyalgia. Pristiq Major depressive disorder. Effexor Major depressive disorder. Generalized anxiety disorder (Effexor XR only).
Amitriptyline (Elavil) Imipramine (Tofranil) Clomiparmine (Anafranil) Mirtazapine (Remeron) Protriptyline (Vivactil) For patients who fail with SSRIs or other newer generation antidepressants As adjunct therapy with newer generation antidepressants It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression Orthostatic hypotension Others Older patients Dizziness, postural hypotension, constipation, delayed micturition, edema, muscle tremors DRUG REACTION WITH EOSINOPHILIA AND SYSTEMATIC SYMPTOMS (DRESS) ARRHYTHMIAS SEIZURES, SUICIDAL THOUGHTS (Anafranil) AGRANULOCYTOSIS, NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS (Remeron) Elavil dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias Tricyclics like imipramine can cause photo sensitivity where others do not. Concurrent use with MAO inhibitors may result in serious potentially fatal reactions (MAO inhibitors should be stopped at least 14 days before imipramine therapy. Imipramine should be stopped at least 14 days before MAO inhibitor therapy). Concurrent use with MAO- inhibitor like drugs , such as linezolid or methylene blue may ↑ risk of serotonin syndrome; concurrent use contraindicated; Concurrent use with SSRI antidepressants may result in ↑ toxicity and should be avoided; Hypertensive crisis may occur with clonidine; Imipramine is metabolized in the liver and may be affected by drugs that compete for metabolism in the liver including other antidepressants, phenothiazines, carbamazepine; ↑ CNS depression with other CNS depressants including alcohol, antihistamines, clonidine, opioids, and sedative/hypnotics. Barbiturates may alter blood levels and effects. Phenothiazines or hormonal contraceptives ↑ levels and may OCDs (clomipramine) Adjunctive analgesics for chronic pain conditions, such as trigeminal neuralgia
cause toxicity. Cigarette smoking (nicotine) may ↑ metabolism and alter effects. Drugs that affect serotonergic neurotransmitter systems, including SSRI , SNRIs, fentanyl, buspirone, tramadol and triptans ↑ risk of serotonin syndrome. Drug-Natural Products: Use with St. John's wort ↑ of serotonin syndrome. Concomitant use of kava-kava, valerian, or chamomile can ↑ CNS depression.↑ anticholinergic effects with jimson weed and scopolia. MAOIs (Antidepressant) Isocarboxazid (Marplan) (Nonselective) Phenelzine (Nardil) (Nonselective) Selegiline (Emsam) (Selective) Marplan Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) in the body. Therapeutic Effect(s): Improved mood in depressed patients. Emsam Following conversion by MAO to its active form, selegiline inactivates MAO by irreversibly binding to it at Marplan SEIZURES, dizziness, headache, akathisia, anxiety, ataxia, drowsiness, euphoria, insomnia, restlessness, weakness; blurred vision; HYPERTENSIVE CRISIS, orthostatic hypotension; nausea, black tongue, constipation, diarrhea, dry mouth; dysuria, sexual dysfunction, urinary incontinence, urinary retention; photosensitivity Emsam SEROTONIN SYNDROME, insomnia, abnormal thinking, agitation, amnesia, worsening of mania/hypomania; tinnitus; ↑ cough; HYPERTENSIVE CRISIS, chest pain, orthostatic hypotension, peripheral edema; diarrhea, altered taste, anorexia, constipation, flatulence, gastroenteritis, vomiting; dysmenorrhea, metrorrhagia, Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death. Avoid foods that contain tyramine! Aged, mature cheeses (cheddar, bleu, Swiss) Smoked, pickled, or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté) Yeast extracts; Red wines (Chianti, burgundy, sherry, vermouth) Italian broad beans (fava beans) Aged cheese Marplan Treatment of depression (usually reserved for patients who do not tolerate or respond to other modes of therapy [e. tricyclic antidepressants, SSRIs, SSNRIs or electroconvulsive therapy]). Emsam Major depressive disorder.
to 2 mEq/L begin to produce toxicity, including gastrointestinal (GI) discomfort, tremor, confusion, somnolence, seizures, and possibly death. Keeping the sodium level in the normal range (135 to 145 mEq/L) helps to maintain therapeutic lithium levels.*** headache. Bipolar disorder. Anxiety. Diabetic peripheral neuropathy gain, anorexia, flatulence, gingivitis; RHABDOMYOLYSIS, arthralgia, ↑ creatine kinase; ataxia, altered reflexes, hyperkinesia, paresthesia; ANAPHYLAXIS, ANGIOEDEMA, MULTIORGAN HYPERSENSITIVITY REACTIONS bicarbonate ↑ renal elimination and ↓ effectiveness. Psyllium can ↓ lithium levels. Drug-Natural Products: Caffeine-containing herbs ( cola nut, guarana, mate , tea, coffee) may ↓ lithium serum levels and efficacy. Drug-Food: Large changes in sodium intake may alter the renal elimination of lithium. ↑ sodium intake will ↑ renal excretion. headache. Bipolar disorder. Anxiety. Diabetic peripheral neuropathy. Thorazine Chlorpromazine Oldest antipsychotic; still being used. Alters the effects of dopamine in the CNS. Has significant anticholinergic/alpha- adrenergic blocking activity. Therapeutic Effect(s): Diminished signs/symptoms of psychosis. Relief of nausea/vomiting/intractable hiccups. Decreased symptoms of porphyria.
NEUROLEPTIC MALIGNANT SYNDROME,
sedation, extrapyramidal reactions, tardive dyskinesia; blurred vision, dry eyes, lens opacities; hypotension (↑ with IM, IV), tachycardia; constipation, dry mouth, anorexia, hepatitis, ileus, priapism; urinary retention; photosensitivity, pigment changes, rash; galactorrhea, amenorrhea; AGRANULOCYTOSIS, leukopenia; hyperthermia; allergic reactions Pimozide ↑ the risk of potentially serious cardiovascular reactions; concurrent use contraindicated. May alter serum phenytoin levels. ↓ pressor effect of norepinephrine and eliminates bradycardia. Antagonizes peripheral vasoconstriction from epinephrine and may reverse some of its actions. May ↓ elimination and ↑ effects of valproic acid. May ↓ the pharmacologic effects Second-line treatment for schizophrenia and psychoses after failure with atypical antipsychotics. Hyperexcitable, combative behavior in children. Nausea and vomiting. Intractable hiccups. Preoperative sedation. Acute intermittent porphyria. Unlabeled Use(s):
of amphetamine and related compounds. May ↑ blood levels and effects of tricyclic antidepressants. Antacids or adsorbent antidiarrheals may ↓ adsorption; ↑ risk of anticholinergic effects with antihistamines, tricyclic antidepressants, quinidine, or disopyramide. Barbiturates may ↑ metabolism and ↓ effectiveness. Additive hypotension with antihypertensives. Additive CNS depression with alcohol, antidepressants, antihistamines, MAO inhibitor, opioid analgesics, sedative/hypnotics , or general anesthetics. Concurrent use with lithium may produce disorientation, unconsciousness, or extrapyramidal symptoms. Concurrent use with meperidine may produce excessive sedation and hypotension. Concurrent use with propranolol ↑ blood levels of both drugs. Drug-Natural Products: Concomitant use of kava-kava, Vascular headache. Bipolar disorder.
trihexyphenidyl (Artane). Tardive dyskinesia (TD): Involuntary contractions of oral and facial muscles. Choreathetosis (wavelike movements of extremities. Occurs with countinuous long- term antipsychotic therapy. Haldol: Seizures, extrapyramidal reactions, blurred vision, dry eyes, constipation, dry mouth. Risperdal: Minmal EPS at therapeutic dosages of 1 to 6 mg/day. Seroquel: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, dizziness. quinidine, and disopyramide. ↑ CNS depression with other CNS depressants, including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics. Concurrent use with epinephrine may result in severe hypotension and tachycardia. May ↓ therapeutic effects of levodopa. Acute encephalopathic syndrome may occur when used with lithium. Dementia may occur with methyldopa. Drug-Natural Products: Kava-kava, valerian, or chamomile can ↑ CNS depression. Maintenance treatment of bipolar I disorder (with lithium or divalproex). Adjunctive treatment of depression The antihypertensives propranolol (Inderal) and clonidine (Catapres), as well as lithium and carbamazepine (Tegretol) have been successful in alleviating nightmares, intrusive recollections, insomnia, startle responses, and angry outbursts associated with PTSD. Carbamazepine anticonvulsant used for bipolar disorder and resistant schizophrenia
NANDAs:
(All NANDAs are interchangeable amongst the disorders. Based on appropriateness per patient.) Disorder NANDA Behaviors Goals Intervention Major Depressive Disorder (MDD) 1. Risk for suicide 2. Powerlessness 3. Insomnia 4. Spiritual distress 1. Depressed mood; feelings of hopelessness and worthlessness; anger turned inward in the self; misinterpretations of reality; suicidal ideation, plan, and available means 2. Apathy, verbal expressions of having 1. Pt will seek out staff when feeling the urge to harm self. Pt will make short-term verbal (or written) contract with the nurse not to harm self. 1. Ask client directly “Have you thought about killing yourself?” if so “What do you plan to do?” “Do you have the means to carry out this plan?”
no control, dependence on others to fulfill needs. 3. Difficulty falling asleep, difficulty staying asleep; lack of energy; difficulty concentrating; verbal reports of not feeling well rested. 4. Expresses anger toward God; expresses lack of meaning in life; sudden changes in spiritual practices; refuses interactions with significant others or with spiritual leaders. Client will not harm self. Client will not harm self (long term) 2. Pt will participate in decision making regarding own care within 5 days Pt will be able to effectively problem solve ways to take control of their life situation by time of discharge from treatment, thereby decreasing feelings of powerlessness. 4. Pt will identify meaning and purpose in life, moving forward with hope for the future. Pt will express achievement of support and personal satisfaction from spiritual practices. Create safe environment for Pt. Formulate a short term verbal or written contract that the Pt will not harm self. Maintain close observation. Make rounds frequently irregular intervals. Encourage Pt to express honest feelings. 2. Encourage Pt to set goals of their own care they wish to achieve. Allow Pt to establish own schedule. Provide Pt with privacy. Provide positive feedback for decisions made. Help Pt set realistic goals. Help Pt identify life situations they can control. Help Pt identify life situations that are not in their control. 4. Be accepting and nonjudgmental when Pt expresses anger. Encourage Pt to vent feelings related to meaning of own existence. Encourage Pt as part of grief work to reach out to previous religious
and minerals. Walk or sit with Pt while they eat. 5. Be accepting of client and spend time with them, even though pessimism and negativity present. Promote attendance in therapy groups that offer Pt simple methods of accomplishment. Encourage Pt to recognize areas of change and provide assistance toward this effort. Teach assertiveness techniques. Teach effective communication techniques. Premenstrual Dysphoric Disorder
- Social isolation/Impaired social interaction
- Insomnia
- Withdrawn, uncommunicative, seeks to be alone; dysfunctional interaction with others; discomfort in social situations.
- Difficulty falling asleep, difficulty staying asleep; lack of energy; difficulty concentrating; verbal reports of not feeling well rested. Disruptive Mood Dysregulation Disorder
- Disturbed thought process
- Inappropriate thinking, confusion, difficulty concentrating, impaired problem-solving ability; inaccurate interpretation of environment; memory deficit.
- The Pt will Demonstrate orientation to person, place, and time within 24 hours Demonstrate decreased hallucinations or delusions within 24 to 48 hours Demonstrate decreased push of speech, tangentiality, loose
- Set and maintain limits on behavior that is destructive or adversely affects others. Initially, assign the Pt to the same staff members when possible, but keep in mind the stress of working with a client with manic behavior for extended periods of time. Decrease environmental stimuli
associations within 24 to 48 hours Demonstrate an increased attention span, for example, talk with staff about one topic for 5 minutes, or engage in one activity for 10 minutes, within 2 to 3 days Talk with others about present reality within 2 to 3 days Stabilization The client will Demonstrate orientation to person, place, and time Demonstrate adequate cognitive functioning whenever possible. Respond to cues of increased agitation by removing stimuli and perhaps isolating the Pt; a private room may be beneficial. Reorient the Pt to person, place, and time as indicated. Spend time with the Pt. Show acceptance of the Pt as a person. Use a firm yet calm, relaxed approach. Make only promises you can realistically keep. Help the Pt plan activities within their scope of achievement. Avoid highly competitive activities. Post-Partum Depression
- Self-care deficit
- Social isolation/Impaired social interaction
- Insomnia
- Complicated grieving
- Uncombed hair, disheveled clothing, offensive body odor.
- Withdrawn, uncommunicative, seeks to be alone; dysfunctional interaction with others; discomfort in social situations.
- Difficulty falling asleep, difficulty staying asleep; lack of energy; difficulty concentrating; verbal reports of not feeling well rested.
- Depression, preoccupation with thoughts of loss; self-blame, grief avoidance; inappropriate expression of anger; decreased functioning in life
- Pt will verbalize which of their interaction behaviors are appropriate and which are inappropriate within 1 week. Pt will demonstrate use of appropriate interaction skills as evidenced by lack of, or marked decrease in, manipulation of others to fulfill own desires.
- Pt will express anger about loss Pt will verbalize behaviors associated with normal grieving.
- Recognize the purpose manipulative behaviors serve for the Pt. Set limits on manipulative behaviors. Do not argue, bargain, or try to reason with Pt. Provide positive reinforcement for nonmanipulative behaviors. Help Pt recognize that they must accept the consequences of own behaviors and refrain from
211 Units 1 & 2 - SI notes
Course: Health Care Concepts II (NSG 211)
University: Germanna Community College
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