Psyc Integrity
What a nurse does if the patient has an advance directive (AD)
-review with the pt and comfirm that it still reflects the pt's wishes -place AD in the pt's MR so it is easily accessible to all HCP -Notify HCP so they can use it to guide the pt care - determine health care agent has a copy of the AD -encourage the pt to discuss the AD with the family and health care agent so that they understand the patient's wishes
A client diagnosed with antisocial personality disorder asks the nurse for an additional smoke break because of anxiety. Which response by the nurse is best? 1. "Smoking is harmful to your health. I don't want to contribute to your bad habits." 2. "Clients are permitted to smoke at designated times. You have to follow the rules."
"Clients are permitted to smoke at designated times. You have to follow the rules."
Which client statements made to the nurse indicates a positive outcome to treatment for suicidal behavior? "I am thankful for my spouse and children." "I know my family realizes that I should never be left alone."
"I am thankful for my spouse and children." Being able to list reasons to live is a positive outcome for suicidal behavior. The client believing that dealing with their pain is harder than death or researching and thinking about ways to kill themself demonstrates ongoing interest in suicide. The client who believes their family feels they cannot be left alone is not taking personal responsibility for safety and remains at risk.
Detachment / denial stage of toddler
- occurs if the toddler's stay in the hospital without the parent is prolonged because the toddler settles in to the hospital life and denies the parents' existence - e.g., not reacting when the parents come to visit
A living will can include decisions about:
- use of equipment, such as dialysis machines and ventilators - resuscitation - hydration - nutrition, such as the insertion of a feeding tube and administration of enteral or parenteral nutrition - treatment for pain, nausea, and other symptoms - donation of organs and body tissues.
Despair stage in toddler
- withdrawn and obviously depressed - engaging in play activities and sleeping more than usual
If the patient doesn't have an advance directive
-Provide the patient with verbal and written information about advance directives so that the patient can make an informed decision about developing one. Make sure the materials are in the patient's preferred language to promote understanding. Arrange for an interpreter if necessary. -Determine whether the patient would like to have family present for the discussion. -Answer the patient's questions about advance directives, or have a social worker or patient representative discuss the documents with the patient. Social workers and patient representatives are specially trained in ethics and the discussion of sensitive issues.
The nurse is caring for a young adult with hepatitis A. The client is crying and saying that they hate the way they look with yellow skin. Which response is most appropriate? "Try covering your face with a little make-up. The discoloration will be hardly noticeable." "If you start to get well and feel better, the skin will return to its normal color."
"If you start to get well and feel better, the skin will return to its normal color." The nurse must communicate honestly and give the client factual information about their appearance. Leaving the client alone or telling them not to cry ignores the client's feelings and needs. Make-up wouldn't conceal the jaundiced appearance, so using it might upset the client more.
Acceptance stage of dying
-desire the quiet company of a family member or friend
Avolition
-lack of motivation -impairment in the ability to initiate goal-directed activity.
Denial stage of dying
-may refuse to accept the diagnosis - s/s with stress reaction—shock, fainting, pallor, sweating, tachycardia, nausea, and GI disorders -maintain communication -allow the pt to express feelings -dont force the pt to confront this reality
The family of a 22-year-old client with bipolar disorder is having difficulty coping with the client's rapid mood swings, irritability, grandiose delusions, and overly inclusive behaviors. Following a visit to the unit, the parents and the nurse discuss how the family can deal with the client's behaviors and help their child. Which response, if made by the family, would indicate to the nurse that the teaching was effective? "We need to make sure the client is taking their medication correctly and to help them get out of debt." "We need to help our child establish a routine for work and school and monitor their mood."
"We need to help our child establish a routine for work and school and monitor their mood." A normal routine and careful monitoring of the client's mood assists the client in taking action when their routine or mood becomes disrupted. Maximum independence within a supportive community is a priority. Advising the family to follow the client's medications and to monitor their spending, or to restrict spending and driving, will create a controlling relationship and promote tension. This will increase caregiver burden and create disagreements over illness management and financial responsibilities. Waiting to call the police is also incorrect and indicates that the situation has spiraled out of control. The parents may resort to this to protect themselves and their property, but a more proactive solution is to teach the client to keep a routine and monitor their mood.
Depression stage of dying
-may withdraw from friends, family members, the practitioner, and you -may suffer from anorexia, increased fatigue, or self-neglect
regression stage
-return to a developmentally earlier phase because of stress or crisis -e.g., a toddler who could feed himself before this event is not doing so now
While providing palliative care to a client in the home setting, the client's family expresses concern that the client is receiving "too much narcotic medication." Which statement is the most therapeutic response by the nurse? "Do you want me to call the doctor now and explain that you are concerned?" "You are concerned that the client is receiving too much narcotic medication?"
"You are concerned that the client is receiving too much narcotic medication?" Using a reflective statement without judgment allows the family to elaborate so the nurse can answer the specific concerns. The other options are not correct because they do not promote more conversation to help the family gain a better perspective on the treatment.
protest stage in toddler
- Screaming, crying, clinging to parents, resistance to other adults. - physically and verbally attacks anyone who attempts to provide care
An older adult has few health problems, performs self-care, plays cards, and talks about "the good old days." The client wants to make "final" arrangements, such as completing an advance directive and planning and paying for a funeral and burial. What interpretation does the nurse make about the client? 1. The request suggests that the client has a premonition about dying soon and needs to talk about it. 2. The request is age-appropriate and should be honored.
2. The request is age-appropriate and should be honored. Given the client's age, making final plans is age appropriate. The absence of any signs of ill health, depression, or suicidal ideation makes the other options inappropriate.
living will
A document that indicates what medical intervention an individual wants if he or she becomes incapable, terminal illness or permanent unconsciousness (vegetative state) of expressing those wishes.
Silence
Allowing for a pause in communication that gives you and the patient time to think about what has taken place
A nurse is preparing a 4-year-old child for surgery. Which is the best nursing intervention? 1. Allowing the child to wear underwear if desired. 2. Ensuring that the child has only favorite foods for 24 hours.
Allowing the child to wear underwear if desired.
A client diagnosed with terminal lung cancer expresses a desire to seek spiritual advice. Which intervention by the nurse best provides spiritual support for this client? 1. Identify the name of the spiritual advisor from the client's admission history. 2. Ask who the client's spiritual advisor is and make the contact.
Ask who the client's spiritual advisor is and make the contact. The nurse may contact the client's spiritual advisor if the client so desires. The nurse can listen to the client, but spiritual support is best from someone proficient in that field, such as a spiritual advisor. It would be appropriate for the nurse to contact the clergy of another faith, only if no other resources are available and if the client consents. The nurse should speak with the client and get the information firsthand, before researching the admission history.
Focusing
Asking goal-directed questions to help the patient focus on key concerns
Open-ended questions
Asking neutral questions that encourage the patient to express concerns by responding with more than a "yes" or "no"
S&S of Hypothyroidism
Fatigue, Mental sluggishness, Hypothermia, Dry flaky skin and thinning nails, cold intolerance, weight gane depression and sadness
Encouraging elaboration
Helping the patient describe in more detail the concerns or problems under discussion
Seeking clarification
Helping the patient put unclear thoughts or ideas into words
Looking at alternatives
Helping the patient to see options and to participate in the decision-making process related to the patient's health care and well-being
Summarizing
Highlighting the important points of a conversation by condensing what you both said
S/S of CNS depression - 9
Hyperpyrexia slow pulse weight gain hypotension listlessness increased appetite slowing of sensorium arrhythmias
Reflection
Identifying the main emotional themes contained in a communication and directing these back to the patient
overindulgence
Parents who feel guilty about a child's illness
Mirroring
Repeating word-for-word what the patient said
Giving information
Sharing with the patient relevant information for the patient's health care and well-being
Example of Assertiveness
The client asks a roommate to put away dirty clothes because the untidiness bothers the client.
A client with a diagnosis of bipolar disorder is energetic, impulsive, and verbalizing loudly in the community room. To prevent injury while complying with the principle of the least-restrictive environment, which action should the nurse take to prevent escalation of the client's mood? 1. Place the client in seclusion with the door open 2. Try to channel the client's energy into appropriate activities 3. Obtain a court order for a higher level of treatment
Try to channel the client's energy into appropriate activities. Constructive activities, such as painting, are a positive way to prevent inappropriate or destructive use of the client's excessive energy. Placing the client in seclusion with the door open allows the client to leave the seclusion room; this action doesn't comply with the principle of providing the least-restrictive environment. It isn't appropriate for the nurse to obtain a court order for a higher level of treatment. Monitoring the client's behavior isn't as effective as intervening before a crisis
Opening remarks
Using general statements based on observations and assessments about the patient
perseveration
a person repeats the same word or idea in response to different questions
assertiveness training
a set of methods for helping clients learn to express their feelings and stand up for their rights in social situations
health care power of attorney
a written document that allows a person to designate another individual, known as a health care agent or health care proxy, to make health care decisions on the person's behalf if the person becomes unable to make them
The nurse is aware that clients in the initial stages of a terminal diagnosis may present with which behavior? crying uncontrollably over the diagnosis asking for other medical opinions
asking for other medical opinions Seeking other opinions to disprove the inevitable is a form of denial used by individuals with illnesses that have a poor prognosis. The other choices may be occur at some point, but not initially. They are all based on the Kubler-Ross stages of dying.
A 4-year-old child continues to come to the nurses' station after being told children are not allowed there. What behavior is the child exhibiting? aggressive behavior attention-seeking behavior resistance against authority exaggerated stress
attention-seeking behavior The child wants attention from the nurse, even if the behavior is met by a negative response. Aggression, resistance against authority, and exaggerated stress are behaviors that can be associated with a 4-year-old. However, coming to the nurses' station after being told not to do so is not an example of these behaviors.
bargaining stage of dying
bargain with God or fate for more time
Communication is very important when preparing a client for a mastectomy. What is the primary issue for the nurse to discuss? 1. concerns regarding the cancer and how the surgery will affect the client 2. how body image changes will affect the client's sexual relationship
concerns regarding the cancer and how the surgery will affect the client
offering self
making oneself available to listen to the patient
Anger stage of dying
may show deep resentment toward those who will live on after the patient dies—to you, to the facility staff, and family members.
Side effects of CNS stimulants - 4
mood swings anorexia wt loss tachycardia
tangential
never gets to the point of the communication
Restatement
repeating pt's idea by using different words
what are the nursing intervention for pt with antisocial or borderline personality disorder?
set limitation/schedule and consistency
Nsg dx with s/s fatigue, sensitivity to criticism, decreased libido, and feeling self-conscious. The client also has aches and pains 1. situational low self-esteem 2. posttrauma syndrome 3. delayed growth and development
situational low self-esteem. All symptoms define a disturbance in self-esteem. There isn't enough information to determine delayed growth and development. The client's complaints don't involve the ability to perform the roles. Posttrauma syndrome occurs after experiencing a traumatic event and doesn't coincide with the data obtained from this client.
The client has tearfully described her negative feelings about herself to the nurse during their last three interactions. Which goal would be most appropriate for the nurse to include in the plan of care at this time? The client will: 1. verbalize three things she likes about herself 2. increase her self-esteem
verbalize three things she likes about herself The nurse must communicate honestly and give the client factual information about their appearance. Leaving the client alone or telling them not to cry ignores the client's feelings and needs. Make-up wouldn't conceal the jaundiced appearance, so using it might upset the client
what attitude of a person who passive-aggressive
won't confront or discuss issues with others but will go to great lengths to "get even."
