N484 Exam 2

Erickson's Stages of Psychosocial Development

Trust vs. Mistrust Autonomy vs. Shame & Doubt Initiative vs. Guilt Industry vs. Inferiority Identity vs. Role Confusion Intimacy vs. Isolation Generativity vs. Stagnation Integrity vs. Despair

Barbituates/Sedative Hypnotics action

Used for sedation and insomnia

Nursing Implications of barbituates/sedative hypnotics

Zolpidem-may cause daytime drowsiness, give with food 1 - 1 ½ hours before bedtime

Examples of Tricyclics

amitriptyline, nortriptyline

Tricyclic Antidepressant Side Effects

anticholinergic side effects, sedation, poor concentration, tachycardia, ortho hypotention, N/V

Nursing Implications of MAOIs

cannot be used with tricyclics and SSRIs, MUST teach clients to avoid foods high in tyramine to avoid a HYPERTENSIVE crisis (aged cheese, wine, beer, beef and chicken liver, yeast, yogurt, soy sauce, chocolate, bananas)

Antipsychotic Meds Action

controls psychotic behavior (hallucinations, delusions, and bizarre behavior)

Older Adult

Integrity vs Despair

A nurse is planning care for a hospitalized toddler. To best maintain the toddler's sense of control and security and ease feelings of helplessness and fear, which action should the nurse take?

Keep hospital routines as similar to routines at home

The nurse is caring for a hospitalized 14-year-old child who is placed in Crutchfield traction. The child is having difficulty adjusting to the length of the hospital confinement. Which nursing action would be appropriate to meet the child's need?

Let the child wear his/her own clothing when friends come to visit

Caring for the hospitalized adolescent

Lose peers, separation anxiety from peers, fears: pain, body image, loss of control Care Givers: some adolescents will want them to stay and some don't. Give adolescents privacy during assessments. Let them have their favorite foods if it's okay with their diet.

A mother of a toddler who is hospitalized with mild dehydration must leave her child to go to work. Which behavior would the nurse expect to observe in the toddler immediately after the mother's departure?

Loudly crying and kicking both feet

The nurse is caring for a school-age child who has just had an appendectomy. Which information does the nurse need to know about pain in children to plan effective care?

Pain is expressed differently according to developmental stages

The nurse instructs a parent regarding the appropriate actions to take when the toddler has a temper tantrum. Which statement by the parent indicates a successful outcome of the teaching?

"I will ignore the tantrum as long as there is no physical danger"

A preschool child is placed in traction for a femur fracture. The child has started bedwetting, even though the child has been toilet trained for a year. The mother is very upset about the situation. The nurse explains to the mother that this is an example of which behavior?

Regressing to earlier developmental behavior

#1 Intervention for Depression

Safety

Tricyclic Antidepressants Nursing Implications

Administer at bedtime, may take 2-6 weeks to see therapeutic effects, teach the client to avoid alcohol, evaluate suicide ideation

The mother of a toddler asks the nurse when she will know that her child is ready to start toilet training. The nurse should tell the mother that which observation is a sign of physical readiness?

The child can remove his/her own clothing

Infant

Trust v Mistrust

The nurse employed in a well-baby clinic is providing nutrition instructions to the mother of a 9-month-old infant. Which instruction is appropriate?

Begin to initiate self-feeding

The nurse observes a 4-year-old boy in a day care setting. Which behavior should the nurse expect this child to exhibit?

Boasts aggressively when telling a story

A nurse performing a physical assessment of a 12-month-old infant notes that the infant's head circumference is the same as the chest circumference. Based on this finding, what should the nurse do?

Document the findings in the healthcare record

A 16-year-old client diagnosed with diabetes is admitted for hyperglycemia. The client states, "I'm fed up with having my life ruled by diets, doctors' prescriptions, and machines!" This behavior is related to which condition?

Feelings of loss of control

An infant is admitted to the hospital for fever of unknown origin. The mother's time at the hospital is limited to the hours that her other children are in school. Which of the statements made by the nurse is most accurate?

Games like peek-a-boo and hide and seek will help your child understand that you will return

The information that should be given to the parents of a 12-month-old regarding appropriate play activities would include which of the following?

Give large push-pull toys for kinetic stimulation

The nurse is performing an assessment on a preschool child. What would the nurse do to facilitate the cooperation of the child?

Have the child pretend to be the nurse

The nurse performs an assessment on a 9-month-old infant. Which finding indicates a physiological problem and the need for follow-up?

Head lag noted when pulled to sitting

Risk Factors for Depression

History of depression, previous attempts, family history of depression/suicide

The nurse employed in a well-baby clinic is collecting data regarding the language and communication developmental milestones of a 7-month-old infant. Which milestone would the nurse expect to occur in the infant at this developmental age?

Increased interest in sounds

A 4-year-old child has cystic fibrosis. Which stage of Erikson theory of psychosocial development is the nurse addressing when teaching inhalation therapy?

Initiative

Nursing Implications of Antianxiety meds

administer at bedtime to reduce daytime sleepiness, instruct client to avoid driving or working around equipment, used as short-term use only

Examples of Antianxiety Meds

alprazolam, lorazepam (benzodiazepines

Toddler

autonomy vs shame and doubt

Antipsychotic Meds SE

different for different classes Haloperidol- monitor for extrapyramidal reactions, blurred vision, dry mouth, urinary retention, leukocytosis Risperidone- monitor for neuroleptic malignant syndrome- EPS, dizziness, GI symptoms, anxiety

Antipsychotic Nursing Implications

different for different classes Haloperidol-teach client to avoid alcohol Risperidone- Monitor WBCs for 1st 6 months, monitor for EPS and NMS

SE of SSRIs

drowsiness, dizziness, headache, insomnia, depressed appetite

SE of barbituates/sedative hypnotics

drowsiness, sedation

Middle-Age Adult

generativity vs stagnation

Examples of Antipsychotics

haloperidol, risperidone

Teenager

identity vs role confusion

Grade-Schooler

industry vs inferiority

Pre-Schooler

initiative vs guilt

Young Adult

intimacy vs isolation

Examples of Mood Stabilizers

lithium carbonate, olanzapine

Nursing Implications of Mood Stabilizers

monitor for signs of toxicity (diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination , monitor renal labs and sodium, monitor thyroid labs, teach client about s/s of toxicity

SE of Mood Stabilizers

nausea, fatigue, thirst, polyuria, fine hand tremors, weight gain, hypothyroidism, possible renal impairment

Examples of MAOIs

phenelzine, isocarboxazid

Examples of barbituates/Sedative hypnotics

phenobarbital, zolpidem

Caring for a hospitalized patient with ASD

quiet rooms, space out cares, routine, keep same nurses if possible

Antianxiety Meds Action

reduces anxiety, induces sedation, relaxes muscles, treats alcohol and drug withdrawal symptoms

SE of Antianxiety meds

sedation, drowsiness, ataxia, dizziness, irritability, habit forming

Examples of SSRIs

sertraline, citalopram

A 4-month-old infant is brought to the clinic by her parents for a well-baby checkup.Because 4-month-old infants are developing very fast, the health-care worker reminds parents that they can help prevent an accident by:

supporting child firmly during bathtime

SE of MAOIs

tachycardia, urinary hesitation, constipation, impotence, dizziness, insomnia, dry mouth, dizziness, confusion, hypertensive crisis

Nursing Implications of SSRIs

takes 2-4 weeks for therapeutic effexts, Cannot be taken with MAO (hypertensive crisis),

Tricyclic Antidepressant Action

treats depression

Action of MAOIs

use for depression, phobias, and anxiety

Action of Mood Stabilizers

used for bipolar disorders especially in the manic phase

Action of SSRI

used for depression, anxiety, panic disorder, aggression, OCD, anorexia nervosa

Depression

•Affects thoughts, feelings, and behaviors •Causes •Severity •Interventions-medical & cognitive •Treatments

Risk/Safety Issues for Pediatrics

•Motor vehicle injuries •Drowning •Burns •Poisoning •Falls •Choking and suffocation •Bodily damage

Mental Health Pharmacology

•Selective Serotonin Reuptake Inhibitors (SSRIs) •Tricyclic Antidepressants • Monoamine Oxidase Inhibitors (MAOIs) •Mood Stabilizers • Antianxiety or Anxiolytic Medications •Barbiturates and Sedative-Hypnotics •Antipsychotic Medications *Neuroleptic Malignant Syndrome

Autism Spectrum Disorder (ASD)

•Social Skills •Communication •Repetitive behaviors & routines •Emotional attachment

Erickson's stages of psychosocial development: mneumonic

•To My •Aunt Sally •In Georgia, •I'm Interested •In Relocating •I'm Independently •Going Somewhere •In December