Psych Exam 2 Part 1

Discuss criteria for evaluating nursing care of clients with NCDs.

**Evaluation of the client with an NCD is based on a series of short term goals rather than on long- term goals **Outcomes are measured in terms of slowing down the process rather than stopping or curing the problem -Has the client experienced injury? -Does the client maintain orientation to time, person, place, and situation to the best of his or her cognitive ability? -Is the client able to fulfill basic needs? Have those needs unmet by the client been fulfilled by caregivers? -Is confusion minimized by familiar objects and structured, routine schedule of activities? -Do the prospective caregivers have information regarding the progression of the client's illness? -Do caregivers have information regarding where to go for assistance and support in the care of their loved one? -Have the prospective caregivers received instruction in how to promote the client's safety, minimize confusion and disorientation, and cope with difficult client behaviors (e.g., hostility, anger, depression, agitation)? -Has the client been able to maintain the best quality of life within the limitations posed by his or her illness?

Distinguish between Wernicke 's encephalopathy and Korsakoff's Syndrome

*Wernicke's encephalopathy* -most serious thiamaine def in alcoholic pt s/s -paralysis of ocular muscles, diplopia -ataxia -somolence -stupor *If thiamine replacement therapy is not undertaken quickly, death will ensue *Korsakoff's psychosis* -Syndrome of confusion, loss of recent memory, & confabulation in alcoholic pt -frequently encountered in clients recovering from Wernicke's encephalopathy -Treatment is with parenteral or oral thiamine replacement

A key issue for nurses who engage in cultural and spiritual care is

*self-awareness* Being culturally sensitive requires that nurses understand how their own values, beliefs and biases can profoundly influence their ability to provide nursing care to clients and families.

Asian/Pacific Islander Americans cultural variances

-A large group in the United States today, comprising more than 4 percent of the U.S. population. -Includes immigrants (and their descendants) from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. -Although they are viewed as one (Asian) culture, they constitute a multiplicity of differences regarding attitudes, beliefs, values, religious practices, and language. -Many younger generation Asian Americans have become almost totally acculturated into the U.S. culture. -Asian Americans are soft-spoken; to raise the voice indicates a loss of control. -Touching is not considered appropriate by some Asian Americans. -The family is the ultimate social organization, and loyalty to family is emphasized above all else. -Education is highly valued, although many remain undereducated. -Religious practices and beliefs are diverse and exhibit influences of Taoism, Confucianism, Hinduism, Buddhism, Islam, and Christianity. -Time orientation is both past and present. -Restoring the balance of yin and yang is the fundamental concept of Asian health practices. -Rice, vegetables, and fish are main staple foods. -Psychiatric illness is viewed as behavior that is out of control and brings great shame to the family. -Incidence of alcohol dependence is low, perhaps because of a possible genetic intolerance of the substance.

Interventions for Dementia Patients (Neurocognitive)

-Arrange furniture and other items in the room to accommodate client's disabilities -Store frequently used items within easy access -Keep the bed in the lowest position from the floor when the client is not being immediately attended to.Pad side rails and headboard if client has history of seizures. Keep bed rails up when client is in bed(if regulations permit). -Assign room near nurses' station;observe frequently -Assist client with ambulation -Keep a dim light on at night. -If client is a smoker, cigarette sand lighter or matches should be kept at the nurses' station and dispensed only when someone is available to stay with client while he or she is smoking -Frequently orient client to place,time, and situation.i. If client is prone to wander, provide an area within which wandering can be carried out safely. -Soft restraints may be required if client is very disoriented and hyperactive

alcoholics tend to have what deficiencies?

-B vitamin deficiency/thiamine

Interventions for a substance recovery plan

-Begin by working to develop a trusting nurse-client relationship.Be honest. Keep all promises. -Convey an attitude of acceptanceto client. Ensure that he or she understands "It is not you but your behavior that is unacceptable. -Provide information to correctmisconceptions about substanceabuse. Client may rationalize hisor her behavior with statementssuch as "I'm not an alcoholic. Ican stop drinking any time I want.Besides, I only drink beer," or "Ionly smoke pot to relax beforeclass. So what? I know lots ofpeople who do. Besides, youcan't get hooked on pot. -Identify recent maladaptivebehaviors or situations that haveoccurred in client's life, and discusshow use of substances may havebeen a contributing factor. -Use confrontation with caring. Do not allow client tofantasize about his or her lifestyle(e.g., "It is my understanding thatthe last time you drank alcohol,you . . ." or "The lab report showsthat you were under the influenceof alcohol when you had the accident that injured three people") -Do not accept rationalization orprojection as client attempts tomake excuses or blame otherpeople or situations for his orher behavior. -Encourage participation in groupactivities. -Offer immediate positive recognition of client's expressions ofinsight gained regarding illnessand acceptance of responsibilityfor own behavior -Offer immediate positive recognition of client's expressions ofinsight gained regarding illnessand acceptance of responsibilityfor own behavior pg 436

Arab Americans cultural variances

-Conversants stand close together, maintain steady eye contact, and touch (only between members of the same gender) the other's hand or shoulder. -Speech is loud and expressive with lots of gesturing. -Time is present oriented, and punctuality is not taken seriously except in the case of business or professional meetings. -The man is the head of the household, and women are subordinate to men. -The family is the primary social organization, and children are loved and indulged. -Women value modesty and many observe the custom of hijab—covering the body except for one's face and hands. -Cardiovascular disease is a common health concern. -Muslims are prohibited from eating pork and pork products. -Spiritual medicine is combined with conventional medical treatment. -Mental illness is a major social stigma, and symptoms are likely to be presented as physical complaints.

Caring for a patient with dementia

-Determination and correction of the underlying causes (first step) -Additional attention must be given to fluid and electrolyte status, hypoxia, anoxia, and diabetic problems -Staff to remain with client at all times to monitor behavior and provide reorientation and assurance -Room with low stimulus level -Primary consideration is given to etiology, with focus on identification and resolution of potentially reversible processes. -The need for general supportive care with provisions for security, stimulation, patience, and nutrition, has been recognized and accepted

Native Americans cultural variances

-Less than half of Native Americans live on reservations. -Touch is not highly regarded by Native Americans, and a handshake may be viewed as aggressive. -They sometimes appear silent and reserved. -They can be uncomfortable expressing emotions. -Primary social organizations are the family and tribe. Children are taught to respect tradition. -Native Americans are present-time oriented. -A medicine man is called a shaman and uses a variety of methods in practice; may work closely with conventional medicine to heal the sick. -Health problems include diabetes, heart disease, tuberculosis, alcoholism, and nutritional deficiencies.

African Americans cultural variances

-Some African Americans are completely assimilated into the dominant culture; others find it too difficult and prefer to remain in their own social organizations. -Forty-seven percent of African American households are headed by a woman. -They have large support groups of families and friends. -Some African Americans (particularly from the rural South) practice folk medicine and receive their care from a "granny," "old lady," or "spiritualist." -Hypertension and sickle cell anemia have genetic tendencies within the African American community.

Latino Americans Cultural variances

-Touch is a common form of communication. -primary social organization is a large, extended family. -Latinos tend to be present oriented -Roman Catholicism is the predominant religion. -The folk healer is called a curandero (male) or curandera (female). -Many still subscribe to the "hot and cold" theory of disease (a concept similar to the yin and yang beliefs of Asian Americans). -The prevalence for psychiatric illness is higher among U.S.-born Latinos than it is for immigrants from the same cultural group.

Northern Eurpoean Americans cultural variances

-Value territory, personal space is abt 18 inch - 3ft -Less value is placed on marriage and religion than once was. -Punctuality and efficiency are valued highly. -They are future oriented. -Most value a healthy lifestyle but still enjoy fast food.

Western Eurpean Americans Cultural Variances

-Warm and affectionate, very physically expressive; use a lot of body language, including hugging and kissing. -Very family oriented. Interact in large groups. -A strong allegiance to the cultural heritage is common. -Father is head of the household -Western European Americans are present oriented and view whatever happens in the future as God's will. -Most follow health beliefs and practices of the dominant American culture, but some folk beliefs and superstitions endure.

Disulfiram

-a drug that can be administered as a deterrent to drinking to individuals who abuse alcohol -Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a great deal of discomfort for the individual -not a cure for alcoholism, but rather a measure of control to avoid impulse drinking

Signs and symptoms of delirium tremens nursing action

-hallucinations -delirium -cardiac dysthymias -severe hypertension -tremors *alcohol withdrawal can progress to this *can lead to death *can occur 2-3 after stopping drinking o Load them up with benzos when they come in

Signs and Symptoms of Alcohol Withdrawal

-vomiting -tremors -seizures = PRIORITY bc of safety ==> BENZOS -restlessness -increase in HR, RR, BP, temp *Hallucinations; visual & tactile hallucinations (ants crawling up)

what meds do we give during alcohol withdrawal?

1. *Benzos* **this is our first med that we give*** *Vit B does NOT stop seizures* 2. Carabamezpine 3. Clonidine 4. Beta Blockers

Identify cultural differences based on six characteristic phenomena.

1. Communication 2. Space 3. Social Org 4. Time 5. Environmental Control -Has to do with the extent to which individuals perceive they have control over their environment 6. Biological Variations

CAGE Assessment

1. Have you ever felt you should Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt bad or Guilty about your drinking? 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

Transcultural Nursing Theory

A formal area of study founded by Dr. Madeline Leininger that focuses on comparative holistic culture care, health, and illness patterns of people with respect to differences and similarities in their cultural values, beliefs, and lifeways with the goal to provide culturally congruent, competent, and compassionate care.

Amok

A state of depression followed by violent or homicidal behavior and ending with a period of exhaustion,somnolence, and amnesia; persecutory ideas are also common

Jewish Americans cultural variances

Alcohol, especially wine, is an essential part of religious holidays and festive occasions. Religious laws dictate how food is prepared, served, and consumed •Time orientation is simultaneously to the past, present, and future. •Children are highly valued and are expected to be forever grateful to their parents for giving them the gift of life.. •Jewish Americans are very health conscious, and maintenance of mental health is as important as physical health.

Which psychiatric diagnosis is common within the Native American culture? A.Schizophrenia B.Alcohol use disorder C.Posttraumatic stress disorder D.Impulse control disorder

B

Most widely used group of drugs for substitution therapy in alcohol =

Benzodiazepines Chlordiazepoxide (Librium), oxazepam (Serax), lorazepam (Ativan), and diazepam (Valium) know the drug info

COWS scale is for...

Clinical Opiate Withdrawal Scale

Which value of the Northern European American culture should a nursing instructor include when teaching about cultural diversity? A. Northern European Americans are present oriented. B. Northern European Americans are highly religious, and church attendance is critical. C. Northern European Americans value punctuality and efficiency. D. Northern European Americans emphasize family cohesiveness due to increased technology.

D

Distinguish between delirium and dementia

Delirium -extreme distractability (cannot focus) -speech is is rambling, irrelevant, pressured, and incoherent -cannot reason -disorientation to time and place -can have delusions and hallucinations -agitated and restless and can fluctuate to a vegetative state -impairment of recent memory -Sleep may fluctuate between hypersomnolence and insomnia -*changes in VS and LOC* *high HR, high BP -causes: *UTI, etc* TIME FRAME: over a short period of time (hours to days) & duration is usually brief and goes anway during tx of underlying cause Dementia TIME FRAME: gradual (months - years) -VS stable -LOC stable -will have progressive memory loss, change in personality, and impaired judgment -impairment in speech (aphasia), ADLs, movement (apraxia) -wandering -incontinence -causes are neurocongnitive: *Alzheimer's *Parkinson's *traumatic brain injury -NOT reversible and progressive

depression in older adults can mimic the early stages of Alzehimer's...what is one tool to assess depression in elderly

Geriatric Depression Scale A screening instrument used in clinical settings to assess depression in older people. It uses a yes and no answer format. A score of 5+ is suggestive of depression and should warrant a follow-up comprehensive assessment. A score 10+ is indicative of depression

Susto

Latin America appetite and sleep disturbances, sadness, pains,headache, stomachache, and diarrhea. The soul isthought to leave the body (during dreams or followinga traumatic event), resulting in unhappiness and illness

Wernicke's encephalopathy

Most serious form of thiamine deficiency in alcoholic patients. s/s = confusion and loss of mental activity that can progress to coma and death; ataxia; vision changes

How do you know someone is experiencing tolerance with meds?

Same dose not giving the same effect, the pt needs more med to get the same effect

Goals for caring for a patient with sensory alterations

Short Term Goal ‒Client will utilize measures provided to maintain reality orientation. ‒Client will experience fewer episodes of acute confusion. Long-term goal -Client will maintain reality orientation to the best of his or her cognitive ability The goal of treating clients with these disruptions should be to help the client maintain reality orientation.

Korsakoff's psychosis

Syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients. It is frequently encountered in clients recovering from Wernicke's encephalopathy. Treatment is with parenteral or oral thiamine replacement. s/s = pyshcosis -Inability to form new memories -Loss of memory, can be severe -Making up stories (confabulation) -Auditory and/or visual hallucination

What medications are there to treat opioid use

Treat Opioid Intoxication 1. Naloxone (Narcan) 2. Naltrexone (ReVia) 3. Nalmefene (Revex) 1. Methadone -given on the first day in a dose sufficient to suppress withdrawal symptoms -The dose is then gradually tapered over a specified time 2. Buprenorphine -less powerful than methadone but is considered to be somewhat safer and causes fewer side effects 3. Clonidine (Catapres) -used to suppress opiate withdrawal symptoms. -As monotherapy, it is not as effective as substitution with methadone, but it is nonaddicting. **look at ATI flashcards**

_____________ ______________ and __________ syndrome are different conditions that often occur together. Due to what?

Wernicke encephalopathy and Korsakoff syndrome •Both are due to brain damage caused by lack of vitamin B1 Manifestation of chronic alcoholism

Disturbed sensory perception is defined as

a "change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli"

The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

assess risk and severity of withdrawal from alcohol. may be used for initial assessment as well as ongoing monitoring of alcohol withdrawal symptoms 1. Paroxtsmal sweats 2. anxiety, ask 3. agitation 4. visual disturbances -"Does the light appear to betoo bright? Is its color different? Does it hurt your eyes? Areyou seeing anything that is disturbing to you? 5. headahce, fullness in head -does your headfeel different? Does it feel like there is a band around yourhead?" 6. orientation & clouding of sensorium (ask orientation questions)

pancreatitis, cirrhosis, hepatitis

complications of alcohol abuse

substance abuse disorder

continued substance craving and use despite significant life disruption and/or physical risk physical dependence: need for increasing amounts to produce desired effects & go thru withdrawal psych dependence: overwhelming desire to repeat for pleasure or to avoid discomfort

Working with a different cultural, important to understand that they have different

definitions of illness and health How do they define health, what is healthy to them

What signals that someone is in the early stage of dementia? nursing actions during this stage

forgetful often losses and misplaces items actions: often can still preform ADLs....

Interventions for sensory perception

including using clocks, calendars, and signs and providing the client with items that may help promote feelings of security and orientation. For clients with delusions and hallucinations, it is important to discourage delusional thinking, provide reassurance that the client is safe, and focus on real situations and people. review: -constantly orient them -minimize stimulus sensory perceptions may be dt side effects of meds

Inductive versus deductive reasoning in cultural care

inductive reasoning = begins with observations of something specific and then applying a general theory to it *transcultural nursing was based on this type of reasoning but now, the theory is used in terms of deductive reasoning *using a general observation to arrive at a more specific conclusion *so we use her theory to get optimal ways of treating pt from different cultures

Know the signs and symptoms of amphetamine use & withdrawal

intoxication: •Euphoria, impaired judgement, confusion, changes in vital signs (increased HR, BP) •energy, jitters •pupils constricted Withdrawal: •Dysphoria, fatigue, sleep disturbances, and increased appetite, craving, *depression*

what is delirium?

mental state characterized by an acute disturbance of cognition, manifested by short-term confusion, excitement, disorientation, and clouded consciousness

What signals that someone is in the middle stage of dementia? nursing actions during this stage

more difficulty with organizing and planning change in personality & behavior wander and get lost actions: reorienting, reminding them, helping with ADLs

____________ can help with smoking cessation

nicotine patch · Don't give patch, too much nicotine???

Nursing interventions in sleep pattern disturbance

o Stick to a schedule o Avoid exercises later in the evening o Don't eat close in the bedtime o No electronics o No caffeine after 1pm o No reading in bed o Dark room o No TV in room o dont drink a lot of fluids before bed

for someone in rehab for alcohol abuse, we want to promote participation in

outpatient support system (90 meetings in 90 days) Long term treatment; NO CURE; life long issue/sobriety is a life long issue... Promote participation in outpatient support system (90 meetings in 90 days) = test question, usually at the end of the 90 days will get chip

substance abuse addition: recovery can be...

painful and time consuming

what is one of the biggest reasons for delirium in older patients? ***

polypharmacy so assess their drug list, bring in a list of meds

Goals for substance recovery plan

short term goal -Client diverts attention away fromexternal issues and focuses onbehavioral outcomes associatedwith substance use

what are Cultural bound syndromes?

those that are specific to a cultural group and do not share an exact correlation to any diagnostic categories listed in the DSM 5 Important to understand this physical and behavioral manifestations Ex: ataques de ervious (attack of nerves), a latin american cultural syndrome may sound similar to DSM 5 category of panic attacks, but is its is a distance syndrome with distinct treatment implications

with substance addiction, _________ develops which means

tolerance the amount required to achieve the desired effect increases.

What signals that someone is in the late stage of dementia? nursing actions during this stage

will require help with all ALDs will eventually lose all ability to move, possible talk, and impaired swallowing --> bed ridden all about comfort and respect

when does alcohol withdrawal begin?

within 4-12 hrs after last drink peaks 24-48 hrs

There may be some personality factors that contribute to development of addictive behavior

•Low self esteem •Frequent depression •Inability to relax or defer gratification