Depression: Signs/Symptoms
-loss of interest in life's activities
-negative view of the world
-anhedonia
-usually related to loss
-poor kept
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Depression Signs/Symptoms: What is anhedonia?
loss of pleasure in usually pleasurable things
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Depression Signs/Symptoms: In mild depression there is _____________ while there is ______________ in severe depression
weight gain; weight loss
Depression Signs/Symptoms: There are crying spells with ________________ and no more tears with ___________________
mild to moderate depression; severe depression
Depression Signs/Symptoms: It is commons for client's to experience
sleep disturbances
Depression Signs/Symptoms: These clients have slow thoughts so we need to
speak slowly to them and use the therapeutic communication technique of silence (give them time to process)
Depression Signs/Symptoms: Clients who are depressed can have ___________________ and _________________
delusions; hallucinations
Depression Treatment: They may need help with
their self-care
Depression Treatment: Prevent _________________ because _______________________ makes the client feel better
isolation; interacting with others
Depression Treatment: Help them experience
accomplishments
Depression Treatment: Be careful with _______________ as they may make the client _________________
compliments; feel worse
Depression Treatment: If severely depressed, ________________________________ may be the best thing you can do. It's a _______________________________
sitting with client and making no demands; self-esteem thing
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Depression Treatment: As they feel better, encourage them to _____________________. Let the client know that _________________________________________
describe their feelings; you understand they are in pain and feel powerless
Depression Treatment: Help them set
accomplishable goals
Depression Treatment: If they are capable, activities such as _________________________________________ will help with depression
walking, running, weight lifting
Depression Treatment: Assess for
suicide risk
Depression Treatment: As depression lifts, what happens to suicide risk?
the risk goes up
Depression Treatment: Observe clients when they start taking antidepressants because
their risk for suicide just went up (increase in SSRIs and energy)
Depression Treatment: A sudden change in mood towards the better may indicate
that the client has made the decision to kill themselves
Depression Treatment: Culturally, ____________________ have a higher suicide rate
American Indians
Depression Treatment: ___________ clients are particularly at risk for suicide
Elderly
Depression Treatment: ______________________ tend to be very successful because they generally use ______________________
Elderly men; very lethal methods
Depression Treatment: When assessing suicide risk, ask clients 3 very important questions
1. do they have a plan?
2. what is the plan?
3. how lethal is the plan?
Depression Treatment: When assessing suicide risk, determine if they ____________________ and if they have ever ____________________
have access to the plan; attempted suicide before
Depression Treatment: When assessing suicide risk, watch for things like
-isolating themselves
-writing a will
-collecting harmful objects
-giving away their belongings
Depression Treatment: Suicide interventions include
-direct, closed ended statements
-providing a safe environment
-safe-proofing the room
-getting a signed contract to postpone suicide
Depression Treatment: A signed contract post poning suicide is done in hope that
the client will develop coping mechanisms during this time
Mania: One pole is __________ and the other is ________________
mania; depression
Mania: Signs/Symptoms
-continuous high
-labile emotions (periods of extremes)
-flight of ideas
-delusions
-constant motor activity
-no inhibitions
-altered sleep patterns
-poor judgment
-manipulation
Mania: Delusions are just
a false idea
Mania: Types of delusions can include
-delusions of grandeur (ex. client thinks they are
Jesus)
-delusions of persecution
Mania: Constant motor activity leads to
exhaustion
Mania: Lack of inhibition can include
-inappropriate dress
-hyper-sexual behaviors (an attention-seeking
mechanism)
Mania: Manipulation makes these clients
feel secure and powerful
Mania Treatment: Decrease
the stimuli
Mania Treatment: Don't ___________ or __________________
argue; try to reason
Mania Treatment: Do you talk a lot about the delusion?
no
Mania Treatment: Let the client know you ____________________________, but that you ___________________
accept that they need the belief or delusion; do not believe it
Mania Treatment: Look for the
underlying need in the delusion
Mania Treatment: The underlying need with delusions of persecution is the
need to feel safe
Mania Treatment: The underlying need with delusions of grandeur is the
need to feel good about self
Mania Treatment: Set ___________ and be ______________
limits; consistent
Mania Treatment: They feel most secure in
one-on-one relationships
Mania Treatment: Remove
hazards (no cigarettes-1 or 2 then monitor)
Mania Treatment: Stay with the client as
anxiety increases
Mania Treatment: These clients need
a structured schedule
Mania Treatment: Provide _______________ to replace _____________________________
activity; non-purposeful activity
Mania Treatment: Supply __________________ because they are _________________________
finger foods; too busy to stop and eat
Mania Treatment: Walk with client during
meals
Mania Treatment: Don't forget about ________________ because this client can become ____________________________________
fluids; dangerously dehydrated
Mania Treatment: Make sure dignity is
maintained
Mania Treatment: ECT treatment can induce
a tonic clonic seizure
Mania Treatment: ECT treatment is used for clients with
severe depression
Mania Treatment: Prior to ECT treatment, what needs to happen?
-client needs to be NPO
-client needs to void
-atropine is given (prevent aspiration)
-consent is signed
-succinylcholine (Anectine) is given (relax muscles)
Mania Treatment: ECT treatments are given in a
series of treatments depending on the client's response
Mania Treatment: Following ECT treatment, what must be done?
-position client on side (prevent aspiration)
-stay with the client
-reorient them repeatedly
-return to day-to-day activities ASAP
Mania Treatment: What is expected post ECT treatment?
temporary memory loss
IMPORTANT TO REMEMBER: With psych patients,
get people involved and active!!
Schizophrenia: Signs/Symptoms
-focus is inward (they create their own world)
-inappropriate affect, flat affect, or blunted affect
-disorganized thoughts (looseness of associations)
-ineffective communication skills
-concrete thinking (don't say "clean your plate")
-religiosity
-delusions
-hallucinations
Schizophrenia: What is one of their biggest problems?
communication
Schizophrenia: What specific communication problems do they have?
-echolalia
-neologism
-word salads
Schizophrenia: What is echolalia?
hearing a word and repeating it
Schizophrenia: What is neologism?
making up new words that have special meaning to the client, but NOT to the nurse
Schizophrenia: What should you do when client expresses neologism?
seek clarification (ex. I don't understand)
Schizophrenia: With neologism, what do these words mean?
nothing
Schizophrenia: What are the most common hallucinations that these clients have?
auditory
Schizophrenia: Treatment includes
-decreasing stimuli
-frequent observation
-frequent orientation
-reality based conversation
-observing for hallucinations
Schizophrenia Treatment: When observing, make sure
you don't look suspicious (physically go in the room-no peeking)
Schizophrenia Treatment: With frequent orientation, it's important to remember that
although client may know person, place, and time, delusions may still occur
Schizophrenia Treatment: When observing for hallucinations, make sure you
warn them before touching them
Schizophrenia Treatment: When observing for hallucinations, make sure you don't
refer to the voices as "they" because this makes the hallucinations seem real
Schizophrenia Treatment: Pertaining to hallucinations, let the client know that you
do NOT share the perception
Schizophrenia Treatment: Hallucinations are connected to
times of anxiety
Schizophrenia Treatment: Get these patients
involved in an activity
Schizophrenia Treatment: Elevate
the head of the bed
Schizophrenia Treatment: Turn off
the TV
Schizophrenia Treatment: You should offer reassurance because
the client is frightened
Schizophrenia Treatment: The nurse should observe for command hallucinations, these are
auditory hallucinations that command the client to hurt themselves or others
Schizophrenia Treatment: Command hallucinations are often frightening for the client and can signal
a psychiatric emergency
Paranoid Personality Disorder: Signs/Symptoms
-always suspicious for no reason
-distrust of others
-can't explain away their delusions or false beliefs
-pathologic jealousy
-hypersensitive to comments or actions
-can't relax
-no humor
-unemotional
-abnormal anger response, responds w/rage when
provoked
Paranoid Personality Disorder: Treatment includes
-being reliable (do what you say to build trust!)
-being honest
-consistent nurses and brief visits
-being matter-of-fact
-respecting personal space
-being careful with touch
-don't mix medications
-may need to give sealed foods
-restraints [Show Less]