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Hello Class of 2007, Welcome to our blog community. This is our area to share information, resources, ask and answer questions. You will have fellow students, past students, and many other assets available to you through this site. Everyone is encouraged to discuss and problem solve here. Check back frequently as we post sample questions and links to relevant sites. We are on the same journey, let's discover it together.
Hello Class of 2007, Welcome to our blog community. This is our area to share information, resources, ask and answer questions. You will have fellow students, past students, and many other assets available to you through this site. Everyone is encouraged to discuss and problem solve here. Check back frequently as we post sample questions and links to relevant sites. We are on the same journey, let's discover it together.
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First part: questions 1-10
N5 Fall 06
Study Guide – Exam #4
1. Describe communication techniques appropriate for use with a client exhibiting paranoid delusions.(p 401 Box 20.3)
-Be open, honest, and reliable in interactions to reduce suspiciousness.
-Respond to suspicions in a matter-of-fact and calm manner.
-Ask the clients to describe the delusions, for instance, " Who is trying to hurt you?"
-Avoid arguing about the content but interject doubt when appropriate, for instance, " I don't think it would be possible for that petite girl to hurt you."
-Focus on feelings the delusions generate, i.e., "It must fell frightening to think there is a conspiracy against you."
-Once a client describes a delusion, do not dwell on it. Rater, focus conversation on more reality based topics. If the client obsesses about delusions, set firm limits on the amount of time you will devote to talking about them.
-Observe for events that trigger delusions. If possible, discuss these with the client
-Validate if part of the delusion is real, for instance, " Yes, there was a man at the nurse's station, but I did not hear him talk about you."
2. What patient education should a nurse give to a client who has the side effect of orthostatic hypotension.
-Get up gradually in the morning. Take 5 minutes to get up and use support. Perform isometric exercises before moving.
-Advise client to dangle feet before getting out of bed to prevent dizziness and subsequent falls.
-Avoid hot showers or excessive heat. Use air conditioners.
-Avoid straining at stool ( because this may lower the blood pressure)
-Eat frequent small meals. Avoid sudden standing after eating.
-Sleep with head of bed elevated about 15-20 degrees (4-6 inches). This maneuver increases blood volume and after a few days, is helpful. It is also helpful in that it may reduce supine hypertension (sometimes BP is too high lying flat, and too low standing up). Try to be up during the day, not lying in bed. Reconditioning may be helpful for persons who have been on bed rest for long periods of time.
-Take in extra amounts of salt - about 10 mg/day total. Another way to get extra salt is to use salt containing beverages (i.e. gatorade) If you start to have trouble breathing or get excessive swelling at the ankles, you may have to use less than 10 gm. Similarly, be careful not to overdo it and end up with hypertension.
3. A client with paranoid schizophrenia has difficulty with medication compliance. What options might be available to increase compliance? (p 414 -419)
-The first thing to remember is that someone that is paranoid has trust issues. So the first thing is to try and establish trust and to make sure that when given meds that you open the package in front of them.
-Side effects of medications (atypical antipsychotics) can lead to nonadherence to medications. Educating clients regarding side effects (extreme fatigue or weakness) - how long they last and what actions can be taken that can give increased sense of control over symptoms.
-Evaluate medication response with the physician in the hospital to identify drugs and dosages that have increased therapeutic value and decreased side effects.
-Use long-acting injectable forms. (this eliminates the need to take pills everyday such as "depot" or Decanoate".
-Decanoate is a type of drug administered by injection that has a much longer length of effect than traditional injection. It is frequently used in areas where patient compliance may be an issue, such as psychiatry.
-i.e. Fluphenazine (Decanoate)
4. Describe a characteristics of a client with catatonic schizophrenia and associated priority interventions.
-Catatonic Schizophrenia
-It is characterized by catatonic stupor, evidenced by extreme psychomotor retardation and posturing; catatonic excitement and extreme psychomotor agitation with purposeless movements that may harm self or others. Echolalia, echopraxia are also common manifestation (ATI p122)
Priority Interventions :
a) Catatonia : Withdrawn Phase
-This essential feature of catatonia is abnormal motor behavior. Clients show either extreme psychomotor retardation ( with mutism, even stupor). Other behaviors are posturing, waxy flexibility, stereotyped behavior, extreme negativism, or automatic obedience, echolalia and echopraxia.
-Self Care Needs - When client is extremely withdrawn, physical needs take priority. A client may need to be hand fed or tube fed to maintain adequate nutritional status. Because normal control over bladder and bowel functions may be interrupted, an assessment of urinary or bowel retention is essential, and the appropriate interventions must be applied.
-Milieu Needs - The client may be on a continuum from decreased spontaneous movement to complete stupor. Waxy flexibility or the ability to hold distorted posture for extensive periods is often seen. Caution is advised because even after holding for long periods, the client may suddenly and without provocation show brief outburst of gross motor activity in response to inner hallucinations, delusions and change in neurotransmitter levels.
B) Catatonia : Excited Phase
-Counseling : Communication Guidelines - In excited or acute stage, the person talks or shouts continually and verbalizations may be incoherent. Therefore, the nurse's communication needs to be clear, direct and to reflect concern for the safety of the client and others.
-Self care needs - Client can be completely exhausted due to intense hyperactivity. May die if medical attention is not available. Most often IM antipsychotic agent is administered. During this time, client requires additional fluids, calories and rest.
5. Describe a client who suffers a dystonic reaction after receiving a traditional antipsychotic medication. What are priority interventions (including possible medications).
-Dystonic reactions are adverse extrapyramidal effects that often occur shortly after the initiation of neuroleptic drug therapy. Dystonic reactions (i.e. dyskinesias) are characterized by acute contractions of tongue, face, neck, back (tongue and jaw first).
-Opisthotonos - titanic heightening of entire body, head and belly up.
-Oculogyric crisis - eyes looked upward.
-Priority Interventions :
-First choice : Benadryl (Diphenhydramine hydrochloride) 25-50 mg IM/Iv. Relief occurs in minutes.
-Second choice : Benztropine, 1-2 mg IM/IV.
-Prevent further dystonias with any anticholinergic agent in Table 20-10 p 410 ( Artane, Cogentin, Akineton, Kemadrin, Parlodel).
-Experience is very frightening. Take client to quiet area and stay with the client until medicated (Text p408).
6. Describe common AND dangerous side effects of traditional antipsychotic medications including the drug trifluoperazing (Stelazine).
Most common side effects :
-Extrapyramidal effect - parkinsonism, dystonia, akathisia, tardive dyskinesia
-Anticholinergic effects - dry mouth, blurred vision, orthostatic hypotension, lowered seizure threshold
Dangerous side effect :
-Neuroleptic Malignant syndrome and agranulocytosis.
7. Discuss the characteristics of a client who is using an “idea of reference.”
p 413
-A client having paranoid schizophrenia uses ideas of reference. These people are paranoid and are unable to trust the actions of those around them and so they are usually guarded, tense and reserved. A common defense used by paranoid individuals to maintain self-esteem is to disparage others and dwell on shortcomings of others. The client frequently misinterprets the messages of others or give private meaning to the communication of others called ideas of reference. i.e. If a client sees his primary nurse talking to the physician, he might believe that they are planning to harm him in some manner.
8. Describe the diagnostic criteria for disorganized schizophrenia along with priority nursing interventions. p 415
-A person diagnosed with disorganized schizophrenia may have marked looseness of associations, inappropriate affect, bizarre mannerisms, and disorganized speech. They may also display extreme social withdrawal. Typical behaviors include posturing, grimacing or giggling and mirror gazing.
Priority Nursing intervention :
-The client is too disorganized to carry out simple ADL's, so assisting with self care needs. The nurse should encourage optimal level of f unctioning, preventing further regression, and offering alternatives for inappropriate behaviors whenever possible.
9. Prior to a “first break” or onset of schizophrenia, a prodromal stage exists. Describe characteristics of that prodromal stage.
-These begin 1 month to 1 year before the first psychotic episode and include increased anxiety, evidence of a thought disorder, such as poor concentration, inability to keep out intrusive thoughts, attaching symbolic meaning to ordinary events, and misinterpretation of others' action or words. In the later part of the prodromal stage the client may experience emotional and physical withdrawals, hallucinations, delusions, odd manerisms, preoccupation with religion, neologisms, preoccupation with homosexual themes.
10. Compare and contrast the conditions of delirium and dementia.
-Delirium is characterized by a disturbance of consciousness and a change in cognition, such as impaired attention span, disorentation and confusion, that develop over a short period of time and fluctuates throughout the day. It is always secondary to another condition. It is transient and recovery occurs when the cause is correctec. Delirium can affect up to half of all hospitalized and elderly medically ill people in any one time and up to 60% to 80% of all dementia in the U.S.
-Amnestic disorder is characterized by loss of both short and long term memory. Reversible cases are usually secondary to other processes (ex. tumors, trauma, infections, toxic, disturbances, vitamin deficiencies), which is treated, allow the dementia to improve. Some secondary dementias such as HIV encephalopathy are progressive.
-Most irreversible dementias are primary dementias (such as Alzheimer's disease, Pick's disease, multi-infarct dementias) and have no cure. Primary dementias are progressive. The person shows a progressive decline in ADL's, memory, and personality disorganization.
Second part : questions 11-20
Work in progress!
11. Describe priority assessment questions for the client who describes auditory hallucinations in the form of voices telling him to “do things.”
12. Describe the severe antipsychotic medication side effect of neuroleptic malignant syndrome and priority nursing actions.
13. Compare and contrast the expected levels of functioning (as expressed in GAF, Global Assessment of functioning) for clients with paranoid ideation, disorganized schizophrenia, catatonic schizophrenia, and undifferentiated schizophrenia.
14. Discuss the various forms of hallucinations.
15. Describe priority nursing interventions for clients with delirium. …with dementia.
16. Compare and contrast the four stages of Alzheimer’s disease.
17. Describe nursing diagnoses for a client who is homeless and severely mentally ill with substance abuse problems.
18. Describe alternative treatments for clients with chronic pain.
19. Discuss the stages associated with grief and appropriate nursing interventions.
20. Describe characteristics of anticipatory grieving.
Third part : questions 21-34
Work in progress!
21. Discuss the phenomenon of “visualizations” as part of the grieving process.
22. Describe characteristics of Attention Deficit Hyperactive Disorder (ADHD).
23. Discuss adolescent reactions of parents’ divorcing and appropriate nursing interventions.
24. Describe autistic disorders, conduct disorders, oppositional defiant disorders.
25. What childhood circumstances are most closely linked to dissociative identity disorder.
26. Describe characteristics of “resiliency” in children and factors that support resiliency.
27. Describe the sleep disorders of sleep paralysis,k sleep-related bruxism, night terror disorder, and REN sleep behavior disorder.
28. Describe characteristics of adult attention deficit hyperactivity disorder.
29. Discuss the diagnosis of gender identity disorder and possible medical therapeutic interventions.
30. Discuss suicide risk in elderly clients.
31. Describe side-effects of tricyclic antidepressants that should be closely observed for in the elderly.
32. Review common alternative treatments such as aromatherapy, vitamin megadoses, acupuncture, herbs and homeopathy and massage.
33. Describe the purpose and common side effects (if any) of ginko, valerian, SAMe and St. John’s Wort.
34. Define the following:
loose associations
neologisms
anhedonia
concrete thinking
thought withdrawal
thought insertion
aphasia
apraxia
anhedonia
agnosia
confabulation
akathisia
tardive dyskinesia
pedophilia
exhibitionism
fetishism
voyeurism
impulsivity
hyperactivity
inattention
defiance
Thanks Rupert!
thanks rupert!!!
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