Nursing Tips

Phases of a helping/therapeutic relationship: Orientation, Working, and Termination. During Orientation, parameters are established: Goal of relationship; Meeting location, frequency, and length; Confidentiality; Duration of relationship.

Phases of Helping Relationships

Cathy Parkes

Phases of a helping (therapeutic) relationship with a patient include Orientation, Working, and Termination.

2 comments

Phases of Helping Relationships

Cathy Parkes

Phases of a helping (therapeutic) relationship with a patient include Orientation, Working, and Termination.

2 comments
KEY points about Alcoholics Anonymous (AA).

Key Principle from Alcoholics Anonymous

Cathy Parkes

KEY points about Alcoholics Anonymous (AA).

Key Principle from Alcoholics Anonymous

Cathy Parkes

KEY points about Alcoholics Anonymous (AA).

Major Depressive Disorder (MDD) has 3 phases: Acute, Continuation, Maintenance. Patient is at greatest risk for suicide during the Acute phase of MDD.

Major Depressive Disorder Phases

Cathy Parkes

Major Depressive Disorder (MDD) has 3 phases: Acute, Continuation, Maintenance. Patient is at greatest risk for suicide during the Acute phase of MDD.

Major Depressive Disorder Phases

Cathy Parkes

Major Depressive Disorder (MDD) has 3 phases: Acute, Continuation, Maintenance. Patient is at greatest risk for suicide during the Acute phase of MDD.

Key nursing interventions for patients with Alzheimer's Disease: Provide frequent reorientation; Provide consistency with caretakers; Keep communication short, simple, and clear.

Alzheimer's Disease Key Interventions

Cathy Parkes

Key nursing interventions for Alzheimer's Disease: Provide frequent reorientation, consistency with caretakers; Keep communication short, simple, and clear.

Alzheimer's Disease Key Interventions

Cathy Parkes

Key nursing interventions for Alzheimer's Disease: Provide frequent reorientation, consistency with caretakers; Keep communication short, simple, and clear.

For patients with eating disorders, the nurse should stay with them during meals and for at least an hour following.

Eating Disorders

Cathy Parkes

Bulimia Nervosa is an eating disorder characterized by binge eating followed by compensatory measures to avoid weight gain (e.g., vomiting, laxative use, extreme exercise). Anorexia Nervosa is an eating disorder characterized by...

Eating Disorders

Cathy Parkes

Bulimia Nervosa is an eating disorder characterized by binge eating followed by compensatory measures to avoid weight gain (e.g., vomiting, laxative use, extreme exercise). Anorexia Nervosa is an eating disorder characterized by...

Word Salad is a type of disorganized speech seen in schizophrenia (e.g., "happy green friendly running monkeys").

Word Salad

Cathy Parkes

Word Salad is a type of disorganized speech seen in schizophrenia (e.g., "happy green friendly running monkeys").

Word Salad

Cathy Parkes

Word Salad is a type of disorganized speech seen in schizophrenia (e.g., "happy green friendly running monkeys").

The timing of nursing interventions for the restrained patient is crucial! Be sure to assess the patient's status every 15 minutes.

Nursing Interventions for the Restrained Patient

Cathy Parkes

The timing of nursing interventions for the restrained patient is crucial! 1) Assess the patient's status every 15 minutes. 2) Offer fluids, ROM exercises, and toileting every 2 hours. 3)...

Nursing Interventions for the Restrained Patient

Cathy Parkes

The timing of nursing interventions for the restrained patient is crucial! 1) Assess the patient's status every 15 minutes. 2) Offer fluids, ROM exercises, and toileting every 2 hours. 3)...

Sublimation is marked by an individual transforming unacceptable impulses into socially acceptable behaviors.

Sublimation

Cathy Parkes

Sublimation is marked by an individual transforming unacceptable impulses into socially acceptable behaviors. 

Sublimation

Cathy Parkes

Sublimation is marked by an individual transforming unacceptable impulses into socially acceptable behaviors. 

Progressive Relaxation involves tightening and relaxing muscle groups. Guided Imagery helps a patient relax by visualizing detailed images. Meditation can improve health and well-being by helping an individual focus on a word or sensation.

Therapeutic Relaxation Techniques

Cathy Parkes

Progressive Relaxation involves tightening and relaxing muscle groups. Guided Imagery helps a patient relax by visualizing detailed images. Meditation can improve health and well-being by helping an individual focus on...

Therapeutic Relaxation Techniques

Cathy Parkes

Progressive Relaxation involves tightening and relaxing muscle groups. Guided Imagery helps a patient relax by visualizing detailed images. Meditation can improve health and well-being by helping an individual focus on...

Patients always have the right to refuse medication, even if they have been involuntarily admitted (except in an emergency)! Support the patient's right to autonomy.

Right to Refuse Medication

Cathy Parkes

Patients always have the right to refuse medication, even if they have been involuntarily admitted (except in an emergency)! Support the patient's right to autonomy.

Right to Refuse Medication

Cathy Parkes

Patients always have the right to refuse medication, even if they have been involuntarily admitted (except in an emergency)! Support the patient's right to autonomy.

Neuroleptic Malignant Syndrome (NMS) is a life-threatening condition by the use or withdrawal of antipsychotic medications.

Neuroleptic Malignant Syndrome (NMS)

Cathy Parkes

Neuroleptic Malignant Syndrome (NMS) is a life-threatening condition by the use or withdrawal of antipsychotic medications.

Neuroleptic Malignant Syndrome (NMS)

Cathy Parkes

Neuroleptic Malignant Syndrome (NMS) is a life-threatening condition by the use or withdrawal of antipsychotic medications.

Complicated grief is that which lasts longer than a year and interferes with the individual's daily functioning.

Complicated Grief

Cathy Parkes

Complicated grief is that which lasts longer than a year and interferes with the individual's daily functioning.

Complicated Grief

Cathy Parkes

Complicated grief is that which lasts longer than a year and interferes with the individual's daily functioning.

Assertive Community Treatment (ACT) is useful for individuals with severe and persistent schizophrenia or major depressive disorder with psychosis.

Assertive Community Treatment (ACT)

Cathy Parkes

Assertive Community Treatment (ACT) is useful for individuals with severe and persistent schizophrenia or major depressive disorder with psychosis.

Assertive Community Treatment (ACT)

Cathy Parkes

Assertive Community Treatment (ACT) is useful for individuals with severe and persistent schizophrenia or major depressive disorder with psychosis.

Bipolar I Disorder is characterized by episodes of severe mania and depression. Bipolar II Disorder is marked by episodes of hypomania (less severe than true mania) and depression.

Bipolar Disorders: I and II

Cathy Parkes

Bipolar I Disorder is characterized by episodes of severe mania and depression. Bipolar II Disorder is marked by episodes of hypomania (less severe than true mania) and depression.

Bipolar Disorders: I and II

Cathy Parkes

Bipolar I Disorder is characterized by episodes of severe mania and depression. Bipolar II Disorder is marked by episodes of hypomania (less severe than true mania) and depression.

Any patient taking psychiatric medications should avoid St. John's wort, as this increases the risk for serotonin syndrome.

St. John's Wort and Serotonin Syndrome

Cathy Parkes

Any patient taking psychiatric medications should avoid St. John's wort, as this increases the risk for serotonin syndrome.

St. John's Wort and Serotonin Syndrome

Cathy Parkes

Any patient taking psychiatric medications should avoid St. John's wort, as this increases the risk for serotonin syndrome.

How to recognize behaviors that may indicate intention to commit suicide! These include giving away prized possessions, sudden improvement of mood or calmness, and making preparations.

Indications of Intent to Commit Suicide

Cathy Parkes

Recognize behaviors that may indicate an intention to commit suicide . For example: Giving away prized possessions, sudden improvement of mood or calmness, and/or making of final preparations.

Indications of Intent to Commit Suicide

Cathy Parkes

Recognize behaviors that may indicate an intention to commit suicide . For example: Giving away prized possessions, sudden improvement of mood or calmness, and/or making of final preparations.

Alcohol withdrawal occurs within 4 to 12 hours of cessation of heavy, prolonged alcohol abuse. Symptoms peak ~24 to 72 hours after the patient’s last drink. Be sure to ask the patient when they had their last drink!

Alcohol Withdrawal

Cathy Parkes

Alcohol withdrawal starts 4-12 hours after last drink and peaks at 24-48 hours. Be sure to ask the patient when they had their last drink!

Alcohol Withdrawal

Cathy Parkes

Alcohol withdrawal starts 4-12 hours after last drink and peaks at 24-48 hours. Be sure to ask the patient when they had their last drink!

Electroconvulsive therapy (ECT) is used to treat severe depression that is unresponsive to drug therapy.  It is used in conjunction with drug therapy. It does not replace the need for medication!

Electroconvulsive Therapy

Cathy Parkes

Electroconvulsive therapy (ECT) is used to treat severe depression that is unresponsive to drug therapy.

Electroconvulsive Therapy

Cathy Parkes

Electroconvulsive therapy (ECT) is used to treat severe depression that is unresponsive to drug therapy.

Bipolar patients & mania

Bipolar patients & mania

Cathy Parkes

For bipolar patients experiencing mania: be sure to provide high-calorie portable snacks (finger foods).

Bipolar patients & mania

Cathy Parkes

For bipolar patients experiencing mania: be sure to provide high-calorie portable snacks (finger foods).

For a patient at risk for suicide:  Do NOT place a patient at risk for suicide in a private room. Provide 1:1 observation at all times.

Patient at risk for suicide

Cathy Parkes

For a patient at risk for suicide: Do NOT place a patient at risk for suicide in a private room. Provide 1:1 observation at all times.

Patient at risk for suicide

Cathy Parkes

For a patient at risk for suicide: Do NOT place a patient at risk for suicide in a private room. Provide 1:1 observation at all times.

A nurse should always protect patient privacy per HIPAA laws, except when there is a duty to warn! If the patient poses a serious threat to another person, the nurse must protect the third party!

Duty to Warn

Cathy Parkes

A nurse should always protect patient privacy per HIPAA laws, except when there is a duty to warn! 

Duty to Warn

Cathy Parkes

A nurse should always protect patient privacy per HIPAA laws, except when there is a duty to warn! 

Criteria for hospitalization of patients with Anorexia Nervosa:  Body weight < 75% of ideal body weight; Body fat < 10%; Heart rate < 45/min; SBP < 90mmHg; Body temp < 96 degrees F; EKG abnormalities

Criteria for hospitalization of patients with anorexia

Cathy Parkes

Criteria for hospitalization of patients with Anorexia Nervosa.

Criteria for hospitalization of patients with anorexia

Cathy Parkes

Criteria for hospitalization of patients with Anorexia Nervosa.

Ask your patient directly about hallucinations, including command hallucinations which are when a patient hears a voice instructing them to perform an action.

Patient with hallucinations

Cathy Parkes

Ask your patient directly about hallucinations, including command hallucinations. Implement 1:1 observation if indicated!

Patient with hallucinations

Cathy Parkes

Ask your patient directly about hallucinations, including command hallucinations. Implement 1:1 observation if indicated!

Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Dementia vs. delirium

Cathy Parkes

Dementia vs delirium: Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Dementia vs. delirium

Cathy Parkes

Dementia vs delirium: Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Key S&S of bulemia nervosa: normal (or slightly higher) body weight, calluses on knuckles, parotid gland enlargement, tooth erosion.

Bulimia Nervosa

Cathy Parkes

Key S&S of bulimia nervosa: normal (or slightly higher) body weight, calluses on knuckles, parotid gland enlargement, tooth erosion.

Bulimia Nervosa

Cathy Parkes

Key S&S of bulimia nervosa: normal (or slightly higher) body weight, calluses on knuckles, parotid gland enlargement, tooth erosion.

POSITIVE symptoms in schizophrenia include the presence of things that are NOT normally present. This includes:  Hallucinations, delusions, paranoia, speech alterations, abnormal body movements

Positive Schizophrenia Symptoms

Cathy Parkes

POSITIVE symptoms in schizophrenia include the presence of things that are NOT normally present.

Positive Schizophrenia Symptoms

Cathy Parkes

POSITIVE symptoms in schizophrenia include the presence of things that are NOT normally present.

Donepezil is a KEY medication used for Alzheimer's disease. It does NOT cure the disease, but it may improve memory, cognition, and an individual’s ability to perform ADLs.

Donepezil & Alzheimer's

Cathy Parkes

Donepezil is a KEY medication used for Alzheimer's disease. It does NOT cure the disease, but it may improve memory, cognition, and an individual’s ability to perform ADLs.

Donepezil & Alzheimer's

Cathy Parkes

Donepezil is a KEY medication used for Alzheimer's disease. It does NOT cure the disease, but it may improve memory, cognition, and an individual’s ability to perform ADLs.

Assault vs. Battery: Remember A before B! Assault is threatening a patient, Battery is following through with that threat.

Assault versus Battery

Cathy Parkes

Assault vs. Battery Remember A before B! Assault is threatening a patient, Battery is following through with that threat.

Assault versus Battery

Cathy Parkes

Assault vs. Battery Remember A before B! Assault is threatening a patient, Battery is following through with that threat.

ADHD medications (e.g. methylphenidate and amphetamine mixtures) cause decreased appetite and weight loss in children.  Key Nursing Intervention: Monitor child's weight during therapy!

ADHD Medication and Children's Weight

Cathy Parkes

ADHD medications cause decreased appetite and weight loss in children.

ADHD Medication and Children's Weight

Cathy Parkes

ADHD medications cause decreased appetite and weight loss in children.

A patient with borderline personality disorder: Exhibits SPLITTING behavior (i.e. characterizes people/things as ALL good or ALL bad). Engages in impulsive behavior. Is at high risk for self-harm! Provide for patient safety.

Splitting Behavior

Cathy Parkes

A patient with borderline personality disorder exhibits SPLITTING behavior, engages in impulsive behavior, and is at high risk for self-harm.

Splitting Behavior

Cathy Parkes

A patient with borderline personality disorder exhibits SPLITTING behavior, engages in impulsive behavior, and is at high risk for self-harm.

Antisocial personality

Antisocial personality

Cathy Parkes

An antisocial personality disorder does NOT mean an individual doesn't like to be around people. 

Antisocial personality

Cathy Parkes

An antisocial personality disorder does NOT mean an individual doesn't like to be around people. 

Suppression is VOLUNTARY denial of  thoughts or feelings. Repression is UNCONCIOUS (i.e. involuntary) denial of thoughts or feelings. Both are defense mechanisms used to cope with unpleasant thoughts, feelings, or behaviors.

Suppression and Repression

Cathy Parkes

Suppression is VOLUNTARY denial of thoughts or feelings. Repression is UNCONCIOUS (i.e. involuntary) denial of thoughts or feelings.

Suppression and Repression

Cathy Parkes

Suppression is VOLUNTARY denial of thoughts or feelings. Repression is UNCONCIOUS (i.e. involuntary) denial of thoughts or feelings.

Key nursing interventions for patients with Eating Disorders: Supervise patients before and after meals; Set limits on exercise; Restrict caffeine; Provide rewards for calories consumed.

Eating Disorders Key Interventions

Cathy Parkes

Key nursing interventions for patients with Eating Disorders: Supervise before/after meals; Set limits on exercise; Restrict caffeine; Provide rewards for calories consumed.

Eating Disorders Key Interventions

Cathy Parkes

Key nursing interventions for patients with Eating Disorders: Supervise before/after meals; Set limits on exercise; Restrict caffeine; Provide rewards for calories consumed.

Patient with mild anxiety, can assist patient with problem-solving/relaxation techniques. Patient with severe anxiety, problem-solving NOT realistic. Provide minimal stimulation, remain with the patient, use simple directions, administer PRN medications.

Mild and Severe Anxiety

Cathy Parkes

For mild anxiety, you can assist the patient with problem-solving and relaxation techniques. For severe anxiety, problem-solving is NOT realistic.

1 comment

Mild and Severe Anxiety

Cathy Parkes

For mild anxiety, you can assist the patient with problem-solving and relaxation techniques. For severe anxiety, problem-solving is NOT realistic.

1 comment
For a patient with Obsessive Compulsive Disorder (OCD): Set time limits for compulsive behavior. The nurse should also help the patient identify the source of anxiety (which prompts the compulsive behavior) and provide medications (ex: SSRIs) as ordered.

Obsessive Compulsive Disorder

Cathy Parkes

For Obsessive Compulsive Disorder (OCD): Set time limits. Help the patient identify source of anxiety and provide medications as ordered.

Obsessive Compulsive Disorder

Cathy Parkes

For Obsessive Compulsive Disorder (OCD): Set time limits. Help the patient identify source of anxiety and provide medications as ordered.

NEGATIVE symptoms in schizophrenia include the absence of things that normally present. Symptoms (5As): Anhedonia (inability to experience pleasure), Anergia (lack of energy), blunt Affect, Alogia (↓ speech), and Avolition (↓ motivation).

Negative Schizophrenia Symptoms

Cathy Parkes

NEGATIVE symptoms in schizophrenia include the absence of things that normally present. Symptoms (5As): Anhedonia (inability to experience pleasure), Anergia (lack of energy), blunt Affect, Alogia (↓ speech), and Avolition (↓...

Negative Schizophrenia Symptoms

Cathy Parkes

NEGATIVE symptoms in schizophrenia include the absence of things that normally present. Symptoms (5As): Anhedonia (inability to experience pleasure), Anergia (lack of energy), blunt Affect, Alogia (↓ speech), and Avolition (↓...

Lithium

Lithium

Cathy Parkes

Lithium is a mood stabilizer, used for Bipolar Disorder. Patients on lithium need adequate fluid and sodium intake! Diuretics, anticholinergics, NSAIDs are not recommended.

Lithium

Cathy Parkes

Lithium is a mood stabilizer, used for Bipolar Disorder. Patients on lithium need adequate fluid and sodium intake! Diuretics, anticholinergics, NSAIDs are not recommended.

Priority for Patients with Depression

Priority for Patients with Depression

Cathy Parkes

If a patient has depression, your PRIORITY is to assess the patient's risk of suicide and implement 1:1 observation if indicated.

Priority for Patients with Depression

Cathy Parkes

If a patient has depression, your PRIORITY is to assess the patient's risk of suicide and implement 1:1 observation if indicated.

Signs/Symptoms of PTSD

Signs and Symptoms of PTSD

Cathy Parkes

Signs/Symptoms of PTSD: flashbacks, distressing dreams, difficulty concentrating, insomnia, anxiety, irritability, detachment from others, hyper-vigilance, exaggerated startle response, feeling of guilt, and negative self-image.

Signs and Symptoms of PTSD

Cathy Parkes

Signs/Symptoms of PTSD: flashbacks, distressing dreams, difficulty concentrating, insomnia, anxiety, irritability, detachment from others, hyper-vigilance, exaggerated startle response, feeling of guilt, and negative self-image.

Transference vs. Countertransference:  Transference: Patient views nurse as being similar to an important person in his/her life.  Countertransference: Patient reminds the nurse of someone in his/her life.

Transference vs. Countertransference

Cathy Parkes

Transference vs. Countertransference: Transference: Patient views nurse as being similar to an important person in his/her life. Countertransference: Patient reminds the nurse of someone in his/her life.

Transference vs. Countertransference

Cathy Parkes

Transference vs. Countertransference: Transference: Patient views nurse as being similar to an important person in his/her life. Countertransference: Patient reminds the nurse of someone in his/her life.

Meds that Promote Alcohol Abstinence

Meds that Promote Alcohol Abstinence

Cathy Parkes

Meds that promote alcohol abstinence: disulfiram, naltrexone, acamprosate. These meds are NOT used during alcohol withdrawal!

Meds that Promote Alcohol Abstinence

Cathy Parkes

Meds that promote alcohol abstinence: disulfiram, naltrexone, acamprosate. These meds are NOT used during alcohol withdrawal!

Lithium Side Effects vs. Toxicity

Lithium Side Effects vs. Toxicity

Cathy Parkes

Lithium: fine hand tremors are an EXPECTED side effect, coarse hand tremors indicate TOXICITY.

Lithium Side Effects vs. Toxicity

Cathy Parkes

Lithium: fine hand tremors are an EXPECTED side effect, coarse hand tremors indicate TOXICITY.

SSRIs and Serotonin Syndrome

SSRIs and Serotonin Syndrome

Cathy Parkes

For patients taking SSRIs, watch for serotonin syndrome! Symptoms: agitation, hallucinations, fever, diaphoresis, tremors.

SSRIs and Serotonin Syndrome

Cathy Parkes

For patients taking SSRIs, watch for serotonin syndrome! Symptoms: agitation, hallucinations, fever, diaphoresis, tremors.

Patients in a crisis

Patients in a crisis

Cathy Parkes

When assisting a patient with a crisis, be sure to ask him/her about past ways of coping.

Patients in a crisis

Cathy Parkes

When assisting a patient with a crisis, be sure to ask him/her about past ways of coping.

Electro convulsive therapy

Electro convulsive therapy

Cathy Parkes

Short-term memory loss is EXPECTED after electroconvulsive therapy.

Electro convulsive therapy

Cathy Parkes

Short-term memory loss is EXPECTED after electroconvulsive therapy.