Hesi HintsTaken from Mosby book

Therapeutic CommunicationBasic communication principles:

Establish trustBe nonjudgmentalOffer selfBe empathetic, not sympatheticUse active listeningAccept and support client’s feelingsClarify and validate client’s statementsUse matter of fact approach

ECTNausea is a common complaint after ECT. Vomiting by an unconscious client can cause aspiration. Because post ECT clients are unconscious, nurses must observe closely and maintain patent airway

PHOBIAWhen a client describes a phobia, the nurse should acknowledge the feeling . once trust is established , a densitization process may happenThis includes:

Assist client to recognize the factors associated with feared stimuliTeach and practice alternative coping strategiesExpose client progressively to feared stimuliProvide positive reinforcement whenever a decrease in phobic reaction occursNurse should place an anxious client where there are reduced environmental stimuli

OCDCompulsive acts are used in response to anxiety. Nurse can help alleviate anxiety:Actively listen to client’s obsessionsAcknowledge the effects that ritualistic acts have on clientBe empathicDo not judge

PTSDNurse should: actively listenAssess suicide riskAssist client to develop objectivity about event and problem solve regarding possible means of controlling anxietyEncourage group therapy with other clients who have experienced similar traumatic eventsSOMATOFORM DISORDERS

Be aware of your own feelings when dealing with this type of clientIt is hard to be nonjudgementalThe pain is real to the person experiencing itThese disorders cannot be explained medically; they result from internal conflictThe nurse shouldacknowledge the symptom or complaintReaffirm that diagnostic test results reveal no organic pathologyDetermine the secondary gains acquired by the client

1

PERSONALITY DISORDERLongstanding behavioral traits that are maladaptive responses to anxiety and that cause difficulty in relating to and working with other individualsPersons with personality disorders are usually comfortable with their disorders and believe that they are right and the world is wrongThese individuals usually have very little motivation to change

EATING DISORDERS

People with anorexia nervosa gain pleasure from providing others with food and watching them eat. These behaviors reinforce their perception of self control do not allow these clients to plan or prepare food for unit based activities

Individuals with bulimia often use syrup of ipecac to induce vomiting. If ipecac is not vomited and is absorbed, cardiotoxicity may occur and can cause conduction disturbanced, cardiac dysrhyhthmias, and circulatory failure. Because heart failure is not usually seen in this age group, it is often overlooked. Assess for edema and listen to breath sounds.

Physical assessment and nutritional support are a priority; the physiologic implications are great. Nursing interventions should increase self esteem and develop a positive body imageBehavior modification is useful and effective. Family therapy is most effective because issues of control are common in these disordersTherapy is usually long term

DEPRESSION

The most important signs and symptoms of depression are a depressed mood with a loss of interest in the pleasures of life. Other symptoms:

Significant change in appetiteWeight loss or gainInsomnia or hypersomniaFatigue or lack of energyFeelings of hopelessness, worthlessness, guilt, or overresponsbilityLoss of ability to concentrate or think clearlyPreoccupation with death or suicide

Depressed clients have difficulty hearing and accepting compliments because of their lowered self concept. Comment on signs of improvement by noting the behavior, “ I notice you combed your hair today”, not “you look nice today”

The nurse knows depressed clients are improving when they begin to take an interest in their appearance or begin self care activities

SUICIDE

Nurse should suspect an imminent suicide attempt is a depressed client become better. When dealing with a depressed client, nurse should assist with personal hygiene tasks and encourage client to initiate grooming activitiesSIT QUIETLY with patient.

MEDSAntianxiety- causes sedation, drowsinessAntidepressants cause anticholinergic SEMAOis- cause hypertensive crisis

2

Lithium very important drug to know~ affects kidneysTherapeutic range between .5 and 1.5

EPS- know these: acute dystonic reaction, akithesia , parkinsonisms

TD- tardive dyskinesia- irreversible

MANIC patients can become argumentative- avoid arguing with themOffer noncompetitive physical activitiesReduce stimuliPlace him in quiet part of unit

If client becomes abusive:

Redirect negative behaviorStay calm, be firmDon’t get defensiveDon’t argueSuggest a walkSet limitsMay need to seclude or give PRN if client becomes out of control

SCHIZOPHRENIA

Do not argue with a client who is delusionalThey may need a PRN if they are hearing voicesTrust is basis for all interactions with these patients Be supportive and nonjudgmentalStress increases anxietyDo not agree that you hear voices, but acknowledge your observation, for eg, You look like you are listening to something

ALCOHOLISM

Use rationalization and denialThey must be confronted so that they become accountableNutrition is a priority with alcoholicsThey can have DTS within 12 to 36 hours after last intake of alcohol. Librium or ativan are commonly used to treat withdrawals

ABUSE

Women who are abused may rationalize the spouse’s behavior. Be sure to give her the number of a shelter or help line for future and help her to develop a safety planRape victims are at high risk for PTSDImmediate interventions to diminish distress is vital

Legal responsibility of the nurse. In children, the nurse is legally responsible for reporting all suspected cases of abuse.

3