NUR 253 Exam 3 (2026/2027) COMPLETE QUESTIONS WITH VERIFIED CORRECT ANSWERS || 100% GUARANTEED PASS NEWEST VERSIONA+!!!

NUR 253 Exam 3 (2026/2027) COMPLETE QUESTIONS WITH VERIFIED CORRECT ANSWERS || 100% GUARANTEED PASS NEWEST VERSIONA+!!! Different ways to diagnose/treat people - ANSWER • Admit to hospital • Partially hospitalized • In day treatment settings Milieu management is a significant part of treatment - ANSWER o Goal is to manage pt affect in group context Community meetings Coping skills group Socialization groups When behaviors emerge - ANSWER o Calmly review therapeutic goals o boundaries of treatment o avoid rejection and rescuing • Assess for suicide intentions Dependent Personality Disorder - ANSWER thought to be a result of chronic physical illness, punishment, indecent behavior or independent behavior in childhood, inherited trait of submissiveness, dependent personality disorder What is important when planning their care? - ANSWER o Empathy o Independence dependent personality disorder-characteristics - ANSWER o Clingy o Submissive o Fear of separation o Difficulty making everyday decisions o Dependent on other people to do things for them o Need others to assume responsibility for the major areas in their life o Do not express any kind of disagreement o Difficulty in initiating projects or doing things on their own o Helpless or uncomfortable being alone Due to fears of being unable to care for themselves Borderline Personality Disorder- - ANSWER Thought to be a result of early abandonment which results in an unstable view of self and others Borderline personality disorder-important in planning care - ANSWER • Importance of maintaining a calm and matter of fact response • Don't give in to the persuasion of these patients trying to manipulate • Give rules, don't sugar coat, and be consistent o Behavioral contracts • Goal is to get these patients to verbalize when they want to hurt either themselves or others. Borderline personality disorder-characteristics - ANSWER o Dramatic o Instability in emotional regulation and interpersonal relationships o Impulsiveness Spending money Binge eating Sex Substance abuse Reckless driving o Identity of self-image distortions o Unstable mood and affect Borderline personality disorder-Ineffective and harming self-soothing habits - ANSWER Cutting Promiscuous sexual behavior Numbing with substance abuse (most common) Splitting (primary defense mechanism coping style): cannot incorporate positive and negative aspects of one's self or others into one image. Idealize a person at start of a new relationship and hoping this person can meet all their expectations. With the first frustration comes immediate hatred of the same person. Suicidal behaviors • Will make gestures and threats Feelings of emptiness Inappropriate and intense flashes of anger that are uncontrollable Histrionic Personality Disorder- - ANSWER ‘Earliest as 3-5 yrs of age with an overly intense attachment to parent of opposite sex parent which results in fear of retaliation of same sex parent Histrionic Personality Disorder- Know characteristics one might exhibit - ANSWER o Uncomfortable in situations where self is not the center of attention o Interactions with others is often characterized by inappropriate sexual seductive and provocative behavior o Consistently using physical appearance to draw attention to self o Self-dramatic, theatrical Exaggeration of expression and emotion o Think relationships are more intimate than they actually are o Excessive emotional and attention seeking begins in early adulthood Presents in variety of contexts Narcissistic Personality Disorder - ANSWER result of childhood neglect and criticism. Did not learn that other people can be the source of comfort and support so as adults they hide their feelings of emptiness with exterior or invulnerability of self sufficiency Narcissistic Personality Disorder-Know signs and symptoms of what a patient would appear like with this disorder – ANSWER o No sympathy for others o Excessive admiration of self o Thoughts of entitlement Everything is mine I am the best You owe it to me I'm perfect Admire me Its all about me o Obsessed with themselves o Will take advantage of others in order to achieve personal goals Make themselves look the best regardless of the cost o No thought to the feelings of others o Not fun to be around Obsessive Compulsive Disorder- - ANSWER thought to be a result of excessive parental criticism, control and shame Obsessive Compulsive Disorder- s/s that one might exhibit - ANSWER o Rigid o Stubborn o Do not fluctuate from a routine Need to close the door a certain amount of times before leaving the house o Not flexible Obsessive Compulsive Disorder-Important to them - ANSWER Detail Rules Schedules Routines Perfectionism Work Productivity Reluctant to delegate tasks • They want it done their way Antisocial Personality Disorder - ANSWER genetically linked Antisocial Personality Disorder-s/s of disorder - ANSWER o No remorse o Do not care o Deceitful o Impulsive o Irritable o Aggressive o Reckless o Disregard to safety of self or others o Irresponsible o At least 18 years of age In a child would be called conduct disorder Anorexia Nervosa:Know what this person looks like (clinical manifestations - ANSWER 1. Underweight 2. growth of fine, downy hair (lanugo) on the face and back 3. mottled, cool skin on the extremities 4. low blood pressure, pulse, and temperature. 5. These patients are consistent with a malnourished, dehydrated state. 6. Binge-purge type has similar characteristics but present with severe electrolyte imbalances due to purging. low weight caused by - ANSWER calorie restriction amenorrhea - ANSWER low weight yellow skin - ANSWER hypercarotenemia lanugo - ANSWER starvation cold extremities - ANSWER starvation peripheral edema - ANSWER hypoalbuminemia and refeeding muscle weakening - ANSWER starvation, electrolyte imbalance constipation - ANSWER starvation abnormal lab values - ANSWER starvation cardiovascular abnormalities - ANSWER starvation, dehydration, electrolyte imbalance impaired renal function - ANSWER dehydration hypokalemia - ANSWER starvation anemic pancytopenia - ANSWER starvation decreased bone density - ANSWER estrogen deficiency. low calcium intake how patients with anorexia feel, who it may affect - ANSWER feel that they are fat, though they look skeletal. High achievers in school and may have many pressures on them. Food becomes the only thing that they can control. They don't want to maintain body weight. They are malnourished and do not eat. goal for anorexic patient - ANSWER begin nutritional stabilization. When the patient is stabilized, the therapist will work with the patient on strengthening coping skills. They will work to change the patient's current body image. Exercise will be closely monitored tx plan for anorexic patient may include - ANSWER • Eating plan • Gain small increments of weight back is more realistic • Weigh daily • Food journals nursing diagnosis for anorexia - ANSWER 1. Imbalanced nutrition: less than body requirements 2. Decreased cardiac output 3. Risk for injury (electrolyte imbalance) 4. Risk for imbalanced fluid volume 5. Anxiety 6. Chronic low self esteem 7. Disturbed body image 8. Deficient knowledge 9. Ineffective coping 10. Powerlessness 11. Hopelessness outcomes for anorexia - ANSWER weight gain, weight maintenance, anxiety that is self-controlled. Short term indicators of anorexia - ANSWER caloric, fat, carbohydrate, and protein intake, sets to achievable healthy weight, selects a healthy target weight, commits to a healthy eating plan, monitors intensity of anxiety, plans coping strategies for stressful situations, verbalized self-acceptance, feelings of self-worth. how patient with anorexia may act - ANSWER Refusal to maintain body weight at or above minimally normal weight for age and height or failure to make expected weight gain during period of growth, intense fear of gaining weight or becoming fat, even though underweight, disturbance in the way body weight or shape is experienced, denial of seriousness of current low body weight, amenorrhea. • Re-feeding syndrome - ANSWER complications that occur from having the patient eat regular portions. The electrolytes will shift because the body cannot accommodate the increased calories. This can cause cardiac collapse. complications of refeeding syndrome - ANSWER • Important to monitor for electrolyte imbalances that can take place within the first week and delirium and other neurologic features afterward. bulimia nervosa - ANSWER is a type of eating disorder. People with bulimia will eat a large amount of food in a short time (binge). Then they will do something to get rid of the food (purge). They may vomit, exercise too much, or use medicines like laxatives. They are ashamed of their behaviors, but feel they have no control over them. They may be at a normal weight, underweight, or overweight because the body will hold up to 75% of calories. bulimia nervosa hx - ANSWER anorexia, depressed, problems with relationships, possible chemical deficiency. throw up for the comfort medical complications of bulimia - ANSWER • Sinus bradycardia • Orthostatic changes in BP and pulse • Cardiac arrhythmias • Cardiac arrest from electrolyte imbalances • Cardiac murmur • Elevated serum bicarb levels • Hypokalemia • Hypochloremia • Dehydration • Loss of dental arch • Diminished chewing ability • Parotid gland swelling • Esophageal tears • Severe abdominal pains • Russell's sign ( callus on knuckles from self-induced vomiting) What is the nurses role when assisting a patient who is being monitored during meal times - ANSWER Observation during and after meals to prevent purging, promote normalization of eating patterns, and maintenance of appropriate exercise. Know nursing diagnosis and assisting the patient with outcomes that deal with ineffective coping and or loneliness - ANSWER • Decreased cardiac output • Powerlessness • Chronic low self-esteem • Anxiety • Ineffective coping outcomes of tx for bulimia - ANSWER • Ineffective coping= Patient will demonstrate at least 2 coping strategies that result in adhering to a structured meal schedule. • Loneliness= Patient will maintain at least one healthy relationship. Substance abuse - ANSWER Maladaptive pattern of substance use leading to significant impairment or distress, manifested by one or more of the following: • Inability to fulfill a major role ( school, work, home) • Hazardous situations ( like driving intoxicated) • Recurrent legal or interpersonal problems • Continued use despite problems Abuse= - ANSWER that's all they focus on, that drug will interfere in ability to maintain work, unable to fulfill major roles. Substance dependence- - ANSWER 3 or more of the following in 12 months: - Presence of tolerance of drug - Presence of withdraw syndrome - Substance taken in larger amounts, a longer period than intended - Unsuccessful or persistent desire to cutdown or control use - Increase time in getting, taking, or recovering from substance - Absence from social, occupational, or recreational activities - Substance used despite knowing problem caused by substance Dependence - ANSWER withdrawal symptoms. Larger amounts for longer time, does not want to cut down on substance • Alcohol - ANSWER CNS depressant ( acts on GABA receptors, increases availability of dopamine and norepinephrine) • Opiates/Herion - ANSWER action on opiod receptors, dopamine, catecholamine, GABA syst., and glutamate. • Cocaine and Amphetamines - ANSWER increases level of norepinepherine, serotonin, and dopamine. • Tolerance- - ANSWER person physical response, when body gets used to amount of the substance that is being ingested. Person requires more substance for same effect. • Withdraw - ANSWER Body's response to a sudden discontinuance of a substance- due to a blood and tissue concentration decreased levels. Psychological, and physical symptoms depending on substance. • Alcohol intoxication s/s - ANSWER - signs- slurred speech, incoordination, unsteady gait, decreased B/P, drowsiness, stupor, Nystagmus, impaired memory or attention, sexual, mood, and judgment prob. overdose of alcohol - ANSWER coma, shock, convulsions, vomiting tx of overdose of alcohol - ANSWER If awake- Activated charcoal, check vitals every 15 min. o If in a coma- IV fluids, clear airway, gastric levage, seizure precautions, Flumazenil (Benzo antagonist) Alcohol withdrawal- - ANSWER • Cessation of alcohol with cause- n/v/anxiety, hallucinations (visual, auditory, and tactile), increased pulse (greater than 100), hand tremors, seizures (Grand Mal), sweating, psychomotor agitation, insomnia. With use that has been heavy or prolonged. (2 or more of the side effects is considered alcohol withdrawal) delirium w/ alcohol abuse - ANSWER after 5-15 years alcohol and opiates equal - ANSWER synergistic effect-will have double the effect (both are cns depressants) can be lethal alcohol and cocaine together - ANSWER can cause tachycardia. must not mix benzos for alcohol withdrawal - ANSWER helps patient relax, decreases delirium, decrease s/s, help prevent seizures when do alcohol withdrawal s/s peak - ANSWER 24-48 hours may have seizures, delirium, tachycardia, disorientation, fevers visual or tactile hallucinations Delirium from alcohol withdrawal - ANSWER medical emergency, peaks 2-3 Days after substation of alcohol. *** Immediate medical attention**** Physical complications with drug abuse- Ingest cocaine - ANSWER nasal defect, ulcers, tachycardia, respiratory arrest, arrhythmias IV physical complications with drug abuse - ANSWER AID's, hepatitis, bacterial endocarditis, renal failure, cardiac arrest, coma, seizure, resp arrest, dermatitis, pulmonary embolism, abscesses, septicemia, tetanus. inhalants-physical complications with drug abuse - ANSWER sniff/snorted, can cause resp. arrest. Abuse programs- - ANSWER AA, residential programs, tx programs= for those who have long history. goal of abuse programs` - ANSWER Aim for treatment is self responsibility, non compliance is not a factor drug for overdose of benzo's - ANSWER ex:Valium, Xanax, Ativan, Klonopin Narcan drug for alcohol overdose - ANSWER antibuse drugs to tx opiate - ANSWER methadone/methadone tapering, narcan-antagonist reverse respiratory depression, clonidine drugs to tx cocaine/crack - ANSWER antidepressants, dopamine agonist- bromocriptine Topamax - ANSWER decreases alcohol cravings campral - ANSWER helps abstain from alcohol revia - ANSWER decreases or eliminates alcohol cravings what are inhalants - ANSWER - big = sudden death because it leads to resp. then cardiac arrest. ** No antidotes, support affected systems, Toxic to heart, liver and kidneys Sudden death- anoxia, vagal stimulation, resp depression, dysrhhythmias Hallucinens- LSD/PCP - ANSWER 1 hour after ingestion, 5 min IV smoked and intranasaly LSD- causes trip PCP- anxiety, acute psychosis, tranquilizer, generalized anesthesia Marijuana - ANSWER THC- mixed depressant and hallucinogenic Euphoria, detachment, relaxation See- talkative, slowed perception of time, inappropriate hilarity, sensitivity to stimuli, anxiety, and paranoia. Overdose- cravings Use: N/V w/ chemo, decreased intraocular pressure, appetite stimulant Long Term Use causes: memory loss, difficult concentrating, lethargy, anhendonia use marijuana for med tx such as - ANSWER Use: N/V w/ chemo, decreased intraocular pressure, appetite stimulant Long Term Use causes: memory loss, difficult concentrating, lethargy, anhendonia Long Term Use causes from marijuana - ANSWER memory loss, difficult concentrating, lethargy, anhendonia Heroin Phases: - ANSWER 1st- euphoria, immediate rush- facial flushing and deep voice 2nd- "high" well being for several hours 3rd- "Nod" escape from reality, virtual unconsciousness 4th- period before withdraw, seeking more what does opium/morphine/dilaudid/fentanyl overdose look like - ANSWER Dilated pupils due to anoxia (can be constricted during intoxication), n/v/insomnia/impaired judgment , memory and attention, decrease in B/P, drowsiness, psychomotor retardation. what does cocaine overdose look like - ANSWER pupils dialated, increase B/P, N/V, insomnia, ataxia, hyperpyrexia, MI, Resp distress and death. illusions - ANSWER you see, hear, etc. something but misinterpret it (my IV tubing is rope to hang me) Delusions - ANSWER a belief that is not true: People are trying to poison me NI: - Don't whisper or laugh in the presence of the client - Don't argue or attempt to disprove delusional or suspicious thoughts - Explain all procedures and interventions, including medication management. - Provide for personal space and don't touch without warning the client - Maintain eye contact during interactions with client - Provide consistency in care - Awareness syndrome Medication management. - Neuroleptic meds/antipsychotic - Improvement 1-2 days ; full effect is 6-8 wks Reactive Attachment Disorder - ANSWER consistent pattern of inhibited & emotionally withdrawn behavior. Rarely directs attachment to behavior to caregiver & doesn't seek comfort from them when distressed. Caused by lack of bonding experience w/ primary caregiver by the age of 8 months. Related to: -severe neglect - changes in caregivers - care in institutional setting NI for reactive attachment disorder - ANSWER - Structure - Consistency - loving environment Disinhibited Social Engagement Disorder - ANSWER children come across as remarkably friendly. Demonstrate no fear of strangers & are usually willing to go off w/ people who are unknown to them. Rarely check back w/ caregivers & seem unfazed by separation Acute Stress Disorder - ANSWER right after a traumatic event before PTSD. immediately after a highly traumatic even (death, sexual violence). Symptoms develop right after the event, but a diagnosis is not made until they have persisted for 3 days. Diagnosis must be made w/in a month of the trauma. After a month the stress response will resolve or go on to become PTSD NI for Acute Stress Disorder - ANSWER - Ensure & maintain safety - establish a therapeutic relationship - assist to problem solve - connect person to supports (family, friends), - collaborate for coordination of care - refer to a licensed mental health provider - Monitor response and/or adherence to treatment. Critical incident stress debriefing (CISD) has been used for those who have suffered from acute trauma. (12-48 hrs after trauma) Adjustment Disorder - ANSWER precipitated by a stressful event, usually trauma isn't severe. **Ex. retirement, chronic illness, breakup.** Diagnosed immediately or w/in 3 months. Hallmarks are cognitive, emotional and behavioral symptoms that negatively impact normal functioning. SXS of Adjustment Disorder - ANSWER Symptoms run the gamut of all forms of distress including guilt, depression, anxiety & anger. May be combined w/ physical complaints, social withdrawal, or work or academic inhibition. **affects individuals' life** Complicated Grief Disorder - ANSWER type of adjustment disorder that addresses the needs of those who have lost a loved one w/in the past 12 months. Manifested by intense yearning/ longing for the deceased & intense sorrow & emotional pain or preoccupation w/ the deceased or the circumstances of the death. The person may feel anger, diminished sense of self, emptiness, and/or difficulty in relationships or in planning future activities Dissociative Fuge - ANSWER subtype of dissociative amnesia characterized by sudden unexpected travel & an inability to recall one's identity & information about some or all of the past. Often function adequately in their new identities by choosing simple undemanding occupations & having few social interactions •Often remember things unrelated to identity, such as how to drive a car •After return to former self, unable to remember time of the altered identity •Malingered fugue •Occurs in people trying to avoid legal, financial, or unwanted personal situations **Rare case can form a whole new identity. Risk Factors for Delirium - ANSWER Cognitive impairment older age severity of disease infection multiple comorbidities polypharmacy intensive care units unaddressed orientation visual or hearing issues fractures surgery stroke aphasia restraint use change in hospital rooms Mild and Major neurocognitive disorders - ANSWER Evidence of significant cognitive decline from previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: 1. Concern of the individual, a knowledgeable informant, or clinician that there has been significant decline in cognitive function; 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications). C. The cognitive deficits do not occur exclusively in the context of delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia). Alzheimer's disease - ANSWER Memory impairment Disturbances in executive functioning Language Problems: Anomia, Aphasia & Agnosia Apraxia: self-neglect; personality/mood changes Short-term memory fails; routine task performance diminishes; impaired judgment SXS: Diminishing language skills; disturbing behaviors Behavior problems; suspicion of others Sundowning syndrome Advanced: totally unaware of surroundings Most common causes of death Pneumonia; UTIs; infected decubitus ulcers NI: basic needs, healthy, stable Cluster A personality disorders - ANSWER Tend to demonstrate odd or eccentric behavior Paranoid- Persistent pattern of suspicion or mistrust SXS: •Guarded and mistrustful •Hypervigilant •Anticipate hostility NI: Counteract mistrust 2.Simple language/neutral/not too friendly 3.Limit setting for threatening behavior - Typical behaviors often seen by early adulthood - A possible genetic link to schizophrenia is seen in the tendency with this disorder Schizoid- withdrawn and secluded SXS: •Loner •Not invited •Doesn't talk NI: . Build trust 2. Prevent against ridicule / Do not force socialization 3. Improve functioning in community - Characteristics seen in most aspects of life by adult years - Increased incidence in people who have a family history of schizophrenia Schizotypal- withdrawn, secluded with unusual patterns of thinking and communicating SXS: Magical thinking, •Odd beliefs •Abstract conversations •Social anxiety NI: Perform careful assessment (cult, magical thinking etc?) 2. Increase functioning 3. Develop self-care skills - Typically apparent during childhood and adolescence. - Treatment is usually sought for symptoms of anxiety or depression rather than for the symptoms of the personality disorder itself **not over friendly, clear language, set limits, be protective** Cluster B personality disorders - ANSWER Dramatic, emotional, erratic behavior Antisocial- SXS: Sociopath, Hostile, punitive scheming, Easily bored, restless, Impulsive, Sexually aggressive, Compulsive self-indulgence •Rule-breaker (outfit) •Substance abuse •Charming •Deceitful (business) NI: . Prevent/reduce manipulation (flattery, seductiveness instilling guilt etc) 2. Therapeutic communication (active listening/empathy) 3. Boundaries/limits - Most people have a history of conduct disorder with an onset before the age of 15 - low socioeconomic class and crowded living situations - There tends to be a familial pattern with it occurring more often in those with first degree biologic relatives - Performs actions impulsive explosive anger and verbal assault are common - Victimize others for materialistic self-gain and are often described as con-artists. - Individuals may use alias names, or change jobs in an attempt to avoid recognition by law enforcement Narcissistic- excessive love and attention given to one's own self-image SXS: •Grandiose •Blaming-unable to apologize •Need for admiration NI: Avoid power struggle/defensiveness 2.Role model empathy 3.Use therapeutic nurse/patient relationship to practice engaging in meaningful interactions - The disorder occurs when the traits become inflexible and maladaptive enough to cause dysfunction in the person's life. - Person has a continuous need for lavish attention - Admiration with little regard for the feelings of others. - Will often exploit others for their own needs - Perceive an awesome superior self although there is an underlying feeling of inferiority and envy of others Borderline Personality disorder- SXS:Quick change from clingy behavior to angry outbursts (Jekyll and Hyde), **Splitting**, Self-mutilation •Intense romance •Substance abuse/promiscuity/suicide attempt •Fear of separation •Flirtac Cluster C personality disorders - ANSWER Anxious and fearful types of behavior Avoidant- Sensitive to rejection, Social inadequacy with intense anxiety, Lack of trust, Fear of criticism, Embarrassment in intimate relationships, Self-doubt, low self-esteem, Extreme shyness, social withdrawal - An extreme fear of ridicule or disapproval, people with this disorder tend to avoid events or situations that involve interaction with others - Educational and work opportunities may be rejected out of fear of rejection - The person is afraid that others might become aware of his or her self-doubt and tends to withdraw from relationships - This feeling is linked to feelings inferiority and incompetence. There is a perception of rejection even when it doesn't exist - Clients desire to have intimate interpersonal relationships but their guardedness often prevents them from doing so. Dependent- SXS: Insecurity, self-doubt Extreme fear of being alone Extreme reliance on others Inability to make decisions Constant need for reassurance Feelings of incompetence Self-sacrificing, submissive Extremely anxious - Demonstrate a consistent and extreme need to be cared leading to a reliance on others - Perceive selves as helpless and incompetent If one relationship ends, there is a need immediately to begin a new one - Difficulty making decisions that affect everyday life unless prompted and reassured by others - Relinquish control and priority for their own needs to someone else - Disagree with those caring for them, they do not express these feelings for fear of upsetting the other person Obsessive-Compulsive- SXS: •Arrived exactly on time •Precise time spent with each person •Social rehearsal •"perfect" work - Usually dependable but want rigid control and lack the flexibility to allow for compromise. NI: Help to accept/tolerate less than perfect 2. Help relinquish control 3. Assessment for personality disorder - ANSWER 1. Assess for suicidal or homicidal thoughts. If these are present, the patient needs immediate attention. 2. Determine whether the patient has a medical disorder or another psychiatric disorder that may be responsible for the symptoms (especially a substance use disorder). 3. View the assessment about personality functioning from within the person's ethnic, cultural, and social background. 4. Ascertain whether the patient experienced a recent important loss. Personality disorders are often exacerbated after the loss of significant supporting people or in a disruptive social situation. 5. Evaluate for a change in personality in middle adulthood or later, which signals the need for a thorough medical workup or assessment for unrecognized substance use disorder. ADHD - ANSWER Define: no known cause. Evident before 7 years of age; lasting at least 6 months. SXS: • Inappropriately inattentive • Excessive impulsiveness. • Short attention span; easy distractibility. • Squirming and fidgeting. • Hyperactivity may or may not be present. NI: • balance between energy expenditure and quiet time. • attainable goals. • less stimulation (play only one after another) • firm and consistent discipline; ignore temper tantrums. • facilitates success and satisfaction. med side effect: • Methylphenidate hydrochloride (Ritalin) is frequently used. • Although dextroamphetamine sulfate (Dexedrine) may be also given. • Pemoline ( Cylert ) Autism - ANSWER Define SXS NI Med side effect Suicide - ANSWER Assessment: PLAN, HX OF ATTEMPTS (if the pt has a plan highest priority) SXS: giving things away, positive/negative change in behavior, poor appetite, sleeping problem, difficulty concentrating, loss of interest, hopelessness, NI: one on one, remove harmful objects, keep pt busy, non-suicide contract, discuss feelings Fact witness nurse - ANSWER assesses the personality seen and heard. Book says- it is an individual considered by court to be capable and qualified to summarize and explain complex and voluminous medical records and medical terminology. Fact witness testifies regarding what was personally seen or heard, performed, or documented regarding a patient's care and testifies as to first-hand experience only. • Resources to send abused victims - ANSWER o Safe houses o Battered Women shelter We're going to protect these patients and bring them into a shelter that is private. These shelters look like regular houses in neighborhoods. They are private non-advertised shelters that are meant to not look like shelters to maintain safety. Cycles of Violence - ANSWER • Honeymoon phase: o Abuser: Loving behavior such as bringing gifts and flowers doing special things for the victim Contrite, sorry, makes promises to change o Victim: Trusting, hoping for change, wants to believe partner's promises • Tension-building Phase: o Abuser: Edgy, has minor explosions May become verbally abusive, minor hitting, slapping, and other incidents begin o Victim: Feels tense and afraid, like "walking on eggs" Feels helpless, becomes compliant, accepts blame • Serious battering phase: o The tension becomes unbearable; victim may provoke an incident to get it over with o Victim may try to cover up the injury or may look for help Elderly Abuse - ANSWER The elderly are really vulnerable to abuse by caregivers, especially if it's a family member that is a lot younger. Usually, these caregivers are stressed out; trying to work a full time job and then come home to take care of their elderly person. Priority Nursing Action for Elderly Abuse - ANSWER • Assess and treat wounds. • Ensure victim is removed from the threatening environment. • Adhere to mandatory abuse reporting laws. • Notify caseworker of the situation. • Document the occurrence, findings, actions taken, and victim's response Forensic Nursing - ANSWER It can be a SANE. Usually forensic nurses are advance practice forensic nurse, forensic nurse generalist, or nurse coroner death investigator. Expert witness nurse - ANSWER • looks at motives on the time of the crime. • They question the person standing trial. • They will interview the person and play out or reconstruct the crime to find out the motive. • Has a medical knowledge or background to describe procedures leading up to death. • Book says- recognized by court as having certain level of skill or expertise in a designated area and possesses superior knowledge because of education or specialized experience. • Usually forensic nurses with advanced degrees are called upon as expert witness. PTSD - ANSWER SXS: - avoidance - irritability - detachment - depression (suicide) - sleep disturbance - hypervigillance - guilt - poor concentration NI: - assure client feelings are normal - recognize behavior between feeling and from trauma - express feeling - monitor suicide risk - coping mechanisms - support groups Dissociative Identity Disorder - ANSWER - multiple personality disorder •One sub-personality manifested at a time •"Host" or primary personality dominant assumes given name, is passive and self-blaming, usually seeks treatment •Host unaware of other states during their dominance •Switching process changing of personalities •Unable to connect aspects of identity with past/present Dissociative Amnesia - ANSWER Inability to recall information SXS: - inability to recall important info - memory impairment can be partial- complete - may identify as different identity in a new environment, drift from place to place, develop few relationships, then return home and not be able to remember the amnesia depersonalization/derealization disorder - ANSWER •Depersonalization—focus on self •Derealization—focus on outside world •Persistent and recurrent experience of feeling detached from mental processes or body without disorientation SXS: •Unsure of personal identity or information •Derealization perceive external environment as unreal or changing (mechanical) •Unable to recognize illogical nature of feelings •Anxiety, depression, somatic complaints •Report feeling like a robot or outside observer - feeling of detachment - intact reality testing NI for Dissociative Disorders - ANSWER - orient the client - trusting relationship - encourage verbal expression of painful experiences - coping strategies - identify source of conflict - focus on strength and skill - non demanding simple routines - progress at own pace - stress relief - therapy Somatic Symptom disorder - ANSWER worry associated with maladaptive response regarding physical illness without physical illness findings. NI: -explore needs being met by physical sxs - alternative ways to meet needs - use pain scale - explore source of anxiety - assist with recognizing own feelings (client) - relaxation techniques - diversional activities - positive feedback - anti anxiety meds illness anxiety disorder - ANSWER Characterized by extreme worry & fear about the possibility of having a disease. Which leads to frequent scanning of body for signs of illness **hypochondriac** Factitous disorder - ANSWER (previously known as Munchausen syndrome) consciously pretend to be ill to get emotional needs met & attain the status of patient. Pt. w/ this disorder artificially, deliberately, & dramatically fabricate symptoms or self inflict injury with the goal of assuming the sick role. **do have actual sxs** **unexplained fever/bleeding** Delirium - ANSWER ACUTE, often EMERGENT, caused by and UNDERLYING AND USUALLY REVERSIBLE CAUSE. •Acute onset •Emergent •LOC fluctuates •Cognitive impairment •Disoriented •Agitated/fear/panic •Delusions, hallucinations, illusions •Common in hospitalized patients (elderly) •Very common post op •NEED TO KNOW PATIENT'S BASELINE COGNITION Dementia - ANSWER CHRONIC, NONEMERGENT, PROGRESSIVE, and IRREVERSIBLE Chronic •Progressive •Irreversible •Not emergent •Alzheimer's Disease (majority) •(frontotemporal lobar degeneration, Lewy bodies, vascular disease, TBI, Parkinsons, Huntingtons, HIV, substances) •Memory Impairment Causes of Delirium - ANSWER -Dehydration -Infection -Medication reaction -Electrolyte imbalance -Hypoxia NI for Delirium - ANSWER FIND UNDERLYING CAUSE •Monitor physical parameters •Keep environment clear •Enhance 5 senses (light, hearing aid, glasses) •Speak to the patient when awake (reorient) •Assess Sleep/wake cycles interrupted •Speak direct, simply •Assess pt. medications •Assess skin turgor, UA output, VS, fever, etc SXS of Dementia - ANSWER Denial •Confabulation (made up stories) •Perseveration •Aphasia (unable to understand speech) •Apraxia (inability to perform activities) •Agnosia (unable to interpret sensations) •Agraphia (unable to write) •Hyperorality (put things in mouth) •Hypermetamorphosis NI for Dementia - ANSWER Therapeutic Lies •Redirection •May need to assist with basics (Maslow) Rationale: They will not improve because it is progressive and irreversible Meds for Dementia - ANSWER Cholinesterase Inhibitors: Tacrine (cognex) - liver (no longer in U.S.) **Donepezil (aricept)- GI** Rivastigmine (Exelon)-GI Galantamine (Razadyne) •Caution if taking NSAIDs , GI problems •Can cause bradycardia and syncope Namenda (moderate to severe stages unlike other drugs) works on glutamate - May be used with cholinesterase inhibitors Hallucinations - ANSWER something is coming through one of the 5 senses that is not present at all NI: - Decrease environmental stimuli, such as loud noise extreme bright colors and flashing lights - Attempt to identify precipitating factors by asking the client what happened prior to the onset of hallucination - Monitor TV programs to minimize external stimuli - Monitor command hallucinations that may precipitate aggressive or violent behavior - Admin. prescribed meds. Know own biases about substance abuse: - ANSWER Disapproval, intolerance, morally week, angry, exploited from manipulative behaviors. See patient as willful, uncooperative, impossible to work with, may have power struggles with patients. Asses for drug abuse: - ANSWER dilated pupils/or constricted, VS, needle marks, tremors Two ? of importance to ask patient - ANSWER In last year have you ever drank or used drugs more than you meant to? Have you felt you wanted or needed to cut down on your drinking or drug use in the last year? what to know when talking to patient about drug/alcohol abuse - ANSWER Route Quantity Time last used Usual pattern of use Cocaine, crack, caffeine, nicotine-all CNS stimulants-s/s - ANSWER dryness oronasal cavity, dilation of pupils, excessive motor smoking crack-what it does, s/s - ANSWER Effects in 4-6 seconds 5-7 min high, followed by deep depression S/E: Anestetic, stimulant sex and violent behaviors Caused by Imbalance in neurotransmitters • Rape - ANSWER type of sexual assault that is non-consensual, it can be vaginal, anal, or oral penetration obtained by force or threat of bodily harm or when a person is incapable of giving consent. • Attempted rape - ANSWER physical attempts and verbal threats of rape. Attempted rape can also be something a person is charged with. #1 priority for abused patient - ANSWER safety! S.A.N.E stand for? and what do they do - ANSWER Sexual Assault Nurse Examiner these nurses are trained and certified to assess sexually assaulted victims. SANE looks at what is going on with the trauma victim. They look at the emotional state of the patient. SANE nurse may see - ANSWER • Sobbing • Smiling • Laughing • Joking • Restlessness • Agitation • Anger • Confusion • Disoriented • Calm, • Shocked • Numb • Pt may be in disbelief Physiological signs and symptoms of rape victims are: - ANSWER • Sleep disturbances • Grimacing • Twitching • Stomach pains • Nausea • Paralysis • Diarrhea • Vaginal itching • Vaginal discharge, pain, and discomfort • Emotional anxiety and fear • Denial Nursing Care for Victims of Rape- - ANSWER • Provide a private, quiet environment • Stay with victim • Assess stress level before performing treatment and procedures • Victims should not shower, bathe, douche (female), or change clothing until examination is performed. • Must give consent for the examination, photographs, lab results, release of information, and lab samples. • Look and evaluate for any STDs • Conduct pregnancy risk evaluation and prevention • Conduct crisis intervention • Follow up counseling • Perform a rapid assessment of needs • Support to prevent further trauma • Provide emotional support • Treating and documenting injuries • Write down everything you see and exactly as you see it • Provide a translator if needed • Reinforce to the victim that surviving the assault is most important victim feels dirty and guilty. wants to shower, but don't let them. why? - ANSWER because this can wash away important evidence needed to charge the abuser. Intervention for Rape- - ANSWER Provide support person to stay with pt Explain legal proceedings available to patient Explain rape protocol and obtain consent to proceed through protocol Document whether patient has showered, douched, or bathed since incident Document mental state, physical state (clothing, dirt, and debris), history of incident, evidence of violence, and prior gynecological history things to advise rape victim - ANSWER SANEs can take long time examining patient teach patient about PTSD, talk about coping mechanisms • Risk Factors for Abusive Persons and Family Violence: - ANSWER o A child that has been abused when they were younger will think the abuse is normal and will continue, as they get older. These individuals have a higher risk factor for abusing other people.