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Hesi Hints Taken from Mosby book Therapeutic Communication Basic communication principles: Establish trust Be nonjudgmental Offer

self Be empathetic, not sympathetic Use active listening Accept and support clients feelings Clarify and validate clients statements Use matter of fact approach ECT Nausea 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 PHOBIA When a client describes a phobia, the nurse should acknowledge the feeling . once trust is established , a densitization process may happen This includes: Assist client to recognize the factors associated with feared stimuli Teach and practice alternative coping strategies Expose client progressively to feared stimuli Provide positive reinforcement whenever a decrease in phobic reaction occurs Nurse should place an anxious client where there are reduced environmental stimuli OCD Compulsive acts are used in response to anxiety. Nurse can help alleviate anxiety: Actively listen to clients obsessions Acknowledge the effects that ritualistic acts have on client Be empathic Do not judge PTSD Nurse should: actively listen Assess suicide risk Assist client to develop objectivity about event and problem solve regarding possible means of controlling anxiety Encourage group therapy with other clients who have experienced similar traumatic events SOMATOFORM DISORDERS Be aware of your own feelings when dealing with this type of client It is hard to be nonjudgemental The pain is real to the person experiencing it These disorders cannot be explained medically; they result from internal conflict The nurse should acknowledge the symptom or complaint Reaffirm that diagnostic test results reveal no organic pathology Determine the secondary gains acquired by the client

PERSONALITY DISORDER Longstanding behavioral traits that are maladaptive responses to anxiety and that cause difficulty in relating to and working with other individuals Persons with personality disorders are usually comfortable with their disorders and believe that they are right and the world is wrong These 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 image Behavior modification is useful and effective. Family therapy is most effective because issues of control are common in these disorders Therapy 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 appetite Weight loss or gain Insomnia or hypersomnia Fatigue or lack of energy Feelings of hopelessness, worthlessness, guilt, or overresponsbility Loss of ability to concentrate or think clearly Preoccupation 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 activities SIT QUIETLY with patient. MEDS Antianxiety- causes sedation, drowsiness Antidepressants cause anticholinergic SE MAOis- cause hypertensive crisis

Lithium very important drug to know~ affects kidneys Therapeutic 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 them Offer noncompetitive physical activities Reduce stimuli Place him in quiet part of unit If client becomes abusive: Redirect negative behavior Stay calm, be firm Dont get defensive Dont argue Suggest a walk Set limits May need to seclude or give PRN if client becomes out of control SCHIZOPHRENIA Do not argue with a client who is delusional They may need a PRN if they are hearing voices Trust is basis for all interactions with these patients Be supportive and nonjudgmental Stress increases anxiety Do not agree that you hear voices, but acknowledge your observation, for eg, You look like you are listening to something ALCOHOLISM Use rationalization and denial They must be confronted so that they become accountable Nutrition is a priority with alcoholics They 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 spouses behavior. Be sure to give her the number of a shelter or help line for future and help her to develop a safety plan Rape victims are at high risk for PTSD Immediate 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.