Review therapeutic communication & med packets 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 client s feelings Clarify and validate client s statements Use matter of fact approach ECT !ausea is a common complaint after ECT" #omiting by an unconscious client can cause aspiration" Because post ECT clients are unconscious, nurses must observe closely and maintain patent air$ay %&OB'A (hen a client describes a phobia, the nurse should ac)no$ledge the feeling" once trust is established, a densiti*ation process may happen This includes: Assist client to recogni*e the factors associated $ith feared stimuli Teach and practice alternative coping strategies E+pose client progressively to feared stimuli %rovide positive reinforcement $henever a decrease in phobic reaction occurs !urse should place an an+ious client $here there are reduced environmental stimuli OC, Compulsive acts are used in response to an+iety" !urse can help alleviate an+iety: Actively listen to client s obsessions Ac)no$ledge the effects that ritualistic acts have on client Be empathic ,o not judge %T-, !urse should: actively listen Assess suicide ris) .

Assist client to develop objectivity about event and problem solve regarding possible means of controlling an+iety Encourage group therapy $ith other clients $ho have e+perienced similar traumatic events -O/ATO0O1/ ,'-O1,E1Be a$are of your o$n feelings $hen dealing $ith this type of client 't is hard to be nonjudgmental The pain is real to the person e+periencing it These disorders cannot be e+plained medically2 they result from internal conflict The nurse should: ac)no$ledge the symptom or complaint 1eaffirm that diagnostic test results reveal no organic pathology ,etermine the secondary gains ac3uired by the client %E1-O!A4'T5 ,'-O1,E14ongstanding behavioral traits that are maladaptive responses to an+iety and that cause difficulty in relating to and $or)ing $ith other individuals %ersons $ith personality disorders are usually comfortable $ith their disorders and believe that they are right and the $orld is $rong These individuals usually have very little motivation to change EAT'!6 ,'-O1,E1%eople $ith anore+ia nervosa gain pleasure from providing others $ith food and $atching them eat" These behaviors reinforce their perception of self control do not allo$ these clients to plan or prepare food for unit based activities 'ndividuals $ith bulimia often use syrup of ipecac to induce vomiting" 'f ipecac is not vomited and is absorbed, cardioto+icity may occur and can cause conduction disturbance, cardiac dysrhythmias, and circulatory failure" Because heart failure is not usually seen in this age group, it is often overloo)ed" Assess for edema and listen to breath sounds" %hysical assessment and nutritional support are a priority2 the physiologic implications are great" !ursing interventions should increase self7esteem and develop a positive body image Behavior modification is useful and effective" 0amily therapy is most effective because issues of control are common in these disorders Therapy is usually long term ,E%1E--'O! 8

The most important signs and symptoms of depression are a depressed mood $ith a loss of interest in the pleasures of life" Other symptoms: -ignificant change in appetite (eight loss or gain 9loss is much more prevalent than the older adult: 'nsomnia or hypersomnia 0atigue or lac) of energy 0eelings of hopelessness, $orthlessness, guilt, or overresponsbility 4oss of ability to concentrate or thin) clearly %reoccupation $ith death or suicide ,epressed clients have difficulty hearing and accepting compliments because of their lo$ered self7concept" Comment on signs of improvement by noting the behavior, ; ' notice you combed your hair today<, not ;you loo) nice today< The nurse )no$s depressed clients are improving $hen they begin to ta)e an interest in their appearance or begin self7care activities -U'C',E !urse should suspect an imminent suicide attempt if a depressed client becomes better" (hen dealing $ith a depressed client, nurse should assist $ith personal hygiene tas)s and encourage client to initiate grooming activities -'T =U'ET45 $ith patient" /E,Antian+iety7 causes sedation, dro$siness Antidepressants cause anticholinergic -E /AOis7 cause hypertensive crisis Lithium very important drug to know~ affects kidneys; Therapeutic range between . and !. "ear#y symptoms nausea$ po#yuria & po#ydipsia$ tremors$ & as it gets more to%ic vomiting$ diarrhea$ drowsiness$ #oss of coordination& E%-7 )no$ these: acute dystonic reaction, a)ithesia , par)insonisms T,7 tardive dys)inesia7 irreversible unless caught early enough /A!'C patients can become argumentative7 avoid arguing $ith them Offer noncompetitive physical activities 1educe stimuli %lace him in 3uiet part of unit 'f client becomes abusive: 1edirect negative behavior -tay calm, be firm ,on t get defensive ,on t argue -uggest a $al) >

-et limits /ay need to seclude or give %1! if client becomes out of control -C&'?O%&1E!'A ,o not argue $ith a client $ho is delusional They may need a %1! if they are hearing voices Trust is basis for all interactions $ith these patients Be supportive and nonjudgmental -tress increases an+iety ,o not agree that you hear voices, but ac)no$ledge your observation, for eg, 5ou loo) li)e you are listening to something A4CO&O4'-/ Use rationali*ation and denial They must be confronted so that they become accountable !utrition is a priority $ith alcoholics They can have ,T- $ithin .8 to >@ hours after last inta)e of alcohol" 4ibrium or ativan are commonly used to treat $ithdra$als ABU-E (omen $ho are abused may rationali*e 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 plan 1ape victims are at high ris) for %T-, 'mmediate interventions to diminish distress is vital 4egal responsibility of the nurse" 'n children, the nurse is legally responsible for reporting all suspected cases of abuse"