What should a stoma look like?
shiny, moist, beefy red
What are the rules regarding restraints?
- must be last resort, least restrictive means must be used first
- indicated if the client is not cooperating with treatment, or if they are a threat to themselves or others
- you must have a written prescription for the restraint within 1 hour and a provider assess within 1 hr
- leave enough space for 2 fingers
- always to bed frame, never side rails
- assess the client every 15-30 minutes for physical needs, safety, and comfort
- release restraints every 2 hours
- prescription must be renewed every 24 hours
How does antisocial personality disorder present?
- disregard for others (exploitation)
- lack of empathy
- unlawful actions
- failure to accept personal responsibility
- sense of entitlement
- impulsive
- seductive, verbally charming/engaging
How does borderline personality disorder present?
- instability of affect, identity, realtionships
- splitting
- manipulation
- impulsiveness
- fear of abandonment
- self injurious
- suicidal
- ideas of reference
How does borderline personality disorder present?
- instability of affect, identity, relationships
- splitting (all good or all bad)
- manipulation
- impulsiveness
- fear of abandonment
- self injurious
- suicidal
- ideas of reference
*safety is priority, but also limit setting and consistency
How does histrionic personality disorder present?
- attention seeking behavior (center of attention)
- seductive and flirtatious
**may benefit from assertiveness training or role modeling
How does narcissistic personality disorder present?
- arrogance
- grandiose views of self-importance
- the need for consistent admiration
- lack of empathy for others (trouble with relationships)
- sensitive to criticism
What are the early/mild/first s/sx of AD?
- forgetfulness
- losing common objects
- recent memory changes often
- sometimes overwhelmed due to declining cognition
What are the middle/moderate/second s/sx of AD?
- difficulty managing ADLs
- personality changes
- bowel/bladder changes
- some assistance needed
- remote memory details become scattered
- wandering
What are the late/advanced/severe/third/end-stage s/sx of AD?
- remote and recent memory are significantly impaired
- may not remember others
- requires continued care
What causes Parkinson’s disease?
too little dopamine to support the CNS and limbic system and too much acetylcholine
What are the risk factors for Parkinson’s? (4)
- age- 40-70
- gender- male
- genetics
- meds- antipsychotics
What are the s/sx for Parkinson’s? (6)
- tremors (pill-rolling)
- stooped posture
- slow, shuffling gait
- bradykinesia (slow mvmt)
- flat affect
- muscle rigidity
What are the medications we can give the patient with Parkinson’s?
Dopaminergics: levodopa/carbidopa *no extra protein, take with food, check vs frequently
Dopamine Agonists: bromocriptine *monitor for orthostatic hypotension, hallucinations, dyskinesias
Anticholinergic:
benztropine *drying effects, do not use with open angle glaucoma
MAOI:
selegiline *contraindicated for use with levadopa/carbidopa
What causes Multiple Sclerosis?
it is autoimmune and the myelin sheath is destroyed which interrupts the flow of nerve impulses
What are the risk factors for MS?
- genetics
- gender- female
- age- 20-40
- after pregnancy
What are the s/sx of MS?
- trips/falls
- paresthesia
- fatigue
- muscle spasticity
- muscle weakness
- eye and ear changes
What are the medications we would use to treat MS?
Immunomodulators (-rab, -mab)
Antispasmodics (baclofen, dantrolene)
Immunosuppressants (Azathiprine, cyclosporine)
What is the nursing care for the client with MS?
- high protein diet
- avoid temperature extremes
- safety
What is personality disorganzation?
In the 4th phase of crisis the person may experience personality disorganization which can manifest as violence, aggression, or total withdrawal
What are some of the Benzodiazepines? Indications?
Prototype: alprazolam
Others: diazepam, lorazepam, clonazepam, oxazepam, chlordiazepoxide
Indications: GAD, ASD, PTSD, panic disorder, seizures, alcohol withdrawal, anesthesia
What are some considerations when administering Benzos?
- we have to be careful of CNS depression*
- no alcohol
- no driving
ANTIDOTE: flumazenil
Other considerations: avoid grapefruit juice and taking with fatty foods. Contraindicated in clients with sleep apnea or glaucoma.
What is an example of an atypical anxiolytic? Indications?
Buspirone (buspar)
Indications: GAD, PTSD, OCD, panic disorder, smoking cessation
**2-4 weeks before you will see effects
What are some considerations when administering buspirone?
-take with food (nausea)
-avoid driving (lightheaded)
-increase fiber and fluid (constipation)
-safety (suicidal ideation)
:) no sexual dysfunction :)
- **AVOID use with MAOIs (HTN crisis) (wait 14 days)
- **AVOID grapefruit juice, St John’s Wort, erythromycin, ketoconazole
