Sunday, February 8, 2009
Protected meal times
Please check out my protected meal times blog below. The date on it says March. That might be when I started it but today I finished it.
Friday, February 6, 2009
Anxiety Disorders
ANXIETY DISORDERS
- Anxiety
- Apprehension, fearfulness or a sense of powerlessness due to a threat that is less visible definable than fear, which has a visible object or trigger.
- ANXIETY DISORDERS
- Excessive anxiety responses
- Demonstrates unusual behaviors
- Disorder significantly impairs their daily routine, social life and occupational functioning.
- GENERAL ETIOLOGY OF ANXIETY nursinglectures.blogspot.com
- Psychodynamic Theory nursinglectures.blogspot.com
- Psychoanalytical theory
- Anxiety as a response to danger
- Psychic conflict
- Overuse of Defense mechanism
- inhibit emotional growth
- Poor PS skills
- Difficulty with relationship.
- Ego matures
- Interpersonal theory
- Values of their parents and family
- Problems in interpersonal relationship = ANXIETY
- Cognitive - Behavioral theory
- Learned through experiences
- Biological theory
- Genetic theory
- Brain abnormality
- Impaired glucose metabolism in the prefrontal cortex & basal ganglia
- Activation of the R frontal hemisphere
- Diminished volume of the hippocampus
- Neurochemical Theory
- GABA, 5Ht, NE
- TREATMENT
- Combination of medication & therapy
- Cognitive behavioral therapy
- “ ASSERTIVENESS TRAINING”
- “ POSITIVE REFRAMING”
- “ DECATASTROPHIZING”
- MENTAL HEALTH PROMOTION
- Tips for Managing Stress
- Positive attitude
- Acceptance
- Well balanced diet
- Enough rest
- Stress management techniques
- Set realistic goals
- ANXIETY DISORDERS
- GAD
- PD
- OCD
- Phobic disorder
- ASD and PTSD
- GENERAL ANXIETY DISORDER
- “ free floating anxiety”
- APPREHENSIVE WORRYING
- UNCONTROLLABLE WORRYING = problems with ADL
- AD
- months
- Primary symptoms
- Nervousness
- Irritability
- Apprehension
- Agitation
- Tension
- Tachycardia
- Diaphoresis
- SOB
- Difficulty falling and staying asleep
- Overlaps those with Panic and depressive
- Overeacts to mild stress
- 50% of the time for months
- Depression
- Use of Alcohol or Drugs
- TREATMENT:
- Multimoda l
- Psychopharmacology
- Cognitive Behavioral Approach
- Individual and Family therapy
- Psychoeducation
- TNPR
- First , to reduce the level of anxiety
- ULTIMATE GOAL: to assist patient’s with developing adaptive coping responses.
- Initially, patient needs support and reassurance
- TRUST
- Reduce the Level of Anxiety, HOW?
- Calm and quiet Environment
- Awareness of the Problem
- Ask patients to identify what and how they feel
- Encourage to describe and discuss their feelings
- Identify possible causes
- Listen carefully for patient’s expression of helplessness and hopelessness
- Provide Activities
- AFTER THE REDUCING THE LEVEL OF ANXIETY
- Assist in examining their coping behaviors = Problem Solving Skills
- PSYCHOPHARMACOLOGY
- Benzodiazepines
- Alprazolam (XANAX)
- Lorazepam (ATIVAN)
- NON – Benzodiazepines
- Buspar
- Antidepressant
- SSRI
- MILIEU
- To reduce tension
- Recreational activities
- Relaxation exercises and tapes that should be practice when she is relatively calm.
- PANIC DISORDER
- Greek word “PANIKOS” meaning FEAR.
- Panic attacks that is 15 to 30 minutes (some for an hour) of rapid intense, escalating anxiety
- peak: 10 mins.
- NO precipitating factor
- DSM IV CRITERIA for PANIC ATTACK
- Increase HR, Palpitations or chest pain
- Chills or hot flushes, sweating trembling, dizziness or light headedness
- Feeling of choking or SOB
- Nausea or abdominal distress
- Numbness or tingling
- Fear of dying, “going crazy” or losing control
- Derealization or Depersonalization
- DSM IV CRITERIA for PANIC DISORDER
- Recurrent , unexpected panic attacks
- “ Out of the blue”
- Situationally bound
- Panic Attacks are followed by a month or more of worry about having additional attacks, worry about the results of the attacks, and behavioral changes related to the attacks
- Can be accompanied by agoraphobia
- Onset
- Late adolescence and mid 30’s
- ETIOLOGY:
- Genetics
- Environmental factors
- Neurotransmitter
- SEROTONIN
- BRAIN ABNORMALITY
- Abnormalities benzodiazepine receptors
- Burst of activity in the raphe nuclei and locus ceruleus
- Caffeine, Carbon Dioxide and sodium lactate
- Psychological factors
- TNPR
- Key Nursing Intervention:
- To help patients to get through the panic attack safely with as little discomfort as possible.
- Education
- Reassurance
- Cognitive Restructuring
- Stay with the patient and acknowledge the patient’s discomfort
- Speak in short, simple sentences
- If the patient is hyperventilating, provide a brown paper bag and focus on breathing with the patient.
- Allow the patient to pace or cry
- “ REASSURANCE”
- Psychopharmacology
- SSRI “drug of choice”
- TCA’s
- Imipramine (TOFRANIL)
- Benzodiazepines
- Alprazolam (ZANAX)
- Clonazepam (KLONOPIN)
- MAOI
- Phenelzine (NARDIL)
- Milieu
- Same with GAD
- Gross motor activities
- Walking
- Jogging
- Basketball
- Stationary Bicycle
- OBSESSIVE COMPULSIVE DISORDER
- O - recurrent thoughts, ideas, impulses or images that are experienced as intrusive and senseless.
- C - are repetitive behavior that are performed in a particular manner in response to an obsession
- OCD recognize that thoughts are products of their own mind
- Obsession = Compulsion
- Compulsion are performed to prevent discomfort and to bind or neutralize anxiety.
- Central feature: subjective experience of loss of voluntary control.
- 2 Forms:
- Washers
- Checkers
- Others
- counting, touching, hoarding, ordering
- “ Doubt”
- DEPRESSION is a feature
- Self esteem and self worth
- DM:
- Reaction formation
- Isolation
- Undoing
- Magical thinking “ thinking equals doing”
- Strong SE
- ETIOLOGY:
- Genetics
- BRAIN
- Increase brain activity in the frontal lobe and basal ganglia
- NT
- SEROTONIN dysregulation
- TNPR
- Ensure that Basic needs of food, rest and grooming are met
- Provide patients with time to perform rituals
- Explain expectataions, routines, and changes
- Empathy
- Structure simple activities, games, task for patients
- Reinforce recognize positive non ritualistic behaviors
- Psychopharmacology
- C L O MIPRAMINE (ANAFRANIL) “drug of choice”
- SSRI
- Fluoxetine (PROZAC)
- Setraline (ZOLOFT)
- Fluvoxamine(LUVOX)
- Benzodiazepines
- Milieu
- Stress management groups
- Recreational and social skills group
- Cognitive therapy
- Problem solving groups
- Communication or assertiveness training groups
- Behavior treatment
- Response prevention – delaying rituals
- PHOBIC DISORDER
- Specific
- Are intense irrational fear responses to an external object, activity or situation.
- Phobia is a response to experienced anxiety
- Phobias are ways of coping with anxiety by displacing it onto an object or situation that can be avoided.
- Phobic symptoms become phobic disorders when?
- three types
- A GORAPHOBIA s hx of Panic
- Greek for “fear of marketplace”
- separation anxiety in childhood
- S OCIAL PHOBIA
- S PECIFIC PHOBIA
- Natural environmental, Blood injections phobias, Situational, Anima and Others
- ETIOLOGY:
- Individual factors
- Environment
- Family environment and Genetic
- Develop based on the influence of the environment and genetic predisposition.
- TNPR
- Safety
- Empathy
- Help patients to recognize that their behavior is a method of coping with anxiety.
- Psychopharmacology
- Non specific; meds that reduces depression and blocks panic attacks
- Milieu
- Assertiveness training and goal setting groups
- Social skills groups
- Behavior therapy
- Systematic desensitization
- Flooding
- Self exposure
- ASD and PTSD
- develops after exposure to a clearly identifiable traumatic event that threatens the self, others, resources and or a sense of control or hope.
- Traumatic stressors:
- War
- Community violence
- Torture
- Natural and manmade disasters
- Accidents
- Catastrophic illness
- Major personal or business losses.
- DSM IV CRITERIA
- ASD
- Exposure to a traumatic event
- Responses of horror, helplessness and or fear
- Dissociative symptoms during or immediately after the event
- absence of emotions, numbing
- decreased awareness of surroundings
- Derealization & Depersonalization
- Amnesia
- Avoidance of stimuli related to trauma; feeling, thoughts, people, conversations, places, activities . Distress when exposed
- Increased arousal or anxiety; hypervigilance, startle response, irritability, restlessness, decreased concentration.
- Re-experiencing or reliving traumatic event; distressing thoughts, dreams, flashbacks, illusions
- Impairment or distress in functioning
- Duration
- ASD
- Onset: within 4 weeks after the event
- Duration: 2 days to weeks
- PTSD
- Onset: Acute within 6 months after the event, Delayed: 6 months or more after the event
- Duration: A= 1 – 3 months. D: 3 or more
- PTSD may develop problems with depression. Anxiety related disorders and substance abuse.
- ETIOLOGY:
- Fear conditioning to auditory and visual stimuli
- Failure of Extinction
- Behavioral sensitization
- TNPR
- TRUST
- Be Non judgmental, honest, empathic and supportive.
- Assure patients that their feelings and behaviors are typical reactions to serious trauma
- Take time for the patient to recognize the relationship between current problems and original traumatic event.
- Evaluate their past behaviors
- Eye Movement Desensitization and Reprocessing (EMDR)
- Encourage adaptive coping strategies, exercise, relaxation techniques and sleep promoting strategies.
- Facilitate progressive review of the trauma and it’s consequences
- Psychopharmacology
- Benzodiazepines
- Clonidine and Propanolol
- Lithium
- SSRI (fluoxetine, fluvoxamine)
- TCA’s
- MAOI’s
- Neuroleptics
- Milieu
- Inpatient or outpatient
- Social activities
- Recreational and exercise programs
- Community Resources
- Group therapy or Self Help Groups
- S AFETY
- V erbalization of feelings
- C alm Environment and Activities
Thursday, February 5, 2009
2/5 NP jobs posted on NPworld.us
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Wednesday, February 4, 2009
Nursing grand Rounds
On January 23, 2009 St. Joseph held the third annual Nursing Grand Rounds dedicated to Nursing Research and Evidence Based Practice projects being conducted at the hospital.
St. Joseph Hospital’s Nurse Research Facilitator, Dana Rutledge, RN, PhD, led the seminar on the use of evidence-based practice in guiding health care decisions and improving patient outcomes.
This four-hour seminar featured twelve St. Joseph Registered Nurses providing updates on nursing research studies and evidence-based practice projects that are currently underway at St. Joseph. The classroom was decorated with posters created by St. Joseph nurses that have been submitted to regional, national, and international nursing conventions. In addition, nursing unit based “Show Me the Evidence” posters were displayed. These posters are the Research Council’s effort to bring nursing research to the bedside nurse by presenting research articles that relate to the patient population of that unit.
The EBP and nursing research course started with an analysis of clinical narratives from both novice and expert nurses which revealed nursing presence in varying degrees. Projects presented included outcomes from utilizing a low residue diet for bowel cleansing prior to colonoscopy, how implementing a newborn palliative care program supports expectant parents through the grieving process, and the establishment of transplant nurse competencies in meeting regulatory requirements needed for accreditation as a transplant center.
The hospital’s Condition H (HELP) program where the patient and/or family can initiate an emergency page regarding care was presented with the first year results. Also featured were the efforts to enhance mobility in the critically ill and how an environment can be established to aid the critically ill at the end of life. A discussion on the risk of secondary traumatic stress among oncology nurses indicated its effects on the nurse. Julie Smith, the manager of the St. Joseph Burlew Medical library provided an update on the EBP Blog, PubMed and CINAHL databases available to assist staff in nursing research and evidence-based projects while Dr. Rutledge presented the Iowa model and principles of evidence-based practice that is utilized at St. Joseph.
2/4 NPworld.us Nurse Practitioner Jobs
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