Chapter 57 Nursing Care of Patients with Mental Health Disorders

Answers CHAPTER 57 NURSING CARE OF PATIENTS WITH MENTAL HEALTH DISORDERS AUDIO CASE STUDY Samantha and Bipolar Disorder 1. Sleeping most of the time, loss of interest in eating, no energy to do anything, cried a lot. 2. Excitation, cooking huge amounts of food, buying a bigger freezer, believing she was going to be on television. 3. Delusions. 4. Medications (mood stabilizers), therapy for Samantha and her family. VOCABULARY 1. alogia 2. codependence 3. phobia 4. obsession 5. bipolar 6. Autism 7. schizophrenia 8. delirium 9. Addiction 10. Anhedonia CRITICAL THINKING 1. Remain calm, and keep your distance. Ask, “Who told you what I am up to?” If his answer is not in touch with reality (e.g., the voices in his head told him), then gently say, “Mr. Joers, I know the voices seem real to you, but I can’t hear them. The surgeon wants to fix your broken hip this morning, so I need to check your blood pressure. It will just take a minute.” If the night nurse is still on the unit, consider having him or her assist because this will be a familiar face to Mr. Joers. 2. This depends on several factors. He will need to be reasonably cooperative to complete preoperative care. Check to see if his consent form has been signed. If he is disoriented or psychotic, then he will not be able to legally sign. See if he has a legal guardian who can give consent. It is possible that surgery will need to be delayed until he is more stable. 3. The stress of admission to the hospital, fear and anxiety related to pain, and impending surgery. Also, medication schedules are sometimes disrupted during transfers from one institution to another. 4. Check his medication record to see if any medications that might help are due to be given. Be sure to consult physician orders for medications to give or hold before surgery. Notify the registered nurse and/or the surgeon of Mr. Joers’s symptoms. Based on his response to your interventions, be prepared to share your opinion about whether he is cooperative enough to be able to proceed with surgery. If there is a family member who has a close, trusting relationship with Mr. Joers, consider calling him or her in to assist with his care. 5. If Mr. Joers is psychotic, he will not be oriented to the fact that he has a broken hip. His gait is also affected by his Parkinson disease. He is at risk for danger to himself or others. He will need one-on-one supervision to be sure he does not try to get out of bed or otherwise harm himself. In addition, his paranoia may pose a danger to staff if he perceives that staff is trying to harm him. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3) is correct. Drinking alcohol before work could impair judgment and cause harm to patients. (1, 2, 4) are all reasonable and safe responses to anxiety. 2. (1) is correct. Group support is one of the most effective treatments for alcoholism. (2) is incorrect. Drugs may be used during acute withdrawal but are not ideal for long-term therapy. (3) is incorrect. Electroconvulsive therapy is not a treatment for alcoholism. (4) is incorrect. Reducing alcohol consumption is not successful for most people. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 3. (1) is correct. This amount of sleepiness is unusual. (2) is incorrect. Tolerance can occur, but this amount of sleepiness is not an expected response. (3) is incorrect. It is unsafe to get the patient up if he is difficult to arouse. (4) is not an independent nursing action. 1 2 Chapter 57 Answers 4. (3) is correct. This response lets the patient know what is real and then distracts with a walk. (1, 4) do not correct the misperception, and (2) is not kind or respectful. 5. (2) is correct. Fluctuations in sodium affect metabolism of lithium. (1, 3, 4) are not known to affect lithium. 6. (4) is correct. Speaking to other staff so that the patient cannot hear may be interpreted personally by the patient. (1, 2, 3) are therapeutic for the patient with schizophrenia. 7. 150 mg 5 mL 100 mg = 7.5 mL 8. (1) is correct. It shows the patient is able to sort what is true and what is not. (2, 4) show hopeless thoughts. (3) is incorrect and is not healthy for one’s own feelings to be dependent on another person’s behavior. 9. (3) is correct. It may take 6 to 8 weeks for an antidepressant to be effective. (1, 2) are not appropriate. (4) can cause a dangerous drug interaction. 10. (1, 2, 3, 5) are correct. (4) is incorrect. Patients are typically hypothermic rather than hyperthermic.