TODDLER

Push pull toys; parallel play Rituals & routines; regression Autonomy vs shame and doubt; accidents Involve parents Separation anxiety Elimination; explore

PRESCHOOL
Mutilation Associative play; abandonment Guilt Initiative; imaginary playmate; imagination Curious

SCHOOLE AGE
Death Industry vs inferiority; immunization Modesty Peers Loss of control Explanation of procedures

ADOLESCENT Peer group Altered body image Identity - image Role diffusion Separation from peers

TRUST

TRY EXPRESSION REFLECTION OF WORDS USE OF SILENCE SETTING LIMITS TIME WITH CLIENT

TRUST

Trust Rapport Unconditional positive regard Setting limits Therapeutic communication

JOHARIS WINDOW
Known to self
Known to others Not known to others OPEN HIDDEN

Not known to self

BLIND UNKNOWN

EATING DISORDERS

Encourage express of feelings Always use the same scale To promote feelings of control Include dietitian No signs of malnutrition Goal

EATING DISORDERS
Amenorrhea No organic factor accounts for weight loss Obviously thin but feels fat Refusal to maintain normal body weight Epigastric discomfort is common X symptoms (hiding of foods) Intense fear of gaining weight Always thinking of food

EATING DISORDERS
Binge eating Under strict dieting or vigorous exercise Lacks control over eating binges Induced vomiting Minimum of 2 binge episode/week for 3 mos Increase/persistent concern of body shape/size Abuse of diuretics and laxatives

ANXIETY INTERVENTIONS
Calm Anxiety - aware Listen Medications Environment Reassurance

ANXIOLYTICS
VLAST ME VAIB

Valium Librium Ativan Serax Tranxene

ANXIOLYTICS
Miltown Equanil

Vistaril Atarax Inderal Buspar

ANXIOLYTICS
LEAVS

Librium Equanil Atarax Valium Serax

DEPRESSION

Flat affect Lethargic Apathy Tearful

DEPRESSION MANAGEMENT

Prevent suicide Environment Esteem Relationships

ANTI - DEPRESSANTS

Asendin Norpramin Tofranil Sinequan Aventyl; Anafranil Vivactil Elavil

ANTI - DEPRESSANTS

Prozac Paxil Zoloft

Marplan
Nardil Parnate

TRICYCLICS

Each VictimS A Tough Neurotic

ELAVIL VIVACTIL SINEQUAN AVENTYL TOFRANIL NORPRAMIN

MAOIS TYRAMINE RICH FOODS

Beer, wine, cheese, livers, yeast rolls, cola, chocolate, over the counter cold medicines

Leads to HYPERTENSIVE CRISIS

BIPOLAR DISORDER

Mood elevated A grandiose delusion Needs for sleep, eat Inappropriate C langing, loud, vulgar

BIPOLAR DISORDER

Depressed O out for suicide Wont sleep, eat Negative

DRUG FOR MANIA

Levels Incontinence Thirst; Thyroid Hand tremors Increase fluids Unsteady Manic; Many salts

SCHIZOPHRENIA Hallucinations Affects; ambivalence; autism; associative looseness Relationship Delusions

CHARACTERISTICS of ALCOHOLICS

Domineering Denial Disatisfied Demanding Dependent

ALCOHOLISM

Coping mechanism Orient to community resources Plan may include antabuse Encourage vitamin B, folic acid Seizures

COMBAT

Control immediate situation Out of situation Maintain calm Be firm and set limits Avoid restraints Try consequences

 Impairment in communication skills (all vowels use short sentences in communicating) Presence of stereotyped behavior, interests and activities (routines consistency; headbanging protect head) Impairment in social interactions

Subaverage intellectual functioning resulting in impairment in adaptive behavior

Persistent pattern of inattention Hyperactive and impulsive behavior

 Diagnosed at age 2 Impaired interpersonal functioning

Before age 18 Inadequate mental functioning

Before age

Inattention Hyeractivity Impulsivity

Brain anoxia, intake of drugs

Multifactorial

Frontal lobe hypoperfusion & drug use by mom

 Crying tantrums Loves to spin objects Echolalia Acts as deaf Resist normal teaching method Silly laughing Insensitive to pain No fear of danger

Educable (50/55-70) Trainable (35/40-50/55) Needs close supervision (20/25-35-40) Needs cutodial care (below 2025)

Difficulty remaining seated Easily distracted Fidgeting Interupts others Child hyperactive Indulge in destructive behavior Talks excessively

 Difficulty interacting with others Attachment to inanimate objects Wants block not ball No eye contact Resist change in routine Points to anything Not cuddly

 Risk for injury

Repetition Role modeling Restructuring the environment

Risk for injury Nutrition Safety

DOC: RITALIN (methyl penidate)

TYPES OF BODY PHYSIQUE (Kretschmer)

Pyknic type usually short stature; stocky, round body figure; barrelshaped chest and abdomen; short, but large extremities; round facial features, ruddy complexion; tendency to accumulate fat.
Asthenic type height usually normal; a few are short; slender, thinboned body figure; thin, sunken-appearing chest and abdomen; poor muscular development; oval facial features; pale or sallow complexion.

TYPES OF BODY PHYSIQUE (Kretschmer)

Athletic type strong muscular development, especially around the neck, shoulders, legs, and arms, broad shoulders, narrow hips, square facial features with bony prominences.
Dysplastic type variations in physique are composed of combinations of the three main body types. a tendency to accumulate fat in some particular part of the body, such as around hips or shoulders. a large percentage of persons of the dysplastic type are afflicted by endocrine disorders.

3 Main Temperament Types (Carl Jung)

Extrovert actively aggressive, ambitious, enthusiastic, uninhibited; expresses feeling and relates to other persons readily inclined to engage in organization, political, business activities this type has been linked to the pyknic body physique and manic depressive disorders.

3 Main Temperament Types (Carl Jung)

Introvert reserved, quiet, shy, contemplative, serious, studious, sensitive limits social relations and feeling expressions interests and attention are subjectively directed inclined to engage in scientific pursuits and the creative arts has been linked to the leptosomic body physique, especially the asthenic type and schizophrenic reactions.

3 Main Temperament Types (Carl Jung)

Ambivert
possesses characteristics of both the introvert and extrovert, but does not lean too heavily in either direction. Most persons manifest this middle type of personality temperament.

COMMON PROBLEMS ENCOUNTERED BY THE NURSE IN MAINTAINING A THERAPEUTIC RELATIONSHIP AND THE APPROPRIATE NURSING ACTION

Problems of Scheduling
The patient doesnt come to the session locate the patient re-schedule the appointment remind the patient ahead of time give the patient an appointment card The patient is habitually late 1.determine the patients orientation to time 2.be on time and wait for the patient 3.explore with the patient his reasons for lateness 4.close the session on time

The nurse is late or has to change the scheduled time notify the patient directly or thru a written message apologize re-schedule the appointment when appropriate The patient asks to cut the session short or change the time of the meeting explore the expressed needs re-orient the patient to the time schedule as per initial agreement

The patient abruptly leaves the session ask the patient where he/she is going tell the patient that you are going to wait for her until the end of the session remain in the room wait expectantly for the patients return and do not become involved in any other activity.

Problems on Responses and Questioning

The patient asks personal questions 1. briefly answer factual and self-evident questions and refocus 2. explore with the patient his need to ask 3. redirect the focus of communication toward the patient The sessions are interrupted by patients or staff. 1. clearly state to the interrupting individual that the therapy session is in progress 2. review with the patient previous agreement

The patient doesnt want to talk: 1. sit quietly beside the patient 2. look at patient with an interested expectant expression 3. observe nonverbal behavior 4. remind the patient of the remaining time 5. tell the patient that you are there when he is ready to talk. The patient says I have nothing to say or I dont know: 1. rephrase the question 2. sit quietly, wait and be patient 3. continue to explore areas of interest and concern 4. be persistent dont give up

The patient tells the nurse to go away or says dont bother me remain calm; assess the patients level of hostility make judgment based on assessment and set accordingly leave the patient with a promise to return at a later time or remain and explore the patients feelings

The nurses questions upset the patient or make him more nervous: its a good sign something is happening maintain focus on the topic dont avoid it identify the topic help the patient to recognize the topic review and analyze data to prevent: Prying; pushing beyond the patients level of readiness; uncooperativeness

 According to Busch (1987), there may be at least three styles of the noninvolved client: Resistant the patient who is afraid to face emotions, clings to his defenses, and is afraid to change. Reluctant the patient who is coerced or forced to get treatment and claims he does not need it (denial). Uncommitted the patient whose goals for treatment are incompatible with the treatment modality or the therapists beliefs.

Hallucinations
Initial approach with a patient who appears to be listening to or talking with voice is to comment on his behavior: You look as if you are listening to something. What do you hear? If the patient acknowledges hearing something the nurse cannot hear, the nurse can say, I dont hear anything. Tell me what you hear. The early assessment of hallucinations is of the content of messages that reveal dynamics of the patient THE MEANING, such as themes of powerlessness, guilt, loneliness, or suicide. Once the content is known, there is no need to focus on the hallucinations; doing so could reinforce them: I know the voices are important to you, but lets talk about your loneliness right now.

Delusions
The initial approach with respect to delusions as clarification of meanings, such as, Who do you think is trying to hurt you? or Tell me about this power you think you have. As with hallucinations, delusions are not discussed once the meanings are clarified. The underlying themes reflected in the delusions are more appropriately addressed in interventions, such as helping the patient who says she is a queen feel important in realistic ways.

Sexual innuendos or inappropriate touch

Patients generally stop these behaviors when asked and when they are reminded that they are inappropriate The nurse then discusses the underlying need. If they do continue, the limit setting can be stronger: I want to talk to you but not if you continue to touch me. If you dont stop, I will have to leave and come back later. It may also help to pair a sexually acting-out patient who has poor impulse control with a staff member of the same sex until he is further along in treatment.

Manipulation
Common manipulations are for attention, sympathy (poor me), control, and dependence for others to take responsibility. Often manipulation is not reorganized until it has already worked. Then the nurse may experience anger or embarrassment The initial approach is to point out what is happening (or has happened): Im getting the feeling you like me to tell you what to do. What scares you about this decision? Or You are experiencing a lot of pain and would like me to relieve it for you. Lets talk about what you can do to relieve it. Limit setting is useful with manipulative patients. A power struggle with the patient is useless. Helping a patient relate effectively with others is more fruitful.

Hyperactivity
Excessive physical and emotional activity in the patient is upsetting to the staff, to other patients, and often to the patient himself. Even unintentionally the patient may harm himself or others. The patient needs to be in a quiet area with minimal auditory and visual stimulation. Physical activity, such as walking or using a stationary bicycle, may help drain excess energy. The nurse must remain calm, speak slowly and softly, and respect the patients personal space. Directions are given in a kind, simple, but firm manner.