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O make observation and validate ex you look nervous o

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oMake observation and validate” EX: “you look nervous”oAssess/rateo“What happened?”or clarify thoughts/feelingsoEncourage problem solvingoFind outlets---exercise, journaling, relaxation breathing, social supportsoAnticipate/ID anxiety provoking situationsInterventions for Severe and Panic Levels Anxiety Table 15-10oMilieu: difficult when there is so much noiseoDon’t leave alone—be alert to safety:alwaysoBe Calm! Calm! Calm!Repeat! Repeat! Repeat! “you are safe. Safe……you are safe…… you are safe…”oSpeak slowly and simply; low pitched voiceoSet limits:talk in firm, authoritative voiceoDon’t touchoReinforce reality---eye contact—focus on here and nowoStart deep breathing ---breathe with themoMonitor/Provide for physical needs including fluids high in caloriesoListen for themesoValue of EXERCISE!! Exercise over time reduces the incidence of panicImplementationspecific to Obsessive-Compulsive DisorderoWatch judgments: they are a person, not a disorderoFocus person not symptomsoTeach interventions to interrupt obsession: CBT:oThought stopping: EX: wearing a rubber band and snapping it when youhave the thoughtsoAllow compulsion.WHY? Decreases anxiety!!Implementationspecificto Panic AttackoIncrease structure: breathe with them, make the focus on somethingoDon’t touch;Don’t leave aloneoTime attack to help keep it in perspective.So that later you will knowduring the panic attack say “its okay, you are safe, its been 20 seconds,you are halfway through this attack”CounselingoEnhance coping: talk to them, increase social supportoInstill hope: identify the problem then work on itoEnhance self esteem: call them by their name. tell them what they havedone welloTeach relaxation: teach deep breathing44
Teamwork and SafetyoCollaborate and consistency: Calm, consistent care giverPromotion of Self-Care Activitiessee p. 285-287oNutrition and fluid intakeoPersonal hygiene and groomingoElimination: can be excessive or not at alloMonitor skin (esp with OCD)oSleepPharmacological Interventions(Table 15-11)oAntidepressants(See Psychotropic Drug List--PDL)SSRI: selective serotonin reuptake inhibitorSNRI:serotonin-norepinephrine reuptake inhibitoroAntianxiety Drugs(Anxiolytics)--- (See PDL)Benzodiazepines—BNZAdvantagesCan use prnQuick onsetEffectiveDisadvantages/SE:SedationAtaxia (people can fall)AddictionNursing Implication:Monitor effectiveness by assessing AnxietyTeach:Don’tdrive or operate heavy equipmentDon’tincrease dosage; take only as prescribedDon’t get PG (pregnant)Don’t use with alcohol, CNS depressants orcaffeine(makes anxiety go up)Interactions cantacids; Take c food if GI upsetStopping drug: withdraw slowly, can lead torebound hyperactivity of CNS -- withdrawlOther Classes of meds:Non-Benzodiazepine (See PDL)Beta blocker: propranalol (Inderal)Works with increased HR/BP & tremors:Good with social/performance anxiety45

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Term
Winter
Professor
NoProfessor
Tags
Nursing, mental health, Psychiatry, Psychiatric Mental Health Nursing, The Unconscious,

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