SNA Meeting May 14th @ 1:00-2:00pm Locke 314
Last meeting of Spring 2007.
Rootbeer Floats and Much Needed Info!
Special Guest Speakers:
Rocky La Jeunesse, Guidance and Counseling
Topic: Requirements for Transfer (LVN/PT to RN, RN to BSN)
Shelba Durston, Kymn Trujillo and Dean Alin Ciochina
Topic: Work Experience/Internship/Apprenticeship Program
Anyone interested in getting units for working while in school or gearing towards furthering your education should not miss this meeting – see you there!
Sunday, April 29, 2007
Friday, April 27, 2007
Tuesday, April 24, 2007
this is cute...even if it's not Christmas time
Carols for the not so mentally healthy
stolen from Futurenurses2007 and from 3rd semester
Schizophrenia --- Do You Hear What I Hear?
Multiple Personality Disorder --- We Three Queens Disoriented Are
Dementia --- I Think I'll be Home for Christmas
Narcissistic --- Hark the Herald Angles Sing About Me
Manic --- Deck the Halls and Walls and House and Lawn and Streets and Stores and Office and Town and Cars and Busses and Trucks and trees and Fire Hydrants and......
Paranoid --- Santa Claus is Coming to Get me
Borderline Personality Disorder --- Thoughts of Roasting on an Open Fire
Personality Disorder --- You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout, Maybe I'll tell You Why
Obsessive Compulsive Disorder ---Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells
stolen from Futurenurses2007 and from 3rd semester
Schizophrenia --- Do You Hear What I Hear?
Multiple Personality Disorder --- We Three Queens Disoriented Are
Dementia --- I Think I'll be Home for Christmas
Narcissistic --- Hark the Herald Angles Sing About Me
Manic --- Deck the Halls and Walls and House and Lawn and Streets and Stores and Office and Town and Cars and Busses and Trucks and trees and Fire Hydrants and......
Paranoid --- Santa Claus is Coming to Get me
Borderline Personality Disorder --- Thoughts of Roasting on an Open Fire
Personality Disorder --- You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout, Maybe I'll tell You Why
Obsessive Compulsive Disorder ---Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells
Wednesday, April 18, 2007
N5 study guide #2
1. What communication techniques work best for clients rendered immobile by anxiety?
Clients with panic anxiety are out of control so they need to know that they are safe from their own impulses. Firm, short, and simple statements are useful. Use a low pitched voice, speak slowly and with repetition. Reinforce reality if distortions occur, listen for themes in communication (Varcarolis pg 216).
• Maintain a calm manner, and remain with the patient who is experiencing the severe to panic anxiety attack
• Minimize environmental stimuli (move to a quieter setting)
• Use clear simple statements and repetition in a low-pitched voice while speaking slowly
• Reinforce reality if distortions occur while listening for themes in communication
• Attend to physical and safety needs when necessary (warmth, fluids, pain, etc.)
• Safety is an overall goal, a “show of force” or use of physical limits may need to be implemented
• Provide opportunities of exercise to help dissipate tension
• Offer high caloric drinks to someone who is constantly moving and pacing
• Assess need for meds or seclusion after other interventions have failed
• If hypercapnia occurs, instruct client to take slow, deep breaths. Breathe with the patient to obtain cooperation.
• Keep expectations minimal and simpleSee also table 14-2 page 233, and table 14-5 page 237
2. What techniques are used by a crisis nurse that might not be used in a traditional therapeutic setting?
The nurse must be willing to take an active, even directive role in intervention; this is in direct contrast to what occurs in conventional therapeutic interventions, which stress a more passive and nondirective role for the practitioner (Varcarolis pg 459).
• The following are important assumptions when working with a client in crisis: The person is in charge of their life; the person is able to make decisions; the crisis counseling relationship is one between partners.
• See Table 22-4 page 465, and Box 22-1 #8 page 459
3. Differentiate between primary and secondary crisis interventions.
Primary care promotes mental health and reduces mental illness to decrease the incidence of crisis. The nurse will work with the client to recognized potential problems, teach specific coping skills and evaluate life changes to decrease the negative effects of stress.
Secondary care establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization. The nurse’s primary focus is to ensure the safety of the client. Then the nurse will assess the clients problem, support systems, and coping styles to lessen the time a person is mentally disabled during a crisis (Varcarolis pg 465).
4. Describe characteristics of clients manifesting escalation of aggressive behavior.
Hyperactivity: most important predictor of imminent violenceIncreasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self,Verbal abuse, profanity and argumentativeness.Loud voice: change in pitch, or very soft voice forcing others to strain to hearintense eye contact or avoidance of eye contact (Varcarolis pg 493).
• Recent acts of violence, including property violence
• Stone silence
• Alcohol or drug intoxication
• Possession of a weapon or object that may be used as a weapon
• Milieu characteristics conducive to violence: overcrowding; staff inexperience; provocative or controlling staff; poor limit setting; Arbitrary revocation of privileges
5. Discuss techniques used when staff needs to administer IM medication to an aggressive client.
A team with about five staff members is gathered and organized before approaching the client. They are equipped with medication and the right size restraint. Each member knows which limb to secure or task to perform. The team leader explains to the client in a matter of fact manner exactly what the team is about to do and why. Often the client will cooperate at this point, if not the team remains calm and acts as quickly as possible to restrain the client. Once restrained the nurse administers the IM injection (benzodiazepine, major tranquilizer, or antihistamine). The nurse provides an explanation to the client of the medication. Throughout the whole process the team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency and control (Varcarolis pg 496).
• The nurse’s role is to provide an explanation to the client for the medication and to make sure the client is properly restrained so that the medication can be safely administered.
• The team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency, and control.
• Prior to medication administration, the client needs to be restrained and in doing so each team member needs to have proper training
• The approach needs to be organized with each team member knowing what their role is
• Also make sure to appropriate sized equipment is ready
• The team leader explains to the client in a matter-of-fact manner exactly what the team is about to do and why; this may provoke the client to cooperate or move into a seclusion room
• Refer to Box 24-3 page 497 for some other guidelines to restraint.
6. Describe aspects of a unit milieu that decreases likelihood of violent behavior.
The following are to be avoided to decrease likelihood of violence:Overcrowding.Staff inexperience.Provocative or controlling staff.Poor limit setting.Arbitrary revocation of privileges (Varcarolis pg 493).
• You want to make sure that the environment provides enough space for clients to prevent overcrowding.
• There also needs to be a balance between structure and quiet time
• Staff should be provided education in verbal de-escalation techniques
• Counseling of staff regarding the use of punitive and arbitrary approaches to clients
• The need to look for escalating events and how to provide immediate intervention to prevent overt violence (deescalating techniques, restraints/seclusion, and/or medication)
• Provide the client with the tools via psychotherapeutic approaches to the client new skills for handling anger.
• See box 24-2 page 496 for deescalating techniques, and refer to questions 5 and 6
7. Discuss reasons for seclusion and restraint as well as priority actions by a nurse caring for a client who has been restrained and secluded.
Seclusion or restraint is used in the following circumstances:
Ø Alternative interventions have been tried (documented) and failed. These include; verbal intervention, behavioral care plan, medication, decrease in sensory stimulation, removal of problematic stimulus, presence of significant other, frequent observation, and one-on-one observation of client.
Ø The client presents clear and present danger to self or
Ø The client presents a clear and present danger to others or
Ø The client has been legally detained for involuntary treatment and is thought to pose an escape risk or
Ø The client requests to be secluded or restrained.Priority actions by the nurse caring for a restrained or secluded client include:
Ø Be sure to receive or maintain an updated Physician’s Order for the restraint.
Ø Have nurse in constant attendance.
Ø Complete written record every 15 minutes.
Ø Release limb from restraint every 2 hours.
Ø Stretch limb through range of movement.
Ø Monitory vital signs, observe blood flow.
Ø Observe that restraint is not rubbing.
Ø Provide for nutrition, hydration, and elimination.
Ø Closely monitor client to determine the client’s ability to reintegrate into the unit activities (Varcarolis pg 497).
8. Differentiate between child abuse and neglect.
Child abuse is a broad category, which includes battering, neglect, physical endangerment, and sexual abuse.
Child neglect is either physical (failure to provide medical, dental, or psychiatric care needed to prevent or treat physical or emotional illnesses), developmental (failure to provide emotional nurturing or the physical or cognitive stimulation needed to ensure freedom from developmental deficits), or educational (failure to provide education in accordance with state law) (Varcarolis pg 511,786).
• Physical violence: is the infliction of physical pain or bodily harm
• Sexual violence: is any form of sexual contact or exposure without consent, or in circumstances in which the victim is incapable of giving consent (childhood sexual abuse destroys an individual’s positive self-concept and can interfere with the learning of self care skills)
• Emotional violence: is the infliction of mental anguish and take the form in the following; terrorizing through verbal threats; demeaning an individuals self worth; directing blatant or subtle hostility and hatred; persistently ignoring an individuals needs; consistently belittling and criticizing an individual; with holding warmth and affections; threatening an individual with abandonment or institutionalization.
• Neglect: can be physical, developmental, or educational.
• Physical neglect: failure to provide the medical, dental, or psychiatric care needed to prevent or treat physical or emotional illness
• Developmental neglect: failure to provide emotional nurturing and the physical and cognitive stimulation needed to ensure freedom from development deficits
• Educational neglect: when a child’s caretakers deprive the child of the education available in accordance with the state’s education laws.
9. Describe the cycle of violence and assessment priorities for a nurse caring for a victim of physical abuse.
Periods of intense violence alternate with periods of safety, hope, and trust during three phases known as the cycle of violence.
Ø Tension building stage is characterized by minor incidents such as pushing, shoving, and verbal abuse.
Ø Acute battering stage involves a serious battering incident where the perpetrator releases the build-up tension by brutal and uncontrollable beatings.
Ø Honeymoon Stage is characterized with kindness and loving behaviors. The perpetrator feels remorseful, is apologetic, brings gifts and makes promises to change
(Varcarolis pg 511).
Assessment priorities for a victim of physical abuse include
Ø A series of minor complaints such as headaches, back trouble, dizziness, accidents or falls.
Ø Bruising, scars, burns, and wounds around head face, chest, arms, abdomen, back, buttocks and genitalia.
Ø Be wary if the explanation does mot match the injury or if the client minimizes the seriousness of the injury, a high index of suspicion is key.
Ø Bruises on an infant younger than 6 months is suspicious, shaken baby syndrome is frequently overlooked and manifest as an abnormal pulmonary examination, or head circumference greater then 90th percentile.
Ø Nonverbal responses are also important such as hesitation or lack of eye contact (Varcarolis pg 514).
o Escalating-deescalating: conditions of anger and fear escalate until an incident of violence takes place, after which there is a defusing of tension and a brief feeling of safety; victims over time believe that the beatings are deserved and accept blame.
• Important interviewing guidelines are listed in box 25-4 page 512
• Priorities that should take place are initially started with safety and addressing any signs/ symptoms of the traumatic injuries that were inflicted during the incident. Should utilize the “Abuse Assessment Screen” found on page 517, figure 25-2
• Assess for potential problems in vulnerable families
• Physical, sexual, and/or emotional abuse and neglect, and economic maltreatment in family should be assessed
• Observe what family coping patterns are present
• Assess the client’s support system
• Assess for drug/ alcohol abuse
• Are there any suicidal or homicidal ideation
• Is post traumatic stress disorder present?
• Appropriate agencies need to be contacted to handle the matter.
10. Know the priority nursing diagnoses for clients with Alzheimer’s disease who may be suffering from abuse.
Risk for injury related to helplessness as evidenced by signs of violence
Page 510, table 25-3 on page 518.
• Elderly adults may become vulnerable because they are in poor mental and/pr physical health, or are disruptive (i.e. an Alzheimer client)
• There is a dependency need upon caretakers which places the client at risk for abuse.
• Refer to questions 8 and 9 for addition information
• View page 518, under Nursing diagnosis for potential Dx in the Elderly
• Some might include: Risk for injury; Anxiety; Fear; Disabled family coping; Interrupted family process; pain related to physical injuries.
• See also box 25-3 page 518 for potential nursing Dx in family violence
11. Differentiate between mild, moderate, severe, and panic levels of anxiety in victims of abuse.
Mild anxiety occurs in the normal experience of everyday living, the person’s ability to perceive reality is brought into sharp focus. A person may display physical symptoms such as slight discomfort, restlessness, irritability, or mild tension relieving behaviors.
Moderate anxiety causes perceptual field to narrow and some details are excluded from observation. The person will see, hear, and grasp less information than normal. Physical symptoms include tension, pounding hearth, increased pulse and respiration rate along with mild somatic symptoms.
Severe anxiety causes the perceptual field to be greatly reduced. The person may focus on one particular detail or many scattered details. Behavior is autonomic and the person may complain of increased severity of somatic symptoms along with trembling, pounding heart and hyperventilation.
Panic Level anxiety is the most extreme form and results in markedly disturbed behavior. The person is not able to process what is going on in the environment and may lose touch with reality (ie screaming or hallucinations) (Varcarolis pg 213-215).
12. Discuss priority assessments and discharge instructions for rape victims in emergency departments.
Assessment guidelines include
Ø Assess psychological trauma. Write down verbatim statements of the client.
Ø Assess level of anxiety
Ø Assess physical trauma. Use a body map and ask permission to take photos
Ø Assess available support system. Often partners or family members do not understand the trauma of rape and may not be the best supports to draw on.
Ø Identify community supports (attorneys, support groups, therapists) ect
Ø Encourage the client to tell his or her experience. Do not press the client to tell (Varcarolis pg 536).
Because the ramifications of rape are experienced for an extended time after the acute phase discharge instructions must include information for follow-up care. In addition information on likely physical concerns, emotional reactions, legal matters, victim compensation, and ways that the family and friends can help should be provided. Everything must be in writing since the amount of verbal information the client can retain may be limited due to anxiety. (Varcarolis pg 537-538).
13. Describe key features of the following disorders:
Anxiety disorders: Anxiety becomes a problem when it interferes with adaptive behavior, causes physical symptoms, or exceeds a tolerable level. The client with an anxiety disorder will use rigid, repetitive, and ineffective behaviors to try and control anxiety. The anxiety is so high that it interferes with personal, occupational, or social functioning (Varcarolis pg 228).
Ø Agoraphobia: Intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing, or in which help might not be available if a panic attack occurred. Feared places are normally avoided. This avoidance behavior can be debilitating and life constricting. (Varcarolis pg 234).
Ø Obsessive-compulsive disorder: Obsessions or compulsions cause marked distress to the individual, rituals are performed to relieve anxiety. The rituals are time consuming and interfere with normal routine, social activities, and relationships with others. Obsessions are thoughts, impulses, or images that persist and recur, so that they cannot be dismissed in the mind (think of a song stuck in your head). Compulsions are ritualistic behaviors that an individual feels driven to perform in an attempt to reduce anxiety (this decreases the anxiety temporarily until the compulsive act needs to be repeated). Table 14-4 page 235 shows common traits. These clients are humiliated by their acts but they cannot control it. (Varcarolis pg 234).
Ø Post-traumatic stress disorder: Repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others. Symptoms often begin within 3 months after the trauma but a delay of years is not uncommon. Post-traumatic stress disorder: characterized by repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others with intense fear, helplessness, and horror. Usually 3 months after the event occurred and has a couple of key features: Persistent re-experiencing (flashbacks); persistent avoidance of stimuli associated with the trauma; experience persistent numbing of general responsiveness (detached from others, feeling empty inside); also a persistent increased arousal (difficulty sleeping, difficulty concentrating, hypervigilance, or startled responses). There are issues of trust, and also chemical abuse involved. (Varcarolis pg 236).
Ø Social phobias: (Social anxiety disorder) is a severe anxiety or fear provoked by exposure to a social situation or a performance situation. Fear of public speaking is the most common social phobia (Varcarolis pg 234).
Ø Panic attacks: Sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom. The feelings of terror present are so severe that normal function is suspended. People experiencing panic attacks believe they are losing their minds or having a heart attack. Usually come out of the blue. (Varcarolis pg 232).
Somatoform disorder: Physical symptoms suggest a physical disorder for which there is no demonstrable base. There is a strong presumption that the symptoms are linked to psychobiological factors (Varcarolis pg 253).
Ø Conversion disorder: Development of one or more symptoms or deficits suggesting a neurological disorder (blindness, deafness, loss of touch) but which is NOT due to a general medical condition, a malingering or factitious disorder and is not culturally sanctioned. Symptoms are associated with psychological factors and are initiated or exacerbated by psychological stressors. They are not caused by a substance. Significant impairment is present (Varcarolis pg 255).
Ø Hypochondriasis: For at least 6 months preoccupation with fears of having a serious disease, these persist despite appropriate medical tests and reassurances. Other disorders are ruled out (somatic delusional disorders) and significant impairment in social or occupational functioning or marked distress is present (Varcarolis pg 255).
Ø Somatoform pain disorder: Pain in one or more anatomical sites which causes significant impairment in occupational or social functioning or marked distress. The pain is associated with psychological factors and is not intentionally produced or feigned (Varcarolis pg 255)
.Ø Body dysmorphic disorder (BDD): Preoccupation with some imagined defect in appearance, or excessive concern over a minor defect that is present. Preoccupation causes significant impairment and is not better accounted for by another mental disorder (Varcarolis pg 255).
Personality disorders: An enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment (Varcarolis 275-276).
Ø Paranoid: Distrust and suspiciousness towards others, based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive the person. They are hyper-vigilant, anticipate hostility and may provoke hostile responses. They are difficult to interview and, underneath the surface, are quite anxious about being harmed (Varcarolis 280).
Ø Schizoid: Is emotionally detached and does not seek out or enjoy close relationships (Varcarolis 280)
Ø Schizotypal: Odd beliefs lead to interpersonal difficulties. The client has an eccentric appearance and shows evidence of magical thinking or perceptual distortions. The client cannot understand the usual interpersonal cues in social situations and thus relates to others inappropriately. The person is more likely to seek psychiatric help then those with Schizoid PD because of the intense anxiety felt in social relationships (Varcarolis 280).
Ø Borderline: Instability in affect, identity, and relationships. Individuals desperately seek relationships to avoid feeling abandoned however often drive others away because of their excessive demands. Multiple dramatic suicidal gestures may be present and risk of suicide is increased (Varcarolis 282).
Ø Narcissistic: Arrogance with a grandiose view of self-importance. The person has a need for constant admiration along with a lack of empathy for others. Underneath the surface of arrogance they feel intense shame and fear that if they are bad they will be abandoned and are afraid of their mistakes (Varcarolis 284).
Ø Histrionic: Emotional attention-seeking behavior, in which the person needs to be the center of attention. The person is impulsive and melodramatic and may act flirtatious or provocative to get the spotlight (Varcarolis 282).
Ø Dependent: Extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends. The person has difficulty making independent decisions and are constantly seeking reassurance. Their submissiveness makes them vulnerable to abusive relationships. (Varcarolis 284).
Ø Obsessive-compulsive: Perfectionism with a focus on orderlineness and control. The person becomes so preoccupied with details and rules that they may not be able to accomplish a given task. They do not have full blown obsessions or compulsions but do not have insight about their own difficult behavior (Varcarolis 286).
14. Describe complications of re-feeding syndrome in clients with anorexia nervosa.
A potentially catastrophic treatment complication in which the demands of a replenished circulatory system overwhelm the capacity of a nutritionally depleted cardiac muscle, which results in cardiovascular collapse (Varcarolis 308).
15. Discuss binge-purge syndrome and likely triggering factors.
This typically has a binge eating behavior (eating till they are literally stuffed) followed by self induced vomiting (laxatives and diuretics can also be used). There are depressive signs and symptoms and have problems with: Interpersonal relationships; problems with self concept; and problems with impulsive behavior. There is increased level of anxiety and compulsivity, possible chemical dependence, and compulsive stealing. They can be found to have 5-8 episodes per night of the binge eating followed by the purging.
• Refer to table 17-1 for phenomena surrounding bulimia on page 303, also refer to box 17-1 on page 304 for some medical complications
16. Name some physical assessment findings in the client with severe anorexia nervosa.
Low weight, amenorrhea, yellow skin, lanugo, cold extremities, peripheral edema, muscle weakening, constipation, hypotension, bradycardia, heart failure, kapokalemia, anemic pancytopenia, and decreased bone density (Varcarolis 302).
17. Describe the defense mechanism of splitting and circumstances that provoke its use.
Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Aspects of self or others tend to alternate between opposite poles either all good or all bad. This defense mechanism is prevalent in personality disorders, especially the borderline ones (Varcarolis pg 282).
• Splitting usually takes place when a client tries to be manipulative to get there way and will use flattery, seductiveness, even instilling guilt to get there way. The second the nurse does not provide what the client desires then splitting takes place. Staff splitting can occur because of the clients which is why it is important to have supervision over the staff to monitor for splitting and have debriefing once a week to prevent it.
• Read Case study and plan of care 16-1 on page 290 to get a better picture of a borderline client
18. List pertinent client education for those who are prescribed alprazolam (Xanax) for acute anxiety disorders.
The medication reduces the ability to handle mechanical equipment, do not drink alcohol or take other anti-anxiety drugs because depressant effects can be potentiated and avoid caffeine. Avoid becoming pregnant because the drug increases the risk for congenital anomalies, do not breast feed because the drug can be excreted in the milk. Cessation may cause withdrawal symptoms, take with food or shortly after to reduce gastrointestinal discomfort. Antacids delay absorption, cimetidine interferes with metabolism, alcohol and barbituarates can cause increased sedation (Varcarolis pg 246).
19. Name a drug that might be prescribed for the social phobia – fear of public speaking.
Antidepressant Selective serotonin reuptake inhibitors are the first line treatment for anxiety disorders because they have a more rapid onset of action and fewer problematic side effects then alternatives. Keltner mentions Paroxetine (Paxil) and Sertraline (Zoloft) specifically. Fluoxetine (Prozac) is our prototype drug in that class (Keltner pg 251).
20. Discuss the drug buspirone (Buspar) and contrast it with the drug diazepam (Valium) for those clients with anxiety.
Buspirone (Buspar) is a nonbezodiazepine anxiolytic used to treat anxiety disorders. It does not cause dependence and so can be used by clients with known substance abuse problems. It does however take 2-4 weeks for full effects; it may be used for long-term treatment and must be taken regularly. In contrast diazepam (Valium), an anxiolytic benzodiazepine has a rapid onset of action but has the potential for dependence. It can cause sedation, impair performance, and is associated with falls in elderly. It is ideal for short periods until other medication or treatments reduces symptoms (Keltner pg 237).
• Buspar is a drug that reduces anxiety without having strong sedative-hypnotic properties
• It is much better tolerated than benzodiazepines because it does not induce sleepiness.
• Since it is not a CNS depressant, it will not have adverse affects with other depressants
• It seems to act as an antagonist to presynaptic serotonin receptors, thus stopping the negative feedback mechanism which usually stops the secretion of serotonin. By stopping this feedback, there is a greater amount of serotonin in the synaptic cleft. Which presumably accounts for its benefit of decreased anxiety.
• Valium is a benzodiazepine which acts as a depressant and can cause significant adverse affects if mixed with other depressants.
• This drug works by binding to GABA receptors to help increase the infinity of GABA, thus increasing the affects of GABA (only works if GABA is present, unlike Buspar which does not have this stipulation).
Clients with panic anxiety are out of control so they need to know that they are safe from their own impulses. Firm, short, and simple statements are useful. Use a low pitched voice, speak slowly and with repetition. Reinforce reality if distortions occur, listen for themes in communication (Varcarolis pg 216).
• Maintain a calm manner, and remain with the patient who is experiencing the severe to panic anxiety attack
• Minimize environmental stimuli (move to a quieter setting)
• Use clear simple statements and repetition in a low-pitched voice while speaking slowly
• Reinforce reality if distortions occur while listening for themes in communication
• Attend to physical and safety needs when necessary (warmth, fluids, pain, etc.)
• Safety is an overall goal, a “show of force” or use of physical limits may need to be implemented
• Provide opportunities of exercise to help dissipate tension
• Offer high caloric drinks to someone who is constantly moving and pacing
• Assess need for meds or seclusion after other interventions have failed
• If hypercapnia occurs, instruct client to take slow, deep breaths. Breathe with the patient to obtain cooperation.
• Keep expectations minimal and simpleSee also table 14-2 page 233, and table 14-5 page 237
2. What techniques are used by a crisis nurse that might not be used in a traditional therapeutic setting?
The nurse must be willing to take an active, even directive role in intervention; this is in direct contrast to what occurs in conventional therapeutic interventions, which stress a more passive and nondirective role for the practitioner (Varcarolis pg 459).
• The following are important assumptions when working with a client in crisis: The person is in charge of their life; the person is able to make decisions; the crisis counseling relationship is one between partners.
• See Table 22-4 page 465, and Box 22-1 #8 page 459
3. Differentiate between primary and secondary crisis interventions.
Primary care promotes mental health and reduces mental illness to decrease the incidence of crisis. The nurse will work with the client to recognized potential problems, teach specific coping skills and evaluate life changes to decrease the negative effects of stress.
Secondary care establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization. The nurse’s primary focus is to ensure the safety of the client. Then the nurse will assess the clients problem, support systems, and coping styles to lessen the time a person is mentally disabled during a crisis (Varcarolis pg 465).
4. Describe characteristics of clients manifesting escalation of aggressive behavior.
Hyperactivity: most important predictor of imminent violenceIncreasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self,Verbal abuse, profanity and argumentativeness.Loud voice: change in pitch, or very soft voice forcing others to strain to hearintense eye contact or avoidance of eye contact (Varcarolis pg 493).
• Recent acts of violence, including property violence
• Stone silence
• Alcohol or drug intoxication
• Possession of a weapon or object that may be used as a weapon
• Milieu characteristics conducive to violence: overcrowding; staff inexperience; provocative or controlling staff; poor limit setting; Arbitrary revocation of privileges
5. Discuss techniques used when staff needs to administer IM medication to an aggressive client.
A team with about five staff members is gathered and organized before approaching the client. They are equipped with medication and the right size restraint. Each member knows which limb to secure or task to perform. The team leader explains to the client in a matter of fact manner exactly what the team is about to do and why. Often the client will cooperate at this point, if not the team remains calm and acts as quickly as possible to restrain the client. Once restrained the nurse administers the IM injection (benzodiazepine, major tranquilizer, or antihistamine). The nurse provides an explanation to the client of the medication. Throughout the whole process the team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency and control (Varcarolis pg 496).
• The nurse’s role is to provide an explanation to the client for the medication and to make sure the client is properly restrained so that the medication can be safely administered.
• The team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency, and control.
• Prior to medication administration, the client needs to be restrained and in doing so each team member needs to have proper training
• The approach needs to be organized with each team member knowing what their role is
• Also make sure to appropriate sized equipment is ready
• The team leader explains to the client in a matter-of-fact manner exactly what the team is about to do and why; this may provoke the client to cooperate or move into a seclusion room
• Refer to Box 24-3 page 497 for some other guidelines to restraint.
6. Describe aspects of a unit milieu that decreases likelihood of violent behavior.
The following are to be avoided to decrease likelihood of violence:Overcrowding.Staff inexperience.Provocative or controlling staff.Poor limit setting.Arbitrary revocation of privileges (Varcarolis pg 493).
• You want to make sure that the environment provides enough space for clients to prevent overcrowding.
• There also needs to be a balance between structure and quiet time
• Staff should be provided education in verbal de-escalation techniques
• Counseling of staff regarding the use of punitive and arbitrary approaches to clients
• The need to look for escalating events and how to provide immediate intervention to prevent overt violence (deescalating techniques, restraints/seclusion, and/or medication)
• Provide the client with the tools via psychotherapeutic approaches to the client new skills for handling anger.
• See box 24-2 page 496 for deescalating techniques, and refer to questions 5 and 6
7. Discuss reasons for seclusion and restraint as well as priority actions by a nurse caring for a client who has been restrained and secluded.
Seclusion or restraint is used in the following circumstances:
Ø Alternative interventions have been tried (documented) and failed. These include; verbal intervention, behavioral care plan, medication, decrease in sensory stimulation, removal of problematic stimulus, presence of significant other, frequent observation, and one-on-one observation of client.
Ø The client presents clear and present danger to self or
Ø The client presents a clear and present danger to others or
Ø The client has been legally detained for involuntary treatment and is thought to pose an escape risk or
Ø The client requests to be secluded or restrained.Priority actions by the nurse caring for a restrained or secluded client include:
Ø Be sure to receive or maintain an updated Physician’s Order for the restraint.
Ø Have nurse in constant attendance.
Ø Complete written record every 15 minutes.
Ø Release limb from restraint every 2 hours.
Ø Stretch limb through range of movement.
Ø Monitory vital signs, observe blood flow.
Ø Observe that restraint is not rubbing.
Ø Provide for nutrition, hydration, and elimination.
Ø Closely monitor client to determine the client’s ability to reintegrate into the unit activities (Varcarolis pg 497).
8. Differentiate between child abuse and neglect.
Child abuse is a broad category, which includes battering, neglect, physical endangerment, and sexual abuse.
Child neglect is either physical (failure to provide medical, dental, or psychiatric care needed to prevent or treat physical or emotional illnesses), developmental (failure to provide emotional nurturing or the physical or cognitive stimulation needed to ensure freedom from developmental deficits), or educational (failure to provide education in accordance with state law) (Varcarolis pg 511,786).
• Physical violence: is the infliction of physical pain or bodily harm
• Sexual violence: is any form of sexual contact or exposure without consent, or in circumstances in which the victim is incapable of giving consent (childhood sexual abuse destroys an individual’s positive self-concept and can interfere with the learning of self care skills)
• Emotional violence: is the infliction of mental anguish and take the form in the following; terrorizing through verbal threats; demeaning an individuals self worth; directing blatant or subtle hostility and hatred; persistently ignoring an individuals needs; consistently belittling and criticizing an individual; with holding warmth and affections; threatening an individual with abandonment or institutionalization.
• Neglect: can be physical, developmental, or educational.
• Physical neglect: failure to provide the medical, dental, or psychiatric care needed to prevent or treat physical or emotional illness
• Developmental neglect: failure to provide emotional nurturing and the physical and cognitive stimulation needed to ensure freedom from development deficits
• Educational neglect: when a child’s caretakers deprive the child of the education available in accordance with the state’s education laws.
9. Describe the cycle of violence and assessment priorities for a nurse caring for a victim of physical abuse.
Periods of intense violence alternate with periods of safety, hope, and trust during three phases known as the cycle of violence.
Ø Tension building stage is characterized by minor incidents such as pushing, shoving, and verbal abuse.
Ø Acute battering stage involves a serious battering incident where the perpetrator releases the build-up tension by brutal and uncontrollable beatings.
Ø Honeymoon Stage is characterized with kindness and loving behaviors. The perpetrator feels remorseful, is apologetic, brings gifts and makes promises to change
(Varcarolis pg 511).
Assessment priorities for a victim of physical abuse include
Ø A series of minor complaints such as headaches, back trouble, dizziness, accidents or falls.
Ø Bruising, scars, burns, and wounds around head face, chest, arms, abdomen, back, buttocks and genitalia.
Ø Be wary if the explanation does mot match the injury or if the client minimizes the seriousness of the injury, a high index of suspicion is key.
Ø Bruises on an infant younger than 6 months is suspicious, shaken baby syndrome is frequently overlooked and manifest as an abnormal pulmonary examination, or head circumference greater then 90th percentile.
Ø Nonverbal responses are also important such as hesitation or lack of eye contact (Varcarolis pg 514).
o Escalating-deescalating: conditions of anger and fear escalate until an incident of violence takes place, after which there is a defusing of tension and a brief feeling of safety; victims over time believe that the beatings are deserved and accept blame.
• Important interviewing guidelines are listed in box 25-4 page 512
• Priorities that should take place are initially started with safety and addressing any signs/ symptoms of the traumatic injuries that were inflicted during the incident. Should utilize the “Abuse Assessment Screen” found on page 517, figure 25-2
• Assess for potential problems in vulnerable families
• Physical, sexual, and/or emotional abuse and neglect, and economic maltreatment in family should be assessed
• Observe what family coping patterns are present
• Assess the client’s support system
• Assess for drug/ alcohol abuse
• Are there any suicidal or homicidal ideation
• Is post traumatic stress disorder present?
• Appropriate agencies need to be contacted to handle the matter.
10. Know the priority nursing diagnoses for clients with Alzheimer’s disease who may be suffering from abuse.
Risk for injury related to helplessness as evidenced by signs of violence
Page 510, table 25-3 on page 518.
• Elderly adults may become vulnerable because they are in poor mental and/pr physical health, or are disruptive (i.e. an Alzheimer client)
• There is a dependency need upon caretakers which places the client at risk for abuse.
• Refer to questions 8 and 9 for addition information
• View page 518, under Nursing diagnosis for potential Dx in the Elderly
• Some might include: Risk for injury; Anxiety; Fear; Disabled family coping; Interrupted family process; pain related to physical injuries.
• See also box 25-3 page 518 for potential nursing Dx in family violence
11. Differentiate between mild, moderate, severe, and panic levels of anxiety in victims of abuse.
Mild anxiety occurs in the normal experience of everyday living, the person’s ability to perceive reality is brought into sharp focus. A person may display physical symptoms such as slight discomfort, restlessness, irritability, or mild tension relieving behaviors.
Moderate anxiety causes perceptual field to narrow and some details are excluded from observation. The person will see, hear, and grasp less information than normal. Physical symptoms include tension, pounding hearth, increased pulse and respiration rate along with mild somatic symptoms.
Severe anxiety causes the perceptual field to be greatly reduced. The person may focus on one particular detail or many scattered details. Behavior is autonomic and the person may complain of increased severity of somatic symptoms along with trembling, pounding heart and hyperventilation.
Panic Level anxiety is the most extreme form and results in markedly disturbed behavior. The person is not able to process what is going on in the environment and may lose touch with reality (ie screaming or hallucinations) (Varcarolis pg 213-215).
12. Discuss priority assessments and discharge instructions for rape victims in emergency departments.
Assessment guidelines include
Ø Assess psychological trauma. Write down verbatim statements of the client.
Ø Assess level of anxiety
Ø Assess physical trauma. Use a body map and ask permission to take photos
Ø Assess available support system. Often partners or family members do not understand the trauma of rape and may not be the best supports to draw on.
Ø Identify community supports (attorneys, support groups, therapists) ect
Ø Encourage the client to tell his or her experience. Do not press the client to tell (Varcarolis pg 536).
Because the ramifications of rape are experienced for an extended time after the acute phase discharge instructions must include information for follow-up care. In addition information on likely physical concerns, emotional reactions, legal matters, victim compensation, and ways that the family and friends can help should be provided. Everything must be in writing since the amount of verbal information the client can retain may be limited due to anxiety. (Varcarolis pg 537-538).
13. Describe key features of the following disorders:
Anxiety disorders: Anxiety becomes a problem when it interferes with adaptive behavior, causes physical symptoms, or exceeds a tolerable level. The client with an anxiety disorder will use rigid, repetitive, and ineffective behaviors to try and control anxiety. The anxiety is so high that it interferes with personal, occupational, or social functioning (Varcarolis pg 228).
Ø Agoraphobia: Intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing, or in which help might not be available if a panic attack occurred. Feared places are normally avoided. This avoidance behavior can be debilitating and life constricting. (Varcarolis pg 234).
Ø Obsessive-compulsive disorder: Obsessions or compulsions cause marked distress to the individual, rituals are performed to relieve anxiety. The rituals are time consuming and interfere with normal routine, social activities, and relationships with others. Obsessions are thoughts, impulses, or images that persist and recur, so that they cannot be dismissed in the mind (think of a song stuck in your head). Compulsions are ritualistic behaviors that an individual feels driven to perform in an attempt to reduce anxiety (this decreases the anxiety temporarily until the compulsive act needs to be repeated). Table 14-4 page 235 shows common traits. These clients are humiliated by their acts but they cannot control it. (Varcarolis pg 234).
Ø Post-traumatic stress disorder: Repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others. Symptoms often begin within 3 months after the trauma but a delay of years is not uncommon. Post-traumatic stress disorder: characterized by repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others with intense fear, helplessness, and horror. Usually 3 months after the event occurred and has a couple of key features: Persistent re-experiencing (flashbacks); persistent avoidance of stimuli associated with the trauma; experience persistent numbing of general responsiveness (detached from others, feeling empty inside); also a persistent increased arousal (difficulty sleeping, difficulty concentrating, hypervigilance, or startled responses). There are issues of trust, and also chemical abuse involved. (Varcarolis pg 236).
Ø Social phobias: (Social anxiety disorder) is a severe anxiety or fear provoked by exposure to a social situation or a performance situation. Fear of public speaking is the most common social phobia (Varcarolis pg 234).
Ø Panic attacks: Sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom. The feelings of terror present are so severe that normal function is suspended. People experiencing panic attacks believe they are losing their minds or having a heart attack. Usually come out of the blue. (Varcarolis pg 232).
Somatoform disorder: Physical symptoms suggest a physical disorder for which there is no demonstrable base. There is a strong presumption that the symptoms are linked to psychobiological factors (Varcarolis pg 253).
Ø Conversion disorder: Development of one or more symptoms or deficits suggesting a neurological disorder (blindness, deafness, loss of touch) but which is NOT due to a general medical condition, a malingering or factitious disorder and is not culturally sanctioned. Symptoms are associated with psychological factors and are initiated or exacerbated by psychological stressors. They are not caused by a substance. Significant impairment is present (Varcarolis pg 255).
Ø Hypochondriasis: For at least 6 months preoccupation with fears of having a serious disease, these persist despite appropriate medical tests and reassurances. Other disorders are ruled out (somatic delusional disorders) and significant impairment in social or occupational functioning or marked distress is present (Varcarolis pg 255).
Ø Somatoform pain disorder: Pain in one or more anatomical sites which causes significant impairment in occupational or social functioning or marked distress. The pain is associated with psychological factors and is not intentionally produced or feigned (Varcarolis pg 255)
.Ø Body dysmorphic disorder (BDD): Preoccupation with some imagined defect in appearance, or excessive concern over a minor defect that is present. Preoccupation causes significant impairment and is not better accounted for by another mental disorder (Varcarolis pg 255).
Personality disorders: An enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment (Varcarolis 275-276).
Ø Paranoid: Distrust and suspiciousness towards others, based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive the person. They are hyper-vigilant, anticipate hostility and may provoke hostile responses. They are difficult to interview and, underneath the surface, are quite anxious about being harmed (Varcarolis 280).
Ø Schizoid: Is emotionally detached and does not seek out or enjoy close relationships (Varcarolis 280)
Ø Schizotypal: Odd beliefs lead to interpersonal difficulties. The client has an eccentric appearance and shows evidence of magical thinking or perceptual distortions. The client cannot understand the usual interpersonal cues in social situations and thus relates to others inappropriately. The person is more likely to seek psychiatric help then those with Schizoid PD because of the intense anxiety felt in social relationships (Varcarolis 280).
Ø Borderline: Instability in affect, identity, and relationships. Individuals desperately seek relationships to avoid feeling abandoned however often drive others away because of their excessive demands. Multiple dramatic suicidal gestures may be present and risk of suicide is increased (Varcarolis 282).
Ø Narcissistic: Arrogance with a grandiose view of self-importance. The person has a need for constant admiration along with a lack of empathy for others. Underneath the surface of arrogance they feel intense shame and fear that if they are bad they will be abandoned and are afraid of their mistakes (Varcarolis 284).
Ø Histrionic: Emotional attention-seeking behavior, in which the person needs to be the center of attention. The person is impulsive and melodramatic and may act flirtatious or provocative to get the spotlight (Varcarolis 282).
Ø Dependent: Extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends. The person has difficulty making independent decisions and are constantly seeking reassurance. Their submissiveness makes them vulnerable to abusive relationships. (Varcarolis 284).
Ø Obsessive-compulsive: Perfectionism with a focus on orderlineness and control. The person becomes so preoccupied with details and rules that they may not be able to accomplish a given task. They do not have full blown obsessions or compulsions but do not have insight about their own difficult behavior (Varcarolis 286).
14. Describe complications of re-feeding syndrome in clients with anorexia nervosa.
A potentially catastrophic treatment complication in which the demands of a replenished circulatory system overwhelm the capacity of a nutritionally depleted cardiac muscle, which results in cardiovascular collapse (Varcarolis 308).
15. Discuss binge-purge syndrome and likely triggering factors.
This typically has a binge eating behavior (eating till they are literally stuffed) followed by self induced vomiting (laxatives and diuretics can also be used). There are depressive signs and symptoms and have problems with: Interpersonal relationships; problems with self concept; and problems with impulsive behavior. There is increased level of anxiety and compulsivity, possible chemical dependence, and compulsive stealing. They can be found to have 5-8 episodes per night of the binge eating followed by the purging.
• Refer to table 17-1 for phenomena surrounding bulimia on page 303, also refer to box 17-1 on page 304 for some medical complications
16. Name some physical assessment findings in the client with severe anorexia nervosa.
Low weight, amenorrhea, yellow skin, lanugo, cold extremities, peripheral edema, muscle weakening, constipation, hypotension, bradycardia, heart failure, kapokalemia, anemic pancytopenia, and decreased bone density (Varcarolis 302).
17. Describe the defense mechanism of splitting and circumstances that provoke its use.
Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Aspects of self or others tend to alternate between opposite poles either all good or all bad. This defense mechanism is prevalent in personality disorders, especially the borderline ones (Varcarolis pg 282).
• Splitting usually takes place when a client tries to be manipulative to get there way and will use flattery, seductiveness, even instilling guilt to get there way. The second the nurse does not provide what the client desires then splitting takes place. Staff splitting can occur because of the clients which is why it is important to have supervision over the staff to monitor for splitting and have debriefing once a week to prevent it.
• Read Case study and plan of care 16-1 on page 290 to get a better picture of a borderline client
18. List pertinent client education for those who are prescribed alprazolam (Xanax) for acute anxiety disorders.
The medication reduces the ability to handle mechanical equipment, do not drink alcohol or take other anti-anxiety drugs because depressant effects can be potentiated and avoid caffeine. Avoid becoming pregnant because the drug increases the risk for congenital anomalies, do not breast feed because the drug can be excreted in the milk. Cessation may cause withdrawal symptoms, take with food or shortly after to reduce gastrointestinal discomfort. Antacids delay absorption, cimetidine interferes with metabolism, alcohol and barbituarates can cause increased sedation (Varcarolis pg 246).
19. Name a drug that might be prescribed for the social phobia – fear of public speaking.
Antidepressant Selective serotonin reuptake inhibitors are the first line treatment for anxiety disorders because they have a more rapid onset of action and fewer problematic side effects then alternatives. Keltner mentions Paroxetine (Paxil) and Sertraline (Zoloft) specifically. Fluoxetine (Prozac) is our prototype drug in that class (Keltner pg 251).
20. Discuss the drug buspirone (Buspar) and contrast it with the drug diazepam (Valium) for those clients with anxiety.
Buspirone (Buspar) is a nonbezodiazepine anxiolytic used to treat anxiety disorders. It does not cause dependence and so can be used by clients with known substance abuse problems. It does however take 2-4 weeks for full effects; it may be used for long-term treatment and must be taken regularly. In contrast diazepam (Valium), an anxiolytic benzodiazepine has a rapid onset of action but has the potential for dependence. It can cause sedation, impair performance, and is associated with falls in elderly. It is ideal for short periods until other medication or treatments reduces symptoms (Keltner pg 237).
• Buspar is a drug that reduces anxiety without having strong sedative-hypnotic properties
• It is much better tolerated than benzodiazepines because it does not induce sleepiness.
• Since it is not a CNS depressant, it will not have adverse affects with other depressants
• It seems to act as an antagonist to presynaptic serotonin receptors, thus stopping the negative feedback mechanism which usually stops the secretion of serotonin. By stopping this feedback, there is a greater amount of serotonin in the synaptic cleft. Which presumably accounts for its benefit of decreased anxiety.
• Valium is a benzodiazepine which acts as a depressant and can cause significant adverse affects if mixed with other depressants.
• This drug works by binding to GABA receptors to help increase the infinity of GABA, thus increasing the affects of GABA (only works if GABA is present, unlike Buspar which does not have this stipulation).
Sunday, April 15, 2007
Give blood for your club!
Here's the deal. If a student club can get 20 folk to donate blood then they are eligible to receive $300. SNA could put that $$ to good use helping YOU with information, activities and scholarships. YOU get to help your community by providing lifesaving blood.
Details:Wednesday 4/16..... 9am-230pm in Upper Danner Hall - need photo ID with date of birth on it to donate; to save time call Barbara Barroga @ 209-954-5100 to sign up. Please identify yourself as an SNA member/supporter.
Please respond here if you can attend and donate. Many of us will be in clinicals that day and unable to attend, but pass the word and let's see if we can get a mass o' nursing talent there to support SNA and the Blood Bank!
Details:Wednesday 4/16..... 9am-230pm in Upper Danner Hall - need photo ID with date of birth on it to donate; to save time call Barbara Barroga @ 209-954-5100 to sign up. Please identify yourself as an SNA member/supporter.
Please respond here if you can attend and donate. Many of us will be in clinicals that day and unable to attend, but pass the word and let's see if we can get a mass o' nursing talent there to support SNA and the Blood Bank!
Saturday, April 14, 2007
area AA mtgs and more - for N5'ers
Complete list by city here:
http://www.aadelta.org/meeting_search.htm
Alanon/Alateen by city
http://www.ncwsa.org/meeting.html#anchor50845
Narcotics Anonymous
http://portaltools.na.org/portaltools/MeetingLoc/
Cocaine Anonymous
http://www.norcalca.com/schedules/Stockton.asp
http://www.aadelta.org/meeting_search.htm
Alanon/Alateen by city
http://www.ncwsa.org/meeting.html#anchor50845
Narcotics Anonymous
http://portaltools.na.org/portaltools/MeetingLoc/
Cocaine Anonymous
http://www.norcalca.com/schedules/Stockton.asp
Thursday, April 12, 2007
Job Opportunity
Mrs Batson forwarded this info to me so that I can let y'all know about it:
Part-time jobs are available with the Census Bureau.
Flexible hours $12.25-$14.oo/hour in the San Joaquin area.
Contact: Jennie Rillamas cell # 604-4788
Part-time jobs are available with the Census Bureau.
Flexible hours $12.25-$14.oo/hour in the San Joaquin area.
Contact: Jennie Rillamas cell # 604-4788
Sunday, April 08, 2007
SNA Meeting reminder, Spread the Word...
SNA Meeting April 9, 2007
1:00 in Locke 314
Come join your fellow nursing/health students for snacks, raffles and prizes, and most of all, info about the SNA. Also find out the benefits of being an officer, leadership scholarships and more.
Don't forget, we need officers for President, Vice President, Secretary, Treasurer and ICC Representative. Description of duties listed below, if you are interested or know someone who is, please attend the meeting.
Elections for Officer Positions:
President: Oversees club activities, responsible for meeting agendas, representative of SNA at monthly faculty meetings, responsible for active club status with Student Activities, and delegation of other officers as needed.
Vice President: Supports President in planning and implementing ideas and club events.
Secretary: Makes and posts flyers for meetings, takes notes at meetings and formats minutes to be distributed at the next meeting.
Treasurer: Keeps financial records, makes deposits and payment requests for club events, manages inventory and ordering.
ICC Representative: Represents the SNA at the mandatory InterClub Council (ICC) meetings two Thursdays a month or as scheduled by Student Activities; this can be done by rotation of SNA members but MUST BE DONE or we cannot continue our Association.
Hope to see you there!! Spread the word.
1:00 in Locke 314
Come join your fellow nursing/health students for snacks, raffles and prizes, and most of all, info about the SNA. Also find out the benefits of being an officer, leadership scholarships and more.
Don't forget, we need officers for President, Vice President, Secretary, Treasurer and ICC Representative. Description of duties listed below, if you are interested or know someone who is, please attend the meeting.
Elections for Officer Positions:
President: Oversees club activities, responsible for meeting agendas, representative of SNA at monthly faculty meetings, responsible for active club status with Student Activities, and delegation of other officers as needed.
Vice President: Supports President in planning and implementing ideas and club events.
Secretary: Makes and posts flyers for meetings, takes notes at meetings and formats minutes to be distributed at the next meeting.
Treasurer: Keeps financial records, makes deposits and payment requests for club events, manages inventory and ordering.
ICC Representative: Represents the SNA at the mandatory InterClub Council (ICC) meetings two Thursdays a month or as scheduled by Student Activities; this can be done by rotation of SNA members but MUST BE DONE or we cannot continue our Association.
Hope to see you there!! Spread the word.
Sunday, April 01, 2007
Hey ladies and gents, our next SNA meeting will be Monday, April 9th at 1:00 in Locke 314. Please be sure to attend, we have lots of exciting info for you. We also need officers for the next election for SNA leaders. If you are interested or know someone who is, please attend the meeting. Just an FYI, the SNA meetings are for all students: ADN, LVN, Psych Tech, and those who are taking prerequesites. Support you fellow nursing/health students. A reminder with more info to follow as the meeting approaches. Thanks in advance.Sandra Hardy
Thursday, March 22, 2007
Test Taking Strategies
* Are you able to eliminate all but two choices on exams and always seem to choose the wrong answer?
* Do you find yourself over analyzing each question?
* Do you want to learn what key points to remember when taking an exam in the Nursing Program?
If you answered yes to any of these questions mark you calendar for…
What: Workshop on Test Taking Strategies
Where: Locke 313
When: Thursday March 29th
Time: 12:30 to 3:30 (open workshop-come when you can)
Facilitated By: Bonnie Boss, RN and Debbie Vogel, RN
For Further Details Contact:
Nursing Student Success Program
(209) 954-5445
Locke 304
* Do you find yourself over analyzing each question?
* Do you want to learn what key points to remember when taking an exam in the Nursing Program?
If you answered yes to any of these questions mark you calendar for…
What: Workshop on Test Taking Strategies
Where: Locke 313
When: Thursday March 29th
Time: 12:30 to 3:30 (open workshop-come when you can)
Facilitated By: Bonnie Boss, RN and Debbie Vogel, RN
For Further Details Contact:
Nursing Student Success Program
(209) 954-5445
Locke 304
Wednesday, March 21, 2007
Skills Lab Help
I was going to read for the skills lab tomorrow assessment. I opened my syllabus and found that I don't have the right text book or maybe I do. I don't know. I bought all of the required books at the bookstore. I bought the Dillon book Nursing Health Assessment. Then I look in the syllabus and it says to read the Gidden Wilson Health Assessment book. That is in the N2 required books not ours. So my question is to you people who already took N4 do we need to buy the other book or is the reading the same in our book?
Thanks to anyone who can help.
Susan
Thanks to anyone who can help.
Susan
Just something to think about when you're taking care of the elderly
What Do You See Nurse?
What do you see, nurse, what do you see?
What are you thinking when you look at me?
A crabbed old women, not very wise
Uncertain of habit, with faraway eyes.
Who dribbles her food and makes no reply.
When you say in a loud voice, "I do wish you'd try."
Who seems to not notice the things that you do
And forever is losing a stocking or shoe.
Who unresisting or not, lets you do as you will
With bathing or feeding, the long day to fill
Is that what you're thinking, is that what you see?
Then open your eyes, you're not looking at me.
I'll tell you who I am as I sit there so still.
As I move at your bidding, as I eat at your will.
I'm a small child of ten with a father and mother,
Brothers and sisters who love one another.
A young girl at sixteen with wings on her feet
A bride soon at twenty--my heart gives a leap
Remembering the vows I promised to keep.
At twenty-five, now, I have young of my own
Who need me to build a secure happy home.
A women of thirty, my young now grow fast
Bound to each other with ties that should last.
At forty my young now will soon be gone,
But my man stays beside me to see I don't mourn.
At fifty once more babies play round my knee.
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead.
I look at the future, I shudder with dread.
For my young are all busy rearing young of their own.
I'm an old woman now and nature is cruel.
Tis her just to make old age look like a fool.
The body it crumbles, grace and vigor depart.
There is now just a stone where I once was a heart.
But inside this old carcass a young girl still dwells.
And now and again my battered heart swells.
I remember the joys, I remember the pain.
And I'm loving and living life all over again.
I think of the years all to few-- gone so fast.
And accept the stark fact that nothing can last.
So open your eyes, nurse, open and see.
Not a crabbed old women--look closer--SEE ME.
What Do You See Nurse?
What do you see, nurse, what do you see?
What are you thinking when you look at me?
A crabbed old women, not very wise
Uncertain of habit, with faraway eyes.
Who dribbles her food and makes no reply.
When you say in a loud voice, "I do wish you'd try."
Who seems to not notice the things that you do
And forever is losing a stocking or shoe.
Who unresisting or not, lets you do as you will
With bathing or feeding, the long day to fill
Is that what you're thinking, is that what you see?
Then open your eyes, you're not looking at me.
I'll tell you who I am as I sit there so still.
As I move at your bidding, as I eat at your will.
I'm a small child of ten with a father and mother,
Brothers and sisters who love one another.
A young girl at sixteen with wings on her feet
A bride soon at twenty--my heart gives a leap
Remembering the vows I promised to keep.
At twenty-five, now, I have young of my own
Who need me to build a secure happy home.
A women of thirty, my young now grow fast
Bound to each other with ties that should last.
At forty my young now will soon be gone,
But my man stays beside me to see I don't mourn.
At fifty once more babies play round my knee.
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead.
I look at the future, I shudder with dread.
For my young are all busy rearing young of their own.
I'm an old woman now and nature is cruel.
Tis her just to make old age look like a fool.
The body it crumbles, grace and vigor depart.
There is now just a stone where I once was a heart.
But inside this old carcass a young girl still dwells.
And now and again my battered heart swells.
I remember the joys, I remember the pain.
And I'm loving and living life all over again.
I think of the years all to few-- gone so fast.
And accept the stark fact that nothing can last.
So open your eyes, nurse, open and see.
Not a crabbed old women--look closer--SEE ME.
Tuesday, March 20, 2007
Lodi Memorial Hospital N4~ 1st rotation
The Lovely Ladies of Lodi Memorial
Forget Nursing, She is going to be a Sombrero Model!!!
This Was A VERY Happy Day!
Ohhh, What A KissADIOS Nursing 4!!!!!
Monday, March 19, 2007
SNA Today!
SNA meeting today in Locke 314 @1:00pm.
Elections for Officer Positions.
Guest speakers describe their Specialties.
Raffle prizes for SNA gear.
See you there!
Sunday, March 18, 2007
Friday, March 16, 2007
Chest presses, not breaths, help CPR - article
By MARILYNN MARCHIONE, AP Medical Writer 1 hour, 25 minutes ago
Chest compression — not mouth-to-mouth resuscitation — seems to be the key in helping someone recover from cardiac arrest, according to new research that further bolsters advice from heart experts.
A study in Japan showed that people were more likely to recover without brain damage if rescuers focused on chest compressions rather than rescue breaths, and some experts advised dropping the mouth-to-mouth part of CPR altogether. The study was published in Friday's issue of the medical journal The Lancet.
More than a year ago, the American Heart Association revised CPR guidelines to put more emphasis on chest presses, urging 30 instead of 15 for every two breaths given. Stopping chest compressions to blow air into the lungs of someone who is unresponsive detracts from the more important task of keeping blood moving to provide oxygen and nourishment to the brain and heart.
Another big advantage to dropping the rescue breaths: It could make bystanders more willing to provide CPR in the first place. Many are unwilling to do the mouth-to-mouth part and become flummoxed and fearful of getting the ratio right in an emergency.
Sudden cardiac arrest — when the heart suddenly stops beating — can occur after a heart attack or as a result of electrocution or near-drowning. It's most often caused by an abnormal heart rhythm. The person experiencing it collapses, is unresponsive to gentle shaking and stops normal breathing.
In the new study, researchers led by Dr Ken Nagao of Surugadai Nihon University Hospital in Tokyo analyzed 4,068 adult patients who had cardiac arrest witnessed by bystanders. Of those, 439 received chest compressions only from bystanders, and 712 received conventional CPR — compressions and breaths.
Any CPR attempt improved survival odds. However, 22 percent of those who received just chest compressions survived with good neurological function compared with only 10 percent of those who received combination CPR.
"Eliminating the need for mouth-to-mouth ventilation will dramatically increase the occurrence of bystander-initiated resuscitation efforts and will increase survival," Dr. Gordon Ewy, a cardiologist at the University of Arizona College of Medicine in Tucson, writes in an accompanying editorial.
A big caveat: The combination CPR in the Japanese study was given according to the old guidelines of 15 presses for every two breaths, not the 30 presses recommended now.
The American Heart Association said the study supports a focus on chest presses, but the association does not expect its advice to change. It recommends that bystanders provide compression-only CPR if they are "unwilling or unable" to do mouth-to-mouth breathing at the same time and for emergency dispatchers to give instructions on that.
The association wants to see survival results from programs that use compression-only CPR for cardiac arrest.
"It is important to note that victims of cardiac arrest from non-cardiac causes, like near-drowning or electrocution, and almost all victims of pediatric cardiac arrest benefit from a combination of rescue breathing and chest compressions," a heart association statement says.
More than 300,000 Americans die from cardiac arrest each year. About 75 percent to 80 percent of all cardiac arrests outside a hospital happen at home, and effective CPR can double a victim's chance of survival.
Roughly 9 out of 10 cardiac arrest victims die before they get to the hospital — partly because they don't get CPR.
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On the Net:
Lancet article: http://tinyurl.com/2fup97
American Heart Association: http://www.americanheart.org
Chest compression — not mouth-to-mouth resuscitation — seems to be the key in helping someone recover from cardiac arrest, according to new research that further bolsters advice from heart experts.
A study in Japan showed that people were more likely to recover without brain damage if rescuers focused on chest compressions rather than rescue breaths, and some experts advised dropping the mouth-to-mouth part of CPR altogether. The study was published in Friday's issue of the medical journal The Lancet.
More than a year ago, the American Heart Association revised CPR guidelines to put more emphasis on chest presses, urging 30 instead of 15 for every two breaths given. Stopping chest compressions to blow air into the lungs of someone who is unresponsive detracts from the more important task of keeping blood moving to provide oxygen and nourishment to the brain and heart.
Another big advantage to dropping the rescue breaths: It could make bystanders more willing to provide CPR in the first place. Many are unwilling to do the mouth-to-mouth part and become flummoxed and fearful of getting the ratio right in an emergency.
Sudden cardiac arrest — when the heart suddenly stops beating — can occur after a heart attack or as a result of electrocution or near-drowning. It's most often caused by an abnormal heart rhythm. The person experiencing it collapses, is unresponsive to gentle shaking and stops normal breathing.
In the new study, researchers led by Dr Ken Nagao of Surugadai Nihon University Hospital in Tokyo analyzed 4,068 adult patients who had cardiac arrest witnessed by bystanders. Of those, 439 received chest compressions only from bystanders, and 712 received conventional CPR — compressions and breaths.
Any CPR attempt improved survival odds. However, 22 percent of those who received just chest compressions survived with good neurological function compared with only 10 percent of those who received combination CPR.
"Eliminating the need for mouth-to-mouth ventilation will dramatically increase the occurrence of bystander-initiated resuscitation efforts and will increase survival," Dr. Gordon Ewy, a cardiologist at the University of Arizona College of Medicine in Tucson, writes in an accompanying editorial.
A big caveat: The combination CPR in the Japanese study was given according to the old guidelines of 15 presses for every two breaths, not the 30 presses recommended now.
The American Heart Association said the study supports a focus on chest presses, but the association does not expect its advice to change. It recommends that bystanders provide compression-only CPR if they are "unwilling or unable" to do mouth-to-mouth breathing at the same time and for emergency dispatchers to give instructions on that.
The association wants to see survival results from programs that use compression-only CPR for cardiac arrest.
"It is important to note that victims of cardiac arrest from non-cardiac causes, like near-drowning or electrocution, and almost all victims of pediatric cardiac arrest benefit from a combination of rescue breathing and chest compressions," a heart association statement says.
More than 300,000 Americans die from cardiac arrest each year. About 75 percent to 80 percent of all cardiac arrests outside a hospital happen at home, and effective CPR can double a victim's chance of survival.
Roughly 9 out of 10 cardiac arrest victims die before they get to the hospital — partly because they don't get CPR.
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On the Net:
Lancet article: http://tinyurl.com/2fup97
American Heart Association: http://www.americanheart.org
Thank you Bonnie and Debby!!
I just wanted to thank Bonnie and Debby for taking the time to put together the workshop yesterday. This was a real eye opener, I highly recommend it to everyone, even if you have passed N4 already it will definently prepare you for the NCLEX. Once again thank you ladies!!!
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