CARE OF PATIENT ON PSYCHOTROPIC MEDICATIONS- Anti-anxiety agents
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- Anti-convulsants
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- Anti-psychotics:
- Evaluation of side effects:
- hypotension
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- extrapyramidal
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- oversedation
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- anticholinergic
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- agranulocytosis
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- photosensitivity
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- early signs of tardive dyskinesia
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- Neuroleptic Malignant Syndrome
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- Rapid tranquilization
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- Antipsychotics:
- Proloxin
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- Haldol
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- Clorizil
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- Anti-Parkinsonism agents:
- Benadryl
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- Cogentin
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- Anti-depressants:
- Tricyclics:
- Anticholinergic side effects
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- Anticholinergic delirium
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- monitoring therapeutic blood levels
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- Monoamine oxidase inhibitors (MAOI):
- food/drug interactions
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- tyramine dietary restriction
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- hypertensive crisis
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- Lithium Carbonate:
- Therapeutic blood levels
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- Signs of toxicity
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- Medications for hyperactivity
- Ritalin and Cylert:
- side effects
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- appetite
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- growth in children
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- Assessment for PRN psychotropics
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- Psychotropic drug overdose
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- Psychotropic drug interactions
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- Patient teaching:
- Self-administered medication
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- Long-term use of medication
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ENVIRONMENTAL AND UNIT SAFETY
- Identification of safety hazards in milieu
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- Unlocked unit precautions
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- Locked unit precautions
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- Privilege levels - escorting patients off unit,liability for passes/outings
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- Escape /runaway precautions-flow sheets
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- A.W.O.L. - notifying authorities
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- Patient searches:
- Confiscation of contraband
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- Strip searches
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- Legalities
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- Alarm systems
- Unit security
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- Panic alarms and responses
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- Utilization of security personnel
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LEGAL- Knowledge of legal status
- Involuntary holds
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- Court-ordered evaluations
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- Voluntary consent for evaluation/treatment
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- Certification procedures
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- Legal custody/guardianship
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- Patients’ rights
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- Child abuse reporting
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- Restriction of phone, mail, visitors, clothes, and/or personal property
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- Confidentiality/release of information
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- Patients’ right to refuse medication
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- Use of:
- Emergency or involuntary medication
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- Court-ordered medication
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MEDICAL MANAGEMENT- Infection control procedures
- Assessment of risk
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- Blood and body fluid precautions
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- Tube feedings
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- Neurological vital signs
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- Management of patient with seizure disorder
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- Obstructed airway management:
- Heimlich maneuver
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- Insertion of oro-pharyngeal airway
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- Intubation
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- Assisted ventilation - Ambu bag
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- Oxygen administration
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- Oro-naso-pharyngeal suctioning
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- Initiating cardiopulmonary resuscitation
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- Insertion and care of IV's
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- Informed consent for medical procedures
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MILIEU MANAGEMENT
- Assessment of therapeutic milieu
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- Participation in milieu therapy
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- Structuring therapeutic programming
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- Leading community meetings
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- Behavioral contracting:
- Individuals
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- Groups
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- Crisis intervention:
- Recognizing potentially dangerous situations
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- Use of low level interventions to de-escalate:
- individual and/or groups
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- Behavioral charting
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SPECIFIC PSYCHIATRIC CONDITIONS
- Assessing and intervening with the patient who demonstrates:
- Thought disorder:
- hallucinations
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- delusions
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- paranoia
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- need for reality orientation
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- Depressive disorder:
- social withdrawal and apathy
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- lack of self-care
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- hopelessness
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- self-destructive potential
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- Bipolar disorder:
- manic episodes
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- Character disorders/personality disorders:
- manipulation
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- irresponsibility
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- denial and resistance to change
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- Borderline personality disorder:
- emotional liability
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- identity issues
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- staff splitting
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- self-destructive behavior
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- Dissociative disorders:
- multiple personality
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- hysterical reactions
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- Post traumatic stress disorder
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- Eating disorders:
- monitoring physical status
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- control issues
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- family therapy
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- behavioral contracting
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- Drug/alcohol dependence:
- acute intoxication:
- hallucinogens,PCP
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- alcohol
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- polysubstance abuse
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- withdrawal syndromes:
- alcohol
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- CNS depressants
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- CNS stimulants
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- cocaine
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- drug/alcohol dependent rehabilitation
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- Suicidal/self-destructive behavior:
- suicide precautions
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- one-to-one observation
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- environmental safety
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- Aggressive, violent behavior:
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- Provocative, disruptive behavior
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- Manipulative, attention-seeking behavior
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- Threatening, intimidating behavior
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- Children /adolescents:
- Pervasive developmental disorder (autism,childhood psychosis)
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- Developmentally disabled
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- Conduct disorder
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- Attention deficit disorder/hyperactivity
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- Enuresis/encopresis
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- Antisocial behavior
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- Depressed suicidal behavior
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- Runaway behavior
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- Prostitution
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- Satanic involvement
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- Chronically mentally ill adult:
- Resources and support systems in community
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- Family involvement
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- Long term hospitalization
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- Organic brain syndrome:
- Geriatric patient
- sensory perceptual precautions
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- self-care
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- safety and security precautions
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- Alzheimers
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- Huntington’s Chorea
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SPECIFIC TREATMENT MODALITIES
- Behavioral modification-point & level systems
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- Behavioral contracting-reward systems
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- Psychodynamic/psychoanalytic therapies
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- Rational-emotive therapy
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- Milieu therapy
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- Individual therapy
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- Group therapy
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- Play therapy
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- Family therapy
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- Working with children and their families:
- Therapeutic limit-setting
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- Teaching basic parenting skills
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- Care of the patient receiving ECT
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- Groups teaching:
- Basic social skills
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- ADL
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- Emancipation skills
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- Care of patient in seclusion/restraints:
- Assessment of psychiatric emergency
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- Ambulatory restraints
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- Full 4-point restraints
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- Documentation of physical care
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- Restraint scissors
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- Assaultive behavior management:
- Self-protection techniques
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- Therapeutic physical control and restraint techniques
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- Take downs
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- Care of patient and staff following an assault
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TREATMENT PLANNING
- Role of nurse in a multidisciplinary treatment team
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- Primary nurse:
- Admission
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- Mental status assessment
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- Initial nursing assessment and nursing care plan
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- Psychiatric nursing diagnosis
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- Individual therapy
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- Group therapy
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- Patient health teaching
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- Role-modeling
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- Nursing reassessment and nursing care plan update
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- Discharge planning
- continuity of care in the community
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- family and support system contacts
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- medications at discharge
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- AMA discharge
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- Therapeutic nurse-patient relationship:
- Stages:
- initiation and rapport building
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- working phase
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- termination
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- Boundaries of a therapeutic relationship
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- Concepts of transference and countertransference
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