NURSING INTERVENTIONS IN ANXIETY

GENERAL PRINCIPLESNURSING CONSIDERATIONS

Assess level of anxietyLook at body language, speech patterns, facial expressions, defence mechanism, and behaviour used. Distinguish levels of anxiety.

Keep environmental stresses/ stimulation low when anxiety is highFirst actionNeed to intervene with severe or panic levelBrief orientation to unit or proceduresWritten information to read later, when anxiety is lowerPleasant, attractive, uncluttered environmentProvide privacy if presence of other patients is over stimulatingProvide physical care necessaryAvoid offering several alternative or decisions when anxiety is high

Assist client to cope with anxiety more effectivelyAcknowledge anxious behaviour; reflects and clarifyAlways remain with client who is moderately or severely anxiousAssist client to clarify own thoughts and feelingsEncourage measures to reduce anxiety, e.g., exercise, activities, taking with friends, hobbiesAssist client to recognize his/her strengths and capabilitiesrealisticallyProvide therapy to develop more effective coping andinterpersonal skills, e.g., individual, groupMay need to administer antianxiety medications

Maintain accepting and helpful attitude toward clientUse an unhurried approachAcknowledge clients distress and concern about problemEncourage clarification of feelings and thoughtsEvaluate and manage own anxiety while working with clientRecognize the value of defence mechanism and realize thatclients is attempting to make the anxiety tolerable in the bestway possibleAcknowledge defence but provide reality, e.g., You do not seethat you have a problem with alcohol but your blood level ishighDo not attempt to remove a defence mechanism at any time

NURSING CARE OF CLIENT WHO ACTS WITHDRAWN

ProblemInterventions

Lack of trust and feeling of safety and securityKeep interactions brief, especially orientationStructure environmentBe consistent and reliable; notify patient ofanticipated schedule changesDecrease physical contactEye contact during greetingMaintain attentiveness with head slightly leaning toward patient and nonintrusive attitudeAllow physical distanceAccept patients behaviour, e.g., silence; maintain matter-of-fact attitude towards behaviour

HallucinationsMaintain accepting attitudeDo not argue with patient about reality ofhallucinationsComment on feeling, tone of hallucination, e.g., That must be frightening to you.Encourage diversional activities in which patient can gain a sense of mastery, e.g., artworkEncourage discussions of realitybased interests

Lack of attention to personal needs, e.g., nutrition, hygieneAssess adequacy of hydration, nutritionStructure routine for bathing, mealtimeOffer encouragement or assistance if necessary, e.g., sit with patient or feed patient if appropriateDecrease environmental stimuli at mealtime, e.g., suggest early dinner before dining room crowdsPositioning and skin care for care for catatonic patient

NURSING CARE OF A PATIENT WHO ACTS SUSPICIOUS

ProblemInterventions

Mistrust and feeling of rejectionKeep appointments with patientsClear consistent communicationAllow patient physical distance and keep dooropen when interviewingGenuineness and honesty in interactionsRecognize testing behaviour and show persistence of interest in patient

DelusionsAllow patient to verbalize the delusion in a limited wayDo not argue with patient or try to convince that delusion are not realPoint out feeling tone of delusionProvide activities to divert attention from delusionsSolitary activities best at first and then mayprogress to non-competitive games or activitiesDo not reinforce delusion by validating themFocus on potential real concerns of patient

ALCOHOL WITHDRAWAL

WITHDRAWALDELIRIUM TREMENSNURSING CONSIDERATION

TremorsEasily startledInsomniaAnxietyAnorexiaAlcoholicHallucinationsTremorsAnxietyPanicDisorientationHallucinationVomitingDiarrheaParanoiaDelusional symptomsIdeas of referenceSuicide attemptsGrand mal convulsion (esp. first 48H after drinking stopped)Potential coma/death

Administer benzodiazepines, Chlordiazepoxide, DiazepamMonitor VS- PR, BP, Temp.Seizure precautionsProvide quiet, well lit environmentOrient patient frequentlyDont leave hallucinating, confused patient aloneAdminister thiamine IV or IM as neededAdminister IV glucose as needed10% morality rate

CHRONIC CNS DIORDERS ASSOCIATED WITH ALCOHOLISM

ALCOHOLIC CHRONIC BRAIN SYNDROME (DEMENTIA)WERNICKES SYNDROMEKORSAKOFFS PSYCHOSIS

SymptomsFatigue, anxiety, personality changes, depression, confusionLoss of memory of recent eventsCan progress to dependent, debridden stateConfusion, diplopia, nystagmus, ataxiaDisorientation, apathyMemory disturbance with confabulation, loss of memory of recent events, learning problemPossible problem with taste, loss of reality testing

Nursing considerationBalanced diet, abstinence from alcoholIV or IM thiamine, abstinence from alcoholBalanced diet, thiamine, abstinence

NONALCOHOLIC SUBSTANCE ABUSE

MEDICATION/DRUGSYMPTOMS OF ABUSESYMPTOMS OF WITHDRAWALNURSING CONSIDREATION

Barbiturates(downers, barbs, pink ladies, rainbows, yellow jackets)PhenobarbitalNumbutal

Respiratory depressionDecreased BP and pulseComa, ataxia, seizuresIncreasing nystagmusPoor muscle coordinationDecreased mental alertness

Anxiety, insomniaTremors, deliriumConvulsion

Maintain airway(intubate, suction)Check LOC and vital signsStart IV with large-gauge needleGive activated charcoal, use gastric lavageHemodialysis

NarcoticsMorphineHeroin (horse, junk, smack)CodeineDilaudidMeperidine (Demerol)Methadone-for detoxification and maintenance

HyperpyrexiaSeizures, ventricular dysrhythmiasEuphoria, then anxiety, sadness, insomnia, sexual indifferenceOverdose-severe respiratorydipression, pinpoint pupils, comaWatery eyes, runny nose Loss of appititeIrritability, tremors, panicCramps, nauseaChills an sweatingElevated BPHallucinations, delusions Maintain airway(intubate, suction)Control seizuresCheck LOC and vital signsStart IV, may be given bolus of glocuseHave lidocaine and defibrillator availableTreat for hyperthermiaGive Narcan to reverserespiratory depressionHemodialysis

Stimulants(uppers, pep pills, speed, crystal meth)Cocaine (crack)AmphetamineBenzedrineDexedrine

Tachycardia, increased BP,tachypnea, anxietyIrritability, insomnia, agitationSeizures, coma, hyperpyrexia, euphoriaNaussea, vomitingHyperactivity, rapid speechHallucinationsNasal septum perforation (cocaine)ApathyLong period of sleepIrritabilityDepression, disorientation

Maintain airway(intubate, suction)Start IVUse cardiac monitoringCheck LOC and vital signsGive activated charcoal, use gastric lavageMonitor for suicidal odeationKeep in calm, quiet envirnment

Cannabis derivatives(pot, weed, grass, reefer, joint, mary jane)MarijuanaHashishFatigueParanoia, psychosisEuphoria, relaxed inhabitationsIncreased appetiteDisoriented behaviourInsomnia. HyperactivityDecreased appetiteMost effects disappearin 5-8 hr as drug wears offMay cause psychosis

HallucinogensLSD (acid)PCP (large dust, rocket fuel)Mescaline (buttons, cactus)Nystagmus, marked confusion, hyperactivityIncoherence, hallucinations, distorted body imageDelirium, mania, self-injuryHypertension, hyperthermiaFlashbacks, convulsions, comaNoneMaintain airway(intubate, suction)Control seizuresCheck LOC and vital signstalk down patientReduce sensory stimuliSmall doses of ValiumCheck for trauma, protect from self-injury