Things to Memorize

Aminoglycosides

A MEAN OLD -MYCIN!

• Antibiotic used to treat serious, life-threatening, resistant, gram - infections

  • Use a mean ol’ -mycin to treat MEAN things

• If it ends in “-MYCIN” its a mean old mycin, but if it has “thro” in it you THROW it away

  • Ex) eryTHROmycin, zyTHROmycin, & clariTHROmycin

    • these are NOT __

    • These are used for milder infections

Aminoglycosides Adverse Effects

1. When you see a -MYCIN think of MICE (like mickey mouse ears)

• So, -mycin is ototoxic (meaning it can negatively impact your ears

• S/S: tinnitus, vertigo, dizziness, HEARING damage, ringing in ears

2. The human ear is shaped like a kidney, so remember -MYCIN is NEPHROTOXIC

• Monitor Cr (Cr is the best indicator of kidney function)

3. Think about how easy “8” fits into the kidney/ear shape, this should remind you of 2 things:

• Toxic to CN VIII (8) this is our vestibulocochlear nerve

• Administer every 8 hrs IM or IV ONLY

  • oral is not absorbed, so it will have no effect

When to take -mycins orally

1. For Hepatic Encephalopathy (when ammonia is too ^, oral _ can decrease ammonia)

2. Preop bowel surgery because it will sterilize the bowels

• Who can sterilize my bowels? NEO CAN

  • NEOmycin and CANdamycin are used orally to sterilize bowels

TAP levels

T - Troughs are drawn first (troughs are drug at lowest level)

A - Administer your drug

P - Peaks are drawn last (peaks are drug at highest level)

\
* typically these are only drawn got meds with a narrow therapeutic range
* ex) digoxin (0.8-2.0); and mycin

Trough

drug at lowest level

\
FOR EVERY ROUTE, __ is the same

* you take the __ **30 min BEFORE** the next dose

Sublingual Peak

Take 5-10 minutes after it is dissolved

IV Peak

Take 15-30 min after drug is finished

IM Peak

Take 30-60 min after you give it

Crutches

• Height is measured 2-3 finger-widths below axilla

• 30 degree elbow flexion with proper hand grip placement

Even for Even; Odd for Odd

• use even # gait when you have an even amount of legs messed up

  • 2-point for mild problem

  • 4-point for severe problem (severe bilateral weaknesses)

• use odd # gait when 1 leg is odd

  • choose gait #3

• Swing thru method used for non-weight bearing

For stairs:

• UP with the GOOD

• DOWN with the BAD

• Crutches move with the bad

2-point gait

• Move 1 crutch & opposite foot together (2-2)

• moving 2 things at once, one foot with one crutch at all times

3-point gait

• Move 2 crutches and BAD foot together

• moving (3-1), 3 things at once: both crutches and bad foot, then your strong leg follows

4-point gait

• Move 4 parts separately

• Move 1 crutch, one leg, 1 crutch, and the other leg

Canes

• Hold on STRONG side

• move weak leg with cane

Walkers

Pick it up, set it down, walk to it

• tie belongings to SIDES not front

• boards doesn’t like tennis balls or wheels on walkers

Airborne Precautions

MTV

• M - Measles

• T - TB

• V - Varicella

• Private room required, unless cohort with same condition

• N95 mask (TB)

• gloves, wash hands, mask

• Pt wears mask when leaving room!

• Negative pressure

Order of putting on and taking off PPE

Put on:

• Gown

• Mask

• Goggles

• Gloves

Take off (in alphabetical order):

• Gloves

• Goggles

• Gown

• Mask

Droplet Precautions

1. Meningitis (all types)

2. H-flu (HiB) - causes epiglotitis

3. Mumps, rubella, pertussis

• Private room preferred

• Can cohort with same condition

• Mask, gloves, hand washing

• Pt mask when leaving room

• Disposable supplies and dedicated equipment

Contact Precautions

• Anything enteric (from intestines)

  • Fecal/oral

  • C-dif

  • Hep A (A is for Anus)

    • Anything with a VOWEL comes from the BOWEL (Hep A & E)

• Steph infections

• RSV (even though it is respiratory)

• Herpes infections

• Private room is preferred

• Can be put in cohort with same infection

• Gloves, gown, hand-wash, disposable supplies, and dedicated equipment

Bizarre (used to describe rhythm strip)

refers to tachycardia

Chaotic (used to describe rhythm strip)

refers to fibrillation

Congenital Heart Defects

either ALL TROUBLE or ALL okay!

Remember TRouBLe

• T- ALL __ that start with a “T” are trouble. if it does not start with a “T,” it is not trouble

• R- if the pt has a trouble defect, there will be a Right → Left shunting of blood

• B- is for BLUE (R-L shunts are blue) meaning it causes cyanosis

• L- Left → Right shunts are NO trouble

whether it is trouble or not ALL kids with __ will have

• a murmur (because there is a shunt of blood)

• an echocardiogram done!

Tetralogy of Fallot

VarieD PictureS Of A RancH

1. VD - Ventricular Defect

2. PS - Pulmonary Stenosis

3. OA - Overriding Aorta

4. RH - Right Hypertrophy

Calcium Channel Blockers

__ are like valium for your heart!

• It is going to calm your heart down, the way valium calms someone down

1. Negative inotropic, chronotropic, dromotrops relax your heart (valium effect) - these are cardiac DEPRESSANTS

2. What do they treat?

• A - Antihypertensives

• AA - Anti-Anginals (decrease O2 demand by relaxing heart)

• AAA - Anti- Atrial - Arrhythmia (a-flutter, a-fib, PAC, atrial anything, & SVT)

3. Side effects (H&H):

• Headache

• Hypertension (hold if systolic <100)

Names:

• Anything ending in “-dipine”

  • nifedipine

  • amlodipine

• VERAPAMIL

• DILTIAZEM/CARDIZEM (continuous IV drip)

  • regularly check B/P

  • Titrate according to B/P

Ventricular Arrhythmias Treatment

use lidocaine or AMIODARONE

Atrial Arrhythmias Treatment

ABCDs

A - Adenocard (adenosine) push

Chest Tube

1. If it is for HEMO, there should be drainage in the __ __, but if it is PNEUMO there should NOT be drainage, instead there should be bubbling

• suction control chamber should be CONTINUOUS BUBBLING (not intermittent)

• Water-seal chamber should have INTERMITTENT BUBBLING (not continuous)

2) Location of tube

• Apical (higher in lung → removes air) A for A

• Basilar (bottom of lung → removes Blood) B for B

3) Assume chest surgery or trauma is unilateral unless otherwise specified

4) IF the device breaks:

• Clamp the tube

• Cut the tube from the broken device

• Put end of tube in sterile water

• Unclamp

High Pressure Ventilator Alarm

Caused by occlusions

3 Types of occlusions:

1. Kinks (unkink to solve)

2. Water condensing in tube (empty water to solve)

3. Mucous secretions in airway (turn, cough, deep breathe!!!) suction if needed

Low Pressure Ventilator Alarms

caused by disconnections

2 Types of disconnections:

1. Disconnection of main tubing (reconnect)

2. O2 sensor tubing (measures FrO2 at trach) (just plug back in)

Antidepressants

Take 2-4 weeks to work

If pH is high (>7.45), my pt symptoms are UP

As ph __, so does my pt (except K+)

* Alkalosis pH is __, we will see:
* Increased RR
* Increased HR
* Hyperreflexia
* Borborygmi
* & DECREASED K+ (which places pt at risk for heart dysrhythmias)

If pH is low (

As pH __, so does my pt (except K+)

• In acidosis pH is __, we will see:

  • Decreased RR (more likely to need an ambu bag)

  • Decreased HR

  • Hyporeflexia

  • Paralytic Ileus

  • K+ increased (places pt at risk for elevated T-waves)

• Metabolic ACidosis is the ONLY acid-base imbalance where you see in MACkussmal respirations

Causes of AB inbalance

Often the cause of the AB imbalance is the opposite of the S/S of the imbalance

1. Is it a lung scenario (if yes, it is respiratory)

2. Is the client over-ventilating (alkalosis → blowing off ACID CO2) or under-ventilating (acidosis → retaining too much CO2)

• Don’t rely on RR for your answer because it often compensates

3. Everything else that isn’t lung, is likely Metabolic Acidosis

• Unless they are vomiting or suctioning (losing stomach acid which would be alkalosis)

  • Once they are dehydrated it becomes acidosis

Disulfiram

used to treat alcoholism

• Aversion therapy

• This is the drug that when you drink alcohol it causes a bad reaction and makes you sick (can be life-threatening)

• Onset and duration of effectiveness is 2 weeks! (this means you have to be off for 2 weeks before drinking again

Pt teaching:

• Avoid ALL alcohol to avoid N/V and possibly death

  • Mouth wash

  • After shaves

  • Perfume/cologne

  • Insect repellant

  • Alcohol-based hand sanitizer

  • ELIXERS

  • Uncooked icings

  • Vanilla extract

Wernickes and Korsakoffs

Wernickes is encephalopathy and Korsakoffs is psychosis

1. Psychosis induced by vitamin B1 (thiamine) deficiency (this can be prevented by taking Thiamine)

2. Amnesia with confabulation (make up stories)

• They believe the stories they make up

• lose decades of memory (it is not a small memory loss)

They don’t have to stop drinking, just have to take B1 (thiamine)

• It is considered irreversible

• So it is preventable, arrestible, and irreversible

How to help someone with amnesia from Wernickes and Korsakoffs:

• do NOT present reality, it won’t help (because they can’t learn reality)

• Instead, REDIRECT “let’s shower and then do this”

Uppers (5) and S/S

1. Caffeine

2. Cocaine

3. LSD/PCP

4. Methamphetamines

5. ADDerall

Uppers will make you go UP

• Tacycardia

• Euphoria

• Restlessness/irritability

• Diarrhea

• Hyperreflexia

• Seizure (ambu bag)

Downers and S/S

anything else that is not an upper is a downer

Downers will make you go DOWN

• Lethargic

• Bradycardia

• Respiratory depression and arrest

• Constipation

• Pinpoint pupils

How to solve Overdose and Withdrawal Questions

Every abused drug is either an upper or a downer

Ask yourself:

1. Is it and upper or a downer?

Uppers: Cocaine, Caffeine, PCP/LSD, Methamphetamines, ADDerall

2. Overdose or withdrawal?

• Overdose will give you the S/S of the upper or downer

• Withdrawal will be the opposite of the overdose symptoms

  • ex) if you are withdrawing from cocaine (upper), your S/S would be the same as a person who overdosed on a downer (you would be presenting with DOWN symptoms)

  • If you are OD with cocaine you will have dilated pupils, withdrawal from cocaine will be pinpoint pupils

3) ALWAYS assume intoxication NOT withdrawal in babies at birth

• 24 hrs after birth you can consider withdrawal

Alcohol Withdrawal Syndrome (AWS) vs. Delirium Tremens (DTs)

1. Every alcoholic goes into withdrawal within 24 hrs

• at 72 hrs they can experience DTs

• AWS will ALWAYS come 1st

2. AWS is NOT life-threatening; DTs can kill you

3. AWS pts are not a danger to self or others, but DTs are a danger to self/others

Alcohol Withdrawal:

• Reg diet

• Room can be anywhere

• Up ad-lib

• No restraints

• May be given antihypertensives, tranquilizers, and thiamine

Delirium Tremens:

• NPO/clear liquids (because seizure risk, we don’t want aspiration)

• Private room near nurses station

• Restricted bedrest

• MUST be restrained because they are dangerous (use vest or 2-point soft leathers - goes on opposite arm and leg)

• Can also be given antihypertensives, tranquillizers, and thiamine

Hyper and Hypokalemia S/S

Kalemias do the same as the the prefix, except for HR and urine output

1. Hyperkalemia everything goes up except HR and urine output

• bradycardia (in severe cases heart attack)

• low urine output

• Hyperreflexia

2. Hypokalemia everything goes down except HR and urine output

• tachycardia/dysrhythmias (u-wave)

• polyuria

• decreased RR

Hyperkalemia treatment

__ can cause cardiac arrest so it is the MOST dangerous of ALL electrolyte imbalances (we need to treat immediately)

• Fastest way to lower potassium is D5W with Regular Insulin which drives K+ into cells

• KayexeLATE (makes K+ exit late, leaves body slowly)

-so we would give D5W with reg insulin first

Hypokalemia Treatment

• NEVER push K+ IV

• No > 40 of K+ in 1 L

• use IV pump

Hyper and Hypocalcemia

Calcemias do the opposite of the prefix

1. Hypercalcemia

• bradycardia

• constipation, etc

2. Hypocalcemia

• Spasms (chovsek and trusseus signs)

• If it is an UP s/s but not skeletal muscle or nerves, pick K+ as the cause of the symptoms

Hyper and Hypomagnesemia

Magnesemias do the opposite for the prefix

* in a tie, don’t pick Mg because it is likely not the culprit of the symptom

Hypernatremia

is associated with DEhydration (hot, flushed, dry, skin)

Hyponatremia

is associated with fluid Overload and seizures

Earliest Signs of Electrolyte disorders

1. Paresthesias (numbness and tingling)

• Circumoral paresthesias

2. Paresis (muscle weakness)

Lithium Range

0\.6-1.2

\
Toxic is > or = 2

Lanoxin/Digoxin Range

1-2

\
Toxic is > or = 2

(if given a value of 2, say it is toxic)

Aminophylline and Phenytoin Range

10-20

\
Toxic is > or = 20

Bilirubin in Newborns

• breakdown of RBCs

elevated level in newborn is 10-20 (9.9 is high, but okay)

Toxic > or = 20

1. Jaundice (yellow color from bilirubin in skin)

2. Kernicterus (bilirubin in the brain (this happens when levels are very high and can be dangerous)

3. Opistotonos (baby’s hyperextend and become rigid when bili is high) → place child on side!!

Dumping Syndrome

• usually follows gastric surgery and causes gastric contents to dump into duodenum too quickly

• MOVING TOO FAST in the RIGHT direction!

• Talk about DRUNK (S/S similar to drunk person)

  • labile emotions

  • staggering gait

  • slurred speech

• Talk about SHOCK (S/S also similar to shock)

  • cold, clammy, pale skin

  • tachycardia and tachypnea

  • Low b/p

• Symptoms of Abdominal Distress

• Treatment:

  • HOB Flat (slows flow of gastric contents)

  • Fluids NEVER with meals (1-2 hrs before or after meals because fluids would aid in digestion)

  • LOW carbs (carbs and sugars are digested quickly)

  • HIGH protein (takes longer to digest)

Hiatal Hernia

• regurgitation of acid into the esophagus because upper part of stomach herniates into diaphragm

• Moving in WRONG DIRECTION at the RIGHT RATE

• S/S (like GERD):

  • Heartburn

  • Indigestion

• This pt has GERD if they lie down after eating!

• Treatment (in HIatal hernia, everything should be HIGH -except protein)):

  • HOB elevated (allows food to go down according to gravity)

  • Fluids increased!

  • Carbs increased!

  • Protein decreased

-Treatment for hiatal hernia is OPPOSITE of dumping syndrome!

Hyperthyroidism

Think: HYPER-Metabolism

S/S (most things are up):

• Restless, heat-intolerance, decreased weight, diarrhea

• Ophthalmus (buldging eyes)

Graves Disease

• literally RUN self into grave (meaning things move FAST, HYPER)

• Problem is HYPERthyriodism (hyper → run)

• Treatment:

  • Radioactive Iodine

    • Pt should by by SELF for 24 hrs

    • Flush urine 2-3x (urine is radioactive)

  • PTU (Propylthyrocil)

    • __P__uts __T__hyroid __U__nder

    • Also treats cancer, so remember that this med can cause IMMUNOSUPPRESSION (check WBCs!!)

  • Thyroidectomy (remove thyroid)

    • Total Thyroidectomy

    • Subtotal Thyroidectomy

    • Most important part of a thyroidectomy question is if it is total or subtotal because treatment and s/s depend on this

Total Thyroidectomy

• will need lifelong T2, T4 hormone replacement

• Risk for HYPOCALCEMIA

  • S/S:

    • Tetany → earliest sign is paresthesia

• 12-48 hrs after a total:

  • at risk for hypocalcemia and tetany

Subtotal/Partial Thyroidectomy

• At risk for THYROID STORM (thyrotoxicosis)

  • This is life-threatening and can cause brain damage

• 4 S/S of thyroid storm:

  • Very high Fever >105

  • Very high B/P (ex 210)

  • Severe Tachycardia

  • Psychotic Delirium

Thyroid Storm Treatment

1. Decrease the temperature

• Give ice packs

• Use cooling blanket (more effective)

2. Increase O2

• Give mask @ 10 L

Treatment focuses on saving the brain until they come out of the storm

Thyroidectomy Post-Op Complications

• Regardless of surgery (total or subtotal), during the 1st 12 hrs the TOP PRIORITY is AIRWAY!

  • Edema in the thyroid area can compress the airway

• 2nd priority is HEMORRHAGE!

• 12-48 hrs after a Total:

  • top complication is hypocalcemia (tetany)

• 12-48 hrs after a Subtotal:

  • at risk for thyroid storm

Hypothyroidism

Think: HYPO-metabolism

S/S:

* Obese, dull, cold-intolerance, low HR, brittle nails

Myxedema

• Problem is hypothyroidism

• Treatment:

  • Synthroid (levothyroxine)

  • DO NOT sedate these people because they are already DOWN

    • can put them into myxedema coma

  • NEVER HOLD thyroid meds before a procedure (even if pt is NPO)

    • call to clarify with provider if it says to hold thyroid meds

Adrenal Cortex Diseases

start with the letter A or C

• Addison’s Disease

• Cushing’s Disease

ADDison’s Disease

Undersecretion of adrenal cortex

• need to ADD steroids (ADD a -sone!)

• S/S:

  • Hyperpigmented

  • Do NOT adapt to stress (glucose and B/P will fall and can go into shock!)

  • Hypoglycemia, hyperkalemia, hyponatremia, FVD, weight loss

• Treatment:

  • Steroids like glucocorticoids and mineralcorticoids

    • end in -sone (prednisone, hydrocortisone)

Cushing’s Syndrome

oversecretion of adrenal cortex

• cushy = more (if you got a cushy tooshy, you got more lol; so cushings is over secretion

• S/S (these are also the side effects of steroids)

  • look at the drawing 13 s/s

• Treatment: Adrenoectomy

Diabetes

Can’t properly metabolize glucose, but glucose is the primary energy source

• 3 P’s:

  • polyuria, polydipsia, polyphagia

• Type 1 Diabetes:

  • Insulin dependent

  • Ketosis prone

• Type 2 Diabetes:

  • Non-insulin dependent

  • Non-ketosis prone

Treatment of Type 1 Diabetes

if you don’t treat type _, they can DIE

• D - Diet

• I - Insulin (most important)

• E - Exercise (second most important)

  • Think about exercise like another shot of insulin, so you need carbs before exercising

Treatment of Type 2 Diabetes

treat type __, with DOA

• D - Diet (most important)

  • Calorie restrictions!! are very important

  • 6 small feedings a day prevents big peaks

• O - Oral hypoglycemic (metformin)

• A - Activity

4 Types of Insulin

1. Regular

2. NPH

3. Humalog/Lispro

4. Glargine

To remember onset, peak, and duration for regular and NPH remember:

1,2,4,6,8-10,12

• Expiration date is invalidated after opening insulin (good for 30 days after opening)

  • write Exp:

Regular Insulin

if it has an R, it is Regular!

ex) Humulin R

• Remember… Rapid and Run

  • it is RAPID-acting and can be RUN through an IV drip (the only one that can be given through IV)

• Onset: 1 hr

• Peak: 2 hrs

• Duration: 4 hrs

NPH

if it has an N, it is NPH

ex) Humilin N

• Remember… Not so Fast and Not in the Bag

  • it is iNtermediate-acting

  • it is CLOUDY-suspension and CANNOT be IV drip

• Onset: 6 hrs

• Peak: 8-10 hrs

• Duration: 12 hrs

Fast-Acting Insulin

Remember LAG

• Lispro (humalog)

• Aspart

• Glulisine

• Give with meal

• Onset: 15 min

• Peak: 30 min

• Duration: 3 hrs

Glargine (Lantus)

• long-acting insulin

• no peak (is so long acting, there is no peak)

• Duration: 12-24 hrs

• LOW hypoglycemia risk

• Can give at bedtime routinely!

Sick Days

S/S:

1. Hyperglycemia

2. Dehydration

• Take insulin even when not eating

• Drink lots of fluids

3 Acute Complications of Diabetes

1. Hypoglycemia

2. DKA (type 1)

3. HHS (type 2)

Hypoglycemia/insulin shock (low blood sugar)

• Causes:

  • not enough food

  • too much insulin (most common cause)

  • too much exercise

  • Can cause brain damage

• S/S (DRUNK in SHOCK):

  • Decreased BP, Tachycardia, tachypnea, cool, clammy

• Treatment:

  • Give sugar and starch/protein

    • OJ and crackers

    • Apple juice and turkey

    • Skim milk

  • Give Glucagon IM or Dextrose IV if unconscious

DKA

this occurs in type 1 diabetics

• #1 cause is acute viral respiratory infections within the last 2 weeks

• S/S: DKA

  • Dehydration → give fast IV fluids

  • Ketones in blood confirms diagnosis

    • Kussmal respirations

    • K+ elevated

  • Acidosis

    • Acetone breath (fruity breath)

    • Anorexia w/ nausea

• Treatment:

  • 1st treatment is fluids

  • regular IV insulin @200hr

Hyperosmolar Hyperglycemic Non-Ketotic Coma (HHS)

this occurs in type 2 diabetics

• this is DEHYDRATION

• S/S:

  • Skin (hot, flushed, dry)

  • Fluid volume deficit

  • GIVE FLUIDS!

Long-Term Complications of Diabetes

1. Poor tissue perfusion

• Poor healing

• Bad kidneys

2. Peripheral Neuropathy

• loss of bladder control

HgA1C (glycosated hemoglobin

normal: 4-6%

• want to be below 7% in pts with diabetes

• 8% is out of control

Kids Toys 3 Questions to ask yourself

1. Is it safe?

• no small parts/toys if < 4 y/o

• no metal/dicast toys where O2 is in use

• Beware of FOMITES (ex. if immunocompromised → no stuffed animals)

2. Is it feasible?

• ex) a 10 y/o with a cast should not go swimming

3. Is it age appropriate?

NEVER pick answer with these words if child is < 9 months:

• Build

• Sort

• Stack

• Make

• Construct

0-6 months old

Sensorimotor stage

• Best toy: Musical Mobile

• 2nd best toy: Something SOFT and large

6-9 months old

Object-Permanence

• Best toy: cover, uncover toy

  • ex) peak-a-boo, jack-in-the-box, books with little pop out windows

• 2nd best toy: something large, hard, metal, plastic

• Musical mobile is the WORST toy for this age range because they can stand and pull it and strangle themselves

9-12 months old

Vocalization

• Best toy: talking toy (like a talking elmo)

• They can begin doing purposeful activities with objects

  • like building a tower of blocks

Toddler (1-3 y/o)

• Best toy: push/pull (ex. wagon, stroller, etc.)

• Work on gross motor skills (running, jumping)

• if it takes finger dexterity, a __ cannot do it

  • however, they can do finger painting because that doesn’t require finger dexterity

• PARALLEL PLAY

• they like routine

Preschoolers (3-6 y/o)

1. Work on fine motor skills (puzzles, chalk, crayons)

2. Work on balance (tricycles, dance class)

• Cooperative play

• Like to pretend (very imaginative)

School-Aged (7-11 y/o)

Characterized by 3 C’s

1. Creative

• Blank paper and colored-pencils so they can make own things and not fill in things

• Legos are perfect

2. Collective

• Always collecting things like beanie babies

3. Competitive

• Love games with winners and losers

Adolescents (12-18 y/o)

• peer group association (hang out in large groups doing nothing)

• Allow adolescents to be in each others rooms unless 1 of them is:

  • Fresh post-op (<12 hrs)

  • Immunosuppressed

  • Contagious

2 Groups of Psych Patients

1. Nonpsychotic

• has insight and is reality based

• Therapeutic communication

2. Psychosis

• no insight and is not reality-based

• don’t think they are sick

Psychosis

includes hallucinations, delusions, and illusions

1. Hallucinations

• false, fixed SENSORY experience

• auditory, visual, tactile, gustatory, and olfactory

2. Delusions

• false fixed idea or belief (NOT sensory)

• Paranoid

  • think people want to harm you

• Grandiose

  • Think you are superior

• Somatic

  • false belief about body

  • ex) think you’re pregnant

3. Illusion

• Misinterpretation of reality

• sensory experience

• There is a REFERENCE to reality which is different from hallucinations

• it is an illusion if there is a referance to something that is actually there like a wall

3 Types of Psychosis

1. Functional (married, can pay bills, work, take care of self)

2. Psychosis of Dementia

3. Psychotic Delirium

Functional Psychosis

4 people fall into this category:

1. Schizophrenia 2) Schizoaffective

2. Major Depression 4) Manic

• this group of people have the potential to learn reality!!

  • so priority is to TEACH REALITY

• How to teach reality:

  • Acknowledge feelings

  • Present reality

  • Set limits (we will NOT talk about those voices)

  • Enforcing limits (end convo when not reality-based)

• Choose the more positive answer choice

Psychosis of Dementia

occurs because of brain damage (stroke, senile, etc.)

• because of this they CANNOT learn reality

• How to communicate with these pts:

  • Acknowledge feelings

  • Redirect them!!!

    • don’t present reality when having psychosis

      • However, if they are simply having dementia-related confusion (NOT psychosis) you should orient them to reality such as where they are right now

Psychotic Delirium

temporary, sudden, dramatic, secondary loss of reality

• usually due to chemical imbalance in body

  • delirium tremens

  • Cocaine OD

  • Meth OD

  • ICU psychosis

  • UTI

  • Thyroid storm

  • Adrenal crisis

• How to communicate with these pts:

  • acknowledge feelings

  • REASSURE that:

    • this is temporary

    • they are safe

Redirection with Dementia pt

when redirecting, don’t change the subject

\
ex) pt says the people over there are plotting to kill them. You respond, “that must be scare, let’s move you somewhere where you feel more safe”

\
This would be a better response than just changing the subject because you are acknowledging their feelings :)

Piaget Intellectual Development

1. 0-2 yrs - Sensorimotor

2. 3-6 yrs - Preoperational Preschooler

3. 7-11 yrs - Concrete Operations

4. 12-15 yrs - Formal Operations

Sensorimotor (0-2 yrs) Piaget

totally PRESENT oriented

• there is no past, no future, only present to them

• So, you would teach them as you do a procedure → teach verbally

• No pre-op teaching to the child because they only know the present

Preoperational Preschooler (3-6 yrs) Piaget

Fantasy oriented; illogical

• So teach them the day of right before the procedure (this way they don’t have time to make up scary scenarios)

• can show with a doll

• if you teach to ahead, they think illogically and might imagine the worst possible thing

Concrete Operations (7-11 yrs) Piaget

Rule-oriented; cannot abstract

• believe there is only 1 way to do things (there is only RIGHT and wrong)

• Perfect age to TEACH SKILLS because they will follow exactly what you say since they are so rule-oriented

• Can teach days ahead (they won’t think the worst because in their mind everything will go exactly as you said)

• Can teach what you are going to do and the skills that they may need for their care

• Do NOT used play, use reading and audio-visual materials

Formal Operations (12-15 yrs) Piaget

able to think abstractly/like adults

• teach like a normal adult

• teach to manage own care

Humilin 70/30

this is a mix of N & R

N = 70%

R = 30%