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Unit 21 Sending and receiving
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The Giver * Jonas feels frightened after seeing an aircraft fly over the community. * The community has very strict rules. * Families share feelings every day. * Jonas lives with Mother, Father, and Lily. * We learn about the “Ceremony of Twelve.” Chapter 2 * Parents explain the Ceremony of Twelve to Jonas. * At age 12, children receive their life assignments. * Jonas worries about what assignment he will get. * Father works with newborn babies. * The community values sameness and order. Chapter 3 * Jonas notices something strange about Gabriel’s eyes — they are pale like his own. * Jonas briefly sees an apple change color. * Father secretly brings Gabriel home for extra care. * Jonas begins noticing differences others do not. Chapter 4 * Jonas volunteers at the House of the Old. * He helps bathe an elderly woman named Larissa. * Larissa talks happily about “release.” * Jonas thinks release is a positive ceremony. Chapter 5 * Families discuss dreams in the morning. * Jonas has a dream about Fiona and realizes he is having “Stirrings.” * His mother gives him pills to stop these feelings. * The community controls emotions and attraction. Chapter 6 * The Ceremony begins. * Different age groups receive new responsibilities. * Children move to new stages of life. * Jonas becomes nervous waiting for his assignment. Chapter 7 * The Chief Elder skips Jonas during the Ceremony of Twelve. * Jonas feels embarrassed and afraid. * The community reacts silently. * The Chief Elder says Jonas was not forgotten. Chapter 8 * Jonas is selected as the new Receiver of Memory. * The Receiver is the most honored role in the community. * Jonas is told he has intelligence, integrity, courage, and wisdom. * Previous Receiver-in-training failed 10 years earlier. Chapter 9 * Jonas receives special rules: * He may lie. * He is exempt from rudeness rules. * He cannot discuss training. * He may ask any question. * Jonas becomes frightened by the power of his role. Chapter 10 * Jonas goes to the Annex behind the House of the Old. * He meets the Receiver, who asks Jonas to call him “The Giver.” * The room contains books, unlike the rest of the community. * Jonas begins his training. Chapter 11 * The Giver gives Jonas his first memory: snow and sledding. * Jonas experiences real pain and pleasure for the first time. * He learns his community removed memories to avoid suffering. * Jonas now understands snow, hills, and sunshine are real things from the past
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Exception Atoms + Rules
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Limiting and Excess Reagents
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OOP-Exception
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OOP-Exception try resrource
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NCLEX Review: Mental Health Disorders Anxiety Disorders Generalized Anxiety Disorder (GAD) Excessive worry lasting 6 months or more Symptoms: Restlessness Muscle tension Fatigue Poor concentration Sleep disturbance Panic Disorder Sudden intense fear with: Chest pain Palpitations Shortness of breath Feeling of doom Nursing: Stay with client Calm environment Short/simple communication Phobias Irrational fear of object/situation Treatment: Exposure therapy CBT SSRIs sometimes used OCD (Obsessive-Compulsive Disorder) Obsessions = intrusive thoughts Compulsions = repetitive behaviors to reduce anxiety Nursing: Do not suddenly stop rituals Set limits gradually Encourage coping skills PTSD Triggered after traumatic event Symptoms: Flashbacks Hypervigilance Nightmares Avoidance Priority: Safety Trauma-informed care Depression Disorders Major Depressive Disorder Symptoms SIGECAPS: Sleep changes Interest loss Guilt Energy low Concentration poor Appetite changes Psychomotor changes Suicidal thoughts Nursing Priorities Suicide assessment Nutrition/hydration Sleep/rest Medication adherence Medications SSRIs Examples: Sertraline Fluoxetine Teachings: Takes weeks to work Do not stop abruptly Watch for serotonin syndrome Serotonin Syndrome Symptoms: Agitation Fever Tremor Hyperreflexia Diarrhea Bipolar Disorder Mania Symptoms Mnemonic: DIG FAST Distractibility Indiscretion Grandiosity Flight of ideas Activity increased Sleep deficit Talkative Nursing Care Reduce stimulation Set firm limits High-calorie finger foods Encourage rest Medications Mood Stabilizers Lithium Anticonvulsants Lithium Toxicity Therapeutic level: 0.6–1.2 mEq/L Toxic signs: Tremor Vomiting Confusion Ataxia Severe diarrhea Important: Maintain sodium/fluid intake Dehydration increases toxicity risk Schizophrenia Spectrum Disorders Positive Symptoms Things added: Hallucinations Delusions Paranoia Disorganized speech Negative Symptoms Things lost: Flat affect Social withdrawal Anhedonia Lack of motivation Hallucination Nursing Response Present reality “I do not hear the voices.” Assess for command hallucinations Delusions Do NOT argue. Respond: “I understand this feels real to you.” Antipsychotics First Generation Haloperidol Risk: EPS Tardive dyskinesia Neuroleptic malignant syndrome (NMS) Second Generation Olanzapine Risperidone Risk: Weight gain Diabetes Metabolic syndrome EPS Symptoms Acute dystonia Akathisia Parkinsonism Tardive dyskinesia Treatment: Benztropine Diphenhydramine Neuroleptic Malignant Syndrome Medical emergency: Fever Rigidity Confusion Elevated CK Personality Disorders Cluster A Odd/eccentric Paranoid Schizoid Schizotypal Cluster B Dramatic/emotional Antisocial Borderline Histrionic Narcissistic Borderline Personality Disorder Fear of abandonment Splitting staff Self-harm risk Nursing: Consistent boundaries Team communication Cluster C Anxious/fearful Avoidant Dependent Obsessive-compulsive personality disorder Eating Disorders Anorexia Nervosa Severe restriction Distorted body image Bradycardia Electrolyte imbalance Priority: Monitor cardiac status Daily weights Observe after meals Bulimia Nervosa Binge/purge behavior Normal weight often seen Complications: Hypokalemia Dental erosion Substance Use Disorders Alcohol Withdrawal Starts within hours after last drink
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