Mental Health: Session 1

 

Mental Health Session 1

 

overview and introduction.

 

There can be genetic predisposition to mental health episodes,

 

Social determinants such as loss of stability, employment, housing, or emotional system of support can cause mental health issues as well.

 

Mental illness is when the person can no longer cope with their symptoms and they show with significant dysfunction and it is over at least 2 weeks or a month.

 

Recovery Oriented Practice – working with the patient to meet their recovery goals, this can be how you talk about the patient: say the patient with schizophrenia, not the schizophrenic. The have a disease, they are not the disease.

Incidence is the number of new cases

Prevalence is the overall amount or % of people in a population with the illness.

 

Dr. Hildegard Peplau (1909 – 1990) Interpersonal relationship theory.

Dr. Jean Watson: reflective nursing practice – Theory of human caring. A former dean of UC Denver Anschutz medical Campus.

 

A therapeutic relationship is important to nursing integral, needs clear boundaries, the first encounter sets the tone for the relationship,

  • We need to use therapeutic communication to develop the relationship as well.
  • Ask about Sleep, Smoking, and Sex
  • Phrasing, use of silence, clarification, open ended questions, and reflection will help cultivate this.  
  • Empathy – the patient is the center of the conversation and you help them work though the issue themselves.
  • Sympathy – you turn the conversation to something about you and pity the person. Empathy is preferred.

 

Transference – a patient gets feelings for a Healthcare professional

Countertransference – when the healthcare professional develops feelings or makes a connection between the patient and a person that the healthcare professional knows.

 

Med Surg Session 11: Renal

Session 11

 

Renal disorders

 

Know why you are giving diuretics

Empty the foley bag before the diuretic is administered so you can track the output closely. 

Can have pre, intra, and post renal injuries

  • Post renal is an obstruction
  • Intrarenal is Structural damage to the kidney can be caused by radiocontrast dye
  • Prerenal is a reduction in blood flow
  • Structural damage to the kidney

 

Things that increase the chance for infection in urinary system

  • Urinary stasis
  • High levels of glucose in the urine

 

Pyelonephritis – infection of the kidneys,

  • Give lots of fluids
  • Treat pain, infection, and nausea

 

Glomerulonephritis –

  • Look for blood in the urine
  • Proteinuria, high BUN, periorbital edema, and hematuria

 

Renal calculi –

  • rf – high protein, dehydration, warm climates
  • Flank and abdominal pain
  • Use a NON radio contrast CT scan
  • Manage pain!

 

BPH – benign prostatic hyperplasia

  • Digital rectal exams are the prefered method
  • Increase chance of renal stones due to urine retention.
  • May need a catheter placed to urinate properly.
  • Can give Alfa blockers to relax smooth muscle
    • A side effect of these is orthostatic hypotension
  • Three way foley is use to continuously irrigate the bladder and catheter to prevent clots from stopping up urine flow.

 

Prostate cancer –

  • Mimics BPH symptoms
  • Screen with DRE and PSA

 

Chronic kidney disease –  long term decrease in kidney function

  • Can have chronically high BUN and Cre levels
  • polyuria in the beginning, it will progress to oliguria
  • Often need dialysis
  • On HTN meds, Na and fluid restrictions, calcium based phosphate binders
  • Indications for dialysis – we wait as long as possible  because being dialyzed is not optimum for the patient.  
  • Types – hemo, and peritoneal
    • Peritoneal has a high chance for infection, but the person can do it at home and does not need to be hooked up to the dialysis machine for 12 hours a week.  4x day for about 30 mins each time.
    • Hemodialysis – 12 hours a week at the center
      • Have an Arteriovenous fistula for better access commonly in the forearm

Med Surg Session 10: GI

GI session 10

 

Gastritis – usually acute but can by chronic.

  • Often from an irritant such as increased Ibuprofen (or other NSAIDs) intake
  • Irritation of the stomach
  • May cough up blood
  • Gastroenteritis – inflammation of stomach an bowel.

 

PUD – Peptic Ulcer Disease –

  • gastric – superficial, more common in women, 50 and 60 y.o., pain after meals,
  • duodenal – Deep, more common in men, 35-45 yo, pain just below xiphoid process, H. pylori in 90%+
  • PPI’s tend to be better for recovery
  • H2 blockers tend to be better for prophylaxis of PUD
  • Surgeries are less common now because of the medications controlling it well
    • Billroth 1 stomach to Duodenum
    • Billroth 2: stomach to the Jejunum
  • Avoid SMOKING, NSAIDs, chocolate, and fatty foods

 

IBD -Inflammatory bowel disease

  • can be Crohn’s Dx (CD) or Ulcerative Colitis (UC)
  • CD – cobblestone (skip) lesions, can be throughout the whole bowel large or small, full thickness of bowel affected,
  • UC – continuous lesions, Partial thickness, Rectal bleeding, colonic dilation, colorectal cancer,
  • colonoscopy for visualization of the lesions
  • Drugs: to decrease inflammation: 5-Aminosalicylates, corticosteroids, immunosuppressants, antidiarrheals.
  • treatment: colectomy or Proctocolectomy (colostomy or ileostomy)
  • We are looking for dehydration, imbalance in electrolytes, Pain

 

Viral Hepatitis

  • inflammation of the liver
  • caused by drugs, chem, autoimmune, virus,
    • viral – a,b,c,d,e
  • s/s: tired, anorexia, nausea, abd pain, jaundice, hepatomegaly, occasional vomiting
  • Diagnosis with labs (do not need to know the specific bili and liver levels right now)
  • Types
    • A food born, and poor hygiene
    • B sexually transmitted
    • C iv drug and contaminated blood transfusion

 

Obstructions

  • proximal obstruction
    • accumulation of fluid and gas, this can lead to sepsis
  • Small BO
    • vomiting, dehydration, high pitched bowel sounds above obstruction, alkalosis, ABD distension.
  • Large BO
    • vomiting, high pitched bowel sounds above obstruction, ABD distension.
  • care: NPO, NG tube on suction, I/O, abd girth, IVF, and electrolytes.

 

Gallbladder Alterations

  • gallstones
  • Risk factors 5 Fs: female forty fat fertile, fare (white)
  • ERCP – tube down the esophagus to the common bile educt, to break up and pull out stones
  • The stones can block the duct of both the bile and the pancreatic enzymes causing pancreatitis.

 

Diverticulitis – inflammation of the diverticula, causing a perforation into the peritoneum.

diverticulosis – out pouching of the colon.

  • caused by constipation most of the time.

 

Appendicitis

  • wory about perforation

 

Peritonitis

  • extreme guarding and pain
  • surgery asap to clean out the cavity

 

Anti emetic meds

  • reglan
  • zofran