My Nursing Education

When the individual’s blood sugar gets very high and they are profoundly deficient in insulin, the body becomes unable to utilize blood sugar efficiently. The body then begins to burn fat stores for food. As these fat stores are burned, a by product is released called Ketones. It is ketones that are responsible for lowering the body’s pH level below 7.35. Metabolic acidosis occurs when the pH of the body drops below 7.35. The body attempts to excrete the ketones via the kidneys, causing ketones to be released in the urine, a term called ketonuria. However along with the negative ketones, the body’s positively charged electrolytes are also excreted. This leads to an electrolyte imbalance. The body continues to burn other glucose stores in the body such as proteins, causing nitrogen losses.

Now the body has depletion in electrolytes. This can cause nausea and vomiting, depleting more electrolytes. The individual is now in a severe hyperglycemic state and is hypovolemic as well. If these conditions are left untreated, the person can go into hypovolemic shock, become comatose and die.

Outward signs and symptoms of DKA include the following; eyeballs are soft and appear sunken, skin turgor is poor, (Dehydration of tissues can be tested by pinching the skin fold on the sternum. If the skin stays in one place or does not loose its shape rapidly, then dehydration can be assumed.), the person is very pale, cold, clammy, and exhibits deep rapid respirations, an effort the body makes to eliminate excess carbon dioxide. The individual may also exhibit severe abdominal pain and tachycardia, (heart rate greater than 100 beats per minute.) Diagnostic laboratory findings from arterial blood gases would indicate a pH less than 7.35, blood glucose level greater than 250 mg/dL, serum bicarbonate level less than 15 mEq/L, as well as ketones in the urine.

Interventions must be immediate to prevent irreversible destruction to the body’s organs and prevent coma or death. Ensure a patent airway, and begin to administer oxygen via nasal cannula or mask. Establish an intravenous access with a large bore needle (18 to 20 gauge). Begin fluid stabilization with 0.9 Normal Saline. This is an isotonic fluid, compatible with the body’s pH. The purpose of using an isotonic infusion initially is to re-establish blood pressure which was low and to increase urinary out put to 30-60ml/hr. When urinary output is less than 30 ml/hr, kidney failure can rapidly occur. Fluids should continue for one hour or until stabilization occurs. Next begin insulin infusion with a drip rate or 0.1U/kg/hr. During this time it is important to monitor the person’s vital signs every fifteen minutes until stable or for at least one hours after treatment begins. If necessary, potassium should be administered to correct for hypokalemia, and sodium bicarbonate to correct for metabolic acidosis, if the pH is less than 7.0. The person should also have electrocardiogram leads placed on chest to monitor heart rhythms.

When the diabetic is at home and feels these bodily signs and symptoms beginning to occur, they should take the following steps; call 911, check their blood sugar, administer insulin per sliding scale, drink an electrolytic fluid, (i.e., sports fluids), breath into a paper bag, use oxygen if available, lie down, raise feet level with the heart and wait for the ambulance.

Preventative measures to avoid DKA include consistent control of blood sugar with administration of insulin per protocol. The diabetic should avoid too much food intake, and avoid taking too much or too little insulin. Stressful life situations can also cause elevations in glucose levels. Therefore the diabetic should prepare to check their blood sugar more often during times of stress and administer insulin as prescribed.

Understanding the complications of diabetes can help the diabetic take the necessary actions to prevent DKA from occurring and help them live a healthy life.

References:

1. Lewis, Heiitkemper, Dirkesen, Medical Surgical Nursing 6^th ed., Copyright 2006, Mosby, St. Louis., pages 1273 -1278.
2. www.defeatdiabetes.org/support_groups
3. www.accu-chek.com
4. www.Type2Diabetes-Info.com
5. www.ChildrensDiabetesFdn.org
6. www.diabetesinmichigan.org
7. www.diabetesmonitor.com

If you have the desire to go into nursing, then you must first get ready to take the N.E.T., the HESI or the TEAS entrance test. You can begin preparing for your career by practicing your skills using the online tutorials and tests at The Nurses Learning Center. There are over 1000 questions and answers. You will get unlimited internet access, 24/7. It is yours to keep. New questions are added daily. It’s like sitting for the N.E.T., The HESI or the TEAS in your home.

Diabetes can be a real threat to the cardiovascular system. It comes on slowly and can wreak havoc with the bodies systems before the individual knows that they even have diabetes. Diabetes can cause harm not only to the cardiovascular system but the eyes, the nerves, the kidneys, and impede the healing process. A clinical sign that someone may have diabetes is that they may have a difficult time healing from the slightest of skin injuries. People that have diabetes are at a two to four fold increase to developing heart disease or having a stroke. The advantage that pre-menopausal women have over men is diminished when they have diabetes. (1)

According to Christopher Saudek, M.D professor of medicine at Johns Hopkins University in Baltimoore and past president of The American diabetes Association (ADA)., “having diabetes is such a strong risk factor for heart disease that it’s equivalent to already having had a heart attack,” Just why diabetes causes heart disease on such a destructive is unknown. Dr. Robert H. Eckel, M.K., professor of medicine at the University of Colorado Denver and past president of the American Heart Association., say “It’s a complicated connection”.

From a physics standpoint, it can be seen that the heart is muscle and one that is reposonispible for pumping blood to the entire body. Since muscles need glucose to move and expend energy, it can be inferred what when there is a problem with he functioning of glucose iin the body, there will also be a problem with the heart as well.

There are those people that are insulin resistant. This implies that their bodies do not respond to insulin like other people. Insulin is responsible for putting sugar or glucose back into the cells instead of having it run rampant throughout the system. “insulin resistance leads to vascular dysfunction, which indicate that there is an altering of the function of the blood vessels to respond normally to the bodies hormonal signals that tell veins to expand and or contract., notes, David M. Nathan, M.D. , professor medicine at Harvard Medical School and director of the Massachusetts general hospital Diabetes Center. “It also leads to systemic, inflammation, as measured by levels of C=reactive protein and inflammatory cytokines. In this scenario, when type 2 diabetes develops there is a system of cascading events that effects many systems and causing such untoward effects such as high blood pressure, kidney disease, and heart disease.

Given as such wide spread evidence on the effects of diabetes on the cardiovascular system and other body functions, the reality of taking precautionary health measures becomes important. An estimated two out of every three adults with diabetes have hypertension. Diabetic dyslipidemia requires frequent blood work so that the individual knows what their levels of good cholesterol (LDL) and bad cholesterol (HDL) are. When the two are out of sync, a condition called atherosclerotic heat disease can occur. These people are usually candidates for heart bypass surgery, since their arteries become clogged.

In summary, those people with diabetes should take an active role in controlling their disease process. They can do this by getting regular fasting blood glucose levels and having their HDL and LDL tested. Normal values of these cholesterol levels are as follows; total cholesterol should be under 200; LDL under 200 and HDL above 50 for women, 40 for men, and triglycerides below 150. if you’re LDL, HDL and triglyceride levels are also at desirable levels and you have no other risk factors for heart disease, total blood cholesterol below 200 mg/dL puts you at relatively low risk of coronary heart disease. Even with a low risk, however, it’s still smart to eat a health diet, avoid tobacco smoke and try to exercise daily… Have your cholesterol levels checked every five years or as your doctor recommends, and get regular fasting blood glucose levels. This preventative health maintenance should help increase your lifespan and provide many healthy and fulfilling years.

If you have the desire to go into nursing, then you must first get ready to take the N.E.T., the HESI or the TEAS entrance test. You can begin preparing for your career by practicing your skills using the online tutorials and tests at The Nurses Learning Center. There are over 1000 questions and answers. You will get unlimited internet access, 24/7. It is yours to keep. New questions are added daily. It’s like sitting for the N.E.T., The HESI or the TEAS in your home.

Electrolyte imbalances within the body can occur in response to many factors. When a person is dehydrated either from sickness or starvation, their electrolytes can become depleted. Certain medications can cause electrolyte imbalances as well as chronic diseases such as diabetes and renal failure. Electrolytes have a large role in balancing all metabolic reactions related to the delicate pH balance of the body, which is 7.35-7.45. Within this limited pH range all metabolic reactions can go to completion. For instance ATP can be released and produced, muscle contractions occur in simple or complex body movements, our thinking processes and those muscle contractions not in conscious control such as our beating heart and peristalsis of the bowel. When a particular electrolyte is either in to great or too small a concentration the pH of the body responds in kind to correct the imbalance by pulling from other sources in the body. When this happens the person begins to have symptoms that something is wrong. Sometimes the symptoms are barely noticeable while other times the person must be immediately hospitalized in intensive care. Hyperkalemia deals with an electrolyte imbalance in which there is too much potassium or (K+) in the body. When the serum potassium levels rise above 5.3 mEq/L or the blood pH drops below 7.35 the person is considered to be in a state of hyperkalemia. Hyperkalemia is diagnosed in up to 8% of hospitalized patients. Death can be as high as 67% if severe hyperkalemia is not treated quickly. Drugs are an underlying cause in 75% of inpatient cases. Some of the causes of hypekalemia can be seen in the table below;

Signs and symptoms of hyperkalemia include muscle cramps, weakness in the lower extremities, nausea, diarrhea, low blood pressure, bradycardia, and an abnormal electrocardiogram. It is important to carefully monitor the elderly and small children for hyperkalemia. Normal occurrences like diarrhea and vomiting can be life threatening to infants and the elderly. This is due to the lack of fluids within them prior to the occurrence. Therefore careful observation for the above signs and symptoms can save a life. The first step in treatment is to determine whether life threatening cardiac toxicity is present and treat if required. Treatment is based on eliminating or decreasing potassium intake, shifting potassium form the ECF to the ICF, and improving renal and gastrointestinal potassium excretion. With cardiac arrhythmias or changes in the ECG, IV calcium gluconate is given first, then insulin or sodium bicarbonate is administered. If output does not exceed greater than 30 mL per hour then dialysis is usually started.

ECG abnormalities from hyperkalemia related to the P wave include either a low amplitude or wide and flattened to non discernible in severe states. The PR interval may be normal or prolonged, or not measurable if there is no P wave. The QRS complex is widened, and the T wave is tall and peaked. The QT interval is shortened and the ST segment may be elevated.

References

Lippincott Williams & Wilkins, ECG Interpretation an Incredibly Easy Pocket Guide., copyright 2006

Macklin, Murphy-Ende., Saunders Nursing Survival Guide Fluids and Electrolytes, Copyright 2006, Saunders Elsevier, St. Louis Missouri

If you have the desire to go into nursing, then you must first get ready to take the N.E.T., the HESI or the TEAS entrance test. You can begin preparing for your career by practicing your skills using the online tutorials and tests at The Nurses Learning Center. There are over 1000 questions and answers. You will get unlimited internet access, 24/7. It is yours to keep. New questions are added daily. It’s like sitting for the N.E.T., The HESI or the TEAS in your home.

My Experience in E.R.

Nursing/Medical Surgical 222

By Nancy Taji

Upon arriving at the emergency room at 8:00 A.M., I was greeted by a nurse at the desk who asked me if they could be of service. I explained that I was there to a make up clinical day with a staff nurse who was also an instructor at Henry Ford Community College Nursing Department. They assigned me to Sam, short for Samantha. She was a very kind woman, who immediately began to show me the ropes. The first thing that she showed me was how the rooms were set up. As it turned out the rooms were arranged in a circle from one to seventeen. There were only a few rooms open at this hour. She explained that the midnight shift was very busy and that many of the patients currently have been there since late last night. She began to show me how the E.R. charts were put together and the trail of paperwork that had to be followed. It seemed rather confusing to me. I could immediately see how things could get quite crazy as more and more patients were to come in. The first patient we went to see was a young woman in her early thirties who had come in because of chest pain. Sam asked me to do an assessment on her. I greeted the patient and performed a complete assessment as taught in nursing school. Sam, then showed me the med room. What I found very interesting, was that the med cart was activated by fingerprint identification. “Wow”, I said. “This is definitely, high tech stuff.” Sam agreed. She said that this is the type of med cart that you would frequently come across when working in a E.R.. The cart was computerized so that it counted the meds each time one was programmed out of the cart. The E.R. doctor was very gracious in explaining to Sam and I the purpose in ordering a dose of magnesium for the patient. I have to say that I couldn’t understand all of what he said other than that magnesium helped women that were in labor as well as helping the heart muscle. Sam asked me to prepare the magnesium. I had to draw up the magnesium from two vials and then inject it into a I.V. fluid so that it could be given. Sam and I went back into the room where I hung the magnesium I.V. on a pump, while Sam gave her something for pain.
I soon found my self separated from Sam. Though, I am not sure how this exactly happened. I believe that it started when one of the other E.R. nurses asked Sam if she could show me how she wrapped a frost bite burn. So off I went with another nurse to see how this was done. She went into a room where a gentleman was lying on a stretcher, looking rather disheveled with his bare feet sticking out from the covers. The nurse pointed out several of his toes that were a dusky blue. “Not a good sign”, I thought to my self. The E.R. doctor came in just prior to the nurse wrapping his toes to evaluate his condition. “Not bad, you must have some good circulation”, the E.R. doctors said to the man. The man replied in a not so concerned voice as he sipped a cup of coffee, “do you think I’m going to loose them Doc?” The doctor replied, “We won’t know just yet, let’s wait a while and see how this warming blanket works.” After the doctor left the nurse began to wrap the mans toes by first applying Silvadine ointment and then wrapping them with gauze. When she left the room, I decided to say a while longer and talk to this gentleman. I asked him if he a place to stay, when he leaves the hospital. He replied that he did not have anywhere to go, that the last place that he was staying in, which was a shed was no longer an option. This was because someone called the police on him, and the police asked him to leave since there was no plumbing or heat. I thought to myself, “so it’s against the law to stay somewhere that provides shelter, but if it doesn’t have hot and cold running water, you have to live outside.”. I bent down to pick up his clothes that had fallen on the floor and put them back on the chair only to find they were wet to the touch and extremely dirty. Pity filled my heart for this man. He asked if he could have some more coffee, stating that he was a coffeeholic, and that he could sit here all day and drink the stuff. Funny, how something so small like a cup of hot coffee could make someone so happy. Realizing that I couldn’t change the world, I briskly walked over to the coffee pot that seemed to have a endless supply of coffee in it at all times and poured the man a cup. After that, I just kept the cups coming. I moved on to several other patients, completing assessments the best that I could, and passing my information to the nurses and E.R. doctor. I had a feeling of some autonomy while I was in the E.R.. I’m not sure if that was a good thing, seeing that I was there to work directly with Sam. However, I knew that she must have been keeping a close eye on me, of which I was glad. It made me feel secure. All in all it was a good experience for a student nurse. There were a couple of very intense and emotional moments that took place while I was there that day, but I feel that I cannot write about them since they are too fresh in my mind and elicit some very strong feelings. The emergency room is a place were an experienced nurse can apply her expertise and still gain knowledge. I felt very fortunate to have had the opportunity to work with Sam. She is a special individual.

If you have the desire to go into nursing, then you must first get ready to take the N.E.T., the HESI or the TEAS entrance test. You can begin preparing for your career by practicing your skills using the online tutorials and tests at The Nurses Learning Center. There are over 1000 questions and answers. You will get unlimited internet access, 24/7. It is yours to keep. New questions are added daily. It’s like sitting for the N.E.T., The HESI or the TEAS in your home.

Running head: PSYCHOPATHOLOGY PAPER 3 Psychopathology Paper 3 H.F.C.C. Psychiatric Nursing 150 By Nancy Taji Running head: PSYCHOPATHOLOGY PAPER 3 Definition of Medical Diagnosis: Alcoholism in this case scenario is characterized by the DSM-IV-TR criteria for substance dependence. To qualify for a diagnosis of substance dependence there must be at least three of the following criteria met within a twelve month period. 1. Presence of tolerance of the drug. 2. Presence of withdrawal syndrome. 3. Substance is taken in larger amounts for longer periods than intended. 4. Unsuccessful or persistent desire to cut down or to control use. 5. Increased time spent in getting, taking and recovering from the substance. 6. Reduction or absence of important social, occupational or recreational activities. 7. Substance used despite knowledge of recurrent physical or psychological problems. (DSM-IV-TR, APA, American Psychiatric Society 2000) Alcohol related disorders such as alcohol intoxication, alcohol withdrawal and substance induced delirium are also associated with the diagnosis of alcoholism. Psychodynamics: The psychodynamics of alcoholism are multifactorial. Alcoholism touches everyone in one way or another. It has been around since mankind first invented alcohol. The early original schools of Freudian psychology thought alcoholism to be a learned response that eventually became a habit. This school of thought was called nurture, or the environment. As science progressed throughout the century, alcoholism Running head: PSYCHOPATHOLOGY PAPER 3 was viewed as a genetic defect, or occurring due to nature. Presently theorist view alcoholism as arising out of epigenetic causes. In other words nature and nurture combined. Basically this theory places importance on genes as well as environment. In any case alcoholism is considered a disease. It is a disease that robs those who are affected by it of their lives, their families and their futures. Alcoholism can turn a mild man into a wife beater and a child molester, and can turn a women into a wonton harlot. It devastates the lives of all whom it touches. (Varcarolis, 2002) Case Presentation: The client is a 45 year old Caucasian female who appears her stated age. She was admitted to the hospital with the following symptoms of slurred speech, unsteady gait, dehydration and a disheveled appearance along with strong fumes of alcohol emanating from her breath. The client was one week post admission upon this case study. Her appearance was that of a graciously mannered, well groomed lady. Her hair was in a meticulous braid, and she wore a loose fitting sweatshirt and stretch pants. She carried her self with an air of self confidence and met her eyes directly with the person that was talking to her. Her eyes were bright and clear. She spoke in a even toned voice depicting appropriated expressions of joy or sorrow when the conversation warranted. She stated that she has had an addiction to alcohol for the past twenty years. She expressed concern that her liver may now be damaged and that her doctor had ordered some liver tests to be run. She explained in detail about her life and the tragedies that she had to face beginning at a young age, with the death of her boyfriend at the wheel of the car that she was also in, and the sexual abuse by her alcoholic father. She Running head: PSYCHOPATHOLOGY PAPER 3 was able to talk about these past experiences calmly. She went on to explain that she would binge drink on the weekends and eventually wind up drinking throughout the week to simply keep the hangovers at bay. Consequently, she would always loose her job. She did say that she did very well for a time as a manager for an apartment complex. When asked what attributes she like about herself she could not describe any. She stated that she didn’t really like herself and had tried to commit suicide on several occasions using prescription pills and alcohol. Evidently, she had recently been diagnosed with bipolar disorder. She stated that the medication that she was on helped her keep her moods steady. She stated that the depressive mood was totally exhausting and that it was impossible to function. She thought that her late father may have also suffered from a bipolar disorder. When asked about her family, she replied that her sister who was 7 years her junior was also an alcoholic as was her mother. She wanted to remain in the hospital for a few more days although her doctor was going to release her. She stated that she needed to start taking care of herself and that realizing that she needs help is a positive step. She said that she may not have asked to stay for further treatment if she hadn’t restructured her thoughts about herself. Running head: PSYCHOPATHOLOGY PAPER 3 Table 1 Textbook Characteristics of Alcoholism versus Client Characteristics Observed Textbook Characteristics of Alcoholism 1. Presence of tolerance to the drug 2. Presence of withdrawal syndrome. 3. Substance is taken in larger amounts for longer period. 4. Increased time spent in getting taking and recovering. 5. Incapacitated from social, family and occupational events due to substance 6. Using substance despite knowledge of its harm. (Varcarolis, 2002) Characteristics Observed in Client 1. Client states that she must drink large amounts of beer and whiskey 2. Client states that without the alcohol she has tremors and is on Antabuse. 3. Client states that she has been drinking for over twenty years. 4. Client says that her binge drinking on weekends spills over into the weekdays. 5. She states that while she is drinking she is incapacitated from all family, social and occupational functions. 6. Client acknowledges harm of the substance yet continues to use it. Running head: PSYCHOPATHOLOGY Table 2 Nursing Interventions for Client 1. Tolerance to alcohol: Client will attend group therapy and acknowledge to refrain from drinking. 2. Withdrawal symptoms: Client will remain hydrated with fluids that contain electrolytes and take vitamin B. 3. Larger Amounts for Longer Periods: Client will participate in cognitive restructuring to identify positive strengths and build self confidence. 4. Unsuccessful to cut down or control use: Client will participate in Alcoholics Anonymous. 5. Increased time in obtaining and recovering from substance: Client will work with therapy and counseling to cognitively restructure life style. 6. Reduction and absence from activities: Client will engage in recreational and occupational therapy. 7. Substance used despite knowledge of harm: Client will refrain from the use of alcohol and verbalize harm, possible using biofeedback as a tool. (Varcarolis, 2002) Running head: PSYCHOPATHOLOGY PAPER 3 Table 3 Medical Interventions Medical Interventions Suggested for Alcoholism 1. Anti Alcohol drug 2. Anti anxiety medication 3. Vitamins and fluids 4. Group Therapy 5. Family Therapy 6. Alcoholics Anonymous 7. Rest (Varcarolis, 2002) Medical Interventions Implemented for Client 1. Antabuse 2. Halcyon 0.25mg P.O. at 2400 3. Dosages of Thiamine and I.V. of D5/lactated ringers 4. Client attends Group therapy 5. Client attends family therapy 6. Attends Alcoholics Anonymous 7. Client is convalescing in hospital (Clients Chart) Running head: PSYCHOPATHOLOGY PAPER 3 References Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing. (4th ed.) New York, N.Y., Saunders
If you have the desire to go into nursing, then you must first get ready to take the N.E.T., the HESI or the TEAS entrance test. You can begin preparing for your career by practicing your skills using the online tutorials and tests at The Nurses Learning Center. There are over 1000 questions and answers. You will get unlimited internet access, 24/7. It is yours to keep. New questions are added daily. It’s like sitting for the N.E.T., The HESI or the TEAS in your home.

Running head: PSYCHOPATHOLOGY PAPER 2

Psychopathology Paper 2
H.F.C.C. Psychiatric Nursing 150
By Nancy Taji

Running head: PSYCHOPATHOLOGY PAPER 2
Definition of Medical Diagnosis: According to the DSM-IV-TR, the criteria for Schizophrenia can be summed up as follows:
Two or more of the following symptoms during a one month period, such as delusions, hallucinations, disorganized speech,
Grossly disorganized or catatonic behavior and negative symptoms such as affective flattening, avolition and or alogia. In regards
to personal, interpersonal/social and self care, the client falls short of being able to maintain normal functioning. The duration of
the illness persists for at least six months with at least one month that meets the positive symptoms of the disease. (Varcarolis,
2002, p. 529)
“Schizophrenia is a devastating disease of the brain that affects a person’s thinking, language, emotions, social behavior and ability to accurately perceive reality.” (Varcarolis, 2002, p. 524)
Psychodynamics: The psychodynamics of the disease process can be classified using the four A’s. The four A’s are:
1. Affect, usually blunted or inappropriate and or bizarre.
2. Associative looseness, which refers to a incoherent stringing together of words that have no meaning.
3. Autism, refers to the world in which the person lives in within their head. It is an imaginary world that only they live in and sometimes respond to with speaking to inner voices. This is referred as responding to internal stimuli.
4. Ambivalence, is the polarization of feelings coexisting within the individual. Such as holding love and hate simultaneously and not being able to express either. This can be paralyzing for the individual. They usually withdraw and can become catatonic. (Varcarolis, 2002, p. 526)
Running head: PSYCHOPATHOLOGY PAPER 2
Generally the disease has been found to be genetically transmitted and there have been abnormal findings on PET scans. Some of the abnormal findings include frontal lobe inactivity, cortical enlargement and well as third ventrical enlargement. With later onset of positive symptoms such as delusions and hallucinations the prognosis seems to respond with greater success to medications than with a earlier onset of the negative symptoms such as Autism. As the case in any disease, the symptoms are treated for life, since there is no cure at the present time. The drugs for the treatment of schizophrenia are termed antipsychotics of which there are the typical and atypical variety. Currently the atypical variety treat the positive as well as the negative symptoms of the disease but without as drastic extrapyramidal side effects as the typicals.
Case Presentation: The client is a male Caucasian in his early thirties. He was dressed in a red sweatshirt and jogging pants. He was well groomed. He displayed a crew cut and was clean shaven. His nails appeared appropriately short and clean. The client expressed great sorrow as he explained how he was involved in an accident in which a child on a bike was killed. He spoke in depth about the deaths he had seen in his life. His expression was appropriate. He did not display any signs or symptoms of schizophrenia. He explained that he was on prolixin, and this atypical antipsychotic kept the voices away. The client explained that he had been hearing voices for many years and that he had used and currently uses alcohol when the voices wouldn’t go away. He stated that the voices consisted of the devil, although the voice would not identify himself as such, but the client said he knew it was him, a little boy and a women. He said that the voices tell him that he is next to die, and that they are more audible at night than in the daytime. He stated that he was able to hold down a successful job as a brick
Running head: PSYCHOPATHOLOGY PAPER 2
layer, married and fathered two children. However, the marriage ended in divorce and the wife took the children to Texas. He has not seen his children for a while and expressed a great desire to be reunited with them. The client stated that he was afraid to get close to anyone for fear that something bad would happen to them. He stated that he felt free of the debilitating symptoms of the disease at the present, which is why he sought treatment initially.

Running head: PSYCHOPATHOLOGY PAPER 2
TEXTBOOK CHARACTERISTICS OF SCHIZOPHRENIA CLIENT CHARACTERISTICS OBSERVED/DESCRIBED BY CLIENT
1. Associative looseness 1. Not noted
2. Affective flattening 2. Slightly blunted, possibly due to medication
3. Alogia 3. Client stated thoughts were jumbled at times
4. Avolition-apathy 4. Client stated that it is only the thought of seeing his children again that keeps him going. None noted.
5. Anhedonia 5. Client states that is it is hard to find the will to continue living and with the thoughts of dying make it difficult to find joy in life.
5a. Asociality 5a. Afraid to make friends for fear they will die
6. Hallucinations 6. None at the present while on medication
7. Delusions 7. Client states that he hears voices telling him he will die
8. Bizarre behavior 8. Client did not exhibit any bizarre behavior, very pleasant.
(Varcarolis, 2002, p. 533)

Running head: PSYCHOPATHOLOGY PAPER 2
Nursing Interventions For Client
1. Associative looseness: “Tell the client what you do understand and reinforce clear communication and accurate expression of needs, and thoughts.” (Varcarolis, 2002, p. 534)
2. Affective flatness: “All people with schizophrenia are uniquely different and all have unique personal strengths and disease-associated deficits. Ideally, outcomes should reflect enhancing the person’s strengths and minimizing the effects of the client’s deficits.” (Varcarolis, 2002, p. 536)
3,4. Alogia and Anhedonia: Encourage participation in activity groups, (only if client’s anxiety level allows for such participation). Such actions help to: “decrease withdrawal, promote motivation, modify unacceptable aggression and increase social competence.”
(Varcarolis, 2002, p. 540)
“Encourage drawing pictures, reading poetry, and listening to music.” (Varcarolis, 2002, p. 541)
5. Asociality: Encourage client to groom self and give praise. Supportive teaching in regards to the understanding and acceptance of the illness. Encourage group and family therapy.
6. Hallucinations: “Approach client in a nonthreatening and nonjudgmental manner. Maintain eye contact, speak simply in a louder voice than usual, and call the person by name.” (Varcarolis, 2002, p. 541)

Running head: PSYCHOPATHOLOGY PAPER 2
7. Delusions: “Clarify the reality of the client’s experience, and empathize with the client’s apparent experience, the feelings of fear.” (Varcarolis, 2002, p. 542)
8. Bizarre behavior: Ensure the safety of the client. Gently assist client to a less stressful and quiet area. Make sure that there are no objects that the client can hurt themselves or others with. Speak in a calm clear voice and try to bring the client back to reality.

Medical Interventions for Schizophrenia
1. Antipsychotic medication 1. Client is currently on Prolixin 2.5mg T.I.D.
2. Group Therapy 2. Client participates in RT and OT daily
3. Psychotherapy 3. Client meets Psychologist and Psychiatrist regularly in hospital during stay.
4. Client teaching 4. Client receives one on one education on illness with nurse daily.
5. Antianxiety and or antidepressants used concurrently 5. Client receives Ativan 1mg q. h.s.

Running head: PSYCHOPATHOLOGY PAPER 2
References
Lehne, R. (2004). Pharmacology for Nursing Care. Missouri: Saunders
Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing: A Clinical approach. Pennsylvania: Saunders

Running head: PSYCHOPATHOLOGY

Psychopathology Paper 1
H.F.C.C. Psychiatric Nursing 150
By Nancy Taji

Running head: PSYCHOPATHOLOGY
Diagnosis Bipolar Disorder: “Bipolar disorder is a severe biologic illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal.” (Lehne, 2004, p. 321)
The following is a short synopsis according to the DSM-IV-TR, “Criteria for Bipolar Disorder includes a distinct period of abnormality and persistently elevated, expansive, or irritable mood for at least:
• 4 days for hypomania
• 1 week for mania
During the period of mood disturbance, at least three or more of the flowing symptoms have persisted and have been present to a significant degree:
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual or pressure to keep talking
• Excessive involvement in pleasurable activities that have a high potential for painful consequences.” (American Psychiatric Association [APA], 2000).

Psychodynamics of the Disease: The onset of the disease usually occurs during late adolescence or in the mid twenties. However, the disease has been known to occur up into the fifth decade of life. The mood swings that accompany this disorder are of several types. They are as follows: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,
Running head: PSYCHOPATHOLOGY
impairment in normal social functioning usually requiring hospitalization; Hypomanic Episode, evidenced by a milder form of the Pure Mania, without the loss of normal functioning that would require hospitalization; Major Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death; the last episode associated with Bipolar disorders is the Mixed Episode in which, “patients experience symptoms of mania and depression simultaneously. The combination of high energy and depression puts them at significant risk of suicide.” (Lehne, 2004, p. 321)
Case Presentation: A Caucasian woman in her mid twenties presented signs and symptoms of self mutilation with a straight edge razor inflicted gash across her lower abdomen approximately six inches below the umbilicus. The depth of the gash just stopped at the abdominal fascia. The patient was sent from the emergency room to the
psychiatric floor. Upon meeting the patient one day after her admission to E.R., she appeared dressed in pajama bottoms and a t-shirt, shuffling down the hall in her socks. She was holding her abdomen with one hand and appeared in some discomfort. Her black hair was short and disheveled. When the patient arrived at her room she sat down on her bed. She acknowledged with blunted affect that she cannot stop self mutilation, and described how she cut herself through the muscles in her abdomen almost down to the fascia. Her voice was tremulous and fast paced. This could be due to the fact that she had just been given her first dose of Clozaril. She stated that her mouth was dry and that she needed to drink some water. She then went on to say that she was getting very sleepy. The client felt comfortable with the interview.
Running head: PSYCHOPATHOLOGY
She shared personal information in regards to being sexually abused by her bother beginning at the age of seven until the age of fifteen. Her brother was two years older than her and died in a automobile accident at the age of eighteen. She went on to say that her mother never knew or acknowledged the sexual abuse and that she could not tell her because the mother idolized the son. The client was receptive to cognitive reframing, however she was very critical of herself and stated that she felt worthless and ashamed. She appeared very tired and stated that she wanted to sleep.

Running head: PSYCHOPAHTOLOGY
Table 1
Textbook characteristics of Bipolar disorder versus client characteristics observed

Textbook Characteristics of Bipolar Disorder
1. Pure Manic Episode
2. Hypomanic Episode
3. Major Depressive Episode-
a.) Affective Flattening
b.) Alogia
c.) Avolition-apathy
d.) Anhedonia
4. Mixed Episode
5. Rapid-Cycling Bipolar Disorder- Patients experience four or Client Characteristics Observed

1. No current symptoms
2. Rapid breathing, rapid speech, however due to medication a client was concurrently exhibiting s
3. lethargy
4. Client acknowledged sadness/ worthlessness
a.) Facial expression flat
b.) Thoughts of dying, hard to focus
c.) Hair/clothes unkempt
d.) Expressed no interest in children or own

Running head: PSYCHOPATHOLOGY
Client’s Symptoms
1. Hypomania

2. Depression
a.) Affective Flattening
b.) Alogia
c.) Avolition & Apathy
d.) Anhedonia
3. Mixed Episode
4. Rapid Cycling

(Varcarolis, 2004, p. 485)

Nursing Interventions
1. Observe the client every 15 minutes while suicidal, remove all dangerous, sharp objects from room.
2. Reinforce that she is worth while,
a.) Assist the client in evaluating the positive as well as the negative aspects of her life
b.) Encourage the appropriate expression of angry feelings.
c.) Schedule regular periods of time throughout the day for recreational/occupational therapy, encourage client to groom self, offer praise for completing grooming.
d.) Ensure client’s participation in taking mood stabilizing medications. Watch client swallow medication.
3. Engage client in interpersonal therapies, cognitive-behavioral therapy,
4. Encourage client to attend group therapy, and journal episodes.
Running head: PSYCHOPATHOLOGY
Table 2
Medical Interventions, Bipolar Disorder
1. Drug therapy using
a.) Mood stabilizer
b.) Antidepressants
c.) Antipsychotics
2. Education and Psychotherapy
3. ECT
(Varcarolis, 2002, p. 483)

Clients Medical Interventions
1. Drug therapy includes
a.) Lithium 300mg every h.s.
b.) Not taking any
c.) Clozaril
2. Client is receiving psychotherapy, family counseling, group therapy while in hospital, and cognitive restructuring.
3. None

Running head: PSYCHOPATHOLOGY
References
Lehne, R. (2004). Pharmacology for Nursing Care. Missouri: Saunders
Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing: A Clinical
Approach. Pennsylvania: Saunders

Wednesday continuing on fluids and e-lytes
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

I. Respiratory Acidosis

A. Signs and symptoms
a. Acidosis signifies that H+ ions are prevalent and multiplying.
b. There are several reasons that H+ ions are present. Let us look at the bicarbonate ion, H2Co3. The bicarbonate ion is a very good buffer. It allows enzymatic reactions to take place without drastically altering the pH of the blood. Our blood must remain at a pH of between 7.35-7.45

2. Let’s take a look at what constitutes respiratory acidosis given a few scenarios
A. pH = 7.2
PCO2 = 25
HCO3- = 15

Here are the normals

pH = 7.35-7.45
pCO2 = 35-45 mm/hg
HCO3 – = 20-30 mmol/L

Now here’s how we do this
1. First look at the pH. Notice that it is 7.2 which is in the acidic range for the blood.
2. Now look at the pCO2, it is in the abnormal range. It is below the normal range. This means that the less pressure in the respiratory system the less CO2 present and more O2. But as the pressure decreases beyond the normal range we have a alkaline situation. This doesn’t match our pH. Could it be that the respiratory system is trying to compensate for the acidic situation occurring? Yes.
3. Now look at the bicarb- ion, it is in the abnormal range below the base normal of 20 mmol/dl. What does this mean? Well, it means that as the bicarbonate ion decreases the H+ proton increases.
4. Now let’s see what we have. What two values agree with each other? The answer to that would be the Acidic pH and the Acidic bicarbonate ion. Since they are both acidic, the term of the system is metabolic acidosis, and the respiratory system is trying to compensate.
5. So the system is partially compensated.
Let’s take a look at what happens in a system that is under Respiratory Alkalosis

pH [The body is in a state of alkalosis]

7.50 The body is
[trying to get back to normal]

7.47
[back to normal]

7.45

pCO2 [below normal]
alkaline

30mm hg [below normal]
alkaline

30mm hg [below normal]
alkaline

30mm hg

HCO3-
[normal range]

20 mmols/L
[below normal] becoming acidic

18 mmols/L
[farther below normal]more acidic

16 mmols/L
What’s
happening Respiratory Alkalosis
uncompensated Respiratory Alkalosis

Partially compensated We are still in respiratory alkalosis, however, the kidneys have Fully compensated by bringing the pH back to normal by releasing more H+ ions
The less CO2 in the respiratory system, the more alkaline it becomes. Or in other words the more HCO3- that is generated.

1. pH = 7.17

pCO2 = 98 mm hg

HCO3- = 38 mmols/L

Let’s see what’s happening here. First of all the pH is below normal which means that it is in the Acidic range.
Next, we look at the pressure in the lungs. We see that the pressure is very high. We know that as the pressure of CO2 increases, that it means that CO2 is multiplying in the lungs and creating a higher pressure. The more CO2 that we have, the more H2CO3 [carbonic acid] that is going to be made. Look at the bicarb ion. This is also elevated. However, if the bicarb ion[HCO3-] is elevated, this means that more base is being made. More base is being made in response to the acidic state of the body. So what is happening, is that the body is in Respiratory Acidosis, and the kidneys are trying to hang on to the bicarb ion to counter act the acid environment.

Alternative Medication Therapy
Alternative medication can be defined as those compounds that are intended for use in the treatment, prevention or diagnosis of disease but are not approved or recognized as medication by the Food and Drug Administration (FDA). Included in this definition are compounds that are commonly referred to as herbal medicines, nutritional or dietary supplements, phytomedicinals and organic and natural products. Compounds that are available as prescription medication in a foreign country but are not approved by the FDA for use in the United States will also be considered Alternative Medication for purposes of this discussion.
Medication products that are approved for use by the FDS but are being used for unlabeled indications will not be considered Alternative Medication, for the purposes of this discussion. Investigational medication that is not approved for routine use by the FDA but is being used as part of a research protocol will also not be considered within the scope of this discussion. It is the responsibility of care givers such as physicians and nurses to be aware of the medications that are being used to treat patient’s. Many hospitals have protocols in place that deal exclusively with alternative medication therapies, to ensure the efficacy that the medicines are safe, pure and of known composition. Alternative medications as defined previously have not undergone rigorous scientific evaluation to establish safety and efficacy, are not subject to the stringent manufacturing and quality standards imposed by the FDA, and are not reliably indentifiable to content. It is recognized that some Alternative Medication may have scientific evidence and, in some cases, years of tradition which support a real or perceived therapeutic value. As a general rule, those patients that are admitted to hospitals are usually allowed to keep their Alternative Medications with them. However, before they can use them the medications must go down to pharmacy where they are labeled and identified with the patient’s name and room number. Pharmacy will then send the medication to be placed in the medication drawer of the patient for the nurse to administer. Most often a physicians order is necessary before the patient is allowed to use their medication form home. Patients feel a sense of relief that they are allowed to use their Alternative Medication while in the hospital. If the hospital were in fact to procure such medication, then the patient would be charged a great deal of money, which their insurance probably would not pay. Times are changing to the effect that care givers must deal with the reality that there is a great number of people who don’t have medical coverage, are unemployed and have little to no money to pay for hospital stays. In some cases, Alternative Medication therapy is less expensive that generic or name brand drugs. While recognizing the fact that many people are considering Alternative Medication therapy, it is also up to the physician to have a thorough knowledge of such medications. These medications can be very potent, interfere with other medications by either causing a harmful effect of nullifying the effect of the prescribed medication. Thorough health assessments must include questions that ask the patient if they are taking such medications. Health professionals should learn as much as possible regarding uses and side effects of Alternative Medication therapies if they are to treat people.

Patients Require Information Related to Their Medications
By Nancy L. Kimmel R.N. PhD CHMM
October 25, 2008

Patients are often prescribed medications for different diagnoses that they may have. Having multiple diagnoses and or aliments is not uncommon. However, in this day and age of specialization, patients are required to see a different doctor for each diagnosis. This is not only time consuming for the patient, it is also very expensive. Most specialists charge more than general practitioners. Each doctor will prescribe medication for the patient based on that one diagnosis. If there are three different doctors all prescribing medications for a particular ailment, then the patient is placed in a dangerous situation of having possible adverse side effects from interactions of medications. The main point is that all of the doctors must know what medications their patient is taking and be able to explain to the patient the side effects and interactions. They should also keep in contact with the other specialists in case one doctor notices a discrepancy in medication prescribed that could cause serious side effects. Multiple drug therapy should be beneficial to the patient not harmful. Take the drug Ultram Ò, this drug is a mild analgesic that is prescribed for muscle aches and pains. If this drug is taken in conjunction with certain psychotropic medications a possibly fatal physiological reaction can occur. Certain blood pressure medications such a beta-blockers act on the beta-receptors of the heart to prevent the angiotensin enzyme cascade, thereby preventing angiotensin I from complexing into angiotensin II. Once angiotensin II is formed, the release of a very strong hormone called Vasopressin enters into the blood stream causing a dangerous rise in blood pressure. These same beta-blockers can also act on the beta-receptors of the lungs as well, causing stimulation of the Para-sympathetic nervous system, (or competition with the sympathetic nervous system). which causes fluid to build up in the lungs. Normally this side effect is rare, however, if the patient has respiratory problems to begin with, then this side effect could be very detrimental. Patients with congestive heart failure, emphysema or chronic bronchitis should tell their doctors that they could be sensitive to beta-blockers. Beta-blockers or Beta-Adrenergic Blocking Agents block the nerve impulse transmission to the beta-receptor of the sympathetic division of the Autonomic nervous system. These receptors are found in greater numbers at the postjunctional terminals of the nerve fibers that control the heart muscle and reduce muscle tone. These drugs include atenolol, carteolol, metoprolol, nadolol, penbutolol, pindolol, propranolol, and timolol. These drugs block postsynaptic alpha 1 adrenergic receptors resulting in a dilation of arterioles and veins resulting in lowering the blood pressure. One would think that the doctor should know this, and it should not be the patient’s burden to have to inform the doctor. It seems however in today’s society that they patient must be very well educated regarding their own health, and doctors should pay close attention. The public is more educated now than ever, regarding medications side effects and its purposes. This may be due to the fact that more people of advanced ages are computer literate and are able to access the many health related sites. Patients are subjected to an information overload regarding their medications. It is up to doctors to help their patients not feel overwhelmed. They can do this by keeping the lines of communication open between specialists and knowing each medication that the patient is taking. The extra time and effort will prevent untoward side effects and possible fatal drug interactions. Patients are also encouraged to continue with their efforts in learning all that they can regarding the medications that they are taking and to ask their doctor any questions that they may have. New medications and strict medication regimes are the key to longevity. It is up to the doctor and patient to find the best combination to ensure a long, healthy and happy life.