Patients who are actively sick (acute) have difficulty listening to anything other than what is happening within their body. Pain, nausea, vertigo, and other symptoms of illness make it hard to communicate beyond the most basic information needed to relieve the most disturbing concerns
Patients who are not acutely ill (chronic) have trouble concentrating because of the psychological noise whirling around in their brains. Worrisome thoughts fill their minds, such as, “How will this affect my career, my marriage, my life?” “How can I pay for this?” “Will I be scarred, disabled, or sick for the rest of my life?” “Will I die from this?”
Timeline of illness pt behaviors:
Seeking knowledge – researching more about illness
Seeking comfort – comfort and support from social/spiritual groups
Learning self-care – mentally adjust to changes and learn self-care, sometimes with your help
Goal-setting – breaking illness into manageable steps
Planning alternative directions – preparing for life altering adjustments
Other types of PPE in addition to eyewear and facemasks:
Water-repellant gowns, gloves, hair coverings, foot coverings
Facing pt with a face mask on will also allow them to hear you better. Eyes can often express you’re smiling
Cancer therapies:
Radiation therapy - high energy rays are directly targeted to a particular area of the body to kill cancer cells and shrink tumors
Chemotherapy - drugs administered to kill cancer cells
Hormone therapy - Hormone-origin cancers may be treated
Immunotherapy – Treatment using the body’s own immune system
Providing supportive material from resources such as the ACS and regional cancer support groups can be valuable for both patients and their loved ones.
Symptoms of depression:
-Appetite changes, either eating less with weight loss or eating more with weight gain
-Sleep changes, either difficulty sleeping or sleeping too much (Figure 6-3)
-Social interaction changes, ranging from isolation to excessive
-Feeling worthless or guilty
-Fatigue, loss of energy
-Loss of pleasure in things once enjoyed
-Loss of interest in daily activities and occupations
-Absenteeism from work or school
-Difficulty thinking clearly, concentrating or making decisions
-Thoughts of self-harm or suicide
Seasonal affective disorder is a major depressive disorder “with seasonal pattern
Peripartum depression is extreme sadness, anxiety, and exhaustion affecting women during pregnancy or after delivering the baby
Bipolar disorder is not a depressive disorder, but the patient oscillates from “manic” or extremely high moods to low moods that meet the criteria for a major depressive episode
CBT: functions on belief “how you think affects how you feel”.
Unlike other psychotherapies, focuses on the present and works best at solving problems
Pt’s verbal and nonverbal cues:
Look for sullenness, despair, desperation, hopelessness, talk of having “the blahs” or “the blues.”
Some questions for potentially depressed pts:
“On a scale of 1 to 10, with 10 being the highest, how depressed would you say you currently are?”
“What is the most depressed you have ever been?”
“Is there anything that you’ve done or found helpful to find relief?”
“Has it ever gotten to the point where you have thought of harming yourself”
CDC Data and Statistics Fatal Injury Report on suicide in the US or 2016:
The suicide rate increased by 19.5% from 2007 to 2016.
It is the 10th leading cause of death.
Men die by suicide 3.53 times more often than women, but women attempt suicide more frequently than men.
The rate of suicide is highest in middle age, among white men in particular. White males accounted for 7 of 10 suicides.
IS PATH WARM mnemonic stands for:
Ideeation – thoughts of suicide?
Substance Abuse – demonstrated increased drug or alcohol use?
Purposelessness – states there is no purpose in his or her life
Anxiety – overly worried, ruminating, trouble concentrating
Trapped – states no way out of current situation
Hopelessness – anything to look forward to?
Withdrawal – isolation from others
Anger – acting with rage or seeking revenge?
Recklessness – risk-taking behaviors, acting like doesn’t care about consequences
Mood Changes – dramatic changes in mood
The medical community draws a distinction between using a substance and overusing a substance to the extent that it harms a person’s health and wellbeing, or the health and wellbeing of others…
Further, it is possible for a person to use or even overuse a substance without being addicted. A person can be dependent on a substance without being addicted, as a patient might be dependent on blood thinners or insulin
DSM-5 – Diagnostic and Statistical Manual of Mental Disorders
(5th edition published in 2013 by the American Psychological Association)
Diagnosis of SUD when 2 or more criteria are observed within one year:
-The substance is taken for longer periods or in larger doses than intended.
-There is a persistent desire or unsuccessful attempts to decrease the use of substance.
-Significant amount of time and energy spent trying to get the substance or recover from its effects.
-A strong craving or desire to use the substance.
-Recurrent substance use resulting in a failure to complete obligations at work, school or home.
-Continued substance use despite experiencing social or interpersonal consequences.
-Limiting social and/or recreational activities to use of the substance.
-Recurrent substance use in physically dangerous situations, like driving.
-Continued substance use when the individual knows it is causing physical and/or psychological harm.
-The development of tolerance, reduced effects following repeated use of the substance
-Experiencing withdrawal, symptoms following cessation of substance use
People who are psychologically addicted may be so attached to this form of stress relief that they subconsciously increase stress levels as an excuse to fall back into the behavior - For example, the smoker or alcoholic who is trying to stop, but starts a fight with a spouse as an excuse to say, “See, you made me start smoking (or drinking) again when I was trying so hard to stop.”
Many studies suggest that addictive personalities usually have a low frustration threshold and poor self-esteem and need the support of the substance as a coping mechanism
Be aware of the most common drugs in your area and their street names, signs of abuse
Bath salts:
Packaged in small foil pouches - these substances might also be sold as “plant food,” “phone screen cleaner,” or “jewelry cleaner.” To evade law enforcement authorities, the package is usually labeled “not for human consumption,” and sold openly online and at smoke shops and head shops.
Since it is an amphetamine derivative, all similar dangers exist (hypertension, tachycardia, hyperthermia, diaphoresis, seizures, arrhythmias, and respiratory distress, which can lead to a heart attack, stroke, coma, or death)
Because synthetic cannabinoids (K2 and Spice) are unregulated and sold openly online, at “head shops,” gas stations, and the like, some users may mistakenly think they are safe. In reality, some synthetic cannabinoids produce much stronger effects than marijuana.
“Opioid” refers to any synthetic, semi-synthetic, or naturally occurring drug that acts on opioid receptors in the brain. In contrast, an opiate is a drug derived from the opium poppy; an opiate is a type of opioid.
Included in the prescription opioid group are codeine, morphine, fentanyl, meperidine (Demerol), oxycodone (OxyContin), tramadol (Ultram), and hydrocodone (Vicodin). Heroin is a non-prescription street drug.
Fentanyl –
Irresponsible drug manufacturers cut illicitly manufactured fentanyl (IMF) into heroin as a cost-cutting measure, while on the street, unsuspecting users overdose not knowing the product has been laced. A fatal dose of IMF is very small (Figure 6-9), and therefore its proliferation contributes to the increasing number of often fatal overdoses
In medicine, fentanyl is prescribed for SEVERE chronic pain.
Prescribed in oral (pill or lozenge) and transdermal (slow-release patch) forms
Nicotine withdrawal symptoms:
insomnia, anxiety, and agitation
Quitting: Social support groups can be very effective. Several new drugs have shown promise in breaking the addiction. They are available as patches, oral medications, and prescription gum.
Vaping – also called E-Cigarettes, Electronic Nicotine Delivery System (ENDS)
The safety of vaping is unknown. There may be harmful chemicals that are inhaled into the lungs.
Educate patients to talk candidly with physicians regarding potentially-addicting medications. Patients who we know or suspect to be at risk for addiction may be offered other, less potentially-addictive medication choices by their providers.
Alzheimer’s: There is no cure.
ADLs – skills requiring “active motion” include: toileting, brushing teeth, eating nutritionally, and otherwise living independently.
Health care professionals who embrace person-centered care focus less on “what is done” and more on “how it is done” (Kitwood, 1997).
Rule of Fives: sentences no longer than five words, words no longer than five letters.
Anorexia nervosa:
Weight loss of 25% or more for no apparent reason is a warning sign
Pt may have a depressed mood, low libido, irritability, and insomnia. Rather than avoiding the thought of food, this patient can have a food obsession, collecting recipes, watching cooking shows, hoarding food, and cooking for others
Semi-starvation can result in any of several physical affects and symptoms over time, some of which can be life-threatening. Physiological indicators include vital sign abnormalities, such as low blood pressure, slowed breathing and pulse. Women may have amenorrhea, the cessation of menstruation. Laboratory values may indicate anemia, low white blood cell count, and high cholesterol. The patient may complain of feeling tired and/or cold all the time, and may suffer from constipation. Outwardly, emaciation presents with brittle hair and nails, dry and yellowish skin
Bulimia Nervosa
Patients are typically ashamed of their behavior, and keep their eating habit hidden. Bulimics more frequently are women, adolescents and girls from families that expect a high degree of success
Tooth decay is from stomach acids from regurgitating frequently
Autism
Restricted interests:
in an insistence on sameness or routines, fixation on an object) and repetitive behaviors, such as repeating patterns of speech, lining up objects.
Autism
Other symptoms of ASD:
-Failing to or being slow responding to someone calling their name or other verbal attempts to gain attention
-Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
