Psychology

Depression

Symptoms

• Feelings of hopelessness, worthlessness, and emotional emptiness.

Treatment

• Combines behavioral therapy with pharmacological interventions, including antidepressant medications.

Nursing Considerations

• Avoid isolating the patient and encourage open expression of emotions.
• Do not pressure the patient into making decisions.
• Regularly evaluate for risk of suicide.

Suicidal Ideation

Risk Factors

• Higher likelihood with severe depression, social isolation, psychotic disorders, or situational crises.
• Patients with a history of suicide attempts or ideation are at increased risk of recurrence.

Management

• Implement one-on-one observation and position the patient’s room near the nursing station.
• Screen personal items for hazards, removing sharp objects, cords, or other potential weapons.
• Ensure medications are swallowed under supervision to prevent hoarding.

Abuse

• Interview the patient in a confidential, secure setting.
• If the account of the injury doesn’t align with the physical evidence, consider the possibility of abuse.

Alcohol Withdrawal

Symptoms Timeline

• Initial Phase (6–36 hours after last drink): Common symptoms include shaking, headaches, anxiety, rapid heart rate, and sweating.
• 12–48 Hours: Hallucinations may emerge.
• 48 Hours: Risk of seizures.
• 48–96 Hours: Potential onset of delirium tremens (DTs), a severe withdrawal condition.

Assessment and Treatment

• Use the CIWA scale for evaluation.
• Treatment options include benzodiazepines (e.g., Ativan, Valium), glucose, thiamine, treatment for electrolyte imbalances, and IV fluids.

Wernicke’s Encephalopathy

• Caused by a deficiency in thiamine.
• Symptoms: Nystagmus, eye muscle paralysis, and gait problems.
• Treatment: Thiamine supplementation.

Korsakoff Syndrome

• Also caused by a thiamine deficiency.
• Symptoms: Memory loss, amnesia, and reduced spontaneity.
• Treatment: Thiamine supplementation.

Delirium

• Behavior: Impaired judgment, leading to prolonged hospital stays and increased mortality.
• Management: Document assessments and provide supportive care.
• Referral: Refer patients to social services and report any suspected child or elder abuse to law enforcement.

Benzodiazepine Withdrawal

• Timeline: Symptoms occur within 2–21 days after discontinuation.
• Symptoms: Anxiety, tremors, psychosis, and seizures.
• Treatment: Administer benzodiazepines or Librium to manage symptoms.

Opioid Withdrawal

• Timeline: Symptoms appear 24 hours after stopping opioids.
• Symptoms: Insomnia, restlessness, fever, chills, tremors, muscle spasms, and rapid heartbeat.
• Treatment: Provide opioids to ease withdrawal.

Risk Factors

• Factors such as pre-existing dementia, critical illness, benzodiazepine use, history of hypertension, and alcohol consumption can increase the likelihood of withdrawal complications.

Assessment Considerations

• Avoid assessing patients who are unresponsive or heavily sedated.

Criteria for Delirium

• Delirium is indicated by a sudden change in cognitive function, leading to disorganized thinking.
• Symptoms may include disorientation, confusion, altered mental status, and possible increased agitation.

Prevention and Care

• Reorient the patient, ensure the use of corrective devices like glasses/hearing aids, maintain consistency in caregivers, and adjust lighting to a regular day-night cycle.
• Minimize environmental noise, avoid restraints, and ensure hemodynamic

ABCDE Bundle for Sedated Patients

• A: Awakening trial
• B: Breathing trial
• C: Communication and collaboration with the team
• D: Delirium management
• E: Early mobility