CHAPTER 13 TREATMEMENT MODALTIES -A team approach provides the most comprehensive interventions for...
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CHAPTER 13TREATMEMENT MODALTIES
-A team approach provides the most comprehensive interventions for client with psychiatric disorder in an inpatient, partial hospitalization, or day treatment setting.
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Individual therapy:-Helps client explain problem areas, define new options, & discuss how the new behavior may help solve original problem.
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Group therapy:-Problem-solving oriented.-Based on repeated dynamics of individuals in group.
-Very useful for clients require a lot of attention.
-Group members will help client to understand effect of his behavior on each of them, so that client can use information when relation to significant people in his everyday life.
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Family therapy-Helpful for clients as dynamics of family system are often repeated in other relationships in client’s life, such as with his boss or spouse.
-Family sessions consist of assessment of family system & explication of how family dynamics are affected by current problems that caused client to seek care.
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Milieu therapy-When client is hospitalized, he becomes part of this milieu (environment).-To re-create community setting on these units (of hospital), so that client can interact with other client peers in order to identify & problem solve issues that occur while relating to others.-Community meetings may be used to delegate tasks of unit, such as cleaning off tables at the end of meal.-This meeting can be used to ask each member to think through daily goal for therapy & discuss how he plans to meet that goal.
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Occupational therapy-To assess a client’s abilities & disabilities & help client increase functioning & independent living skills in area such as self-care, work, or ensure activity.-To teach adaptive skills for home, school, or jobfunctioning.-Groups such as stress management, enhancing parenting skills, conflict resolution, time management, money management, budgeting, feeling, & self-awareness are oftenplanned and controlled.
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Art therapy-Using art as a means of helping the client express thoughts & feelings he may not be able to verbalize.-Helps client to understand problem areas from a symbolic standpoint.-Teaches client alternative means of expression & self-soothing.Example:A client who is feeling intense rage & has feelings of wanting to self-mutilate may use art to draw these feelings rather than act on them.
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Music therapy-To help client express feelings & thoughts that may not be easily verbalized.-To help client relax & learn alternative self-soothing strategies.
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Movement therapy-Teaches clients how they move their bodies when stressed & helps them learn methods of relaxation.
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Recreational therapy-Helps clients explore ways without use of self- destructive behaviors, such as abusing alcohol or drugs.-Helpful for clients who have difficulty socializing because recreation strengthens social skills.
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Medication therapy-Client who demonstrates violence against others may require medications to gain emotional & behavioral control over their impulses.
-Clients who are very agitated or psychotic may respond to the use of neuroleptic or anti-psychotic med.
-Clients with extreme violence who are unable to control impulse may be given IV or IM sedative-hypnotics.
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-It is found that Haloperidol helped client increase global functioning, decrease hostility & increases impulse control.
-It is found that amitriptyline (TCA) decreased hostility & increases control for clients with borderline personality disorder.
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Electro Convulsive Therapy (ECT)-Type of somatic Rx in which electric cure is applied to brain through electrodes placed on temples.
-Current is sufficient to induce a grand mal seizure, from which desired therapeutic effect is achieved.
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Indications-Severe depression.-In conjunction with antidepressants, but preferably only after unsuccessful trial of drug therapy.
-Fast-acting Rx for very hyperactive manic pts. (physical exhaustion) & with extremely suicidal pts.
-Was originally attempted in Rx of schizophrenia, but with little success in most instance.
-Effective in Rx of acute psychoses & catatonia & schizophrenia that is accompanied by affective sx.
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ContraindicationsBrain tumor, recent myocardial infarction.
Mechanism of action-Exact mechanism of ECT is unknown, but it is thought to produce biochemical changes in Brian, increase levels of Nor-Epinephrine & Serotenin-similar to effects of anti-depressants.
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Side effects and nursing implicationsTemporary memory loss & confusion:-The most common side effects of ECT.-Nurse should be present when pt. awakens to attenuate fears that accompany this loss of memory.-Provide reassurance that memory loss is only temporary.-Describe to pt. what has occurred.-Reorient pt. to time & place.-Allow pt. to verbalize fears & anxieties R/T ECT.-Provide good deal of structure for pt.’s routine-action to minimize confusion.
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Risks involved: Death:-Mortality rate from ECT: 0.01%-0.04%.-Major cause is cardiovascular complications, such as acute MI or cardiac arrest.-Brian damage is considered to be risk but evidenced is largely unsubstantiated.-Prolonged or permanent memory loss has beenreported by some individuals.*Although the potential for these effects appears to be minimal, pt. must be made aware of the works involved before consenting Rx.
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Potential nursing diagnoses associated with ECT:-High risk for injury R/T certain risks associated ECT.
-Risk for aspiration R/T altered level of consciousness immediately following treatment.
-Decreased cardiac output R/T vagal stimulation occurring during ECT.
-Altered thought process R/T side effect of temporary memory loss & confusion.
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-Knowledge deficit R/T necessity for & side effects & risks of ECT.
-Anxiety (moderate to severe) R/T impending therapy.
-Self-care deficit R/T incapacitation during poetical stage.
-Risk for activity intolerance R/T post-ECT confession & memory loss.
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Nursing interventions for patient receiving ECT:1. Ensure that physician has obtained informed consent & that signed permission form is on chart.2. Ensure that most recent reports (CBC, urinalysis, ECG & x-ray) are available.3. Pt. should be NPO on morning of Rx.4. Prior to Rx, pt. should void, dress in night clothes, & remove dentures & glasses lenses.5. Take baseline vital signs.
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6. Administer cholinergic blocking agent (atropine sulfate) approximately 30 min. before Rx to decrease secretion & increase heart rate (which is suppressed in response to vagal stimulation).7. Assist physician &/anesthesiologist as necessary in administration of IV meds.8. Administer O2 & provide suctioning as required.9. After procedure, take v/s q 15 min/1st hour. 10. Position pt. on side to prevent aspiration.11. Stay with pt. until he/she is fully awake.