Monitor the Person’s Respons
Should include potential for agitation and aggression.<br /> Should also consider adding a statement about potential for a person to be angry that they "lost their high" because they were given naloxone despite the fact they almost died
Unconsciousness or inability to awaken Slow, shallow breathing or breathing difficulty manifested by choking sounds or a gurgling/snoring noise from a person who cannot be awakened Fingernails or lips turning blue or purple
and pinpoint pupils
Slow, shallow breathing or breathing difficulty manifested by choking sounds or a gurgling/snoring noise from a person who cannot be awakened
or respiratory arrest
Wernicke’s encephalopathy is an acute, life-threatening neurological condition characterized by nystagmus, ataxia, and confusion caused by thiamine deficiency.
Should include information about Korsakoff's as untreated Wernicke's can progress to Korsakoff's, which is chronic and has slim chance of reversal as opposed to Wernicke's
Antipsychotic medications reduce the intensity and frequency of psychotic symptoms.
Antipsychotics inhibit dopamine neurotransmitters
females.
I've read somewhere that prognosis is better in females too.
it will resolve as these conditions are treated. If it is a symptom of mental illness, treatment typically includes a combination of antipsychotic medicines and psychological therapies.
It is important to note that we should rule out another condition before treatment because we don't want to treat psychosis and allow the other condition to deteriorate.
Patient Story: Postpartum Depression
Great scenario to develop an assignment for the students.
7.5 Applying the Nursing Process to Depressive Disorders
This section is perfect for ADN students! It's thorough but easy to read. Good use of connecting the pieces of the nursing process together. Enjoyed evaluating the interventions and how they are nicely separated. Based on what I've read so far, I would definitely support implementing this book for students
Table 7.5d Nursing Interventions Targeting Physiological Signs of Depression and Self-Care Deficit
I love the use of the tables throughout the book. It helps the students be able to group information easier than having to read a paragraph to pull the information.
It's important to discuss the physiological symptoms but would like to see specific information on vegetative signs of depression.
Electroconvulsive therapy (ECT) is a medical treatment reserved for patients with severe major depression who have not responded to medications, psychotherapy, or other treatments.
Suggest adding a statement, "part of several brain stimulation options" since, even thought the preferred BST, this is not the only option available
*Hypertensive crisis
It's important to identify med interactions and the need to wait a significant amount of time in between stopping and starting different medication classes
Hypertensive crisis can occur when clients taking monoamine oxidase inhibitors (MAOIs) also take medications containing pseudoephedrine or eat foods containing tyramine (aged foods; fermented foods; cured meats; alcoholic beverages such as beer or red wine; or overripe fruits such as raisins, prunes, or bananas). Hypertensive crisis is an acute rise and significantly elevated blood pressure, typically over 180/120 mm Hg, that causes acute end-organ damage such as stroke, myocardial infarction, or acute kidney damage. It is treated in the intensive care unit with intravenous medications to safely and quickly lower the blood pressure.
I would include that MAO's breakdown tyramine and by inhibiting this, there is too much tyramine in the body so we need to restrict tyramine in our diet.
Similar to SSRIs but with two neurotransmitters.
and side effects are less tolerated than SSRI's
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Was this supposed to be in the table??
Brain chemistry may contribute to an individual’s depression and may factor into their treatment. Read more about the causes of depression in the previous section of this chapter. For this reason, antidepressants might be prescribed to help modify an individual’s brain chemistry. Antidepressants may produce some improvement within the first week or two, but full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, the mental health care provider can alter the dose of the medication, add another medication, or substitute another antidepressant. Nurses should encourage clients to contact their mental health care prescriber if a medication is not working within the expected time frame or if they are experiencing ongoing side effects. It is typically recommended that clients continue to take medication(s) for six or more months after the symptoms have improved. Long-term maintenance therapy may be suggested to decrease the risk of future episodes for people at high risk for recurrence.[2]
I think it's important to add why the provider might choose one class over the other, like side effects (tricyclics and pain and sleep, or, cardiac issues, for example), family history of success with certain medications, patient symptoms (like consider a class that helps increase appetite in patients with weight loss), and so on...
Stress triggers a chain of chemical reactions and responses in the body. If the stress is short-lived, the body usually returns to normal. But when stress is chronic or the system gets stuck in overdrive, changes in the body and brain can be long-lasting. Every real or perceived threat to one’s body triggers a cascade of stress hormones that produces physiological changes called the stress response. Normally, a feedback loop allows the body to turn off “fight-or-flight” defenses when the threat passes. In some cases, though, the floodgates never close properly, and cortisol levels rise too often or simply stay high. These elevated cortisol levels can contribute to problems such as high blood pressure, immune suppression, asthma, and depression.
Should include increased glucose levels and risk for diabetes.
The hypothalamus is involved in the stress response. The stress response starts with a signal from the hypothalamus. The hypothalamus, pituitary gland, and adrenal glands form the hypothalamic-pituitary-adrenal (HPA) axis, which governs a multitude of hormonal activities in the body and also plays a role in depression. When a physical or emotional threat looms, the hypothalamus secretes corticotropin-releasing hormone (CRH) that rouses the body. CRH follows a pathway to the pituitary gland, where it stimulates the secretion of adrenocorticotropic hormone (ACTH) into the bloodstream. When ACTH reaches the adrenal glands, it prompts the release of cortisol. The boost in cortisol readies the body to fight or flee by causing the heart to beat faster, the blood pressure to rise, and the respiratory rate to increase. CRH also affects the cerebral cortex, part of the amygdala, and the brain stem. It is thought to play a major role in coordinating one’s thoughts and behaviors, emotional reactions, and involuntary responses. Working along a variety of neural pathways, it influences the concentration of neurotransmitters throughout the brain. Disturbances in hormonal systems affect neurotransmitters and vice versa.[6]
It's important we identify the sympathetic nervous system is triggered.
ongoing exposure to the stress hormone
I know this is a citation but I would include the hormone. The sentence says "the stress hormone." I will include cortisol somewhere in this paragraph
Figure 18.5 START Adult Triage
Good Tool to help students get past typical thinking of treating patient identified as "expectant" first
vulnerable population
I would also include rural residents
16.4 Learning Activites
Good idea including some basic NGN type activities for student practice
as previously discussed in the “Community Health Concepts” section.
I like the referrals back and forth within the sections. Helps students understand there is more to discuss, or if they skip over a part, they are referred back to it.
View a video of a windshield survey[6]: https://youtu.be/aAzW1bW_Dbw.
I like that the students can see an example, to get a better understanding of the concept
Healthy People 2030 Resources
Love the links. Just a click to get more information. I believe students will be more likely to use the links now that it's so easy to get to
Leading Health Indicators (LHIs)
This is a great addition!
Role Negotiation and Confidentiality
Great concept to think about
I would encourage a comprehensive list of community health nursing areas like forensic nursing, case management, and home care.
I would consider including the follow barriers: isolation (maybe only nurse, no one to bounce ideas off or ask for help) and the elements (consider northern states in middle of winter or southern states in middle of summer)
Easy to read. Concepts are simple and easy to grasp. Well written introduction for the associate's degree nursing level. Most community nursing books are written at the baccalaureate or master's level.