Join these word combinations without looking at the text, then look at the text to check your answers. Choose some of the combinations to learn
| 1 | changes | a | relatively normal life |
| 2 | facial | b | completely |
| 3 | the onset of | с | side effects |
| 4 | think | d | suicide |
| 5 | commit | e | expressions |
| 6 | reduce the | f | treatment |
| 7 | have bad | g | the illness |
| 8 | lead a | h | in behaviour |
| 9 | recover | i | logically |
| 10 | long-term | j | symptoms |
ТЕМА 2.СЕСТРИНСКИЙ УХОД ЗА ПАЦИЕНТАМИ С ПСИХИЧЕСКИМИ РАССТРОЙСТВАМИ.
Text С. NURSING CARE OF THE DEPRESSED PATIENT
Focus: Suicide Assessment
1. QUICK READING:Look through the text and say what the most important part of caring plan of highly suicidal patients is.
Although suicide potential can exist in a number of psychiatric disorders and as a result of other social or personality factors, the majority of suicidal patients experience depression. Although most patients have some desire to live despite the suicidal feelings, such a situation is high risk, since the person’s judgment may be impaired by their illness.
When caring for a depressed patient, the nurse should be assessing the patient for suicidal thinking and behavior. What signs should you pay particular attention to? If the patient has threatened to commit suicide or even hinted at it, serious consideration must be given to this. Some communication usually takes place prior to a person attempting suicide. The statements may be vague; example: Nurse: «See you tomorrow, Mr. Jones.» Patient: «Who knows?» Such a statement must be followed up immediately, with the suicide assessment described below and nursing judgment must be made as to the best intervention.
Does the patient have a plan? The more thought out the plan, the higher the suicide risk. Sometimes the person feels suicidal, but has no plan of how to proceed. How lethal is the plan? Violent means, such as guns, jumping from a building, or hanging provide little time for a professional to respond once the plan is in action and thereby are considered highly lethal. Other methods such as overdose of medication are considered less lethal but no less serious. Lethality assessment may help to plan the kind of observation of the patient in the hospital.
How much of the time does the person spend thinking about the plan? Does it pre-occupy his thoughts or is it something that he dwells on from time to time? Does he have the means to carry out his plan? If he is preoccupied with suicidal thoughts and has a plan and the means, the risk is great.
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Has there been a previous attempt? How lethal was this attempt? A history of previous attempts and a family history of suicide are significant risk factors.
Can the person agree to contract for safety? This means that if the person is feeling suicidal, they will not act on it, but speak to someone instead. If the person cannot contract for safety, this will determine the kind of suicide precaution observations that will be needed.
There are also non-verbal cues to pay attention to. A quiet and withdrawn patient becomes talkative, expressive, almost like a different person. Although someone might think his depression has lifted, a more careful examination is necessary. A drastic shift in personality can mean the patient has made a decision to carry out his plan. A time of risk is when the depression is just beginning to lift, since the person may now have the energy to carry out the plan. Also, if a patient becomes more detached from those around him, and gives away personal possessions, this may indicate the patient is preparing for death.
Once you assess the suicide risk of the patient, the psychiatric team will determine the best plan of care. Highly suicidal patients need constant observation by nursing staff. For the highest risk group, a special duty nurse who stays within arm’s length of the patient at all times may monitor them. For other, less suicidal patients, they may need to be observed every 5 minutes, or fifteen minutes, depending on assessment data. If the person cannot contract for safety, they will most likely be on 1:1 or 5-minute checks.
It is important to remember that the nursing assessment process is a constant one, evaluating the plan and assessing the patient’s status on an on-going basis. A dialogue with the patient is essential, since understanding his thinking and mood are vital for safe and therapeutic care.
II. Increase your vocabulary
1. Which words or expressions from the text mean the opposite to the following?
Minority___________
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Afterwards__________
Always_____________
Verbal______________
low __________
risk __________
curable ___________
insignificant ____________
talkative________________
common _______________
under ___________
dose ____________
danger____________
2. Write out from the text combinations with the word «suicide» and its derivatives. Translate them.
3. Find in the text English equivalents of the following Russian words and word-combinations.
Психическое расстройство; социальные или личностные факторы; переживать суицидальную депрессию; суицидальные мысли и поведение; угрожать совершением самоубийством; намекать на что-либо; попытка самоубийства; продумать план; передозировка лекарственного препарата; важные факторы риска; застраховаться от несчастного случая; отстраниться от окружающих; находиться рядом с пациентом.
III. Grammar review
1. Write out from the text 10 sentences with the Infinitive or the Infinitive constructions. Define their function in the sentence. Translate the sentences.
Text Exercises
1. What does the word in italics in the following sentences refer to?
1) It is important to remember that the nursing assessment process is a constant one.
2) Patients often are very slow to respond to questions so it is advisable to try and engage them in conversation.
3) If the patient has threatened to commit suicide or even hinted at it, serious consideration must be given to this.
4) This means that if the person is feeling suicidal, they will not act on it, but speak to someone instead.
5) For other, less suicidal patients, they may need to be observed every 5 minutes.
2. Pair work.
Ask questions of all five types to the text. Answerthequestions.
ТЕКСТЫДЛЯДОМАШНЕГОЧТЕНИЯ
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ADDITIONAL READING.
Bipolar Disorder Symptoms
What is bipolar disorder?
Bipolar disorder is a mood disorder. The mood alternates between highs and lows, which are called mania and depression. There are many symptoms of bipolar disorder.
What are the symptoms of bipolar disorder?
Bipolar symptoms are classified by mood episode. Select a mood episode below to learn about their symptoms.
Depressive episode: the person experiences low mood and classic symptoms ofdepression. Discover Bipolar Depression Symptoms.
Manic episode: During a manic episode, the person experiences elevated or euphoric mood. Discover Bipolar Mania Symptoms.
Hypomanic episode: During a hypomanic episode the person experiences the symptoms of mania, but they are less severe. Learn more about Hypomanic Episodes.
Mixed episode: During a mixed episode, the person experiences both symptoms of mania and depression. Learn more about Mixed Episodes.
A. Bipolar Depression Symptoms
1. Sadness
What is sadness?
Normally, sadness is a healthy emotion. It occurs when people lose things, feel helpless, or are in difficult situations. As a symptom of bipolar disorder, the sadness is more intense, disproportionate, and frequently, crippling. The intense feelings of sadness may prevent a person from going to school and work.
What is it like to experience this sadness?
The person feels intensely sad and hopeless. They may cry for prolonged periods of time. Possibly, they feel hopeless, lonely, and believe life has little to offer. When these feelings of sadness are intense, the person may not understand what caused them to feel this way. This can be frightening and confusing.
In severe bipolar depression, the person may be unable to experience emotion.37 Instead of feeling sad, they feel emotionless. They may feel numb, hollow, or empty.
How can I recognize this symptom?
The person who feels intensely sad may cry uncontrollably. It is difficult to console this individual. They may have a pessimistic outlook on life. They are difficult to motivate. Facial expression of emotions is inhibited.
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How does this bipolar disorder symptom impact life?
The individual may find it difficult to have positive interactions with friends, family, and coworkers. They may experience low concentration and fatigue, and may wish to isolate and stay at home. Socializing, leisure activities, or employment may appear to be insurmountable tasks.
For family and friends, it may be difficult to understand why the person has such little motivation, energy, and such a pessimistic outlook on life.
2. Anhedonia
What is anhedonia?
Anhedonia is the inability to experience pleasure. A person who used to enjoy activities will find these are no longer enjoyable.
What does anhedonia feel like?
Anhedonia prevents feelings of happiness. Instead of happiness, the person feels nothing. Activities that used to excite, energize, calm or relax now offer no positive reward. Life seems boring, not enjoyable, and empty.
How can I recognize this symptom?
The person does not express interest in activities that they normally enjoy. The individual may not go on their daily walks, as they always enjoyed doing. Possibly, they may not answer the telephone. The individual may not go out with their friends for coffee, dinner, or pursue leisure activities. They may tell you they feel bored.
How does this bipolar disorder symptom impact life?
Exercise, socialization, or leisure activities usually provide pleasure and enjoyment. When the positive emotional rewards are absent, a person may have less motivation to pursue these activities.
The person becomes increasingly sedentary and isolative. A decrease in exercise, socialization, and leisure activities may worsen the symptoms of bipolar disorder.
3. Weight Change
Why is weight gain or weight loss significant?
Small weight changes are normal. Large weight gains or losses may reflect a change in appetite due to depression.
What is it like to suffer from appetite and weight changes?
Weight gain can result from overeating in order to cope with feelings of sadness, loneliness, guilt or anxiety. Food can comfort and distract a person from these feelings.
Some medications used to treat bipolar disorder increase appetite. The individual may say they are hungry or wish to eat more, even though they have recently eaten.
Weight loss can result from decreased appetite.
How can I recognize this symptom?
There is a substantial increase or decrease in the quantity of food consumed. Significant appetite changes eventually will result in physical manifestations of rapid weight gain or loss.
How does this bipolar disorder symptom impact life?
Weight gain may result in low self-esteem and increases physical complications such as diabetes, high blood pressure, and stroke.
Significant appetite disturbances are less common in bipolar depression than unipolar depression.
4. Sleep
How does bipolar depression affect sleep?
Patients who suffer from bipolar depression frequently sleep more than usual. This is opposite to bipolar insomnia that is characteristic of mania.
Regular sleep-wake cycles become disrupted. The person may sleep more, or the same amount, but during a different time of day.
What is it like to experience an increased need to sleep?
Upon waking, the person may feel fatigued and unusually tired. Due to feelings of fatigue, sadness, or apathy, the person may wish to sleep longer and not start their day.
In the morning, changing clothes, eating breakfast and performing basic hygiene may seem like insurmountable tasks.
How can I recognize this symptom?
The person stays in their bedroom for extended periods of time. They may appear to be sleeping or isolating. Their regular sleep/wake routine is disrupted.
How does this bipolar disorder symptom impact life?
A person may choose to stay in bed longer to cope with their thoughts and feelings of depression. This makes it difficult to be punctual for work or school.
Job loss or terminated schooling may occur when a person is depressed. Not needing to go to school or work can further disrupt sleep routine.
5. Apathy
What is apathy?
Apathy refers to indifference and lack of emotion. A person suffers from apathy when they do not have any feelings about events that normally evoke emotions. Apathy is also defined as a lack of motivation.
What does apathy feel like?
The person feels indifferent. Nothing really matters, and very few things are important. Although they do not feel happy, they find it difficult to be very upset or disappointed.
How can I recognize this symptom?
The person seems indifferent to events that normally give pleasure or cause concern. The person neither responds expressively to positive or negative news, events, or experiences.
The apathetic person seems careless, indifferent, and "cold" emotionally. Possibly, their conversation and behavior seem rude and unpleasant.
How does this bipolar disorder symptom impact life?
The lack of drive caused by apathy interferes with a person's ability to function at school or work.
In severe apathy, the person may lack motivation to take care of his or her basic needs, such as hygiene & meals.
A person suffering from apathy ordinarily could be caring, expressive and emotional. This sudden shift in attitude can be confusing and difficult to understand for friends, family and co-workers.
6. Fatigue
What is fatigue?
Fatigue refers to a constant feeling of tiredness, lack of energy, and exhaustion. Tiredness and exhaustion continue despite adequate rest or sleep.
What does it feel like to be fatigued?
The individual feels tired constantly, even when not exercising, or performing strenuous activities. The person may spend large amounts of time in bed, on a chair or couch. They may feel frustrated by their inability to be active like they used to.
How can I recognize this symptom?
The fatigued person needs more rest. There is a decrease in exercise and socialization.
How does this bipolar disorder symptom impact life?
When fatigued, it is difficult to be active. As a result, the person becomes increasingly sedentary.
Prolonged fatigue accompanied by other bipolar symptoms lead to an imbalanced lifestyle. This makes recovery challenging.
7. Excessive Guilt
What is excessive guilt?
Excessive guilt is a disproportionate feeling of guilt.
It is usually accompanied by low self-esteem and feelings of worthlessness.
What is it like to experience excessive guilt?
Excessive guilt leaves the person feeling small, incapable, and unworthy.
The person may feel that they have let others down. The person belittles themselves and feels inadequate.
It becomes difficult to recognize successes or positive personal attributes.
How can I recognize this symptom?
When experiencing excessive guilt, it may be difficult to set appropriate boundaries and limits. The person feels obliged to satisfy others. They may find it difficult to say no to others' requests. Feeling guilty about not spending enough time with family and friends is common.
How does this bipolar disorder symptom impact life?
Excessive feelings of guilt are debilitating. As the mind ruminates about the past, less attention is given to the external environment.
The person turns inward and blames themselves. The world view becomes unrealistic, dark, and negative.
8. Poor Concentration
What is poor concentration?
In poor concentration, it is difficult to maintain attention. It results in indecisiveness.
What is it like to experience poor concentration?
The person may feel confused and lost. They find it difficult to process multiple stimuli. This causes decision making to be a strenuous and difficult activity. The mind may feel 'clouded' or 'foggy'.
This slowness of mind is especially frustrating to a person who recently experienced bipolar mania. In mania, the mind frequently feels clear and sharp, allowing the person to make timely conclusions and decisions.
The shift from mania to depression is a dramatic one, leaving the person feeling slow, confused, and incapable. The person may miss their mental sharpness and creativity.
How can I recognize this symptom?
As information processing ability is reduced, the individual finds it increasingly difficult to finalize decisions. It takes longer for the person to answer questions.
Poor concentration may be a warning sign of an oncoming depressive episode.25
How does this bipolar disorder symptom impact life?
Poor concentration affects everything from leisure activities, to work, school, and relationships. The person may find it is difficult to play sports, read, watch television, play board games, study, or work. It may be impossible to stay on topic during conversation.
At times, poor concentration increases the risk for injury. For example, a driver who is unable to process road signs and danger information in a timely manner is at increased risk of having an accident.
Simple, everyday tasks become complex and stressful. For example, in grocery shopping, the person has difficulty reading the shopping list, finding products in the store, and is unable to decide which products to take home.
9. Suicidal Thoughts
What are suicidal thoughts?
Suicidal thoughts result from feelings of hopelessness, worthlessness, confusion, and guilt. When a person suffers from bipolar disorder, they may believe that life will never improve and that there is no way out. They may think frequently of death, dying, and possibly, of suicide.
What is it like to suffer from suicidal thoughts?
A person may feel desperate to stop the pain and suffering. Suicidal thoughts could be like: “I would be better off dead – life is terrible, and I have to die anyways”.
During times of depression, a person's outlook on life is unrealistically pessimistic and hopeless. Due to intense feelings of misery, mental suffering, and feelings of powerlessness, suicide may seem to be a viable solution even when it is not.
Not everyone who suffers from suicidal thoughts agrees with them. They may not have a desire to die, but still bothered by suicidal thoughts. They disagree and dislike them, yet, are unable to suppress the ruminative and at times compulsive thinking.
How can I recognize this symptom?
The person experiencing suicidal thinking may express "I'd rather be dead" or "I don't want to be alive." Frequently, however, the person may give little warning of their desire or intent.
It is important to take note of any unusual behavior, such as when people leave goodbye notes, send goodbye e-mails, or give their personal belongings away.
It may be difficult to realize that a loved one is suicidal. People who suffer from suicidal thoughts may not express them. Therefore, it is important the person suffering from suicidal thoughts see their health professional or treatment team on a regular basis for professional follow up.
Health professionals may assess for the presence of a suicide plan, a history of suicide in the family, past suicide attempts, a person's motivation to stay alive, and if a suicide plan is present, the lethality of such a plan, among other things.
How can friends and family help?
If you are concerned that a family member or you are at risk for suicide, get help immediately. Make sure the individual's treating physician, psychiatrist, or treatment team is aware of the suicidal thoughts.
B. Bipolar Mania Symptoms
Grandiosity
What is grandiosity?
Grandiosity occurs when a person has an inflated self-esteem, believe they have special powers, spiritual connections, or religious relationships.
When grandiosity is severe, the person may be delusional about his or her capabilities.
What does it feel like to be grandiose?
A grandiose individual feels unrealistically powerful, important, and invincible. These beliefs are frequently accompanied by feelings of euphoria and intense pleasure. Nothing seems impossible and every problem has a solution.
The person may feel an urgent need to initiate projects or activities.
How can I recognize this symptom?
To others, the person's behavior seems pompous, boastful, and exaggerated. Observers may perceive the grandiose individual to be conceited and condescending.
The person's speedy pursuit of dreams, goals, and projects may seem impulsive.
Set goals and initiated plans may be unrealistic.
How does grandiosity impact life?
Bipolar disorder symptoms affect all aspects of life. A grandiose person may appear to be rude and boastful. Naturally, this makes it difficult to make new friends and current relationships are strained.
When a person is grandiose at work, they may find it difficult to be productive. Grandiosity is frequently accompanied by decreased judgment.
For example, a person may believe they have special insight that their employer does not have. The person may feel obliged to share their break-through knowledge with their employer and disagree with management decisions. The felt passion and urgency lead to inappropriate arguments.
The fallout of grandiose behavior, especially when compounded with other symptoms of bipolar disorder, can be devastating. The high risk behavior, inflated self-esteem, and delusions may lead to job loss, expulsion from school, and terminated relationships.
Sometimes, the pursuit of unrealistic ideas involves financial investment. The person may suffer significant financial losses.
Irritability
What is irritability?
Irritability occurs when a person responds excessively to physical or emotional stimuli.
How does the irritable person feel?
Irritability is a very uncomfortable feeling. It is opposite to the feelings of euphoria and intense pleasure that could also occur in bipolar mania. The person suffering from irritability feels very stressed.
To the observer, irritable behavior may seem exaggerated. The person appears to be over-reacting. The person's experience, however, is intense. The feelings are urgent and important.
How can I recognize this symptom?
The person may present as argumentative, demanding, intrusive, hostile, impatient, angry, or over-sensitive.
The person takes most things personal. The person is easily and quickly offended at seemingly neutral comments. The person may feel threatened when faced with normal, harmless stimuli, and as a result, may respond aggressively.
The person may become angry quicker than usual.23 Intense feelings of anger may not be controllable and possibly results in verbal or physical aggression.
How does irritability impact life?
A person who normally is respectful, careful and socially appropriate may find themselves arguing with strangers over trivial matters. Their demanding and intrusive behavior may prevent them from creating new relationships.
The person who suffers from irritability and other mania symptoms may initiate altercations that result in verbal or physical disputes. The person may find themselves in trouble with the law.
The person may not realize the consequences of their words, behavior, or arguments. To the observer this seemingly selfish, unloving, and arrogant behavior may be unacceptable.
Like most symptoms of bipolar disorder, irritability can have disastrous effects on relationships and quality of life. Continued irritable behavior may lead to job loss, terminated relationships, and marital conflict.
Distractibility
What is distractibility?
Distractibility is an inability to maintain focus or attention. Minimal stimuli cause the mind's attention to divert and wander.
The person may be distracted internally (thoughts, feelings, ideas or emotions) and externally (environmental events and physical stimuli).
What does distractibility feel like?
The person may feel frustrated by their inability to pay attention. The mind may feel out of control.
How can I recognize distractibility?
The person's productivity decreases. He or she may seem 'lost'.
New projects are started prior to completion of current or old ones. The person is unable to maintain attention on simple and short activities.
The person changes the subject of the conversation frequently.
He or she seems busy and occupied, while at the same time, not getting much done.
How does distractibility impact life?
Tasks of daily living such as work, studying, or leisure activities become difficult. For example, a student may be unable to stay attentive in class and find it difficult to submit assignments on respective deadlines.
Distractibility, by itself, is a cognitive challenge. When present with other symptoms of bipolar disorder, distractibility is debilitating. It makes the success of already unrealistic and manic goals and activities even less likely.
Distractibility usually presents simultaneously with other bipolar mania symptoms. The combined effect of these symptoms can leave the person unable to perform activities of daily living.
Insomnia
What is insomnia?
Insomnia refers to an inability to fall or stay asleep at night.
What does insomnia feel like when caused by mania?
The person may feel energetic and believe they have an unlimited supply of energy. The person's experience may be that they do not need to sleep. They may believe they don't require the same amount of sleep as other persons.
The person may sleep less in order to pursue grandiose projects. It is not uncommon that a person may pursue grandiose ideas into all hours of the night during a bout of mania.
How can I recognize insomnia?
To others, it is evident that the person has difficulty sleeping. They may stay up late at night and sleep in. The individual may look tired and worn throughout the day.
It is possible the person sleeps in or naps during the day in order to compensate for lost sleep during the night. This may further disrupt the circadian rhythm (regular sleep cycle).
They may say, "I'm not tired", or "I don't need that much sleep, I'm very busy with my projects."
Other signs and symptoms of bipolar disorder are evident. Increased energy, racing thoughts, and flight of ideas are common during insomnia. As a result, the person who may not be sleeping at night may also be unusually active.
Exercising in the middle of the night in order to cope with bipolar symptoms such as increased energy is not unusual.
How does insomnia impact life?
In bipolar disorder, sleep deprivation can trigger a manic episode, or increase the severity of already present mania symptoms.
Work and school performance may decrease. Students may falls asleep in class or workers may need extended periods of rest in order to make it through the day.
Pressure of Speech
What is pressure of speech?
Pressure of speech is an unusual increase in the rate or speed of conversation. The person with pressure of speech talks much faster than what is considered normal or ordinary.
Pressure of speech may be severe enough that the person may not be understood.
What is it like to have pressure of speech?
The person experiences an urgent need to raise a point, discuss an idea, or to talk.
The person may feel frustrated or irritated by other people's request to talk slower, repeat sentences or to calm down.
How can I recognize this symptom?
It is frequently difficult to interrupt an individual who experiences pressure of speech. When it is a symptom of mania, the person may appear to be anxious, enthusiastic, and speak with urgency.
When the person also has flight of ideas and racing thoughts, their conversation reflects an abundance of ideas, which may not all be related to the subject of the conversation.
The person also may rhyme words or use words that sound similar. The person may play with words and use puns.
How does pressure of speech impact life?
The person with pressure of speech may find what he or she talks about to be of great importance. The person may talk even when not appropriate.
For example, a student may interrupt the teacher in class to share ideas. The teacher finds it difficult to guide the conversation so that it benefits the rest of the class. She struggles to take control and to continue teaching.
At work, a person suffering from pressure of speech may talk incessantly in meetings or with co-workers. The experienced need for urgency results in disrupted meeting schedules, and decreased productivity in the workplace.
The person who has pressure of speech and other bipolar symptoms at work may experience reprimand or job loss.
6. Racing Thoughts & Flight of Ideas
What are racing thoughts & flight of ideas?
Racing thoughts literally mean that thoughts race, or go very fast. Racing thoughts usually present with flight of ideas.
In flight of ideas, the subject of thought changes very quickly. A person suffering from this bipolar symptom will change the topic of conversation frequently.
What does it feel like to have racing thoughts & flight of ideas?
Racing thoughts and flight of ideas leave the person feeling exhausted and overwhelmed.
Although the person may feel worn and tired, the inability to fall asleep can result in feelings of frustration.
How do I know if someone suffers from racing thoughts and flight of ideas?
The person may be highly distracted and change the subject of the conversation constantly.
Pressured speech is common. The words may sound rushed and sentences are scrambled. He or she is unable to talk fast enough to keep up with their thoughts and ideas.
The person may share with you that their thoughts are going very fast, feeling uncomfortable and annoyed by their incessant thinking.
How does this bipolar disorder symptom impact life?
Racing thoughts may trigger insomnia or interfere with a person's ability to work, study, or to enjoy leisure activities. It is difficult to fully interact with the external environment when the mind is active and draws attention inward.
The person may be busy, but unable to accomplish a great deal. Their attention shifts consistently and the person begins to work on other things without finishing tasks in progress.
Bipolar mania sufferers often report they have no control over their thoughts and are unable to slow them down. This may prevent them from falling asleep at night
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