精神看護
解き方
- 差し迫ったリスクがあるかを判断します:自殺、暴力、薬物による緊急事態、身体疾患。
- まず安全を確保します:観察する、手段を取り除く、鎮静化(デエスカレーション)を図る、有害な薬を中止する、助けを呼ぶ。
- 治療的な応答を選びます:感情を受け止め、現実を伝え、根拠のない安心づけや「なぜ」という質問は避けます。
- 権利を尊重します:最も制限の少ない方法、同意、そして限界のある守秘義務。
公式集、全トピックの解法の要点、6 問の演習問題。完全な解答は巻末にあります。
According to Maslow's hierarchy of needs, which patient need should a nurse on a mental health ward address first?
On the fourth day after giving birth, a mother is tearful and moody but is caring for her baby, eating and sleeping when she can. What is the most appropriate nursing response?
自殺リスクの評価で、将来の自殺企図を最も強く予測する要因の 1 つはどれですか?
22 歳の人に 2 か月間幻覚と妄想があり、その後完全に消失しました。気分エピソードはありませんでした。最も当てはまる診断はどれですか?
Benzathine benzylpenicillin (penicillin G benzathine) is ordered. Which route is correct?
A patient with epilepsy needs pain relief. Why is tramadol used with caution?
答え: B · A patient who has not eaten or drunk anything for two days
Maslow places physiological needs, such as food and fluids, before safety, love and belonging, esteem and self-actualisation. A patient who is not eating or drinking has the most basic unmet need.
答え: B · Explain that these "baby blues" are common, offer support and advise her to seek help if they last more than about 2 weeks
Baby blues are common in the first days after birth and usually resolve within 2 weeks. Symptoms that last longer or are severe may indicate postpartum depression and need assessment.
答え: A · 過去の自殺企図
自殺企図の既往は最も強い危険因子の 1 つです。自殺念慮について直接尋ねてもリスクは高まらず、それは適切な評価の一部です。
答え: A · 統合失調症様障害
統合失調症様障害は統合失調症の症状をもちますが、持続期間は 1 か月から 6 か月です。期間が、短期精神病性障害や統合失調症と区別する主な特徴です。
答え: C · Deep intramuscular only
Benzathine penicillin is a depot suspension given deep IM. Accidental intravenous injection can cause cardiorespiratory arrest and death.
答え: D · It lowers the seizure threshold
Tramadol can cause seizures, especially at high doses or with other drugs that lower the seizure threshold. Its serotonergic action also raises the risk of serotonin syndrome.
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