精神科护理
方法
- 判断是否存在即时风险:自杀、暴力、药物急症或躯体疾病。
- 先保障安全:观察、移除危险物品、缓和局面、停用有害药物、寻求帮助。
- 选择治疗性回应:承认感受、陈述现实,避免虚假的安慰和“为什么”式提问。
- 尊重权利:采用限制最少的方案,知情同意,以及保密及其限度。
公式表、每个专题的关键方法步骤和 6 道练习题,完整解答附在最后。
How does aripiprazole differ from most other antipsychotics?
A 30-year-old who used cocaine an hour ago has crushing chest pain and sweating. What is the priority?
哪种异常标准在某种行为在人群中罕见时就判定其为异常?
一项研究把一种新疗法与等待名单对照组比较,发现效果很大。为什么这可能高估了该疗法的特异性效果?
Which rule applies when giving phenytoin intravenously?
为什么建议使用长效硝酸酯类药物的患者每天有几小时的无硝酸酯期?
答案: D · It is a partial agonist at dopamine D2 receptors
As a partial agonist, aripiprazole lowers dopamine activity where it is high and supports it where it is low. It is less likely to raise prolactin or cause sedation, but akathisia is a common side effect.
答案: A · Treat it as a possible heart attack, with an urgent ECG and medical review
Cocaine can cause coronary vasospasm, myocardial infarction and arrhythmias, even in young people without heart disease. Chest pain after cocaine use needs urgent cardiac assessment.
答案: C · 统计上的罕见性
统计罕见性把远离平均水平的行为定义为异常。其缺点是有些罕见特质(如极高的智商)是令人向往的。
答案: A · 等待名单控制了时间推移,但没有控制关注、期望或治疗联盟
等待名单设计表明治疗优于不治疗,但希望和与治疗师接触等共同因素没有得到控制。要检验特异性成分,需要积极疗法对照或注意-安慰剂对照。
答案: A · Mix or flush it only with normal saline and give it slowly
Phenytoin precipitates in glucose solutions, so only normal saline is used. Rapid infusion can cause hypotension and arrhythmias, so the rate is limited and the patient is monitored.
答案: A · 防止对硝酸酯产生耐受
血药浓度恒定时,对硝酸酯的耐受很快产生。采用不对称给药方案或夜间揭去贴片可以保持其疗效。
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