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。
What is the main difference between disulfiram and naltrexone in alcohol dependence?
一名服用奥氮平的患者 3 个月内体重增加了 8 kg,并诉说口渴和尿频。护士应怎么做?
哪种副作用是第一代(典型)抗精神病药的长期风险?
为什么 DSM-5 用单一的"物质使用障碍"取代了"物质滥用"和"物质依赖"?
In which patient is bupropion contraindicated?
A patient on simvastatin is prescribed gemfibrozil. What is the main concern?
答案: B · Disulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward
Disulfiram blocks the breakdown of acetaldehyde, so drinking causes flushing, nausea and palpitations. Naltrexone blocks opioid receptors and reduces the pleasurable effect of alcohol.
答案: C · 安排血糖检测并通知开医嘱者
奥氮平可引起体重增加、胰岛素抵抗和新发糖尿病。口渴和多尿提示高血糖,因此应检测血糖并由开医嘱者复核治疗。
答案: A · 迟发性运动障碍
长期阻断多巴胺可导致迟发性运动障碍,表现为面部、舌和四肢不自主的重复运动,且可能不可逆。
答案: A · 研究发现这两个类别反映的是同一维度,用严重程度分级描述更好
研究表明,滥用和依赖的标准构成一个连续体。DSM-5 把它们合并为一种障碍,并按符合的标准数量评定严重程度。
答案: B · A patient with a seizure disorder or an eating disorder
Bupropion increases the risk of seizures, especially with bulimia or anorexia, where electrolyte disturbances are common. It is used for depression and as a smoking cessation aid.
答案: D · A much higher risk of myopathy and rhabdomyolysis
Gemfibrozil reduces statin clearance and adds its own muscle toxicity. The combination greatly increases the risk of rhabdomyolysis and is generally avoided.
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