Patient-Specific Care - NCLEX-PN

An infant begins to show signs of anxiety toward strangers between 8 and 12 months of age and may recur until two years of age. This anxiety can show as silence, staring, writhing or crying in the presence of people they don't know.

Object permanence is the understanding that an object still exists even when it can not be seen, heard, or touched. It is often tested by placing an object on a surface, then covering that object and allowing the infant to attempt to uncover it, thus demonstrating a knowledge that the object remains present though it is hidden.

The grasping reflex is the earliest reflex developed by the infant. It is often present at birth: the infant will grasp at objects such as a finger placed into their open palm.

The inferior pincer grasp is the ability to pick up small objects such as by resting the forearm on a surface and pinching using the sides of the thumb and the index finger. It is an important milestone in the development of fine motor skills.

The "grimace" category of the APGAR score actually refers to a wide variety of reflexive behavior. These include sneezing and coughing, crying on stimulation, pulling away, and facial expression.

The APGAR score is calculated one minute after birth, and then again at five minutes after birth. It is common for infants to be born with depressed respiration, cyanosis, and other physical signs of struggle that are quickly resolved within five minutes after birth. If signs of respiratory or cardiovascular distress do not improve by this time, however, emergency intervention may be required.

Molding, or the elongation of the infants head during labor and delivery, is a normal adaptation allowing the relatively large skull to traverse the narrow space of the birth canal. It generally resolves in 1-5 days.

Meconium is a sticky, dark-green to black stool that is the first stool passed by neonates after birth. It is composed of the content of the infant's digestive tract before it has begun drinking milk - primarily water, mucus, bile, lanugo, and intestinal epithelial cells. A newborn that has begun to feed on breastmilk or formula should pass a normal stool (yellow to mustard-green and creamy rather than sticky) within 24 hours.

Yawning, cramps, and diarrhea are common signs of heroin withdrawal.

Anxiety, nausea, and vomiting are common symptoms of opium withdrawal.

All of the items listed are part of the DSM V criteria for substance abuse. In addition, the individual's symptoms must not qualify for substance dependence and recurrent substance-related legal problems are other DSM V criteria for substance abuse.

The symptoms described by this patient put his alcohol use in the category of substance dependency, according to the DSM V, a more severe form of abuse than substance addiction. The criteria for this condition are:

1. Tolerance
2. Withdrawal
3. Unintentional excesses in consumption
4. Persistent desire or unsuccessful efforts to reduce or control substance use
5. A great deal of time is spent to get, use, or recover from the substance
6. Interference with social life
7. The substance use is continued despite knowledge problems caused by use

All of the drugs listed are considered to be CNS depressants. While generally classified as a psychedelic, marijuana has multiple central depressant effects such as sedation and muscle relaxation. Also, alcohol is another commonly used depressant.

Prolonged alcohol abuse can result in a severe deficiency in thiamine, or vitamin B1 by reducing dietary thiamine intake, impairing gastrointestinal absorption of thiamine, and causing impaired thiamine utilization in cells. Note that individuals who partake in prolonged alcohol abuse may have various other dietary deficiencies.

Wernicke-Korsakoff syndrome is caused by a severe deficiency in thiamine, often seen in severe alcohol dependency. It is characterized by visual disturbances, ataxia, and altered consciousness. Wolf-Hirschhorn syndrome is a genetic disorder causing developmental disability and may involve seizures. Lewy body dementia is associated with Parkinson's disease. Agnosia is a neurological disorder causing impaired ability to process sensory information.

Delirium tremens (DT) is a rapid onset of confusion seen during alcohol withdrawal. The symptoms of DT include altered mental status, autonomic instability, and even seizures. DT is also characterized by hallucinations such as the sensation of something "crawling" on the patient. DT is the most severe consequence of withdrawal and can be fatal if untreated.

Buddhists will want time for meditation, and may refuse medications that alter awareness. A shrine to Buddha may be placed in the client's room.

Elderly patients may suffer from bowel problems like constipation due to lower motility in the gastrointestinal tract. The nurse should advise this client to exercise daily (to increase blood flow to the GI tract), stay hydrated (to prevent hard, dry stools), eat more fiber (such as fruits, vegetables, nuts, grains, and beans), and stay away from milk and cheese (as lactose sensitivity is common and may be a cause of constipation or bloating). This patient should not take laxatives each time a bowel movement is expected; reliance on laxatives is not recommended because it can desensitize the bowel and make constipation worse.

Feelings of sadness, hopelessness, or guilt, insomnia, difficulty coping with normal life activities, social avoidance, and anxiety after giving birth are all signs of postpartum depression, a condition that affects as many as four out of five people after giving birth. Postpartum psychosis is a much more serious condition, involving delusions, extreme mood swings, and risk of self harm.

While vitamin deficiencies, lack of sleep, and social stresses can all contribute to depressed mood after giving birth, the primary cause of postpartum depression is an extreme drop in hormones (primarily estrogen and progesterone) that occurs after delivery of the placenta.