Nursing Considerations for Patients Receiving Central Nervous System Stimulants CNS兴奋剂使用者的护理考虑
Assessment: History and Examination 评估：病史与检查
• Assess for contraindications or cautions for the use of the drug, including any known allergies to the drug; glaucoma, anxiety, tension, fatigue, or seizure disorder; cardiac disease and hypertension; pregnancy or lactation; a history of leukemia; and a history of drug dependency, including alcoholism.
评估有无药物使用禁忌或注意事项，包括药物的已知过敏；青光眼，焦虑，紧张，疲劳，或癫痫发作；心脏疾病和高血压；妊娠或哺乳；白血病史；药物依赖史，包括酒精中毒。
• Assess temperature; skin color and lesions; CNS orientation, affect, and reflexes; ophthalmic examination; bowel sounds and reported output; pulse, auscultation, and blood pressure, including orthostatic blood pressure; respiration rate and adventitious sounds; and urinary output to determine baseline status before beginning therapy and for any potential adverse effects. Also obtain a CBC.
评估体温；皮肤颜色和损伤；CNS定向力，情感，反射；眼科检查；肠鸣音和排出报告；脉搏，听诊，血压，包括体位性血压；呼吸率和附加音；尿排量；以确定治疗前基线状况及潜在性不良效应。同时获取CBC。
Nursing Diagnoses 护理诊断
Nursing diagnoses related to drug therapy might include the following:
与药物疗法相关护理诊断可能包括如下：
• Disturbed Thought Processes related to CNS effects of the drug.
思维过程紊乱，与药物的CNS效应相关
• Decreased Cardiac Output related to CV effects of the drug.
心排血量减少，与药物的CV效应相关
• Risk for Injury related to CNS and visual effects of the drug.
损伤风险，与药物的CNS和视觉效应相关
• Deficient Knowledge regarding drug therapy.
知识缺乏，与药物疗法相关
Implementation With Rationale 措施与说明
• Ensure proper diagnosis of behavioral syndromes and narcolepsy because these drugs should not be used until underlying medical causes of the problem are ruled out.
确保行为综合征和发作性睡病的正确诊断，因为，在排除这些问题的深层原因之前不应使用这些药物。
• Arrange to interrupt the drug periodically in children who are receiving the drug for behavioral syndromes to determine whether symptoms recur and therapy should be continued.
因行为综合征而接受药物治疗的儿童应安排定期停药，以确定症状是否再次出现，治疗是否继续。
• Arrange to dispense the least amount of drug possible to minimize the risk of overdose and abuse.
安排尽量少用药物，以最大限度减少剂量过量和滥用危险。
• Administer drug before 6 P.M. to reduce the incidence of insomnia.
下午6时前用药，减少失眠发生。
• Monitor weight, CBC, and ECG to ensure early detection of adverse effects and proper interventions.
监测体征、CBC和ECG，确保尽早发现不良效应，采取适当措施。
• Consult with the school nurse or counselor to ensure comprehensive care of school-aged children receiving CNS stimulants.
咨询学校护士或辅导员，确保接受CNS兴奋剂治疗的学龄期儿童的综合护理。
• Provide safety measures such as side rails and assistance with ambulation if CNS effects occur to prevent patient injury.
若出现CNS效应，应提供安全措施，如床边栏、协助步行等，以防止患者受伤。
• Provide thorough patient teaching, including drug name, prescribed dosage, the need to secure the drug as a controlled substance, measures for avoidance of adverse effects, warning signs that may indicate possible problems, and the need for monitoring and evaluation to enhance patient knowledge about drug therapy and to promote compliance. Offer support and encouragement to help the patient to cope with the drug regimen.
提供充分的患者宣教，包括药物名称、处方剂量、确保管制物质药物安全的必要性、避免不良效应的措施、提示可能问题的警示信号、监护和评价的必要性等，以增强患者的药物疗法知识，促进治疗依从性。提供支持和鼓励，帮助患者妥善服药。
★Vocabulary for Today ★
glaucoma – n. 青光眼
tension – n. 紧张
drug dependency – 药物依赖
affect – n. 情感，感动
ophthalmic – a. 眼的，眼科的
adventitious – a. 偶然的，获得的，附加的
disturbed thought processes – 思维过程紊乱
decreased cardiac output -- 心排血量减少
risk for Injury – 损伤危险
related to – 与…相关
deficient knowledge -- 知识缺乏
recur—v. 再发生，复发
dispense – v. 分发，配（方），配药
1. A client with depression is taking phenelzine (Nardil). The nurse advises the client to avoid consuming which foods while taking the medication
A. Crackers.
B. Vegetable salad.
C. Oatmeal.
D. Yogurt. 2. A patient with a diagnosis of major depression who has attempted suicide says to the nurse, “I should have died! I’ve always been a failure. Nothing ever goes right for me.” Which response demonstrates therapeutic communication?
A. “You have everything to live for.”
B. “Why do you see yourself as a failure?”
C. “Feeling like this is all part of being depressed.”
D. “You’ve been feeling like a failure for a while?”
Answers 1. D. Yogurt. Rationale：
Phenelzine (Nardil) is a monoamine oxidase (MAO) inhibitor. The client should avoid eating tyramine-rich foods such as chocolate, alcoholic beverages, aged cheese, yogurt, processed meats, and fruits such as raisins, avocados, bananas, or figs. 2. D. “You’ve been feeling like a failure for a while?” Rationale:
Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the patient’s experience and do not facilitate exploration of the patient’s expressed feelings. In addition, use of the word “why” is nontherapeutic.
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