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NURSING THE PATIENT WITH Hallucinations
Hallucinations are disturbances of perception (perception) post without adanyarangsangan senses from the outside that can include all systems where sensing occurs when the individual consciousness is full / good.
Hallucinations are the most frequent form of perceptual disorders. This can be a form of hallucinatory voices or buzzing noise, but the most frequent form of words arranged in sentences form a rather perfect. Usually the sentence had been talking about the sad state of the patient or the patient is addressed. As a result patients can fight or speak with a voice that hallucination. Can also be seen as acting in the patient's hearing or speaking loudly as if he answered the question a person or his lips twitched. Sometimes patients find hallucinations come from any body or outside body. These hallucinations are sometimes fun example is lying, and other threats.
According to Durant Thomas May (1991), hallucinations in general can be found in patients with mental disorders such as: Skizoprenia, Depression, Delirium and conditions relating to use of alcohol and substance of the environment. Based on the results of studies on mental hospital patients found 85% of patients with cases of hallucination. So the writer feel drawn to write the case with the provision of nursing care from assessment through evaluation.
B. Classification
Classification hallucinations as follows:
Hallucinations hear (acoustic, auditory), the patient heard a voice talking, taunting, ridicule, or threaten but not for background noise.
Hallucinations see (visual), the patient was at the sight of people, animals or anything that does not exist.
Hallucinations smell / breathe (olfactory). Hallucinations are rare in get. Patients who have said the smell smells like the smell of flowers, the smell of incense, the smell of dead bodies, that there is no source.
Hallucinations soy sauce (gustatorik). Hallucinations usually occur simultaneously with the smell / breathe. The patient feels (to taste) a taste in his mouth.
Allusions Hallucinations (tactile, kinaestatik). The individual feels there is someone who touched or hit. If this is sexual stimulation rabaab hallucinations are called hallucinations heptik.
C. Etiology
According to Mary Thomas Durant (1991), Hallucinations can occur in clients with mental disorders such as skizoprenia, depression or state of delirium, dementia and conditions relating to use of alcohol and other substances. Adapat hallucinations also occur with epilepsy, the condition of systemic infection with metabolic disorders. Hallucinations also can be experienced as side effects of various treatments including anti-depressant, anti-cholinergic, anti-inflammatory and antibiotic, while the hallucinogenic drugs can make the same hallucinations as the drugs mentioned above. Hallucinations can also occur when the normal individual circumstances of the individuals who experience isolation, sensory changes, such as blindness, loss of hearing or any problems with the talks. Specific causes of auditory hallucinations is unknown but many factors influencing such biological factors, psychological, social, cultural, and environmental stressors originators are stress, biological, trigger problems coping resources and coping mechanisms.
D. Psychopathology
Psychopathology of hallucinations that certainly is not known. Many theories are proposed that emphasize the importance of psychological factors, physiological and others. Some say that in normal awake brain is bombarded by a flow stimulus that comes from within the body or from outside the body. This input will inhibit the emergence of the perception that more of the nature of this input sadar.Bila attenuated or none at all as we encountered in normal or pathological condition, then the material contained in or preconscious unconsicisus be released in the form of hallucinations.
Another opinion says that the hallucinations began with a repressed desire to unconsicious and then because it was a personality breakdown and loss of power to assess the reality of the desire had been projected out in the form of external stimulus.
E. Signs and Symptoms
Patients with hallucinations tend to pull away, often in getting to sit with eyes riveted on one particular direction, smiling or talking to herself, suddenly angry or attacking other people, anxiety, conduct such movements are enjoying something. Also, information from patients themselves about the hallucinations that in its natural (what is seen, heard or felt in).
F. Management
Management of hallucinations in patients with:
Creating a therapeutic environment
To reduce levels of anxiety, panic and fear of patients due to hallucinations, preferably at the beginning of the approach is done on an individual basis and try to place knntak eyes, if I can touch the patient in or on hold. Patients should not in isolation either physically or emotionally. Each nurse came into the room or near the patient, talk with patients. So also when will leave should notify patients. The patient was told that action would be undertaken.
In that room should be provided the means to stimulate interest and encourage patients to get in touch with reality, such as wall clocks, picture or wall hangings, magazines and games.
Implement physicians therapy program
Often patients refuse medication that is given in connection with the stimulation of the receipt hallucinations. The approach should be persuasive but instructive. The nurse must observe for the drug that is given right at telannya, as well as drug reactions given.
Exploring the patient's problems and help solve existing problems
After the patient is more cooperative and communicative, nurses can explore the problem of patients who are causing hallucinations and help overcome existing problems. The collection of this data can also be through the patient's family information or other people close to the patient.
Give activity in patients
Patients were invited to enable themselves to perform physical movement, such as exercising, playing or conducting. This activity can help to direct patients to the real life and cultivate relationships with other people. Patients in whom arrange the schedule of activities and choose appropriate activities.
Involving the family and other officers in the treatment process
Patient's family and other officers should be told about patient data for unified opinion and continuity in the nursing process, misalny from conversations with patients in the know when I'm alone, he often heard men who taunted. But if there are other people nearby voices were not heard clearly. The nurse suggested that patients should not be alone and busied himself in the game or activity that exists. This conversation should be in tell the patient's family and petugaslain not to let the patient alone and advice that is given is not contradictory.
Nursing Hallucinations in Patients with
A. Assessment
At this stage the nurse to explore the factors that exist under this are:
Predisposing factors.
Are risk factors that affect the type and number of sources that can be generated by individuals to cope with stress. Obtained either from patients or their families, about the cultural factors of social development, biochemical, psychological and genetic risk factors that affect the type and amount of resources that can be generated by individuals to cope with stress.
Growth Factors
If the task of development experience obstacles and disturbed interpersonal relationships, the individual will experience stress and anxiety.
Sociocultural factors
Various factors can cause a community to feel excluded by the loneliness of the environment where the client was raised.
Biochemical Factors
Have an influence on the occurrence of mental disorders. With the excessive stress experienced by a person then in the body will produce a substance that can be hallucinogenic and neurochemical like Buffofenon Dimetytranferase (DMP).
Psychological Factors
Interpersonal relationships are not harmonious and the presence of conflicting multiple roles and often accepted by the children will lead to high stress and anxiety disorders and ends with reality orientation.
Genetic factors
Genes that influence what skizoprenia not yet known, but the findings indicate that family factors showed a very influential in this disease.
Precipitation Factor
Stimulus that is perceived by individuals as a challenge, threat / demands that require extra energy for coping. The presence of environmental stimuli which often is as client participation in the group, too long encouraged communication, objects that exist in the environment are also the atmosphere of quiet / isolation is often a trigger hallucinations because it can increase stress and anxiety that stimulates the body issued a hallucinogenic substance.
Behavior
Client response to the hallucinations can be a suspicion, fear, insecurity, anxiety and confusion, self-destructive behavior, lack of attention, not able to take decisions and can not distinguish the real and unreal circumstances. According to Rawlins and Heacock, 1993 tried to solve the problem of hallucinations based on the nature of the existence of an individual as a creature that was built on the basis of the elements of bio-psycho-socio-spiritual so that hallucinations can be seen from the dimensions:
Physical Dimensions
Man was built by the system senses to respond to external stimuli provided by the environment. Hallucinations can be caused by some physical conditions such as unusual fatigue, drug use, fever up to delirium, alcohol intoxication and difficulty to sleep in a long time.
Emotional Dimension
Excessive anxiety on the basis of problems that can not be solved is the cause hallucinations that happen. The content of the hallucinations can be a force command and frightening. Clients no longer able to oppose the order until the condition of the client to do something to startle them.
Intellectual Dimension
In this intellectual dimension explains that individuals with hallucinations would show a decrease in ego function. At first hallucination is a business of his own ego to fight the impulse to press, but it is a matter that raises awareness that can take the entire attention of the client and not infrequently will control all client behavior.
Social Dimension
Social dimension in individuals with hallucinations showed a tendency to be alone. Individuals preoccupied with hallucinations, as if it is a place to meet the need for social interaction, self-control and self-esteem that is not obtainable in the real world. Contents hallucinations made by the individual's control system, so that if a command hallucinations in the form of threat, himself or others individuals tend to it. Therefore, an important aspect in implementing the nursing interventions with clients seeking a process of interpersonal interactions that lead to a satisfying experience, as well as client mengusakan not be alone so that clients always interact with their environment and hallucinations did not last.
Spiritual Dimensions
God created human beings as social creatures, so that interaction with other human beings is a fundamental requirement. In these individuals tend to be alone until the above process does not occur, the individual is not aware of its existence and hallucination into control systems within the individual. When hallucinations individuals lose control over her life herself.
Coping Resources
An evaluation of one's choice of coping and strategies. Individuals can overcome stress and anxiety by using a source of coping in the environment. Coping such as capital sources to solve problems, social support and cultural beliefs, can help one integrate the experience that causes stress and adopt coping strategies that work.
Coping Mechanisms
Every effort is directed at the implementation of stress, including efforts to settle the problem directly and defense mechanisms that are used to protect themselves.
B. Nursing Diagnosis Appears
The risk of violent behavior in yourself and others associated with hallucinations.
Changes in sensory perception: hallucinations associated with withdrawing
Social isolation: withdrawing associated with low self-esteem.
C. Intervention
Diagnoasa 1.:
The risk of violent behavior in yourself and others associated with hallucinations
Objective: There were no violent behavior in yourself and others.
Criteria Results:
Patients can express their feelings in the current situation verbally.
Patients may mention the usual action during hallucinations, hallucinations and decide how to carry out an effective way for patients to use
Patients can use the patient's family to control hallucinations in a way often interact with the family.
Intervention:
Community Relations of trust
Give the client the opportunity to express his feelings.
Listen to the client expression with empathy
Hold a brief but frequent contacts gradually (time adjusted to the conditions of the client).
Observation of behavior: verbal and non verbal associated with hallucinations.
Explain to the client signs of hallucinations with illustrates the behavior of hallucinations.
Identification with the client and create a situation that does not cause hallucinations, content, timing, frequency.
Give the client the opportunity to express his feelings when natural hallucination.
Identification with the action taken when the client is experiencing hallucinations.
Discuss ways to decide hallucinations
Give clients the opportunity to express how decide hallucinations in accordance with the client.
Encourage clients to participate in group activity therapy
Instruct the client to notify the family when experiencing hallucinations.
Discuss with the client about the benefits of medication to control hallucinations.
Help clients use the drug correctly.
Diagnosis 2.:
Changes in sensory perception: hallucinations associated with withdrawing
Objectives: The client is able to control hallucinations
Criteria Results:
Patients can and want to shake hands.
Patients want to mention names, would call the name of the nurse and willing to sit down together.
Patients may mention the cause of the client withdrew.
Patients want to deal with other people.
Having conducted home visits to clients associated with the family gradually
Intervention:
Construct a trusting relationship.
Make a contract with the client.
Make introductions.
Call a favorite.
Encourage patients to talk with the friendly.
Assess client's knowledge about the behavior of withdrawn and the signs
and give clients the opportunity to express feelings cause the patient did not want to hang out / pull out.
Explain to the client about the behavior of withdrawn, and signs that may be the cause.
Give praise to the client's ability to express feelings.
Discuss about the benefits of touch.
Slowly and patient in the room with the activity through the stages specified.
Give praise for the success already achieved.
Instruct the patient to independently evaluate the benefits of touch.
Discuss the daily schedule that can be patient to fill his time.
Motivation of patients in following the activity room.
Give praise for participation in the activity room.
Do kungjungan house, building a trusting relationship with the family.
Discuss with your family about withdrawing behavior, its causes and a family car deal.
Encourage family members to communicate.
Instruct the patient's family members regularly visit patients at least once a week.
Diagnosis 3.:
Social isolation: withdrawing associated with low self esteem
Objective: Patients can connect with other people in stages.
Criteria Results:
Patients may mention coping that can be used
Patients may mention the effectiveness of coping used
Patients are able to start evaluating ourselves
patients are able to make a realistic plan in accordance with the existing capabilities in him
Patients are responsible for any actions taken in accordance with rencanan
Intervention:
Encourage the patient to mention that there are positive aspects to her physically.
Discuss with the patient about its expectations.
Discuss with patient skill that stands out for at home and in hospital.
Give praise.
Identify the problems being faced by patients
Discuss coping used by patients.
Discuss coping strategies are effective for patients.
Together with the patient identification penialian patient stressors and how to stressors.
Explain that the beliefs of patients toward the stressor affects the mind and behavior.
Together with the identification of patients illustrates the belief that goals are not realistic.
Together with the identification of patients coping strengths and resources owned
Demonstrate the concept of success and failure with the perception that match.
Discuss adaptive coping and maladaptif.
Discuss the losses and due to a maladaptive coping response.
Help the patient to understand that only patients who can transform themselves not others
Encourage the patient to formulate plans / objectives themselves (rather than nurses).
Discuss the consequences and realities of planning / goal.
Help the patient to be clearly menetpkan expected changes.
Encourage the patient to begin a new experience to develop according to the potential that exists in him.
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