LP4-KT1-Klinisch redeneren
Inhoud
College: Organisatie van de GGZ ............................................................................................................. 6
2.1: Het sociaal domein (Peeters, 2018) ............................................................................................. 6
2.1.1: Sociale wijkteams .................................................................................................................. 6
2.1.2: Critical Time Intervention (CTI) ............................................................................................. 6
2.1.3: Maatschappelijke steunsystemen ......................................................................................... 6
2.1.4: Veiligheidshuis ....................................................................................................................... 7
2.2: De geestelijke gezondheidszorg (Peeters, 2018) ......................................................................... 7
2.2.1: Flexible Assertive Community Treatment (FACT) ................................................................. 7
2.2.2: Vroege Interventie Psychose (VIP) ........................................................................................ 8
2.2.3: Intensive Home Treatment (IHT)........................................................................................... 8
2.2.4: High Intensive Care (HIC)....................................................................................................... 8
2.2.5: Active Recovery Triade (ART) ................................................................................................ 8
2.2.6: Herstelacademie.................................................................................................................... 9
2.2.7: Teaminterventies .................................................................................................................. 9
2.2.8: Verschillen binnen de SGGZ-organisatie ............................................................................. 10
2.2.9: POH-GGZ.............................................................................................................................. 10
2.2.10: Basis-GGZ........................................................................................................................... 10
2.3: Een organisatiemodel van de zorgketen voor mensen met een psychiatrische aandoening
(Peeters, 2018) .................................................................................................................................. 10
2.3.1: Opschalen en afschalen ....................................................................................................... 11
Aantekeningen bij het college ........................................................................................................... 11
Overzicht organisatie van de GGZ ................................................................................................. 11
Sociale wijkteams (WMO) ............................................................................................................. 11
Bemoeizorg (WMO) (CTI) .............................................................................................................. 11
POH-GGZ........................................................................................................................................ 12
Basis-GGZ ....................................................................................................................................... 12
Specialistische GGZ ........................................................................................................................ 12
Intensieve thuiszorg (IHT).............................................................................................................. 12
Klinische intensieve behandeling (KIB).......................................................................................... 13
Flexibele assertive community treatment (FACT) ......................................................................... 13
High Intensive Care (HIC)............................................................................................................... 13
Active Recovery Triade (ART) ........................................................................................................ 13
College: Herstelondersteunende zorg................................................................................................... 14
, Hoofdstuk 8:De Nieuwe GGZ (Peeters, 2018) ................................................................................... 14
8.1: Herijking van het doel (Peeters, 2018) ................................................................................... 14
8.2: De rol van kennis verandert (Peeters, 2018) .......................................................................... 14
8.3: Betrokkenheid van niet-professionals (Peeters, 2018) .......................................................... 14
8.4: Behandeling in het dagelijks leven (Peeters, 2018) ............................................................... 15
8.5: Conclusie (Peeters, 2018) ....................................................................................................... 15
Aantekeningen bij het college ........................................................................................................... 15
Werkgroep 1 .......................................................................................................................................... 18
Hoofdstuk 2: Diagnostische besluit: Wat is er aan de hand? (Dobber, 2016) .................................. 19
2.1: Wat is een diagnose? ............................................................................................................. 19
2.2: Wat is diagnostisch redeneren? ............................................................................................. 19
2.3: Hoe worden het gezondheidsprobleem, de aanwijzingen en de verschijnselen in de
diagnose verwerkt? ....................................................................................................................... 19
2.4: Wanneer moet ik diagnostisch redeneren? ........................................................................... 19
2.5: Hoe kom ik aan een diagnose?............................................................................................... 20
2.6: Hoe kom ik achter de symptomen van een patiënt? ............................................................. 20
2.7: Hoe kan ik de ernst en het belang van de symptomen inschatten? ...................................... 21
2.8: Hoe kom ik van de symptomen tot een overzicht van mogelijke gezondheidsproblemen? . 21
2.9: Hoe kom ik aan informatie over de kenmerkende verschijnselen van de diagnose? ............ 22
2.10: Hoe kan ik de kenmerkende verschijnselen toetsen? .......................................................... 22
2.11: Hoe verwerk ik alle voorafgaande informatie tot een diagnose? ........................................ 22
2.12: Hoe zit dat bij diagnoses op het gebied van preventie? ...................................................... 22
Hoofdstuk 6: Klinisch redeneren: van beoordeling tot diagnose (Nanda International, 2018) ........ 23
6.1: Inleiding .................................................................................................................................. 23
6.2: Het verpleegkundig proces..................................................................................................... 23
6.3: Gegevens analyseren.............................................................................................................. 25
6.4: Herkennen van mogelijke verpleegkundige diagnoses (diagnostische hypothesen) ............ 26
6.5: Speciële anamnese ................................................................................................................. 26
6.6: Samenvatting.......................................................................................................................... 27
Aantekeningen werkgroep 1: ............................................................................................................ 28
College: Stemmingsstoornissen ............................................................................................................ 29
Hoofdstuk 6: Stemmingsstoornissen (Clijsen, 2016) ......................................................................... 29
6.1: DSM-5-Classificatie van stemmingsstoornissen ..................................................................... 29
6.2: Disruptieve stemmingsdisregulatiestoornis ........................................................................... 30
6.3: Depressieve stoornis .............................................................................................................. 31
6.4: Persisterende depressieve stoornis (dysthymie) ................................................................... 41
, 6.5: Premenstruele stemmingsstoornis ........................................................................................ 42
6.6: Bipolaire stoornis.................................................................................................................... 42
6.7: Cyclothyme stoornis ............................................................................................................... 46
6.8: Overige stemmingsstoornissen .............................................................................................. 47
13.8: Interventies gericht op verpleging (Multidisciplinaire richtlijn depressie) .............................. 47
Aantekeningen college ...................................................................................................................... 48
College: Metabool syndroom ................................................................................................................ 50
Artikel; Schizofrenie en antipsychotica: samenhang met het metabool syndroom ......................... 50
Aantekening college .......................................................................................................................... 51
Waarom is het van belang? ........................................................................................................... 51
Wat is het metabool syndroom? ................................................................................................... 51
Wat verhoogt het risico? ............................................................................................................... 52
Wat kan ik als verpleegkundige doen? .......................................................................................... 53
College: Slaap Fysiologie ....................................................................................................................... 54
12.5.3: Functies → onderdeel slapen (Gregoire, 2014) .................................................................... 54
12.6.2: Hypothalamus (Gregoire, 2014) ............................................................................................ 54
12.7.4: Reticulaire formatie (Gregoire, 2016) ................................................................................... 55
13.1: Normale slaap (Clijsen, 2016) ................................................................................................... 56
13.1.1: Definitie en functie ............................................................................................................ 56
13.1.2: Regeling van slaap en waak ............................................................................................... 57
13.5.2: Casus OSAS (Clijsen, 2016) .................................................................................................... 57
Aantekeningen college slaap ............................................................................................................. 57
Werkgroep 2 .......................................................................................................................................... 59
College: Brein 1...................................................................................................................................... 59
Filmpje: Zenuwstelsel: anatomische en functionele inleiding
(https://www.youtube.com/watch?v=mcVnfY-fPTk) ....................................................................... 60
Hoofdstuk 12: Zenuwstelsel (Gregoire, 2014)................................................................................... 60
12.1: Algemene functies ................................................................................................................ 60
12.2: Algemene werking ................................................................................................................ 60
12.3: Indelingen ............................................................................................................................. 61
12.4: Zenuwweefsel....................................................................................................................... 63
Aantekeningen college ...................................................................................................................... 66
College: Slaap: Verpleegkundige interventies bij slaapproblemen ....................................................... 69
Aantekeningen college ...................................................................................................................... 69
College: Brein 2...................................................................................................................................... 70
Filmpje; Actiepotentiaal (https://www.youtube.com/watch?v=8oXnDc3KmSs) ............................. 70
, Aantekeningen college ...................................................................................................................... 72
College Angstproblematiek ................................................................................................................... 75
Hoofdstuk 4: Angststoornissen en obsessieve-compulsieve stoornissen (Clijsen, 2016) ................. 75
4.1: Angst en angststoornis ........................................................................................................... 75
4.2: DSM-5-classificaties van angststoornissen en obsessieve-compulsieve stoornissen ............ 75
4.3: Angststoornissen .................................................................................................................... 76
4.4: Epidemiologie van angststoornissen ...................................................................................... 78
4.5: Verklaringsmodellen voor angststoornissen .......................................................................... 78
4.6: Vragenlijsten........................................................................................................................... 79
4.7: Behandeling van angststoornissen ......................................................................................... 79
4.8: Obsessieve-compulsieve en verwante stoornissen ............................................................... 80
4.9: Angststoornissen door een middel of somatische aandoening ............................................. 82
4.10: De rol van de verpleegkundige in de behandeling ............................................................... 82
4.11: Cognitieve gedragstherapie ................................................................................................. 82
4.12: De gedragstherapeutische relatie ........................................................................................ 83
4.13: Verpleegkundige begeleiding en gedragstherapeutische behandeling bij patiënten met een
angststoornis ................................................................................................................................. 83
4.14: Dwangstoornissen ................................................................................................................ 84
4.15: Begeleiding bij angststoornis en/of obsessieve-compulsieve stoornis op een niet-
specialistische afdeling .................................................................................................................. 86
Aantekeningen college ...................................................................................................................... 86
Werkgroep 3 .......................................................................................................................................... 89
13.4: Behandeling (Clijsen, 2016) ...................................................................................................... 90
13.5.1: Casus insomnia (Clijsen, 2016) .............................................................................................. 91
NHG-Standaard Slaapproblemen en slaapmiddelen
(https://www.nhg.org/standaarden/volledig/nhg-standaard-slaapproblemen-en-
slaapmiddelen#idp20544) ................................................................................................................. 92
Begrippen ...................................................................................................................................... 92
Fysiologische slaap ........................................................................................................................ 92
Slapeloosheid ................................................................................................................................ 93
Het obstructieveslaapapneusyndroom (OSAS) ............................................................................. 93
College Stress ........................................................................................................................................ 93
College: FACT: Flexibele ACT teams ...................................................................................................... 94
Aantekeningen college ...................................................................................................................... 94
Werkgroep 4 .......................................................................................................................................... 96
Hoofdstuk 3: Persoonlijkheidsstoornis (Clijsen, 2016) ...................................................................... 97
3.1: Wat zijn persoonlijkheidsstoornissen? ................................................................................... 97
Inhoud
College: Organisatie van de GGZ ............................................................................................................. 6
2.1: Het sociaal domein (Peeters, 2018) ............................................................................................. 6
2.1.1: Sociale wijkteams .................................................................................................................. 6
2.1.2: Critical Time Intervention (CTI) ............................................................................................. 6
2.1.3: Maatschappelijke steunsystemen ......................................................................................... 6
2.1.4: Veiligheidshuis ....................................................................................................................... 7
2.2: De geestelijke gezondheidszorg (Peeters, 2018) ......................................................................... 7
2.2.1: Flexible Assertive Community Treatment (FACT) ................................................................. 7
2.2.2: Vroege Interventie Psychose (VIP) ........................................................................................ 8
2.2.3: Intensive Home Treatment (IHT)........................................................................................... 8
2.2.4: High Intensive Care (HIC)....................................................................................................... 8
2.2.5: Active Recovery Triade (ART) ................................................................................................ 8
2.2.6: Herstelacademie.................................................................................................................... 9
2.2.7: Teaminterventies .................................................................................................................. 9
2.2.8: Verschillen binnen de SGGZ-organisatie ............................................................................. 10
2.2.9: POH-GGZ.............................................................................................................................. 10
2.2.10: Basis-GGZ........................................................................................................................... 10
2.3: Een organisatiemodel van de zorgketen voor mensen met een psychiatrische aandoening
(Peeters, 2018) .................................................................................................................................. 10
2.3.1: Opschalen en afschalen ....................................................................................................... 11
Aantekeningen bij het college ........................................................................................................... 11
Overzicht organisatie van de GGZ ................................................................................................. 11
Sociale wijkteams (WMO) ............................................................................................................. 11
Bemoeizorg (WMO) (CTI) .............................................................................................................. 11
POH-GGZ........................................................................................................................................ 12
Basis-GGZ ....................................................................................................................................... 12
Specialistische GGZ ........................................................................................................................ 12
Intensieve thuiszorg (IHT).............................................................................................................. 12
Klinische intensieve behandeling (KIB).......................................................................................... 13
Flexibele assertive community treatment (FACT) ......................................................................... 13
High Intensive Care (HIC)............................................................................................................... 13
Active Recovery Triade (ART) ........................................................................................................ 13
College: Herstelondersteunende zorg................................................................................................... 14
, Hoofdstuk 8:De Nieuwe GGZ (Peeters, 2018) ................................................................................... 14
8.1: Herijking van het doel (Peeters, 2018) ................................................................................... 14
8.2: De rol van kennis verandert (Peeters, 2018) .......................................................................... 14
8.3: Betrokkenheid van niet-professionals (Peeters, 2018) .......................................................... 14
8.4: Behandeling in het dagelijks leven (Peeters, 2018) ............................................................... 15
8.5: Conclusie (Peeters, 2018) ....................................................................................................... 15
Aantekeningen bij het college ........................................................................................................... 15
Werkgroep 1 .......................................................................................................................................... 18
Hoofdstuk 2: Diagnostische besluit: Wat is er aan de hand? (Dobber, 2016) .................................. 19
2.1: Wat is een diagnose? ............................................................................................................. 19
2.2: Wat is diagnostisch redeneren? ............................................................................................. 19
2.3: Hoe worden het gezondheidsprobleem, de aanwijzingen en de verschijnselen in de
diagnose verwerkt? ....................................................................................................................... 19
2.4: Wanneer moet ik diagnostisch redeneren? ........................................................................... 19
2.5: Hoe kom ik aan een diagnose?............................................................................................... 20
2.6: Hoe kom ik achter de symptomen van een patiënt? ............................................................. 20
2.7: Hoe kan ik de ernst en het belang van de symptomen inschatten? ...................................... 21
2.8: Hoe kom ik van de symptomen tot een overzicht van mogelijke gezondheidsproblemen? . 21
2.9: Hoe kom ik aan informatie over de kenmerkende verschijnselen van de diagnose? ............ 22
2.10: Hoe kan ik de kenmerkende verschijnselen toetsen? .......................................................... 22
2.11: Hoe verwerk ik alle voorafgaande informatie tot een diagnose? ........................................ 22
2.12: Hoe zit dat bij diagnoses op het gebied van preventie? ...................................................... 22
Hoofdstuk 6: Klinisch redeneren: van beoordeling tot diagnose (Nanda International, 2018) ........ 23
6.1: Inleiding .................................................................................................................................. 23
6.2: Het verpleegkundig proces..................................................................................................... 23
6.3: Gegevens analyseren.............................................................................................................. 25
6.4: Herkennen van mogelijke verpleegkundige diagnoses (diagnostische hypothesen) ............ 26
6.5: Speciële anamnese ................................................................................................................. 26
6.6: Samenvatting.......................................................................................................................... 27
Aantekeningen werkgroep 1: ............................................................................................................ 28
College: Stemmingsstoornissen ............................................................................................................ 29
Hoofdstuk 6: Stemmingsstoornissen (Clijsen, 2016) ......................................................................... 29
6.1: DSM-5-Classificatie van stemmingsstoornissen ..................................................................... 29
6.2: Disruptieve stemmingsdisregulatiestoornis ........................................................................... 30
6.3: Depressieve stoornis .............................................................................................................. 31
6.4: Persisterende depressieve stoornis (dysthymie) ................................................................... 41
, 6.5: Premenstruele stemmingsstoornis ........................................................................................ 42
6.6: Bipolaire stoornis.................................................................................................................... 42
6.7: Cyclothyme stoornis ............................................................................................................... 46
6.8: Overige stemmingsstoornissen .............................................................................................. 47
13.8: Interventies gericht op verpleging (Multidisciplinaire richtlijn depressie) .............................. 47
Aantekeningen college ...................................................................................................................... 48
College: Metabool syndroom ................................................................................................................ 50
Artikel; Schizofrenie en antipsychotica: samenhang met het metabool syndroom ......................... 50
Aantekening college .......................................................................................................................... 51
Waarom is het van belang? ........................................................................................................... 51
Wat is het metabool syndroom? ................................................................................................... 51
Wat verhoogt het risico? ............................................................................................................... 52
Wat kan ik als verpleegkundige doen? .......................................................................................... 53
College: Slaap Fysiologie ....................................................................................................................... 54
12.5.3: Functies → onderdeel slapen (Gregoire, 2014) .................................................................... 54
12.6.2: Hypothalamus (Gregoire, 2014) ............................................................................................ 54
12.7.4: Reticulaire formatie (Gregoire, 2016) ................................................................................... 55
13.1: Normale slaap (Clijsen, 2016) ................................................................................................... 56
13.1.1: Definitie en functie ............................................................................................................ 56
13.1.2: Regeling van slaap en waak ............................................................................................... 57
13.5.2: Casus OSAS (Clijsen, 2016) .................................................................................................... 57
Aantekeningen college slaap ............................................................................................................. 57
Werkgroep 2 .......................................................................................................................................... 59
College: Brein 1...................................................................................................................................... 59
Filmpje: Zenuwstelsel: anatomische en functionele inleiding
(https://www.youtube.com/watch?v=mcVnfY-fPTk) ....................................................................... 60
Hoofdstuk 12: Zenuwstelsel (Gregoire, 2014)................................................................................... 60
12.1: Algemene functies ................................................................................................................ 60
12.2: Algemene werking ................................................................................................................ 60
12.3: Indelingen ............................................................................................................................. 61
12.4: Zenuwweefsel....................................................................................................................... 63
Aantekeningen college ...................................................................................................................... 66
College: Slaap: Verpleegkundige interventies bij slaapproblemen ....................................................... 69
Aantekeningen college ...................................................................................................................... 69
College: Brein 2...................................................................................................................................... 70
Filmpje; Actiepotentiaal (https://www.youtube.com/watch?v=8oXnDc3KmSs) ............................. 70
, Aantekeningen college ...................................................................................................................... 72
College Angstproblematiek ................................................................................................................... 75
Hoofdstuk 4: Angststoornissen en obsessieve-compulsieve stoornissen (Clijsen, 2016) ................. 75
4.1: Angst en angststoornis ........................................................................................................... 75
4.2: DSM-5-classificaties van angststoornissen en obsessieve-compulsieve stoornissen ............ 75
4.3: Angststoornissen .................................................................................................................... 76
4.4: Epidemiologie van angststoornissen ...................................................................................... 78
4.5: Verklaringsmodellen voor angststoornissen .......................................................................... 78
4.6: Vragenlijsten........................................................................................................................... 79
4.7: Behandeling van angststoornissen ......................................................................................... 79
4.8: Obsessieve-compulsieve en verwante stoornissen ............................................................... 80
4.9: Angststoornissen door een middel of somatische aandoening ............................................. 82
4.10: De rol van de verpleegkundige in de behandeling ............................................................... 82
4.11: Cognitieve gedragstherapie ................................................................................................. 82
4.12: De gedragstherapeutische relatie ........................................................................................ 83
4.13: Verpleegkundige begeleiding en gedragstherapeutische behandeling bij patiënten met een
angststoornis ................................................................................................................................. 83
4.14: Dwangstoornissen ................................................................................................................ 84
4.15: Begeleiding bij angststoornis en/of obsessieve-compulsieve stoornis op een niet-
specialistische afdeling .................................................................................................................. 86
Aantekeningen college ...................................................................................................................... 86
Werkgroep 3 .......................................................................................................................................... 89
13.4: Behandeling (Clijsen, 2016) ...................................................................................................... 90
13.5.1: Casus insomnia (Clijsen, 2016) .............................................................................................. 91
NHG-Standaard Slaapproblemen en slaapmiddelen
(https://www.nhg.org/standaarden/volledig/nhg-standaard-slaapproblemen-en-
slaapmiddelen#idp20544) ................................................................................................................. 92
Begrippen ...................................................................................................................................... 92
Fysiologische slaap ........................................................................................................................ 92
Slapeloosheid ................................................................................................................................ 93
Het obstructieveslaapapneusyndroom (OSAS) ............................................................................. 93
College Stress ........................................................................................................................................ 93
College: FACT: Flexibele ACT teams ...................................................................................................... 94
Aantekeningen college ...................................................................................................................... 94
Werkgroep 4 .......................................................................................................................................... 96
Hoofdstuk 3: Persoonlijkheidsstoornis (Clijsen, 2016) ...................................................................... 97
3.1: Wat zijn persoonlijkheidsstoornissen? ................................................................................... 97
