-
Anxiety Disorders - Anxiety is a response to stress
-
Panic Disorder - The Client may experience Agoraphobia due to a fear of being in places where previous panic attacks occured
-
Phobias - Fears of a specific object or situation to an unreasonable level causing severe anxiety
Social Phobias - fear of Embarassment
Agoraphobia - the Clients avoids being outside
- Specific Phobias:
- Fear of Specific Objects
- Arachnophobia
- Fear of Spiders - Ophidiophobia - Fear of Snakes
- Xenophobia - Fear of Strangers
- Fear of Specific Experiences
- Aviophobia - Fear of Flying
- Nyctophobia - Fear of Dark
- Claustrophobia - Fear of enclosed spaces
-
Obsessive-Compulsive Disorder (OCD) - Client has intusive thoughts of unrealistic obsessions & tries to control these thoughts with compulsive behaviors such as repetitive cleaning or washing hands.
Goals: decrease behaviors
-
Generalized Anxiety Disorder (GAD)
More than 6 months of uncontrollable, excessive worry
At Least 3 of the ff: physical symptoms are present: Fatigue, Restlessness, problems with Concentration, Irritability, Increased Muscle Tension, Sleep Disturbances
-
Post-Traumatic Stress Disorder (PTSD)
Exposure to traumatic even causes intense fear, horror, flashbacks, feelings of detachment & forboding, restricted affect, & impairment
Persistent re-experience
S/S: Sleep Disturbance, Avoiding People
-
Anxiety Nursing Interventions:
Remain with the Client during the worst of the anxiety
Evaluate the coping mechanisms that work
Teach the client to Identify when anxiety is developing
-
Somatoform Disorders:
Client may receive Secondary Gains
-
Hypochondriasis:
Persists for at least 6 months despite negative medical evaluation; evaluate all new sysmptoms
-
Conversion Disorder:
Behaviors are necessary for the client to cope
Don't focus on Symptoms (reinforces behavior)
-
Body Dysmorphic Disorder
Preoccupation with an Imagined defect in appearance, causing significant distress
Imagined defect by Cosmetic Surgery
Client may Avoid Appearing in Public
- Nursing Interventions
- Avoid suggesting to the Client that his condition is due to emotional rather than Physical Problems
- Encourage Client to Verbalize fears and stressful life situations
- Encourage Family Members to spend time with & pay attention to the client when symptoms are absent, this reinforces the idea that the somatic symptoms do not bring special attention from others
-
Symptoms of Dissociative Identity Disorder (DID)
May Experience Depersonalization (feeling unreal) or Derealization (experiencing familiar persons)
-
Personality Disorders:
Inflexibility/Maladaptive Responses to stress
Disability in Social/Professional Relationships
Tendency to provoke Interpersonal Conflict
Capacity to Cause Irritation or Stress to others
Splitting is the Inability to Incorporate + & - aspects of self into a whole image & is commonly associated with Borderline Personality Disorder
In Splitting, client tends to characterize people or things as All Good or All Bad
Personality Disorders are Divided into 3 groups called Clusters:
- Cluster A - Described as Odd or Eccentric
- *Paranoid Personality - Distrustful, suspicious, hypervigilant, toward others, exploit
- *Shizoid Personality - emotional detachment, disinterests in close relationships, criticism, social withdarwal
- *Schizotypal Personality - odd beliefs leading to Interpersonal difficulties, eccentric appearance
- Cluster B - Described as Dramatic, Emotional, or Erratic
- *Antisocial Personality - disregard for others with exploitation; repeated unlawful actions, deceit, sexual acting out, failure to accept personal responsibility, maladaptive coping, low tolerance for frustration; violence
- *Borderline Personality - Instability of affect, identity & relationships; lack of self esteem; fear of abandonment, strong dependency needs; splitting behaviors, manipulation & impulsiveness; often tries self mutilation & may be suicidal
- *Histrionic Personality - emotional attention seeking behavior, in w/c the person needs to be the center of attention; often seductive & flirtatious
- *Narcissistic Personality - Arrogant, grandiose views of self importance, & a lack of empathy for others that strains most relationship
- Cluster C - Described as Anxious or Fearful
- *Avoidant Personality - social Inhibition & Avoidance of Situations
- *Dependent Personality - Extreme Dependency
- *Obsessive Compulsive Personality - perfectionistic with Focus
- Communication Strategies:
- Borderline or Antisocial P.D. - Set Limits & be consistent (Manipulative)
- Dependent & Historionic P.D. - use assertiveness training & Modeling
- Histrionic P.D. - Maintain Boundaries (Flirtatious)
- Schizoid or Schizotypal P.D. - Respect need for Social Isolation
- Dependent Clients - Self assess for Countertransference
-
Eating Disorders: Bulimia Nervosa
Characterized by recurrent episodes of eating large quantities of food over a short period of time (bingeing); self induced Vomiting (Purging)
- Common Laboratory Findings:
- Electrolyte imbalance method used when purging such as Vomiting, Laxative Use, or Diuretic Use
-
Eating Disorders: Males
Mortality rate of eating disorders is high & Suicide is a Risk
Tx focuses in Normalizing Eating Patterns & beginning to address issues raised by Illness
- Nursing Interventions:
- Monitor meal Intake, exercise Patterns, & attempts to Purge after eating
- Provide a Highly structured Milieuin an Inpatient Unit: Closely monitor client during/after meals
- Eating Disorders: Complications
- *Refeeding Syndrome - Circulatory Collapse - Implement reffeding over 7 days check electrolytes
- *Cardiac Dysrhytmias - severe bradycardia & hypotension - Cardiac monitoring check V/S
- *Osteoporosis - Calcium Supplements
-
Mood Disorders: Depression:
Depression is a Mood (affective) Disorder - a widespread problem, rank high among cause of disability
Unipolar Depression means the client's present mood is "Normal" or Depressed
High Risk for Suicide - especially if family or personal history of suicide attempts
-
Major Depressive Disorder (MDD)
Symptoms must happen almost every day, last most of the day, & occur continuosly for a minimum of 2 weeks
-
MDD & the DSM-IV-TR Classifications
Chronic Features - Depressive Episode lasts over 2 years in duration
-
Dysthymic Disorder - is a Milder form of Depression, that usually has an earlier onset; such as childhood & adolescence, & lasts at least 2 years in length for adults
-
Phases of Recovery
- Acute Phases - hospitalization may be needed in thsi phase which lasts 6-12 weeks. Symptoms of depression are reduced; such as difficulty socializing with others
- Continuation Phase - lasting from 4-9 months purpose of this phase of Tx is to prevent relapse through education, medication & psychotherapy.
- Maintenance Phase - this phase includes prevention of future depressive episodes & may last several years
-
Data Collection in Depression
- Anergia - lack of Energy
- Anhedonia - Lack of Pleasure
- Affect - Looks sad
- Decrease Communication - May seem too tired to speak
- Psychomotor Retardation (slowed movement) is more common,
- Assessment of suicide risk is Vital in any client with depression
- Nursing Interventions:
- Close Observation or one to one Supervision
- Positive Group Activities (success promotes self Esteem)
- Make Time to be with the Client
- St. John's Worth - plant product ingested by some individuals to relieve symptoms of depression
-
Mood Disorders: Bipolar
Bipolar Disorders - are mood disorders with recurrent episodes of depression and mania
Psychotic, paranoid, &/or bizarre behavior may be seen during periods of mania
Mania - abnormally elevated mood, which may be described as expansive or irritable, easily distracted; usually requires inpatient treatment
Hypomania - less severe episode of Mania
Sleep Disturbances may come before be associated with or be brought on by an epssode of Mania
- Types of Bipolar Disorders:
- Cyclothymia - at least 2 yrs of repeated hypomanic episodes alternation with Minor Depressive episodes
- Depressive Phase of Bipolar Disorder:
- Affect: Flat Blunted, Labile
- Nursing Interventions:
- Decrease Stimulation without isolating the client
- Provide Outlets for physical activity
- Do not Involve the Client in activities requiring a high level of Concentration
- Use a Clam, matter of Fact, specific approach
- Avoid Power Struggle & Do not React Personally to the Client's comments
-
DSM-IV-TR DiagnosticCriteria
Delusions, Hallucinations, Disorganized speech, Grossly Disorganized or Catatonic Behavior & negative Symptoms.
One or More major areas of Social or Occupational Dysfunction Exist (ex: work, self care, interpersonal relationships)
-
Delusions - (Alterations in thought) are false fixed beliefs that cnnot be corrected by reasoning and are usually bizarre
- Ideas of Reference - Such as believing that others, who are discussing the next meal, are talking about him
- Delusions of Persecution - the clients feels singled out for harm by others, such as being hunted down by FBI.
- Delusions of Grandeur - the Client believes that she is all Powerful & Important, Like a God
- Somatic Delusions - Such as Growing a third arm
- Being Controlled - A Force outside his body is controlling him
- Thought Broadcasting - thoughts are heard by others
- Thought Insertion - others' thoughts are being inserted into his mind
- Thought Withdrawal - her thoughts have been removed from her mind by an outside agency
-
Alterations in Speech:
- Flight of Ideas - each sentence may related to another topic, & listener is unable to follow the clients thoughts
- Neologisms - made up words that only have meaning to the client, such as, "I tranged and fittled"
- Echolalia - the client repeats the words spoken to him
- Clang Association - meaningless rhyming of words, often forceful, such as "oh fox box, & lox"
- Word Salad - Words Jumbled together with little meaning or significant to the listener
-
Signs & Symptoms of Schizophrenia
- Positive Symptoms - Hallucinations, delusions disorganized speech, Bizarre Behavior
- Negative Symptoms - Blunted or Flat affect, Alogia, Avolition, Anhedonia, Anergia
- Cognitive Symptoms - Disordered thinking inability to make decisions, poor problem solving ability
- Depressive Symptoms - Hopelessness, Suicidal Ideation
-
Terminology
- Alogia - Poverty of thought of Speech
- Avolition - Lack of Motivation in Activities & Hygiene
- Anhedonia - lack of Pleasure or Joy, Indifferent to things that often make others happy
- Anergia - Lack of Energy
-
Paranoid Schizophrenia
- Characterized by Suspicion toward others
- Other Directed Violence may occur
-
Residual Schizophrenia
Common Symptoms Include: Anergia, Anhedonia, Avolition
- Nursing Interventions:
- Establish a trusting Relationship with the Client
- Ask the Client about Hallucinations. "I don't hear anything"
- Don't argue with a Clients Delusion
- Attempt to focus Conversations on Reality based subjects
|
|
