1. Anxiety Disorders - Anxiety is a response to stress
  2. Panic Disorder - The Client may experience Agoraphobia due to a fear of being in places where previous panic attacks occured
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. Somatoform Disorders:
    Client may receive Secondary Gains
  9. Hypochondriasis:
    Persists for at least 6 months despite negative medical evaluation; evaluate all new sysmptoms
  10. Conversion Disorder:
    Behaviors are necessary for the client to cope
    Don't focus on Symptoms (reinforces behavior)
  11. 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
  12. Symptoms of Dissociative Identity Disorder (DID)
    May Experience Depersonalization (feeling unreal) or Derealization (experiencing familiar persons)
  13. 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
  14. 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
  15. 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
  16. 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
  17. Major Depressive Disorder (MDD)
    Symptoms must happen almost every day, last most of the day, & occur continuosly for a minimum of 2 weeks
  18. MDD & the DSM-IV-TR Classifications
    Chronic Features - Depressive Episode lasts over 2 years in duration
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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)
  24. 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
  25. 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
  26. 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
  27. 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
  28. Paranoid Schizophrenia
    • Characterized by Suspicion toward others
    • Other Directed Violence may occur
  29. 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
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