-
Will a child with no obvious signs of developmental/physical development have mental problems
problems may still occur
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Emotional Development
- •This is ongoing
- •Consists of problem solving
- •Consists of coping- simple tasks to complex
- •Children may be sensitive during specific growth periods
- •Children may be sensitive to positive AND negative influences
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Common behavioral problems
- •Infant- Colic
- •Behavior typically peaks at about 2-3 months
- •Can persist to age 4-5 months
- •Dx- based on s/s- crying with eating and after
- -Cries for more than 3 hours/d for 3 weeks or more
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Problems with sleep
- •Night terrors, sleepwalking
- •Insomnia
- •Night time waking
- •Bedwetting
- •Establish a routine for a restful night
- •Limit pm fluid intake
- •Bathroom routine
- •Reassure the child
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Adolescent
- •Physical development- 2 areas- physical maturation & Sexual development
- -Physical maturation- developing an adult body form- wght/hght increase, major organs double in size
- -Sexual development- hormones and puberty
- * Girls- puberty 8-14, menstruation begins about 12 years and 9 months- average (can be as early as 10 and as late as 16)
- •Boys- develop more slowly
- -Puberty about 10-12 years
- -Last till about age 18
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Common adolescent problems
- •Internal- identification of ones-self seperate from the family
- •Introspection- of thoughts, beliefs, actions, attitudes
- •Brings on change in mood, behavior, and attitude
- •External- environmental problems
- -3 areas = family, social, environmental
- *Family- about 11-14- independence begins
- -14-17- full push for independence
- -Some kids are over-protected and yet some may be abused or neglected or both
- -Some may have parents in jail or parents with drug/etoh problems- these kids may have difficulties in areas of development
- -Same sex friends important early in adolescence, but later on there is interest in the opposite sex (around 14)
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Psychosocial development
- •This is the non-physical realm of human function
- •Teens may feel inadequate
- •Cognitive development- thinking and learning
- •Self esteem and body image at a bout 10-13
- •Coping with physical and psychosocial changes can be confusing
- •Teens can be very moody and have outbursts
- •Teens tend to become private- somewhat normal
- •By about 18*- may be somewhat in control of emotions and have established self-concept
- •Identification with a peer group
- •By 18- many having intercourse, dating is important
- •Spiritual development may be present
- •Some question beliefs and values they were raised with
- •Some may stop going to church and family functions
- •Some swing the other way and attend church more often
- •Planning for the future
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Mental
health problems in the
child
- •Many emotional problems in the adult can be traced back to childhood issues
- •There are 7 categories of mental health problems in the child:
- -Environmental, parent-child conflict
- -Emotional problems, behavioral problems
- -Problems with eating/elimination, developmental problems, and pervasive developmental didorders
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Environmental
problems
- •Poverty, homelessness, abuse, neglect
- •By age 5- poverty stricken kids score lower on IQ tests and have increased feelings of anxiety and unhappiness
- •Homeless infants have a high mortality rate
- •Illness is 2X the norm and serum lead levels are elevated often
- •May have inappropriate social interactions
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Abuse and Neglect
- •Abuse- mistreating or causing harm
- •Neglect- not meeting basic needs (includes love and belonging)
- •Death of children under age 4 due to abuse and neglect outnumber choking, falls and MVA deaths
- •Burns, bruises, fractures, head and abdominal injuries common- also sexual abuse
- •Neglect can be physical and emotional
- •Causes chronic anxiety and depression
- •Aggressive behavior and risk taking
- •Children who are disabled or unwanted? Incidences increase-
- •Chroinc parental stress can = abuse/neglect
- •YOU must recognize signs! It is your responsibility legally and morally to report
- •Educate
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Emotional Problems
- •Can start when a child cannot successfully cope with situations
- •Can be depression, anxiety, suicide
- •When children are loved and nurtured- most will learn to successfully cope with life’s anxieties
- •But sometimes they may require assistance from outside sources
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Anxiety
- •Uneasy feeling of threat- some is normal throughout the life span
- •Separation anxiety-infants/toddlers
- •If over age 4- may present an issue if more than a few weeks
- •Confront the issues (best as you can with this age group), and make a plan for success
- •Reassure
- •Attachment Disorder-
- •This is a bit more exaggerated-
- •May need anti-depressants for sever anxiety/ depression
- •If on meds: watch for s/s of more severe depression and suicidal thoughts
- •Increase water intake and high fiber- may cause constipation
- •Sever anxiety not helped here- May be OCD
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Depression
- •On the rise in children??
- •If parent or parents depressed- child has increased risk
- •= in boys and girls, school age tend to act out
- •Adults tend to withdraw
- •Treatment- help those in the child’s life to respond to childs needs and relieve discomfort
- •Provide emotional support and try to identify problems and remove or change it
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Assessment of Depression
S I G E C A P S
- •Sleep problems
- •Interest is decreased
- •Guilty feelings
- •Energy decreased
- •Concentration decreased
- •Appetite up or down
- •Psychomotor function decreased
- •Suicidal ideations
- •Assess!!
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Somatoform Disorders
- •What is this? Child (or adult) has s/s of illness or disease with no traceable cause
- •Children- HA, stomach ache, pains
- •Not unusual in school aged children
- •Thought is- expression of another underlying conflict/stress
- •Sometimes mimics what may be going on in another family member/parent
- •Children need support and understanding
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PTSD
- •Child has been exposed to repeated acts of violence
- •The psyche attempts to protect them
- •Usually develops after an extremely traumatic experience
- •Children may appear disorganized in thought and aggitated- nightmares, insomnia, outbursts
- •Somatic d/o may start
- •Early recognition and support is the treatment
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ADHD
- •Attention Deficit Hyperactivity Disorder
- •Also adult ADHD and ADD
- •7 to 1- boys
- •Inattention and impulsivity
- •Subgroups:
- - With learning disabilities, with speech disorder, with
- psychiatric disorder, with brain dysfunction
-
2
clinical histories for ADHD in kiddos:
- 1)Fussy as an infant
- 2)“Difficult” child
- -May be considered a “handful”, immature, short attention
- span
- -Has to win, has trouble taking turns, is impatient, has
- poor self-control
- -Difficulty completing assigned tasks
- -Usually academically an underachiever- but most are very
- smart! Above average in intelligence
- •Many have trouble with authority
- •Some with problems with anxiety, depression, and aggression
- •Some isolate because they have trouble with interpersonal relationships
- •Many are risk takers- safety can be an issue
- •Assess and be aware
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Treatment for ADHD
- •Educate family and caregivers
- •Some need special education allowances
- •Positive reinforcement and structure
- •Limit setting
- •Pharm- ritalin, aderall, concerta, anti-depressants,
- anti-anxieties
- •Conner testing- filled out by each parent and by 2 teachers- sent to Dr. for eval
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Behavioral problems in adolescents
- •ADHD and ADD- be aware of misuse of meds
- •Conduct disorders- defiance and aggression toward others
- -Common factor- harsh parental discipline and physical punishment
- -More common in boys
- -Fighting, running away, destruction of property, violence, truancy, vandalism
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Disruptive Behavioral Conduct
- -Defy authority
- -Are aggressive to others, may be violent
- -Violate others rights
- -May be from broken homes, drug/etoh, abusive homes
- -Outlook long term is poor if s/s displayed before age 10
- or if anti-social behavior is present by the surrounding adults
- -Early dx. And txt. Is a must!
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ODD
- •Oppositional Defiance Disorder
- •Disobedient defiance, hostile to authority
- •Argue with adults, deliberately annoy and argue, refuse to compromise
- •Blames others for behavior
- •Violent- losses temper daily, fighting, vandalism, carries weapons, threatens others, etoh/drugs, hurts animals, risk-taker, details acts of violence
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Eating and Elimination Disorders
- •Feeding disorders- anorexia nervosa, pica, bulimia
- •Encopresis, enuresis = elimination d/o’s
- •Eating disorders first:
- -Children do not eat enough or eat wrong foods
- -Weight loss or gain for one month without GI issues? Dx.
- •Food available- child does not eat
- •Most feeding d/o’s seen under age 1, but can be seen in 2-3 years of age as well
- •Developmental delay and malnutrition- increased risks
- •Abuse, neglect, excessive sleep, parental mental health issues = increased risks
- •R/o physical causes first
- •Educate
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Anorexia Nervosa and Bulimia
- -Bulimia- can start about 12 and go into adulthood, but sharp decrease after mid-30’s
- -Self-imposed starvation may be between purges
- -Many medical complications- esophogeal erosion, erosion of tooth enamel, abnormal lytes, pancreatitis, loss of hair, liver dysfunction
- -So.. Stabilize
- physical abnormalities/conditions
- -Re-feeding programs,
- no force feeding*
- -Psych treatment is a
- must- pt. and family
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PICA
- •Persistent eating of non-foods for > 1 month
- •Infants and younger children- paint, plaster, hair, string, cloth
- •Older kids- pebbles, insects, animal droppings
- •Adults- laundry detergent, starch, clay, soil
- •Often in those with MR or autism
- •Assess…
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PICA treatment
- •r/o physical problems first- vitamin/mineral deficiencies
- •Remove the items, replace with acceptable foods
- •May require therapy
- •May be due to other mental health issues
- •Assess and educate
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Rumination D/O
- •Infants regurgitate food and rechew
- •Most often in 3-12 months, but older if with MR and also in adults with MR
- •Satisfaction with regurgitation?
- •Malnutrition- if food brought back into mouth very soon after ingestion
- •D/o often disappears as the child grows older
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Elimination D/O’s
- •Enuresis- invol. Urination 5 or older
- •Can be familial
- •3 types
- 1)Primary nocturnal- boys more common
- 2)Diurnal- daytime- less common, children often shy or
- with ADHD, = in boys/girls
- 3)Secondary- develops after child develops normal bladder
- control, due to stress/anxiety
- treatment:May need drug therapy- desmopressin, imipramine
- •Emotional support parents and patient
- •Educate a routine at bedtime
- •Have child express feelings associated with symptoms- so…
- •Therapy
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Encopresis
- •Repeated, usually voluntary passage of feces in inappropriate places
- •Age 4 and over with no physical problems
- •Rarely seen in adolescents
- •Focus treatment on a routine
- •Praise child for continence
- •Have child clean own garments
- •Those with little emotional effect- harder to treat
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Developmental problems
- •MR- powerful label
- •Based on more than 1 standard IQ test
- •Score < 70
- •Stages:
- 50-70 on IQ test = mild MR
- 35-50 = moderate MR20-35 = severe MR
- Below 20 = profound MR
- •Adaptive functioning is the true measure- how does this child cope with basic demands in life?
- •Skills training, home care, social interaction, communication skills, school?, self-direction
- •Safety is a must here- many are taken advantage of…
- •FAS- fetal alcohol syndrome- leading cause of MR
- •Sometimes- inborn errors in metabolism, birth injuries, Down’s syndrome, shaken baby, illness and disease as an infant/child, falls, poisonings..
- •Heredity is a factor as is- pregnancy problems, environmental influences, 30-40% idiopathic
- •Treatment- help them attain highest possible potential, meet basic needs, safety, life skills
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Learning D/O’s
- •May have normal achievements on reading, writing, math tests, but falls below that of his peers in same age group
- •About 5% of children in America have learning disabilities of some sort
- •Often have low self-esteem and become discouraged easily
- •Early drop outs
- •Can be due to many factors
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Learning D/O’s
- •Assess vision and hearing, speech and any other possible physical difficulties
- •Consider culture…
- •Dyslexia- letters and numbers configured correctly but child does not see it this way
- •Words often substituted, omitted, twisted
- •Early diagnosis important
- •Many to be diagnosed may be overlooked
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Communication D/O’s
- •Trouble receiving or sending messages
- •Stuttering
- •Usually seen by age 3
- •May speak slowly, rapidly or may have trouble with expression
- •If it interferes with learning or ADL’s- it is diagnosed a disorder
- •Support, love and be patients- encourage
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Pervasive Developmental D/O
- •Pervasive- means that several areas of functioning is affected
- •Many have great trouble with social skills communication and learning
- •Reasons unknown-
- - May be due to MR, congenital disorders, infection and
- abnormal CNS function
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Autism
- •Appears for the most part at birth
- •Problem with nervous system?
- •Serious social interaction problems
- •Communiation and immagination problems
- •Restricted scope of activity
- •Seen more in boys
- •Majority score low on IQ tests
- •Motor skills may be inappropriate
- •Some can be functioning adults
- •R/O CNS problems first- educate and support
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Rett Syndrome
- Development of motor, language and social problems
- -Loss of previously learned skills that occur between 5 months and 4 years of age
- -Head growth declines
- -Hand movements resemble wringing, speech impairment
- -Loss of interest in all skills and socialization
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Aspberger’s Syndrome
- •Repeated behavioral patterns
- •Interests and activities repeated in excess
- •Severe and long lasting impairment of social interaction
- •Appears at birth
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Childhood Disintegrative D/O
- •Period of regression
- •Many areas affected including socialization
- •Usually happens after age 2 with normal development up until that time
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Chemical Dependency
- •Most who experiment do not become addicted
- •Accidents common die to lack of jugement
- •May experience interpersonal violence, abuse, depression, worsening relationships with others
- •Increase in risk behavior- lowered inhibitions and memory lapses
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Chemical Dependency
- •Most who experiment do not become addicted
- •Accidents common die to lack of jugement
- •May experience interpersonal violence, abuse, depression, worsening relationships with others
- •Increase in risk behavior- lowered inhibitions and memory lapses
- •4 stages:
- -Experimentation
- -Active seeking
- -Preoccupation
- -Burnout
- •Changes in attitude and behavior, may become rebellious
- •Family history???
- •Treatment is focused on finding the problem underlying
- •Replace the chemicals with more effective coping skills
- •In or out patient txt, counseling, group therapy
- •Keep a safe environment
- •Watch for risk taking, talking and behavior
- •Suicidal ideations
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CAGE Assessment
- •Have you ever tried to Cut back on your use?
- •Have you ever been Annoyed or Angered when questioned about your use?
- •Have you ever felt Guilt about your use?
- •Have you ever had an Eye-opener to get your day started?
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Other substances- chemical dependency area
- •Steroids- associated with MI, CVA, CVD
- •Increases acne and causes baldness
- •Affects mood and increases hostility
- •Needle risks
- •“Roid rage” behaviors
- •“Shotgunning” behavior
- •“Stacking”- use of many kinds
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Suicide
- •Adolescent girls attempt 3X more often than boys, but boys are typically more successful
- •Why?
- •Suicide attempt IS A CRY FOR HELP!
- •Teens who attempt:
- -Depression? Anxiety?
- -Trying to influence others? Mental health issues?
- -Getting back at someone? Attempt to scare?
- -Seriously ill with no way out?
-
Highest risk?- Suicide
- •Older adolescent boys who have voiced a true wish to die
- •Previous plans
- •Written plans
- •Available tools
- •All of these heighten the risks!
- •An increase in attempts often seen if a classmate attempts??
- •Assess everyone for risks (alll ages)
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Suicide- Warning signs
- •Change in grades, loss of interest
- •Rapid highs and lows
- •Not following rules- as previously
- •Secretive behavior
- •Withdraws from friends and family, Isolation
- •Change in personal hygiene
- •Gives away prized possessions
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Suicide- Precautions
- •Lock windows
- •Shatter proof glass and mirrors
- •Plastic flatware if any
- •NO phone cords, extension cords, curtains, equipment that can harm, belts, matches cigarettes, sharps or razors
- •1 to 1 obs.
- •Staff communication is crucial
- •Restraints? Meds?
- •Monitor and restrict visitors
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Suicide-Watch for:
- •Plans and history of past attempts
- •Make a no-suicide 24 hour contract (or sooner)
- •Escort patient to activities
- •Encourage a diary of thoughts
- •Demonstrate concern and care
- •Discuss plans, thoughts, ideas
- •Support and educate family
- •When less depressed= attempt may succeed**
- •Psych care is a must
-
5 STAGES OF ILLNESS:
- 1. SYMPTOMS- when one becomes aware that something is not right
- •May be physical or emotional
- •The nature of the symptoms, knowledge of the person, availability of resources enter into determining if an actual illness exists
- •Emotional responses often govern behavior during this stage
- •One may treat self if the s/s are mild
- •One may seek treatment for more serious illnesses
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5 STAGES OF ILLNESS:
- 2. Sick Role
- •One who is ill, seeks the advice from family, friends, co-workers.
- •The social group supports the presence of illness and the individual wither plays the “sick role” or continues to deny illness
- •If the “sick role” is chosen, one is excused from every day duties, others pitch in to help, permission is given for the person to rest and heal
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5 STAGES OF ILLNESS:
- 3. Medical Care
- •If the person remains ill and self-remedies do not help, one may seek professional help
- •The professional can confirm the illness, offer assistance, and educate- or the person can continue to deny the illness
-
5 STAGES OF ILLNESS:
- 4. Dependency
- •During this stage, the individual accepts the attention of others
- •One who relies on the kindness and energy of others has chosen the dependency role
- •People in this stage need to be emotionally supported
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5 STAGES OF ILLNESS:
- 5. Recovery & Rehabilitation
- •This can occur suddenly- response to drug therapy
- •Can occur slowly- recovery from CVA or mental disorder
- •If recovery is quick and complete- the individual continues the same role as before illness
- •For longer recovery- long term care arrangements are made (at home if at all possible)
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Impact on illness
- •NOT ISOLATED- affects the activities of the individual and those in contact with them
- •SERIOUS mental/physical problems may have emotional and behavioral changes
- •Some may react to illness with anxiety, anger, denial, shock, or withdrawal
- •If the illness involves a change in physical appearance it will have a strong impact on the individual’s BODY IMAGE.
- •Self-esteem issues are also impacted and this can take a toll on the family as the affected person starts lacking self-confidence
- •Prolonged illness can cause “situational stress’’ or stress due to the actual situation at hand that would not have existed if the family member would not have become
- sick
- •Often, new roles and habits must be established- this adds stress to the family unit
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Illness Behaviors
- •Some emotions serve to protect the individual from further stress
- •Others can be destructive if they block efforts toward resolving health problems
- •EXAMPLE- denial can be “paralyzing” or useful
-
Denial
- •Psychological defense mechanism used to ward off the painful feelings.
- –can be helpful when it allows time to collect and reorganize thoughts and plans
- –Can be deadly if it clouds judgment from taking steps to restore health
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Hospitalization
- Placement in an in-patient care facility for continuous nursing
- care and organized medical staff
- •Remember that people can be affected by other’s experiences
- •The person who is ill must rely on their coping skills that are being challenged by the anxieties of being ill
- •Most feel hospitalization is a crisis- some have difficulty coping
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Situational Crisis
- •In emergency situations, one is admitted to the hospital in a time of crisis-
- •There is NO time to prepare emotionally to the fact that hospitalization is eminent
- •Lives are suddenly interrupted
- •If illness is long-term, lifestyle adjustments must be made QUICKLY
- •ALL hospitalized patient’s must deal with issues of feeling out of control and dependency
- •**Those who are hospitalized due to a pre-existing condition, usually have some time to prepare for hospitalization both physically and emotionally
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When one is hospitalized
- •Causes high anxiety
- •One goes from being an individual to a “client or patient”
- •Think of the paperwork = one becomes a medical record #
- •The armband = the persons identity
- •The hospital gown = strips the persona of part of their identity
- •One is touched and asked personal questions by strangers
- •Remember that when focusing on the physical problem, that the personal has emotions and feelings attached
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3 steps: when one is hospitalized
- 1. OVERWHELM- separated from loved ones
- •left alone in a strange environment
- •People who are ill are often exhausted – we all know you CAN NOT rest in the hospital!
- •High anxiety secondary to medical procedures, some painful
- 2. STABILIZATION- patient gains some strength to re-establish some identity
- •Individuals become self centered in this stage
- 3. ADAPTATION- The individual has regained enough of their personal identity to adapt
-
During ADAPTATION:
- •Often becomes interested/willing to learn about health
- problems
- •Uses coping techniques and interested in preventative measures
- •Energy is replenished- body feels better
- •Emotional responses are stable
- •IF… transferred to another institution, the crisis begins again!!
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Psychiatric hospitalization
- •Individuals and family members must deal with the stigma of being admitted into a psychiatric facility
- •Friends may not want to discuss the illness with the client and may not know how to offer support
- •Insurance companies may refuse payment
- •Employers may ask questions
- •The diagnostic label will follow people for years if not forever
- •Admission may make the person feel that they are “crazy”
- •The client may fear other client’s behavior
- •Fear what will happen after release
-
Psychosocial care
- •First- assess coping abilities
- •Try to identify problems before a crisis begins, plan preventative interventions
- •Use active listening skills
- •Encourage discussion of anxieties and fears
- •Clarify the clients perception of the problems
- •DO NOT pass judgment
- •Create an accepting environment
- •Establish a trust in the therapeutic relationship
- •Assist the client in coping with the fight or flight response brought on by crisis if illness and hospitalization
- •Encourage relaxation and teach relaxation techniques
- •Be alert for any cultural practices that may assist in the healing process
- •Assess any possible risk factors
- •Remember risk factors may be very evident, sometimes not- so SAFETY!
-
Support the S. O.’s
- •Families are what the client perceives them as – may not be “traditional”
- •Some men who are the support of the family, may feel inadequate when illness strikes
- •Family should be kept informed of progress
- •Family members are also in crisis- if the family feels the client is being cared for well, there will be decreased anxiety
-
Pain management
- •The same nursing for the mental health care patient – but…
- •Pain may be perceived differently, exaggerated, or ignored
- •Some may drug seek
- •Some may attempt to od
- •Some will refuse meds to exert control
-
Coping-
- How one copes with losses is based upon how they have coped with loss, stress in the past
- }Responses can be calm, quiet withdrawal
- }Responses can be anger and violence
- }Losses are INTERNAL and EXTERNAL
- }EXTERNAL losses relate to objects, possessions, environment, loved ones
- }INTERNAL losses are more personal- loss of emotional, physical, sociocultural or spiritual self
-
Characteristics of loss
- }Can be an actual or potential state (a threat or based on reality)
- }Losses can be imagined (what if…)
- }How a loss is defined is based on the importance and value the person places on the object
- }Remember to assess the importance of the loss for each person as the loss will be different for each
- }With loss comes change
- }Losses may be temporary or permanent, expected or unexpected
- }Losses can be sudden or gradual
- }Illness can be considered a loss if there is a loss of roles or obligation
- }Loss of a limb is permanent and life changing
- }Losses can cause gain of maturity- giving something up in order to gain a higher form of development
- }“Situational losses”- occur in response to external events (divorce, loss of a loved one)
- }Here there is no control over the loss
- }Different developmental stages cope with loss differently-
-
Behaviors associated with loss
- Children’s perception and understanding and reaction is based on the level of development, past experiences, and current support systems
- }We must be aware of the person’s stage of mental development to understand coping with loss
- }Infants- loss of caregiver with little emotional reaction as long as basic needs are met
- }Toddlers- concerned with themselves. There may be little understanding if the parent is “gone”
- }Preschoolers- have inability to understand the permanence of loss as in with death
- ◦they believe that thoughts can control events- this may lead to shame, guilt and doubt
- ◦Children have developed fewer coping mechanisms
- }School-age children- have some idea about cause and effect, but they still associate misdeeds with loss
- }Children 6 or 7 years of age- will often give responsibility for loss to the devil or God
- }By 9 or 10 years of age- they realize that some losses are permanent, and some are temporary. Attitudes and reactions and responses to loss are now FIRMLY ESTABLISHED
- }Adolescents-can react to losses with adult thinking and childlike emotions
- ◦Least likely to accept their situations
- ◦They grieve acutely and fear rejection from their peers
- ◦They are still establishing identity- death of a loved one may make them stand out differently from their peers
- ◦Many adolescents ignore or minimize the loss of deny their own mortality
- }Adults- know the difference b/t temporary and permanent losses
- }- Most are able to accept their losses and grow from the experience
- - As we encounter and cope with various losses we develop a sense of self-confidence and motivation about life and death
- - By the time we reach OLD AGE, we have developed the ability to cope with loss because of the many life’s losses we have probably endured
-
Grief, Mourning, and Bereavement
- }GRIEF- set of emotional reactions that accompany loss
- }MOURNING- process of working through or resolving grief
- }BEREAVEMENT- emotional and behavioral thoughts, feelings and activities that follow loss
- }Grief may be short or long term, very personal
- }There is no right or wrong way to grieve
-
Grieving Process
- }This is the method for resolving losses and a way to heal or recover
- }Grieving, mourning and bereavement are normal, healthy responses to loss
- }Allows time to get things back together on the road to normalcy pre-loss
- }The nurses role- provide atmosphere for clients, support them in accomplishing the painful process
-
Stages of Grieving
- }Say “NO”- refusal to give up the object so loved and accept the loss
- ◦One may refuse to acknowledge the loss
- ◦One may pretend the object is still present
- ◦“DENIAL” at this stage provides an emotional buffer that gives grieving people time to gather their resources for the work to come
-
Loss
- }When we realize the loss and it can no longer be ignored, denial turns to “yearning”:
- ◦The reality of the loss sinks in and the griever becomes overwhelmed
- ◦Crying, anger and self-blame is common
- ◦One can become disorganized and “fall apart”- depression may become apparent
- ◦Suicide may be an option considered
- ◦Emotional support of friends and family is a must
-
Depression and Identification
- }As the impact of the loss is felt in day to day living- DEPRESSION &IDENTIFICATION with the lost object begins to settle
- ◦MOURNING begins as the full impact of the loss is realized
- ◦Guilt /remorse are frequently felt feelings as attempts are made to cope with the loss
- ◦The one grieving may withdraw from social activities, feel lonely, and may use maladaptive, coping mechanisms
-
Acceptance & Recovery
- }ACCEPTANCE AND RECOVERY- begins when the grieving individual begins to focus energies toward living
- ◦One starts to refocus on the relationships of those living
- ◦Life begins to slowly stabilize
-
Regression can happen!
- }One may backslide and regress in the stages or make multiple adjustments at one time
- }Experts say that grieving gradually decreases within 6-12 months
- }Mourning may continue for 5 years +
- }When the grieving process and mourning is done successfully and adaptively- one can recognize and accept the loss – one becomes healed and is able to continue
-
What is Anticipatory Grief?
- }Grieving before the actual event takes place
- }Example: - one diagnosed with CA
- - or one who knows about an impending amputation
-
Unresolved Grief
- }Mental health problems can occur if the grieving process is prolonged or impairment of function is an issue
- }There can be many different unhealthy, ineffective grieving reactions
- }2 types:
- 1. Bereavement related depression
- 2. Complicated grief
-
Bereavement related depression
- }Grieving is so intense one feels despair and worthlessness that overcomes daily life
- ◦Life becomes a burden
- ◦Changes are seen in eating, sleeping habits and activity levels
- ◦One may become angry, hostile
- ◦One may have an inability to concentrate or work
- ◦People become more socially isolated
- ◦This can lead to suicide
- ◦If recognized and treated early, this type of grief can be treated successfully
- ◦Psychotherapy and drug therapy has been effective, but emotional and social support are always important
-
Complicate grief
- }Persistent
- yearning for the deceased person that often occurs
- without s/s of depression
- ◦S/S appear to
- be that of normal grieving, but there is impaired psychological functioning and mood, self-esteem and sleep disturbances
- ◦One may relive past experiences- because life in the present is not as desirable
- ◦One may become socially isolated
- ◦Grief is treated with emotional support, and sometimes with drugs if there are also signs of depression
- ◦Nurses need to be alert for s/s of adaptive as well as maladaptive coping and grieving
- ◦Therapeutic listening is a must!!
-
Caregivers grief
- }Even though the nurse and the client have a therapeutic relationship- there is often a close bond that forges b/t them, especially if the client is dying!
- }Caregivers can share the grief experience, but need to understand that the role of the nurse is to be there for family as a support, therapeutic listening and communication becomes necessary
- }Many healthcare facilities offer group therapy for nurses who work with dying clients
- }Understand the steps of the grieving process
- }Know that grieving is normal to some degree
- }Talk if you need to!
- }Take care of you
-
The Dying Process
- }Dying is the last stage of growth and development
- }It is inevitable and is individually personal
- }For some it is a welcomed end to suffering
- }For others it is the ultimate fear
- }Remember to keep in mind the cultural aspects for death and dying- allow grieving time and respect healthy traditions
- }Death may be sudden or gradual- sometimes it is expected
- }Some die with loved ones in comfortable
- surroundings
- }Some die alone and in a strange place- like a hospital, nursing homes
-
Age Differences and Dying
- }Before age 8- most children do not understand the permanency of death, but they do acknowledge the fear of death
- }By age 12- children know death is irreversible
- }Adolescents and young adults often do not relate to death unless forced to
- }As we grow old we loose family and friends and begin to face our own mortality
-
Terminal Illness
- }This is a condition where the outcome is DEATH
- }Dx. is very difficult for anyone in any age group
- }There are often periods of hope and then devastation and grieving is constantly ongoing through the process
- }How do people respond and prepare for death?
- }What does death mean to the individual?
- }What coping mechanisms have been used throughout their lives?
- }If the person is comfortable/satisfied with his life- death is usually accepted without fear
- }One who has had his share of struggling in life- may have the same in the dying process
- }True crisis-
- when one is dx. with a terminal illness, there is shock and disbelief
- }Crisis
- involves the family as well as the client- CRISIS INTERVENTION may be effective
- }Denial
- and hope may soon begin with condition progression
- }This
- allows time for adjustment for the reality of the situation
-
Hope and Denial
- }HOPE- allows the individual /family to endure the present
- suffering; offers possibility that things may get better
- }DENIAL- offers a way of coping with little losses until the
- situation is finally accepted
- }During this time- one is encouraged to initiate self-care and “life as usual” for a s long as possible
- }As time goes on- the client and family will gradually begin to accept the inevitable or continue to deny until it is no longer possible…
- ◦For those who are diagnosed with a terminal illness and are young and feel healthy- denial is very much a part of the beginning process
- ◦For others- this may be seen as a “wake-up call” and major lifestyle changes begin
- ◦Caregivers should accept and support clients’ decisions about terminal illness and structure the goals of care to provide the best interventions within the REALITIES of each situation!
-
Culture and Dying
- }Please review what we covered last semester..
- }Culture, religion, spirituality will all come into play
- }Burial, funeral and mourning practices will be different
- }Nurses must respect and advocate
- }This is part or Transcultural Nursing!
-
Stages of Dying
- }Review Elizabeth Kubler – Ross
- }5 stages include- denial, anger, bargaining, depression, acceptance
- }Later theorists changed this up some:
- 1- Resistance- fights the issue through denial, avoidance, anger and bargaining
- 2- Working-life review, dealing with unfinished business
- 3- Open awareness-death is accepted, talk becomes present, allows grief with the patient instead of FOR the patient!
- So these stages are similar, but arranged differently
- Please be aware of them all!
-
Therapeutic interventions
- }Define- Good death (full participation)
- }May refuse treatments, meds, etc.
- }Peace and acceptance replace denial, anger and depression
- }Each day is cherished
- }No fear of death
- }Focus on all needs-
- not just the physical ones
-
Hospice
- }Humane care for the dying patient
- }24 hour care in-patient or in the home
- }Allows some control by the patient
- }Allows for dignity and choices
- }Family is usually very involved
- }Patient often chooses the comfort of own home
- }Family support
-
Criteria for Hospice
- }Terminal
- }Death within about 6 months
- }Does not have to be CA
- }End-stage, treatment finished
- }Patient must be aware of diagnosis and prognosis
- }If possible- patient should request hospice
-
Meeting the needs of the dying patient
- }Free of pain!
- }Addiction is not an issue
- }Able to voice fears and concerns
- }Patient advocation by the nurse
- }Preserve self-esteem and personal identity
- }Nutrition- what they want
- }COMFORT
- }Respect and dignity for patient and family
-
Loss and Grief in Mental Health
- }If stuck in grieving- can cause mental health issues
- }DSM-IV- Bereavement and Bereavement Depression = significant impairment > 2 months
- }Mentally ill- loss can be devastating
- }If inadequate coping- increased mental issues
-
Mental Health Treatment Plan-
- Difficult in identifying and defining problems when dealing with mental illness
- REMEMBER: Physiologic effects often accompany physical/mental illness and vice versa!
-
On admission to the mental helath care system:
- §Full assessment- interviews by multidisciplinary team members
- §Physical and physiological testing is done
- §Team members then meet to compare data
- §Treatment plan is devised with the input of the client and goals are stated
- §Behavioral therapies as well as the possibility of medications are started
- §Progress toward the goal will be evaluated often and changes may be made in the treatment plan
- §The mental health treatment plan changes often and is revised as new information is gathered
-
DSM-IV-TR Diagnosis:
- §AXIS I = Clinical disorders (Mood, substance abuse, schizo d/o)
- §AXIS II = Personality d/o and mental retardation (Dependent, antisocial d/o, and mild, moderate, severe retardation)
- §AXIS III = General medical conditions (Physical d/o as in heart problems, etc)
- §AXIS IV = Psychosocial/environmental problems (Education, housing, legal, economic)
- §AXIS V = Global assessment of functioning (GAF) –(
- Overall level of psychological, social and occupational functioning)
-
Nursing process-
- §Supports goal-directed care for the client
- §Nurses perform holistic assessments
- §Develop Nursing Diagnoses
- §Work with mentally troubled client’s to set and achieve realistic goals
- §Clients are involved in the treatment planning, at least some part
- §Clients responses to the treatment is evaluated and documented, and adjusted as needed to aid in reaching the goals set and necessary for the client
-
Assessment
- §Gathering and verifying information relative to the client
- §This is ON-GOING
- §Assessment data includes:
- - physical info
- - social info
- - cultural info
- - Spiritual info
- §A more complete assessment aids in more effective treatment for the client
-
Data Collection
- §OBJECTIVE
- §What is measured and shared
- §Gathered thru smell, taste, touch, sight
- §ex: Bp, P,T, labs, testing results compared with the normals
- §Done via physical exam, repeated observations of behavior
- §SUBJECTIVE:
- §Relates to the clients perceptions
- - Remember that often the perceptions are distorted!
- §ex: pain, nausea, anxiety- are not measurable by anyone except the person experiencing them
- §Feelings, emotions
-
In an interview:
- §You are meeting people with the purpose of exchanging or obtaining information
- §Can be formal and structured, or casual
- §Usually documented
- §Serves as a starting point for the therapeutic relationship-
- §Done during the WORKING phase
-
Part of the interview involves:
- §purposeful looking
- § or “observation”
- §Be careful not to show bias or personal opinion/attitude
- §Do NOT pass judgment
- §We are not the judge and jury
-
Physical Exam
- §Observation or “INSPECTION” – purposeful exam of the body
- §AUSCULTATION/PERCUSSION – use hearing to detect sounds within the body
- §PALPATION- sense of touch to feel (temp, texture, pulsations)
- §Used to evaluate changes and to evaluate effectiveness of the therapeutic intervention
-
The Assessment Process:
- Done using a holistic approach- always!
- §HOWEVER: emphasis is on mental/emotional functioning vs. physical functioning
- §USE THE PSYCHIATRIC ASSESSMENT TOOL to collect data about the problems, coping behaviors, and
- resources of clients
- §If the client is a risk to themselves or others- risk factor assessment should be done first!
-
Risk Factor Assessment
- §Helps formulate a nursing diagnosis by identifying risk factors that potentially present an immediate threat to the client.
- §Eight areas for potential risk are identified
- §POSITIVE FINDINGS- lead to more specific assessment s or appropriate safety precautions
- §Usually done by a RN, but other healthcare workers gather data and make objective observations
-
Health History
- §Interviewed upon admission
- §Introduction and purpose are stated
- §Serves as the starting point of the therapeutic relationship!
- §Insight into the clients concerns and expectations are gained
- §Offers clues to areas that may be of more concern and need for further investigation
-
Socio-cultural Assessment
- §Focuses on cultural, social, spiritual aspects of the individual
- §Obtaining information of the client’s background
- §Gives the healthcare provider to observe behaviors, appearance and attitude
- §6 general areas include:
- Gender,Education,Age,Ethnicity,Income,Belief System
- §Risk factors and stressors are defined also
- §This helps develop accurate and appropriate plans of care
- §Helps caregivers identify risks and potential risks for the patient
- §Helps guide the services to be provided
-
Physical Assessment
- §Physical exam on admission to psychiatric services
- §Are there physical problems that need medical treatment?
- §Alterations in behavior can often be traced to a physical cause
- §Complete physical exam by DR. , Routine assessment of the clients status done by the nurses and must be alert to changes
- §Diagnostic studies-
- §Serum and urine testing
- §Electrolyte studies
- §Hormone function
- §Many clients may be screened for HIV, TB, STD’s
- §X-rays, ECG’s, EEG’s, CT, MRI
-
Mental Status Assessment Overview:
- §Explores- general state
- §Emotional state
- §Experiences
- §Thinking
- §Sensorium and Cognition
-
1- General Description
- §General appearance, speech, motor activity, behavior
- §Physical characteristics, dress, facial expressions, motor activity, speech, reactions.
- §Describing body build, coloring, cleanliness, manner of dress
- §Are they neat and tidy or unkempt, body odor?
- §Does the appearance match the dress, age, gender, situation
- §Facial expressions:
- §Eye contact?, dilated pupils = drug intoxication, and small pupils = narcotic use
- §Speech:
- §Volume, rapid or slow, abnormal patterns
- §Motor activity:
- §Gestures/posture, movement during activity, type of activity, unusual movements
- §Is the client irritated, agitated, lethargic (depression), anxious, excessive movement (anxiety/mania), are these characteristics drug induced?
- §Repeated movements (OCD)
- §Picking at clothing (delirium, toxic reaction)
- §What is the client’s behavior:
- §Hostile, overly friendly, cooperative, trusting?, did their verbal messages match the behavior?
-
2- Emotional State
- §MOOD- overall feelings
- §Mood is subjective! Can only be explained by the person in that “mood”
- §Can change throughout the day based on specific situations
- §AFFECT-emotional display of the mood being experienced
- §Labile- rapid, dramatic mood changes
- §Inconsistent- Affect and mood do not agree
- §Flat- Unresponsive emotions
-
Affect:
- §Pleasurable response-
- Euphoria- feeling “too good”
- Exaltation- Intense happiness, feelings of grandeur
- §Unpleasurable Response (Dysphoric)
- Aggression- anger, hostility, rage that is out of the situation
- Agitation- Motor restlessness, seen often with anxiety
- Ambivilence- Positive and negative feelings
- Anxiety- Vague, uneasy feeling, often from an unknown cause
- úDepression- Sadness,
- hopelessness
- úFear- reaction to a
- recognized danger
-
3- Experiences
- §PERCPTIONS- ways in which one experiences the world.
- §AKA “Frame of reference”- helps determine the clients sense of reality
- §Many with mental health problems have difficulty perceiving reality
- §What positive and negative experiences have they had?
-
4- Thinking
- §Is thinking clear or distorted
- §Is speech clear
- §Is the conversation appropriate to the subject
- §Is the conversation fluid or is the “flight of ideas” or “word salad”
- §Is the patient making up their own language
- §Is thinking threatened or threatening (OCD, Suicide, Homicidal thought)
-
5- Sensorium and Cognition
- §Insight
- §Judgment
- §Reliability
-
How one adapts to stress varies
- }The stress response mechanism is to designed to protect us during times of stress and illness
- }Think fight or flight response- biochemical response in the body
- }Provides one with the energy needed for fighting or running for survival
- }“General Adaptation Syndrome”- biochemical reactions of the stress response and their effects on various body systems
- }Hans Selye
- }The
- hypothalamus communicates to the pit. gland and it notifies the adrenal glands
- (biochemical cascade of events!)
- }The adrenal glands manufacture and release the stress hormones- DOPAMINE,
- }EPI, NOREPI and CORTISOL
- }Body functions are very easily controlled and changed in response to changes in the levels of these chemicals
- }The continuum of psychophysical responses- from maladaptive to adaptive responses and effects everything in between (see page 225) when the body is under biochemical changes as in times of crisis/illness
- }The immune system is affected by stress
- }BP increases, HR, RR all increase during stress or anger-
- }Stress and anger have a definite effect on the immune system
- }POSITIVE attitude and lifestyle also effects the immune system
- }If one is able to deal with stress effectively and before it becomes a true crisis- physically, the effects on the body are few
- }Physical problems can arise from psychological sources when one focuses stress into body activities and functions
-
Here are the Disorders:
- }SOMATOFORM DO- feeling physical symptoms without evidence of disease or out of proportion to an ailment
- }PSYCHOSOMATIC DO- emotionally related physical disorders
- }PSYCHOPHYSICAL DO- more recent terminology for psychosomatic DO- stress related physical problems
-
The physiologic stress response affects the body systems:
- GI Tract-
- }Problems with indigestion
- }vomiting
- }constipation
- }diarrhea
- }ulcerative colitis
- }gastric/peptic/duodenal ulcers
- Respiratory tract-
- }Hyperventilation
- }Asthma
- Cardiac-
- } Tachycardia
- }Increased blood pressure
-
Theories of Stress Related Illnesses:
- }Stress Response Theory- humans are biochemically patterned to react to stress - ANS- fight or flight
- }Symbolism vs- Symptoms- developing a medical illness due to no outlet for stress responses due to being inappropriate, etc… (causes hypertension, ulcers, etc)
- }Personality Types- Higher risk for illness due to stress for those who are independent, hard working, overly ambitious- may develop heart attacks, etc
- }The quiet, non-complainer can still suffer ill effect- ulcers, headaches, etc…
- }Organic Weakness- one body system is weaker than the others, therefore each individual will suffer in that particular system- individual to each person
- }The symptoms of illness is r/t the body’s attempt to lower stress
- }Remember- the illness is very real to that person- don’t treat the symptoms as casual complaints- they can be life threatening!
-
Primary and Secondary Gains
- Primary Gains- anxiety reducing benefit
- Secondary Gains- the “sick role”- relief of responsibilities
- }One can easily become dependent on this behavior
- }Encourages this behavior if secondary gains benefits are great
-
Lets talk about the Disorders in depth:
- SOMATIZATION- feeling physical symptoms withoThis is a common stress reducing mechanism
- }No OBJECTIVE cause for the symptoms of illness
- }No physical dysfunctions either
- }The symptoms DO however suggest a medical illness
- }All physical dysfunctions are ruled out before a somataform DO dx. can be made
- }Approx. 80% of healthy people have a somataform disorder within each week
- }Under stress the body’s immune system IS at risk…
- }Somatization DO- “Briquet’s Syndrome” or hysteria
- }Begins before age 30 (typically)
- }More frequent in women
- }Tends to be familial
- }Males in the family tend to show an increase in some anti-social personality and increased substance abuse
- }Genetics as well as environment contribute to he risk of developing this disorder
- }Complaints are often exaggerated
- }May seek treatment from many physicians- watch for polypharmacy!
- }Most common c/o= sexual complaints and GI complaints, PAIN, false neuro problems
- }Anxiety and depression complaints are common
- }May be impulsive and possible suicidal
- }There is often marital problems and life in general seems
- chaotic
- }What is assessed in order to make a dx. of Somataform DO vs- medical problems:
-
Assessment:
- }Multiple system organ involvement
- }Early onset and chronicity with no physical changes over time
- }The absence of any abnormalities in lab values
- }So you see- there is little to no change in the physical assessment, but the patient has many, many complaints…
-
FYI
- }This is typically not the case in the elderly-
- }Assess carefully if they complain of increased problems with multiple organ systems!
- }They may actually have a problem- so assess and rule out…
-
OTHER SOMATAFORM DO’s-
- Conversion Disorder
- }Relatively uncommon disorder
- }Somataform disorder- complaints are related to SENSORY and MOTOR functions
- }More common in those in lower socioeconomic status and in those with little knowledge of healthcare
- }More common in women
- }In men- often associated with the military, industrial accidents and antisocial personalities
- }Onset usually during late childhood through early adulthood (after 10, before 35)
- }Children usually present with gait problems and seizures
- }In adults- symptoms are usually sudden
- }Symptoms usually only last a short time
- }In the hospitalized client- symptoms often disappear within 2 weeks
- }Re-occurence is common
- }Conversion disorders are thought to be the result of emotional conflict
- }Seizures and paralysis may be common complaints- but the symptoms are not compliant with the actual symptoms (seizures are not typical- paralyzed limd moves on its own, etc..)
- }“La Belle Indifference”- feature = lack of concern about the s/s
- }Symptoms are more exaggerated during increased stress
- }S/s can be modified or intensified by the reaction of others
- }Labs often show NO abnormalities- this helps to make a DX!
- }Treatment focuses on eliminating any possibility of physical problems- then focuses on the conflicts that may be causing the s/s
- }Psychotherapy, behavior modification
- }Counseling
- }Pharmacotherapeutic treatment
-
Hypochondriasis
- }Intense fear or preoccupation with having a serious disease based on a misinterpretation of s/s
- }Watch for polypharmacy and Dr. shopping
- }These clients feel that Dr.’s are ignoring their complaints, etc…
- }Can begin at any age- more commonly in early adulthood
- }Strains interpersonal relationships because of self focus
- }Employment can be strained
- }Anxiety
- }Depression
- }Compulsive personality traits
- }Be patient, listen, use therapeutic communication, OBSERVE carefully
- }Show emotional support
- }Anti-anxieties and antidepressants can help- long-term psychotherapy
- }Preoccupation must be present for at least 6 months to dx.
-
Less common Somataform disorders:
- SOMATAFORM PAIN DO-
- }pain and discomfort is the focus of distress AND no other causes of pain is identified
- BODY DYSMORPHIC DO-
- }preoccupation with a physical difference or defect in
- one’s own body
- }Face/head is the main focus
- }Defect is described as painful, devastating
- }Feel “ugly” and avoid social situations
- }Affects interpersonal relationships and work
- }Watch for severe depression and suicide/self mutilation ideations
- }It is all in the way the person “sees” himself
- }Can often lead to self mutilation
- }Can lead to eating disorders and more
-
FACTICIOUS DISORDERS AND MALINGERING-
- }S/s are intentionally produced to assume the “sick role”
- }Done for some form of gain
- }Illnesses and injuries are self inflicted
- }(discuss abcesses)
- }Psychological as well as physical s/s are expressed by the client
- }These client’s definitely shop for doctors
- }They often seek repeated hospitalizations
- }“Munchausens by proxy”- deliberate production of s/s in another person
- }Often a child of the parent or caregiver- inducing illness to seek medical care
- }Dx. can be difficult
- }In client’s with Facticiuos DO- will often explain a very colorful medical history but are very vague about any details
- when questioned or assessed
- }If the cause of the original s/s are ruled out- they often come up with new s/s
- }If confronted, can become belligerent and will often check out AMA
- }The client with malingering- usually with a specific goal- students who fake illness to get out of a test…
- }Also those who seek compensation from government and social programs
-
Goal for all of these disorders
- }R/o anything medically wrong
- }Develop trust in the therapeutic relationship if possible with the client
- }Attempt to understand the client’s purposes served by the clients
- }Teach anxiety lowering skills
- }Convey an attitude of acceptance for the client
- }Encourage autonomy
-
Caregivers…
- Expected to be helpful in problem solving
- Serve as role models for good mental and physical health
- Work to instill confidence
- Work to help encourage change within the security of the therapeutic relationship
-
Self-awareness
- Self-awareness is a
- consciousness of one’s personality
* This is the ability to objectively look at one’s self
- Allows us to be in
- control of our own growth and development
- Caregivers encourage
- self-awareness in our clients
-
What else do I need to know about “Caring”?
- CARING: Allows us to interact and establish a connection with EACH client!
- What happens to an infant without care and love? FAILURE TO THRIVE
- What happens to adults without care and love?
- *ISOLATION/DEPRESSION/LONELINESS
-
The 5 C’s
COMMITMENT- to the patient and to caring and helping
- COMPASSION – FEELING THE SORROW AND SUFFERING OF OTHERS, TOLERANCE FOR THE DIFFERENCE IN OTHERS - EMPATHY
- COMPETENCE- You know what you are doing and you are up to date on all the newest ideas
- CONSCIENCE – FEELING OF WHAT IS RIGHT AND WRONG AND CORRECTING WHAT MAY BE WRONG
- CONFIDENCE – FOSTERS TRUSTING RELATIONSHIPS. ASSITING CLIENT’S IN COPING WITH HEALTH PROBLEMS. ALSO TRUST AND BELIEF IN OWNS OWN ABILITY
-
INSIGHT
- We gain insight and wisdom through experience
- The ability to see things clearly
- Relies on common sense and good jugement
- For care providers- includes sensitivity to people, willingness to seek new knowledge
-
INTROSPECTION
- INTROSPECTION- looking into ones own mind/analysis of ones-self
- Also the process of observing our own behavior in various situations
- Allows care givers to identify personal and professional learning needs
-
Risk taking and failure
- In order to grow, we must take risks
- Risk taking behaviors are practiced when the rewards of success are larger than the consequences of failure
- What about the possibility of failure? – Can be filled with defeat or can be filled with positive growth promoting experiences.
- Can be the next step toward success if we use failure to grow
-
Guidelines to therapeutic actions
- DO NOT limit clients with your own values
- Set some high expectations and encourage!
- Allow clients the same ability to grow and fail and LEARN from this.
-
Acceptance- part of self awareness
- The receiving of the whole person and the world in which they function
- THE DOES NOT mean to accept all behaviors!
- DON”T correct the person, DO correct the unacceptable behavior
-
Boundaries for helping…
- Care for yourself in order to care for others
- Personal boundaries- provide order and security b/c they help to establish the limits of one’s behavior (based on values and beliefs)- focus on self
- Professional boundaries- define the needs of the caregiver vs. the different needs of the client- focus on the client
- DO NOT become “controlling”
- Do assist in helping and encouraging success, but do NOT ignore the client’s true needs based on our need to succeed
Personal and professional lives are to remain VERY separate
Re-evaluate the relationship with the client often
If the caregiver feel they are the ONLY one’s who can help and understand the client- CO-DEPENDENCY can occur.
-
Over-involvement
This can shadow the professional relationship. It can be easy to become emotionally attached
When the client-caregiver relationship begins to fulfill the needs of the caregiver- “CODEPENDENCY” can occur. This will lead to unmet goals for the client!
Do NOT show a significantly greater concern for one client over another to avoid the risk of co-dependency
-
Personal Commitments
- MOST IMPORTANT- to yourself
- The promise to do your best in every situation
Commitment to your personal growth- allows you to learn from errors and to gain insight in them, this in turn allows you to assist others to grow.
Also commit to your patient
-
What is a positive outlook?
Positive attitude will assist others in the same
Negative attitudes discourage others from interacting with them
THINK ABOUT IT… Does a positive outlook and attitude affect one’s health?
- A positive attitude can serve as a role model for those client’s who have not learn to cope with the world effectively
- Those client’s who are mentally and emotionally troubled deal with a lot of negative misfortune and unhappiness-
- There is often a need for a positive attitude to give hope for these clients
- If the personnel has a positive outlook- then you are modeling for the patients!
-
Awareness on a daily basis
- Listen to your “self-talk”- pay attention to the words you use.
- Words can become emotional- is this negative or positive?
- Change recurrent negative themes- replace negative, self-defeating needs with positive one’s- this leads to greater self-esteem and a highly effective immune system
- Present yourself with positive thoughts
- Visualize future success- picture yourself achieving your goals
- Act the part- a positive mental attitude helps to develop self-esteem, self-respect and self-acceptance.
-
PRINCIPLES AND PRACTICES FOR CAREGIVERS
- Frustration and failure can come easily when we are unable to alleviate pain and suffering
- We become easily worn
- out or BURNED OUT!!
- Find a balance
- KNOW YOUR STUFF!
- Value each individual
- Be responsible and accountable for your own actions
- Be open to new ideas
- Connect with others- support your peers
- Like what you do and take pride
- Recognize moments of joy (live for the moment)
- Recognize and accept your own limitations, but strive to improve. Focus on your accomplishments
- Rest each day and start over!
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