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Psychiatric Nursing Reviewer 1

Psychiatric Nursing Reviewer 1

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Published by Gilbert Garcia

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Published by: Gilbert Garcia on Jun 10, 2010
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PSYCHIATRIC NURSINGTYPICAL SIGNS AND SYMPTOMS OF PSYCHIATRIC ILLNESS DEFINED
I. CONSCIOUSNESS: State of awareness
A. DISTURBANCES OFCONSCIOUSNESS
o
Apperception: Perception modified by one’s own emotions & thoughts
o
Sensorium: State of cognitive functioning of the special senses1. DisorientationDisturbance of orientation in time, place, or person.2. Clouding of consciousnessIncomplete clearmindedness w/ disturbances in perception & attitudes3. StuporLack of reaction to & unawareness of surroundings.4. DeliriumBewildered, restless, confused, disoriented reaction associated with fear &hallucinations.5. ComaProfound degree of unconsciousness.6. Coma VigilComa in w/c a px appears to be asleep but ready to be aroused (akineticmutism)7. Twilight stateDisturbed consciousness w/ hallucinations8. Dreamlike stateOften used as a synonym for complex partial seizure or psychomotor epilepsy9. SomnolenceAbnormal drowsiness10. ConfusionDisturbance of consciousness in w/c reactions to environmental stimuli areinappropriate: manifested by a disordered orientation in relation to TPP11. DrowsinessA state of impaired awareness associated with a desire or inclination to sleep12. SundowningSyndrome in older people that usually occurs at night & is characterized bydrowsiness, confusion, ataxia & falling as the result of being overly sedatedw/ medications (Sundowner’s Syndrome)
B. Disturbances of Attention
Is the amount of effort exerted in focusing on certain portions of anexperience;Ability to sustain a focus on one activity ; Ability to concentrate1. DistractibilityInability to concentrate attention; state in w/c attention is drawn tounimportant or irrelevant external stimuli2. Selective inattentionBlocking out only those things that generate anxiety3. HypervigilanceExcessive attention & focus on all internal & external stimuli, usually 2ndaryto delusional or paranoid states4. TranceFocused attention & altered consciousness, usually seen in hypnosis,dissociative d/o’s, & ecstatic religious experiences
C. Disturbances insuggestibility
Compliant & uncritical response to an idea or influence1. Folie a deux ( folie a trois)Communicated emotional illness bet 2 (3) persons2. HypnosisArtificially induced modification of consciousness characterized by aheightened suggestibility
II. Emotion
: Complex feeling state w/ psychic, somatic, & behavioral components that isr/t affect & mood
A. Affect
Observed expression of emotion1. Appropriate affectCondition in w/c the emotional tone is in harmony w/ the accompanying idea,thought, or speech2. Inappropriate affectDisharmony bet the emotional feeling tone & the idea, thought, or speechaccompanying it3. Blunted affectDisturbance in affect manifested by a severe reduction in the intensity oexternalized feeling tone4. Restricted or ConstrictedReduction in intensity of feeling tone les severe than blunted affect butclearly reduced5. Flat affectAbsence or near absence of any signs of affective expression; voicemonotonous, face immobile6. Labile affectRapid & abrupt changes in emotional feeling tone, unrelated to externalstimuli
B. MOOD
A pervasive & sustained emotion, subjectively experienced & reported by apx & observed by others1. Dysphoric moodan unpleasant mood2. Euthymic moodnormal range of mood, implying absence of depressed or elevated mood3. Expansive mooda person's expression of feelings without restraint, frequently with anoverestimation of their significance or importance.4. Mood swings (labile mood)oscillations between euphoria & depression or anxiety5. Elevated moodAir of confidence & enjoyment; a mood more cheerful than usual6. Euphoriaintense elation with feelings of grandeur7. EcstasyFeeling of intense rapture8. Depressionpsychopathological feeling of sadness9. IrritableA state in w/c a person is easily annoyed & provoked to anger10. Anhedonialoss of interest in and withdrawal from all regular and pleasurable activities, of-ten associated with depression11. Grief or mourningsadness appropriate to a real loss12. Alexithymiaa person's inability to or difficulty in describing being aware of emotions or mood.13. Suicidal ideationthoughts or act of taking one's own life.14. ElationFeelings of joy, .euphoria, triumph, intense self-satisfaction, or optimism.
C. OTHER EMOTIONS
1
 
1. AnxietyFeeling of apprehension caused by anticipation
of danger, which may beinternalorexternal.
2. Free-floating anxiety
Pervasive,unfocusedfear notattachedlo any idea.
3.
FearAnxietycaused by consciously recognizedand realisticdanger.
4.
Agitationsevere anxiety associatedwith motor restlessness.5. Tensionincreased and unpleasant motor and psychological activity.6. Panicacute, episodic,intense attack of anxiety associated with overwhelming feelingsof dread and autonomic discharge.7. Apathydulled emotional tone associatedwith detachment or indifference8. Ambivalencecoexistence of two opposing impulses toward the samething in the same thing inthe same personat the same time.
9. Abreactionemotional release or discharge after recalling a painful experience.10. Shamefailure to live up to self-expectations.11. Guiltemotion secondary to doing what is perceived as wrong.12. Impulse controlability to resist an impulse, drive, or temptation to perform an action.13. Melancholiasevere depressive state; used in the term
involutional melancholia
bothde
scriptively and also in reference to adistinct diagnostic entity
D.
PHYSIOLOGICALDISTURBANCES ASSOCIATEDWITH MOOD
:signs of somatic (usually autonomic) dysfunction, most often associatedwithdepression(Also called vegetative signs).
1.
Anorexialoss of or decrease in appetite.
2.
Hypcrphagiaincrease in appetite and intake of food.
3.
Insomnialack of or diminished ability to sleep.
 
a. Initialdifficulty in falling asleep
 
b. Middledifficulty in sleeping through thenight without waking up and difficulty in goingback to sleep.
 
c. Terminalearly morning awakening4. Hypersomniaexcessive sleeping5. Diurnal variationmood is regularly worst in themorning, immediately after awakening, andimproves as the day progresses.6. Diminished libidodecreased sexual interest, drive, and performance (increasedlibido is oftenassociated with manic states).7. Constipationinability to defecate or difficulty in defecating.
8. Fatigue
a feeling of weariness, sleepiness, orirritability following a period of mental orbodily activity.
9. Pica
craving and eating of nonfood substances, such as paint and clay (usually girls)10. Pseudocyesisrare condition in which a patienthas the signs and symptoms of pregnancy,suchas abdominal distention, breast enlargement, pigmentation, cessation of menses, and morning sickness.
11.
Bulimiainsatiable hunger and voracious eating; seen in bulimia nervosa and a typicaldepression
12. Adynamia
III. MOTOR BEHAVIORBEHAVIOR (CONATION):
aspect of the psyche that includes impulses, motivations, wishes, drives, in-stincts, and cravings, as-expressed by a person's behavior or motor activity.1. Echopraxiapathological imitation of movements of one person by another.2. Catatonia and posturalabnormalitiesseen in catatonic schizophrenia and some cases of brain diseases, such asencephalitis.a. Catalepsygeneral term for an immobile position that is constantly maintainedb. Catatonic excitementagitated, purposeless motor activity uninfluenced by external
stimulic. Catatonic stupormarkedly slowed motor activity, often
ID
a point of immobility and seemingunawareness of surroundingsd. Catatonic rigidityVoluntary assumption of a rigid posture,-held against all efforts to bemoved.e. Catatonic posturingvoluntary assumption of an inappropriate or bizarre posture, generally maintainedfor long periodsf.
Cerea flexibilitas
(waxy flexibility)condition of a person who can be molded into a position that is then maintained;when an examiner moves the person's limb, the limb feels as if it were made of wax.g. Akinesialack of physical movement, as inthe extreme immobility of catatonic schizo-phrenia; may also occur as an extrapyramidal side effect of antipsychoticmedication.3. Negativismmotiveless resistance to all attempts to be moved or to all instructions4. Cataplexytemporary loss of muscle tone and weakness precipitated by a variety of emo-tional states.5. Stereotypyrepetitive fixed pattern of physicalaction or speech.6. Mannerismingrained, habitual involuntarymovement.7. Automatismautomatic performance of an act or acts generally representative of unconscioussymbolic activity.8. Command automatismautomatic following of suggestions (also automatic obedience).
9.
Mutismvoicelessness without structural abnormalities.10. Overactivity
a. Psychomotor agitationExcessive & motor & cognitive overactivity, usually nonproductive & inresponse to inner tension.b. Hyperactive (hyperkinesis)Restless, aggressive, destructive activity, often associated with someunderlying brain pathologyc. TicInvoluntary, spasmodic motor movementd.
Sleepwalking (somnambulism)motor activity during sleep.
2
 
 e. Akathisiasubjective feeling of musculartension secondary to antipsychotic or othermedication, which can cause restlessness,pacing, repeated sitting and standing;can be mistaken for psychotic agitation
f. Compulsion
uncontrollable impulse to perform an act repetitivelyi. Dipsomaniacompulsion to drink alcoholii. Kleptomaniacompulsion to stealiii. Nymphomaniaexcessive and compulsive need for coitus in a womaniv. Satyriasisexcessive and compulsive need for coitus in a manv. Trichotillomaniacompulsion to pull out hairvi. Ritualautomatic activity, compulsivein nature, anxiety reducing in origing. Ataxiafailure of muscle coordination; irregularity of muscle actionH. Polyphagiapathological overeatingi. Tremorrhythmical alteration in movement,which is visually faster than one beat asecond; typically, tremors decrease during periods of relaxation and sleep andincrease during periods of anger and increased tension.|11. Hypoactivity (Hypokinesis)decreased motor and cognitive activity, as in psychomotor retardation; visibleslowing of thought, speech, and movements.12. Mimicrysimple, imitative motor activity of childhood.
13.
Aggression
forceful, goal-directed action thatmay be verbal or physical; the motorcounterpart of the affect of rage, anger, or hostility
14.
Acting Out
direct expression of an unconscious wish or impulse in action;living outunconscious fantasy impulsively in behavior
15.
Abulia
reduced impulse to act and think, associated with indifference aboutconsequences of action; a result of neurological deficit16. Anergialack of energy (anergy)17. Astasia abasiathe inability to stand or walk in a normal manner, even though normal legmovements can be performed in asitting or lying down position. The gait isbizarre and is not suggestive of a specific organic lesion;seen in conversiondisorder.
18.
Coprophagiaeating of filth or feces19. Dyskinesiadifficulty in performing voluntarymovements, as in extrapyramidal disorders.20. Muscle rigiditystate in which the muscles remain immovable; seen in schizophrenia.21. Twirlinga sign present in autistic childrenwho continually rotate in the direction in whichtheir head is turned.22. Bradykinesiaslowness of motor activity with n decrease in normal spontaneous movement.
23. Chorearandom and involuntary quick, jerky, purposeless movements.24. ConvulsionAn involuntary, violent muscular contraction or spasm
 
a. Clonic convulsionconvulsion in which the muscles alternately contract and relaxb. Tonic convulsionconvulsion in which the muscle contraction is sustained25. Seizurean attack or sudden onset of certain symptoms, such as convulsions, loss oconsciousness, and psychic or sensory disturbances; seen in epilepsy and can besubstance-induceda. Generalized tonic-clonic seizuregeneralized onset of tonic-clonic movements of the limbs, tongue biting, andincontinence followed by slow, gradual recovery of consciousness and cognition;also called grandmal seizure and psychomotor seizureb. Simple partial seizurelocalized ictal onset of seizure without alteration:; in consciousness.c. Complex partial seizureLocalized ictal onset of seizure with alterations in consciousness26. Dystoniaslow, sustained contractions of the trunk or limbs; seen in medication-induced dystonia
IV. THINKING
Goal-directed flow of ideas, symbols, and associations initiated by a problem ortask and leading toward a reality-oriented conclusion; when a logical sequenceoccurs, thinking is normal; parapraxis (unconsciously motivated lapse from logicis also called a freudian slip) considered part of normal thinking.
A. GENERAL DISTURBANCES IN FORM OR PROCESS OF THINKING
1. Mental disorderClinically significant behavior or psychological syndrome associated with distress ordisability, not just an expected response to a particular event or limited to relationsbetween a person and society.2. Psychosisinability to distinguish reality from fantasy; impaired reality testing, with the creation oa new reality (as opposed to neurosis: mental disorder in which reality testing is intact;behavior may not violate gross social norms, but is relatively enduring or recurrentwithout treatment)
3. Reality testingObjective evaluation and judgment of the world outside the self.4. Formal thought disorderdisturbance in the form of thought rather than the content of thought; thinkingcharacterized by loosened associations, neologisms, and illogical constructs; thoughtprocess is disordered and the person is defined as psychotic5. Illogical thinkingThinking containing erroneous conclusions or intern al contradictions;psychopathological only when it is marked & when not caused by cultural values orintellectual deficit.
6. Dereismmental activity not concordant with logic or experience7. Autistic thinkingPreoccupation with inner, private world; term used somewhat synonymously withdereism.8. Magical thinking
A form of dereistic thought; thinking similar to that of the preoperational phase inchildren(jean piaget), in which thoughts, words, or actions assume power (e.g. tocause or prevent events)
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