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Psychiatric Nursing 1

Psychiatric Nursing 1

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St. Louis Review Center
ANXIETY
\u2297
Vague sense of impending doom
\u2297Subjective response to stress
\u2297
Is a state of apprehension, uneasiness, uncertainty or tension experienced
by an
individual in response to an unknown object or situation.
Signs and symptoms:
Mild
\u2297Physical - \u2191PR, RR, BP, pupillary dilatation, sweating
\u2297
Cognitive - Attentive and alert
\u2297
Emotional - Minimal use of defenses
Moderate
\u2297
Physical - Nausea, Anorexia, Vomiting, Diarrhea, Constipation, Restlessness
\u2297
Cognitive - narrowed perceptual field & selective inattention
\u2297
Emotional - use of any defense mechanism available
SEVERE
\u2297
Physical - s/sx becomes the flow of attention
\u2297
Cognitive \u2013 perceptual field is greatly narrowed, focus of attention is trivial events
\u2297
Emotional \u2013 defense mechanism operate
PANIC
\u2297
Physical \u2013 s/sx of exhaustion ignored
\u2297
Cognitive \u2013 personality disorganized
\u2297
Emotional \u2013 defense mechanism fail
Nursing Diagnoses:
\u2297
Ineffective individual coping
\u2297
Anxiety
Nursing Management:
\u2297
Calm
\u2297
Administer medications
\u2297
Listen
\u2297
Minimize environmental stimuli
ANXIETY DISORDERS
Panic Disorder
\u2297An individual may suddenly experience frightening and uncomfortable symptoms
\u2297May include terror, sense of unreality or fear of loosing control
\u2297
Attack: 1 minute and 1 hour
Phobic Disorder
\u2297Phobia is an irrational fear of an object, place, activity or situation.
\u2297
Avoidance will allow the individual to be free from anxiety.
Examples:
\ue000
Agoraphobia - fear of open places and of being alone in public places.
\ue000
Social phobia - irrational fear of criticism, humiliation or embarrassment.
\ue000
Acrophobia - fear of heights
\ue000
Algophobia - fear of pain
\ue000
Claustrophobia - fear of enclosed place
\ue000
Thanatophobia - fear of crowds
\ue000
Pathophobia - fear of disease
\ue000
Monophobia - fear of being alone
Generalized Anxiety Disorder
(GAD)
\u2297
Unrealistic, excessive anxiety and is unable to control worry.
\u2297Clients may experience: fatigue, irritability, restlessness, muscle tension, sleep disturbance
Obsessive Compulsive Disorder
\u2297
Is characterized by recurrent obsessions and compulsions that interfere with normal life.
Obsession
\u2297
Refers to persistent, painful intrusive thought, emotion or urge that one is unable to suppress or ignore.
Compulsion
\u2297
Refers to repetitious uncontrollable act and sometimes a purposeful act to prevent a certain mistake in an event
or situation.
Post-Traumatic Stress Disorder (PTSD)
\u2297
Is the delayed reaction of the person who has been involved or exposed to a traumatic events.
\u2297
Symptoms of this disorder are:
\ue000
intense psychological distress
\ue000
feeling of detachment or estrangement from others
\ue000
insomnia
\ue000
decreased concentration
Psychiatric Nursing: Lecture Aid
Page 20
St. Louis Review Center
\ue000
avoidance of thoughts and feelings
\ue000
recurrent distressing dreams
\ue000
inability to recall an important aspect of the trauma
Nursing Interventions
\u2297
Calm and nonjudgmental approach to convey acceptance.
\u2297
Use short and simple sentences or words.
\u2297
Help the client develop an increase tolerance to anxiety.
\u2297
Help the client to:
\ue000
develop a problem-solving and coping skills of the client.
\ue000
develop the ability to remain calm in anxiety-producing situations.
\u2297
Approach: kind-firmness
\u2297
Systematic desensitization (phobic disorders)
\u2297
Clients with ritualistic behavior (obsessive-compulsive disorder) should not be prohibited or reprimanded.
\u2297
Biofeedback, change of the scenery, therapeutic touch, hypnosis, massage or relaxation exercises.
\u2297
Administer medications, as ordered.
ANXIETY RELATED DISORDERS
Somatization Disorder
\u2297
Free floating anxiety disorder
\u2297
Clients:
\ue000
express emotional turmoil or conflict through physical symptoms.
\ue000
usually seek for repeated medical attention.
\ue000
may exhibit antisocial behavior and may attempt suicide.
\u2297
Associated with anxiety and depression
Conversion Disorder
\u2297
A condition in which an anxiety-provoking impulse is converted unconsciously into functional symptoms.
\u2297
Conscious counterpart of malingering
\u2297
Examples: Paralysis, blindness, loss of touch or pain sensation, dyspnea, seizures or convulsions
Hypochondriasis
\u2297
An individual presents an unrealistic or exaggerated physical complaints.
\u2297
The person becomes, preoccupied with the fear of developing or having already a disease or illness in spite of
medical reassurance.
Body Dysmorphic Disorder
\u2297
Preoccupation with an imagined defect in his or her appearance.
\u2297
Slight physical abnormality = excessive concern / anxiety
Dissociative Amnesia
\u2297
Inability to recall extensive amount of important information
\u2297
Caused by trauma
\u2297
Characterized by:
\ue000
Disorientation
\ue000
Purposeless wandering
\ue000
Impairment in ability to perform ADL
\u2297
Rapid recovery generally occur
PERSONALITY DISORDERS
\u2297
Are pervasive and inflexible patterns of functioning that is stable overtime, and leads to distress or impairment.
Types of Personality Disorders:
Eccentric Personality Disorder (Type A)
\u2297Paranoid (Suspicious and distrustful)
\ue000
Persons who display pervasive and long stand suspiciousness
\ue000
More common in men
\u2297Schizoid (Socially distant and detached)
\ue000
Pattern of detachment from social relationship
\ue000
Chooses solitary activities
\ue000
Topics are inanimate objects and ideas
\u2297Schizotypal (Odd and eccentric)
\ue000
\u201cmild schizophrenia\u201d
\ue000
Acute discomfort in close relationships
\ue000
Cognitive or perceptual distortion
Dramatic-Erratic Personality Disorder (Type B)
\u2297
Antisocial (aggressive and manipulative)
\ue000
Pattern of disregard for the violation of the rights of others
\ue000
Low self-esteem
\u2297Borderline (destructive and unstable)
\ue000
Characterized by patterns of instability in relationships, self image and mood
\ue000
Self-mutilating behavior
\ue000
Affective instability
\ue000
More common in women
\u2297Narcissistic (boastful / superiority complex)
\ue000
Grandiosity and need for constant admiration
\ue000
Exploitation of others for fulfillment of own desire
Psychiatric Nursing: Lecture Aid
Page 21
St. Louis Review Center
Anxious or Fearful Personality Disorder (Type C)
\u2297Avoidant (inferiority complex)
\ue000
Social inhibition
\ue000
Feelings of inadequacy and sensitivity
\ue000
Low self-esteem
\ue000
Social withdrawal in spite of a desire for affection and acceptance
\u2297Dependent(submissi ve )
\ue000
Submissive clinging behavior related to excessive need to be cared for by others
\ue000
Lack of self-confidence
\ue000
Perceive self as helpless and stupid
\u2297Obsessive-Compulsive(perfe ctionist)
\ue000
Preoccupied with orderliness, perfectionism, inflexibility, need to be in control
\ue000
Formal and serious interpersonal relationship
\ue000
Judgmental of self and others
\u2297
Passive-Aggressive
\ue000
Intentional inefficiency
\ue000
Passive resistance to demands for adequate performance in both occupational and social functioning
Nursing Diagnosis:
\u2022
Ineffective individual coping
\u2022
Self-esteem disturbance
DISORDERS COMMONLY DIAGNOSED TO CHILDREN
AUTISM
\u2297
Characterized by:
\ue000
impairment in communication skills
\ue000
presence of stereotyped behavior, interests and activities.
\ue000
associated with impairment on social interactions
\u2297
treatable but not curable
\u2297
more common among boys
\u2297
usually diagnosed at age 2
\u2297
Main problem: Interpersonal functioning
\u2297Most acceptable cause: Biological factors - brain anoxia, intake of drugs
Signs and Symptoms
\u2297Odd play

\u2297Not cuddly
\u2297Echolalia
\u2297Crying tantrums
\u2297Head towards anything
\u2297Inanimate object attachment
\u2297Loves to spin objects / self
\u2297Difficulty interacting with others
\u2297Wants blocks
\u2297Acts as deaf
\u2297Resists normal teaching method / routine changes
\u2297No fear of danger
\u2297Insensitive to pain
\u2297No eye contact
\u2297Giggling or silly laughing

Nursing Interventions
\u2297Environment: safe & consistent
\u2297
Encourage the client to participate for self-care
\u2297
Speak calmly when giving instructions
\u2297
Use simple words or phrases
\u2297
Repeat instructions as necessary.
\u2297Haloperidol - symptomatic relief for hyperactivity, stereotypical and self-destructive behavior
MENTAL RETARDATION
\u2297
Not a mental illness.
\u2297
Problem of inadequate mental functioning.
\u2297
Onset: 18
\u2297
IQ below 70
\u2297
Manifested by sub-average intellectual functioning in:
\u2297
Communication
Self-care
Psychiatric Nursing: Lecture Aid
Page 22

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