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NURSING PSYCH COMPREHENSIVE TABLE

NURSING PSYCH COMPREHENSIVE TABLE

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Published by AILENLEIVA
STILL A WORK IN PROGRESS...THOUGHT YOU MAY BENEFIT FROM IT
STILL A WORK IN PROGRESS...THOUGHT YOU MAY BENEFIT FROM IT

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Published by: AILENLEIVA on Dec 05, 2008
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04/26/2013

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SUMMARY OF PSYCHIATRIC DISORDERSANXIETY DISORDERS
CONCEPT
Individuals experience a degree of anxiety that is so high that it interferes with personal, occupational, or social functioning. ANXIETY DISORDERS are
the most commonform of psychiatric Disorder
in the USA.
TYPES/SUBTYPESPANIC DISORDERGENERALIZED ANXIETYDISORDER (GAD)PHOBIASOBSESSIVE-COMPULSIVEDISORDER (OCD)POST-TRAUMATIC STRESS DIRORDER (PTSD)FEATURES1.The patient experiences
recurrent panicattacks
2. Episodes typically last 15-30 minutes3. Four or more of the following symptomsare present:-
Palpitations, SOB,
Choking or SmotheringSensation,
Chest Pain,
 Nausea, Feelings of Depersonalization,
Fear of Dying
, Chills or Hot Flashes, Fear of going crazy, Decreased perceptual and cognitive abilities4. Pt may experience Changes in Behavior and/or Persistent Worries about when the nextattack will occur 5. May experience Agoraphobia due to fear of  being in places where previous panic attacksoccurred.*
MAY BE CONFUSED WITH A HEARTATTACK *DOES NOT NECESSARILY FOLLOWS ANSTRESSFUL, IDENTIFIABLE EVENT
1. More than 6 months of uncontrollable, excessive, unrealisticworries (inadequacy in interpersonalrelationships, job responsibilities,finances, health of family members,household chores, and lateness for appointments)2. GAD causes significant impairmentin one or more areas of functioning.3. At least 3 of the following symptomsare present:-Fatigue-Restlessness-Inability to Concentrate-Irritability-Muscle Tension-Sleep Disturbances4. Characterized by Remissions andexacerbations (no acute anxiety attack)1. The client fears aspecific object or situationto an unreasonable level.Phobias include:-SOCIAL PHOBIA-AGORAPHOBIA-SPECIFIC PHOBIAS:-Fear of specific objects(snakes, spiders,strangers)-Fear of specificexperiences (flying, beingin the dark, riding anelevator, being in anenclosed space)1. The client has intrusivethoughts of unrealisticobsessions and tries tocontrol these thoughts withcompulsive behaviors,which are repetitive – ritualistic--Clients who engage inconstant ritualistic behaviorsmay have difficulty meetingself-care needs-If ritualsinclude constanthandwashing or cleaning,skin damage and infectionmay occur.1. Exposure to a traumatic event causes intense fear,horror, flashbacks, feelings of detachment andforeboding, restricted affect, and impairment for longer than 1 month after the event. Symptoms may last for years.-ACUTE PTSD: Symptoms last less than 3 months-CHRONIC PTSD: Symptoms last more than 3 monthsSYMPTOMS:-Recurrent, intrusive recollection of event-Dreams or images-Reliving through flashbacks, illusions, or hallucinations-Irritability, difficulty with concentration, sleepdisturbances, avoidance of stimuli associated withtrauma, inability to show feelings.(it differs from Acute Stress Disorder in that ASD occursafter exposure to a traumatic event, causing numbing,detachment and amnesia about the event for NOT MOREthan 4 weeks following the event, with symptoms lastingfrom 2 days to 4 weeks)ASSESSMENT
1.
Perform a thorough Physical and Neurological examination to help determine if anxiety is primary or is secondary to another psychiatric disorder, a medical condition, or substance use.
2.
Assess Risk for Suicide
3.
Perform psychosocial assessment (To help client identify the problem to be addressed by counseling (stressful marriage, recent loss, stressful job or school situation)4.Assess coping mechanisms5.Use a standardized assessment scale, such as Hamilton Rating Scale for Anxiety.EXPECTEDOUTCOMES
1.
Client uses coping mechanisms to prevent panic anxiety when stressful situations occur.
2.
Client verbalizes acceptance of life situations over which he or she has no control3.The client is able to recognize signs of anxiety and intervene to prevent panic levelsINTERVENTIONSIn General, Interventions for Anxiety disorders attempt to:1.Reduce Anxiety2.Increase Self Esteem3.Increase Reality Testing4.Enhance Coping Mechanisms5.Instill Hope6.Relaxation Therapy1.Ensure Safety
2.
Stay with the client and provide support (Provide reassurance, use therapeutic communication skills, useopen-ended questions, encourage client to verbalize feelings)
3.
Use relaxation breathing techniques as needed4.Reduce environmental stimuli5.Encourage physical activity like walking6.Administer medications as prescribed (SSRIs, TCAs, MAOIs, Benzodiazepines (anxiolytics), Beta Blockers,Mood stabilizers)7.Instill hope (but avoid false reassurance)8.Enhance Self Esteem by encouraging positive statements about self and discussion of past achievements.9.Postpone teaching until acute anxiety subsides: clients with panic attack or severe anxiety are unable to
 
concentrate or learn.10.Teach to limit nicotine and caffeine11.Promote sleep with comfort measuresMEDICATIONS*SSRIsare First linefor all anxietyDisorders exceptAAA (see bellow)*Benzodiazepinesshouldn’t be used totreat GAD: this is achronic disease and benzos should only be used for short periods of time, likein Acute AnxietyAttack (AAA)PANIC DISORDER:
1.SSRIs2.Benzodiazepines
3.TCAs4.MAOIs5.Beta Blockers6.Depakote (Valproic Acid)
+Cognitive-BehavioralTherapy
GENERALIZED ANXIETYDISORDER (GAD)
1.SSRIs
2.TCAS3.Buspirone (Buspar)4.SNRIs5.Depakote (Valproic Acid)
+Cognitive-Behavioral Therapy*No Benzodiazepines
PHOBIAS
1.SSRIs2.Benzodiazepines
3.Buspirone(Buspar)4.Beta Blockers5.Gabapentin(Neurontin)
+Cognitive-BehavioralTherapy
OBSESSIVE-COMPULSIVEDISORDER (OCD)
1.
SSRIs
(EspeciallyLuvox)2.TCAs (EspeciallyAnafranil)
+BehavioralTherapy
POST-TRAUMATIC STRESS DISORDER (PTSD)
1.SSRIs
2.TCAs
3.Benzodiazepines
4.SNRIs5.MAOIs6.Beta-Blockers7.Carbamazepine (Tegretol)
+-Cognitive-Behavioral-Family-Group Therapy with survivors
MISC
Defense mechanisms:
Phobia: DisplacementCompulsion: UndoingObsession: Reaction-Formation/ IntellectualizationPTSD: Isolation/ Repression Nursing Diagnosis:-Risk for Suicide (=Risk for self-directed violence)-Risk for others-directed violence-Risk for injury to self or others-Anxiety (moderate, severe)-Ineffective role performance-Ineffective coping-Disturbed thought process-Disturbed Sleep Pattern-Self-care deficit
FOR ACUTE ANXIETY ATTACK (AAA)First Line of Treatment:
Benzodiazepines
(the only time this group is firstline for anxiety disorders)
 
MOOD DISORDERS (AFFECTIVE DISORDERS)
TYPES/SUBTYPESDEPRESSIONBIPOLAR DISORDEMAJOR DEPRESSIVE DISORDER (MDD) DYSTHYMIC DISORDER (DD) OR DYSTHYMIA
Bipolar disorders are mood disorders with recurrent episodes of depressionand mania. Phases vary depending onthe type of bipolar disorder.
Bipolar disorders usually emerge in late adolescence/early adulthood, but can be diagnosed in the school-age aswell.
TYPES OF BIPOLAR DISORDERS
:
BIPOLAR 
I: At least 1 episode of 
Mania
alternating w/
Major Depression
.
BIPOLAR II:
 
Hypomanic
episodes alternating w/
Major Depressive
ones.
CYCLOTHYMIA:
At least 2 years of alternating episodes of 
Hypomanic
Episodes alternating w/
Minor
 
Depressiv
eepisodes (
dysthymia
)
BEHAVIORSshown with Bipolar Disorders include
:MANIA: Abnormally elevated mood, also described as expansive or irritable.HYPOMANIA: A less severe episode of  mania that lasts at least 4 days accompanied by 3 or 4 symptoms of mania.MIXED EPISODE: A manic episode and an episode of major depression experienced by the client simultaneously. Marked impairment in functioning and may require admission to prevent self-harm or others-directed violence.RAPID CYCLING: Four or more episodes of acute mania within 1 year  ***BIPOLAR DISORDER IS ASSOCIATED WITH THE HIGHEST RATE OF SUICIDE OF ANY PSYCHIATRICDISORDERS.CONCEPT
A
single, recurrent, or chronic
episode (s)of depression resulting in a
significantchange
in the client’s normal functioning(social, occupational, self-care)accompanied by at least
5
specificsymptoms.
These symptoms must happen almost
everyday
, last
most of the day
, and occur continuously for a minimum of 
2 years
.
A milder form of depression thatusually has an
early onset
, such aschildhood or adolescence(
Chronic Depressed Mood)
ITLASTS:
More than 1 year (for Childrenand Adolescents)
More than 2 years (For Adults)
Contains at least
3
symptoms of depression, and may, later in life, become Major DepressiveDisorder 

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