PSYCHIATRIC NURSING 10.

Monitor vital signs and administer

prescribed anxiolytics
COACHING WITH ICONS (April 26, 2023)
Claiming that RN MAY 2023 one take cutie
Anxiety Disorders: Psychopharmacotherapy

100% MAC Vi Et Animo 1. Anxiolytics- potentiates GABA

“Whatever you ask for in prayer, believe that you have received Benzodiazepines- Aprazolam (Xanax)
it, and it will be yours.” – Mark 11:24
o Take on short term basis because it
Anxiety Disorders: Types and Assessment
causes dependence
1. Specific phobia o Taper the dose gradually to avoid
 fearful or anxious about or convulsion, headache tremor, vomiting,
avoidant of objects or situations cramping, and sweating
2. Social Anxiety Disorder (social phobia) o No alcohol, no caffeine
 Fearful or anxious about or
Side effects:
avoidant of social interactions
and situations that involved the o Drowsiness
possibility of being scrutinized o Hypotension
3. Panic Disorder o Confusion
 Recurrent unexpected panic o Headache
attacks and is persistently o Incontinence
concerned or worried about
o Fatigue
having more panic attacks
o Decreased coordination
 Panic Attacks- abrupt surges of
o Depression
intense fear or discomfort that
reach a peak within minutes o Double vision
accompanies by physical and/or o Urinary retention
cognitive symptoms 2. Anti-depressant
 Can be expected or unexpected o A companion of anxiety is depression
 Ataraxia- complete absence of o An anxious client eventually becomes
anxiety (alcoholic and antisocial depressed because of the incapacitating
personality disorders) effect of anxiety

Intervention: General Nursing Measures Obsessive Compulsive and Related Disorders

1. Recognize the anxiety 1. Obsessive Compulsive Disorder

2. Establish trust o Presence of obsession, compulsion or
3. Safety both causing dysfunction
4. Do not criticize coping mechanisms 2. Body Dysmorphic Disorders
5. Do not force to go to situations that o Preoccupation with perceived defects or
provoke anxiety flaws in physical appearance that are not
6. Environmental modification by setting observable or appear only slight to
limits or limiting interactions with others and by repetitive behaviors
others (mirror checking etc) or mental acts
7. Provide creative outlets ( comparing appearance to others ) in
8. Monitor for signs of impending response to the appearance concern
destructive behavior 3. Hoarding Disorder
9. Relaxation exercises
 o Persistent difficulty discarding or paring
with possessions, regardless of their
actual value, as a result of a strong
perceived need to save the items and to
distress associated with discarding them
4. Trichotillomania (hair pulling
disorder)
o Recurrent pulling out of one’s hair
resulting in hair loss and repeated
attempts to decrease or stop hair pulling
5. Excoriation (skin picking) disorder
o Recurrent picking of one’s skin resulting
in skin lesions and repeated attempts to
decrease or stop skin picking
Analysis: Psychopathology
1. Biologic Bases
o Genetic transmission
o Serotonin dysregulation
2. Psychodynamic Bases
o Anal phase- anal habit training- rigid
o Undoing- defense mechanism
II. Obsessive Compulsive and Related
Disorders
NANDA Nursing Diagnosis:
o Anxiety
o Fear
o Ineffective Coping
Key Nursing Interventions
1. Ensure that basic needs of food, rest,
and grooming are met
2. Provide time to perform rituals
3. Explain expectations, routines and
changes
4. Empathy
III. Trauma and Stressor Related Disorders
o Individuals exposure to a traumatic or
stressful event leads to psychological
distress like:
o Anhedonia and dysphoric symptoms
o Angry and aggressive symptoms
o Dissociative symptoms- rather than
anxiety or fear-based
1. Reactive Attachment Disorder
o Absent or underdeveloped attachment
between child and the caregiver
o Depressive symptoms and withdrawn
behavior
o Evident before age 5 years
o Development age of atleast 9 months
2. Disinhibited Social Engagement
o Culturally inappropriate, overly familiar
behavior with strangers
o Common etiology-social neglect
o Developmental age atleast 9 months
3. Posttraumatic Stress Disorder
Criteria A: Exposure- to actual or threatened
death, serious injury or sexual violence
Criteria B: Intrusion symptoms beginning after
the traumatic event
a) Intrusive- distressing memories of the
traumatic event are expressed
b) Recurrent distressing dreams
c) Dissociative reactions (ex: flashbacks)
d) Intense or prolonged psychological
distress
Criteria C: Persistent Avoidance- stimuli
associated with traumatic event
Criteria D: Negative Alteration in cognition
and mood associated with the traumatic event
like inability to remember an important aspect of
the traumatic event
4. Acute Stress Reaction
Criteria:
a) Intrusion symptoms
b) Negative mood
c) Dissociative symptoms
d) Avoidance symptoms
e) Arousal symptoms
Duration: 3 days to 1 month with dysfunctions
5. Adjustment Disorder
 o Development of emotional or behavioral
symptoms in response to an identifiable
stressor occurring withing 3 months of
onset of stressor
o Presence of PTSD criteria A only
(exposure)
Analysis: psychopathology
1. Biological Bases- genetic transmission
o Increased noradrenergic and
dopaminergic system activity and
decreased serotonergic activity
2. Psychodynamic bases
o Exposure to a traumatic event
o Temperamental= dissociation
NANDA Nursing Diagnosis:
o Ineffective Coping
Key Nursing Interventions:
1. Be nonjudgmental and honest, empathy,
support, acknowledge any unfairness or
injustices related to trauma
2. Help patients to recognize the
connections between trauma experience
and their current feelings, behaviors and
problems
3. Encourage safe verbalization of feelings
especially anger
4. Encourage adaptive coping strategies,
exercises
5. Faciliatte progressive review of the
trauma and its consequences
6. Encourage patient to establish or re-
establish relationships
Psychotherapeutic Strategy:
o Covert rehearsal
Psychopharmacotherapy:
o Anti-depressant
IV. Dissociative Disorders
o Disruption of and/or discontinuity in the
normal integration of consciousness,
memory, identity, emotion, perception,
body presentation, motor control and
behavior
o Etiology: Frequently found in the
aftermath of trauma
Analysis: Psychopathology
o Pyschodynamic bases= repression =
dissociation (walling or splitting of
some areas of personality or extreme
stress)
1. Depersonalization/derealization
disorder
o Clinically significant persistent or
recurrent depersonalization and/or
derealization with intact reality testing
o Selective (specific aspect of an event)
o Generalized (identity and life history)
2. Dissociative amnesia
o Inability to recall autobiographical
information that is inconsistent with
normal forgetting
3. Dissociative Identity Disorder
o Presence of two or more distinct
personalities states or an experience of
possession and recurrent episodes of
amnesia
NANDA Nursing Diagnoses:
o Sensory Perceptual Disturbances
o Sleep Pattern Disturbance
o Social Interaction Impaired
o Social Isolation
o Altered Thought Process
o Violence potential for self-directed or
directed to others
Key Nursing Interventions
1. Trust and support
2. Rule out organic cause
3. Gather data regarding feelings, conflicts
or situations experienced prior to
amnesia or fugue
4. Safety
 5. Treatment goal: Ultimately integrate the
personalities or memories, if possible so
they can survive or coexist in the
original personality
Psychopharmacotherapy: Prozac
V. Somatic Symptom and related Disorders
Common Feature: the prominence of a somatic
symptoms associated with significant distress or
impairment
1. Somatic Symptoms Disorder
(somatization Disorder)
o Excessive thoughts, feelings or behavior
related to the multiple, recurrent,
distressing somatic symptoms (usually
pain) causing dysfunctions for more
than 6 months
o Doctors’ shopper
o Suicide risk
2. Illness Anxiety Disorder
(Hypochondriasis)
o Preoccupation with having or acquiring
a serious illness for at least 6 months
o Extensive worries about health no or
minimal somatic symptoms
3. Conversion Disorder (functional
Neurological Symptoms Disorder)
o Altered voluntary motor or sensory
functions causing clinically significant
distress
o With disability to comparable medical
disease
4. Factitious Disorder
o Falsification of physical or
psychological signs and symptoms or
induction of injury or disease associated
with identified deception
Analysis: Psychopathology
1. Biological Basis= Genetic
2. Psychodynamic bases
o Stressful life events, developmental-
learning personality and socio-cultural
factors
Defense Mechanisms:
o Repression
o Denial
o Displacement
o Somatization
NANDA Nursing Diagnosis
o Pain, chronic
o Post-trauma response
o Powerlessness
o Role performance altered
o Interrupted family process
Key Nursing Interventions
o Matter-of-fact, caring approach for
physical symptoms
o Allow verbalization of feelings and ask
to describe feelings
o Assist with developing more appropriate
ways to verbalize feelings and needs
o Positive reinforcement to increase non-
complaining behavior. Set limits by
withdrawing attention from patients
when they focus on physical complaints
V. Feeding and eating Disorders
o Persistent disturbance or eating related
behavior that results in the altered
consumption or absorption of food
causing dysfunctions
1. Pica
o Eating of nonnutritive, non-food
substance for more 1 month
2. Rumination Disorder
o Repeated regurgitation of food atleast 1
month
3. Avoidant/restrictive food intake
o Persistent failure to meet appropriate
nutritional and/or energy needs
4. Anorexia Nervosa
 o Persistent energy intake restrictions, 3. Low or high in appetite, weight loss,
intense fear of gaining weight or sexual libido
becoming fat or persistent behavior that 4. Hypersomnia or insomnia
interfered with weight gain and a
disturbance in self-perceived weight or
shape
5. Bulimia Nervosa
o Recurrent episodes of binge eating and
inappropriate compensatory behaviors to
prevent weight gain
o Self-evaluation that is unduly influenced
by body shape and weight
o Bing eating and purge cycle at least
once a week for 3 months
o Common at night

Analysis: Pyschopathology
1. Biological: increased serotonin activity,
may lead to food restrictions
2. Sociocultural factors
3. Family Factors
4. Cognitive and Behavioral factors
5. Psychodynamics
o Regression to a prepubertal state,
attempt to reduce the control of an
overcontrolling maternal figure
Key Nursing Interventions
1. Monitor intake, output and activity
2. Weigh daily
3. Observe signs of purging
4. Plan for dietitian to meet with patients to
discuss information nutrition and
healthy diet
5. Monitor electrolyte status
6. Empathy

VI. Depressive Disorders

1. Major Depressive Disorder
Criteria:
1. Depressed Mood most of the day
2. Marked diminished interest or pleasure