N212: Health Differences Across Lifespan: Mental Health: Unit 1

Eating disorder: Bulimia:

Binge eating followed by compensatory behaviors to rid the body of excessive calories. The binge eating is done in secret. Following the binging the mood is self-degrading and depression.

Name some negative symptoms of a patient with schizophrenia?

Bland or flat affects Apathy Deteriorated appearance Social isolation Waxy flexibility Pacing & rocking Regression

Substance--related and addictive disorders: Hallucinogens:

Cause the user to perceive things differently than they actually are. Effects: May cause psychosis, brain damage, death, possible hypertensive crisis or cardiovascular accident, respiratory arrest, hyperthermia, and/or seizures. Treatments: Room with low stimuli; stay with patient; speak slowly in a clear low voice; diazepam or choral hydrate for extreme anxiety or tension; acidify urine; haloperidol for severe behavioral disturbance.

Hypochondriasis:

Changes that seem to be related to an active disease process. These patients are resistant to doctors. Education and information can temporarily lessen the disease fears.

Schizophrenia spectrum: Schizoaffective disorder:

Client may have symptoms of suicidal ideation, euphoria, hyperactivity. Diagnosis is confirmed with hallucinations or delusions last longer than 2 weeks. This is a better diagnosis than Schizophrenia.

Substance--related and addictive disorders: Stimulants:

Cocaine Crack cocaine Amphetamines

Jean Piaget (1896-1980):

Cognitive Development Theory Theorized how humans think, learn to reason, and exercise judgment has an intellectual organization Theorized each stage lay the foundation for the next stage

Persons who demonstrate self-destructive behavior: Eating disorders:

Common symptom is an eating problem; such as; binge, purging, decrease body weight. Also excessive exercise along with previous symptoms.

What is neurotransmission?

Concerned with the levels of biogenic amines. Mental disorders can be related to an excess or lacking of neurotransmitters.

How to determine the severity of a bulimia patient?

Mild: 1-3 episodes of inappropriate compensatory behaviors per week. Moderate: 4-7 episodes per week. Severe: 8-13 episodes per week. Extreme: 14 or more episodes per week.

What are the BMI results of a patient with anorexia nervosa in a mild, moderate, severe, and extreme state?

Mild: Greater than or equal to 17 kg/m Moderate: 16-16.99 kg/m Severe: 15-15.99 kg/m Extreme: Less than 15kg/m

Lawrence Kohlberg: Moral Development Theory:

* Level 1- Pre-convention: Up to age 9: ---Stage 1- Punish and Obey ---Stage 2- Self-interest orientation * Level 2- Conventional: Age 9 to adolescence: ---Stage 3- Good boy/Nice girl ---Stage 4- Society Maintenance * Level 3- Post-Conventional: Adulthood: ---Stage 5-Social Contract ---Stage 6- Universal Ethics

What are the major concepts of Peplau's interpersonal theory?

Growth, development, communication, & roles

Piaget's Cognitive Development Theory:

* Sensorimotor: 0-2 years: The child builds a set of concepts about reality based on physical interactions and experiences without the use of symbols. * Preoperational: 2-7 years: The child needs concrete physical situations in order to conceptualize. Abstraction isn't in use. * Concrete Operations: 7-11 years: The child begins a logical and systematic manipulation of symbols in relation to concrete objects. Some abstract problem solving is possible, such as using numbers to solve mathematic equations rather than just using objects. * Formal Operations: 11 years to adult: The logical use of symbols is related to abstract concepts, and conceptual reasoning is possible.

What are the 4 phases of the interpersonal process of Hildegard Peplau?

1. Orientation 2. Identification 3. Working 4. Resolution

Name the order for Maslow's hierarchy of needs?

1. Physiological - Basic needs: Food, water, air, sleep 2. Safety & Security - Avoiding harm, order 3. Love & Belonging 4. Self Actualization

What are 3 useful tools for nurses when communicating with mental health patients?

1. Use of silence - encouraging the person to talk by waiting for answers. 2. Active listening - observing the clients nonverbal behavior. 3. Clarifying techniques - restating what the client states or paraphrasing what the client states in fewer words.

Major-Depressive Disorder:

A Mood Disorder. When a person has a lost of interest in life. A disruption in sleep and eating patterns, social isolation, feelings of worthlessness. Impaired social & occupational functioning exists for at least 2 weeks.

Somatic: Depersonalization:

A chronic disorder that symptoms begin in adolescence or early adulthood. Marked by feeling of detachment or distance from one's own experience, body, or self. Recurrent. Feeling out of control of one's actions and movements. Frequently and severely interrupts everyday functioning and experiences. Can be so severe that the external world seems unreal or distorted.

Bipolar disorder: Cyclothymic:

A chronic mood disturbance lasting 2 years. Periods of elevated mood and periods of depressed mood. The symptoms are noticed for more than 2 months.

Bipolar disorder: Hypomania:

A milder degree of mania.

Bipolar Disorder:

A mood disorder that a person will experience episodes of extreme depression and elation. The patient will experience mania, hypomania, distractibility, and flight of ideas.

Seasonal affective disorder:

A mood disorder that occurs during the fall and winter months. This doesn't include people who would normally have a reason for a depression onset; like loss of work during that time frame. Full remission occurs after those winter months have passed.

Post-traumatic Stress Disorder: PTSD:

A person can experience this after being exposed to extremely dangerous or life-threating situation. People at risk are; rape victims, child sexual abuse, battered women. Symptoms must be present for more than 1 month and cause significant interference with functioning to be diagnosed.

Obsessive-Compulsive Disorder:

A responsive disorder. These are unwanted, repetitive thoughts that can lead to anxiety, fear, or guilt. That is the obsessive part. The compulsive behavior are thoughts used to decrease the anxiety that the person is feeling.

Mental Health:

A state of emotional & psychological well-being in which an individual is able to use his or her cognitive & emotional capabilities, function in society, & meet the ordinary demands of everyday life.

Name some problems that a child with FAS can experience?

Abnormal facial features Small head size Shorter in size than normal Hyperactivity Difficulty paying attention Speech delays Sleep & sucking problems

Substance--related and addictive disorders: Alcohol:

About half of Americans aged 12 years & older report being current drinkers (Substance Abuse and Mental Health Services Administration [SAMHSA], 2013). Most abused drug. Contributes to other illnesses like; heart disease, cancer and stroke.

Mood disorders:

Also referred to as affective disorders can be defines as a pattern of mood episodes that result in difficulty functioning in family, work, and social affairs.

What are 2 Dissociative Disorders?

Amnesia & Dissociate Identity Disorder.

Dissociative Disorders:

An alteration in conscious awareness of behavior, affect, thoughts and memories. Common symptoms are day dreaming and lapses in attention.

Bipolar disorder: Mania:

An alteration in mood with feelings of elation, inflated self-esteem, grandiosity, hyperactivity and accelerated speaking.

What is an affective response?

An emotional reaction to anxiety. A response to grief, loss or situational crisis.

Altered Thought Process: Hallucinations:

An occurrence of the senses without stimulation. Early signs of symptoms can be mental disorders. Occur during manic phases, substance abuse, bipolar disorder, depression. The person experiencing these believe they are very real.

Dysthymia:

Another type of mood disorder that is described as sad or "down in the dumps." The patient experiences chronic fatigue and difficulty making decisions. The symptoms observed for 2 years. Children and adolescents symptoms observed for 1 year.

Which disorder is more common in males?

Antisocial behaviors.

Anxiety Response:

Anxiety can be expressed directly through physiological and behavioral changes or indirectly through cognitive and affective responses.

Mental Illness:

Any of various conditions characterized by impairment of an individual's normal cognitive, emotional, or behavioral functioning, & caused by social, psychological, biochemical, genetic, or other factors; like trauma or infections. Also called emotional illness, mental disease, mental disorders.

Altered Thought Process: Examples:

Autism, paranoid behavior, Wernicke-Korsakoff syndrome; shrunken brain post alcoholism, and Huntington's chorea; uncoordinated movements genetically inheritied.

When the nurse notices a medication that treats the positive symptoms of the patient with schizophrenia. What are some positive symptoms?

Delusions Paranoia Magical thinking Hallucinations Concrete thinking Clang associations - rhyming words

What are 4 affective responses to grief?

Denial, anger, guilt, and withdrawal.

What is a nursing diagnosis for Schizophrenia?

Disturbed thought processes evidenced by delusional thinking and suspiciousness.

Which disorder is more common in women?

Eating disorders.

Central Nervous System StimulantsCrack/Cocaine and Amphetamines:

Effects: Respiratory distress Ataxia Hyperpyrexia Convulsions Myocardial infarction Death Treatment: Antipsychotics Medical and nursing management of hyperpyrexia, convulsions, respiratory distress, and/or cardiovascular shock.

Name some client outcomes for a nursing diagnosis of Social isolation.

Give a specific time frame. Identify feelings of isolation Practice social and communication skills needed to interact with others Set and meet goals on initiating interactions with others. Describe feelings of self-worth

Schizophrenia spectrum and other psychotic disorders: Delusional:

False personal beliefs, inconsistent with intelligence. Sub divided: Persecution, Grandeur, Reference, Control or Influence, Somatic. Is characterized by the individual experiencing these for at least 1 month.

The nurse will do a focused assessment related to signs and symptoms of schizophrenia. What will the nurse assess for with hallucinations?

False sensory perceptions involving: Auditory Visual Tactile Gustatory Olfactory

How many symptoms must be present for a patient to be diagnosed with Major Depressive Disorder? What are the symptoms:

Five symptoms must be present. 1. Depressed mood most of the day. 2. Diminished interest in all activities. 3. Significant weight loss. 4. Insomnia. 5. Psychomotor agitation. 6. Fatigue 7. Feelings of worthlessness. 8. Recurrent thoughts of death.

What are circadian rhythms?

Fluctuations of physiological factors of a 24 hour time span. Examples: Temp, energy, sleep, arousal, appetite, hormones.

Psychoanalytic Theory: Sigmund Freud:

Freud believed an individual's basic character is formed by the age of 5, and includes these components: Id: Pleasure principle. Ego: Mediator that promotes well-being and survival. Superego: Ego Ideal. Moral guardian.

What are some symptoms of anorexia nervosa?

Gross distortion of body image Preoccupied with food Refusal to eat

Schizophrenia spectrum: Substance/medication induced:

Hallucinations and delusions are d/t substance intoxication or withdrawal or medication. H&P, lab, and physical assessment help to determine symptoms of substance intoxication or exposure to medication.

Who is the mother of Psychiatric nursing?

Hildegard Peplau

Abraham Maslow is one of the founders of?

Humanistic psychology. He developed a theory of human needs arranged in hierarchical order, under the assumption that basic needs must be met before higher needs can be achieved. The highest human need, is self-actualization, in which a person is moving in the direction of gaining fulfillment and achieving highest potential.

The patient with possible schizophrenia is told that his/her mother has died and begins to laugh. What type of affect is this patient demonstrating?

Inappropriate affect. The patients emotions are not the same as the situation.

Substance--related and addictive disorders: Inhalants:

Include a wide variety of breathable substances that produce mind-altering results and effects. Examples of inhalants include Toluene, plastic cement, paint, gasoline, paint thinners, hair sprays and various anesthetic gases. Effects: Damage to the nervous system, possible polyneuropathy, and myelopathy. Treatment: support affected systems. Neurological symptom may respond to vitamin B12 and folate.

NonVerbal communication:

Includes tone of voice, physical appearance, facial expressions, body posture, amount of eye contact, eye cast, hand gestures, sighs, fidgeting, yawning, etc.

Interpersonal Theory: Harry Stack Sullivan:

Infancy (Birth-18 mo): Gratification of needs Childhood (18 mo-6 yrs): Delayed gratification Juvenile (6-9 yrs): Formation of peer group Preadolescence (9-12 yrs): Developing relationships within same gender Early Adolescence (12-14 yrs): Identity Late Adolescence (14-21 yrs): Forming lasting, intimate relationships

Erikson: Psychosocial Development:

Infancy: 0-1 year: Trust vs. Distrust: Virtue: Hope Toddler: 2-3 years: Autonomy vs. Shame & Doubt: Virtue: Will Preschool: 4-5 Years: Initiative vs. Guilt: Virtue: Purpose Grade-school: 6-11 years: Industry vs. Inferiority: Virtue: Competence Adolescence: 12-18 years: Identity vs. Role Confusion: Virtue: Fidelity Young Adult: Intimacy vs. Isolation: Virtue: Love Middle Adult: Generativity vs. Stagnation: Virtue: Care Late Adult: Integrity vs. Despair: Virtue: Wisdom

What are some symptoms of Hypomania? How long do the symptoms last?

Inflated self-esteem Decreased sleep More talkative Flight of ideas Increase in goal-directed activity Symptoms lasting 4 consecutive days and appearing most of the day.

Harry Stack Sullivan (1892-1949):

Interpersonal Theory According to Sullivan, individual behavior and personality development are the direct result of interpersonal relationships.

Somatoform disorders:

Involve physical symptoms with no underlying cause.

Somatoform disorder: Factitious disorder:

Involves conscious, intentional feigning of physical or psychological symptoms (Black & Andereasen, 2011). Pretend to be ill to get emotional care and support. Also identified with Munchausen syndrome, symptoms can be a combination of physical & psychological or only one or the other.

Cultural communication barriers:

It is becoming increasingly important for nurses to be aware of diversity and the cultural differences in verbal and nonverbal communication. A lack of awareness in this area can lead to inaccurate assessments and inappropriate interventions.

Schizophrenia spectrum: Schizophreniform Disorder:

Like schizophrenia, but symptoms last less than 6 months. Diagnosis can change if lasting longer than 6 months. Good prognosis.

Somatoform Dissociative Amnesia:

Memory loss related to a traumatic event. Most common is localized amnesia; memory loss during a specific time frame related to trauma.

Altered Thought Process: Delusions:

Misunderstanding reality. The person believes this and will not change their mind by logical reasoning or evidence. These can fluctuate over time or may last 1 week or months. These occur with patients diagnosed with schizophrenia, bipolar disorder, OCD, and dementia.

Lawrence Kohlberg (1927-1987):

Moral Development Theory Kohlberg's theory of moral development outlined six stages within three different levels. Kohlberg extended Piaget's theory, proposing that moral development is a continual process that occurs throughout the lifespan.

Schizophrenia spectrum: Persecutory:

Most common type. Individuals believe they are being plotted against, followed, or drugged. May obsess over situation. Lack of satisfaction can progress to violence.

Dissociative identity disorder: DID:

Most severe case of dissociative disorders. A person experiencing 2 different personalities. Each personality has its own memory, value structure, behavioral pattern and affective expression. The patient suffers an alteration in awareness of time.

What is the neurotransmitter primes nervous system for flight or fight?

Norepinephrine. Also functions as; alertness, ability to focus attention, ability to be oriented.

Depression disorders: Postpartum depression:

Occurs in some women following birth. Can begin with 48 hours after delivery. Last about 2 weeks. Symptoms: Depressed mood Irritability Loss of appetite Sleep disturbances Loss of libido

Altered Thought Processes:

Patterns of thought that are "loose"; topics and/or ideas follow one another with far less order than one expects in everyday speech (Frisch & Frisch, 1998). Disordered thought is a major characteristic of schizophrenia which often evolves slowly over years and in early stages may be very subtle.

Personality disorders: Narcissistic:

Perceives self as powerful & important, arrogant. Exaggerate feelings of self importance. Needs attention & admiration. Preoccupied with power & appearance. Exploits others. Verbally: Talks about self & does whatever to draw attention to themselves. Nonverbally: Inattentive, self-centered.

Name some complications of chronic abuse of alcohol?

Peripheral neuropathy Alcoholic myopathy Wernicke's encephalopathy Korsakoff's psychosis Gastritis Pancreatitis Fetal Alcohol Syndrome

What are some symptoms of Dysthymia?

Poor appetite or overeating Insomnia Low energy or fatigue Low self-esteem Feeling hopelessness

Responsive Disorders:

Post-traumatic Stress Disorder, Panic disorder, obsessive-compulsive disorder, dissociative disorder.

Eating disorders: Anorexia Nervosa:

Prolonged loss of appetite. Typically found in females ages 12 to 30.

Erik Erikson (1902-1994):

Psychosocial Development Theory Erikson studied the influence of social processes on the development of the personality Individuals struggle with developmental crises throughout the life cycle Specific tasks in each stage must be completed for emotional growth to occur.

Personality disorders: Histrionic:

Seeks attention by overacting. Overly dramatic, seeks attention, tend to exaggerate. Chaotic relationship, demonstrate angry. Verbally: Loud, excitable, over reactive, attempts to draw attention. Non verbally: Immature, self-centered, dependent on attention from others, seductive, flirty.

What is the neurotransmitter that regulates sleep cycle and regulation of temp?

Serotonin. Also functions as; inhibition of activity, calmness, pain perception.

What does the female brain produce more of than the male brain?

Serotonine - 5-HT. This neurotransmitter inhibits aggressive behavior.

Who is the founder of psychoanalysis?

Sigmund Freud. His personality theory was based on inhibited sexual drives and inhibited aggression as the important elements that determine human behavior.

Who created the Intrapersonal theory?

Sigmund Freud. The theory focuses on behaviors, feelings,, thoughts and experiences of each person. The aspect is the importance of early experiences. The theory is based on personality being shaped by events that occur early in life vs. later in life.

Nursing diagnosis for a patient with Psychotic Disorders may be?

Social isolation. Behaviors that might be seen are: Withdrawal Sad dull affect Need-fear dilemma Preoccupation with own thoughts Uncommunicative Seeks to be alone

Genomics:

Study of all genes in their function, interaction, and a variety of disorders.

What can genes convey regarding mental disorders?

Susceptibility only. It's possible for people to have different doses of risk factors that predispose a person to mental illness.

Schizophrenia spectrum: Brief psychotic:

Symptoms appear suddenly and may or may not indicate a severe psychosocial stressor. Symptoms last at least 1 day to less than 1 month. The individual will have a return to the premorbid level of functioning.

Name some symptoms of Cyclothymic:

Symptoms lasting at least 2 years. Hypomanic and depressed moods. Symptoms are not caused by physiological effects of a substance. Ex. Drug or medication

What are some symptoms of a patient in a mania state? How long does the mania state last?

Symptoms: Decreased sleep Talkative Flight of ideas Distractibility Increase in goal directed activities Symptoms lasting 1 week being present during the day.

Substance disorders: CAGE Screening Tool:

The CAGE Screening Tool is one of the most commonly used alcohol abuse assessment screening tools. C: Have you ever felt that you should cut down on your drinking? A: Have people annoyed you by criticizing your drinking? G: Have you ever felt bad or guilty about your drinking? E: Have you ever taken a drink in the morning as an eye opener?

What are some symptoms of Bulimia?

The client will eat an amount of food that is larger than most individuals can consume. The client will have a lack of control during the episode. The binge eating and the compensatory behaviors happening at least once a week and lasting 3 months.

What is pharmacogenomics?

The customization of meds to maximize the effectiveness and minimize side effects.

What are some important characteristics of the nurse-patient relationship according to Peplau?

The focus is on the patient. The nurse participates in the care of the patient. The nurse has an awareness of role. The nurse will use theory. Nursing is primarily investigative.

Communication skills:

The goal of the nurse is to establish and maintain a therapeutic alliance in which the client will feel safe and hopeful that positive change is possible.

Panic disorder:

The highest level of anxiety. The physiological response is SOB, choking or smothering sensation, sweating, hypotensive, dizziness, chest pain, nausea. The patient must experience at least 4 symptoms to identify a panic attack.

Conversion disorder:

The presence of a paralysis for no reason. Can occur at any age. Sudden onset of symptoms following a stressful experience. Risk factors include: medical illness dissociative disorder personality disorder

Describe the positive symptom magical thinking?

The schizophrenic patient believes their thoughts or behaviors have control over certain situations and people.

What is genetic anticipation?

There may be an earlier onset of mental illness or an increase in the severity of the disorder.

The nurse will assess for depersonalization in a schizophrenic patient. What will the nurse look for?

Unstable self-identity. The patient will believe that an extremity is larger than the other. This is a positive symptom.