Rasmussen Mental Health - Exam 3

Agnosia

A client with agnosia does not recognize objects or understand what they're used for, so the nurse should give the client concrete directions.

Dissociative Disorders

A disturbance in the normally well-integrated continuum of consciousness, memory, identity, and perception. Dissociation is an unconscious defense mechanism to protect the individual against overwhelming anxiety related to past trauma, and ranges from minor to severe in presentation. Patients with dissociative disorders have intact reality testing, meaning they are not delusional or hallucinating.

Body Dysmorphic Disorder

A highly distressing and impairing disorder that ranges along the continuum from distressing to delusional severity. Patients with BDD usually have a normal appearance and the average age of onset is younger than 20 years. They have preoccupation with an imagined defective body part; obsessional thinking, compulsive behaviors and impairment of normal social activities related to academic or occupational functioning. Individuals with BDD are frequently concerned with the face, skin, genitalia, thighs, hips, and hair. There is a high risk of completed suicide.

Substance Dependence

A pattern of repeated use which usually results in tolerance, withdrawal, and compulsive drug taking behavior. Substances are taken in larger amounts and over longer periods than was intended. There is an effort to cut down or quit, most attempts are unsuccessful. Daily activities revolve around use of the drugs "next fix". Substance tolerance is the need for increased amounts of the substance to achieve the high.

Seclusion

A process in which a client is placed alone in a specially designed room for protection and close supervision.

Borderline Personality Disorder

A self-defeating cycle of behavior is a hallmark of borderline personality disorder, creating difficulties at work, social and family relationships. Individuals are inflexible and do not compromise easily. Socially inappropriate behavior is common, as is an unwillingness to change and learn new coping skills. Characteristics include emotional lability, unstable and frequent mood changes, chronic depression, feelings of anxiety, dysphonia, and irritability, emotional dysregulation, feelings of panic and fury. Often self-mutilation and suicide-prone behavior.

Domestic Violence

A woman or man who is a victim of domestic violence often does not seek help or speak about the abuse. Identifying the problem by a health care worker is the first step in helping this patient get help.

The difference between Anger and Aggression is Intent

Aggression is harsh physical or verbal action that reflects rage, hostility, and potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others.

Alcohol withdrawl and intoxication

Alcohol intoxication: occurs at blood alcohol levels from 100 to 200 mg/dL Alcohol withdrawal: occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use Carmen's last drink was 3 hours ago (6:30am), when is she most likely to withdrawl? -- 10:30am (4-12 hours)

Alcohol Withdrawal

Anorexia (nausea/vomiting) anxiety, easily startled, hyper-alertness, hypertension, insomnia, irritability, jerky movements, hallucinations, illusions, delusions, vivid nightmares, reports of shaking inside, seizures (7-48 hrs), tachycardia and tremors. -Symptoms associated with the cessation of the substance Substance taken to relieve withdrawal symptoms

Cluster C Type Personality Disorders

Anxious and fearful - OCD , Avoidant, and Dependent.

Opioid Use Signs and Symptoms

Constricted pupils, decreased respirations, drowsiness, euphoria, hypotension, impairment of memory, judgement, and attention, psychomotor retardation, slurred speech.

Antisocial Personality Disorder

Deceit, manipulation, revenge and harm to other with an absence of remorse for hurting others. They do not adhere to traditional values or standards or societies rules.

Dementia Differentiation from Delirium

Dementia has a gradual onset with progressive deterioration, short and long term memory impaired eventually destroyed. Delirium has a sudden onset and can be resolved once underlying problem is fixed.

Alcohol Abuse Signs and Symptoms

Depression, hostility, suspiciousness, irritability, isolation, decreased inhibitions, decrease self esteem, denial that a problem exists.

CNS Stimulant Withdrawal

Depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating and chills— all signs of the body struggling to regain its normal chemical balance. This question is looking for safety first.

Malingering

Different from Factitious disorder because there is an external incentive such as missing work, evading criminal prosecution, obtaining financial gain. Symptoms stop as soon as they gain what they wanted.

Obsessive Compulsive Disorder

Difficulty expressing warm tender emotion, perfectionism, stubbornness, control issues, devotion to work. Overly conscientious, inflexible, detail oriented (won't focus on anything else), exclude leisure time, miserable, hoarding, rituals.

Medication treatment for Alcoholism

Disulfiram (Antabuse) -If they drink, it makes them extremely sick. So the negative experience keeps them away

CNS Stimulant Signs and Symptoms

Drowsiness, hypotension, memory impairment, attention impairment, judgement impairment, social or occupational functional impairment. Incoordination and unsteady gait, irritability, slurred speech.

Narcan

Early symptoms of narcotic withdrawal are flulike in nature. Seizures are more commonly seen in alcohol withdrawal syndrome. Narcotic antagonists such as naloxone quickly reverse CNS depression, but because the narcotics have a longer span of action than antagonists, the patient may lapse into unconsciousness or require respiratory support again. The remaining options are measures unrelated to naloxone use.

Conversion Disorder Nursing Interventions

Encourage independence in ADL's in a matter of fact manner.

Emotional Abuse

Examples of emotional abuse include having an adult demean a child's worth or frequently criticize or belittle the child. Demeaning a person's worth, frequent criticism. A nurse is a mandated reporter of real or suspected abuse in children, elderly and mentally disabled.

Anger

Feeling of annoyance that may be displaced on another person or object - anger is used to avoid anxiety and gives a feeling of power in situations.

Narcissistic Personality Disorder

Grandiosity, fantasies of power or brilliance, need to be admired, sense of entitlement, arrogant, patronizing, rude, overestimates self and underestimates others. Exploits others to meet their own needs. This behavior covers a fragile ego.

Substance abuse risk factors

Low self-esteem Frequent depression Passivity Inability to relax or defer gratification Inability to communicate effectively

Alcohol Withdrawal Delirium

Manifestations of alcohol withdrawal delirium: 48-72 after cessation and lasts 2-3 days. agitation, anorexia, anxiety, delirium, diaphoresis, disorientation w/ fluctuating levels of consciousness, fever, hallucinations, insomnia, tachycardia and hypertension.

Histrionic Personality Disorder

Manipulating others through their dramatic, charming, flamboyant and sexual/seductive behaviors. Excessively emotional behavior is an attempt to seek the kind of constant attention love and admiration they require.

Anorexia

May have lanugo, mottled, cool skin on the extremities, low blood pressure, pulse and temp, all consistent with malnourished and dehydrated state. They often have overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation with food and wear loose fitting clothes. Can be life threatening due to fluid and electrolyte imbalances , suicide, cardiomyopathy, and malnutrition.

Chemical Restraints

Medications given for the purpose of sedation to inhibit undesired behavior.

Anorexia Nursing Interventions

Milieu therapy, close supervision of the patient's eating, prevention of exercise, and purging. Monitoring at meal time and after to prevent purging and throwing away food. May need parenteral nutrition.

Narcan Nursing Interventions

Monitor the patient closely, monitor VS every 15 minutes, especially respirations. Muscle aches, abdominal cramps and gooseflesh are side effects of narcotic withdrawal.

Evidence of alcohol/drug tolerance

Need for markedly increased amounts Markedly diminished effects

Child Abuse

Nurse's legal responsibility. MUST REPORT Child Abuse in Florida. Each state has specific regulations for reporting child abuse that must be observed. The reporter does not need to be absolutely sure that abuse or neglect occurred, only that it is suspected. Speculation should not be documented, only the facts.

Alcoholic phases

Phase I. Prealcoholic phase: characterized by use of alcohol to relieve everyday stress and tensions of life Phase II. Early alcoholic phase: begins with blackouts: brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person Phase III. The crucial phase: person has lost control; physiological dependence clearly evident Phase IV. The chronic phase: characterized by emotional and physical disintegration; person is usually intoxicated more often than sober

Phencyclidine Piperidine PCP or angel dust Overdose

Possible hypertensive crisis or cardiovascular accident, respiratory arrest, hyperthermia, seizure. Nursing Interventions are administer diazepam (benzodiazepine) or Haloperidol may be used for severe behavioral disturbance.

Hypochondriasis or Illness Anxiety Disorder

Preoccupied with having or eventually developing a serious illness. May or may not present with somatic symptoms, and if they do, the symptoms are usually mild. High level of anxiety and alarm about their health lasting at least 6 months, and may either excessively check for problems or avoid medical care.

Re-feeding Syndrome

Re-feeding resulting in rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse.

All-or-Nothing Thinking

Reasoning is absolute and extreme, in mutually exclusive terms of black or white, good or bad. "If I have one Popsicle, I must eat five." "If I allow myself to gain weight, I'll blow up like a balloon."

Factitious Disorder Imposed On Self or Munchausen Syndrome

Refers to the deliberate fabrication of symptoms or self-injury, without obvious external reward or gain. The patient identifies himself/herself in a deceptive manner to others as sick or impaired. This disorder is further specified as a single episode or recurrent.

Abuse

Refers to the habitual use of a substance that falls outside of medical necessity or social acceptance and is used for the single purpose of altering one's mood, emotion, or state of consciousness.

Dissociative Amnesia

Related to a traumatic incident, and may be accompanied by a fugue where the patient flees from their normal life to another location and starts a new life. Gradually over time, memories of the original life may be triggered. Patients can become confused and embarrassed when the amnesia subsides and memory returns.

Memory Care

Reminiscing. Very common for older adults to reminisce about their pasts. Talking about the good old days can help them reduce feelings of loneliness and isolation.

Caregiver Fatigue

Respite care, support groups, assistance from agencies, support to maintain personal life.

Conversion Disorder Assessment

Rule out physiological causes for symptoms or deficits. Physical limitation or disability, feelings of guilt, anxiety, or frustration. Low self esteem and feelings of inadequacy, unexpressed anger/guilt, conflict. Secondary gain is attention, decrease in workload, decreased responsibilities.

Types of Dementia

• Alzheimer's disease: irreversible form of senile dementia due to nerve cell deterioration, • Vascular dementia: abrupt onset, rapid change in function, vascular lesions, decreased blood supply to the brain. • Pick's disease: degenerative brain disease, affects frontal and temporal lobes, similar to Alzheimer's onset 60 years. • Creutzfeldt Jakob disease: CNS disorder that develops around age 40-60yrs. Altered vision, loss of coordination, rapid progression, encephalopathy caused by is caused by an infectious particle. • Parkinson: slow progressive neurological condition, tremors, rigidity, bradykinesia, postural instability. • Huntington's disease: genetic , involves cerebral atrophy. Onset late 30-40's.

Dementia can Cause

• Aphasia (echolalia, palilalia): language disturbance in understanding and expressing spoken word. • Apraxia: inability to perform motor activities, despite intact motor function. • Agnosia: failure to recognize or identify familiar objects despite intact sensory function. • Amnesia: loss of memory as a result of degeneration.

Co-dependency Issues

• Behaviors that exist in a significant other that enables the addict to abuse w/o experiencing consequences. • Examples: paying the addicts bills, bailing the addict out of jail, helping the addict call in sick to work. • It's important to address codependency issues to maximize the recovery for the addict.

Alcohol Withdrawal Delirium Medications

• Chlordiazepoxide (Librium) is a common medication given for alcohol withdrawal. You can also give benzodiazepines to decrease symptoms. • IM injection of vitamin B1 "thiamine" followed by several days of oral administration to prevent Wernicke's encephalopathy. • Disulfiram (antabuse) alcohol deterrent, causes withdrawal symptoms for those that abuse alcohol.

Alcohol Abuse Therapeutic Communication

• Direct the clients focus to the substance abuse problem. • Identify situations that precipitate anger. • Set limits on manipulative behavior and verbal/physical abuse. • Hold the client firmly to reasonable limits, consistently reinforce rules, with reasonable consequences for breaking rules. • Hold the client accountable for all behavior. Assist them to explore strength and weaknesses. • Encourage the client to to focus on strength if the client is losing control. • Encourage participation in group therapy and support groups.

Violence Assessment

• History of violence or self harm, poor impulse control, low tolerance for frustration. • Defiant and argumentative, raising of voice, making verbal threats, pacing and agitation. • Muscle rigidity, flushed, glaring at others.

Dementia Clinical Course/Onset

• Mild: forgetfulness, that exceeds normal occasional forgetfulness, difficulty finding words, frequently loses objects. • Moderate: confusion is apparent, progressive memory loss, can no longer perform tasks. Still recognizes familiar people. • Severe: personality and emotional changes, delusional, wandering, forget names of family and children, angry outbursts, require assistance with ADLs.

Dysfunctional Behaviors Related to Substance Abuse

• Preoccupation with obtaining the substance, manipulation, anger, violence , abuse, avoidance of relationships. • Family unit may become distant or dysfunctional, the drug seeker may feel a false sense of importance and require special attention, denial (they blame everything but the substance for their issues). Rationalization and projection to justify the use and unacceptable behavior. Depression, low self-esteem.

Alcohol Withdrawal Delirium Nursing Interventions

• Provide non-judgmental care. Check the client frequently, monitor vitals and neuro q 15 min, one to one supervision. • Provide a quiet non-stimulating environment, stay with the client, orient frequently. • Explain all procedures in a quiet simple way. Initiate seizure precautions, administer sedation and anticonvulsants as ordered. • Provide small frequent carbohydrate meals, give antiemetics as needed. • Monitor intake and output. Administer vitamins, assist with ADL's as needed, allow them to express fears and feelings.

Other Factors

• Rebellion and peer pressure during adolescence may contribute to the onset of substance abuse. • Substance abuse may become a coping mechanism, depression may precede or occur as a result of substance abuse. Grief and loss may be associated with substance abuse.

Violence Nursing Interventions

• Use a calm approach , and a clear tone of voice. • Maintain a large personal space, use non-aggressive posture. • Listen actively , acknowledge the clients anger, learn their needs. • Provide the client with clear options that deal with the clients behavior. • Discuss the use of restraints or seclusion if they cant control their anger. • Assist the client in problem solving.

Complications of Alcohol Abuse

• Vitamin deficits: vitamin B deficiency can cause peripheral neuropathy, thiamine deficiency can cause korsakoff's syndrome. • Alcohol induced persisting amnesic disorder, causing severe memory problems. • Wernicke's encephalopathy, causing confusion, ataxia, and abnormal eye movements. • Hepatitis, cirrhosis, esophagitis, gastritis, pancreatitis, anemia, immune system dysfunction, brain damage, peripheral neuropathy, cardiac disorders.

Opioid Withdrawal Medications

• Withdrawal may be treated with methadone detox or tapering dosage of other opioids. • Catapres (clonidine) a-adrenergic blocker assists in the severity of the sympathetic. nervous system generated withdrawal discomfort. • Specific symptom management can include kaopectate for diarrhea and tylenol for muscle aches.

Munchausen Nursing Interventions

- Explore the needs being met by the client, assist with identification of alternative ways to meet needs. - Teach the client to relate feelings and conflicts with the physical symptoms. - Convey understanding that symptoms are real to the client, assure illness has been ruled out. - Explore the source of the anxiety, stimulate verbalization of the anxiety. - Encourage relaxation techniques, use pain assessment scale implement pain reduction. - Report and assess any new physical complaint, provide positive feedback. - Encourage diversional activities, encourage the client to recognize their emotions.

Long term effects if alcoholism

-Peripheral neuropathy: Peripheral nerve damage, Pain, Burning, Tingling, Prickly sensations of the extremities -Alcoholic myopathy: thought to result from same vitamin B deficiency that contributes to peripheral neuropathy Acute: sudden onset of muscle pain, swelling, and weakness; reddish tinge to the urine; a rapid rise in muscle enzymes in the blood Chronic: gradual wasting and weakness in skeletal muscles -Wernicke's encephalopathy: most serious form of thiamine deficiency in alcoholic patients -Korsakoff's psychosis: syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients -Alcoholic cardiomyopathy: effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition -Esophagitis: inflammation and pain in the esophagus occur because of the toxic effects of alcohol on the esophageal mucosa and because of frequent vomiting associated with alcohol abuse -Gastritis, pancreatitis, hepatitis, cirrhosis of the liver, leukopenia, thrombocytopenia, sexual dysfunction, use during pregnancy can cause fetal alcohol syndrome

Restraints

1.Restraints and seclusion should never be punishment and are a last resort. 2. Restraints are used when behavior is physically harmful to self or others. 3. Restraints can be requested by the client. 4. The nurse must document the behavior leading up to the use of restraints. 5. In an emergency a qualified nurse may place a client in restraints then call for an order. 6. Within 1 hour of restraints being placed a psychiatrist must make a face to face assessment and must continuously reevaluate. 7. While in restraints the client must be protected from all sources of harm. 8. While in restraints the client must be closely supervised , physical/ comfort needs need assessed q 15 min- q30 min (foods, fluids, ambulation).

Addiction

Is a chronic, relapsing brain disease characterized by compulsive drug-seeking behavior motivated by cravings, despite harmful consequences, and by long-lasting changes in the brain.

Compulsive Eating Disorder

Binge eating without purging, consumption is out of the eaters control, eating relives tension but doesn't produce pleasure. Eats in response to guilt, anger, depression, boredom, loneliness, inadequacy, ambivalence. The patient feels depressed after eating due to the fact they know that they are doing is harmful. They eat secretly and try numerous fad diets.

CAGE questionaire

C- Have you ever felt 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 had a drink first thing in the morning to steady your nerves or to get rid of a hangover (*eye opener*)?

Aggression

Can be harmful and destructive when not controlled.

Bulimia Nervosa

Certain situations trigger the urge to binge; purging then follows. Hypokalemia is often associated with a patient with bulimia due to vomiting. Bulimia can cause Metabolic Alkalosis. Secretly consumes high calorie food then feels guilty. May vomit, use diuretics, enemas, amphetamines.

Somatoform Disorders

Characterized by the presence of one or more physical symptoms accompanied by abnormal thoughts, feelings, and behavioral reactions in response to these symptoms, often in the absence of known physical findings or medical illnesses that would explain them. Somatization may be used for secondary gains such as attention and decreased responsibilities. Often undergo unnecessary surgeries, invasive diagnostic procedures, and drug trials, all of which can be life-threatening.

Medications for Behavioral Symptoms and Combativeness in Alzheimer's Patients

Cholinesterase inhibitors, antidepressants, antipsychotics, mood stabilizers

Violence

Is a physical force that is threatening to the safety of self or others. Combative, aggressive behavior. Antipsychotic medications can be given to reduce aggression.

Rape

Immediately after the assault, rape victims are often disorganized and unable to think well or remember what they have been told. Written information acknowledges this fact and provides a solution.

Dependent personality disorder

Inability to complete anything on their own. Unable to make decisions without excessive advice & reassurance. Characteristics include being extremely dependent on another person to the point they are unable to be with that person.

Schizoid Personality Disorder

Inability to enter close relationships, social detachment, interest in solidarity activities. Aloof, indifferent, restricted expressions of emotion, lack of interest in others.

Cluster A Type

Odd and eccentric - Schizoid, Schizotypal, and Paranoid.

Opioid Overdose

Opioids include prescribed medications such as oxycodone and morphine, and the illegal substances such as heroin. Respiratory depression, CNS depression, shock, coma, seizures, death - Overdose is treated with antagonist naloxone (Narcan).

Cluster B Personality Disorders

Over-emotional and erratic - Histrionic, Narcissistic, Antisocial, and Borderline.

CNS Overdose

Overdose can cause cardiovascular and respiratory depression, coma, shock, seizure, and death. Nursing interventions: if the client is awake, vomiting is induced and activated charcoal is administered. If the client is comatose, establishment and maintenance of airway and gastric lavage is implemented with activated charcoal are the priorities; seizure precautions. Flumazenil (romazicon) IV may be used for a benzodiazepine OD (ativan, lorazepam).

Visual and Auditory Illusions

Sensory misperceptions. For example, a person may mistake folds in the bedclothes for white rats or the cord of a window blind for a snake. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. Eye glasses and hearing aides can help clarify sensory perceptions.

Borderline Nursing Interventions

Set limits, be consistent and assess your reactions toward patient. Identify the needs and feelings preceding impulsive acts. Teach or refer patient to appropriate place to learn needed coping skills. Dialectical Behavior Therapy (DBT).

Personality Disorders

Setting firm limits and maintaining consistency are essential elements in working with people with personality disorders. Flexibility and providing too many choices does not help the individual with boundaries and limits. Encouraging the patient to attend daily activities may be a part of the care plan, but highest priority is setting limits.

Alcohol Abuse Assessment

Slurred speech, uncoordinated movements, unsteady gait, restlessness, belligerence, confusion, sneaking drinks, drinking in the morning, experiencing blackouts, binge drinking, arguments about drinking, missing work, increased alcohol tolerance, intoxication. Part of the assessment should include type of alcohol, how much, how long, and when was it last consumed.

Avoidant Personality Disorder

Social withdrawal, extreme sensitivity to rejection, feels inadequate, hypersensitive to reactions of others, dislikes criticism, social isolation, lack of support system.

Delirium Nursing Interventions

Speak calmly in a clear low voice, allow adequate time for response, use orienting verbal cues, supportive touch. Keep environmental noise to a minimum. Monitor sleep and void pattern. Monitor intake, discourage daytime napping, encourage some exercise.

Alcohol Withdrawal Nursing Interventions

Usually begins 6 to 8 hours after cessation or marked reduction of alcohol intake. It peaks between 24 and 48 hours, then resolves or progresses to delirium. Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant.

Delirium

Sudden onset, reduced awareness and responsiveness to the environment, disorientation and incoherency and severe memory disturbances. Once underlying cause resolved can have complete recovery. The nurse can help by orienting the patient to person, time and place. Delirium is a syndrome that is always secondary to another condition such as a general medical condition, substance use, medication, toxin exposure, or it may have multiple ideologies.

Paranoid Personality Disorder

Suspiciousness and mistrust of others, argumentative. Hostile, aloof, rigid, critical, controlling, grandiose thoughts.

Alcohol Dependence

The United States has one of the highest levels of substance abuse and addiction in the world. Drug overdose is the leading cause of accidental death in the United States.

Catastrophizing

The consequences of an event are magnified. • "If I gain weight, my weekend will be ruined." • "When people say I look better, I know they think I'm fat."

Risk for Other-Directed Violence

The defining characteristics for Risk for other-directed violence include a history of being abused as a child, having committed other violent acts, and demonstrating poor impulse control.

Hypochondriasis Nursing Interventions

The most common symptoms are pain, gastric or intestinal distress, palpitations, dizziness, shortness of breath, sexual dysfunction, neurological symptoms, and fatigue. Nurses role is to assess for any objective data and to explain the health complaints. Show concern, but avoid fostering dependency.

Dissociative Identity Disorder

The most severe of the dissociative disorders. Disruption of identity by two or more distinct personality states. Involves discontinuity in the sense of self, accompanied by alterations in affect, behavior, memory, and functioning. Patients lose time, meaning they do not have memory of periods of time ranging from minutes to weeks. The patient is often unaware of the other personalities. Each alternate personality has its own pattern of personality, perception, and memories.

Bulimia Nursing Interventions

The nurse should help the patient identify his/her triggers, assess for sign of impulsive eating and explore the need for dietary and health teaching.

Dissociative Fugue

The patient in a fugue state frequently relocates and assumes a new identity while not recalling previous identity or places previously inhabited. The distracters are more consistent with paranoid schizophrenia, generalized anxiety disorder, or bipolar disorder. Head injury, posttraumatic stress disorder, or a neurological disorder should also be considered.

Dementia

The person's children need to make difficult decisions for their parent. This can cause stress and guilt for the children. Nurses role is to teach the family about dementia.

Visual and Tactile Hallucinations Nursing Interventions

The physical safety of the patient is of highest priority. Patients experiencing hallucinations may experience fluctuating levels of consciousness disturbed orientation and visual and tactile hallucinations.

Conversion Disorder

This disorder presents with one or more symptoms of impaired motor or sensory function. Findings are incompatible with or an exaggeration of recognized neurological conditions and are not better explained by another mental or medical disorder. Most common are blindness, deafness, paralysis, inability to talk. Symptoms are beyond conscious control and are related directly to conflict .

Neurocognitive Disorders

Those disorders that affect the structural or functional areas of the brain and cause disturbances in normal cognition such as memory, abstract thinking, or judgment. Affect the brain's ability to function intellectually, emotionally, socially, and occupationally.

Visual and Tactile Hallucinations

Wandering, pulling out intravenous lines and Foley catheters, and falling out of bed are common dangers that require nursing intervention. Hallucinations are false sensory stimuli. Visual hallucinations are common in delirium. For example, delirious individuals may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on their bodies.

Cocaine Abuse & Alcohol

To decrease the feeling of drunkenness. To intensify the cocaine high. To ease the unwanted symptoms of coming down from cocaine. There is a consistent and significant association between alcohol or drug use and injury. Intracranial hematomas, subdural hematomas, and other conditions can remain unnoticed if the symptoms of acute alcohol intoxication and withdrawal are not distinguished from the symptoms of a brain injury.

Schizotypal Personality Disorder

Unusual thoughts, speech or behavior patterns, relationship deficits. Suspicious, paranoid, magical thinking, odd thoughts/speech.

Heroin Overdose

Yawning, insomnia, irritability, runny nose (rhinorrhea), panic, diaphoresis, cramps, nausea, vomiting, muscle aches ("bone pain"), chills, fever, lacrimation, diarrhea.