Transcript Unit I

Mental Health Nursing I
NURS 1300
Unit V
Mental Health Alterations
Objective 1
Describe the mood disorders
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Mood disorder = a condition in which the
prevailing emotional mood is distorted or
inappropriate to the circumstances
Types of mood disorder
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major depression
bipolar disorder
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alternation between significantly depressed
mood and significantly elevated mood (mania)
over time
Mood disorders may present with
psychotic symptoms
Objective 2
Describe the nursing interventions and
medical treatment for clients with a
mood disorder
See Objective 11 for medications for
mood disorders
Objective 2 (cont’d)
Electroconvulsive therapy (ECT)
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may be indicated for clients with severe
depression that does not respond to other
treatment
acts more quickly than medications, and
may produce fewer side effects in older
clients
Objective 2 (cont’d)
Nursing diagnoses for clients with a mood
disorder –
 Risk for self-directed violence R/T
suicidal feelings
 Risk for violence directed toward others
R/T homicidal ideation
 Low-self esteem R/T depression
 Imbalanced nutrition, less than body
requirements R/T lack of interest in food
 Disturbed sleep pattern R/T depression
Objective 3
Describe characteristics of an
individual with suicide potential
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Females attempt suicide 2-3 times
more often than males
Males are 4 times more likely to
complete a suicide
Suicide by firearm is the most common
method of suicide for both men and
women
Risk of suicide is higher for people with
psychiatric conditions
Objective 3 (cont’d)
Specific high-risk populations include –
 previous suicide attempt
 family history of suicide
 suicide of a loved one, friend, coworker, colleague, or role model
suicide pacts
 anniversary dates
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ANYONE THREATENING SUICIDE
Objective 4
State common age groups for suicide
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Adolescents
leading cause of death for people ages 1318
 considered a solution to an environmental
or psychological problem
 experience hostility toward themselves
 seek revenge on others by hurting
themselves
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Objective 4 (cont’d)
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Elderly
Caucasian males over the age of 70 have
the highest rate of suicide
 fewer attempts, but more completed
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methods more lethal
 decreased ability to survive attempt
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planned instead of impulsive
bereavement
 real or perceived losses
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often occur through covert measures
self-inflicted falls
 refusing to eat or take medications
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Objective 5
Define personality disorders
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A personality disorder is a pattern of
perceiving, reacting, and relating to
other people and events that is relatively
inflexible and that impairs a person’s
ability to function socially
Personality traits become rigid and
dysfunctional
Personality disorders are chronic and
maladaptive, impacting all aspects of
one’s life
Objective 6
Describe the types of personality
disorders
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Grouped into three clusters according to
the traits that describe them
Cluster A traits are behaviors considered
odd or eccentric
Cluster B traits consist of dramatic,
emotional, and erratic behaviors
Cluster C traits include behaviors that are
anxious or fearful
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Cluster A disorders
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Cluster B disorders
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Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Cluster C disorders
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Avoidant personality disorder
Dependent personality disorder
Obsessive-Compulsive personality disorder
Objective 7
Identify the nursing interventions and
medical treatments for personality
disorders
Medical Interventions –
 psychotherapy
 group therapy
 behavior modification
 medications
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anxiety
depression
Objective 7 (cont’d)
Nursing diagnoses –
 Ineffective coping R/T personality
disorder AEB reliance on maladaptive
defense mechanisms
 Risk for self-harm R/T unresolved fear of
abandonment AEB attention-seeking
behaviors and threats against self
 Depression R/T self-directed anger AEB
social withdrawal and isolation
Objective 8
Describe behaviors of the
schizophrenic client and identify
causes of schizophrenia
Schizophrenia refers to a group of very
serious, usually chronic, thought
disorders in which the affected person’s
ability to interpret the world accurately
is impaired by psychotic symptoms
Behaviors of schizophrenia
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Disordered thinking
Unusual speech
Apathetic personality
Changing behaviors
Social isolation and withdrawal
Distorted perceptions of reality
Etiology of schizophrenia
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The cause of schizophrenia is unknown
Individuals may be genetically vulnerable
to developing schizophrenia
Influencing factors may include
environmental exposure to anything that
interrupts brain development
Objective 9
Differentiate the types of
schizophrenia
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Catatonic type
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prominent psychomotor disturbances
stupor
waxy flexibility
Disorganized type
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disordered thoughts
flat affect
Types of schizophrenia (cont’d)
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Paranoid type
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Residual type
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delusions
hallucinations
low intensity of symptoms
Undifferentiated type
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presence of symptoms from more than one
subtype of schizophrenia
Objective 10
Discuss the medical treatment and
nursing interventions for the
schizophrenic client
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Medical treatment for the client with
schizophrenia involves therapy modalities
and antipsychotic medication
Therapies include psychotherapy, family
education, and community support
Hospitalization is often required to treat
severe delusions, hallucinations, or selfcare deficits
Nursing diagnoses for schizophrenia
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Disturbed thought processes R/T
delusions/concrete thinking/paranoia AEB
bizarre statements and behaviors
Disturbed sensory perception R/T
hallucinations/illusions AEB inability to tolerate
group therapy, talking to self, or looking for or
at something that is not there
Impaired verbal communication R/T delayed
thinking AEB very slow and delayed speech
Self-care deficit R/T withdrawal and loss of
motivation and judgment AEB poor hygiene,
poor grooming, and avoiding others
Nursing assessment and interventions
for a client with schizophrenia
Refer to assigned readings for complete nursing
assessment of the schizophrenic client
Nursing interventions –
 use nonconfrontational speech and mannerisms
 encourage communication and expression of
feelings and fears
 decrease stimuli and offer quiet activity
 seek clarification of statements
 provide recognition for constructive self-care
activities
 make adjustments in food preparation and
service for patients with paranoia
Objective 11
Identify classifications, uses, actions,
and side effects for selected
classifications of psychoactive
medications as they relate to the
above mental health alterations
Refer to Psychoactive Medications handout