Increased severity of somatic symptoms- headache, nausea, dizziness, insomnia
S/S panic level of anxiety
Unable to process what is going on in environment
Loss of touch with reality
Hallucinations or false sensory perceptions
Interventions mild-moderate anxiety
Ask open-ended questions
Give broad openings
Closing off unrelated topics
Not bringing up irrelevant topics
Recognize pt's distress
Be willing to listen
Evaluate effective past coping mechanisms
Help pt identify anxiety
Anticipate anxiety-provoking situations
Use nonverbal language to demonstrate interest (lean forward, eye contact, nod)
Encourage pt to talk about feelings or concerns
Focus on pt concerns
Ask questions to clarify what is being said
Help pt identify thoughts/feelings before onset of anxiety
Enourage problem solving with pt
Develop alternative solutions to a problem
Explore behaviors that have worked in the past to relieve anxiety
Provide outlets for working off excess energy
Interventions severe-panic levels of anxiety
Maintain a calm manner
Always remain with pt experiencing acute severe to panic level of anxiety
Minimize environmental stimuli
Use clear and simple statements and repetition
Use low-pitched voice; speak slowly
Reinforce reality if distortions occur
Listen for themes in communication
Attend to physical & safety needs as needed
Physical limits may need to be set-speak in firm, authoritative voice
Provide opportunities for exercise
When person is constantly moving or pacing, offer high-calorie fluids
Assess need for meds or seclusion after other interventions have been tried unsuccessfully
What is agoraphobia?
Fear of open spaces
What is acrophobia?
Fear of heights
What is claustrophobia?
Fear of closed places
What is xenophobia?
Fear of strangers
What is mysophobia?
Fear of germs or dirt
What is social phobia?
Social anxiety disorder
Severe anxiety or fear provoked by exposure to a social situation or a performance situation
Fear of public speaking is most common
What is PTSD?
Repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others, to which individual responded with intense fear, helplessness, or horror
Major features of PTSD
Persistent re-experincing of the trauma through recurrent intrusive recollections of the event, dreams, and flashbacks
Persistant avoidance of stimuli associated with the trauma, which results in the individual's avoiding talking about the event or avoiding activities, people, places that arouse memories of the trauma
After the trauma, experience of persistent numbing of general responsiveness, as evidenced by individual's feeling detached or astranged from others, feeling empty inside, or feeling turned off to others
After the trauma, experiencing of persistent symptoms of increased arousal, as evidenced by irritability, difficultyn sleeping, concentrating, hypervigilance, or exaggerated startled response
What is OCD?
Typically involve issues of sexuality, violence, contamination, illness, or death
Time consuming rituals that interfere with normal routines, social activityies, and relationships with others
thoughts, impulses, or images that persist and recur so they cannot be dismissed from the mind and the ritualistic behaviors that an individual feel driven to perform in an attemp to reduce anxiety
What is thought stopping?
Teaches client to consciously say "stop" to maladaptive thoughts
What is hypochondriasis?
Misrepresenting innocent physical sensations as evidence of a serious illness
Marked by severe distress, impqirmeent in ability to function in personal, social, and occupational roles
What is body dysmorphic disorder (BDD)?
Preoccupation with an imagined "defective body part" results in obsessional thinking and compulsive behavior
Highly distressing and impairing disorder
What is a fugue state and what evidence supports it in an assessment?
An altered state of consciousness involving both memory loss and travel away from or from one's usual work locale-involves both flight and forgetfulness
Can the pt remember recent and past events?
Is pt memory clear and complete or partial and fuzzy?
Is pt aware of gaps in memory?
Do the pt's memory place the self with a family, in school, in an occupation?
Does pt ever lose time or have blackouts?
Does pt find themselves in places with no idea how they got there?
What is dissociative identity disorder?
What is a high priority assessment for this diagnosis?
Formerly known as multiple personality disorder
The presence of two or more distinct personality states that recurrently take control of behavior
What is conversion disorder?
Marked by symptoms or deficits that affect voluntary motor or sensory functions, which suggest another medical condition
Dysfunction does not correspond to current scientific understanding of the nervous system and they are judged because of psychological factors
Difference btwn somatoform disorder and dissociative disorder
Dissociative disorder is an altered mind-body connections and believd to be related to stree and anxiety
Consciousness is altered whereas thinking, feeling, and perceptions are less impaired
Somatoform disorders are characterized by the presence of physical symptoms in the absence of pathology or known pathophysiology
Body dysmorphic disorder
Dissociative identity disorder
Questions to ask when assessing a dissociative disorder
How to help pt with depersonalization disorder and feeling mechanical, dreamy, floating
Types of emotions nurses feel when dealing with somatoform disorders
Can antisocial clients be manipulative? What are other characteristics of antisocial persons?
What is limit setting?
The reasonable and rational setting of parameters for pt behavior that provide control and safety
What are boundaries?
Those functions that maintain a clear distinction among individuals with a family or group and btwn family members and the outside world
May be clear, diffuse, rigid, or inconsistent
What are paranoid personality disorders?
Characterized by a pattern of distrust and suspiciousness
Individual interprets other peoples motives as threatening
See chart p 180
What is a borderline personality disorder?
Characteristic lack of affect
Lack of a sense of identity and instability in relationships
Experience overwhelming needs, internal and external, that they seek to have met in relationships, but their excessive demands, unstable anger, and impulsive behavior drive people away
What is paaranoid PD?
Characterized by long-standing problems in behavior, mood, perception, and relationships
What is histrionic PD?
Characterized by excessive emotionality and attention-seeking behaviors that are dramatic and egocentric
What is avoidant PD?
Marked by social inhibition, feelings of inadequacy, and sensitivity to potential rejection or criticism
What is narcissistic PD?
Individual typically demonstrates grandiosity and the need for constant adoration by others
Exaggerates their importance and accomplishments
What is splitting?
Primitive defense mechanism characterized by an "all or none" mentality
There is no recognition that a person may have both good and bad qualities
What feelings may a nurse experience when caring for a client with depression?
What should nurse teach pt and family to report when giving an SSRI for treatment of depression?
What is dysthymia?
Characterized by a chronically depressed mood occuring most of the day, more days than not, for at least a 2yr period
During periods of depressed mood, at least two or more of the other symptoms of depression must be present
Disorder does not usually affect social or occupational functioning
What is anergia?
Lack of energy
What is anhedonia?
The inability to experience pleasure
What are the vegetative signs of depression?
Alterations in those activities necessary to support physical life and growth
Changes in easting patterns: 60-70% report anorexia
Changes in sleep patterns: cardinal sign; insomnia; light sleep prolongs the agony of depression over 24hr
Changes in bowel habits: constipation seen with psychomotor depression
Interest in sex declines: loss of libido
Pain: 2/3 depressed people report pain with or without reporting psychological symptoms
What should pt avoid when taking an MAOI?
What is the time frame btwn taking an MAOI and an SRI? If taken too close what crisis can occur?
What are some statements that show treatment plans are effective with depression?
What are some statements that show treatment plans are effective with anxiety?
What are some statements that show treatment plans are effective with personality disorders?
What are some statements that show treatment plans are effective with somatoform disorders?
What are some statements that show treatment plans are effective with dissociative disorders?
What are proper foods for pt with depression, with nursing diagnosis of imbalanced nutrition < body requirements?
What are proper foods for pt with anxiety, with nursing diagnosis of imbalanced nutrition < body requirements?
For pt constantly pacing or moving, offer high-calorie fluids
Dehydration and exhaustion must be prevented
What pt needs to be watched most closely for depression?
How do you approach and what do you do for a client that is depressed and cannot perform ADL's?
What can ECT do to your short term memory?
Short term memory deteriorates further during a treatment course, but most often resolves within a few weeks after final treatment
Pre and Post procedure Prep for ECT
Prior to test, pt should sign informed consent, which may be withdrawn verbally at any time. May only be done involuntarily with a court order.
NPO at mn before procedure
All jewelry and dentures removed
Procedure should be carried out with resuscitation equip and staff on hand
Pt given anesthetic and neuromuscular blocker to relax skeletal muscles
100% O2 administered while unable to breathe
As soon as unconscious and paralyzed, psychiatrist applies electrodes to head and delivers 70-150volts to brain for 0.1-1sec
Generalized seizure produced and lasts 30-60sec
Pt responsive approx 15min p treatment and fully recovered 1-2hr later
Monitor VS and assess orientation and alertness
Foods to be avoided on a Tyramine restricted diet; interact with MAOI's
Some dietary supplements
What is serotonin syndrome (causes and symptoms)?
Rare, life-threatening associated with the SSRI's
Thought to be related to overactivation of the central serotonin receptors, caused by either too high a dose or interaction with other drugs