Mental Health Test 4

cognition

• brains ability to process, retain, use information

• reasoning, judgment, perception, attnetion, comprehension, memory

cognitive disorders

disruption or impairment in higher level brain functions

neurocognitive disorders (NCDs)

• disruption or impairment of higher level brain

• signs and symptoms often mimic other mental illness

• difficult to obtain direct evidence for definitive diagnosis

delirium - causes and risks

• most frequent in older adults

• medications

• substance use or withdrawl

• fluid and electrolyte imbalances

• metabolic imbalances

• brain tumor or injury

• terminally ill

delirium - interventions

general- assess and reassess, eliminate underlying cause, provide safe environment, coordinate interdisciplinary treatment

biological- stop suspected meds, monitor changes, maintain fluid and hydration, promote sleep and nutrition, prevent aspriation, admin meds as prescribed

psychological- provide support, present reality, encourage expression of fears, reduce stimuli, limit choices

sociological- involve family if possible

delirium - evaluation

• correction of underlying physchological alteration

• prevention of injury

• resolution of confusion and associated behaviors

• return to prior level or functioning

dementia

• disease process marked by progressive cognitive impariment with no change in the level of consciousness

• impaired memory and judgement, aphasia, apraxia, agnosia

• disturbance in executive functioning

• emotional and behavioral changes

• physical and functional decline

• LOC is unchanged

• “sundowning”

• usually irreversible

aphasia

deterioration of language function

apraxia

imparied ability to execute motor functions

agnosia

inability to recognize or name objects

disturbance in executive function

inability to plan initiate, sequence, monitor, and stop complex behavior

dementia - common causes and risks

• advanced age

• prior head trauma

• lifestyle factors (sedentary)

• genetics

• metabolic syndrome

• substance use disorder

• infections (HIV)

• disorders affecting neuro: alzheimers, parkinsons, huntingtons, prion, lewy, ect

delirium

• impairment in consciousness and rapid change in cognition over a short period

• impaired memory and judgement

• rambling incoherent speech

• altered LOC

• vivid dreams and nightmares

• unstable vitals signs

• usually caused by medical condition and considered an emergency

• reversible if cause is treated

etiology of alzheimer’s disease

• loss of neurons and brain volume

• cell death

• genetic factors

• inflammation

• oxidative stress, free radicals

stages of alzeimer’s disease dementia

preclinical- changes in brain, mild memory loss, no impact on ADLs

mild (early)- short term memory lapses, forget familiar words, impaired concentration

moderate (middle)- confusion, memory loss, wandering, help with ADLs, behavioral

changes

severe (late)- loses awareness of environment, loses ability to communitcate, help with

ADLs, incontinent

etiology of vascular dementia

• characterizzed by a marked disruption in cerebral flow with destruction of brain cells

• risk factors: advanced age, TIA, stroke, diabetes, HTN, hypercholestemia

signs and symptoms of vascular dementia

• confusion, dizziness, wandering, slurred speech, muscle weakness, problem following instructions

nursing interventions for dementia

• establish baseline

• provide safety

• therapeutic relationship

• maintain independence

• avoid meds with anticholinergic effects

• promote quality of life

• educate on home care and community resources

• simple consistent routines

psychological nursing interventions for dementia

symptom → intervention

delusion - reduce trigger

confusion - eliminate stimuli

mood changes - address self worth

anxiety - reduce stress

cognitive decline - memory enhancement

social and behavioral nursing interventions for dementia

symptom → intervention

social isolation - social activites

apathy - engagement

agitation - redirection

wandering - motion and sound alarms

pharmacological interventions for dementia

donepezil - mild to severe stages of alzheimer’s

riveastigmine- mild to moderate stages

galantamine- mild to moderate stages

memantine- moderate to severe stages

suvorexant- mild to moderate stages

dementia - evaluation

• individual remains safe and secure

• cognitive decline is slowed

• anxiety is maintained at low level

• individual remains as independent as long as possible

protective factors for older adults - dementia

• marriage

• education

• income

• effective coping

• positive outlook

• healthy lifestyle

• physical activity

psychosomatic

connection between mind and body

somatization

unconscious expression of psychological distress into physical manifestations, symptoms suggest medical illness but cannot be explained by underlying pathology

somatic symptoms disorders (brief description)

characterized by a preoccupation with worrying about their physical manifestations to the point where it assumes a central role

primary gain - somatic symptom disorder

relief of the unconscious psychological distress

secondary goal - somatic symptom disorder

unintended gain, rewards obtained from the physical symptoms that might otherwise not be received

general characteristics of somatic symptom disorders

• chromic or recurrent

• angry at medical community

• comorbidity of anxiety and/or depression

• more commen in women

• difficulty in accepting a psychological diagnosis

somatic symptom disorder (in depth)

• multiple vauge physical symptoms

• involves more than one body symptoms

• interferes with daily functioning

• seeks medical from multiple doctors

• often rejects psychological diagnosis as the cause

pain disorder

• pain is primary physical symptom, generally unrelieved by analgesics

• greatly affected by psychological factors

illness anxiety disorder

• belief in/fear of having or developing a serious disease despite negative findings and clinician reassurances

• very high anxiety, obsessive thoughts and fears about illness

• seeks care from multiple providers or avoids seeking health care

functional neurological symptom disorder

• characterized by transferring mental conflict into a physical symptom for which there is no organic cause

• symptoms: usually sudden deficits in voluntary motor or sensory functions (blindness, paralysis, seizures)

• may cause anxiety but often exhibits indifference

• usually short, rarely chronic

malingering

• intentional production of false or grossly exaggerated physcial or psychological symptoms

• no real physical symptoms or exaggerated minor symptoms

• able to stop the symptoms as soon as secondary gain is received

factitious disorder

previously munchausen syndrome

• characterized by somatization in which the person intentionally causes an illness or exaggerates symptoms for the purpose of assuming sick person role

• willfully controls the phsycial symptoms

nursing interventions for somatic symptom disorders

• establish daily routine, adequate nutrition and sleep

• recognize relationship between stress and physical symptoms

• keep a journal

• limit time spent on physical symptoms

• teach coping strategies

• pharm - ssris

• cognitive behavioral therapy

• behavioral therapy

• groups

evaluation for somatic symptom disorders

• recognizes the interaction of mind and body and the effects of stress

• identifies conflicts or problems in their situation and relationships

• copes well

• assumes appropiate roles in work, family, community

substance use disorder can use

• alcohol

• caffeine

• cannabis

• hallucinogens

• inhalants

• opioids

• sedatives

• stimulants

• tobacco

non substance use disorder (behavioral/process addictions)

• gambling

• shopping

• social media

• internet gaming

substance use disorder risk factors

• genetics

• adolescent population

• chronic stress

• history of trauma

• lowered self esteem and tolerance for pain

• few relationships and life successes

• risk taking tendencies

substance use disorder protective factors

• positive family support, social relationships, self esteem

• caregiver involvement in child and adolescent

• availability of community resources and programs

• employment

substance use disorder sociocultural theories

• alaskans and native americans have higer percentage

• asians have lower percentage

• peer pressure

• older adults with history of alcohol use

substance use disorder - questions to ask

• type of substance

• pattern and frequency

• amount used

• age at onset

• periods of abstinence

• previous withdrawal manifestations

• date of last substance use

• blackouts, stress, sleep problems, weight loss/gain

CIWA-Ar

10 item scale to assess and manage alcohol withdrawal, sum indicates severity of withdrawal

• mild < 15

• moderate = 16-20

• severe > 20

treating substance use disorder

• tolerance

• withdrawal

• abstinence syndrome

opioids

intended effect- euphoria/pain relief

intoxication- slurred speech, impaired memory, decreased LOC

withdrawal manifestations- sweating, tremors, irrtability, weakness, N/V, muscle aches, fever

antidotes- naloxone, flumazenil

abstinence maintenance- methadone, clonidine, buprenorphine

substance use disorder - alcohol

0.08% is legally intoxicated

fetal alcohol syndrome

intended effects- relaxation, decreased social anxiety, stress reduction

excess- slurred speech, memory impairment, decreased motor skills

chronic use- cardiovascular damage, liver damage, gastritis, gastrointestinal bleeding

withdrawal manifestations- cramping, vomiting, tremors, restlessness, anxiety, increased blood pressure

meds to treat withdrawal- chlordiazepoxide, diazepam, lorazepam, oxazepam

abstinence maintenance- disulfiram, naltrexone, acamprosate

more CNS depressants

sedatives- benzodiazepines

hypnotics- barbiturates

anxiolytics- club drugs

cannabis- marijuana, hashish

hallucinogens- LSD

caffeine

tabacco

treatment for nicotine addiction

bupropion- decrease craving

nicotine replacement therapy

varenicline- release of dopamine

wernicke-korsakoff syndrome

Wernicke’s encephalopathy

• acute and reversible

• altered gait, vestibular dysfunction, confusion

• treatment is large dose thiamine IV 2-3 daily for 1-2 weeks

Korsakoff’s syndrome (if wernicke’s is untreated)

• chronic condition, thiamine for 3-12 months, recovery is 20%

substance use disorder - nursing care

• objective, nonjudgmental

• 1:1 observation during withdrawal, low stimulations

• seizure precautions

• educate client and family about codependent behaviors

• encourage self responsibility

• develop emergency plan

substance use disorder - family therapy and client education

• families learn use of specific substances

• family coping, problem solving, indications of relapse, support groups

• teach CBT

• attend 12 step program

• individual therapy, group therapy, pharmacological therapy

alexithymia

difficulty identifying and expressing feelings

anorexia nervosa

life threatening eating disorder characterized by clients restriction of nutrional intake necessary to maintain a minimally normal body weight, intense fear of gaining weight

binge eating

consuming a large amount of in a discrete period of usually 2 hours or less

body image disturbance

occurs when there is an extreme discrupancy between one’s body image and the perceptions of others perceptions of others and extreme dissatisfaction with one’s body image

bulimia nervosa

recurrent episodes of binge eating followed by inappropiate compensatory behaviors to avoid weight gain

enmeshment

lack of clear role boundaries

orthorexia nervosa

obsession with proper or healthful eating

pica

persistent ingestion of nonfood substances

purging

compensatory behaviors designed to eliminate food by means of self induced vomiting or misuse of laxitives, enemas, diuretics

rumination

repeated regurgitation of food that is then rechewed, reswalled, or spat out

eating disorders risk factors

• family genetics

• biological

• interpersonal relationships

• psychological influences

• environmental factors

eating disorders - prodromal manifestations

• weight changes

• abnormal eating habits

• ritualized mealtime behaviors

• lying about food intake

• preoccupation with weight and body image

• compulsive and/or exercising

eating disorders - expected findings

mental status- overgeneralizations, all or nothing thinking, catastrophizing, emotional reasoning

vital signs- low/high blood pressure, decreased pulse and body temp, potential hypertension

weight- body weight is less than 85% than expected normal weight, overweight/obese

musculoskeletal- muscle weakness, decreased energy, loss of bone density

gastrointestinal- constipation, diarrhea, abdominal pain, self induced vomiting, gastric rupture, excessive use of laxitives

reproductive status- menstrual irregularities, amenorrhea

psychosocial- low self esteem, impulsivity, depressed mood, irritability, insommnia

integumentary- fine downy hair, yellow skin, cool extremities, poor skin tugor

head/neck/throat- enlargement of parotid gland, dental erosion and caries

cardiovascular- heart failure, cardiomyopathy, peripheral edema

fluid/electrolyte- acidosis, alkalosis, dehydration

anorexia nervosa (in depth)

• persistent energy intake restriction

• fear of gaining weight or becoming overweight

• disturbance in self perceived weight or shape

• types: restricting or binging/purging

bulimia nervosa (in depth)

• recurrently eat large quantities of food

• can be followed by inappropriate compensatory behaviors to rid the body of excessive calories

• occurs on average of once per week for 3 months

• binge eating is in a discrete period of time (less that 2 hours)

• amount of food definitely larger than what most individuals would eat in a similar period of time

• clients have a sense of lack of contorl over eating

• types: purging or non purging

binge eating disorder

• recurrently eat large quantities of food over short period of time

• no use of compensatory behaviors

• clients experience distress following the episode

• an excessive food consumption must be accompanied by a sense of lack of control

• at least once per week for 3 months

additional eating disorders

• pica

• rummination disorder

• avoidant/restrictive food intake disorder

eating disorder - criteria for acute care treatment

• weight loss of 20% of ideal body weight OR less than 10% body fat

• unsuccessful weight gain

• abnormal vital signs

• ECG changes

• electrolyte distrubances

• meeting psychiatric criteria

eating disorders - nursing care

• safe, structured, supportive environment

• monitor weight, vital signs, I&O

• moitor electolytes

• teach effective coping with feelings

• administer SSRIs as indicated

• encourage care plan participation

• increase/decrease calorie intake (depends on type)

• therapy and support group

eating disorders - patient centered care

meds- SSRI (fluoxetine), other meds to treat comorbid disorders

interprofessional care- dietitian, CBT, family therapy

client education- develop maintenance plan, follow up treatment plan, support groups, individual therapy

eating disorders- complications

• refeeding syndrome (life threatening)

• cardiac dysrhythmias

• severe bradycardia

• hypotension

ADHD

inattentiveness, overactivity, and impulsiveness

autism spectrum disorder (ASD)

pervasive and usually severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotypical behavioral patterns

coprolalia

use of socially unacceptable words, frequently obscene

palilalia

repeating one’s own sounds or words

stereotypes motor behavior

hand flapping, body twisting, head banging

therapeutic play

used to understand the child’s thoughts and feelings and to promote communication

tic

sudden, rapid, recurrent, nonrhythmic, sterotyped motor movement or vocalization

tourette’s disorder

multiple motor tics and one or more vocal tics, which occur many times a day for more than 1 year

callous and unemotional traits

little empathy for others, does not feel bad or guilty or shows remorse for their behavior, has shallow or superficial emotions

conduct disorder

persistent behavior that violates societal norms, rules, laws, and the rights of others

distruptive behavior

problems with the person’s ability to regulate their own emotions or behaviors

externalizing behavior

problems with outward behaviors

intermittent explosive disorder (IED)

repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outburst, usually lasting less than 30 minutes

internalizing behavior

problems with self regulation of emotions

oppositional defiant disorder (ODD)

enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violantions

factors impeding diagnosis - childhood and adolescence

• language skills

• cognitive development

• emotional development

• wide variation of “normal” behaviors

• difficult to determine

children and adolescent disorders - risk factors

• gentic links, chromosomal abnormalities

• biochemical

• social and environmental

• cultural and ethnic

• resiliency

• witnessing/experiencing traumatic events

oppositional defiant disorder

recurrent pattern of:

• negativity

• disobedience

• hostility

• defiant behaviors

• stubbornness

• limit testing

• unwillingness to compromise

• can develop into conduct disorder later in life

disruptive mood dysregulation disorder

• severe and recurrent temper outburst that do not corrrelate with situation

• observable by others

• temper outbursts are present three or more times per week

• at least within two settings (home, school)

intermittent explosive disorder

recurrent episodic violent and aggressive behavior with the possibility of hurting people, property, or animals

• diagnosed as early as 6 yrs old

• males more affected

• verbal or physical aggression

• overreaction to normal events followed by feelings of shame and regret

• prevents the clients ability to have healthy relationships/employment

conduct disorder

• persistent pattern of behavior that violates the rights of others or rules and norms of society

• categories: aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules

• childhood onset: before age of 10, males more prevalent

• adolescent onset: after age 10, gender equal

• contributing factors: parental neglect, abuse, family history, lack of supervison, rejection, neglect

• can turn into antisocial disorder later in life

conduct disorder manifestations

• lack of remorse or care

• bullies/threatens/intimidates/lies

• low self esteem

• temper outbursts

• reckless behavior

• shop lifts

• destroys property

• physcial cruelty to others

attention deficit hyperactive disorder (ADHD)

involves the inability of a person to control behaviors requiring sustained attention

characteristics: inattention, hyperactivity, impulsivity

behaviors must be present prior to age 12 and more than one setting

types: predominatly inattentive, predominantly hyperactive-impulsive, combined: client exhibits both inattentive and hyperactive impulsive behaviors

* risk for injury

autism spectrum disorder

• thought to be genetic origin

• affects individual’s ability to communicate and interact with others

• cognitive and language development are delayed

• inability to maintain eye contact, repetitive actions, strict routines

• present in early childhood

• more common in boys

• wide variation in functioning

intellectual developmental disorders

• onset of deficits and impairments during the developmental period of infancy or childhood

• deficits with mental abilites: reasoning, abstract thinking, academic learning, learning from prior experiences

• imparied ability to maintain personal independence and social responsibilty

• deficits range from mild to severe

specific learning disorder

• persistent difficulty in acquiring reading, writing, or mathematical skills

• performance in one or more academic areas is significantly lower than the expected range

• benefit from an Individualized Education Program (IEP)

communication disorders

• persistent problems related to language and speech skills

• speech dysfluencies, such as stuttering

• difficulty with conversational skills