Psychiatric Mental Health Nursing Study Guide and Nursing Notes

Table of contents 1

MENTAL HEALTH OVERVIEW

2

TREATMENT SETTINGS

3

THERAPIES

4

THERAPEUTIC RELATIONSHIPS AND COMMUNICATION

5

CULTURAL CONSIDERATIONS

6

LEGAL AND ETHICAL CONSIDERATIONS

7

DEPRESSIVE DISORDERS

8

ANXIETY DISORDERS AND OCD

9

SOMATIC SYMPTOM DISORDERS AND RELATED

10

BIPOLAR DISORDERS

11

SCHIZOPHRENIA SPECTRUM DISORDERS

12

PERSONALITY DISORDERS

13

EATING DISORDERS

14

SUBSTANCE ABUSE DISORDERS

15

CHILDHOOD AND NEURODEVELOPMENTAL DISORDERS

16

IMPULSE CONTROL DISORDERS

17

NEUROCOGNITIVE DISORDERS

eeriere Overview Referee Health ere rare Mental -

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Mental Health: * Complete mental, physical and social wellbeing. * Not just the absence of illness or disease. * Able to cope with the normal stresses of life, be productive, and contribute to the community. * Capable of rational thinking, communication, resilience, and selfesteem.

Mental Illness: geo

* All mental health disorders have defined diagnoses in the DSM-5. * Alterations in thought process, emotions, or behavior. * 1 in 5 adults in America have experienced a mental health issue. * The definition of mental illness varies by culture.

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Mental Health Continuum: Healthy * Normal level of functioning. * Resilient, normal sleep patterns, comfortable with others, etc.

Reacting * Common, reversible distress. * Irritable, nervous, trouble sleeping, low energy, etc.

Injured

Ill

* Significant functional impairment. * Hopelessness, worthlessness, withdrawal, etc.

* Clinical disorder, severe functional impairment. * High anxiety, depression, thinking disturbances, etc.

Psychiatric Nursing:

Factors Affecting Mental Health:

* Care for people in crisis, life problems, and long-term mental illness. * Ex: patients with diagnosed disorders, homeless patients, patients in jail, and patients who have experienced abuse. * Psychiatric nurses work in a variety of settings: * Ex: hospitals, homes, halfway houses, shelters, clinics, etc.

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1 Individual behaviors: * Behaviors you learn to manage - thoughts and feelings.

2 Genetics: * Many mental health disorders are genetic.

3 Social Environment: * Family and peer groups have a significant impact on development and mental health.

4 Economic Circumstances: * Impacts access to mental health support.

5 Environmental Factors: * Access to basic needs like healthcare, food, water, etc. * Cultural beliefs also have a significant impact on what is considered mental illness and what is not.

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DSM-5: o * Published by the American Psychiatric Association. * Identifies mental health disorders based on specific criteria. * Describes the criteria for the diagnosis of 157 disorders.

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Most Acute

Least Restrictive

TIRE.AT REFINER FREE Treatment Settings Primary Care

* Very common because many mental disorders have physical symptoms and there is less stigma.

Specialty Care

* Psychiatrists, psychiatric nurse practitioners, psychologists, counselors, therapists, etc.

Patient-Centered Medical Homes

* Provides health services, social services, acute care, and chronic disease management. Patient can utilize extended hours of service outside of the usual Monday-Friday 9-5.

Community Mental Health Centers

* Provide care on a low-cost, sliding scale. Services include emergency services, home-based services, medication prescription, therapy groups, etc.

Psychiatric Home Care

* Provided for home-bound patients with a psychiatric diagnosis that requires the care of a nurse.

Assertive Community Treatment

* For patients in the community with serious, persistent mental disorders that are unable to participate in traditional treatments. These teams work with the patient wherever they are at that moment.

Intensive Outpatient Programs

* Programs that run Monday-Friday for about half a day. Structured activities, group therapy, and coping strategies are taught.

Partial Hospitalization Programs

* Programs that run Monday-Friday for about 6 hours (slightly longer than intensive outpatient programs).

Structured activities, group therapy, and coping strategies are taught.

Emergency Care

* Primary goal is triage and stabilization. Patients may seek emergency care voluntarily, or may be brought in involuntarily for emergency evaluation.

Crisis Stabilization Units

* Provide patients with rapid stabilization and a short length of stay, usually 72 hours or less.

General and Private Hospitals

* Psychiatric units on a specific floor of a general hospital.

State Hospital

* Provide long-term care for patients with extremely serious, debilitating mental disorders and patients who can’t be stabilized in a general hospital.

? E TREEN Therapies Psychoanalytic Therapy: -

goes Rational-Emotive Therapy:

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* Focuses on unconscious thoughts and feelings. * Transference: unconscious feelings that a patient has towards a healthcare worker. * Ex: the nurse reminds the patient of her mother. * Countertransference: unconscious feelings a healthcare worker has towards a patient. * Ex: the patient reminds you of someone you don’t like.

Psychodynamic Therapy: * Works best with patients who do not have severe disorders and are motivated. * Focuses on the current issues the patient is experiencing. * The number of sessions is predetermined at the start of therapy.

Interpersonal Therapy: * Short-term therapy aimed at improving the severity of psychiatric symptoms by increasing satisfaction with social relationships. * Works well with patients experiencing grief, conflicts with a significant other, and role transitions.

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* Goal is to help patient identify thoughts that are irrational or inaccurate. * Usually negative or self-deprecating thoughts. * Recognizes that thoughts influence behavior.

Cognitive-Behavioral Therapy: * Based on cognitive psychology and behavioral theory. * Focuses on correcting distorted thoughts and beliefs and turning them into positive thoughts and feelings. * Correcting the distorted thoughts and feelings should have a positive impact on feelings and behavior.

Behavioral Therapy: * Goal of changing specific behaviors without insight to the cause. * Modeling: patient learns certain behaviors through imitation. * Operant Conditioning: positive reinforcement to increase desired behaviors. * Systematic Desensitization: patient is exposed to the fear little by little. * Aversion Therapy: pairing a negative stimulus with the undesired behavior.

Psychopharmacology:

Brain Stimulation:

* The use of medications to treat mental disorders. * Decreases the need for hospitalizations and improves the quality of life for patients.

* Used to treat mental disorders that don’t respond to therapy or medication. * Electroconvulsive therapy * Vagus nerve stimulation * Deep brain stimulation * Magnetic seizure therapy

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Fit riant AF ET f Relationships Therapeutic .

Nurse-Patient Relationship: -

Countertransference: -

* Facilitates communication between nurse and patient. * Promotes patient education, self-care, and independence. * Allows patient to examine their behavior and find alternatives when necessary. * Promotes patient recovery.

* When a healthcare worker unconsciously transfers feelings they have for someone from their past onto a patient. * Ex: A nurse has a patient who struggles with substance abuse that reminds them of their father.

Therapeutic Relationship:

Stages of Nurse-Patient Relationship:

* Social Relationship: * Superficial communication * Friendship, enjoyment, advice * Should not be used in nursing practice * Therapeutic Relationship: * Address concerns brought up by patient * Establish clear boundaries * Respect decisions made by the patient * Encourage healthy coping skills and problem-solving * Support behavior change when applicable

Establishing Boundaries: -

Under-Involvement Therapeutic Over-Involvement *

* Establishing boundaries allow nurse and patient to effectively explore patient feelings and treatment. * Blurring of boundaries occurs when: * A therapeutic relationship turns into a social relationship. * The nurse attempts to meet their needs through the patient.

Transference: J

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* When a patient unconsciously transfers feelings they have for someone from their past onto a healthcare worker. * Ex: the nurse reminds the patient of their sister they don’t like.

1 Pre-Orientation Phase: * Reviewing patient chart, receiving report on the patient.

2 Orientation Phase: * Nurse and patient meet, rapport is established, goals are discussed, contract is formed.

3 Working Phase: * Problems the patient is experiencing are explored and patient education occurs.

4 Termination Phase: * Occurs when patient is discharged, new life-skills and coping strategies are reviewed.

O Promoting Patient Growth:

* There are 3 important characteristics that a nurse should implement to promote patient growth: * Empathy: * Validates patient thoughts and feelings. * Positive Regard: * Respect every patient without judgement. * Genuineness: * Be open and honest when interacting with patients.

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Reeeerier e aware Cultural Considerations

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Race: Distinguished visually, genetically, or anthropologically.

Ethnicity: Groups that share a common heritage, history, and worldview.

Culture: Shared customs, social institutions, beliefs, practices, and values that influence O behavior and thinking.

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Western Tradition: J

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* Identity is formed in individuality.

* Disease has a direct cause and can be observed.

* Independence, autonomy, and self-reliance * Treatment of disease is aimed at the are valued. cause. * Mind and body are separate entities. * Importance of right to decide, to be informed, and open communication. * Time is linear.

Eastern Tradition: * Identity is formed around family.

* People are born into their fate, and it cannot change.

* Mind, body, and spirit are one entity.

* Disease is caused by an imbalance in energy forces.

* Time is circular and flexible.

*Importance of compassion, decisions on the behalf of others, and protecting loved ones from the truth.

Indigenous Culture: * Identity is formed around the tribe. * Close relationship with nature. * Mind, body, and spirit are all related. * Time is focused on the present.

* Disease is caused by a lack of harmony with self, others, environment, or spirit. * Importance of contributing to the needs of the community.

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← Cultural Syndromes: Symptoms that occur in a particular culture and are recognized

by that culture.

Cultural Idioms: Ways of expressing distress in a specific culture. Ex: “I’m a nervous wreck.”

Cultural Explanations: Explanation of symptoms, disease, or illness understood ÷ within a particular culture. we

amraam Legal Considerations Types of Admission: 1 Voluntary Admission

Rights of the Patient: * Right to treatment * Least restrictive environment * No unnecessary medication * Right to privacy * Informed consent for all treatments * Right to attorney * Right to refuse treatment * Patients can deny consent and withdraw consent at any time. * Facilities can only medicate a patient against their consent if they are an imminent threat to themself or others. * Right to confidentiality * Patient information cannot be disclosed without consent of the patient. * Right to informed consent * Patient is informed of all risks, benefits, and alternatives of treatment. * Implied consent: less risky/invasive procedures that the patient indicates willingness. * Ex: taking a daily medication * Advance Directives * Patients can express their wishes for treatment in the event of a psychiatric episode. * Seclusion and Restraint * Other methods like diversion, distraction, offering PRN medication should be attempted before seclusion/restraint.

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* Informal Admission: * Least restrictive * Patient is not a threat to harm themself or others. * Patient is free to leave or stay. * Voluntary Admission: * Patient applies in writing to admit themself to the facility. * Patient has the right to request release from the facility. * The provider has the right to initiate involuntary commitment.

O 2 Involuntary Commitment * Court ordered admission to a psychiatric facility without consent of the patient. * The patient must be: * Mentally ill * A danger to themself or others. * Unwilling to seek voluntary treatment. * Disability severely impacts daily life.

3 Emergency Commitment * Temporary/emergency hospitalization. * Usually 24-96 hours.

4 Assisted Outpatient Treatment * Court-ordered outpatient treatment. * Often used as a preventative measure.

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Discharge Procedures: 1 Conditional Release: * Release with a mandatory period of outpatient treatment. o 2 Unconditional Release: * Complete termination of the patientfacility relationship.

O 3 Release Against Medical Advice: * Treatment is beneficial, but patient is not a danger and may choose to leave.

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Torts: o 1 Intentional Tort: intentional assault, battery, or false imprisonment.

2 Unintentional Tort: Unintended acts that cause harm - negligence and malpractice.

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Depressive Disorders Major Depressive Disorder: -

Assessment: o

* 5 or more of the following in a 2-week period: * Affect: may be flat. * Thought Process: judgement, memory, * Weight loss and concentration may be poor. * Change in appetite * Mood: anhedonia (lack of pleasure). * Feelings of worthlessness * Feelings: hopelessness, guilt, anger, etc. * Fatigue or loss of energy * Behavior: lack of energy. * Insomnia or hypersomnia * Cognitive Changes: difficulty carrying * Inability to concentrate out daily activities. * Decreased interest in daily activities * Recurring thoughts of death Potential Nursing Diagnoses: * Must have: J * Depressed mood or anhedonia * Risk for self-directed violence

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Persistent Depressive Disorder: * Also known as dysthymia * Feelings of depression most of the day for the majority of days. * Must last at least 2 years in adults and 1 year in children/adolescents. * Must have at least 2 of the following: * Change in appetite * Change in sleeping pattern * Difficulty concentrating * Low energy * Hopelessness/low self-esteem

Disruptive Mood Dysregulation Disorder: * Consistent/severe anger and irritability that begins before the age of 10 in children age 6-18. * Introduced to decrease false diagnoses of bipolar disorder in children.

* Ineffective coping * Chronic low self-esteem * Social isolation * Hopelessness * Imbalanced Nutrition

Medications: * Depression is caused by imbalances of serotonin and norepinephrine. * Selective Serotonin Reuptake Inhibitors (SSRIs) * Increase availability of serotonin * Monitor for serotonin syndrome (too much serotonin) * Selective Norepinephrine Reuptake Inhibitors (SNRIs). * Increase availability of serotonin and norepinephrine. * Tricyclic Antidepressants * Should not be used in patients with cardiovascular problems and older adults. * Monoamine Oxidase Inhibitors (MAOIs) * Prevents the breakdown of moodboosting neurotransmitters in the brain.

⇐ Premenstrual Dysphoric Disorder:

* Symptoms appear the week before a womans period begins. * Symptoms include mood swings, irritability, anxiety, depression, and difficulty concentrating. * Symptoms interfere with daily life.

Substance-Induced Depressive Disorder:

* Result of prolonged use or withdrawal from drugs or alcohol. c-

O Non-Pharmacological Interventions:

* Electroconvulsive Therapy * Transcranial Magnetic Stimulation * Vagus Nerve Stimulation * Deep Brain Stimulation

E. OCD AEEF and ran Disorders an ety remarries Anxi Levels of Anxiety:

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Specific Phobia: -

* Irrational crippling anxiety/fear of an 1 Mild Anxiety: object, situation, or activity. * A normal experience * Allows individual to grasp more Agoraphobia: J information and problem-solve.

O 2 Moderate Anxiety: * Fear of being in places or situations where * May experience selective inattention escaping may be difficult, or where help * Clear thinking is impaired but problemisn’t available. EX: being outside alone. solving can still occur. * Somatic symptoms begin Obsessive-Compulsive Disorder: 3 Severe Anxiety: *Obsessions: persistent thoughts that can not * Ability to grasp information is significantly be dismissed from the mind. impaired. Learning and problem-solving are *Compulsions: behaviors the individual feels not possible. they must complete to reduce anxiety. * Somatic symptoms increase. * Symptoms occur daily and cause distress.

4 Panic * Individual is unable to process what is Body Dysmorphic Disorder: going down around them. * Individual is obsessed with what they * Patient could be a risk to themself or perceive to be a deformed body part. others.

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Generalized Anxiety Disorder:

Nursing Interventions:

* Anxiety that is out of proportion for the situation the individual is in. * Symptoms include restlessness, fatigue, difficulty concentrating, irritability, sleep disturbances that cause significant distress.

* Priority nursing intervention is to provide safety for the patient and others. * Offer activities that provide distraction. * Listen to the patient’s concerns. * Reinforce reality when patient has a distorted perception. * Provide a quiet, non-stimulating environment for patient if there is severe anxiety or panic. * Ensure patient has adequate nutrition and fluid intake.

Social Anxiety Disorder: * Severe anxiety caused by fear of doing something foolish in a social situation. * Individuals will typically avoid social situations.

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Panic Disorder: s

* Severe anxiety that causes frequent panic attacks with feelings of impending doom.

Separation Anxiety Disorder: * Inappropriate level of anxiety about being away from a significant other for the individuals developmental level. * May be caused by loss of a loved one, assault, immigration, etc. c-

a Medications:

1 Antidepressants: (SSRIs, SNRIs, MAOIs) 2 Anti-Anxiety Drugs: Benzodiazepines, O Buspirone o 3 Beta-blockers, antihistamines, anticonvulsants, and antipsychotics may be used if other medications do not work.

Non-Pharmacological Treatment: * Therapies * Deep brain stimulation

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Somatic Symptom Disorder:

Conversion Disorder:

1 Symptoms: . *Neurological symptoms without a neurological diagnosis caused by psychological stress. * Neurological symptoms may present as paralysis, blindness, numbness, loss of hearing or vision, etc.

2 Assess for: o * Alterations in motor or sensory function. * Assess recent stress levels. * Some patients may experience extreme anxiety, while others seem indifferent (la belle indifference).

3 Nursing Interventions: * Ensure safety of the patient * Encourage the patient to identify what may have triggered the conversion. * Educate the patient on stress management techniques.

1 Symptoms: * The expression of psychological stress through physical symptoms that cannot be explained by pathology. * Patient has excessive thoughts, feelings, and distress related to the symptoms. * Patients frequently seek out medical care and won’t accept psychological diagnoses for their symptoms.

2 Assess for: * Extreme preoccupation with somatic symptoms. * Somatic symptoms present for over 6 months. * Possible overmedication 3 Nursing Interventions: * Encourage independent self-care. * Encourage patient to verbalize feelings. * Educate the patient on coping mechanisms. .

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Factitious Disorder:

Illness Anxiety Disorder: 1 Symptoms: * Commonly referred to as hypochondriasis. * Extreme anxiety and worry about the possibility of having a disease or disorder. * Somatic symptoms are mild or nonexistent. o 2 Assess for: * Excessive fear surrounding health for over 6 months. * Excessive healthcare-seeking behavior or healthcare avoidance.

O 3 Nursing Interventions: * Build trust with the patient. * Encourage patient to verbalize feelings * Educate patient on stress management techniques and " I alternate coping mechanisms.

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1 Factitious disorder imposed on self: * Previously known as Münchausen syndrome * Patient reports falsified physical or psychological symptoms. * Patient may intentionally harm themself. * Done with the intention of gaining attention or sympathy, not personal gain. o 2 Factitious disorder imposed on another: * An individual purposely causes illness or injury to a vulnerable person.

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Potential Nursing Diagnoses: * Ineffective coping * Social isolation * Anxiety *Altered family * Powerlessness processes

Medications 0 * No medications have been approved for use specifically for somatic symptom disorders, but some antidepressants and anti-anxieties may be used off-label.

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i¥E * Mania: Abnormally elevated mood, expansiveness, irritability, and extreme activity lasting for at least 1 week. * Hypomania: Less severe mania that lasts at least 4 days. * Rapid Cycling: At least 4 episodes of mania/hypomania in the same year.

=ofi Bipolar l:

Bipolar ll:

* The most severe bipolar disorder. * Mania is so severe that hospitalization is often required. * Significant impairment in interpersonal relationships and occupational settings. * At least 1 manic episode. * Risk taking behaviors are common. * Patients may begin to experience psychosis, including hallucinations and disturbed thoughts. * After the mania subsides, the patient will fall into a depressive episode.

* Less severe than Bipolar 1. * At least one hypomanic episode alternating with major depressive episodes. * Hypomania can increase functioning. * EX: staying awake for excessively long periods to work on a project. * Psychosis is not present with the hypomania. * Does not usually cause impairment in interpersonal relationship or occupational settings.

Cyclothymic Disorder:

Nursing Diagnoses:

* Symptoms of hypomania that don’t meet the full criteria, * Risk for injury alternating with episodes of mild to moderate depression. * Sleep depreciation * Altered thought processes * Does not meet the criteria for Bipolar ll. * Risk for other-directed violence * Hypomanic episodes tend to be more irritable. * Impaired social interaction * Rapid cycling is more likely to occur and cause poor * Self-care deficit functioning.

Assessment:

Nursing Interventions:

Treatments:

1 Pharmacological: * Assess: * Use firm and calm * Mood stabilizers * Mood directions. * Treats mania * Elevated expressions * Be consistent in * Lithium (monitor for * Energy levels expectations. lithium toxicity) * Hyperactivity * Maintain safety in the *Anticonvulsants * Sleep patterns milieu. * Anti-anxiety medications * Reduced need for sleep * Maintain an environment * Second-generation * Behavior with low-stimulation. antipsychotic medications. * Risk-taking * Redirect aggressive * Antidepressants * Thought-Processes behavior. * SSRIs * Pressured, * Maintain adequate nutrition.

2 Non-Pharmacological: circumstantial, or * Provide frequent high-calorie * Electroconvulsive therapy tangential speech. “finger foods.” * Support groups * Thought content * Encourage patient to take * Cognitive-behavioral therapy * Grandiose delusions, rest periods. persecutory delusions.

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Et Schizophrenia: -

Schizotypal Personality Disorder: -

* Psychotic thinking or behavior that lasts for at least 6 months. * Typically presents between age 15 and 25. * Hallucinations, delusions, disorganized speech or disorganized behavior. * Symptoms significantly impair normal daily functioning.

* Patient has impairments surrounding their personality. * Delusions, fears, and difficulties surrounding the formation and maintenance of relationships.

Schizophreniform Disorder: -

* Patient has all the same symptoms of schizophrenia, but only lasts 1-6 months. * Usually does not impair social or occupational functioning.

Schizoaffective Disorder:

* The patient meets the criteria for schizophrenia as well as bipolar or depressive disorder.

Delusional Disorder: -

* Delusions that last at least 1 month. * The delusions usually are not severe enough to impair functioning. * Behavior is not usually strange or bizarre.

Brief Psychotic Disorder:

* Sudden onset of hallucinations, delusions, disorganized speech, or disorganized behavior. * Lasts between 1 day and 1 month.

Assessment:

Nursing Interventions:

* Positive symptoms: characteristics that should not be present. * Hallucinations, delusions, alterations in speech/behavior * Negative symptoms: characteristics that should be present that are not. * Blunted/flat affect, poverty of thought/speech, anergia (lack of energy), anhedonia (lack of pleasure). * Delusions * Alterations in speech * Alterations in perception * Difficulties with personal boundaries * Alterations in behavior

* Provide a structured environment * Ask the patient about their hallucinations/ delusions. * Tell the patient you do not hear/see anything, but believe that they do. * Focus conversations on reality. * Identify what triggers symptoms. * Assess for paranoid delusions, as they can lead to violence against self or others. * Encourage the patient to participate in group activities and work on building social skills. * Maintaining safety of the patient and other patients is the always the most important focus.

Tf I Treatment:

* First-generation antipsychotics * Second-generation antipsychotics * Antidepressants * Mood stabilizers ⇐

Nursing Diagnoses:

* Disturbed sensory perception * Risk for violence * Impaired communication * Altered thought processes

Personality disorders Cluster A O

* Suspiciousness of others * Belief that others want to harm, deceive, or exploit them. * RN should remain neutral and direct when interacting with patient.

Odd or eccentric behavior

Schizotypal: O

Schizoid: O

Paranoid: O

* Social withdrawal, emotional detachment. * Disinterest in close relationships. * Indifferent to praise or criticism. * Uncomfortable with social interaction.

* Very strange behavior * Magical thinking, odd beliefs, strange speech patterns. * Severe social deficits. * Perceptual distortions (misinterpreting actions of others).

Borderline: Histrionic: Narcissistic: Cluster B Antisocial: ÷ Dramatic, emotional, or erratic behavior

* Disregard for * Instability of others. identity. * Exploitation of * Splitting behaviors others. * Fear of * Will not accept abandonment. responsibility. * Ideas of * Manipulation reference. * Impulsivity * Manipulation * Can be charming * Impulsivity

Cluster C

Avoidant:

* Avoidance of social contact.

Anxious, * Extreme fear of fearful, or rejection. insecure * Feelings of inadequacy. behavior * Extreme anxiety in social situations.

* Lack of empathy * Dramatic, * Arrogance. attentionseeking behavior. * Sensitivity to criticism. * Extroversion * Seeks admiration * Selffrom others. centeredness * Fear of * Difficulty abandonment. forming long* Usually will not lasting accept treatment. relationships

Dependent: * Intense fears of separation. * High need to be taken care of. * Feelings of insecurity. * Lack of confidence in their own abilities and judgement.

ObsessiveCompulsive: * Perfectionism, orderliness, and control. * Stubbornness * Indecisiveness * Often can not accomplish tasks.

# Nursing Considerations:

1 Patients with personality disorders can create strong emotional reactions within the nurse.

Ex: Attempting to create tension between staff.

2 Maintaining safety in the milieu is the highest priority. * Patients with personality disorders are at risk for injury to self or others.

3 Maintain consistent care with the patient and maintain firm boundaries.

O 4 Self-assess for Countertransference reactions. and

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Treatments:

* Medications are prescribed to treat symptom manifestations. * Antidepressants, antianxieties, antipsychotics, and mood stabilizers. * Behavioral and psychotherapy is also utilized.

RATTER Eating REAPPEAR Disorders

¥i¥± Anorexia Nervosa: -

Bulimia Nervosa: -

* Restriction of energy intake that leads to low body weight for height and age. * Most frequently occurs in females in adolescence and young adulthood. * Types: * Restricting type: Drastic reduction of food intake with no binging or purging. * Binge eating / purging type: Patient also binge eats and purges. * Body Mass Index (BMI): * Mild: 17 or less * Moderate: 16-16.99 * Severe: 15-15.99 * Extreme: less than 15

* Repeated episodes where the patient consumes a large amount of food in a short period of time. * Binges are followed by actions such as self-induced vomiting, laxative consumption, fasting, or excessive exercise to rid the body of the calories consumed.

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o 1 Symptoms: -

* Recurrent binging and purging. * Most patients maintain a normal body weight and BMI. * Peripheral edema * Parotid swelling * Tooth erosion 2 Assessment: * Past and current nutritional patterns * Binging and purging patterns * How patient feels about their body * Deterioration of the mouth or throat 3 Nursing Diagnoses: * Disturbed body image * Decreased cardiac output * Ineffective coping

1 Symptoms: * Weight that is lower than normal. * Extreme fear of gaining weight. * Disturbance in the way the patient views their weight or body shape.

2 Risk Factors: * Perfectionism * Environment * Ex: Patient participates in a sport that idolizes a thin body. * Significant life changes Binge-Eating Disorder: 3 Assessment: * Weight in relation to height * Repeated episodes of binge eating followed * Lanugo (fine, downy hair on the face and by significant distress, but no purging.

O back) 1 Symptoms: * Eating habits * Obesity * History of dieting * Dysfunctional eating pattern * Value the patient attaches to weight and * Loss of control when binging body size.

O 2 Assessment: O 4 Nursing Diagnoses: * History of weight cycling (gain and loss) * Imbalanced nutrition: less than body * Nutritional pattern requirements 3 Nursing Diagnoses: * Disturbed body image * Imbalanced nutrition: more than body * Chrnoic low self-esteem requirements. * Ineffective coping * Ineffective coping * Risk for injury * Social isolation * Risk for imbalanced fluid volume * Powerlessness * Chronic low self-esteem -

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restorer Er tea Disorders renren.ae Use Substance Cannabis Use Disorder: -

Alcohol Use Disorder: * Frequent consumption of alcohol in larger amounts or longer periods than intended. * Unsuccessful attempts to decrease alcohol consumption. * Continued alcohol use despite causing problems with relationships, work, etc.

1 Intoxication: * Impaired judgement, poor muscle coordination, slurred speech, memory impairment. * 0.4 mg/dL blood alcohol levels causes impaired vital signs and possible death.

2 Withdrawal: * After 6-8 hours, shakes begin. * After 8-10 hours psychotic symptoms and perceptual distortions May begin. * Withdrawal seizures and alcohol withdrawal delerium May occur and can cause death.

3 Treatment: * Diazepam (Valium), chlordiazepoxide (Librium), and lorazepam (Ativan) can be given to reduce delirium and seizures.

* Use interferes with work, home life, social life, and physical health. * Using larger amounts over long periods of time, tolerance increases.

1 Intoxication: * Heightened sensations * Depersonalization/derealization * Increased appetite * Tachycardia 2 Withdrawl: o * Within 1 week of cessation * Irritability, anger, anxiety, depressed mood, insomnia, headache, shakiness.

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Opioid Use Disorder:

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Hallucinogen Use Disorder: * LSD, PCP, Ketamine, etc. * Strong cravings, tolerance, difficulty maintaining obligations.

1 Intoxication: * Paranoia * Illusions, hallucinations, synesthesia 2 Withdrawal: * Hallucinogen persisting perception disorder 3 Treatment: * Antipsychotic medications and benzodiazepines.

* Heroin, prescription drugs * Increasing tolerance, longer periods of use.

1 Intoxication: * Drowsiness, slurred speech, impaired Inhalant Use Disorder: memory, pupil construction, respiratory depression, can cause overdose and death. * Glues, adhesives, aerosol sprays, paint. * Tolerance develops, unable to maintain 2 Withdrawl: obligations. * Nausea, vomiting, muscle aches, fever.

1 Intoxication: 3 Treatment: * Disinhibition, illusions, hallucinations * Narcan * Can cause death Sedative/Hypnotic/Anti-anxiety

RE E i Medication Use Disorder:

Stimulant Use Disorder:

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* Amphetamines, cocaine, etc.

1 Intoxication: * Cardiac arrhythmia, respiratory depression, dilated pupils, perspiration.

2 Withdrawal treatment: * Antipsychotics for psychosis, diazepam for hyperactivity, bupropion for depression.

1 Intoxication: * Incoordination, slurred speech, impaired thinking.

2 Withdrawal: * Hyperactivity, tremor, insomnia, agitation.

3 Overdose treatment: * Activated charcoal, gastric lavage, vital sign monitoring.

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NEURODEVELOPMENT NEURODEVELOPMENTAL AL DISORDERS DISORDERS

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Autism Spectrum Disorder: y

Communication Disorders: * Deficits in language acquisition that create impairments in communication. o 1 Speech disorders: * Problems with making certain sounds * Child-onset fluency disorder (stuttering) 2 Receptive language disorder: * Difficulty understanding and following directions.

3 Expressive language disorder: * Difficulty using correct words and forming complete sentences.

4 Social communication disorder: * Difficulty interacting socially with others.

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Motor Disorders: 1 Developmental Coordination Disorder: * Impairment of motor skill development * Motor skills do not meet the childs level of development. * Interferes with ability of the child to perform activities of daily living.

2 Stereotypic Movement Disorder: * Repetitive movements with no purpose. * Hand waving, rocking, teeth grinding, head banging, etc.

* Difficulty in reading: dyslexia. * Difficulty in math: dyscalculia * Difficulty in writing: dysgraphia * Children with specific learning disorders are usually put on Individualized Education Programs (IEP) at school. * Early intervention is important to ensure the best possible outcome. .

* Causes deficits in: * Intellectual functioning: thinking, reasoning, etc. * Social functioning: communication, emotions, etc. * Daily functioning: ADLs, self-care, etc.

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* Typically appears between birth and age 3. * Impacts the development of social and communication skills. * Symptoms: * Difficulty developing relationships * Repetitive speech * Hyper-reactivity to sensory input * Extreme focus on routines * Excessive focus on objects * Resistance to change * Children with autism are referred to early intervention programs. * Pharmacological treatment can include second-generation antipsychotics and SSRIs. -

Attention Deficit/Hyperactivity Disorder:

Specific Learning Disorders: -

Intellectual Disability: T

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* Inappropriate levels of hyperactivity, impulsiveness, and inattention. * Symptoms: * Poor social boundaries * Interrupting others * Intrusive behaviors * Difficulty taking turns * Symptoms must be present both at home and school before age 12. * Symptoms can cause: * Frustration * Anger outbursts * Poor school performance * Low self-esteem -

Managing Disruptive Behavior: * Modeling good behavior * Role playing * Ignoring attention-seeking behavior * Redirecting inappropriate behavior * Limit setting * Restructuring activities to meet the needs of the child.

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ofER reioreaeee@erre.oaorrroo.r control disorders Impulse Oppositional Defiant Disorder: O 1 Symptoms: 2 Assessment: O * Angry, irritable mood * Identify power * Easily annoyed struggles. * Resentful * Assess how the * Argumentative, defiant behavior patient views their * Argues with authority behavior. * Refusal to follow rules * Assess ability to * Blames others for behavior take responsibility * Vindictiveness for their actions. * Seeks revenge -

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O 3 Treatment: * Parent training * Group therapy * Anger management * Cognitive-behavioral therapy * Depakote may be used to reduce aggression and irritability.

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Intermittent Explosive Disorder: 1 Symptoms: 2 Assessment: * Behavioral outbursts and * Assess intensity inability to control aggressive and frequency of impulses. violent outbursts. * Anger directed to people, * Assess ability to animals, objects, or control emotions. themselves. * Identify triggers * Anger and aggressive for aggressive outbursts are out of outbursts. proportion to the event that causes it.

Conduct Disorder: -

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O 2 Assessment: * Assess seriousness of * Violation of others rights disruptive behavior. * Disregard for rules * Assess ability to * Destruction of property control impulses. * Causing injury to others * Assess morals and * Deceitfulness and theft belief systems. * Actions cause significant * Assess ability to feel impairment in social, empathy and remorse. academic, and occupational functioning.

O 1 Symptoms: -

3 Treatment: *Individual cognitive-behavioral therapy * Group cognitive-behavioral therapy * SSRIs * Improve social cognition * Mood stabilizers * Used with SSRIs * Antipsychotics * Calming effect * Beta-blockers

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O 3 Treatment: -

* Anger management * Parent management skills * Multi-systemic therapy * Antidepressants * Mood stabilizers * Stimulants * Antipsychotics * Anticonvulsants

REFER TE Disorders RRRRRR RRR IT Neurocognitive Delirium: o

Alzheimers Disease: i s

* Rapid onset in a short period of time * Considered a medical emergency * Common in older patients o 1 Causes: * Infection * Malnutrition * Electrolyte imbalances * Substance use * Medication interactions o 2 Symptoms: * Impairments of memory, thinking, judgement, and focus * Disorientation and confusion * Hallucinations and illusions * Restlessness and anxiety * Personality change 3 Assessment: * Assess level of awareness * Determine usual level of awareness * Assess vital signs and potential for injury 4 Nursing Diagnoses: * Risk for injury * Acute confusion * Impaired social interaction 5 Interventions: * Identify cause of delirium * Administer prn medications for anxiety * Assist with nutrition and self-care needs * Use simple and direct statements * Maintain consistent environment/routines * Maintain 1-on-1 supervision at all times

* Progressive deterioration of memory, cognitive functions, and the ability to complete activities of daily life. * Organized into three stages: * Mild: * Memory lapses * Misplacing items * Difficulty planning and organizing * Moderate: * Forgetting personal history * Wandering and getting lost * Personality and behavioral changes * Severe: * Inability to perform self-care * Changes in physical abilities * Difficulty communicating * Poor awareness of surroundings * Nursing diagnoses: * Risk for injury * Impaired communication * Impaired memory * Treatments: * Community supports for family * Cholinesterase inhibitors * Prevents breakdown of acetylcholine * Donepexil (Aricept) *NMDA receptor agonist * Memantine (Namenda) * Other medications may be used to control behavioral symptoms.

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Neurocognitive Disorder: O 3 Interventions: 2 Symptoms: O -

* Often referred to as dementia. * Memory impairments * Progressive deterioration of * Inability to recognize cognitive functioning. familiar items * Occurs over a period of months or * Speech deficits years. * Functional impairments o 1 Causes: * Agitation * Advanced age * Sundowning syndrome * Traumatic brain injury * Personality change * Genetics . * Diabetes * Other neurological disorders -

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* Monitor nutrition and weight. * Give one direction at a time. * Use distraction to manage behavior. * Provide cues * Utilize written signs * Limit the amount of choices the patient has to make during the day.