This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. McGraw-Hill Education is not responsible for the content of information accessed through the work.
Introduction
- Foundation of Psychiatric and Mental Health Nursing
- Childhood and Adolescent Psychiatric Disorders
- Anxiety and Anxiety Disorders
- Somatoform and Dissociative Disorders
- Schizophrenia
- Personality Disorders
- Mood Disorders
- Substance Abuse
- Eating Disorders
- Sleeping Disorders
- Sexual Disorders
- Therapeutic Communications
- Patient Psychiatric Assessment and Patient Psychiatric Care Plans
- Physiologic Basis of Mental Illness
In this chapter, you will learn about anxiety disorders and what a nurse can do to help the patient recover. In this chapter, you will learn about schizophrenia and interventions that alleviate symptoms for the patient.
Learning Objectives
Foundation of
Psychiatric and Mental Health Nursing
Mental illness
Models of Human behavior
Medical model: Abnormal behavior is caused by an underlying disease that affects neurochemicals in addition to social-environmental factors. A person who focuses on past experiences may become alienated from themselves and is likely to exhibit abnormal behavior.
The nurse focuses on the accomplishments made during the therapeutic relationship and encourages the patient to move forward with follow-up care.
Seek clarification: Repeat the patient's statement and ask the patient if your understanding is correct. In summary: indicate that you understand what the patient said and then give the patient the opportunity to clarify any inaccuracies.
The psychiatric nurse must listen to what the patient says, without judging the patient. The psychiatric nurse should return to the original topic after the patient has finished thinking.
Defense Mechanisms
Denial: A patient refuses to accept reality, such as a patient who denies having a chronic illness. Fantasy: A patient develops unrealistic beliefs when the patient is unable to cope with reality, such as a patient who believes he or she does not have a mental illness.
Legal environment
The patient's care team led by the psychiatrist presents evidence as to why the patient should remain involved. If the patient does not have the legal capacity to give consent, the psychiatrist can commit the patient.
Psychiatric therapies
The patient's anxiety will decrease over time and the patient will be able to cope with the situation. Mind switching: Mind switching requires the patient to replace positive thoughts with unacceptable thoughts.
Psychiatric assessment tests
Thematic apperception test: The thematic apperception test is used to assess the patient's interpersonal relationships and conflicts as well as personality traits. Functional dementia scale: The functional dementia scale measures the patient's ability to perform everyday activities.
The psychiatric diagnosis is used to help the psychiatric nurse develop the patient's care plan. The GAF value is used to evaluate the patient's level of care and treatment outcome.
The psychiatric nurse must be aware that cultural beliefs may influence the patient's responses to questions. A complete psychiatric evaluation should be performed to determine if the patient is at risk of suicide.
Mental status examination
Ask the patient to read and explain a news story to test the patient's comprehension. Abnormal: The patient is unable to repeat the sequence of digits forwards and backwards.
In this section, the psychiatric nurse describes the patient's psychiatric history based on interviews with the patient and a review of the patient's records. The patient has one sibling, a brother, who has a history of polysubstance addiction (alcohol, opioid, cocaine) and has been in recovery for 5 years.
Developing a nursing Diagnosis
SHORT-TERM GOAL: Patient will engage in self-care activities consistent with the patient's ability. A few minutes later after noticing that the nurse is in the chart office, the patient asks the certified nursing assistant (cNA) to make another phone call.
What is the patient doing?
SHORT-TERM GOAL: To articulate substance use as a problem in their lives within 3 to 7 days. The patient made a 10-minute phone call at the beginning of the shift and asked the charge nurse for permission to call again.
FinaL cHeck-UP
The new psychiatric nurse should explain the consent form to the patient and ask the patient to sign the form. The new psychiatric nurse must assess the patient to determine whether the patient is mentally competent.
The new psychiatric nurse must tell the responsible psychiatric nurse that the patient is not competent to sign the form because she is an involuntary patient. The new psychiatric nurse should tell the responsible psychiatric nurse that she is not comfortable asking the patient to sign the document.
Place the patient on constant observation knowing that a patient with depression may attempt suicide.
The patient should not block your exit from the room if he becomes aggressive during the interview.
LEARNING OBJECTIVES
Childhood and
Adolescent Psychiatric Disorders
Checklist for Autism in Toddlers Autism Rating Scale in Children Childhood Depression Inventory (CDi) Defiant behavior.
Childhood and Adolescent Mental Illness
Diagnosing
Treatment
NursiNg Alert
Working With a Difficult Child
Seclusion occurs when a child is placed in a relatively bare room until the child regains self-control or until medication calms the child. During restraint, the child's arms and legs are tied to a bed with leather straps.
Nurse Alert
Attention Deficit Hyperactivity Disorder
Be aware that a diagnosis of a mental disorder can stigmatize the child and the child's family. Be especially careful to explain to them the mental disorder and the prognosis for the child.
Autistic Disorder
Autism Screening Questionnaire: This questionnaire consists of 40 questions and is used to assess a child's social and communication skills. Key to the mainstream approach is the child's ability to be in the classroom.
Conduct Disorder
Introduce change gradually by modifying the picture board and reviewing the picture board with the child to introduce the child to the change. Three of the following criteria must be present in the past year and one criterion in the past 6 months.
Oppositional Defiant Disorder
Four of the following criteria must be present within 6 months to be diagnosed with ODD.
Major Depression Disorder
The symptoms must change from the child's previous behavior and affect the child's ability to function normally. Caution: The child should be weighed weekly to determine if there is any weight gain or loss as a side effect of the medication.
Mental Retardation
Clinical judgment is used to assess potential intellectual functioning for a child who is too young to participate in an IQ test. Encourage the child to socialize within the child's tolerance and the tolerance of peers and family.
Tourette Syndrome
The goal is to increase the child's coping skills for dealing with stressful situations and to increase the child's self-esteem. Work with family and school officials to create a less stressful educational environment for the child.
Why should the mother be concerned?
Question 2. What information should the psychiatric nurse gather from the parent?
What might be the reason for the infant’s lack of response to sound?
FINAL CHECk-Up
- a parent tells the psychiatric nurse that her son has a conduct disorder because the school administrator called saying that he and a few of the other 8-year-old
- What might be the rationale for the grandfather’s opinion?
- What are the faults in the grandfather’s rationale?
- What should the psychiatric nurse suggest the grandfather do in this situation?
- a 23-year-old mother asks the psychiatric nurse for the telephone number of a child psychiatrist because her 2-year-old daughter constantly refuses to do
- a mother of a 5-year-old boy reports that for the past 3 months he is always talking, cannot sit down for any length of time, and always pushes
- a father is devastated that his 12-year-old daughter was diagnosed with Mdd
- the parent of a child who is newly diagnosed with autism disorder asks the psychiatric nurse how the parent should interact with the child. what is the
Tell the mother that the child is demonstrating normal behavior and her actions are consistent with a child struggling with developing independence. Tell the mother to take the child to her pediatrician to rule out underlying medical conditions that could be causing the problem.
CORRECT ANSWERS AND RATIONALES
While the other statements are true, the best response is to educate yourself on the current diagnosis, which is none, and refer the parent to the pediatrician to formally evaluate the child. The child appeared to have a loss of social skills and language skills, which are early signs of autistic disorder.
Anxiety and Anxiety Disorders
The patient may experience major depressive disorder and post-traumatic stress disorder if acute stress disorder is untreated. Help the patient process factors that lead up to and occurred during and after the traumatic event.
Teach the patient signs of anxiety and develop coping skills such as distraction to reduce anxiety. Stay with the patient during an episode of anxiety and encourage the patient to express the patient's concerns.
Obsessive-compulsive Disorder
The obsession-compulsion lasts more than 1 hour per day or significantly interferes with the patient's daily activities. Do not prevent the patient from performing repetitive behaviors as this increases the patient's anxiety.
Panic Disorder
The patient experienced at least four of the following signs and symptoms during the panic attack. Cognitive behavioral therapy (CBT): CBT retrains the patient's thought pattern to decrease the effects of anticipating the next panic attack.
Phobia
Persistent irrational fear caused by a social situation where the patient is exposed to possible scrutiny by others. The patient is gradually exposed to the triggers and then trained to cope appropriately with the anxiety caused by the trigger.
Posttraumatic stress Disorder
Posttraumatic stress disorder increases the patient's risk for self-medication and abuse of alcohol and over-the-counter drugs, depression, suicidal ideation, suicide attempts, and autoimmune and cardiovascular disease. Cognitive behavioral therapy (CBT): CBT retrains the patient's thought pattern to decrease the effects of the triggering event.
Symptoms of anxiety developed within 1 month of the patient becoming intoxicated or withdrawing from medications. The patient must undergo an intensive drug rehabilitation program to prevent further drug abuse.
What should the practitioner suspect occurred?
A patient detoxing from alcohol may experience delirium tremens up to 3 days after the patient stops drinking alcohol. Suddenly she rushes and locks all the doors and all the windows, drawing all the shades before turning off the television and all but one light.
What should the practitioner do first?
What might have caused the patient to react in such a way?
The patient is able to function and received the teacher of the year award last year.
What should be of concern to the patient’s practitioner?
What change in treatment should the practitioner consider for the patient?
FinaL check-UP
The nurse should inform the patient about the next course of action, namely to talk to the primary practitioner about the panic attacks. Complex OCD requires that the obsession interfere with the patient's daily activities.
Somatoform and
Dissociative Disorders
What are somatoform Disorders and Dissociative Disorders?
Factitious Disorders and Malingering Disorders
The patient is overly concerned about the patient's perception of defects in the patient's appearance. Prolonged exposure will desensitize the patient to perceived defects in the patient's body.
Recognize that the patient's symptoms are real and that the patient is not faking symptoms. Encourage the patient to perform daily activities within the patient's ability to avoid the patient becoming disabled.
Hypochondriasis
Psychotherapy: Provides an environment where the patient is able to discuss and resolve internal conflicts. Cognitive therapy: Teach the patient to identify triggers that cause the patient to engage in hypochondriacal behavior.
Pain Disorder
The patient is also at risk for disruption of activities of daily living including employment. Cognitive therapy: Teach the patient to identify the triggers that cause the patient to engage in the behavior.
Explore with the patient any underlying psychological stressors that may be causing symptoms of the pain disorder. There is no therapy for somatization disorder because the patient believes the symptoms are real.
Depersonalization Disorder
The patient experiences interruptions in activities of daily living due to an episode of depersonalization disorder. Help the patient develop coping skills to better deal with the underlying stressors that cause symptoms of depersonalization disorder.
Dissociative amnesia
Help the patient understand that memory loss is the patient's way of coping with a stressful situation. Keep the patient safe during an episode of amnesia, as the patient is likely to be unaware of the patient's surroundings.
Dissociative Fugue
No signs and symptoms are present during an episode of dissociative fugue as the patient carries out activities of daily living under his new identity. Help the patient understand that the dissociative fugue is the patient's way of coping with a stressful situation.
Dissociative identity Disorder
Impaired memory related to the inability to recall events when another personality takes over the patient's behavior. Help the patient focus on the underlying traumatic event that caused the dissociative identity disorder.
What should you do first?
What should be the focus of treatment?
- a husband reports to you that his 53-year-old wife is constantly going to prac- titioners reporting all sorts of symptoms and no one has been able to diagnose
- Your neighbor tells you that her brother has persistent pain; however, physi- cians are unable to find the medical reason and suggest that he see a psychia-
- Your friend is concerned that she has depersonalization disorder because she felt like she was viewing herself from afar during a party last night. what’s your
- a relative asks you about the cause of dissociative identity disorder. which of the following is your best response?
- what type of therapy is used to treat somatization disorder?
- what is the first line of treatment for pain disorder?
Confused, he tells authorities that he appears to have a different name and cannot remember much of the past five years. Some researchers believe that dissociative identity disorder is a survival mechanism related to a traumatic event in early childhood.
Schizophrenia
What is schizophrenia Disorder?
Hallucinations
Delusion
Positive and negative symptoms
That is, a person who is not experiencing an episode of schizophrenic disorder must exhibit specific behaviors. Blunted affect: Blunted affect is when the patient is unable to show emotions, although they continue to feel emotions.
Phases of schizophrenia Disorder
Poverty of speech: The patient gives short answers when someone tries to talk to him.
Degrees of schizophrenia Disorder
- Paranoid schizophrenia Disorder
- Disorganized schizophrenia Disorder
- Undifferentiated schizophrenia Disorder
- residual schizophrenia Disorder
- catatonic schizophrenia Disorder
- a family member of a patient who is diagnosed with catatonic schizophrenia disorder asks you if the practitioner should prescribe antipsychotic medication
- What should you do next?
- a family member mentioned that his sister barricades herself in her house and calls the police every time the mail carrier drops off mail. She has been diag-
- the brother of a patient reports that the patient’s medication stopped working and he has returned to walking the streets late at night chasing trucks out of his
- new parents raise concerns that their son will develop schizophrenia disorder because the husband’s mother had been diagnosed with paranoid schizophre-
- a new patient diagnosed with paranoid schizophrenia disorder arrives on your unit. how should you react?
- a father of a 42-year-old man who has been diagnosed with undifferentiated schizophrenia disorder for many years tries to control his son’s bizarre behavior
Patients with late-onset undifferentiated schizophrenia disorder have the most positive prognosis if the patient is adherent to treatment. The patient is at risk of not being able to perform daily activities.
Personality Disorders
Personality and Personality Disorders
A person with a personality disorder exhibits the same traits, but in extremes and is unable to change their behavior. A person diagnosed with avoidant personality disorder exhibits the same behavior but is unable to return to more normal behavior when the perceived danger passes.
- antisocial Personality Disorder
- avoidant Personality Disorder
- borderline Personality Disorder
- Dependent Personality Disorder
- Histrionic Personality Disorder
- narcissistic Personality Disorder
Avoidant personality disorder occurs when the patient exaggerates the negative as a reason to avoid new situations. The prognosis for a patient diagnosed with dependent personality disorder is good if the patient undergoes treatment.
