Download NERVOUS SYSTEM ASSESSMENT and more Essays (high school) Family and Consumer Science in PDF only on Docsity!
Week 1 [Midterms]
Mood Disorders
Mood Disorders
➢ A disorder characterized by mild to
extreme fluctuations in emotions and
behavior that impairs the individual’s
major functioning.
➢ Pervasive alterations in emotions that
are manifested by depression, mania, or
both.
➢ Group of disorders characterized by a
decrease or entire loss of control over
mood.
➢ Used in varied ways:
○ Sign
○ Symptom
○ Syndrome
○ Emotional state
○ Reaction
○ Disease
➢ Alteration in mood that is expressed by
feelings of sadness, despair and
pessimism
Intrapsychic conflict → the usual way of living
forbids you to do something that what you want
Two Major Categories of Mood Disorders
1. Depressive
2. Bipolar
1. Depressive/ Depression
➢ Refers to an effect of sadness and
feeling of disappointment that are
experienced by everyone.
➢ Response to stress and loss.
➢ As mood disorder, changes in mood
constitute major symptoms
Causes of Depression:
● Biological
○ Stress Response system
(Hypothalamus → Corticotropin
Releasing Hormone → Pituitary
gland → Adrenocorticotropic
hormone → Adrenal gland →
Cortisol → Negative feedback →
back to Hypothalamus)
● Psychological
○ Psychoanalytic Theory
■ Melancholia (deep
sadness/gloom) occurs
after a loss of an object or
rejection.
■ Incorporated to ego that
later develops self-hate.
○ Cognitive (Beck)
■ Depression is cognitive
rather than affective.
■ This results in defeating
attitudes.
Types of Depression:
1. Transitory
➢ Everyday life disappointments.
2. Mild
➢ Sadness appropriate to loss of
object/person
➢ Difficulty concentrating and
performing usual activities.
3. Middle/Moderate (Neurotic)
➢ Grief is prolonged
➢ Fixed on the “anger” stage.
➢ Helplessness, decreased energy,
sleep pattern disturbance,
appetite and weight changes,
slowed speech and movement.
4. Severe
➢ Characterized by depressed
mood or loss of interest or
pleasure in usual activities and
with psychotic symptoms.
➢ Hopeless, worthless, guilt and
shame, lack of motivation,
suicidal thoughts, decrease
sexual activity.
Classification of Depression:
1. Dysthymia (Depressive Neurosis)
➢ Type of Middle/Moderate Level
depression
➢ Duration: for 2 years and no
absence of symptoms more than
2 months
➢ Early onset: before 21 years old
➢ Late onset: after 21 years old
➢ To be called Dysthymia, patient
should have at least 2 of the
following symptoms:
○ Anorexia
○ Insomnia
○ Anergia
○ Low self-esteem
○ Feelings of hopelessness
○ Poor concentration
2. Seasonal affective disorder (SAD)
➢ A type of Severe level
Depression
➢ Common in winter season
➢ Recurrent depressive episodes at
the same time of the year.
➢ Duration: November-December
3. Melancholia/Endogenous Depression
➢ A type of Severe level
depression
➢ Major Depression with loss of
pleasure in all or most of all
activities
➢ Usually 40-60 years old
➢ To be called Melancholia, patient
should have at least 3 of the
following symptoms:
○ Morning depression
○ Excessive guilt
○ Loss of emotional
reactivity
○ Anorexia
4. Major Depressive Disorder
➢ DSM -V diagnostic criteria:
defining features
➢ Criterion A: Characteristic
symptoms
○ Five or more of the
following have been
present during the 2-week
period and represent a
change from previous
functioning; at least one of
these, either 1 or 2.
1. Depressed mood
most of the day.
2. Markedly
diminished interest
or pleasure in all
3. Significant weight
loss or weight gain
4. Insomnia or
hypersomnia nearly
everyday
5. Psychomotor
agitation or
retardation nearly
everyday
6. Fatigue or loss of
energy nearly
everyday
7. Feelings of
worthlessness or
excessive or
inappropriate guilt
8. Diminished ability to
think or
concentrate.
9. Recurrent thoughts
of death.
○ Criterion B: Social/occupational
dysfunction
■ Occupational
■ Social
■ Other important
functioning
2. Attempted Suicide
➢ Suicidal action that did not end or
not fatal
3. Incomplete Suicide
➢ The person did not finish the act
because someone recognized
the suicide attempt as a cry for
help and responded or the
person was…
Suicidal Ideation
➢ The thought of killing oneself
○ Active - thinks about ways on
how to do it.
○ Passive - walang action na
ginawa (ex. Sinabi lang nyang
bibili sya ng baril pero ilang araw
o months na wala pa din)
➢ Involves ambivalence
○ Instinct for life (Eros)
○ Instinct for death (Thanatos)
➢ Introjection
Risk for Suicide:
➢ Sex
➢ Age
➢ Depression
➢ Previous attempts
➢ Ethanol
➢ Rational not
➢ Social support is lacking
➢ Organized plan to suicide
➢ No Family
➢ Sickness
Sucide Triad
1. Loss of spouse
2. Loss of job
3. Aloneness
Nursing Process for Suicide:
Assessment:
➢ History of previous attempts increases
risk for suicide.
➢ The first 2 years after an attempt
represents the highest risk period,
especially the first 3 months.
➢ Those with relative who committed
suicide are at increased risk for suicide;
the closer the relationship, the greater
the risk.
➢ Many people with depression who have
suicidal ideation lack the energy to
implement suicide plans.
➢ Suicidal ideation send either direct or
indirect signals to others about their
intern to harm themselves.
➢ The nurse never ignores any hint of
suicidal ideation regardless of how trivial
or subtle t seems and the client’s intent
or emotional status.
SLAP Assessment
S- specific details of the plan of patient
L- lethality of method
➢ Age and sex
➢ Plan
➢ Stress
➢ Symptoms
➢ Resources
➢ Communication
➢ Reaction of Significant others
➢ Medical status
A-availability of method
P-proximity of help
Suicidal Cues
➢ Becomes energetic after severe
depression
➢ Improved mood after taking
antidepressants
➢ Gives away valuable possessions
➢ Finalizes business or personal affairs
➢ Leaves notes or will
➢ Appears emotionally upset
➢ Makes direct or indirect statement
➢ Evident death plan
➢ Endorsing relatives to others
➢ Verbalization of helplessness
➢ Wish to see all relatives
Nursing Interventions for Suicide:
D → direct question
I → irregular interval visit
E → early AM/endorsement period
K → kill negativity and low self esteem
E → energy is problematic
E → eliminate hazards or suicide tools
P → paper; no suicide contract
M → monitor in giving meds
E → encourage support
S → safety/stimulus
A → assess and evaluates for changes/
authoritative role
F → find out plan
E → encourage verbal of feelings
2. Bipolar
➢ Characterized by mood swings from
depression to extreme mania with
periods of normalcy.
➢ Includes mania, hypomania, mixed
depression and clythomania.
Types of Bipolar
A. Bipolar 1 ➢ Mania and depression ➢ Duration: everyday for 1 week ➢ Bipolar 1 disorder: Manic and Hypomania ) B. Bipolar 2 ➢ Hypomania and depression C. Cyclothymia Disorder ➢ A chronic mood disturbance ➢ Moderate depression and hypomania ➢ Duration: at least 2 years ➢ Citeria for major depression, bipolar 1 and 2 not met. Mania ➢ Alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity , and hyperactivity. ➢ Causes: ○ Increase norepinephrine ○ Increase serotonin levels DSM-V diagnostic criteria (Manic episodes) ○ Criterion A: ■ A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly everyday (or any duration if hospitalization is necessary). ○ Criterion B ■ During period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood
activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequence ○ Criterion C ■ The episode is associated with unequivocal change in functioning that is uncharacteristic of the individual when not asymptomatic ○ Criterion D ■ The disturbance in mood and the change in functioning are observable by others ○ Criterion E ■ The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. ○ Criterion F ■ Not attributable to the physiological effects of a substance or another medical condition ➢ To be considered Bipolar 1 patient must have at least 3 of the following for 1 week: M - mouth/ mood/ manipulative A - activity/ agitated N - need for sleep is decreased I - insomnia/ flight of ideas A - attention (distractibility) C - confidence (grandiose Treatment for Bipolar: ➢ Psychopharmacology ○ Lithium ○ Anticonvulsants ➢ Psychotherapy Nursing Interventions for Mania ➢ Safe environment ➢ No Patient Interaction ➢ Set-limits ➢ Use sedative medications Nursing Interventions for Bipolar patient ➢ Provide safety of patient and others ➢ Set limits on behavior ➢ Short simple sentences ➢ Clarify communication ➢ Provide high calorie high CHOn food, to improve sleep ➢ Provide dignity ➢ Channel clients need for movement into socially acceptable activities Differentiate between MANIC and DEPRESSION ➢ Nursing Diagnosis: ○ Risk for injury (self) ○ Risk for injury (others) ➢ Nursing Priority: ○ Finger Foods (high calorie and CHON) ○ Small frequent feedings (high fiber) ➢ Treatment: ○ Lithium;ECT ○ TCA;SSRI;MAOI;ECT ➢ Milieu: ○ Stimulating ○ Non stimulating (non-bright lights, don’t touch) ➢ Appropriate activity: ○ Monotonous (arth therapy; reading books) ○ Quiet type (gardening; finger paint) ○ Non-competitive ➢ Attitude therapy ○ Matter of fact; set-limits ○ Kind firmness
Week 2 [Midterms] Anxiety ➢ Is a vague unpleasant feeling of apprehension ➢ An emotional response to unknown, and nonspecific danger or threat ➢ Subjective ➢ Anxiety motivates a person to take action, to solve a problem or to resolve a crisis. ➢ Considered normal when it is appropriate to the situation and has been resolved ➢ Anxiety becomes abnormal when it is excessive, chronic and results to impairment in the individual’s major functioning ➢ Anxiety Vs fear ➢ Fear is feeling afraid or threatened by an identifiable external stimulus that presents danger to the person ANXIETY AS A RESPONSE TO STRESS ➢ Stress is the wear and tear that life causes in the body (Selye, 1956) ➢ It occurs when a person has difficulty dealing with life situations, problems, and goals ➢ Each person handles stress differently; one person can thrive in a situation that creates great distress for another person. 3 STAGES OF ANXIETY
- Alarm Reaction ➢ Initial reaction of body to stress ➢ 2 phases of alarm reaction ○ Shock phase ■ (ANS) Autonomic nervous system reactions ■ Fight or flight ○ Countershock ■ Rest or digest ■ After shock
- Stage of Resistance ➢ Adaptation to stress
- Stage of Exhaustion ➢ Inability of the body to maintain homeostasis (maladaptation) People can communicate anxiety both verbally and non verbally LEVELS OF ANXIETY
- Mild ➢ Sensation that something is different and warrants special attention ➢ Psychological Responses ○ Wide perceptual field ○ Sharpened senses ○ Increased motivation ○ Effective problem solving ○ Increases learning ability ○ Irritability ➢ Physiologic Responses ○ Restlessness ○ Fidgeting ○ GI butterflies ○ Difficulty sleeping ○ Hypersensitivity to noise ➢ Nursing management ○ Establish trust ○ Listen ○ Recognize anxiety ○ Explore causes of anxiety ○ Focus on ways of problem solving ○ Engage in goal directed activities ○ No direct intervention
- Moderate ➢ Disturbing feeling that something is definitely wrong; person is nervous. ➢ Psychological Responses ○ Perceptual field narrowed to immediate task ○ Selectively attentive ○ Cannot connect thought or events independently ○ Increased use of automatisms ➢ Physiological Responses ○ Muscle tension ○ Diaphoresis ○ Pounding pulse
➔ Focus ➔ Enhanced learning capacity MODERATE ➔ Pacing ➔ Prn meds ➔ Selective inattention SEVERE ➔ Don’t know what to say/do ➔ Directive ➔ Vomiting PANIC ➔ Bag bawal ➔ Suicide safety CAUSES OF ANXIETY
- Biologic Factor 1.1. Genetic 1.2. Neurochemical-decreased GABA
- Psychodynamic Factor 2.1. Psychoanalytic / intraphysic Theory 2.2. Behavioral Theory 2.3. Interpersonal Theory ANXIETY RELATED DISORDERS Anxiety Disorders ➢ Formerly known as neurotic disorders ➢ Are diagnosed when anxiety no longer functions as a signal danger or a motivation for needed change but becomes chronic and permeate major portion of the person’s life resulting in maladaptive behavior and emotional disability ➢ Composing a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, ang physiologic responses. ➢ Clients suffering from anxiety disorders can demonstrate unusual behaviors such as panic without reason, unwarranted fear of objects or life conditions ➢ DSM IV ○ Generalized ○ Obsessive ○ Panic ○ Phobia ○ Stress Disorder
➢ DSM V
○ Generalized ○ Panic ○ Phobia Panic Disorders/ Panic Attacks ➢ 15 - 30 mins escalation of SNS ➢ Sudden onset of intense apprehension or terror that last for 15-30 mins ➢ Composed of discrete episodes of panic that is 15 to 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiologic discomfort ➢ Common in women than men ➢ Begins during late adolescence to eary adulthood ➢ DM: Conversion ➢ DSM V: diagnostic criteria ○ (Criterion A) Recurrent unexpected panic attacks during which tinne four or more of the following symptoms occur: ■ Palpitations, pounding heart, or accelerated heart rate ■ Sweating ■ Trembling or shaking ■ Sensations of shortness of breath or smothering ■ Feelings of choking ■ Chest pain or discomfort ■ Nausea or abdominal distress ■ Feeling dizzy, unsteady, light-headed, or faint ■ Chills or heat sensations ■ Paresthesias ■ Derealization or depersonalization ■ Fear of losing control or going crazy ■ Fear of dying ○ (Criterion B) At least one of the attacks has been followed by 1 month or more of one or both of the following: ■ Persistent concern or worry about additional panic
attacks or their consequences ■ A significant maladaptive change in behavior related to attacks ○ (Criterion C) ■ Not attributable to the physiological effects of a substance or another medical condition ○ (Criterion D) ■ The disturbance is not better explained by another mental disorder INTERVENTIONS FOR PANIC: ➢ Safe environment ○ Dim light ➢ Stay with the client ○ Reassurance to feel secure ➢ Guide step by step ➢ Restraint if necessary ➢ Communication must be calm and simple ➢ Deep Breathing Exercise and brown bag ➢ Exploration of stress ➢ Psychopharmacology ○ Antidepressants (SSRI and TCA) ○ Anxiolytics: Benzodiazepines and Nonbenzodiazepines AGORAPHOBIA (Agora social specific phobia - irrational fear) ➢ Fear of being in places or situations from which escape might be difficult, or in which help might not be available ➢ DSM V Diagnostic Criteria ○ (Criterion A) Marked fear of anxiety about two or more of the following five situations: ■ Using public transportation ■ Being in open spaces ■ Being in enclosed places ■ Standing in line or being in a crowd ■ Being outside of home alone ○ (Criterion B) ■ The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available. ○ (Criterion C) ■ The agoraphobic situations almost always provoke fear or anxiety ○ (Criterion D) ■ The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety ○ (Criterion E) ■ The fear or anxiety is out of proportion to the actual agoraphobic situations and to the sociocultural context ○ (Criterion F) ■ The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more ○ (Criterion G) ■ The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning ○ (Criterion H) ■ If another medical condition (e,,g,, inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive. ○ (Criterion I) ■ The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder SOCIAL PHOBIA ➢ Also known as social anxiety disorder the person becomes severely anxious to the point of panic or incapacitation when confronting situations involving people ➢ DSM V Diagnostic criteria
- Positive self-talk
- Pharmacological management a. Anti-anxiety - Alprazolam, Buspirone b. Antidepressants - Imipramine, Paroxetine, Sertraline
- Promote desentization through gradual exposure to the event or situation similar to the event
- Provide individual therapy that addresses loss of control issues or anger.
- Stay with patient when flashbacks
- Group therapy GENERALIZED ANXIETY DISORDER ➢ Persistent, unrealistic and excessive anxiety that cannot be controlled or displaced that causes social and occupational dysfunctioning ➢ COMMON in girls ➢ Onset: peaks in middle age and declines across the later years of life ➢ 6 months excessive worrying ➢ DSM V Diagnostic Criteria (Criteria A) Excessive anxiety and worry occuring more than not or at least 6 months, about a number of events or activities (Criteria B) The individual finds it difficult to control the worry (Criteria C) associated with three (or more) of the following six symptoms: ■ Restlessness or feeling keyed up or on edge. ■ Being easily fatigued ■ Difficulty concentrating or mind going blank ■ Irritability ■ Muscle tension ■ Sleep disturbance (Criteria D - Social/occupational dysfunction) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criteria E) Not attributable to the physiological effects of a substance or another medical condition (Criteria F) the disturbance is not better explained by another mental disorder ➢ Interventions:
- Relaxation techniques
- Divert attention by increasing physical activities to release energy
- Teach patient about medication as part of the treatment plan ■ Panic ● SSRI (Prozac and Zoloft) ● SNRI (Effexor) ● Benzodiazepine (Xanax, Klonopin and Valium) ■ GAD ● Non-Benzodiazepine (Buspar) ● Antidepressants ● SNRI (Effexor-Venlafaxine) ● SSRI (Paxil-Paroxetine) ● TCA (Tofranil - Imipramine) ■ Phobia ● Benzodiazepine (Xanax) ● Non-Benzodiazepine (Buspar) ● SSRI (Paxil and Zoloft)
- Positive self-talk
- Exposure therapy
- Cognitive behavioral therapy 1. OCPD (Obsessive-Compulsive Personality Disorder) OBSESSION ➢ Recurrent, persistent, intrusive and unwanted thoughts, images or impulses that cause marked anxiety and interfere with interpersonal, social and or occupation function COMPULSION
➢ Ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety or in response to obsession Characteristic of OCPD patient's
- Routinely done (an act)
- Reduction of obsession
- Ritualistic performance Nursing Diagnosis: Ineffective Individual coping Defense mechanism: Displacement, Undoing, Repression Cause: Unknown; Genetics; Family COMMON RITUALS ➢ Checking ➢ Counting ➢ Touching, rubbing or tapping ➢ Ordering ➢ Exhibiting rigid performance ➢ Aggressive urges ➢ Washing and scrubbing until the skin is raw ➢ Praying or chanting COMMON OBSESSIONS: ➢ Violence ➢ Contaminations ➢ Sex ➢ Power ➢ Wealt ➢ Cleanliness DSM V Diagnostic criteria for OCPD ➢ Criterion A: Presence of obsessions, compulsions or both: ➢ Obsessions are defined by (1) and (2):
- Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
- The individual attempts to ignore or suppress such thoughts, urges, or Images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). ➢ Compulsions are identified by (1) and (2):
- Repetitive behaviors that the individual feels driven to perform
- The behaviors or mental acts are aimed at preventing or reducing anxiety, distress, or preventing some dreaded event or situation; are not connected in relistic way ➢ Criterion B: ○ The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning ➢ Criterion C: ○ The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance ➢ Criterion D: ○ The disturbance is not better explained by the symptoms of another mental disorder Obsession thought → Increase Anxiety → Returns to House (Action - Compulsion) → Decrease Anxiety Management: ➢ Drug of Choice: SSRI (zoloft) ➢ Main goal is to decrease the frequency of obsessions and compulsions and decrease rewards the patients gets from engaging in them ➢ Behavioral therapy ➢ Cognitive therapy ➢ Group and Family therapy ➢ Psychopharmacology: SSRI and TCA, Anxiolytics ➢ Teach clients about medications as part of the treatment plan. Nursing Interventions: ➢ Identifying precipitating factors and maintain manageable level ➢ Intervene to break ritualistic pattern and develop coping skills ➢ Don’t interrupt compulsion but allow time ➢ Maintain and prioritize safety ➢ Establish contract ○ Schedule
Ex. car crashes, industrial accidents, airplane crashes, nuclear plant accidents
- Intentional man-made disasters Ex. war, rape, smuggling, robbery, assault military combat, physical abuse Diagnostic Criteria: A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s)
- Witnessing, in person, the event(s) as it occurred to others.
- Learning that the traumatic event(s) occurred to a close family member or close friend.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
- Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
- Dissociative reactions in which the individual feels or acts as if the traumatic event(s) were recurring
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidence by one or both of the following:
- Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
- Avoidance of or efforts to avoid external reminders D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following:
- Inability to remember an important aspect of the traumatic event(s)
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
- Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
- Persistent negative emotional state
- Markedly diminished interest or participation in significant activities.
- Feelings of detachment or estrangement from others.
- Persistent inability to experience positive emotions E. Marked alterations in arousal and reactivity associated with the traumatic event(s), as evidenced by two or more of the following:
- Irritable behavior and angry outbursts
- Reckless or self-destructive behavior
- Hypervigilance
- Exaggerated startle response
- Problems with concentration
- Sleep disturbance F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning H. The disturbance is not attributable to the physiological effects of a substance ACUTE STRESS DISORDERS ➢ Has similar symptoms to PTSD but is shorter in duration ➢ Symptoms appear during or immediately after traumatic incidence ➢ Lasts from 3 days to 4 weeks
➢ Contributing factors resulting to ASD according to the American Psychiatric Association, 2013 ○ Physical attack ○ Physical abuse ○ Mugging ○ Active combat ○ Sexual violence ○ Natural disaster ○ Serious accidents ○ Hearing or witnessing a violent or accidental trauma of a loved one ○ Repeated exposure to traumatic events DIAGNOSTIC CRITERIA A. Exposure to actual or threatened death, serious injury, or sexual violation in one or more of the following ways:
- Directly experiencing the traumatic event(s)
- Witnessing, in person, the event(s) as it occurred to others. B. Presence of nine or more of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance and arousal, beginning or worsening after the traumatic event(s) occurred: Intrusion Symptoms.
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
- Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s).
- Dissociative reactions (e.g., Flashbacks) in which the individual feels or acts as if the traumatic were recurring
- Persistent inability to experience positive emotions event(s) were recurring Negative mood.
- An altered sense of the reality of one’s surroundings or oneself
- Inability to remember an important aspect of the traumatic event(s) Avoidance Symptoms
- Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
- Efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings Arousal symptoms
- Sleep disturbance
- Irritable behavior and angry outbursts
- Problems with concentration
- Exaggerated startle response C. Duration of the disturbance (symptoms inj Criterion B) is 3 days to 1 month after trauma exposure D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning E. The disturbance is not attributable to the physiological effects of a substance and medical condition INTERVENTIONS ➢ Promote client safety ➢ Discuss self-harm thoughts ➢ Distraction techniques ➢ Make a list of activities and provide materials close at hand ➢ Chest Breathing Technique ➢ Instruct the client in relaxation techniques ➢ Group therapy # ➢ Anti-depressant (zoloft) ○ SSRI - Paroxetine and sertraline ○ Anxio - Alprazolam ➢ Make a list of people and activities in the community for client to contact when he/she needs help ○ Local crisis hotline ○ Local support groups (Ex. DSWD, NGO) TREATMENT OF ACUTE STRESS DISORDER ➢ The primary treatment goal of acute stress disorder is to prevent the disorder from developing into PTSD.
- Debriefing
- Group therapy
➢ Preoccupation with an imagined defect or exaggerated defect in physical appearance FACTITIOUS DISORDER/ MUNCHAUSEN SYNDROME ➢ Inflicting injury on oneself to gain attention ➢ MUNCHAUSEN SYNDROME PROXY EATING DISORDERS ➢ are mental disorders defined by abnormal eating habits that negatively affect a person's physical or mental health ➢ a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health Categories of Eating Disorders
- Anorexia Nervosa a. Restricting b. binge/purging
- Bulimia Nervosa
- Other related disorders Etiology of eating disorders
- Biological factors
- Developmental factors/ Psychological
- Family factors
- Sociocultural factor
ANOREXIA NERVOSA
➢ The term anorexia is of Greek origin: an
-: privation or lack of and orexis -:
appetite. thus is meaning a lack of
desire to eat. A person who is
diagnosed with anorexia nervosa is
most commonly referred to as an
anorexic.
➢ The term "anorectic" can also refer to
any drug that suppresses appetite
➢ Is an eating disorder characterized by a
low weight, fear of gaining weight, a
strong desire to be thin, and food
restriction
➢ A life-threatening eating disorder
➢ DSM V - Diagnostic Criteria
○ Criteria A - Persistent energy
intake restriction relative to
requirements
○ Criterion B - Intense fear of
gaining weight or of becoming fat
○ Criterion C - Distorted perception
of body weight and shape, undue
influence of weight and shape on
self worth, or denial of the
medical seriousness of one’s low
body weight
○ F ear about gaining weight
○ E xpected ideal body weight is not
maintained
○ A menorrhea
○ R eality distortion of the
perception of body, shape and
size
○ S eriousness of the denial of the
problem of extremely low body
weight
➢ Characteristics of Anorexia
○ Common in women
○ Excessive exercise
○ Low self-esteem
○ Dry Skin
○ Hypokalemia and Hyponatremia
○ Perfectionist
○ Introvert
○ Knowledgeable about nutritional
and caloric values
○ Collect cookbooks
○ Malnourished
Two types of Anorexia Nervosa
1. Purging/Binge-eating
a. Weight loss achieved by
vomiting, laxatives, or diuretics
b. During the last 3 months, the
individual has engaged in
recurrent episodes of binge
eating or purging behavior
2. Restrictive/ Restricting
a. Weight loss achieved by
restricting calories (Following
diets, fasting, and exercising in
excess)
b. During the last 3 months, the
individual has not engaged in
recurrent episodes of binge
eating or purging behavior
c. Describes presentations in which
weight loss is accomplished
primarily through dieting, fasting,
and/or excessive exercise.
BULIMIA NERVOSA
➢ Characterized by binge-eating, the
frequent compulsion to eat large
quantities of food in a short period of
time followed by purging, self-induced
vomiting or use of laxatives.
➢ DSM V - Diagnostic Criteria
○ Criterion A - Recurrent episodes
of binge eating.
■ Eating in a discrete period
of time, an amount of food
that is definitely larger than
what most individuals
would eat in a similar
period of time
■ A sense of lack of control
over eating
○ Criterion B - Recurrent
compensatory behavior in order
to prevent weight gain
○ Criterion C - Binge eating and
inappropriate compensatory
behaviors is at least once a week
for 3 months
○ Criterion D - Self-evaluation is
unduly influenced by body shape
and weight
○ Criterion E - The disturbance
does not occur exclusively during
episodes of anorexia nervosa
○ CCCC
■ C onsumption problem:
binge
■ C ompensatory activity or
post-binge behavior:
Purge
■ C hronically ritualistic act of
binge-purge once a week
for three months
■ C onfused body evaluation:
Distorted perception of
Body shape
Types of Bulimia
1. Purging
a. During periods of bulimia,
engaged in self-induced vomiting
and use of laxative
2. Non-Purging
a. Periods of bulimia, the person
has used other inappropriate
compensatory behaviors such as
fasting and excessive exercise,
but has not regularly engaged in
self-vomiting or laxatives.
COMPARISON
ANOREXIA VS BULIMIA
Diet, Diet,
Diet
EATING
PATTERN
Eat, Eat,
Vomit
< 85% of
expected
body weight
WEIGHT Normal
Weight
Amenorrhea MENSES Irregular
Menses
Karen
Carpenter
PERSONALI
TY
Da Ming XU
NURSING INTERVENTIONS
- N o stereotypical beliefs for client &
have Nutritional contract
- U nderstand cognitive and behavioral
therapy
