Unit 3 Lecture Mental Health PDF

Unit 3 Lecture Mental Health Eating disorders: risk factors Genetic Serotonin deficits o MADE 90% IN THE GUT. GOOD FOR BRAIN HEALTH. Sociocultural influences o Environment around them Certain employment o Modeling. Having s fine look job...

Unit 3 Lecture Mental Health Eating disorders: risk factors Genetic Serotonin deficits o MADE 90% IN THE GUT. GOOD FOR BRAIN HEALTH. Sociocultural influences o Environment around them Certain employment o Modeling. Having s fine look job Previous trauma Mental health disorders in the past Eating disorder: indicators Changes in behaviors around food/eating o Earing in private o Exercise before eating o Rule only eating at 8 and 10 o Calorie counting o Exercise exercising o Fixated on bodyweight Obsessions Changes in functionality o Not as productive, missing work, being home more o Low self esteem o chronically ill Eating disorder: warning signs Unexplained obvious weight loss/gain Lying about food/eating Secret eating/bingeing Excessive exercising Pre-occupation with weight and body image Fear of fat Eating disorders: complications Dry skin o Not enough nutrition Electrolyte imbalances o Sodium and potassium Heart failure and renal failure o BUN, creatinine Digestion issues o Constipation Seizures & Cardiac arrest o Anorexic  Osteoporosis, alopecia, menstrual issues Dental erosions o Vomiting in bulimia o No calcium and bone strength in anorexia Thyroid dysfunction o Metabolism dysfunction Eating disorders: Major Classifications Anorexia nervosa (AN) o Self-induced starvation o LOW BMI Bulimia nervosa (BN) o Binge eating followed by purging ▪ Vomiting ▪ Diuretics ▪ Laxatives Binge-eating disorder (BED) o Repeated rapid consumption of large amounts foods without purging o HIGH BMI BULIMIA NERVOUSA AND BINGE EATING DISORDER HAVE A NORMAL TO HIGHER THAN NORMAL BMI Other Eating Disorders Avoidant restrictive food intake disorder o Inflexible eating habits, strong sensory aversion/fear of certain foods Orthorexia o Obsesses with “CLEAN” food Diabulimia o Diabetes stops taking insulin to lose weight Pica o Eating nonedible foods- common in children Rumination o Chewing, swallowing or spitting out regurgitated food EATING DISORDER: Anorexia → SELF INDUCED STARVATION Self-induced starvation LOW BMI- May look “skeletal” Highly distorted body image Excessive exercising Binge purge cycle MILD: below 17 SEVERE: below 15 DEVELOP LANUGO to protect skin and stay warm Altered behaviors Eating disorder: Bulimia Distorted body image  Fear of gaining weight BMI normal or near normal Binge purge cycle Facial cheek, mouth/teeth, throat, knuckles of the hand Binge eat weekly once a week 3 times in one month to be diagnosed Eating disorder: Binge-eating Disorder (BED) Rapid consumption of large amount of food without purging Emotional triggers provoke the binge episode Repeated binges- weight gain and morbid obesity o May have triggers: stress o Go to multiple drive thru for food Anorexia Bulimia BED Body weight: Significantly Usually, overweight Usually overweight underweight but could be in but could be in BMI of 17.5 or less normal weight range norma weight range Body Image: Body image Body image Body dissatisfaction distortion distortion and Extreme concern Perceives self as fat dissatisfaction with body weight, despite appearance Extreme concern shape and size Preoccupied with with body weight, body weight, shape shape, and size and size All groups have distorted body image and self esteem Anorexia Bulimia BED Eating behavior Severely restricted Binge episodes with Binge episodes with food intake and consuming extreme consuming extreme obsessed with amounts of food amounts of food calories during a brief period during a brief period Strict eating rules followed by purging and food rituals via self-induced vomiting, laxative, and/or diuretic misuse Cognitive Impaired Poor attention and Global cognitive manifestation concentration focus; impulsivity; impairment; memory problems; obsessiveness; decreased inhibitory obsessiveness all- or patterns and negative control; addictive none thinking and self- talk style of thinking other cognitive All groups have low focus and concentration and addictive and compulsive thinking  Anorexia Bulimia BED Physical Emaciated, skeletal Fluctuations in Excessive weight gain manifestations appearance weight Hypertension Hypotension, Dental erosion Joint discomfort bradycardia Russell’s sign( sores Elevated blood Muscle weakness on the knuckles)/ glucose Decreased bone chipmunk cheeks density, tooth decay Irregular bowel Brittle hair/nails function Pale/yellow-orange Fluid/elerctrotye tint to skin(eating abnormalities veggies and carrots) Dehydration Constipation Fluid/electrolyte abnormalities Dehydration Menstrual abnormalities Prescribes medications and treatment orders Psychiatrist Manages medical complications Primary care physician Provides most direct care to client Nurse Recommends nutritional intake and monitors Dietitian eating and weight patterns Conducts counseling sessions Psychologist Facilitates discharge planning and case Social Worker management Eating disorders: The Interprofessional team Eating disorders: Recognize Cues Manifestations Lab values o Sodium(brain) potassium(heart) BUN and creatinine, EKG/ ECHO Bone density Eating disorders: Prioritize care Medical stability o Electrolyte imbalance care FIRST o If the patient has loss 20% of their weigh they will need inpatient medical care MED-SURG unit Psychosocial Safety o Environment, prevent self-harm Education Treatment/therapy Medications o SSRI: Fluoxetine ▪ Sexual dysfunction can occur, no driving or heavy lifting, Nutrition Eating disorders: treatment Inpatient or outpatient treatment Address physiologic stability Address psychosocial aspect of eating disorders o Retrain how they think about eating Eating disorders: Take Action – Nutritional Re-engineering Maybe placed on specialized units Managed by dietitian Daily intake starts low o Changes depending on the patient and their needs Avoid refeeding syndrome o Fatal shift on fluid/ electrolyte imbalance o Cardiovascular decompensation o You have to start feeding them slowly due to the body not being able to metabolize foods the body can go into shock Eating disorders: Pharmacotherapy Vitamins, minerals GI meds o Laxatives, gas medications Anti-depressants, mood stabilizers, anxiolytics, SSRI FDA approved medications Fluoxetine: Bulimia Eating disorders: Monitor Meals Meals must be eaten within a specific time frame Everything on tray should be eaten Supplements may be provided Strict calorie count Watch for smearing, hiding of food Eating disorders: Monitor Bathroom Breaks, Weight Wait 1 hour after meals to prevent purging → May have to lock bathroom door Daily weights: with their backs to the scale o 2-3 lbs. a week o In the morning and in a gown Eating disorders: Psychosocial Interventions Behavioral therapy o Changes their behavior Cognitive behavioral therapy  o Retrain their brain on how they think about food and body image Dialectical behavioral therapy o Emotional/hormonal therapy helping them understand how they feel and accept how they feel and implement a reward system The goal is for the patient to have balanced electrolytes, coping mechanism, weight increase Unit 3: Psychiatric Emergencies Goal treatment: psychological well-being and maintain/return to emotional homeostasis Assessment → any behavioral or emotional cues that are red flags Knowledge of crisis stages Stage 1: normal stress : rational and in control of emotions Stage 2: rising anxiety : heightened anxiety, stress, fear, tachycardia, tachypnea Stage 3: severe anxiety : decreased ability to reason, disruptive behavior, agitation, loss of control, physical aggression o Set limits and rules with these patients Stage 4: crisis : no control over thoughts, emotions, behaviors, unable to process information, erratic, unpredictable behavior o Alert someone for help: seclusion or restraints Crisis prevention Primary prevention → prevention, lifestyle changes o Fix it before it happens Secondary prevention → acute crisis intervention o Fixing it while its happening Tertiary prevention → recovery after severe crisis o Prevention in the future Unit 3: anger/aggression Chapter 24 Anger: An emotional response to a frustration of desire, threat to ones needs (emotional, or physical) or a challenge. Releases endorphins Aggression: Anger’s motor counterpart; goal-directed action or behavior that results in a verbal or physical attack. A threat to themselves or others. Anger/aggression: risk factors History of violence Victim of crime Witnessing abuse or violence → bad childhood experiences Low self esteem Inadequate coping skills No positive role models growing up Predictors of violence: Inability to control aggressive impulses Not being able to understand consequences of own actions Lack of remorse when interacting with others  Substance use Anger/Aggression Etiology: Genetic tendency Unbalanced serotonin levels Environmental issues Brain injury; TBI Anger/Aggression: clinical presentation Restlessness Pacing Agitation Verbal threats to self and others Impaired thoughts Anger/aggression: plan of care Verbal de-escalation always do before restraints Safety for client and staff Offer choices Set clear limits Identify wants/needs/feelings o Do not walk up behind the patient if they sit you sit but do not be too close o If talking does not work, medication and then restraints is LAST RESORT Anger/aggression: care Nonpharmacological techniques Pharmacological techniques Seclusion and Physical restraints if necessary o Seclusion o Restraints ▪ Assess every 15 minutes, have a order, time or restraints depend on the pt, they stay on until they are calm, order is only good for 24hrs o Medication Unit 3: thought disorders Chapter 15 Schizophrenia: Severe mental illness that affects how a client experiences and interprets reality Results in disruptions in how they think, feel, act- affects daily living and relationships Psychosis- disconnection from reality in hallucinations and/or delusions o Clinical manifestation- not a diagnosis Chronic: long term Controlled with medication Schizophrenia: criteria Schizophrenia is typically diagnosed when the client is between 16 and 30 years old  Two or more symptoms must be present for a period of 1 month or longer with signs of continuous disturbances for at least 6 months o Impairment in one area of major functioning, such as self-care, work, and or interpersonal relationships, for an extended. o Rule out brain injury and infections on the brain before diagnosis o More likely to be harmed by others o More common on MEN o Cognitive therapy is used Common Facts About Schizophrenia Productive lives when treatment and support are available Stigma leads to limited health care access, under diagnosis under treatment 14 times more likely to be victims of crime or violence than the greater population 1/2 of persons who have a diagnosis of schizophrenia have a co-occurring mental health disorder: Bipolar personality disorder Schizophrenia: types Paranoid MOST COMMON Hebephrenic Undifferentiated Residual Catatonic Schizophrenia: risk factors Genetics: hereditary Environment Brain structure and function abnormalities PTSD Prenatal exposure Birth defects: hypoxia changes thought process Small brain Schizophrenia: Clinical Presentation Positive symptoms o Hallucinations o Delusions o Disorganized speech Negative symptoms o Decreased motivation o Decreased interest o Decreased speak o Not grooming Cognitive symptoms o Poor concentration o Slow thinking o Poor memory Schizophrenia: diagnosis Must eliminate all other medical causes and substance misuse Symptoms that occur before late teen years is rare 1st episode of psychosis occurs late teens to mid twenties Symptoms must persist for at least 6 months TEST FOR SUBSTANCE ABUSE FIRST Schizophrenia: treatment Manage symptoms → improve day to day functioning achieve life goals Pharmacology antipsychotic medications o First generation: ▪ Agents are classified as either low, medium, or high potency depending on their association with extrapyramidal symptoms ▪ Pseud parkinsonism- Controlling, shuffling gate, rigidity, mask like face, tremor including pin rolling ▪ Akathisia-inability to sit or stand still, pacing and agitation ▪ Tardive dyskinesia-involuntary movement of the tongue and face, such as lip smacking and tongue fasciculation ▪ Acute dystonia-severe spasms of the tongue, neck, face and back o Second generation USE FIRST ▪ Release of both positive and negative symptoms ▪ Decrease in effective finding (depression, anxiety) and suicidal behaviors ▪ Improvement of neurocognitive defects such as poor memory ▪ Fewer or no EPSs, including tardive dyskinesia, due to less dopamine blockage ▪ let's relapse Psychosocial treatments therapy, training, employment Education & Support o Patient and family Schizophrenia: The Nurse’s Role Creating and maintaining a safe therapeutic relationship Ensuring a safe, calm, therapeutic environment early detection of psychosis assessment stabilize ACUTE phase: hospitalized Unit 3: personality disorder (chapter 16) Personality disorders: May exhibit behaviors that are odd, dramatic, or anxious, which can cause them to be perceived as mentally ill Behaviors most often appear in the late adolescence to early adulthood o personality disorders are not usually diagnosed in children  o Healthier childhood helps prevent personality disorder Personality disorder: risk factors Genetic Environmental: helps develop personality o Sexual, neglect, Personality Disorders – Three Clusters Cluster A: odd, eccentric o Paranoid personality disorder-characterized by distrust and suspiciousness towards others based on unfounded beliefs to others want to harm, exploit, or deceive the person o Schizoid personality disorder-characterized by emotional detachment, disinterest in close relationships, and indifference to praise or criticism, often uncooperative o Schizotypal personality disorder-characterized by I beliefs leading to interpersonal difficulties, and eccentric appearance, and magical thinking or perceptual distortion that are not clear delusions or hallucinations Cluster B: dramatic, emotional, erratic o Antisocial personality disorder-characterized by disregard for others with exploitation, lack of empathy, repeated unlawful actions, this seat, failure to accept personal responsibilities, evidence of conduct disorder before age 15, sense of entitlement, manipulation, impulsive, seductive behaviors, verbally charming and engaging o Borderline personality disorder-characterized by instability of a fake, identity, and relationships as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment, often self-injuries and potentially suicidal o Narcissistic personality disorder-characterized by arrogance, views of self importance, the need for consistent admiration, and lack of empathy of others that strain most relationships, often sensitive to criticism o Histrionic personality disorder-characterized by emotional attention seeking behavior, in which a person needs to be center of attention, often seductive and flirtatious Cluster C: anxious, fearful o Avoidant personality disorder-characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection, have feelings of inadequacy in our anxious and social situations o Dependent personality disorder-characterized by extreme dependencies in a close relationship with an urgent approach to find a replacement when one's relationships end o Obsessive compulsive disorder-characterized by indecisiveness and professionalism with a focus on orderliness and control to the extent that the individual might not be able to accomplish a given task Personality Disorders Across the Lifespan  Children → difficult to make friends at school adolescent → get teased for having odd habits, ideas, or behaviors Adult → trouble forming intimate relationships or keeping a job Personality disorder: cluster a Types Personality disorder: cluster b Types Personality disorder: cluster c Types Personality disorder: treatment Multidisciplinary collaboration Psychotherapy/Counselors/Psychiatrist Therapy → art, music, yoga Personality disorder: The Nursing Process Personality disorder: Treatment Options Inpatient psychiatric unit Inpatient medical-surgical unit Goals of treatment Vary according to the type/cluster Personality disorder: Generate Solutions o Cluster A: finding and maintaining interpersonal relationship o Cluster B: safety and maintaining appropriate boundaries o Cluster C: decreasing anxiety Personality disorder: Outcomes o A client with a personality disorder may never be truly discharged from care, they may need to return to health care providers occasionally as needed Medications Selective serotonin reuptake inhibitors (SSRI) Selective serotonin and norepinephrine reuptake inhibitor (SNRI) Benzodiazepines → treat anxiety