Mental Health Nursing - نسخة PDF

Mental health nursing Dr: Mohammed -Senan Introduction Mantel health Nursing Health:- The degree of wellness or well-being that the client experiences. Psychology: Study of normal and abnormal mental processes and its effect on human behavior and...

Mental health nursing Dr: Mohammed -Senan Introduction Mantel health Nursing Health:- The degree of wellness or well-being that the client experiences. Psychology: Study of normal and abnormal mental processes and its effect on human behavior and attitudes. Psychiatry. It is a branch of medicine that deals with the diagnoses ,treatment and presentation of mental illness. Psychiatric Nursing:- Is deal with the promotion of mental health , prevention of mental illness care and rehabilitation of mentally ill individuals both in hospital and community. Mantel disorder:- Are conventionally divided into three very categories:- - Mental illness. - Several learning disability. - Personal disorder. Classification of function of mind:- Cognitive Mood Behavior 1 consciousness 1 Immediate 1 motor response 2 Memory 2 Recent 2 Eating 3 Perception 3 Remote 3 Sleeping 4 Thought 4 Comprehension 4 Speech 1 Mental health nursing Dr: Mohammed -Senan Classification of psychiatric diseases: 1. Psychosis 2. Neurosis 3. Psychoneurosis 4. Addiction 5. Psychosomatic Effect of mental disorder:- 1. Cognitive disorder:- Thought Content disorder Process - Delusion - Blocking - Hallucination - flight of idea - Thinking - word salad - Phobia - Neologism - Obsession - Echolalia - Hypochondria - preservation - - Circumstantiality 1. Consciousness: 1- Disorientation( Time –Place – Person ) 2- Distraction 2. Memory: 1- Loose of memory [Amnesia] 2- Para- Amnesia [not complete loose memory] 3- Impaired Intelligence 3. Perception 1- Hallucination 2- Illusion 2 Mental health nursing Dr: Mohammed -Senan 2. Behavior disorder 1. Motor response - Activity= hyperkinesia - stereotype - cataplexy - Compulsive - Exited - Echopraxia - Impulsive - Stupor - Spasm 2. Speech disorder - Mutism - aphasia - Neologism 3. Eating disorder - Bulimia - Anorexia 4. Sleeping disorder - Insomnia - para- insomnia * Psychosis:- The word psychosis is used to describe condition that affect the mind, where there has been some loss of contact with reality. OR:- Is abnormal condition of the mind that result in difficulties telling what is real and what is not. * Causes of Psychosis:- Primary Secondary 1. Genetic 1. Malignancy in brain %25 ‫ إذا كان واحد من االباء مصاب فاحتمالية إصابة االبناء‬- 2.metabolic %65 ‫إذا كان االبويين مصابين فاحتمالية إصابة االبناء‬- disorder such as:- Electrolyte disturbance 3  Mental health nursing Dr: Mohammed -Senan 3.medication drugs 2. Biochemical 4.Post- partum: Increase or decrease after child birth Secretion of Dopamine 3- Neurological 4- Social Symptoms of Psychosis Mid symptoms sever symptoms - Depression - hallucination and delusion - Sleep problems - Disorganization in though - Feeling of suspicion ,speech behavior ❖ Different from Neurosis and psychosis Psychosis Neurosis 1 This is a symptoms of disorder is 1 This group of disorder is not specific mental disorder. specific mental disorder 2 Has lost touch with reality 2 Has not lost touch with reality 3 Causes severe impairment of 3 Causes mild impairment of everyday functioning everyday functioning 4 High risk self-harm 4 Lower risk self-harm 5 hallucination and Delusion are 5 hallucination and Delusion are common not present 6 Including:. 6 Including:. - schizophrenia - phobic anxiety disorder - mania - phobia - Depression - Anxiety - Bipolar disorder - panic disorder 7 Treatment with antipsychotic 7 Is not treatment with anti- medication psychotic medication 4  Mental health nursing Dr: Mohammed -Senan ‫ وال‬،‫المريض ال يعرف بمرضه وينكره‬ ‫ يحضر‬،‫المريض يعرف بأنه مريض‬ ‫يواصلون نشاطهم العملي واالجتماعي‬ ‫بنفسه إلى العيادة‬ ،‫يواصلون نشاطهم االجتماعي والعملي يحضر بواسطه األقارب‬ ،‫ال تتأثر شخصيتهم وال يفقدون تواصلهم ويحتاج إلى رقود في المستشفى‬ ‫تتأثر شخصيتهم فتصاب بعدم االنتظام‬ ‫بالمحيط‬ ‫ال يحتاجون على الرقود في المستشفى‬ ‫غالبا‬ * Diagnosis of psychosis:. 1. Question for patient and family 2. Clinical examination and history 3. CT scan ,MRI brain, X-ray to confined trauma 4. ECG, EEG, Electrolyte test * Treatment:. - Anti psychotics Drugs Contraindication Side effect - Olanzapine 5-10mg Tab - hypersensitivity - Drowsiness - Aripirozole 10-15-20-30mg - children - Dizziness Tab - lactation - Dry mouth - chlorpromazine 75-400 Tab - hepatic or cardio disease -constipation - Risperidon 1-2-4 Tab - history of seizure, - increase appetite - Zipresidone 40-60mg Tab prostatic hypertrophy - increase weight - Quietipine 40-160mg Tab - Glaucoma - hyperglycemia - pregnancy - Diabetes 5  Mental health nursing Dr: Mohammed -Senan * Delusions:. Is perception which correctly sensed internal or external stimulate. * Types of delusion:. 1 Persecution mistaken idea, other ‫اعتقاد بأن هناك أشخاص يتأمرون عليه ويريدون‬ are attempting to do them harm ‫قتله‬ 2 Reference ‫اعتقاد أن هناك ناس يتكلموا عليه أو يراقبوه‬ 3 Control ‫اعتقاد بأن هناك أشخاص يتحكموا في حركته‬ ‫وشعور بدون رغبته‬ 4 Religions ‫اعتقاد بأن للهم مكانه دينية‬ 5 Guilt ‫اعتقاد بالذنب ويستحق العقاب عليه‬ 6 Jealousy ‫اعتقاد بأن هناك اشخاص من أصله يتجسس عليه أو‬ ‫يخونه أوهام الغيرة‬ 7 Grandiose ‫اعتقاد أن له مكانه فوق الناس وأهمية أكثر منهم‬ ‫أوهام العظمة‬ 8 Somatic ‫اعتقاد بأن به مرض عضوي‬ * Hallucination:. Is false sensory perception not associate with real external stimuli, may involve any of the five senses. * Types of hallucination:. 1. Auditory is false perception of sound. 2. Visual They may consist of formed images. 3. Tactile is false perception of sense to touch. 4. Gustatory is false perception of taste. 5. Olfactory is false perception of smell 6 Mental health nursing Dr: Mohammed -Senan schizophrenia Definition Schizophrenia is psychotic condition characterized by disturbance in thinking ,emotions ,volitions, and faculties in the presence of clear consciousness which usually lead to social withdrawal. Causes of schizophrenia: The causes of schizophrenia is unknown same factors including: 1- genetic ( Heredity ) factors 2- Biochemistry factors such as: increase dopamine in brain 3- psychological factors 4- social factors Types of schizophrenia: 1- Paranoid schizophrenia: Symptoms: preoccupation with delusion and /or hallucination usually involving grandeur or persecution and jealousy 2- disorganized schizophrenia: Symptoms: disorganize speech and behavior marked regression to primitive disinhibited behavior (bizarre behavior ) ,sever thought disorder, poor contact with reality. 3-catatonic schizophrenia: Symptoms :psychomotor disturbances, ranging from sever retardation to excitation, mutism is very common. Medical care may be necessary because of exhaustion, malnutrition, self -infection injury. 4- residual Schizophrenia: Symptoms: Absence of positive symptoms ( Delusion , hallucinations , disorganized speech / 7 Mental health nursing Dr: Mohammed -Senan behavior and catatonic behavior ) -patient tend to have Negative symptoms: ( social withdraw , flat affect, occupational dysfunction ). 5- undifferentiated Schizophrenia : Symptoms: Don't meet criteria for other Schizophrenia types. 6- simple Schizophrenia: Characterized by an early and insidious onset, presence of characteristic negative Symptoms Symptoms of Schizophrenia A-Positive symptoms: -Delusions -Hallucinations Disordered -thinking and speech -Disorganized behavior B- Negative symptoms: 1-A constant feeling of being watched 2- strange body positioning 3- feeling indifferent to very important situation 4- deterioration of academic or work performance. 5- A change in personal hygiene and appearance. 6 - A change in personality 7- increasing withdrawal from social situations 8- irrational, angry or fearful response to loved ones. 8 Mental health nursing Dr: Mohammed -Senan Diagnosis of Schizophrenia : 1- Brain imaging finding: -CT -MRI 2- psychological tests -Neuropsychological -personality(projective test ). Treatment of Schizophrenia: 1- pharmacotherapy 2- Elect to convulsive therapy (ECT) 3- psychological therapies - social skill therapy - family therapy 4- psychosocial rehabilitation Nursing interventions: 1- obtain history and assess patient for hostile or self-destructive behavior. 2- provide encouragement in a non-judgmental compassionate way, understanding that symptoms are real to patient. 3- encourage patient to communicate ( verbal, drawing, written ) 4- Ask if hallucinations are instructing then to harm themselves or others 5- provide redirection for inappropriate behaviors , maintain boundaries and guidelines. 6- encourage reality based activities (Quran , music, art, playing, card, ect...) 9 Mental health nursing Dr: Mohammed -Senan 7- explain all procedures slowly and carefully before beginning. 8- avoid nursing large gestures or touching the patients except when necessary 9- gently reorient patient as necessary 10- Avoid arguing with a patient regarding delusion or hallucinations 11- teach patient coping skills to help manage hallucinations or delusion, exercise singing, listening to music.... 12- As symptoms improving , allow patient to make small decisions such as what to eat, wear or choice of activities. 13- Administer medication appropriately 10 Mental health nursing Dr: Mohammed -Senan Bipolar Disorder Most people have emotional ups and downs from time to time. But if you have a brain condition called bipolar disorder, your feelings can reach abnormally high or low levels. Sometimes you may feel immensely excited or energetic. Other times, you may find yourself sinking into a deep depression. Some of these emotional peaks and valleys can last for weeks or months. There are types of bipolar disorder: 1) bipolar 1 disorder 2) bipolar 2 disorder 3) cyclothymic disorder (cyclothymia) 4) Bipolar disorder due to general medical condition. 5) Substance-induced bipolar disorder. Bipolar 1 and 2 disorders are more common than the other types of bipolar disorder. Read on to learn how these two types are alike and different. ▪ Bipolar I disorder :-( manic +depression) is the diagnosis given to an individual who is experiencing, or has experienced, a full syndrome of of manic or mixed symptoms; the client may also have experienced periods of depression. ▪ Bipolar II disorder. (major depression+ hypomanic) Bipolar II disorder is characterized by recurrent bouts of major depression with the episodic occurrence of hypomania; this individual has never experienced a full syndrome of manic or mixed symptoms. 11 Mental health nursing Dr: Mohammed -Senan ▪ Cyclothymic disorder. ( depression+ hypomanic) The essential feature is a chronic mood disturbance of at least 2 years’ duration, involving numerous periods of depression and hypomania, but not of sufficient severity and duration to meet the criteria for either bipolar I or bipolar II disorder. ▪ Bipolar disorder due to general medical condition. This disorder is characterized by a prominent and persistent disturbance in mood (bipolar symptomatology) that is judged to be the direct result of the physiological effects of a general medical condition. ▪ Substance-induced bipolar disorder. The bipolar symptoms associated with this disorder are considered to be the direct result of the physiological effects of a substance (e.g., use or abuse of a drug or a medication, or toxin exposure). Pathophysiology The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been determined, and no objective biologic markers correspond definitively with the disease state. The genetic component of bipolar disorder appears to be complex; the condition is likely to be caused by multiple different common disease alleles, each of which contributes a relatively low degree risk on its own. Many loci are now known to be associated with the development of bipolar disorder.. 12 Mental health nursing Dr: Mohammed -Senan Causes Predisposing factors to bipolar disorder include: ▪ Biological. Twin studies have indicated a concordance rate for bipolar disorder among monozygotic twins at 60% to 80% compared to 10% to 20% in dizygotic twins. ▪ Biochemical. Just as there is an indication of lowered levels of norepinephrine and dopamine during an episode of depression, the opposite appears to be true of an individual experiencing a manic episode. ▪ Physiological. Right-sided lesions in the limbic system, basal ganglia, and thalamus have been shown to induce secondary mania. ▪ Medication side effects. Certain medications used to treat somatic illnesses have been known to trigger a manic response; the most common of these are the steroids frequently used to treat chronic illnesses such as multiple sclerosis and systemic lupus erythematosus. Clinical Manifestations These are the symptoms of bipolar disorder: ❖ Heightened, grandiose, or agitated mood. The effect of a manic individual is one of elation (motor activity)and euphoria(happiness) a continuous “high”. ❖ Exaggerated self-esteem.(irritability) Usual inhibitions are discarded in favor of sexual and behavioral indiscretions. ❖ Sleeplessness. Sleep patterns are disturbed; client becomes oblivious to feelings of fatigue, and rest and sleep are abandoned for days or weeks. ❖ Pressured speech. Loquaciousness, or pressured speech, is so forceful and strong that it is difficult to interrupt maladaptive thought processes. 13 Mental health nursing Dr: Mohammed -Senan ❖ Flight of ideas. There is a continuous, rapid shift from one topic to another. ❖ Reduced ability to filter out extraneous stimuli; easily distractible. There is inability to concentrate because of a limited attention span; the individual is easily distracted by even the slightest stimulus in the environment. ❖ Increased number of activities with increased energy. Motor activity is constant; the individual is literally moving at all times. ❖ Multiple, grandiose, high risk activities, using poor judgment; with severe consequences. Assessment and Diagnostic Findings A number of reasons exist for obtaining selected laboratory studies in patients with bipolar disorder; an extensive range of tests is indicated, because bipolar disorder encompasses both depression and mania and because a significant number of medical causes for each state exist. ▪ Complete blood count. A complete blood count with differential is used to rule out anemia as a cause of depression in bipolar disorder. ▪ Erythrocyte sedimentation rate. The erythrocyte sedimentation rate (ESR) is determined to look for underlying disease process such as lupus or an infection; an elevated ESR often indicates an underlying disease process. ▪ Fasting glucose. In some cases, a fasting glucose level is indicates to rule out diabetes. ▪ Electrolytes. Serum electrolyte concentrations are measured to help diagnose electrolyte problems, especially with sodium, that are related to depression. ▪ Proteins. Low serum protein levels found in patients who are depressed may be a result of not eating. 14 Mental health nursing Dr: Mohammed -Senan ▪ Thyroid hormones. Thyroid tests are performed to rule out hyperthyroidism (mania) and hypothyroidism (depression). ▪ cretonne and blood urea nitrogen. Kidney failure can present as depression; treatment with lithium can affect urinary clearances, and serum cretonne and blood urea nitrogen (BUN) levels can increase. ▪ Substance and alcohol screening. Alcohol abuse and abuse of a wide variety of drugs can present as either mania or depression. ▪ MRI. The total value of performing MRI in a patient with bipolar disorder remains unclear; however, a couple of reasons do exist for performing an imaging study. ▪ Electrocardiography. Many of the anti-depressants, especially the tricyclic agents and some of the antipsychotics can affect the heart and cause conduction problems. Medical Management of Bipolar Disorder The treatment of bipolar disorder is directly related to the phase of the episode (i.e. depression or mania) and the severity of that phase. ▪ Psychotherapy. Psychotherapy helps patients with bipolar disorder but does not cure the disorder itself; when shuttle and colleagues looked at psychotherapy for patients, family, and care givers, they found that although results were heterogeneous, most studies demonstrated relevant positive results in regard to decreased relapse rates, improved quality of life, increased functioning, or more favorable symptom improvement. ▪ Electroconvulsive therapy. Electroconvulsive therapy (ECT) is useful in a number of instances in patients with bipolar disorder, such as when rapid, definitive medical/psychiatric treatment is needed; when the risks of ECT are less than that of other treatments; when the bipolar 15 Mental health nursing Dr: Mohammed -Senan disorder is refractory to an adequate trial with other treatment strategies; and when the patient prefers this treatment modality. ▪ Diet. Patients should be advised not to make significant changes in their salt intake, because increased salt intake may lead to reduced serum lithium levels and reduced efficacy, and reduced intake may lead to increased levels and toxicity. ▪ Activity. Patients in the depressed state are encouraged to exercise; these individuals should try to develop a regular daily schedule of major activities, especially times of going to bed and waking up. ▪ Pharmacological Management ▪ Appropriate medication for managing bipolar disorder depends on the stage the patient is experiencing. ▪ Anxiolytics, benzodiazepines. By binding to specific receptor sites, benzodiazepines appear to potentiate the effects. ▪ Mood stabilizers. Lithium is the drug commonly used for prophylaxis and treatment of manic episodes. ▪ Anticonvulsants. Anticonvulsants have been effective in preventing mood swings associated with bipolar disorder, especially in those patients known as rapid cyclers. ▪ Antipsychotics, 2nd generation. Second generation, or atypical, antipsychotics are increasingly being used for treatment of both acute mania and mood stabilization in patients with bipolar I disease. ▪ Antipsychotics, 1st generation. First-generation antipsychotics, also known as conventional or typical antipsychotics, are efficacious in treating both psychotic and nonpsychotic manic and mixed episodes, as well as hypomania. ▪ Antipsychotics, phenothiazine. Phenothiazine antipsychotics, which are classified as first-generation 16 Mental health nursing Dr: Mohammed -Senan antipsychotics, are efficacious in treating both psychotic and nonpsychotic manic and mixed episodes, as well as hypomania. ▪ Antiparkinsons agents, dopamine agonists. Dopamine agonists are non-ergot agents that bind to D2 and D3 dopamine receptors in the striatum and substantia nigra. ▪ Nursing Management for Bipolar Disorder Nursing Management for Bipolar Disorder ▪ Providing for safety. A primary nursing responsibility is to provide a safe environment for client and others; for clients who feel out of control, the nurse must establish external controls emphatically and nonjudge mentally. ▪ Meeting physiologic needs. Decreasing environmental stimulation may assist client to relax; the nurse must provide a quiet environment without noise, television, and other distractions; finger foods or things client can eat while moving around are the best options to improve nutrition. ▪ Providing therapeutic communication. Clients with mania have short attention spans, so the nurse uses simple, clear sentences when communicating; they may not be able to handle a lot of information at once, so the nurse breaks information into many small segments. ▪ Promoting appropriate behavior. The nurse can direct their need for movement into socially acceptable, large motor activities such as arranging chairs for a community meeting or walking. ▪ Managing medications. Periodic serum lithium levels are used to monitor the client’s safety and to ensure that the dose given has increased the serum lithium level to a treatment level or reduced it to a maintenance level. 17 Mental health nursing Dr: Mohammed -Senan ▪ Provide structured solitary activities with the assistance of a nurse or aide. ▪ Provide frequent rest periods. ▪ Provide frequent high-calorie fluids to Prevents the risk of serious dehydration. 18