1. Mental Health Nursing I NURS 1300 Unit V Mental Health Alterations

2. Objective 1 Describe the mood disorders
Mood disorder = a condition in which the prevailing emotional mood is distorted or inappropriate to the circumstances
Types of mood disorder
major depression
bipolar disorder
alternation between significantly depressed mood and significantly elevated mood (mania) over time
Mood disorders may present with psychotic symptoms

3. See Objective 11 for medications for mood disorders
Objective 2 Describe the nursing interventions and medical treatment for clients with a mood disorder
See Objective 11 for medications for mood disorders

4. Objective 2 (cont’d) Electroconvulsive therapy (ECT)
may be indicated for clients with severe depression that does not respond to other treatment
acts more quickly than medications, and may produce fewer side effects in older clients

5. Objective 2 (cont’d)
Nursing diagnoses for clients with a mood disorder –
Risk for self-directed violence R/T suicidal feelings
Risk for violence directed toward others R/T homicidal ideation
Low-self esteem R/T depression
Imbalanced nutrition, less than body requirements R/T lack of interest in food
Disturbed sleep pattern R/T depression

6. Objective 3 Describe characteristics of an individual with suicide potential
Females attempt suicide 2-3 times more often than males
Males are 4 times more likely to complete a suicide
Suicide by firearm is the most common method of suicide for both men and women
Risk of suicide is higher for people with psychiatric conditions

7. Objective 3 (cont’d) Specific high-risk populations include –
previous suicide attempt
family history of suicide
suicide of a loved one, friend, co-worker, colleague, or role model
suicide pacts
anniversary dates
ANYONE THREATENING SUICIDE

8. Objective 4 State common age groups for suicide
Adolescents
leading cause of death for people ages 13-18
considered a solution to an environmental or psychological problem
experience hostility toward themselves
seek revenge on others by hurting themselves

9. Objective 4 (cont’d) Elderly
Caucasian males over the age of 70 have the highest rate of suicide
fewer attempts, but more completed
methods more lethal
decreased ability to survive attempt
planned instead of impulsive
bereavement
real or perceived losses
often occur through covert measures
self-inflicted falls
refusing to eat or take medications

10. Objective 5 Define personality disorders
A personality disorder is a pattern of perceiving, reacting, and relating to other people and events that is relatively inflexible and that impairs a person’s ability to function socially
Personality traits become rigid and dysfunctional
Personality disorders are chronic and maladaptive, impacting all aspects of one’s life

11. Objective 6 Describe the types of personality disorders
Grouped into three clusters according to the traits that describe them
Cluster A traits are behaviors considered odd or eccentric
Cluster B traits consist of dramatic, emotional, and erratic behaviors
Cluster C traits include behaviors that are anxious or fearful

12. Cluster A disorders Cluster B disorders Cluster C disorders
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Cluster B disorders
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Cluster C disorders
Avoidant personality disorder
Dependent personality disorder
Obsessive-Compulsive personality disorder

13. Objective 7 Identify the nursing interventions and medical treatments for personality disorders
Medical Interventions –
psychotherapy
group therapy
behavior modification
medications
anxiety
depression

14. Objective 7 (cont’d) Nursing diagnoses –
Ineffective coping R/T personality disorder AEB reliance on maladaptive defense mechanisms
Risk for self-harm R/T unresolved fear of abandonment AEB attention-seeking behaviors and threats against self
Depression R/T self-directed anger AEB social withdrawal and isolation

15. Objective 8 Describe behaviors of the schizophrenic client and identify causes of schizophrenia
Schizophrenia refers to a group of very serious, usually chronic, thought disorders in which the affected person’s ability to interpret the world accurately is impaired by psychotic symptoms

16. Behaviors of schizophrenia
Disordered thinking
Unusual speech
Apathetic personality
Changing behaviors
Social isolation and withdrawal
Distorted perceptions of reality

17. Etiology of schizophrenia
The cause of schizophrenia is unknown
Individuals may be genetically vulnerable to developing schizophrenia
Influencing factors may include environmental exposure to anything that interrupts brain development

18. Objective 9 Differentiate the types of schizophrenia
Catatonic type
prominent psychomotor disturbances
stupor
waxy flexibility
Disorganized type
disordered thoughts
flat affect

19. Types of schizophrenia (cont’d)
Paranoid type
delusions
hallucinations
Residual type
low intensity of symptoms
Undifferentiated type
presence of symptoms from more than one subtype of schizophrenia

20. Objective 10 Discuss the medical treatment and nursing interventions for the schizophrenic client
Medical treatment for the client with schizophrenia involves therapy modalities and antipsychotic medication
Therapies include psychotherapy, family education, and community support
Hospitalization is often required to treat severe delusions, hallucinations, or self-care deficits

21. Nursing diagnoses for schizophrenia
Disturbed thought processes R/T delusions/concrete thinking/paranoia AEB bizarre statements and behaviors
Disturbed sensory perception R/T hallucinations/illusions AEB inability to tolerate group therapy, talking to self, or looking for or at something that is not there
Impaired verbal communication R/T delayed thinking AEB very slow and delayed speech
Self-care deficit R/T withdrawal and loss of motivation and judgment AEB poor hygiene, poor grooming, and avoiding others

22. Nursing assessment and interventions for a client with schizophrenia
Refer to assigned readings for complete nursing assessment of the schizophrenic client
Nursing interventions –
use nonconfrontational speech and mannerisms
encourage communication and expression of feelings and fears
decrease stimuli and offer quiet activity
seek clarification of statements
provide recognition for constructive self-care activities
make adjustments in food preparation and service for patients with paranoia

23. Objective 11 Identify classifications, uses, actions, and side effects for selected classifications of psychoactive medications as they relate to the above mental health alterations Refer to Psychoactive Medications handout