Mental Health Test 4

Chapter 11- Childhood and Neurodevelopmental Disorders

Highest risk for a child to develop a psych disorder
= having a parent with a substance abuse or other psych disorder
Autism spectrum disorders = display profoundly disturbed social relatedness
- Seem aloof and indifferent to other, often preferring inanimate objects to human
interaction
- Language is often delayed and deviant ---> cx of relationships
Tx Effective: IMPROVE RELATIONSHIPS
Ex: Hold that parents hand while walking
- Relate to other children
** Social skill training = teaches pt. to recognize the impact of
behavior on others
- uses instruction, role-playing and positive reinforcement
to enhance social outcome
- Distortions in development of social skills and language
* Perception
* Excessive Motor movement
* Attention
* Reality testing
ADHD (Neurodevelopment disorder) in Children
S/S: Unable to set for expected lengths of time (Excessive movement)
Inattentive (Distractible)
Screams unexpectedly/ talks excessively
Aggressive toward others
- Often receive negative feedback from parents, teachers, and peers
= self-esteem disturbance
- May cause peers to avoid the child, leaving the child with ADHD
= vulnerable to loneliness
Tx: CNS stimulants = increase BF to the brain; reduce S/S of ADHD
* Methyphenidate (Ritalin)
* Dexedrine
* Pemoline (Cylert)
Most common side effects: - GI disturbances
- reduced appetite
- weight loss
- urinary retention
- dizziness
- fatigue

- insomnia/sleep disturbances
Tx: Antipsychotic meds = manage aggressive or violent behavior
Effective Tx: social interaction/cooperative play with others
Group therapy for young children = PLAY TIME!!!
** Nurse should alway manage the milieu w/ structure and limit setting
& Reassure parents to be their for their children **
** Nurse should ALWAYS listen (Actively) to their pts and encourage them to talk about
feelings**
Problem w/ Parents: Build TRUST to develop relationship w/ child to build up security
--- pt. may question trust w/ their parents
--- Familial rx factors correlate w/ child psych disorders
** severe marital discord
** low economic status
** large families and overcrowding
** parental criminality
** maternal psych disorders
** foster-care placement
Behaviors:
Impulsivity = inability to take turns, blurt out answers to questions before question, etc.
Hyperactive = physical in nature (running, pushing, and inability to sit still)
Inattention = failure to listen
Defiance = willfully doing what you were told NOT to do
Tourettes = tics (sudden, rapid, involuntary, repetitive movements or vocalizations)
Resiliency = able to handle the stresses of a difficult lifestyle
Children: Adapt to changes in the environment
- Take advantage of nurturing relationships w/ adults other than their parents
- Distance themselves from emotional chaos occuring w/in family
- Learn, and use problem-solving skills
Modern Intellectual Disorder
- progress academically to ~ 2nd grade
- learn to travel in familiar ares
- perform unskilled and semiskilled work
- w/ supervision = functional appropriately within the community
- able to perform self-care activities

Chapter 19 - Sleep-Wake Disorders

Sleep Deprivation = A discrepancy between hours of sleep obtained and hours required leads to
sleep deprivation
- Common complaints = poor general health
- physical and mental distress
- limitations in ADLs
- depressive or anxious s/s
- pain
- Assess for hrs of sleep
Safety = PRIORITY
** Sleep Deprivation causes psychomotor deficits
(Driving w/sleeplessness = DANGEROUS)
**Sleep Deprivation can lead to MV ACCIDENTS**
EEG (electroencephalogram) = measures NREM & REM sleep
REM = dreaming occurs
** Cycles of rapid eye movement sleep increase in the second half of sleep and
occupy longer periods, up to 1 hr. **
Sleep latency = refers to the amount of time it takes a person to fall asleep
* Obesity is the leading factor for obstructive sleep apnea, which causes sleep fragmentation *
Sleep Drugs:
Benzodiazepines = reduces slow-wave sleep
Antidepressants = suppresses REM sleep
Hypnotics/Sedatives = HELP w/ sleep

Increased periods of wakefulness = SUMMER

* Days are longest in Summer ==== Light = promotes wake
Darkness = promotes sleep
Sleep requirements = most accurately determined by going to bed at the usual time and waking
up without an alarm for several nights
* Average = estimated requirements
GABA and genolin = promote sleep
ACh, NE, & dopamine = promote wakefulness

Rapid Eye Movement (REM) Sleep Behavior Disorder

= pt. engages in violent and complex behaviors during REM sleep as through acting out
in dreams
- Older men have higher incidence
Sleep Paralysis = sudden inability to perform voluntary movement at either sleep onset or
awakening from sleep
Bruxism = grinding teeth during stage 2 sleep
Night terror Disorder = occurs as arousal in the first third of the night during NREM sleep
accompanied by feelings of panic
Nightmares = long, frightening dreams from which people awaken in a frightened state
- Occur during REM sleep late in the night
- May lead to sleep deprivation
Short sleepers = require less sleep (< 8hrs)
Long sleepers = requires more sleep (> 8hrs)
Restless Leg Syndrome (RLS)
= sensory and movement disorder characterized by an unpleasant, uncomfortable
sensation in the legs accompanied by an urge to move
- S/S begin or worsen during periods of inactivity (rest, sleep)
= can affect pt. sleep pattern and
Disturbed sleep can be caused by:
- caffeine (CNS stimulants)
- exercise before bedtime
- loud noises (television, loud music, parties, etc.)

Chapter 21 - Impulse Control Disorders

Conduct Disorder
Manifested by:- aggressive against people and animals
- destructive against property
- deceitfulness
- rule violations
- impairment in social, academic, or occupational functioning
- adolescent and parents must agree on a behavioral contract
consists of: outlined rules
expected behaviors
consequences of misbehavior
rewards following the rules
- adolescent and parents must continue w/ family therapy to work on boundary and
communication issues
** Separation is detrimental to the healing process **
- Important for behavior to be managed for a pt. dx w/ a conduct disorder
Manifested by: ** persistent pattern of behavior in which rights of others and
age-appropriate societal norms are violated. **
Ex: shoplifting
kleptomaniac
- Important to establish firm limits to ensure physical safety and emotional security
* protect other patient from others thoughtlessness and aggressive behavior
* Use clear, sharp statements about prohibited behavior and guidance for
performing a behavior that is expected
Tx: ANTIPSYCHOTICS
* Meds are directed by problematic behaviors such as:
aggression, impulsivity, hyperactivity, and mood symptoms.
D/t: Reduced gray matter bilaterally in the anterior insulate cortex and the amygdala.
- May be related to aggressive behavior and deficits of empathy
= less likely to feel remorse for their actions of victims
Intermittent explosive disorder = pattern of behavioral outbursts characterized by an inability
to control aggressive impulses in adults 18 yrs or older
- May have differences in serotonin regulation in the brain and ^^ levels of
testosterone
Oppositional defiant disorder = a repeated and persistent pattern of having an angry and
irritable mood in conjunction with demonstrating defiant and vindictive behavior
Manifested by: negative, hostile, and spiteful toward parents
- blames other for misbehavior
Tx: Redirecting the expression of feelings into nondestructive age-appropriate
behaviors (NO medication is used)

- Ex: physical activity (swimming, running, jumping, etc)

= helps defuse the situation; helps the child learn how to
modulate the expression of feelings and exert self-control
Advanced Nurse Role:
- Individual, group and family psychotherapist
- Educator of nurses, other professions, and the community
- Clinical supervisor
- Consultant to professional and nonprofessional groups
- Researcher
Parent-child interaction therapy (PCIT)
= therapist sits behind one-way mirrors and coaches parents through an ear audio device
while they interact with their children
- therapist can suggest strategies that reinforce positive behavior in the adolescent unit
Goal: improve parenting strategies and thereby reduce problematic behavior
Differences: ODD= TESTS LIMITS & DISOBEYS
CD = VIOLATES the Rights of others

Chapter 23 - Neurocognitive Disorders

Delirium
Characterized by abrupt onset of :
- fluctuating levels of awareness
- clouded consciousness
- perceptual disturbances
- disturbed memory and orientation
Tx: Provide a quiet, shadow-free room
= produces the fewest sensory perceptual distortions
- Treat the underlying cause (UTI, medication interactions, drug toxicity, etc)
** Goal: return pt. to premorbid levels of function **
Amnestic syndrome = memory impairment without cognitive problems
Hallucinations = false perception occuring without a corresponding sensory stimulus
**Stay with the patient, acknowledge the patients feelings & state the perception of
reality **
= increases feelings of security
- reduces anxiety
- offers the opportunity for reinforcing reality
- provides a measure of physical safety
Illusion = misinterpreted sensory perception (ex: misinterpreting shadows)
Tx: Help clarify sensory perceptions
- Glasses = visual hallucinations
- Hearing aides = auditory hallucinations
PRIORITY = RX for injury
- Pt. can perceive environment as distorted, threatening, or harmful
- Pt. exercises poor judgement
- Pt. senses are clouded
** Need: CLOSE SUPERVISION & OBSERVATION **
= Goal: Pt. to remain safe and free from injury
Namenda = antagonist for NMDA
= used in moderate-to-late stages of Alzheimers disease

Alzheimers Disease
Pathophysiology
- alolipoprotein E malfunction
- neurofibrullary tangles
- neuronal degeneration in the hippocampus
- brain atrophy
Stages of Alzheimers Disease

** Use environmental cues**

Nursing Diagnoses
- Caregiver Role Strain
- Urinary incontinence
- Disturbed sleep pattern
- Self Care-deficit
- Impaired communication
Aphasia = loss of language ability (speaking )
Agnosia = loss of sensory ability to recognize objects
Apraxia = lose of purposeful movement
Anhedonia = loss of joy in life
Hyperorality = placing object into the mouth

Dementia
** Pt. should perform all tasks of which they are capable of **
- w/ simple directions = pt. is better able to process info and perform simple tasks
* Pt. may not be able to recognize family members
* Validating, talking with the patient about familiar, meaningful things, and reminiscing
give meaning to existence both for the patient and family members
Characteristics: Impaired level of consciousness
- Disorientation to place, time; however oriented to time
- Wandering attention
- Flactuating LOC
- May experience illusions and hallucinations

Confabulation = making up of stories or answers to questions by a person who does not

remember
- defensive tactic to protect self-esteem and prevent others from noticing memory loss
Preservation = repeating words or phrase over and over

Chapter 24 - Personality Disorders

Personality Disorders
- Often use rationalization to explain behavior and deny wrongdoing
(Ind. who does not believe anything done wrong, will not feel anxiety, remorse, or
guilt about the act)
- Acknowledge manipulative behavior when appropriate
* Maintaining consistent limits is a very difficult intervention
- Have problems with social interactions with others
Antisocial personality disorder
Characteristics: Manipulative
- Clinginess
- Aggressive
- Callous
- Guilt-instilling
- Extroverted than reclusive
- Rarely show anxiety
- Rarely demonstrate clinging or dependent behaviors
- Impulsive
- Manipulative people frequently make requests of many different staff, hoping one will
give in
* Have one decision maker provide consistency and avoid the potential for staff
splitting (Ex: case manager)
- Rarely have feelings of fear or inferiority; rarely seem to learn from experience or feel
true remorse
(Ex: My dog deserves to be beat)
- Often impulsively acts out feelings of anger and feels no guilt
* Acts in haste without taking time to consider the consequences of the
action
- Common problems with anger management and impulse control
Tx: Limits must be set in areas in which the patients behavior affects the rights of
others
= A lack of internal controls leads to manipulative behaviors such as lying,
cheating, conning, and flattering
====> external controls must be maintained
(protect rights of others)
- Occasionally w/: dependent & histrionic behavior

Borderline Personality Disorder

- Characteristics: demonstrates manipulative, splitting and self-destructive behaviors
- fear of abandonment (exacerbated when under success or growth)
- Consistent limit setting is vital for the patients safety
Tx: Mood stabilizing medications
Dialectical behavior therapy = = assist the pt. to choose alternative coping
strategies
* Use telephone access to the therapist for coaching during crises
Effective: Seeking a staff member instead of impulsively self-mutilating
* Use matter-of-fact approach
Splitting = involves loving a person, then hating the person because the pt. is unable to
recognize that a person can have both (+) and (-) qualities
Tx: Frequent team meetings to prevent further progression
Denial = unconsciously motivated refusal to believe something
Reaction formation = unconsciously doing the opposite of a forbidden impulse
Narcissistic Personality Disorder
Characteristics: grandiosity, self-importance, and entitlement
- arrogant
(No genetic links)
Historonic Personality Disorder
Characteristics: charm & seductiveness
- attention seeking
- melodramatic
- flirtatious
Obsessive-Compulsive Personality Disorder
Characteristics: preoccupation with minute details & admiration seeking
- perfectionist
- inflexible, rigid
- preoccupied with rules and procedures
- afraid of making mistakes
Dependent Personality Disorder
Characteristics: expressive difficulty being alone; indecisive and submissive
- socially aggressive behavior
- restless
- impulsive

Schizotypal Personality Disorder

Characteristics: do not want to be involved in relationships
- shy & introverted; poor social skills
- problems thinking, perceiving, & communicating
- prefer fantasy and daydreaming to being involved w/ real people
- odd, eccentric appearance
- often display perceptual and cognitive distortions
* suspicious of others & have difficulty trusting people
- highly anxious & frightened in social situations
Tx: need to respect their desire for social isolation
Outcomes: meet and socialize with others
** Aware of misinterpretations and overtly psychotic symptoms are usu. absent **
Schizophrenic
* Use simple language
* Keep to concrete topics
* Clarify and validate as needed
Avoidant Personality Disorder
Characteristics: timid
- socially uncomfortable
- withdrawn
- avoid situations in which they might fail
- believe to be inferior and unappealing

Chapter 30 - Psychosocial Needs of the Older Adult

Ageism = a bias (negative stereotyping) against older people because of their age
* Older adults might be as guilty of ageism as younger individuals
Consequences:
- Stereotype the elderly as having little to offer = staff avoid working w/
older patients
- Staff shortage = long-term carm
- Elderly pt. are often provided less info about medical care than younger
adults because some health care staff members perceive elders as
less able to understand
- Public policy discriminates against programs for the elderly
Myths of aging
- Older adults are able to learn new tasks ---> learning continues long into life
- Older adults are prone to become crime victims
- Decline in restorative sleep occurs as one ages
Topic of Greatest immediacy = assessment of pain in older adults
** Unmanaged pain can precipitate other problems, such as substance abuse and
depression
- Elderly pts are less likely to be accurately diagnosed and adequately treated for pain
Assessment
* Functional ability and emotional status = provides an overview of patient problems and
abilities
= guides selection of interventions and services to meet identified needs
* Assess for sensory loses (hearing, vision, taste, and smell = decline w/ age)
* Low moods occurring with regularity should signal the need for further assessment for
other symptoms of depression
Dementia
Types: - Lewy body disease
The Pain Assessment in Advanced Dementia Scale = evaluates breathing, negative
vocalizations, body language, and consolability
** Determine the medications the patient is on == may cause confusion **
(C/b drug interactions and adverse reactions)
Legal Issues
Advanced Directive = invoked when patients are unable to make their own health care
decisions
Durable Power of Attorney = instrument that appoints a person other than a HCP to act
as an individuals agent in the event that he or she is unable to make medical
decisions

Adult Day Care Program

= provides recreation and social interaction as well as supervision in a safe environment
Remotivation therapy
= helps to resocialize regressed and apethetic pts by focusing on a single topic, creating a
bridge to reality as group members talk about the world in which they live and
work and hobbies r/t the topic
- Group leaders give members acceptance and appreciation
Alcohol Abuse
= Often c/b: losses
- retirement
- widowhood
- loneliness
- less than high school education
- smoking
- low income
- male gender
Tx: Alcohol Anonymous
= provide opportunity for peer bonding & stress coping strategies
Reminiscence groups = share memories of the past
* Elite-old adults = persons 100+ yrs of age
* Young-old adults 65-75 yrs. of age
Suicide in the Elderly
* Anhendonia
* Sleep pattern changes
* Somatic symptoms (^^ concerns with bodily functions)
* Anorexia
* Delusions of persecution
* Nihilistic deslusions