NOTES ABOUT SUBSTANCE ABUSE
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
1. ALCOHOL
ALCOHOL DEPENDENCE AND ABUSE
Etiology:
•Low self –esteem
•Guilt and anxiety
•Limited life goals, unreliable, impulsive and irresponsible
•Fixation
•Learned Behavior
•Inherited traits
•Mass media and sociologic cultural practices
•Poor parenting and poor role modeling
Phases of Alcohol Dependence and Abuse
1. Pre alcoholic:
2. Prodromal:
3. Crucial:
4. Chronic phase:
Common sequence of Alcohol Withdrawal
Tremulousness
Acute hallucinations
Alcohol withdrawal delirium
CAGE ASSESSMENT
•Have you ever felt the need to CUT DOWN alcohol?
•Has anybody ever been ANNOYED by your attitude when you are under the influence of alcohol?
•Have you ever felt GUILTY about your alcohol dependency?
•Is alcohol an EYE OPENER to you when you wake up in the morning?
COMPLICATIONS OF ALCOHOL DEPENDENCY AND ABUSE
1. DELIRIUM TREMENS
•Clinical Manifestations:
–severe memory disturbance
–agitation and hallucinations 1-5 days
–Diaphoresis
–Hypertension
–Tachycardia
2. WERNICKE’S ENCEPHALOPATHY
Clinical Manifestations:
•mental status changes
•ocular abnormalities:
•vestibular dysfunction
•confusion
•disorientation
•ataxia
•apathy
3. KORSAKOFF PSYCHOSIS
Clinical Manifestations:
•Amnesia
•Dementia
•Confabulation and Learning Problems
•Psychosis
•Loss of reality testing
•Loss of taste and smell
Nursing Interventions
•Supportive care
•Balanced diet
•Psychopharmacology
•Abstain from alcohol
2. OPIUM
•Desensitizes
•Euphoria and well being
Overdose of opiods
•Respiratory depression
•Suffocation
•Aspiration of inhaled compounds or vomitus
•Anoxia
•Vagal Stimulation
•Arrythmias
•Death Cardiac Arrest
Nursing Interventions
SAFETY
RESPIRATION
Monitor for signs and symptoms of withdrawal
Medications
3. VOLATILE INHALANTS
•Lack of Coordination
•Blurred Vision
•Dizziness
•Slurred Speech
•Unsteady gait
•Tremor
•Muscle Weakness
•Nystagmus
•Excitation followed by drowsiness, light headedness, loss of inhibition and agitation
•Aggression
•Apathy
•Enhancement of sexual pleasure
•Inability to function well
•Giggling and laughter
•Stupor
•Coma
*NO WITHDRAWAL EFFECTS
*Only supportive treatment is given.
4. CANNABIS
•Clinical Manifestations with the use of Cannabis:
–Lowered Inhibitions
–Relaxed state
–Euphoria
–Inappropriate laughter
–Increased Appetite
–Distortion of time and perception
–Dysphoria
–Impaired Judgment
–Short term memory
–Impaired motor coordination
–Social Withdrawal
–Dry mouth
–Hypotension
–Tachycardia
–Delirium
–“Blood shot eyes”
–“Devil’s Eyes”
*Overdosage does not occur
*No clinically significant withdrawal syndrome
*Some may experience muscle pains, sweating, anxiety and tremors as the withdrawal symptom.
•Nursing Interventions:
–Ensure comfort and safety.
–Orient to person, time and place.
–Ensure environmental safety especially during episodes of delirium.
–Instruct to abstain from using the substance
5. STIMULANTS
Amphetamines
-short term treatment for obesity, attention deficit and narcolepsy
-also speed or crank
-poor person’s cocaine
-psychosis
Withdrawal: cold turkey
craving
b. Cocaine
- rush
- euphoria
-increased mental awareness
-increased strength
-anorexia
-increased sexual stimulation
-bugs (formication)
-respiratory collapse
c. Hallucinogens
•LSD
•PCP
•Mescaline (Peyote)
•Psilocybin
Clinical Manifestations of LSD, Peyote, and Psilocybin during Overdose
•Psychosis
•Brain damage
•Death
•Clinical Manifestations of PCP during overdose:
–Hypertensive Crisis
–Hyperthermia
–Psychosis
–Seizures
–Respiratory Arrest
DEFENSE MECHANISMS
•Denial
•Rationalization
•Projection
NURSING INTERVENTIONS FOR SUBSTANCE ABUSE
–Identify the type of the substance used
–Observe for signs and symptoms of intoxication and overdose
–Observe for withdrawal symptoms
–Maintain a patent airway and regular respiration
–Treat symptoms of overdose if manifested
–Intravenous therapy should be initiated
–Lavage the client if necessary for overdose especially if the substance used is a sedative
–Request for dialysis as ordered if necessary if the substance used contains barbiturates
–Initiate seizure precautions
–Keep airway on hand: oxygenate as necessary
–Naloxone (Narcan)
–Methadone or Naltrexone
–Treat underlying emotional problems
–Behavior modification
–Detoxification
–Rehabilitation
FOR NURSING UPDATES, visit:
http://www.maritessmanalangquintorn.weebly.com/
http://www.tuesdayrn.blogspot.com/
**This article is protected by copyright law. Photocopying and/or reproducing any part without written permission from the author is punishable by law.
Monday, December 28, 2009
SEXUAL DISORDERS
NOTES ABOUT SEXUAL DISORDERS
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
SEXUAL DISORDERS
nDisorders related to a particular phase of the sexual response cycle
nMay occur to any individual of any age, race or culture.
FACTORS AFFECTING SEXUALITY
Sexual Identity
Gender Identity
Sexual Orientation
Sexual Behavior
STAGES OF SEXUAL RESPONSES
Excitement
Plateau
Orgasm
Resolution
DSM-IV OF SEXUAL DISORDERS(Diagnostic and Statistical Manual IV)
Sexual Dysfunctions
Paraphilias
Gender Identity Disorder
SEXUAL DYSFUNCTIONS
nDisorders that involve a disturbance in the processes that characterize the sexual response cycle or the presence of pain during sexual intercourse
TYPES OF SEXUAL DISORDERS: Sexual Dysfunctions
Sexual Desire Disorder
qHypoactive Sexual Desire Disorder.
ndecreased sexual fantasy and decreased or absent
qSexual Aversion Disorder.
nActively avoids and has a persistent or recurrent extreme aversion to genital sexual contact with a sexual partner
Sexual Arousal Disorder
qFemale Sexual Arousal Disorder.
n(-) Swelling of the external genitalia and vaginal lubrication
qMale Erectile Disorder.
nUnable to maintain an erection throughout sexual activity
Orgasmic Disorder
qFemale Orgasmic Disorder.
nsignificant delay or total absence of orgasm
qMale Orgasmic Disorder.
nWhen a male experiences significant delay or total absence of orgasm following sexual activity
qPremature Ejaculation.
nEven with minimal sexual stimulation, a male client experiences orgasm and ejaculation on a persistent basis.
Sexual Pain Disorder
qDyspareunia.
nGenital pain that accompanies sexual intercourse.
qVaginismus
nhas spasms of the vaginal muscles
qPriapism
nRare condition of prolonged and painful erection
PARAPHILIAS
socially prohibited or unacceptable fantasies, urges or behaviors to human or non human objects
Exhibitionism
qgenital self-exposure to an unsuspecting stranger, which sometimes involves masturbation.
Fetishism
quse of inanimate objects (such as shoes, underwear or any other object).
Frotteurism
qtouching and rubbing against a person who doesn't consent to this behavior.
Pedophilia
qAffects children 13 years old and below
Sexual Masochism
qbehaviors concerning real acts of being beaten, bound, humiliated or otherwise made to suffer.
Sexual Sadism
qbehaviors concerning real acts of causing physical or psychological torment or otherwise humiliating another.
Transvestic Fetishism
qhas intense sexual desires, fantasies or behavior concerning cross-dressing.
Voyeurism
qthe act of watching an unsuspecting person who is naked, disrobing or having sex.
GENDER IDENTITY DISORDER(Transexualism)
nPersistent discomfort with one’s assigned gender and a feeling that is inappropriate or inaccurate
CARE AND MANAGEMENT: Assessment
Sexual History
Biological Assessment
Psychological Assessment
Social Assessment
CARE AND MANAGEMENT: Planning and Implementation
The nurse/caregiver should:
Accept the client as a person in emotional pain
Avoid punitive remarks or responses
Protect the individual from others
Set limits on the individual’s sexual acting out
Medication Management:
qAntiandrogen Therapy
qHormonal Replacement
qSildefanil Citrate (Viagra)
qSSRI
FOR NURSING UPDATES, visit:
http://www.maritessmanalangquintorn.weebly.com/
http://www.tuesdayrn.blogspot.com/
**This article is protected by copyright law. Photocopying and/or reproducing any part without written permission from the author is punishable by law.
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
SEXUAL DISORDERS
nDisorders related to a particular phase of the sexual response cycle
nMay occur to any individual of any age, race or culture.
FACTORS AFFECTING SEXUALITY
Sexual Identity
Gender Identity
Sexual Orientation
Sexual Behavior
STAGES OF SEXUAL RESPONSES
Excitement
Plateau
Orgasm
Resolution
DSM-IV OF SEXUAL DISORDERS(Diagnostic and Statistical Manual IV)
Sexual Dysfunctions
Paraphilias
Gender Identity Disorder
SEXUAL DYSFUNCTIONS
nDisorders that involve a disturbance in the processes that characterize the sexual response cycle or the presence of pain during sexual intercourse
TYPES OF SEXUAL DISORDERS: Sexual Dysfunctions
Sexual Desire Disorder
qHypoactive Sexual Desire Disorder.
ndecreased sexual fantasy and decreased or absent
qSexual Aversion Disorder.
nActively avoids and has a persistent or recurrent extreme aversion to genital sexual contact with a sexual partner
Sexual Arousal Disorder
qFemale Sexual Arousal Disorder.
n(-) Swelling of the external genitalia and vaginal lubrication
qMale Erectile Disorder.
nUnable to maintain an erection throughout sexual activity
Orgasmic Disorder
qFemale Orgasmic Disorder.
nsignificant delay or total absence of orgasm
qMale Orgasmic Disorder.
nWhen a male experiences significant delay or total absence of orgasm following sexual activity
qPremature Ejaculation.
nEven with minimal sexual stimulation, a male client experiences orgasm and ejaculation on a persistent basis.
Sexual Pain Disorder
qDyspareunia.
nGenital pain that accompanies sexual intercourse.
qVaginismus
nhas spasms of the vaginal muscles
qPriapism
nRare condition of prolonged and painful erection
PARAPHILIAS
socially prohibited or unacceptable fantasies, urges or behaviors to human or non human objects
Exhibitionism
qgenital self-exposure to an unsuspecting stranger, which sometimes involves masturbation.
Fetishism
quse of inanimate objects (such as shoes, underwear or any other object).
Frotteurism
qtouching and rubbing against a person who doesn't consent to this behavior.
Pedophilia
qAffects children 13 years old and below
Sexual Masochism
qbehaviors concerning real acts of being beaten, bound, humiliated or otherwise made to suffer.
Sexual Sadism
qbehaviors concerning real acts of causing physical or psychological torment or otherwise humiliating another.
Transvestic Fetishism
qhas intense sexual desires, fantasies or behavior concerning cross-dressing.
Voyeurism
qthe act of watching an unsuspecting person who is naked, disrobing or having sex.
GENDER IDENTITY DISORDER(Transexualism)
nPersistent discomfort with one’s assigned gender and a feeling that is inappropriate or inaccurate
CARE AND MANAGEMENT: Assessment
Sexual History
Biological Assessment
Psychological Assessment
Social Assessment
CARE AND MANAGEMENT: Planning and Implementation
The nurse/caregiver should:
Accept the client as a person in emotional pain
Avoid punitive remarks or responses
Protect the individual from others
Set limits on the individual’s sexual acting out
Medication Management:
qAntiandrogen Therapy
qHormonal Replacement
qSildefanil Citrate (Viagra)
qSSRI
FOR NURSING UPDATES, visit:
http://www.maritessmanalangquintorn.weebly.com/
http://www.tuesdayrn.blogspot.com/
**This article is protected by copyright law. Photocopying and/or reproducing any part without written permission from the author is punishable by law.
NOTES ABOUT MENTAL STATUS EXAMINATION
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
SCHIZOPHRENIA
: Characterized by individuals who exhibits manifestations which are considered bizarre and inappropriate
Etiology:
1. Psychoanalytic
2. Genetics
3. Dopamine hypothesis
4. Other neurotransmitters
Classic Signs of Schizophrenia:
(Bleuler’s Concept of Schizophrenia)
o Looseness of Associations
o Autism
o Inappropriate Affect
o Ambivalence
Confirmatory symptoms:
• Hallucinations
• Delusions
TYPES OF SCHIZOPHRENIA
o Paranoid
o Disorganized
o Catatonic
o Undifferentiated
o Residual
Types of Symptoms:
1. Hard
o Hallucinations
o Delusions
o Echopraxia
o Flight of Ideas
o Perseveration
o Associative looseness
o Ideas of Reference
o Ambivalence
2. Soft
o Apathy
o Alogia
o Flat affect
o Blunt affect
o Anhedonia
o Catatonia
o Lack of volition
Hallucinations Common to Schizophrenic Clients:
o Auditory Hallucination (most common and should be validated)
o Command Hallucination
o Tactile Hallucination
o Olfactory Hallucination
o Gustatory Hallucination
o Cenesthetic Hallucination
o Kinesthetic Hallucination
Delusions Common to Schizophrenic Clients:
o Paranoid Delusions
o Ideas of Reference
o Grandiose Delusions
o Somatic Delusions
o Religious Delusions
Prognosis of the disease process
1. Good
o Late onset
o Positive Symptoms
o Obvious precipitating Factos
o Good premorbid, sexual and work histories
o Mood disorders
o Married
o Family history of mood disorders
o Good support systems
2. Poor
o Young onset
o Sudden onset
o No precipitating factors
o Poor work, sexual or social histories
o Withdrawn, autistic
o Single, divorced, widow
o Family history of schizophrenia
o Poor support systems
o Negative symptoms
o Neuro symptoms
o No remissions in 3 years
o No relapses
o History of assault
Nursing Interventions:
1. Safety
2. Set limits
3. Present Reality
4. Depends on the manifestations of the client
5. Psychopharamcology
6. Behavioral Therapy
7. Milieu Therapy
Medications:
a. Typical b. Atypical
Chlorpromazine (Thorazine) Clozapine (Clozaril)
Trifluoperazine (Trilafon) Risperidone (Risperdal)
Fluphenazine (Prolixin) Olanzapine (Zyprexa)
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
SCHIZOPHRENIA
: Characterized by individuals who exhibits manifestations which are considered bizarre and inappropriate
Etiology:
1. Psychoanalytic
2. Genetics
3. Dopamine hypothesis
4. Other neurotransmitters
Classic Signs of Schizophrenia:
(Bleuler’s Concept of Schizophrenia)
o Looseness of Associations
o Autism
o Inappropriate Affect
o Ambivalence
Confirmatory symptoms:
• Hallucinations
• Delusions
TYPES OF SCHIZOPHRENIA
o Paranoid
o Disorganized
o Catatonic
o Undifferentiated
o Residual
Types of Symptoms:
1. Hard
o Hallucinations
o Delusions
o Echopraxia
o Flight of Ideas
o Perseveration
o Associative looseness
o Ideas of Reference
o Ambivalence
2. Soft
o Apathy
o Alogia
o Flat affect
o Blunt affect
o Anhedonia
o Catatonia
o Lack of volition
Hallucinations Common to Schizophrenic Clients:
o Auditory Hallucination (most common and should be validated)
o Command Hallucination
o Tactile Hallucination
o Olfactory Hallucination
o Gustatory Hallucination
o Cenesthetic Hallucination
o Kinesthetic Hallucination
Delusions Common to Schizophrenic Clients:
o Paranoid Delusions
o Ideas of Reference
o Grandiose Delusions
o Somatic Delusions
o Religious Delusions
Prognosis of the disease process
1. Good
o Late onset
o Positive Symptoms
o Obvious precipitating Factos
o Good premorbid, sexual and work histories
o Mood disorders
o Married
o Family history of mood disorders
o Good support systems
2. Poor
o Young onset
o Sudden onset
o No precipitating factors
o Poor work, sexual or social histories
o Withdrawn, autistic
o Single, divorced, widow
o Family history of schizophrenia
o Poor support systems
o Negative symptoms
o Neuro symptoms
o No remissions in 3 years
o No relapses
o History of assault
Nursing Interventions:
1. Safety
2. Set limits
3. Present Reality
4. Depends on the manifestations of the client
5. Psychopharamcology
6. Behavioral Therapy
7. Milieu Therapy
Medications:
a. Typical b. Atypical
Chlorpromazine (Thorazine) Clozapine (Clozaril)
Trifluoperazine (Trilafon) Risperidone (Risperdal)
Fluphenazine (Prolixin) Olanzapine (Zyprexa)
MENTAL STATUS EXAMINATION
NOTES ABOUT MENTAL STATUS EXAMINATION
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
NEUROPSYCHIATRIC MENTAL STATUS EXAMINATION
A. General Description
–General appearance
–Level of consciousness
–Posture
–Gait
–Movements of limbs, trunk, and face
–Response to examiner
–Native or primary language
B. Language and Speech
a. Comprehension
b. Output Repetition
C. Thought
–Form
– Content
D. Mood and Affect
NEUROPSYCHIATRIC MENTAL STATUS EXAMINATION
E. Insight and Judgment
F. Cognition
–Memory
–Orientation
–Concentration
G. Abstraction
H. Roles and Relationships
I. Self Care Considerations
–ADLs
–Medications
–Sleep Patterns
–Eating Patterns
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
NEUROPSYCHIATRIC MENTAL STATUS EXAMINATION
A. General Description
–General appearance
–Level of consciousness
–Posture
–Gait
–Movements of limbs, trunk, and face
–Response to examiner
–Native or primary language
B. Language and Speech
a. Comprehension
b. Output Repetition
C. Thought
–Form
– Content
D. Mood and Affect
NEUROPSYCHIATRIC MENTAL STATUS EXAMINATION
E. Insight and Judgment
F. Cognition
–Memory
–Orientation
–Concentration
G. Abstraction
H. Roles and Relationships
I. Self Care Considerations
–ADLs
–Medications
–Sleep Patterns
–Eating Patterns
EATING DISORDERS
NOTES ABOUT EATING DISORDERS
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
ANOREXIA NERVOSA
: Loss of appetite
•Signs and symptoms:
–Fear of becoming fat
–Body image disturbance
–Amenorrhea
–Depressed mood, social withdrawal, irritability and insomnia
–Preoccupation with thoughts of food
–Feelings of ineffectiveness
–Strong need to control the environment
–Constipation and abdominal pain
–Cold intolerance
–Lethargy
–Emaciation
–Hypotension, hypothermia, bradycardia
–Hypertrophy of salivary glands
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
•Refusal to maintain body weight
•Intense fear of gaining weight
•Overvaluing of shape or weight or denial of seriousness of loss of weight
•Absence of 3 consecutive menstrual cycles
TYPES OF ANOREXIA NERVOSA
Restricting type: (-) binge eating or purging
Binge-eating/Purging type: (+) binge eating/purging
Etiology:
•Biologic
-Obesity and diet
-Overprotective family
-beauty, thinness
-fitness and preoccupation of achieving ideal body
•Biochemical:
- Increased CSF levels of 5-hydroxyindoleacetic acid (5-HIAA)
•Psychoanalytical
(-)autonomy and identity
dissatisfaction of body image
possible childhood sexual abuse
•Onset:
Ages of 14 to 18 years old
Denies anxiety over appearance and gaining weight
•Treatment:
–Psychotherapy
–Psychopharmacology
BULIMIA NERVOSA
-(+) bingeing or purging episodes with strong emotions and followed by guilt, remorse, shame or self-contempt
SIGNS AND SYMPTOMS OF BULIMIA NERVOSA
•Recurrent episodes of bingeing and purging
•Compensatory behaviors
•Usually within normal weight range, possible underweight or overweight
•Depressive and anxiety symptoms
•Possible substance abuse
•Loss of dental enamel
•Menstrual irregularities
•Esophageal tears
•Fluid and electrolyte abnormalities
TYPES OF BULIMIA NERVOSA
Purging type: (-) binge eating or purging
Non-Purging type: (+) binge eating/purging
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
•Recurrent episodes of binge eating
•A feeling of lack of control over eating behaviors during eating binges
•Recurrent inappropriate compensatory behavior in order to prevent weight gain
•Twice a week for 3 months
•Self evaluation influenced by body shape
Etiology:
•Biologic
:Obesity
:Dieting at an early age
:Substance abuse
:History of personality disorders and anxiety disorders
B. Biochemical:
:serotonin and norepinephrine disturbances
:decreased hypothalamic glucose utilization
:a satiety center disturbance
C. Psychoanalytical
Dissatisfaction of body image
Inability to develop identity
•Onset:
–Late adolescents or early adulthood
Medical Complications of Eating Disorders
•Anorexia Nervosa:
–Arrythmias
•Bulimia Nervosa:
–Metabolic alkalosis
–Metabolic acidosis
Nursing Interventions for Bulimia Nervosa and Anorexia Nervosa:
•Weigh client daily.
•Basic nutritional needs.
•Harmful effects of dieting, bingeing and purging.
•Strengthened family ties.
•Acceptance of different personalities and constant affirmation of child.
•Importance of professional help
•Be alert for attempts to hide food or inflate weight.
•Journal
•Relaxation techniques.
FOR NURSING UPDATES, visit:
http://www.maritessmanalangquintorn.weebly.com/
http://www.tuesdayrn.blogspot.com/
**This article is protected by copyright law. Photocopying and/or reproducing any part without written permission from the author is punishable by law.
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
ANOREXIA NERVOSA
: Loss of appetite
•Signs and symptoms:
–Fear of becoming fat
–Body image disturbance
–Amenorrhea
–Depressed mood, social withdrawal, irritability and insomnia
–Preoccupation with thoughts of food
–Feelings of ineffectiveness
–Strong need to control the environment
–Constipation and abdominal pain
–Cold intolerance
–Lethargy
–Emaciation
–Hypotension, hypothermia, bradycardia
–Hypertrophy of salivary glands
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
•Refusal to maintain body weight
•Intense fear of gaining weight
•Overvaluing of shape or weight or denial of seriousness of loss of weight
•Absence of 3 consecutive menstrual cycles
TYPES OF ANOREXIA NERVOSA
Restricting type: (-) binge eating or purging
Binge-eating/Purging type: (+) binge eating/purging
Etiology:
•Biologic
-Obesity and diet
-Overprotective family
-beauty, thinness
-fitness and preoccupation of achieving ideal body
•Biochemical:
- Increased CSF levels of 5-hydroxyindoleacetic acid (5-HIAA)
•Psychoanalytical
(-)autonomy and identity
dissatisfaction of body image
possible childhood sexual abuse
•Onset:
Ages of 14 to 18 years old
Denies anxiety over appearance and gaining weight
•Treatment:
–Psychotherapy
–Psychopharmacology
BULIMIA NERVOSA
-(+) bingeing or purging episodes with strong emotions and followed by guilt, remorse, shame or self-contempt
SIGNS AND SYMPTOMS OF BULIMIA NERVOSA
•Recurrent episodes of bingeing and purging
•Compensatory behaviors
•Usually within normal weight range, possible underweight or overweight
•Depressive and anxiety symptoms
•Possible substance abuse
•Loss of dental enamel
•Menstrual irregularities
•Esophageal tears
•Fluid and electrolyte abnormalities
TYPES OF BULIMIA NERVOSA
Purging type: (-) binge eating or purging
Non-Purging type: (+) binge eating/purging
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
•Recurrent episodes of binge eating
•A feeling of lack of control over eating behaviors during eating binges
•Recurrent inappropriate compensatory behavior in order to prevent weight gain
•Twice a week for 3 months
•Self evaluation influenced by body shape
Etiology:
•Biologic
:Obesity
:Dieting at an early age
:Substance abuse
:History of personality disorders and anxiety disorders
B. Biochemical:
:serotonin and norepinephrine disturbances
:decreased hypothalamic glucose utilization
:a satiety center disturbance
C. Psychoanalytical
Dissatisfaction of body image
Inability to develop identity
•Onset:
–Late adolescents or early adulthood
Medical Complications of Eating Disorders
•Anorexia Nervosa:
–Arrythmias
•Bulimia Nervosa:
–Metabolic alkalosis
–Metabolic acidosis
Nursing Interventions for Bulimia Nervosa and Anorexia Nervosa:
•Weigh client daily.
•Basic nutritional needs.
•Harmful effects of dieting, bingeing and purging.
•Strengthened family ties.
•Acceptance of different personalities and constant affirmation of child.
•Importance of professional help
•Be alert for attempts to hide food or inflate weight.
•Journal
•Relaxation techniques.
FOR NURSING UPDATES, visit:
http://www.maritessmanalangquintorn.weebly.com/
http://www.tuesdayrn.blogspot.com/
**This article is protected by copyright law. Photocopying and/or reproducing any part without written permission from the author is punishable by law.
FOUNDATIONS OF PSYCHIATRIC NURSING
NOTES ABOUT MENTAL STATUS EXAMINATION
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
FUNDAMENTALS OF PSYCHIATRIC NURSING
A. Theories of Personality Development
Sigmund Freud’s Psychosexual Development
Oral
Anal
Phallic
Latency
Genital
Erik Erikson’s Psychosocial Development
Trust versus Mistrust
Autonomy versus Shame and Doubt
Industry versus Inferiority
Role Identity versus Role Confusion
Intimacy versus Isolation
Generativity versus Stagnation
Ego Integrity versus Despair
Sullivan’s Interpersonal Relationship Development
Infancy
Childhood
Juvenile
Preadolescence
Early Adolescence
Late Adolescence
Young Adulthood
Jean Piaget’s Cognitive Development
Sensorimotor
Preoperational
Concrete Operations
Formal Operations
Hildegard Peplau’s Nurse Client Relationship
Phases of Nurse Client Relationship
Orientation
Working Phase
Termination Phase
CAUTION: The avoidance of transference and counter transference in important in the termination phase.
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)
Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
FUNDAMENTALS OF PSYCHIATRIC NURSING
A. Theories of Personality Development
Sigmund Freud’s Psychosexual Development
Oral
Anal
Phallic
Latency
Genital
Erik Erikson’s Psychosocial Development
Trust versus Mistrust
Autonomy versus Shame and Doubt
Industry versus Inferiority
Role Identity versus Role Confusion
Intimacy versus Isolation
Generativity versus Stagnation
Ego Integrity versus Despair
Sullivan’s Interpersonal Relationship Development
Infancy
Childhood
Juvenile
Preadolescence
Early Adolescence
Late Adolescence
Young Adulthood
Jean Piaget’s Cognitive Development
Sensorimotor
Preoperational
Concrete Operations
Formal Operations
Hildegard Peplau’s Nurse Client Relationship
Phases of Nurse Client Relationship
Orientation
Working Phase
Termination Phase
CAUTION: The avoidance of transference and counter transference in important in the termination phase.
Saturday, December 26, 2009
HANDOUTS FOR PSYCHIATRIC NURSING
NOTES IN PSYCHIATRIC NURSING WILL BE POSTED ON DECEMEBER 28, 2009.
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HAPPY HOLIDAYS TO EVERYONE! :)
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