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The First Nursing School in The Philippines, 1906: Nursing@cpu - Edu.ph
The First Nursing School in The Philippines, 1906: Nursing@cpu - Edu.ph
COLLEGE OF NURSING
The First Nursing School in the Philippines, 1906
Iloilo City, Philippines 5000
Tel. No. (63-33) 3291971 to 79 Local 1037 / 2133
Website: http://www.cpu.edu.ph | Email: nursing@cpu.edu.ph
Lecture Notes on
NCM 3218
(Care of Clients with Maladaptive Patterns of Behavior-Acute/Chronic)
MOOD DISORDERS
DEFINITION
pervasive alterations in emotions that are manifested by depression, mania, or both
MOOD
sustained emotional state
it can be:
- dysphoric
- elevated
- irritable
AFFECT
outward expression of emotion, emotional display & responsiveness
types:
- appropriate
- flat
- blunted
- restricted
- inappropriate
- labile
ETIOLOGY
Genetics
0-70% - identical twin
15% - parent/sibling
5-10% - grandparents/aunt/uncle
Neurochemical
Serotonin
Norepinephrine
Acetylcholine
Dopamine
Neuroendocrine
Hypersecretion of cortisol
Low levels of thyroid hormone
Postpartum hormone alterations
PMS
Biological
circadian rhythm disturbances
Cognitive
Depressed patients – process information in a negative way
Experience cognitive distortions & thinking errors
Cognitive Triad:
I. BIPOLAR DISORDER
involves extreme mood swings from episodes of mania to episodes of depression
Types:
A. Bipolar 1 one or more manic or mixed episodes accompanied by major depressive episode
for at least 1 week
B. Bipolar 2 one or more major depressive episodes accompanied by at least 1 hypomania
terms are used to describe the labile affect:
Treatment:
Psychoactive Drugs
a. ANTIMANIC & ANTICONVULSANT
- Lithium (Eskalith)
- Valproic Acid (Depakote)
- Carbamazepine (Tegretol)
- Gabapentine (Neurontin)
- Guidelines in Lithium Therapy:
o Maintain fluid intake at 2.5-3 L/day (10-13 glasses)
o Maintain adequate dietary salt intake
o Watch out for signs of toxicity
o Take medication with meals - avoid GI upset
o Caution against driving and operating dangerous machinery
o Don’t abruptly stop or alter dosage of medication
o Avoid excessive exercise in warm weather
o Avoid crash or fad diets
o Monitor lithium level regularly
b. ATYPICAL ANTIPSYCHOTICS
- Abilify (aripiprazole)
- Zyprexa (olanzapine)
- Risperdal ( risperidone)
Alternative/Complementary
Therapies
Alternative/Complementary Therapies
a. Kava-kava- ↓ restlessness
b. Black cohosh root- PMDD anPMS
c. Valerian- herb used as sedative/ hypnotic
Psychotherapy
Diagnostic test
d. Mania test
Nursing Interventions:
a. Provide safety
b. Set limits on client’s behavior
c. Use short, simple sentences to communicate
d. Clarify the meaning of client’s communication
e. Frequently provide finger foods that are high in calories and protein
f. Promote rest and sleep
Nursing Diagnosis:
a. Risk for Other-Directed Violence
b. Risk for Injury
c. Imbalanced Nutrition: Less Than Body Requirements
d. Non compliance to Medication
e. Self-Care Deficit
f. Disturbed Sleep Pattern
g. Ineffective Coping
h. Ineffective Role Performance
i. Chronic Low-Self-Esteem
Depression Assessment:
S – sleep disturbances
I – interest decrease in pleasure activities and sex
G – guilty feelings
E – energy decreased
C – concentration
A – appetite
P – psychomotor function
S – suicidal ideations
Somatic Therapy
a. ECT
b. Vagus Nerve Stimulation
Psychotherapy
Complementary/Alternative Therapy
a. St. John Wort
b. SAM-e
Nursing Interventions:
a. Provide for the safety of the client and others. Institute suicide precautions if indicated
b. Begin a therapeutic relationship by spending non-demanding time with the client
c. Promote completion of activities of daily living by assisting the client only as necessary
d. Establish adequate nutrition and hydration
e. Promote sleep and rest
f. Attitude therapy - kind firmness
g. Engage the client in activities
h. Encourage the client to verbalize and describe emotions.
i. Work with the client to manage medications and side effects
Nursing Diagnosis:
a. Risk for Suicide
b. Imbalanced Nutrition: Less Than Body Requirements
c. Anxiety
d. Ineffective Coping
e. Hopelessness
f. Ineffective Role Performance
g. Self-Care Deficit
h. Chronic Low Self-Esteem
i. Disturbed Sleep Pattern
j. Impaired Social Interaction
X. POSTPARTUM DEPRESSION
meets all the criteria for a major depressive episode, with onset within 4 weeks of delivery
XI. POSTPARTUM PSYCHOSIS
psychotic episode developing within 3 weeks of delivery and beginning with:
- fatigue
- sadness
- emotional lability
- poor memory
- confusion
and progressing to:
- delusions
- hallucinations
- poor insight and judgment
- loss of contact with reality
risk for suicide and infanticide
XIII. SUICIDE
intentional act of killing oneself
associated with thwarted/ unfulfilled needs, feelings of hopelessness and helplessness
ambivalent conflicts between survival and unbearable stress
narrowing of perceived options and need to escape
Suicidal Ideation – thoughts about wanting to die
Suicidal Intent – thoughts about a concrete plan to commit suicide
Suicidal Threat – expression of a person’s desire to end his/her life
Attempted Suicide – self-destructive behavior, an act that either failed or was incomplete
Complete Suicide – self-destructive behavior that resulted to death
Common Expressions of a Suicidal Patient:
Cry for help
Form of escape
Heroic act
Manipulation
Relief of Pain
Retaliation
Reunion wish or fantasy
6|Mood Disorders – Prof. Borlado
Etiology:
a. Genetic and Biological
o close relationship- greater risk (twins, families)
o neurochemical changes (serotonin)
b. Sociological
o Egoistic suicide
o Altruistic suicide
o Anomic suicide
c. Psychological
o Theory of Self
o Interpersonal-Psychological Theory
o Theory of Parasuicidal Behavior
- Trichotillomania (TTM)
- Dermatillomania
Diagnostic Tools:
Nursing Diagnosis
a. Risk for Injury
b. Risk for Suicide
Nursing Interventions:
a. Execute a no suicide contract
b. Ask direct questions
c. Use of seclusion and restraints
d. Be alert for cues → 80% give clues
o Behavioral cues:
- Depression to gaiety- lifted
- Continuous early morning awakening (3 to 7 am)
- Talking directly and indirectly about suicide (leaving, gone)
- Previous suicidal attempts
- Giving away personal possessions of unusual value-taking out an insurance
policy, giving jewelry
- Asking questions regarding lethal doses of substances or drugs, drug or alcohol
abuse
- Small pupil, glassy look and vacant stare
- Rehearsing suicide or seriously discussing specific suicide method
- Writing forlorn love notes
- Drug or alcohol abuse
o Situational cues: unexpected death of loved one, divorce, job failure, malignant
diagnosis
e. Provide safe environment
f. Encourage to ventilate feelings and thoughts
g. Assume a non judgmental, caring attitude-stress the person’s life is important to you and to
others
h. Keep active in daily activities- assign simple tasks
i. Don’t promise confidentiality
j. Make patient realize that the tendency to commit suicide is due to a disturbance in the brain
chemistry that is treatable- temporary condition
k. Provide structured schedule and involve in activities with others to self worth and divert
attention
l. Provide an unconditional positive regard
m. Administer medications and monitor client’s responses
n. Conduct suicide lethality assessment (plan of death- method, time, place)
o. Create a support system list
ALWAYS REMEMBER:
a. Suicidal person wants to die only during the period of suicidal crisis- during this time the person
is ambivalent about living and dying
b. Suicidal people give warning
c. Persons recovering from depression are high risk for suicide from 9-15 months after recovery
d. Suicidal people are extremely unhappy but not always mentally ill.
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