Mental Health, Mental Illness, and Stigma (Chapter 2)

Mental health is defined as a state of well-being in which individuals realize their potential, cope with
life’s stresses, work productively, and contribute to their community. Mental illnesses, on the other
hand, are medical conditions that affect a person’s thinking, feeling, mood, behavior, or daily
functioning.

1. Attributes of Mental Health:

o Ability to think clearly, manage emotions, form and maintain relationships, and work
productively.

o Resilience, or the ability to recover from adversity, is a key component of mental health

2. Mental Illness Spectrum:

o Mental health and illness exist on a continuum ranging from mild to severe. A diagnosis
does not always equate to incapacity; individuals may function at varying levels despite
their condition

3. Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

o The DSM-5 provides criteria for diagnosing mental illnesses, ensuring consistency and
standardization in treatment

Stigma and Its Impact

Stigma refers to negative attitudes and beliefs about individuals with mental illnesses, often resulting in
discrimination, rejection, and social isolation

1. Types of Stigma:

o Self-Stigma: Internalized feelings of shame or inferiority by those with mental illnesses.

o Institutional Stigma: Policies or practices that disadvantage individuals with mental

health conditions.

2. Consequences of Stigma:

o Barriers to seeking treatment due to fear of judgment.

o Reduced opportunities in employment, housing, and social relationships.

o Adverse effects on self-esteem and mental well-being..

3. Addressing Stigma:

o Advocacy by organizations like the National Alliance on Mental Illness (NAMI).

o Education to challenge myths and promote understanding of mental health conditions..

Nursing Implications

1. Promoting Understanding:

o Educate patients and families about mental health conditions to reduce stigma.

o Emphasize that mental illnesses are treatable and do not define an individual’s identity.

2. Creating Supportive Environments:

o Foster inclusive care environments free of judgment or bias.

o Encourage participation in community support groups.

3. Advocacy:

o Advocate for equitable healthcare access and policies that reduce systemic stigma..

4. Culturally Competent Care:

o Tailor interventions to the cultural, social, and individual needs of patients.

Defense Mechanisms (Chapter 11)

Healthy Defense Mechanisms

1. Altruism: Addressing stressors by helping others, deriving satisfaction from their gratitude or
response.

o Example: After losing her husband, a woman begins counseling others dealing with grief
and finds satisfaction in helping them.

2. Sublimation: Substituting socially acceptable actions for unacceptable impulses.

o Example: A person with aggressive tendencies channels those feelings into sports.

3. Humor: Using humor to cope with emotional conflicts or stressors.

o Example: A man jokes about his own clumsiness during a stressful job interview, easing
tension.

4. Suppression: The conscious decision to delay focusing on distressing issues.

o Example: A student postpones worrying about financial problems until after an

important exam.

Intermediate Defense Mechanisms

1. Repression: Excluding disturbing thoughts from consciousness.

o Example: Forgetting a difficult event, such as a traumatic childhood experience.

 2. Displacement: Transferring emotions from one target to another.

o Example: A man frustrated by his boss takes out his anger on his family.

3. Reaction Formation: Adopting behaviors or attitudes opposite to one's feelings.

o Example: Someone with resentment towards children becomes overly indulgent with
them.

4. Undoing: Trying to cancel out a distressing thought or action through a compensatory act.

o Example: Gifting someone after an argument to make amends.

Immature Defense Mechanisms

1. Denial: Refusing to acknowledge reality.

o Example: A person denies serious health issues despite clear symptoms.

2. Projection: Attributing personal undesirable feelings to others.

o Example: Blaming others for one's own hostile thoughts.

3. Splitting: Viewing people or situations in all-or-nothing terms.

o Example: Idealizing a friend as perfect but demonizing them after a disagreement.

Prominent Theories and Their Therapeutic Models

1. Psychoanalytic Theory:

o Founded by Sigmund Freud, this theory emphasizes the role of the unconscious mind in
behavior. Freud categorized mental activity into the conscious, preconscious, and
unconscious levels.

o Key concepts include the id (primitive desires), ego (reality-oriented mediator), and
superego (moral conscience).

o Therapy: Psychoanalytic therapy focuses on uncovering unconscious conflicts, often

using methods like free association and dream analysis.

2. Interpersonal Theory:

o Developed by Harry Stack Sullivan, this theory centers on relationships and social
interactions as the basis for mental health or illness.

o Anxiety is seen as a result of social pressures and expectations.

o Therapy: Interpersonal therapy (IPT) emphasizes improving communication patterns

and the patient's current relationships.

3. Behavioral Theories:
 o This approach posits that behaviors are learned and can be unlearned or modified.

o Techniques include classical conditioning (Pavlov), operant conditioning (Skinner), and

aversion therapy.

o Therapy: Behavioral therapy focuses on changing maladaptive behaviors using

reinforcement and systematic desensitization.

4. Cognitive Theory:

o Aaron Beck's work emphasized that thought patterns influence emotions and behaviors.
Dysfunctional thoughts can lead to psychological distress.

o Therapy: Cognitive-behavioral therapy (CBT) identifies and restructures negative

thought patterns, fostering healthier emotional responses and behaviors.

5. Humanistic Theories:

o Abraham Maslow introduced the hierarchy of needs, emphasizing self-actualization and

self-transcendence.

o Carl Rogers’s person-centered therapy focuses on the patient's capacity for self-healing
with the therapist serving as a supportive facilitator.

6. Biological Theories:

o These theories focus on the physical causes of mental disorders, such as genetics,
neurochemistry, and brain structure.

o Therapy: Treatments include psychopharmacology (e.g., antidepressants,

antipsychotics), electroconvulsive therapy (ECT), and newer methods like transcranial
magnetic stimulation (TMS).

Application to Psychiatric Nursing

The chapter emphasizes the integration of these theories into nursing practice. For instance:

• Erikson’s psychosocial development theory provides a framework for understanding patient

behaviors and life-stage challenges.

• Maslow's hierarchy helps prioritize care by addressing basic needs before higher-order goals.

Erikson’s Psychosocial Development Theory

Erik Erikson expanded on Freud's psychodynamic framework, emphasizing the psychosocial aspects of
development throughout the lifespan. His theory outlines eight stages, each presenting a unique
psychosocial conflict that must be resolved for healthy development. Unsuccessful resolution can lead
to future challenges.

Key Stages:

1. Trust vs. Mistrust (Infancy, 0–1 year):

 o Focus: Developing trust in caregivers and the environment.

o Success: Leads to a sense of security and trust.

o Failure: Results in mistrust and insecurity.

2. Autonomy vs. Shame and Doubt (Early Childhood, 1–3 years):

o Focus: Gaining a sense of personal control and independence.

o Success: Develops self-confidence.

o Failure: Leads to shame and doubt about abilities.

3. Initiative vs. Guilt (Preschool, 3–6 years):

o Focus: Exploring, asserting power through play and social interactions.

o Success: Encourages initiative and leadership skills.

o Failure: May lead to feelings of guilt over desires and actions.

4. Industry vs. Inferiority (School Age, 6–12 years):

o Focus: Mastering skills and building competence.

o Success: Creates a sense of achievement.

o Failure: Results in feelings of inferiority.

5. Identity vs. Role Confusion (Adolescence, 12–18 years):

o Focus: Developing a sense of self and personal identity.

o Success: Leads to a strong identity and direction.

o Failure: Causes confusion about future roles and identity.

6. Intimacy vs. Isolation (Young Adulthood, 18–40 years):

o Focus: Building close, meaningful relationships.

o Success: Leads to strong interpersonal bonds.

o Failure: Results in loneliness and isolation.

7. Generativity vs. Stagnation (Middle Adulthood, 40–65 years):

o Focus: Contributing to society and future generations.

o Success: Develops a sense of purpose and legacy.

o Failure: Leads to stagnation and self-absorption.

8. Integrity vs. Despair (Late Adulthood, 65+ years):

o Focus: Reflecting on life and deriving meaning.

 o Success: Brings a sense of fulfillment and wisdom.

o Failure: Leads to regret and despair.

Application in Nursing:

• Erikson's stages help nurses assess psychosocial functioning at different life stages.

• Understanding unresolved conflicts allows for targeted psychosocial interventions.

Maslow’s Hierarchy of Needs

Abraham Maslow’s model emphasizes the sequential fulfillment of human needs, starting with basic
survival needs and progressing to self-actualization. The hierarchy is visualized as a pyramid, with five
levels.

Hierarchy Levels:

1. Physiological Needs (Base):

o Basic survival needs like food, water, warmth, and rest.

o Example: Providing nutrition and hydration to patients.

2. Safety Needs:

o Security, stability, and protection from harm.

o Example: Ensuring a safe hospital environment and protecting patient confidentiality.

3. Belongingness and Love Needs:

o Social relationships, love, and a sense of belonging.

o Example: Encouraging family involvement in patient care to foster connection.

4. Esteem Needs:

o Self-respect, recognition, and a sense of achievement.

o Example: Praising patient progress and empowering them to participate in their care.

5. Self-Actualization (Top):

o Achieving personal growth, fulfilling potential, and pursuing meaning.

o Example: Helping patients set and achieve recovery goals that align with their values.

Application in Nursing:

• Guides prioritization of care: Physiological and safety needs are addressed first before
psychological and self-fulfillment needs.
 • Encourages holistic nursing care by addressing emotional, social, and spiritual aspects alongside
physical needs.

Comparison and Integration in Nursing:

• Erikson’s stages focus on psychosocial growth across the lifespan, while Maslow emphasizes a
hierarchical approach to fulfilling needs.

• Together, they provide a framework for holistic, individualized nursing care, ensuring both
developmental and situational needs are addressed.

Therapeutic Communication Techniques (Chapter

8)
Therapeutic communication involves specific strategies that encourage patients to express their
thoughts and feelings more openly. Here are detailed descriptions of key techniques:

1. Active Listening

• Description: Fully concentrating on what the patient is saying, both verbally and nonverbally.

• Components:

o Observing: Noting the patient's body language, facial expressions, and tone.

o Listening: Hearing the patient's words without interrupting.

o Responding: Providing feedback that shows understanding.

• Application: Encourages patients to share more deeply, fostering trust and rapport.

• Example: Nodding affirmatively and maintaining eye contact while a patient describes their
feelings.

2. Use of Silence

• Description: Allowing pauses in conversation without feeling the need to fill them.

• Purpose:

o Gives patients time to gather their thoughts.

o Encourages them to continue sharing at their own pace.

• Application: Particularly effective when patients are emotionally distressed or processing

complex thoughts.

• Example: Remaining quietly attentive after a patient reveals a traumatic experience, giving them
space to elaborate if they choose.
3. Clarification Techniques

These techniques help ensure that the nurse and patient fully understand each other.

• Paraphrasing:

o Definition: Restating the patient's message in your own words.

o Purpose: Shows that you are listening and validates the patient's feelings.

o Example: Patient says, "I'm so tired of everything." Nurse responds, "You're feeling
overwhelmed and exhausted."

• Restating:

o Definition: Repeating the main idea of what the patient has said.

o Purpose: Encourages the patient to continue or clarify their thoughts.

o Example: Patient says, "I just can't cope anymore." Nurse replies, "You feel like you can't
cope?"

• Reflection:

o Definition: Directing questions or feelings back to the patient to help them explore their
own thoughts.

o Purpose: Aids in self-exploration and insight.

o Example: "What do you think might help you manage these feelings?"

• Exploring:

o Definition: Delving deeper into a subject or idea.

o Purpose: Encourages the patient to elaborate.

o Example: "Can you tell me more about what happens when you feel this way?"

4. Open-Ended Questions

• Description: Questions that require more than a yes or no answer.

• Purpose: Promotes detailed responses and encourages patients to express themselves fully.

• Examples:

o "What brings you here today?"

o "How have you been feeling since we last talked?"

o "What are some things that have been on your mind lately?"

5. Focusing

• Description: Concentrating on a single point or topic.

 • Purpose: Helps patients focus on important issues and feelings that may need attention.

• Application: Useful when patients are overwhelmed or jumping from topic to topic.

• Example: "You've mentioned several concerns, but let's talk more about the anxiety you've
been experiencing."

6. Summarizing

• Description: Briefly stating the main points of a conversation.

• Purpose:

o Reinforces understanding.

o Provides closure.

o Ensures that both the nurse and patient are on the same page.

• Example: "So, today we've discussed your challenges with sleep and how it's affecting your
mood."

7. Offering Self

• Description: Making oneself available to the patient.

• Purpose: Demonstrates empathy and willingness to support.

• Example: "I'm here for you if you'd like to talk about what's troubling you."

8. Providing Information

• Description: Supplying relevant data to help patients make informed decisions.

• Purpose: Empowers patients through knowledge.

• Example: "There are support groups available that can help you connect with others facing
similar issues."

9. Seeking Clarification

• Description: Asking for further explanation when something is not understood.

• Purpose: Ensures accurate comprehension.

• Example: "I'm not sure I understand what you mean by 'feeling lost.' Could you explain that a bit
more?"

10. Encouraging Comparison

• Description: Asking patients to relate similarities and differences among feelings, behaviors, or
events.

• Purpose: Helps patients recognize patterns.

 • Example: "How does your current stress compare to what you felt last year?"

11. Validation

• Description: Recognizing and acknowledging the patient's feelings and experiences.

• Purpose: Affirms the patient's emotions, promoting self-worth.

• Example: "It sounds like you're feeling very alone right now, and that's understandable given
what you've been through."

12. Confrontation (Used Carefully)

• Description: Presenting discrepancies between what the patient says and does.

• Purpose: Encourages self-awareness.

• Application: Should be used gently and only after a trusting relationship is established.

• Example: "You say you're committed to quitting smoking, but you've mentioned having a
cigarette after lunch."

Non-Therapeutic Communication Techniques to Avoid

These can hinder the nurse-patient relationship and should be avoided:

1. Giving Premature Advice

• Issue: Imposes the nurse's solutions rather than helping the patient find their own.

• Alternative: Guide the patient to explore options themselves.

2. Minimizing Feelings

• Issue: Downplays the patient's emotions, making them feel invalidated.

• Example to Avoid: "Don't worry; everything will be fine."

• Alternative: "It sounds like this is really hard for you."

3. False Reassurance

• Issue: Offers unwarranted comfort, which may not be based on reality.

• Example to Avoid: "I'm sure you'll get better soon."

• Alternative: "What are your thoughts about your treatment plan?"

4. Making Value Judgments

• Issue: Conveys disapproval and can make the patient feel criticized.

• Example to Avoid: "You shouldn't feel that way."

• Alternative: "What leads you to feel this way?"

5. Asking "Why" Questions

• Issue: Can come across as accusatory and may make patients defensive.

• Example to Avoid: "Why did you stop taking your medication?"

• Alternative: "Can you tell me about your experience with the medication?"

6. Excessive Questioning

• Issue: Feels like an interrogation and can overwhelm the patient.

• Alternative: Balance questions with reflections and observations.

Nonverbal Communication

Understanding nonverbal cues is as important as verbal communication.

Components:

• Facial Expressions: Smiles, frowns, and eye contact convey emotions.

• Body Language: Posture, gestures, and movements can indicate comfort or distress.

• Paralanguage: Tone, pitch, and pacing of speech affect how messages are received.

• Proxemics: Personal space varies culturally; being aware of boundaries is crucial.

Application:

• Be attentive to the patient's nonverbal signals.

• Ensure your own nonverbal communication is open and non-threatening.

• Match your verbal messages with appropriate nonverbal cues.

Cultural Considerations

Cultural background influences communication styles.

• Eye Contact: In some cultures, direct eye contact is seen as disrespectful.

• Touch: Physical contact may be acceptable in some cultures and inappropriate in others.

• Personal Space: The acceptable distance between individuals varies.

• Expressions of Emotion: Some cultures encourage open expression, while others value restraint.

Application:

• Assess: Be observant and inquire respectfully about cultural preferences.

• Adapt: Modify communication styles to align with the patient's cultural norms.

• Avoid Assumptions: Treat each patient as an individual.

Establishing a Therapeutic Relationship

Effective communication is foundational to building a therapeutic nurse-patient relationship.

Steps:

1. Build Trust: Be consistent, reliable, and honest.

2. Demonstrate Empathy: Show understanding and sensitivity to the patient's feelings.

3. Maintain Professional Boundaries: Keep the relationship focused on the patient's needs.

4. Ensure Confidentiality: Protect the patient's privacy to promote openness.

5. Be Self-Aware: Reflect on your own biases and how they may affect interactions.

Barriers to Effective Communication

• Resistance: Patients may be unwilling to share due to fear or mistrust.

• Transference: Patients may project feelings about others onto the nurse.

• Countertransference: Nurses must be aware of their own emotional responses to patients.

Overcoming Barriers:

• Address concerns openly.

• Seek supervision or consultation when needed.

• Continuously develop self-awareness.

Importance in Psychiatric-Mental Health Nursing

Effective communication techniques are especially critical in psychiatric settings due to:

• Complexities of Mental Illness: Patients may have impaired thought processes.

• Emotional Vulnerability: Patients often experience intense emotions.

• Need for Trust: Therapeutic progress depends on a strong nurse-patient alliance.

• Assessment Accuracy: Gathering accurate information is essential for proper diagnosis and
treatment planning.

Practical Tips for Nurses

• Practice Mindfulness: Be present in each interaction.

• Avoid Medical Jargon: Use language the patient can understand.

• Provide Encouragement: Reinforce positive behaviors and progress.

• Be Patient: Allow patients time to express themselves without rushing.

Anxiety Disorders, Generalized Anxiety Disorder (GAD), Obsessive-

Compulsive Disorder (OCD), and Medications (Chapter 11)
Overview of Anxiety Disorders

Anxiety disorders are characterized by excessive fear and anxiety, often accompanied by behavioral
disturbances. They may result from genetic, neurobiological, environmental, and psychological factors.
These conditions are chronic and pervasive, significantly impairing daily functioning.

Generalized Anxiety Disorder (GAD)

Diagnostic Criteria

• Excessive worry about various events or activities for at least six months.

• Symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and
sleep disturbances..

Nursing Interventions

1. Therapeutic Communication:

o Engage in active listening and validate the patient’s feelings to establish trust.

o Encourage the patient to discuss their worries without judgment..

2. Behavioral Strategies:

o Teach relaxation techniques, such as deep breathing and progressive muscle relaxation.

o Introduce mindfulness practices to manage worry and promote calmness..

3. Cognitive-Behavioral Therapy (CBT):

o Assist patients in identifying and challenging irrational thoughts.

o Develop skills to reduce cognitive distortions contributing to anxiety..

4. Health Teaching:

o Educate about the importance of self-care, regular exercise, and maintaining a

structured routine.

5. Promote Medication Adherence:

o Provide education on prescribed medications, including potential side effects and

benefits.

Obsessive-Compulsive Disorder (OCD)

Diagnostic Criteria

• Obsessions: Recurrent, intrusive thoughts, urges, or images causing distress (e.g., fear of
contamination).
 • Compulsions: Repetitive behaviors or mental acts aimed at reducing anxiety (e.g., excessive
handwashing)..

Nursing Interventions

1. Supportive Environment:

o Allow patients to initially perform rituals to reduce anxiety but gradually work toward
limiting their frequency.

2. Education and CBT:

o Teach patients about the disorder and the cycle of obsessions and compulsions.

o Use exposure and response prevention techniques to manage compulsive behaviors..

3. Behavioral Strategies:

o Encourage distraction techniques and structured activities to divert attention from

obsessions.

4. Physical Care:

o Monitor for physical consequences of compulsions, such as skin damage from excessive
washing.

5. Medications:

o Educate on prescribed medications and emphasize adherence..

Medications for Anxiety Disorders and OCD

1. Selective Serotonin Reuptake Inhibitors (SSRIs):

o Commonly used for GAD and OCD.

o Examples: Sertraline, fluoxetine, escitalopram.

o Benefits: Reduces anxiety and obsessive-compulsive symptoms..

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

o Effective for GAD.

o Examples: Venlafaxine, duloxetine.

3. Buspirone:

o Non-addictive anxiolytic used for GAD.

o Advantages: Lacks sedative and dependency effects compared to benzodiazepines.

4. Benzodiazepines:
 o Short-term use for acute anxiety.

o Risks: Dependency and withdrawal symptoms; should be avoided in patients with

substance use history.

5. Clomipramine:

o Tricyclic antidepressant particularly effective for OCD.

Therapeutic Milieu and Holistic Care

1. Structure and Safety:

o Provide a predictable daily routine to reduce anxiety.

2. Team-Based Approach:

o Engage interdisciplinary teams for comprehensive care.

3. Self-Help Tools:

o Introduce smartphone apps and online resources for relaxation and coping.

Stress-Related Disorders and Adjustment Disorders (Chapter 11)

Stress-Related Disorders

Stress-related disorders, such as posttraumatic stress disorder (PTSD) and acute stress disorder, arise
from exposure to traumatic or stressful events. These disorders can impact emotional, cognitive, and
physical well-being.

1. Acute Stress Disorder (ASD):

o Symptoms occur within four weeks of a traumatic event and resolve within a month.

o Symptoms include dissociation, hypervigilance, and intrusive memories.

2. Posttraumatic Stress Disorder (PTSD):

o Develops after exposure to a life-threatening event or severe trauma.

o Symptoms include re-experiencing the trauma, avoidance of trauma-related stimuli,

hyperarousal, and mood changes.

Adjustment Disorders

Adjustment disorders are emotional or behavioral reactions to an identifiable stressor, occurring within
three months of the onset of the stressor.

1. Symptoms:
 o Emotional distress disproportionate to the severity of the stressor.

o Impairment in social or occupational functioning.

o Symptoms resolve within six months once the stressor is removed or adapted to.

2. Subtypes:

o Adjustment disorder with anxiety: Presents with nervousness, worry, and jitteriness.

o Adjustment disorder with depressed mood: Marked by sadness, hopelessness, and low
energy.

Nursing Interventions

For Stress-Related Disorders (ASD and PTSD):

1. Establish a Safe Environment:

o Create a calm, structured setting to reduce anxiety.

2. Encourage Expression:

o Facilitate open discussions about the traumatic event without forcing the patient to
disclose more than they are comfortable with.

3. Teach Stress-Reduction Techniques:

o Introduce relaxation exercises, mindfulness, and guided imagery to help manage

symptoms.

4. Supportive Counseling:

o Encourage engagement with support groups or therapy focused on trauma.

5. Medications:

o SSRIs (e.g., sertraline and paroxetine) for reducing symptoms of PTSD.

o Prazosin for managing nightmares and sleep disturbances.

For Adjustment Disorders:

1. Therapeutic Communication:

o Use active listening and empathetic responses to validate the patient’s feelings.

2. Problem-Solving Skills:

o Assist the patient in identifying stressors and developing actionable coping strategies.

3. Behavioral Techniques:
 o Encourage the development of new routines and healthy habits to restore a sense of
normalcy.

4. Cognitive-Behavioral Therapy (CBT):

o Use CBT to challenge irrational thoughts and improve adaptive coping mechanisms.

5. Psychoeducation:

o Educate patients and families about the disorder, emphasizing that it is treatable and
temporary.

Medications

1. Selective Serotonin Reuptake Inhibitors (SSRIs):

o Commonly prescribed for PTSD and adjustment disorders with anxiety or depression.

o Examples: Sertraline, fluoxetine.

2. Anxiolytics:

o Short-term use of benzodiazepines may be considered for acute anxiety symptoms but
is avoided due to dependency risks.

3. Sleep Aids:

o Prazosin for PTSD-related nightmares and trazodone for sleep disturbances.

Bipolar Disorders: Signs, Symptoms, Medications, and Nursing

Interventions (Chapter 16)
Types of Bipolar Disorders

1. Bipolar I Disorder:

o At least one manic episode, often followed or preceded by depressive episodes.

o Symptoms can include psychosis requiring hospitalization.

2. Bipolar II Disorder:

o A history of one or more depressive episodes and at least one hypomanic episode.

o Hypomania is less severe than mania and does not typically require hospitalization.

3. Cyclothymic Disorder:

o Alternating hypomanic and depressive episodes for at least two years.

o Mood variations are less severe than in Bipolar I or II.

Signs and Symptoms

Manic Episode Symptoms:

• Euphoria, heightened self-esteem, or irritability.

• Decreased need for sleep.

• Increased activity, rapid speech, and impulsive behavior.

• Risky activities like spending sprees or substance misuse..

Hypomanic Episode Symptoms:

• Similar to mania but less severe.

• Noticeable changes in mood or functioning without psychosis.

Depressive Episode Symptoms:

• Persistent sadness or hopelessness.

• Fatigue, sleep disturbances, and difficulty concentrating.

• Appetite changes and thoughts of death or suicide..

Medications

Mood Stabilizers

1. Lithium:

o First-line treatment for acute mania and maintenance.

o Requires regular serum level monitoring (therapeutic range: 0.6–1.2 me/L).

o Adverse effects: tremors, polyuria, thyroid issues, and renal dysfunction..

2. Anticonvulsants:

o Valproate: Effective for rapid-cycling and mixed episodes.

o Lamotrigine: Beneficial for bipolar depression.

o Carbamazepine: Used for acute mania; requires blood monitoring

Atypical Antipsychotics

• Examples: Olanzapine, quetiapine, and risperidone.

• Used for acute mania, bipolar depression, and as adjunct therapy

Anxiolytics:

• Clonazepam and lorazepam for acute mania with agitation

Nursing Interventions

Acute Mania:

1. Safety:

o Monitor for exhaustion and risky behaviors.

o Reduce environmental stimuli to prevent escalation..

2. Nutrition:

o Offer high-calorie finger foods for patients who struggle to sit through meals.

3. Limit Setting:

o Use consistent, neutral tone communication to address intrusive or aggressive behavior.

4. Medications:

o Administer prescribed mood stabilizers or antipsychotics promptly.

Depressive Episodes:

1. Therapeutic Communication:

o Provide emotional support and encourage verbalizing feelings.

2. Medication Adherence:

o Emphasize the importance of continuing mood stabilizers even during remission(

3. Monitor for Suicide Risk:

o Assess frequently for suicidal ideation, especially during depressive episodes

Long-Term Interventions:

1. Psychoeducation:

o Educate patients and families about early signs of relapse and medication management(

2. Community Support:

o Encourage participation in support groups like the Depression and Bipolar Support
Alliance (DBSA)

3. Relapse Prevention:

o Promote a structured lifestyle with regular sleep, exercise, and reduced stress.

Key Considerations
 • Regular monitoring of serum lithium and kidney function is essential.

• Nonadherence to treatment is common; address it empathetically.

• Collaborative care involving psychoeducation and community resources enhances outcomes

Mood Disorders: Signs, Symptoms, and Nursing Interventions

(Chapter 15)
Overview of Mood Disorders

Mood disorders are characterized by disturbances in a person’s mood that significantly impair their
ability to function. These include depressive disorders and bipolar spectrum disorders.

Major Depressive Disorder (MDD)

Signs and Symptoms:

• Emotional: Persistent sadness, hopelessness, and feelings of worthlessness.

• Physical: Changes in appetite, weight, and sleep patterns; fatigue; and psychomotor agitation or
retardation.

• Cognitive: Difficulty concentrating, indecisiveness, and recurrent thoughts of death or suicide..

Nursing Interventions:

1. Safety:

o Assess for suicide risk and provide a safe environment.

o Remove access to harmful objects.

2. Therapeutic Communication:

o Encourage expression of feelings.

o Use active listening and empathetic responses.

3. Encourage Self-Care:

o Support the patient in meeting basic needs such as eating, sleeping, and grooming.

4. Promote Engagement:

o Introduce small, manageable activities to rebuild interest and motivation.

5. Medications:
 o Administer antidepressants as prescribed (e.g., SSRIs, SNRIs, TCAs, or MAOIs).

Persistent Depressive Disorder (Dysthymia)

Signs and Symptoms:

• Chronic depressive symptoms lasting at least two years.

• Milder but more enduring than MDD, often perceived as part of one’s personality.

Nursing Interventions:

1. Therapeutic Relationship:

o Build trust and encourage the patient to identify long-term patterns of depressive
symptoms.

2. Cognitive Interventions:

o Help the patient reframe negative thoughts.

3. Behavioral Activation:

o Encourage participation in structured activities.

Medications for Mood Disorders

1. Selective Serotonin Reuptake Inhibitors (SSRIs):

o Examples: Fluoxetine, sertraline.

o Fewer side effects compared to older antidepressants.

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

o Examples: Venlafaxine, duloxetine.

o Effective for both depression and anxiety.

3. Tricyclic Antidepressants (TCAs):

o Examples: Amitriptyline, nortriptyline.

o Risk of overdose; used cautiously.

4. Monoamine Oxidase Inhibitors (MAOIs):

o Require dietary restrictions due to risk of hypertensive crisis

Interventions for All Mood Disorders

 1. Psychotherapy:

o Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are effective.

2. Electroconvulsive Therapy (ECT):

o Used for severe depression unresponsive to medication.

3. Family Support:

o Engage family in the care plan to provide additional support.

4. Lifestyle Modifications:

o Encourage regular exercise, healthy diet, and good sleep hygiene

Schizophrenia: Signs, Symptoms, Nursing Interventions, Medications,

and Electroconvulsive Therapy (ECT) (Chapter 17)
Overview of Schizophrenia

Schizophrenia is a chronic brain disorder characterized by psychotic symptoms, including delusions,

hallucinations, and disorganized thought processes. It typically emerges in late adolescence or early
adulthood and affects various aspects of cognition, mood, and behavior..

Signs and Symptoms

1. Positive Symptoms (Excessive or distorted functions):

o Hallucinations (e.g., auditory, visual).

o Delusions (e.g., paranoia, grandiosity).

o Disorganized speech and behavior.

2. Negative Symptoms (Loss of normal functions):

o Apathy and lack of motivation.

o Social withdrawal and anhedonia.

o Flat or blunted affect..

3. Cognitive Symptoms:
 o Impaired memory and attention.

o Difficulty with problem-solving and abstract thinking.

o Disorganized thought processes.

4. Mood Symptoms:

o Depression and anxiety.

o Increased risk of suicidality..

Nursing Interventions

Acute Phase

1. Ensure Safety:

o Assess for suicidal ideation or harm to others.

o Minimize environmental stimuli to reduce agitation

2. Therapeutic Communication:

o Avoid confrontation and focus on reality-based conversations.

o Provide short, clear instructions to improve understanding

3. Medication Adherence:

o Monitor and administer prescribed antipsychotics.

o Educate patients about the importance of adhering to medication regimens

Stabilization and Maintenance Phase

1. Psychoeducation:

o Teach patients and families about the nature of schizophrenia and its treatment.

o Emphasize the importance of recognizing early signs of relapse

2. Promote Social Skills:

o Encourage participation in structured activities or therapy groups.

o Build interpersonal and coping skills

3. Community Support:

o Connect patients with outpatient services, peer support groups, and vocational
programs..
Medications

1. First-Generation Antipsychotics (FGAs):

o Examples: Haloperidol, chlorpromazine.

o Effective for positive symptoms but associated with extrapyramidal side effects (EPS),
such as dystonia and tardive dyskinesia..

2. Second-Generation Antipsychotics (SGAs):

o Examples: Risperidone, olanzapine, quetiapine.

o Address both positive and negative symptoms with fewer EPS but may cause metabolic
side effects (e.g., weight gain, diabetes)..

3. Other Medications:

o Mood Stabilizers: For schizoaffective disorder or mood symptoms.

o Anxiolytics: To manage agitation.

Electroconvulsive Therapy (ECT)

• Indications:

o Severe cases with catatonia or treatment-resistant schizophrenia.

o When rapid symptom relief is necessary.

• Procedure:

o Conducted under general anesthesia.

o Involves electrical stimulation to induce brief seizures, leading to changes in brain

chemistry..

• Nursing Role:

o Ensure informed consent and provide patient education.

o Monitor for adverse effects such as confusion, headache, or memory loss..

Key Considerations

• Schizophrenia requires a multidisciplinary approach, combining medication, psychosocial

therapy, and community support.

• Early intervention improves outcomes, reduces relapse, and enhances quality of life
Personality Disorders and Nursing Interventions (Chapter 13)
Overview of Personality Disorders (PDs)

Personality disorders are enduring patterns of inner experience and behavior deviating markedly from
the expectations of an individual's culture. These patterns are inflexible and pervasive, leading to
significant distress or impairment in functioning.

Types of Personality Disorders

PDs are classified into three clusters based on similar characteristics:

1. Cluster A (Odd or Eccentric) Disorders:

o Paranoid PD: Distrust and suspicion of others.

o Schizoid PD: Detachment from social relationships and restricted emotional expression.

o Schizotypal PD: Acute discomfort in relationships, cognitive or perceptual distortions.

2. Cluster B (Dramatic, Emotional, or Erratic) Disorders:

o Antisocial PD: Disregard for others' rights, lack of remorse.

o Borderline PD: Instability in relationships, self-image, and emotions.

o Histrionic PD: Excessive emotionality and attention-seeking.

o Narcissistic PD: Grandiosity, need for admiration, lack of empathy..

3. Cluster C (Anxious or Fearful) Disorders:

o Avoidant PD: Social inhibition, feelings of inadequacy.

o Dependent PD: Excessive need to be taken care of, submissive behavior.

o Obsessive-Compulsive PD: Preoccupation with orderliness, perfectionism.

Signs and Symptoms

• Emotional Dysregulation: Intense and inappropriate emotional responses.

• Interpersonal Challenges: Difficulty forming and maintaining relationships.

• Cognitive Distortions: Perceptions of events and people are often distorted.

• Impulsivity: Risky or self-damaging behaviors..

Nursing Interventions

General Approaches:

1. Establishing Safety:

o Assess for suicidal, self-harm, or homicidal thoughts.

o Provide a safe environment to reduce triggers for harmful behaviors..

2. Therapeutic Communication:

o Use active listening and empathetic responses.

o Avoid engaging in manipulation or responding emotionally to challenging behaviors..

3. Consistent Limit-Setting:

o Define and enforce boundaries to address manipulative or impulsive behaviors.

o Use clear, matter-of-fact communication to de-escalate emotional outbursts..

4. Promoting Emotional Regulation:

o Teach patients to identify and manage triggers.

o Encourage the use of coping skills like mindfulness and relaxation techniques.

Specific Interventions for Borderline PD:

• Dialectical Behavior Therapy (DBT):

o Focuses on improving emotional regulation, distress tolerance, and interpersonal

effectiveness..

• Safety Planning:

o Develop strategies to handle crises, including recognizing triggers and seeking support.

Interventions for Antisocial PD:

• Behavioral Approaches:

o Reinforce positive behaviors through rewards and consequences.

• Education on Social Norms:

o Help patients understand the impact of their behavior on others.

Interventions for Cluster C Disorders:

• Building Self-Esteem:

o Use supportive therapy to help patients gain confidence in decision-making.

• Encouraging Gradual Exposure:

 o Assist avoidant patients in gradually engaging in social situations.

Therapeutic Techniques

• Cognitive-Behavioral Therapy (CBT):

o Helps patients recognize and change maladaptive thought patterns.

• Group Therapy:

o Provides opportunities to practice social skills in a controlled environment..

Key Considerations

• Medication: While not a primary treatment for PDs, medications may address co-occurring
conditions such as depression or anxiety.

• Caregiver Support: Provide training to staff to manage challenging behaviors effectively and
prevent burnout.

By combining structured interventions, emotional support, and tailored therapies, nurses can
significantly enhance outcomes for patients with personality disorders

Eating Disorders: Overview, Signs, Symptoms, and Nursing

Interventions (Chapter 14)
Overview of Eating Disorders

Eating disorders are severe psychiatric illnesses that significantly affect physical health, emotional well-
being, and social functioning. They are characterized by disordered eating behaviors, distorted body
image, and preoccupations with food, weight, and shape.

Types of Eating Disorders

1. Anorexia Nervosa (AN):

o Intense fear of gaining weight or becoming fat.

o Persistent behavior to prevent weight gain, leading to significantly low body weight.

o Distorted perception of body weight or shape.

2. Bulimia Nervosa (BN):

o Recurrent episodes of binge eating followed by compensatory behaviors (e.g., vomiting,

laxative misuse, excessive exercise) to avoid weight gain.

o Often associated with a normal or slightly above-normal weight.

 3. Binge-Eating Disorder (BED):

o Repeated episodes of consuming large quantities of food in a short period without

compensatory behaviors.

o Often leads to obesity and related comorbidities.

Signs and Symptoms

Anorexia Nervosa:

• Emotional: Preoccupation with food and weight, fear of weight gain.

• Physical: Extreme weight loss, cold intolerance, lanugo (fine body hair), brittle hair and nails.

• Behavioral: Ritualistic eating patterns, refusal to eat in front of others, excessive exercise.

Bulimia Nervosa:

• Emotional: Feelings of guilt, shame, or distress after binge episodes.

• Physical: Erosion of tooth enamel, swollen parotid glands, electrolyte imbalances, calluses on
knuckles (from induced vomiting).

• Behavioral: Secretive eating, frequent bathroom trips after meals, hoarding food.

Binge-Eating Disorder:

• Emotional: Guilt and distress about overeating, feelings of loss of control.

• Physical: Weight gain, increased risk of diabetes, hypertension, and cardiovascular disease.

• Behavioral: Eating in secret, consuming food rapidly, eating when not hungry.

Nursing Interventions

General Nursing Interventions for All Eating Disorders

1. Establish a Therapeutic Relationship:

o Build trust through empathy, active listening, and nonjudgmental communication.

o Validate the patient's feelings and struggles with eating and body image.

2. Monitor Physical Health:

o Regularly check weight, vital signs, and laboratory values to monitor for complications
such as electrolyte imbalances or cardiac issues.

o Prevent refeeding syndrome by gradually reintroducing nutrition for patients with

anorexia nervosa.
 3. Promote Healthy Eating Habits:

o Collaborate with dietitians to create individualized meal plans.

o Encourage balanced meals to address nutritional deficiencies.

4. Address Underlying Psychological Issues:

o Explore underlying factors contributing to disorder eating, such as low self-esteem or

past trauma.

5. Educate and Support Families:

o Provide psychoeducation about eating disorders and treatment approaches.

o Involve family members in therapy when appropriate.

Specific Interventions for Anorexia Nervosa

1. Encourage Weight Gain:

o Set realistic weekly weight goals to restore physical health.

o Avoid power struggles about food to reduce resistance.

2. Supervise Meals:

o Monitor eating behaviors during and after meals to prevent avoidance or compensatory
behaviors.

3. Promote Self-Esteem:

o Use positive reinforcement for healthy behaviors and self-acceptance.

Specific Interventions for Bulimia Nervosa

1. Monitor After Meals:

o Observe the patient for one to two hours post-meal to prevent purging behaviors.

2. Focus on Coping Skills:

o Teach alternative strategies to manage emotions, such as journaling or mindfulness.

3. Encourage Therapy Participation:

o Facilitate engagement in cognitive-behavioral therapy (CBT) to address thought patterns

related to bingeing and purging.

Specific Interventions for Binge-Eating Disorder

 1. Promote Emotional Regulation:

o Encourage the use of healthy coping mechanisms to address triggers for binge eating.

2. Support Weight Management:

o Provide guidance on portion control and physical activity to achieve a healthy weight.

3. Address Emotional Triggers:

o Explore emotional factors that lead to overeating, such as stress or loneliness.

Psychotherapy

1. Cognitive-Behavioral Therapy (CBT):

o Targets maladaptive thoughts and behaviors around food and body image.

o Effective for bulimia nervosa and binge-eating disorder.

2. Dialectical Behavior Therapy (DBT):

o Helps patients with emotional dysregulation, often seen in eating disorders.

3. Family-Based Therapy (FBT):

o Especially effective for adolescents with anorexia nervosa.

Medications

1. Selective Serotonin Reuptake Inhibitors (SSRIs):

o Fluoxetine: FDA-approved for bulimia nervosa to reduce binge-purge episodes.

o Used to treat underlying depression or anxiety.

2. Other Medications:

o Lisdexamfetamine (Vyvanse): Approved for binge-eating disorder to reduce the

frequency of binge episodes.

Multidisciplinary Approach

1. Dietitians: Provide nutritional counseling and meal planning.

2. Therapists: Address psychological aspects of eating disorders.

3. Medical Team: Manage physical complications and comorbidities.

Substance Use Disorders: Overview, Potential Complications, Nursing
Interventions, and Antidotes (Chapter 19)
Overview

Substance Use Disorders (SUDs) involve a pathological pattern of behaviors related to the use of drugs
or alcohol. Addiction is considered a chronic, relapsing brain disease characterized by compulsive drug-
seeking behavior despite harmful consequences.

Potential Complications

1. Physical Health Issues:

o Respiratory depression (opioids).

o Liver damage (alcohol).

o Cardiovascular issues (stimulants).

o Seizures during withdrawal..

2. Psychiatric Complications:

o Depression and anxiety.

o Increased risk of suicide.

o Cognitive impairments.

3. Social and Legal Problems:

o Family conflict.

o Legal issues due to possession or theft.

o Job loss and financial instability..

4. Overdose Risks:

o Life-threatening respiratory depression (opioids, sedatives).

o Cardiac arrhythmias (cocaine).

o Coma and death.

Nursing Interventions

Assessment:

1. Gather a detailed history of substance use:

 o Type, frequency, quantity, and last use.

o Past withdrawal symptoms, including seizures or delirium.

2. Conduct physical and mental status examinations:

o Assess for symptoms of intoxication or withdrawal.

o Perform lab tests (e.g., blood alcohol concentration, toxicology screen).

Acute Care:

1. Ensure Safety:

o Create a safe, quiet environment for patients in withdrawal.

o Use restraints only if necessary to prevent self-harm or harm to others..

2. Manage Withdrawal Symptoms:

o Administer medications to reduce withdrawal effects (e.g., benzodiazepines for alcohol

withdrawal, methadone or buprenorphine for opioid withdrawal).

3. Hydration and Nutrition:

o Treat dehydration with IV fluids.

o Address malnutrition with a high-calorie, nutrient-rich diet.

Long-Term Care:

1. Relapse Prevention:

o Teach coping strategies and identify triggers.

o Promote attendance at support groups such as Alcoholics Anonymous (AA) or Narcotics

Anonymous (NA)..

2. Education:

o Inform patients about the effects of substance use on physical and mental health.

o Instruct on the importance of adherence to prescribed treatments.

3. Support Systems:

o Involve family in treatment planning.

o Connect patients with social services for legal or housing support.

Medications and Antidotes

1. Alcohol Use Disorder:

 o Disulfiram: Creates an aversive reaction to alcohol.

o Acamprosate: Reduces cravings.

o Benzodiazepines: Used during withdrawal to prevent seizures.

2. Opioid Use Disorder:

o Naloxone (Narcan): Reverses opioid overdose effects.

o Methadone: Maintenance therapy to reduce withdrawal symptoms.

o Buprenorphine: Partial agonist to manage withdrawal and maintenance.

3. Stimulant Use Disorder:

o No specific antidote; treatment focuses on symptom management (e.g.,

benzodiazepines for agitation, antipsychotics for hallucinations).

4. Sedative/Hypnotic Use Disorder:

o Flumazenil: Antidote for benzodiazepine overdose.

Electroconvulsive Therapy (ECT)

ECT is not commonly used for substance use disorders but may be considered for coexisting severe
psychiatric conditions, such as treatment-resistant depression.

Key Considerations

• Nonjudgmental Care: Treat patients with respect to reduce stigma and promote engagement in
treatment.

• Relapse is Common: Frame relapse as a learning opportunity rather than a failure.

• Culturally Competent Care: Tailor interventions to align with the patient’s cultural and social
context.

Suicide: Overview, Risk Factors, and Nursing Interventions (Chapter

23)
Overview
Suicide is the intentional act of taking one’s own life. It often stems from mental health disorders,
substance use, or overwhelming life stressors. Recognizing warning signs and implementing effective
interventions are crucial for prevention.

Risk Factors for Suicide

1. Demographic Factors:

o High-risk groups include adolescents, older adults, white males, Native Americans, and
Alaskan Natives.

2. Psychological Factors:

o Depression, anxiety, psychosis, or history of trauma.

o Feelings of hopelessness, isolation, or burdensomeness.

3. Environmental Factors:

o Stressful life events (e.g., financial loss, relationship issues).

o Access to lethal means, including firearms or medications.

4. Medical Factors:

o Chronic illness, pain, or disability.

o History of traumatic brain injury (TBI).

5. Behavioral and Historical Factors:

o Prior suicide attempts.

o Family history of suicide..

Assessment of Suicide Risk

1. Verbal Cues:

o Overt: Direct statements such as “I want to die.”

o Covert: Indirect statements like “I can’t go on.”

2. Behavioral Clues:

o Increased withdrawal, giving away possessions, or a sudden sense of calm after turmoil.

3. Risk Level Evaluation:

o Use tools like the Modified SAD PERSONS Scale or Suicide Assessment Five-Step
Evaluation and Triage (SAFE-T) to identify risk.
Nursing Interventions

Immediate (Crisis) Interventions:

1. Ensure Safety:

o Conduct a thorough environmental risk assessment to remove access to lethal means.

o Monitor patients at risk closely, possibly implementing one-to-one supervision.

2. Crisis Communication:

o Use a calm, nonjudgmental approach.

o Convey messages like:

▪ “This crisis is temporary.”

▪ “Unbearable pain can be survived.”

3. Safety Planning:

o Develop a safety plan with the patient, including coping strategies and emergency
contacts.

4. Hospitalization:

o Admit patients with active suicidal ideation and plans to a safe, structured environment.
.

Ongoing Care (Post-Crisis) Interventions:

1. Therapy and Counseling:

o Engage patients in cognitive-behavioral therapy (CBT) to address negative thought

patterns.

o Explore interpersonal therapy to resolve relationship issues contributing to distress.

2. Support Systems:

o Encourage the involvement of family and friends to provide a safety net.

o Connect patients to community resources such as hotlines or support groups.

3. Education and Follow-Up:

o Provide education on coping strategies and stress management.

o Schedule regular follow-ups to assess progress and address any recurrent thoughts of
self-harm.
Posttension for Survivors:

1. Support for Family and Friends:

o Offer grief counseling to address feelings of guilt, anger, or confusion.

o Facilitate support groups for survivors of suicide loss.

2. Staff Debriefing:

o Conduct postmortem reviews to process the emotional impact on healthcare providers.

o Use these reviews to identify areas for improving suicide prevention measures..

Key Takeaways

• Suicide prevention requires a multidisciplinary approach involving mental health professionals,

families, and community resources.

• Early identification of risk factors and open communication are critical to saving lives.

• Post-crisis interventions and posttension strategies provide long-term support to reduce the risk
of recurrence and aid recovery.

Anger and Violence: Nursing Management and Restraints (Chapter 24)

Anger, Aggression, and Violence

Anger is a normal human emotion that varies in intensity, while aggression refers to behaviors aimed at
harming others. Violence, however, is the expression of anger with the intent to cause physical harm..

Nursing Management of Anger and Violence

Assessment:

1. Identify Predictive Factors:

o Hyperactivity, clenched fists, verbal abuse, intense eye contact, or avoiding eye contact
are signs of potential violence..

o Assess for recent acts of violence, paranoid ideation, and intoxication.

2. Understand Triggers:

o Explore the patient's history of violence, current stressors, and coping mechanisms..

3. Environmental Assessment:
 o Consider milieu characteristics that can increase the risk of violence, such as
overcrowding, loud noise, or inconsistency in staff behavior..

Intervention Strategies:

1. De-escalation Techniques:

o Maintain a calm and nonthreatening demeanor.

o Use a soft, calm voice to encourage discussion and defuse tension.

o Provide clear, concrete communication and set limits respectfully..

2. Safety Measures:

o Ensure the safety of all individuals by removing potentially harmful objects and using
protective measures.

o Have a team approach ready in case physical intervention becomes necessary.

3. Distraction and Comfort:

o Offer distractions like games, magazines, or calming activities to reduce stress.

o Provide comfort items and reassurance to build rapport.

4. Post-Incident Support:

o Conduct a debriefing with staff and patients after any violent episode.

o Evaluate interventions to identify areas for improvement.

Use of Restraints and Seclusion

When to Use Restraints or Seclusion:

1. Criteria for Use:

o Applied only when the patient poses an imminent risk of harm to self or others..

o Other interventions, such as verbal techniques or medications, must be attempted first.

2. Types of Restraints:

o Physical Restraints: Devices that restrict movement.

o Chemical Restraints: Medications used to calm the patient.

Legal and Ethical Considerations:

• Restraints and seclusion must adhere to federal and state guidelines and require a physician's
order.
 • Patients must be closely monitored, and their safety ensured during and after restraint use(

Documentation Requirements:

1. Record of Events:

o Behavior leading to restraint or seclusion.

o Nursing interventions attempted before application

2. Monitoring:

o Document patient’s physical and emotional condition every 15-30 minutes.

o Include food, toileting, and safety checks

3. Debriefing:

o Include post-incident evaluations and reintegration plans for the patient

Long-Term Goals

1. Reduce Violent Behaviors:

o Encourage assertive communication and constructive problem-solving.

o Help patients recognize triggers and manage emotions effectively.

2. Team Collaboration:

o Train staff in crisis prevention and intervention techniques

By integrating de-escalation techniques, careful assessment, and evidence-based interventions, nurses

can effectively manage patients with anger and violent behaviors while ensuring safety for all involved.

Crisis Management: Overview, Phases, and Nursing Interventions

(Chapter 20)
Overview of Crisis

A crisis is defined as a disturbance caused by a stressful event or perceived threat that disrupts the
individual's normal functioning. It can result from developmental milestones, situational stressors, or
external disasters. Crisis resolution typically occurs within 4 to 6 weeks, and successful intervention can
lead to personal growth.

Types of Crises

1. Developmental Crises:

o Arise from normal life transitions (e.g., marriage, childbirth, retirement).

 o May involve difficulty adjusting to new roles and responsibilities.

2. Situational Crises:

o Caused by external events such as job loss, illness, or divorce.

o Often unexpected and sudden.

3. Adventitious Crises:

o Result from extraordinary, unplanned events such as natural disasters, violence, or

pandemics.

o Have widespread impacts on communities and individuals.

Phases of a Crisis

1. Phase 1:

o Increased anxiety due to a conflict or problem threatening self-concept.

o Individuals use defense mechanisms and problem-solving techniques.

2. Phase 2:

o Failure of usual coping mechanisms.

o Increased discomfort and trial-and-error attempts to resolve the issue

3. Phase 3:

o Continued inability to resolve the crisis, leading to severe anxiety or panic.

o May involve withdrawal, flight, or compromise.

4. Phase 4:

o Anxiety overwhelms the individual, causing disorganization, depression, violence, or

suicidal behavior

Nursing Interventions

Assessment:

1. Evaluate:

o The patient’s perception of the event.

o Available support systems.

o Coping skills used previously and currently.

 2. Ensure:

o Immediate safety and assess for risks of self-harm or violence.

Primary Nursing Interventions

• Aim to promote mental health and prevent crises.

• Strategies include:

o Identifying potential stressors.

o Teaching coping skills (e.g., decision-making, relaxation techniques).

o Planning life changes to minimize stress.

Secondary Nursing Interventions

• Focus on acute crisis resolution to prevent long-term damage.

• Actions include:

o Ensuring safety and stabilization.

o Assisting the patient in identifying the problem and developing goals.

o Providing emotional support and connecting with support systems.

Tertiary Nursing Interventions

• Provide ongoing support for recovery.

• Facilitate reintegration into normal functioning through:

o Rehabilitation centers.

o Day hospitals or outpatient programs.

o Structured environments to prevent recurrence

Critical Incident Stress Debriefing (CISD)

A specialized tertiary intervention designed for individuals or groups exposed to traumatic events, such
as natural disasters or violent incidents. The seven-phase process includes:

1. Introductory Phase: Explain purpose and establish confidentiality.

2. Fact Phase: Discuss the facts of the event.

 3. Thought Phase: Share initial thoughts and reactions.

4. Reaction Phase: Explore emotional responses.

5. Symptom Phase: Identify ongoing physical and emotional effects.

6. Teaching Phase: Provide education on coping and stress management.

7. Reentry Phase: Summarize the experience and provide resources for further support

Neurocognitive Disorders: Signs, Symptoms, and Nursing

Interventions (Chapter 18)
Overview of Neurocognitive Disorders (NCDs)

Neurocognitive disorders (NCDs) encompass a range of conditions involving cognitive impairments

caused by brain dysfunction. They are divided into three categories:

1. Delirium: Acute, fluctuating, and often reversible cognitive disturbance.

2. Mild Neurocognitive Disorder: Gradual decline in cognitive abilities that does not severely affect
daily life.

3. Major Neurocognitive Disorder (Dementia): Significant cognitive decline that interferes with
independence..

Signs and Symptoms

Delirium:

1. Cognitive Disturbances:

o Impaired memory, disorganized thinking, and poor attention.

2. Perceptual Changes:

o Hallucinations, illusions, and misinterpretations of the environment.

3. Behavioral Changes:

o Restlessness, agitation, or lethargy.

4. Acute Onset:

o Rapid onset, often fluctuating during the day.

5. Underlying Causes:

o Medical conditions, infections, substance use, or medication side effects

Mild Neurocognitive Disorder:

 1. Cognitive Decline:

o Difficulty with tasks requiring complex planning or memory recall.

2. Preservation of Independence:

o Individuals can perform most daily activities independently.

Major Neurocognitive Disorder (Dementia):

1. Memory Impairment:

o Difficulty recalling recent events, names, or instructions.

2. Impairment in Executive Functioning:

o Trouble with decision-making, planning, and organizing.

3. Behavioral Symptoms:

o Wandering, agitation, and aggression in later stages.

4. Progression:

o Gradual worsening over time, leading to loss of independence.

Nursing Interventions

General Interventions for Neurocognitive Disorders:

1. Establish Safety:

o Reduce environmental hazards to prevent falls or injuries.

o Use bed alarms or monitoring systems for patients at risk of wandering..

2. Provide Orientation Support:

o Use clocks, calendars, and personal items to help with orientation.

o Reorient patients as needed, but avoid arguing about their perceptions.

3. Encourage Cognitive Stimulation:

o Provide activities that stimulate memory and cognitive function, such as puzzles, music
therapy, or reminiscing.

4. Promote Routine and Consistency:

o Maintain a consistent daily schedule and assign consistent caregivers to reduce

confusion and anxiety.
Specific Interventions for Delirium:

1. Identify and Address Underlying Causes:

o Treat infections, correct dehydration, and adjust medications that may cause delirium.

2. Minimize Sensory Overload:

o Provide a quiet, well-lit environment.

o Reduce unnecessary stimuli, such as loud noises or frequent staff changes.

3. Monitor for Fluctuating Symptoms:

o Observe for worsening confusion or agitation during different times of the day (e.g.,
"sun downing").

Specific Interventions for Dementia:

1. Support for Activities of Daily Living (ADLs):

o Assist with dressing, bathing, and grooming as needed while promoting as much
independence as possible..

2. Manage Behavioral Symptoms:

o Use validation techniques to acknowledge patients' emotions and redirect agitation.

3. Provide Family Education:

o Educate caregivers on managing symptoms and accessing community resources.

Pharmacological Interventions:

1. Cholinesterase Inhibitors:

o Examples: Donepezil, rivastigmine.

o Purpose: Slow cognitive decline in early stages of dementia.

2. NMDA Receptor Antagonists:

o Example: Memantine.

o Purpose: Manage symptoms of moderate to severe dementia.

3. Antipsychotics:

o Used cautiously for agitation or psychosis in dementia, but with close monitoring for
side effects.

Key Outcomes:
• Safety: Prevention of falls, injuries, and other complications.

• Cognitive Maintenance: Stabilization of memory and problem-solving abilities as much as

possible.

• Improved Quality of Life: Enhancing daily living activities and emotional well-being for both
patients and caregivers.