Mental Health Nursing I

NURS 1300

Unit V
Mental Health Alterations
 Objective 1
Describe the mood disorders
 Mood disorder = a condition in which the
prevailing emotional mood is distorted or
inappropriate to the circumstances
 Types of mood disorder
 major depression
 bipolar disorder
 alternation between significantly depressed
mood and significantly elevated mood (mania)
over time
 Mood disorders may present with
psychotic symptoms
 Objective 2
Describe the nursing interventions and
medical treatment for clients with a
mood disorder

See Objective 11 for medications for

mood disorders
 Objective 2 (cont’d)

Electroconvulsive therapy (ECT)

 may be indicated for clients with severe

depression that does not respond to other
treatment

 acts more quickly than medications, and

may produce fewer side effects in older
clients
 Objective 2 (cont’d)
Nursing diagnoses for clients with a mood
disorder –
 Risk for self-directed violence R/T
suicidal feelings
 Risk for violence directed toward others
R/T homicidal ideation
 Low-self esteem R/T depression

 Imbalanced nutrition, less than body

requirements R/T lack of interest in food
 Disturbed sleep pattern R/T depression
 Objective 3
Describe characteristics of an
individual with suicide potential
 Females attempt suicide 2-3 times
more often than males
 Males are 4 times more likely to
complete a suicide
 Suicide by firearm is the most common
method of suicide for both men and
women
 Risk of suicide is higher for people with
psychiatric conditions
 Objective 3 (cont’d)

Specific high-risk populations include –

 previous suicide attempt

 family history of suicide

 suicide of a loved one, friend, co-

worker, colleague, or role model
 suicide pacts
 anniversary dates

 ANYONE THREATENING SUICIDE

 Objective 4
State common age groups for suicide
 Adolescents
 leading cause of death for people ages 13-
18
 considered a solution to an environmental
or psychological problem
 experience hostility toward themselves

 seek revenge on others by hurting

themselves
 Objective 4 (cont’d)
 Elderly
 Caucasian males over the age of 70 have
the highest rate of suicide
 fewer attempts, but more completed
 methods more lethal
 decreased ability to survive attempt

 planned instead of impulsive

 bereavement
 real or perceived losses

 often occur through covert measures

 self-inflicted falls
 refusing to eat or take medications
 Objective 5
Define personality disorders
 A personality disorder is a pattern of
perceiving, reacting, and relating to
other people and events that is relatively
inflexible and that impairs a person’s
ability to function socially
 Personality traits become rigid and
dysfunctional
 Personality disorders are chronic and
maladaptive, impacting all aspects of
one’s life
 Objective 6
Describe the types of personality
disorders
 Grouped into three clusters according to
the traits that describe them
 Cluster A traits are behaviors considered
odd or eccentric
 Cluster B traits consist of dramatic,
emotional, and erratic behaviors
 Cluster C traits include behaviors that are
anxious or fearful
 Cluster A disorders
 Paranoid personality disorder
 Schizoid personality disorder
 Schizotypal personality disorder
 Cluster B disorders
 Antisocial personality disorder
 Borderline personality disorder
 Histrionic personality disorder
 Narcissistic personality disorder
 Cluster C disorders
 Avoidant personality disorder
 Dependent personality disorder
 Obsessive-Compulsive personality disorder
 Objective 7
Identify the nursing interventions and
medical treatments for personality
disorders
Medical Interventions –
 psychotherapy

 group therapy

 behavior modification

 medications
 anxiety
 depression
 Objective 7 (cont’d)

Nursing diagnoses –
 Ineffective coping R/T personality
disorder AEB reliance on maladaptive
defense mechanisms
 Risk for self-harm R/T unresolved fear of
abandonment AEB attention-seeking
behaviors and threats against self
 Depression R/T self-directed anger AEB
social withdrawal and isolation
 Objective 8
Describe behaviors of the
schizophrenic client and identify
causes of schizophrenia

Schizophrenia refers to a group of very

serious, usually chronic, thought
disorders in which the affected person’s
ability to interpret the world accurately
is impaired by psychotic symptoms
 Behaviors of schizophrenia

 Disordered thinking
 Unusual speech
 Apathetic personality
 Changing behaviors
 Social isolation and withdrawal
 Distorted perceptions of reality
 Etiology of schizophrenia

 The cause of schizophrenia is unknown

 Individuals may be genetically vulnerable

to developing schizophrenia

 Influencing factors may include

environmental exposure to anything that
interrupts brain development
 Objective 9
Differentiate the types of
schizophrenia

 Catatonic type
 prominent psychomotor disturbances
 stupor
 waxy flexibility

 Disorganized type
 disordered thoughts
 flat affect
 Types of schizophrenia (cont’d)
 Paranoid type
 delusions
 hallucinations

 Residual type
 low intensity of symptoms

 Undifferentiated type
 presence of symptoms from more than one
subtype of schizophrenia
 Objective 10
Discuss the medical treatment and
nursing interventions for the
schizophrenic client
 Medical treatment for the client with
schizophrenia involves therapy modalities
and antipsychotic medication
 Therapies include psychotherapy, family
education, and community support
 Hospitalization is often required to treat
severe delusions, hallucinations, or self-
care deficits
 Nursing diagnoses for schizophrenia
 Disturbed thought processes R/T
delusions/concrete thinking/paranoia AEB
bizarre statements and behaviors
 Disturbed sensory perception R/T
hallucinations/illusions AEB inability to tolerate
group therapy, talking to self, or looking for or
at something that is not there
 Impaired verbal communication R/T delayed
thinking AEB very slow and delayed speech
 Self-care deficit R/T withdrawal and loss of
motivation and judgment AEB poor hygiene,
poor grooming, and avoiding others
 Nursing assessment and interventions
for a client with schizophrenia
Refer to assigned readings for complete nursing
assessment of the schizophrenic client

Nursing interventions –
 use nonconfrontational speech and mannerisms
 encourage communication and expression of
feelings and fears
 decrease stimuli and offer quiet activity
 seek clarification of statements
 provide recognition for constructive self-care
activities
 make adjustments in food preparation and
service for patients with paranoia
 Objective 11
Identify classifications, uses, actions,
and side effects for selected
classifications of psychoactive
medications as they relate to the
above mental health alterations

Refer to Psychoactive Medications handout