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211 Class Notes 08 29 2024
Health Care Concepts II (NSG 211)
Germanna Community College
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Mood and Affect Inego vs super ego: Inego: is me and my Super ego: judgy (concious) Ego=balance Defense mechanisms: Rationalization Personalization Projection Serotonin and norepinephrine - anxiety disorders ● Serotonin syndrome Dopamine neurotransmitter is for schizophrenia Anxiety-Gaba neurotransmitter ***Know Buspirone (Buspar) for anxiety and people with substance abuse -takes about 2 weeks to work -not habit forming Hydroxyzine Lithium Benzodiazepines: DEADLY IN WITHDRAWAL AND OVERDOSE, cause physical dependence -don't take with alcohol -lorazepam -Diazepam Clonidine (Catapres)- it lowers blood pressure and HR helps with anxiety -addiction -ADHD -anxiety -can't give with low BP or low HR What is reason we don't talk about ourselves in a mental health conversation: -it makes it about us and makes the patient feel like it isn't about them and has made the relationship personal Don't ask why questions Don't give false reassurance Dont approve or disapprove
Belittling feelings Panic disorders have panic attacks Personality disorders: ● Personalities that are very rigid Cluster A: odd or eccentric behaviors ● Paranoid personality disorder (paranoid) ● Schizoid personality disorder (hermit) ● Schizotypal personality disorder (odd or eccentric) Cluster B: emotional and dramatic ● Antisocial personality disorder (“you exist for me”) -no regard for other people ● Borderline Personality Disorder (“i love you/ i hate you”) -most negative stigma and gets most hate ● Histrionic personality Disorder(“look at me”) - Makes everything about them ● Narcissistic personality Disorder (“i'm better than you”) - I feel bad about myself anything that damages ego they go after others Cluster C: anxious-anxiety disorder ● Avoidant personality disorder (“they'll laugh at me”) -avoidance out of fear ● Obsessive Compulsive personality disorder (not OCD) -perfectionist -NO compulsions or obssesion -there are no obsession or compulsions ● Dependent Personality Disorder (Needy) -persuasive, excessive, unrealistic need to be cared for -separation anxiety fear of being left alone **KNOW TREATMENT Bipolar is major depressive and mania or hypomania, this is NOT borderline personality disorder Clear and consistent roles One staff contact Frequent staff meeting Manipulation for something: -regular staff meeting -clear consistent rules and boundaries -one staff person Anxiety -Mild anxiety is the only GOOD anxiety
-can happen with a compulsion With anxiety: -HR goes up -Jittery -Sweating Generalized anxiety disorder: -side effects last longer than 6 months -impacts daily roles Anxiety meds: Benzodiazepines: Ativan (lorazepam) for severe and panic Buspirone Wellbutrin Obsession: intrusive thought -germs Compulsions: behavioral (action) -washing hands -flipping light switch -locking the door multiple times Personality disorder does not have compulsions or obsession, its PERFECTIONISTIC Depressive Disorder: Epidemiology: ● Gender: -more prevalent in women that man ● Age: -gender difference less pronounced between ages 44 and 65 ● Social class: -there is an inverse relationship between social class and report of depressive symptoms ● Race: -no consistent relationship between race and affective disorder has been reported ● Marital status: -single and divorced people ● Seasonality: -more prevalent in spring and fall -leading cause of disability in the united states ● Children and adolescents ● Older adults -Comorbidity
● Combination of anxiety and depression is perhaps one of the most common ● Most often see a anxiety disorder ● Major depressive disorder: ● Others: - Disruptive mood dysregulation disorder - Persistent depressive disorder (previously dysthymia) - Premenstrual dysphoric disorder - Substance / medication induced depressive disorder - Depressive disorder due to another medical condition ● All share symptoms of: - Sadness, emptiness, irritability, somatic (body) concerns, and impairment of thinking Major depressive disorder DSM criteria: ● Five for more of the in 2-week period:
- Weight and appetite changes
- Sleep disturbance
- Fatigue
- Worthlessness or guilt
- Loss of ability to concentrate
- Recurrent thoughts of death
- Psychomotor agitation (inability to sit still) ● Plus at least one symptoms is also either:
- Depressed mood or loss of interest or pleasure (anhedonia / loss of joy) ● Persistent: minimum 2 weeks to 6 months ● Chronic: lasting more than 2 years ● Recurrent episodes common ● Symptoms cause distress or impaired function ● Episode not attributed to physiological effects ● Absence of a manic or hypomanic episode ● May include catatonic (vegetative state, very still person ) or psychotic features (hallucinations. Disruptive mood Dysregulation Disorder: ● Diagnosed in children ages 6 to 18 ● Symptoms:
- Constant and severe irritability and anger
- Temper tantrums out of proportion to the situation at least 3 times per week
- Exhibits symptoms in at least two settings: home, school, and with peers ● Management: -symptomcatic medication: CT and parent training, and facial depression recognition training Persistent Depressive Disorder:
Risk Factors: ● Biological factors -genetic (first degree family members) -Biochemical (stressful life events) ● Hormonal ● Inflammatory ● Diathesis-stress model - Interplay between genetic and biological ● Female gender ● Adverse childhood experiences ● Other disorders, such as substance abuse use, anxiety, and personality disorders ● Chronic or disabling conditions Genetic Considerations and Nonmodifiable Risk factors: ● Neurobiology - Prefrontal cortex subject of research - Ventricular enlargement - Neurotransmission hypothesis *deficiency of norepinephrine, serotonin, and dopamine has been implicated *excessive cholinergic transmission may be a factor ● Neuroendocrine disturbances: - Possible failure within the HPA axis - Possible diminished release of TSH - Monoamine oxidase (MAO) *sensitivity of receptors to neurotransmitter CONTINUE NOTES AT 5:46 MINUTES PTSD: DSM Criteria: -flashbacks ( reliving the situation) -any trauma -do not have to experience the trauma yourself -avoidance of stimuli -hypervigilance: watching where everything is -alterations in mood -loss of pleasure (anhedonia) Meds: (mainly some kind of SSRI) Sertraline Alprazolam
Minipress Prizonsin Treatment Modalities: Biological treatment: Pharmacotherapy combine with EMDR or CBT Target symptoms and comorbidities like ADHD or MDD Psychological treatment: CBT EMDR-eye movement desensitization Dissociative disorder: ● Dissociative amnesia: involves amnesia , not remembering and a fuge is where you go someone else ● Depersonalized / derealization disorder : person doesn't feel real , derealization: person feels like everything around them isn't real ● Dissociative identity disorder: when someone dissociates from things they split into different personalities Safety: -person can injure themselves or someone else -suicidal ideation -placing themselves somewhere unsafe Depression Serotonin SSRI is our go to meds Exemplars: Major depressive disorder:(DSM: 5 or more of these for 2 weeks ) -weight and appetite changes -sleep disturbance -Fatigue -Worthlessness or guilt -Loss of ability to concentrate -Recurrent thoughts of death -Psychomotor agitation -suicidal thoughts Disruptive mood dysregulation disorder: -can not control mood Persistent depressive disorder: -low level depressive feelings throughout the most of each day for the majority of days ● At least 2 years in adults
Paroxetine (paxil) -safer in overdose -4-6 weeks to work’ -GI upset, sexual side effects -can cause rebound depression if stopped suddenly -watch for increased risk of suicide - Big death is serotonin syndrome, ends up with high serotonin,BP goes up, HR goes up, seizures Med alerts: Suicide Anhedonia Hopelessness associated with suicide Psychosis Hallucinations Delusions Catatonic: vegetable Postpartum depression: -can last few weeks to months -give SSRI may not be able to breastfed depending on what's happening -mom isn't interested in baby and no properly caring -point out positives about baby always and give it to mom -more likely to have when hormones change Other treatments for depression: ● Integrative medicine: - St. john's wort ● Brain stimulation - ECT (BIG ONE TO KNOW!!!) - Repetitive transcranial magnetic stimulation (rTMS) - Vagus nerve stimulation (VNS) - Deep brian stimulation (DBS) - Light therapy - Exercise Advanced practice interventions: ● Psychological therapies - Cognitive behavioral therapy - Interpersonal therapy - Time limited focused psychotherapy
Behavior therapy ● Group therapy Bipolar disorder: ● have to have 2 weeks of depression 5 days of mania Bipolar 1: look for mania episodes, increase in self esteem, hyper involvement in activities -delusions and hallucinations (intimidator high up and then go all the way down) -psychosis is mania Bipolar 2: more irritability, hyperactivity that isn't marked with hyper involvement (the grizzly goes a little high) -hypomania (less intense mania) -sowanst go to psychosis -doesn't go as high What's going to kill this person first? Look at how strong they are, height and depth Cyclothymia: milder form won't last as long, but over all need 2 years for criteria -hypomania and then minor depression -at least 2 year duration for adult, 1 year for children -little bit up and little but down ***LITHIUM (GO TO MED!!)
takes 2 weeks to work -Toxicity easy to happen: signs are muscle tremors, vomiting and diarrhea increasing level and can kill you, have pateint go get level checked -1 is good, 1 is bad or beginning of bad -Less than 0 doesn't work Lithium is similar to a salt, if drink a lot of water the lithium level goes down, if not drinking water when it's hot the lithium level will go up, pt to be aware of level of fluids ***-Therapeutic Range: 0 to 1 (acute) 0 to 1 (maintenances) Can give antipsychotic to calm them down Communication: ● Use firm and calm approach -provides structure and control ● Use short concise explanations
Minimizes potential for manipulative behaviors ● Identify expectations in simple, concrete terms
Offers safety as patient experiences outside controls while understanding reasons for treatment choices
Developing self esteem
discovery Risk factors: -isolation -terminal diagnosis -previous loss of family member from suicide -looking for anhedonia, hopelessness, change in mood -sudden increase in mood -getting rid of things -neglecting hygiene -making a will -writing farewell notes -putting personal affairs in order Listen for verbal cues, ask about plan if it is lethal and available Protective factors: -strong support system -current treatment -afraid of pain -not having access to harmful things -having resources -things that depend on the person -cultural and religious beliefs (ask beliefs, and then address spirituality) -what are your reasons for being alive, what are the things that keep you here? -African american make group is going up in suicide rate -Veterans are super high risk ****Look at voice over powerpoints and outline know exemplars and concepts *** look at role plays what Gares said can be a test question
211 Class Notes 08 29 2024
Course: Health Care Concepts II (NSG 211)
University: Germanna Community College
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