Disturbances in Affect

⮚ Inappropriate Affect
o Disharmony between the stimulus and the emotional reaction
⮚ Blunted Affect
o Severe reduction in emotional reaction
⮚ Flat Affect
o Absence or near absence of emotional/facial reaction that would indicate
emotions or mood.
⮚ Apathy
o Feelings of indifference toward people, activities, and events.
⮚ Ambivalence
o Holding seemingly contradictory beliefs or feelings about the same
person, event or situation.
o Presence of two opposing feelings.
⮚ Depersonalization
o Clients feel detached from their behavior.
o Feelings of strangeness towards oneself.
o Although client can state his name correctly, he feels as his body belongs
to someone else, or that his spirit is detached from his body.
⮚ Derealization
o Feeling of strangeness towards the environment.
o Environmental objects become smaller or larger, or seem unfamiliar.
o Individual feels that the outside world has changed.
o Everything may seem gray and dull.
Disturbances in Motor Activity
⮚ Echopraxia
o The pathological imitation of posture or action of others
o Imitation of the movements and gestures of another person whom the
client is observing.
⮚ Waxy Flexibility
o Maintaining the desires position for long periods of time without
discomfort even when it is awkward or uncomfortable.
⮚ Confabulation
o Filling a memory gap with detailed fantasy believed by the teller.
o Purpose of confabulation maintain self-esteems.
Example:
Nurse: “Do you know Gemma?” (Referring to one of the residents at the
patient’s home)
Patient: “Yes, I know her I used to play cards with her husband.”
Actually, Gemma’s husband was dead for many years and the patient
had never met him.
⮚ Amnesia
o Inability to recall past events.
Types:
● Anterograde amnesia
✔ Loss of memory of the immediate past.
 ● Retrograde amnesia
✔ Loss of memory of the distant past.
● Déjà vu
✔ Feeling of having been to a place which one has not yet visited.
● Jamais vu
✔ Feeling of not having been to a place which one has visited.

Basic Elements of the Nurse-Patient Relationship

T - Trust
R - Rapport
U – Unconditional positive regard
S – Setting limits
T – Therapeutic communication
Characteristics of the Nurse-Patient Relationship
⮚ Goal directed
⮚ Focused on the need of the patient
⮚ Planned
⮚ Time-limited
⮚ Professional
Phases of Nurse-Patient Relationship
⮚ Pre-orientation Phase
● Begins when the nurse is assigned to a nurse.
● Major task develop self-awareness.
● Tasks include data gathering, planning for the first interaction.
⮚ Orientation Phase
● Begins when the nurse and client meet.
● Ends when the client begins to identify problems to examine.
● Tasks: establishing rapport, developing trust, assessment, establishing
roles, purpose of the meeting, parameters of subsequent
● Major Task: develop a mutually acceptable contract.
⮚ Working Phase
Longest and most productive phase of the nurse-patient relationship. Limited
setting is employed. Divided in two sub-phases.
● Problem Identification
o Client identifies the issues or concerns causing problems.
● Exploitation
o Nurse guides the client to examine feelings and responses and to
develop better coping skills and a more positive self-image.
⮚ Transference
Client unconsciously transfers his feelings to the nurse
⮚ Countertransference
Therapist displaces onto the client attitudes or feelings from his/her past.
⮚ Resistance
Development of ambivalent feelings toward self-exploration.
⮚ Termination Phase
● Also termed Resolution Phase.
 ● Begins when problems are resolved.
● Ends when the relationship is ended.
● It involves feelings of anxiety, fear and loss.
Psychotropic Drug Categories
Anti-Psychotics
⮚ Also known as Neuroleptics.
⮚ Used to treat symptoms of psychosis.
⮚ Primary treatment for schizophrenia
⮚ Used in psychotic depression, acute mania and drug-induced psychosis
Antipsychotic Drugs
Typical Haldol
Thorazine
Trilafon
Prolixin
Mellaril
Serentil
Stelazine
Atypical Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
New Aripiprazole
Generation
Antipsychotic

1. Side Effects
⮚ Extrapyramidal Symptoms (EPS)
● Major side effects of antipsychotic agents.
● Include acute dystonia, pseudoparkinsonism & akathisia
● EPS happen when there is blockade of D2 receptors in the midbrain
region of the brain stem.
Generic (Trade Name) Drug Class
Amantadine Dopaminergic Agonist
(Symmetrel)
Benzropine (Cogentin) Anticholinergic
Bipenden (Akineton) Anticholinergic
Diazepam (Valium) Benzodiazepine
Diphenhydramine Antihistamine
(Benadryl)
Procyclidine Anticholinergic
(Kemadrin)
Propranolol (Inderal) Beta-blocker
Trihexaphenidyl Anticholinergic
(Artane)

⮚ Acute Dystonia
● Torticollis
● Opisthotonus
● Oculogyric Crisis
● Acute muscular rigidity, and cramping
● Stiff or thick tongue
● Difficulty swallowing
● Laryngospasm
● Respiratory difficulties

Pseudoparkinsonism
⮚ Stiff, stooped posture
⮚ Mask-like facies
⮚ Decreased arm swing
⮚ Shuffling, festinating gait
⮚ Cogwheel rigidity
⮚ Drooling
⮚ Coarse pill-rolling movements of thumb and fingers while at rest
Treatment
● Changing antipsychotic medication that has lower incidence of EPS
● Adding an anti-cholinergic agent or amantadine.

Akathisia
⮚ Inability to sit still
⮚ Restless/anxious
⮚ Rigid posture or gait
⮚ Lack of spontaneous gestures
Treatment
● Change of antipsychotic medication
● Addition of an oral agent (Beta-blocker, Anticholinergic, Benzodiazepine)
2. Neuroleptic Malignant Syndrome
⮚ Potentially fatal, idiosyncratic reaction to an antipsychotic
⮚ Rigidity
⮚ High fever
⮚ Autonomic instability (unstable blood pressure, diaphoresis, pallor, delirium).
May fluctuate from agitation to stupor
⮚ Increased risk for dehydration and poor nutrition.
Treatment
● Immediate discontinuance of all antipsychotic medications
● Treatment of dehydration and hyperthermia

3. Tardive Dyskinesia
⮚ Syndrome of permanent involuntary movements
⮚ Most commonly caused by the long-term use of typical antipsychotic drugs
⮚ Involuntary movements of the tongue, facial and neck muscles, upper and lower
extremities and truncal musculature.
⮚ Once it has developed, TD is irreversible.
⮚ Lip-smacking
⮚ Blinking
⮚ Grimacing
Treatment
● Progression can be arrested by decreasing or continuing the antipsychotic
medication
● Clozapine

4. Anticholinergic Side Effects

⮚ Often occurs with the use of antipsychotics
⮚ Side effects usually decrease within 3 to 4 weeks but not entirely remit.
MANIFESTATION
Orthostatic hypotension
Dry mouth
Constipation
Urinary hesitance or
retention
Blurred vision
Dry eyes
Photophobia
Nasal congestion
Decreased memory
Nursing Interventions
● Stool softeners
● Calorie-free beverages
● Adequate fluid intake
● Inclusion of grains and fruits in the diet

Key point:
Droperidol, Thioridazine, Mesoridazine.
These drugs may lengthen the OT interval leading to potentially life threatening
cardiac dysrhythmias or cardiac arrest.

Nursing Responsibilities: Anti-Psychotic Drugs

Dry Mouth ● Drink sugar-free fluids
● Sugar-free hard candy

Constipation ● Increase OFI

● Eat bulk-forming foods
● Exercise
● Stool softeners but not laxatives

Photosensitivity ● Use sunscreen

● Avoid long periods of time in the
sun
● Wear protective covering

Orthostatic ● Rising slowly from a sitting or lying

Hypotension position
Drowsiness ● Avoid driving a car or performing
other dangerous activities
Dizziness ● Wait to walk until dizziness has
subsided
 Medication ● If you forget a dose of antipsychotic
Compliance medication, take it if the dose is
only 3 to 4 hours late. If the missed
dose is more than 4 hours late or
the next dose is due, omit the
forgotten dose/
● If you have difficulty remembering
your medication, use a chart to
record doses when taken, or use a
pill box labeled with dosage times
and/or days of the week to help
you remember when to take
medication.

Key Point:
Clozapine
⮚ May cause agranulocytosis
⮚ Clients should have a baseline WBC count and differential before initiation
of treatment
⮚ WBC count every week throughout treatment and for 4 weeks after
discontinuation of clozapine.
Anti-Depressant Drugs
⮚ Primarily used in the treatment of:
● Major depressive illness
● Anxiety disorders
● Depressed phase of bipolar disorder and psychotic depression.

Types of Anti-Depressant Drugs

Tricyclic Antidepressant
Selective Serotonin Reuptake
inhibitors
Monoamine Oxidase Inhibitors

A. Tricyclic Antidepressant Drugs (TCA)

⮚ First choice of drugs to treat depression
⮚ Available since 1950’s
Key Points
 Potentially lethal if taken in an overdose. Depressed or impulsive clients who
are taking these drugs need to have prescriptions and refills in limited amounts
of decrease the risk.
TRICYCLIC DRUGS
Imipramine (Tofranil) Side Effects:
Desipramine ● Dry mouth
(Norpramin) ● Constipation
Amitriptyline (Elavil) ● Urinary retention
Nortriptyline ● Dry nasal passages
(Pamelor) ● Blurred vision
Doxepin (Sinequan) ● Orthostatic
Trimipramine hypotension
(Surmontil) ● Sedation
Protriptyline (Vicactil) ● Weight gain
Maprotiline ● Tachycardia
(Ludiomil) ● Sexual dysfunction
Mirtazapine ● Agitation
(Remeron) ● Delirium
Amoxapine
(Ascendin)
Clomipramine
(Anafranil)
B. Selective Serotonin Reuptake Inhibitor (SSRI)
⮚ Replaced the cyclic drugs as the first choice in treating depression because they
equal in efficacy and produce fewer side effects
⮚ Effective in the treatment of obsessive-compulsive disorder
⮚ Safest drug to give during panic attack.

SSRI DRUGS
Fluoxetine Side Effects
(Prozac) ● Agitation
● Akathisia
Fluvoxamine ● Nausea
(Luvox) ● Insomnia
Paroxetine ● Sexual
(Paxil) dysfunction
● Weight gain
(less)
 Sertraline ● Sedation
(Zoloft) ● Sweating
● headaches
Citalopram
(Celexa)
Escitalopram
(Lexapro)

C. Monoamino Oxidase Inhibitors

⮚ With low incidence of sedation
⮚ Can cause hypertensive crisis
⮚ This drug should not be given with other MAOIs, tricyclic antidepressants,
Meperidine (Demerol) CNS depressants
MAOI DRUGS
Phenelzine (Nardil)
Tranylcypromine (Pamate)
Isocarboxazid (Marplan)
Side Effects
⮚ Daytime sedation
⮚ Insomnia
⮚ Weight gain
⮚ Dry mouth
⮚ Orthostatic Hypotension
⮚ Sexual dysfunction
Nursing Interventions
⮚ Avoid tyramine foods
⮚ No mature or aged cheeses or dishes made with cheese, such as lasagna, pizza
(except cottage cheese, cream cheese, ricotta cheese, and processed cheese
slices)
⮚ No aged meats such as pepperoni, salami, mortadella, summer sausage, beef
logs, and similar products/
⮚ No Italian broad beans (fava) pods or banana peel. Banana pulp and all other
fruits and vegetables are permitted.
⮚ Avoid all tap beers and microbrewery beer, drink no more than two cans or
bottles of beer (including non-alcoholic beer) or four (4) ounces of wine per day.

Side Effects of other Antidepressants

Sedation Nefazodone
Trazodone
Mirtazapine
 Headache Nefazodone
Trazodone
Dry mouth and Nefazodone
Nausea
Loss of Appetite Bupropion
Nausea Venlafaxine
Agitation
Insomnia
Dizziness Venlafaxine
Sweating
Sedation
priapism Trazodone
Key Points:
Bupropion can cause seizures at rate 4 times that of other antidepressants
Antidepressant Nursing Responsibilities
Nausea Take the medication
with food
Insomnia Take daily doses in the
morning.
Do not use alcohol to
induce sleep because
this will worsen
insomnia
Motor Ask the physician for
restlessness / a medication such as
hand tremor Propranolol or
Benzodiazepene
Dry mouth Use calorie-free
beverages or sugar
free candy
Excessive Balanced diet
Weight Gain
Constipation Increase OFI Stool
Softeners

Mood Stabilizing Drugs

⮚ Used to treat bipolar disorder
⮚ Functions to:
● Stabilize client’s mood
 ● Preventing or minimizing the highs and lows that characterize bipolar
illness
● Treat acute episodes of mania
⮚ Lithium is the most established mood stabilizer, this normalizes the reuptake of
serotonin, NE, acetylcholine & dopamine. Other drugs that are effective in
stabilizing the mood:
● Carbamazepine (Tegretol)
● Valproic Acid (Depakote, Depakene)
● Gabapentin (Neurotin)
● Lamotrigine (Lamictal)
⮚ Lithium
● Available in tablets, capsules, liquid sustained-released form.
● No parenteral form
● Normal level 0.5-1.5mEq/L
● Common side effects:
▪ Mild nausea/diarrhea
▪ Anorexia
▪ Fine hand tremor
▪ Polydipsia
▪ Polyuria
▪ Metallic taste in the mouth
▪ Fatigue
▪ Lethargy
Toxic Effects
⮚ Severe diarrhea
⮚ Severe vomiting
⮚ Muscle weakness
⮚ Lack of coordination

If left untreated, symptoms may worsen

and can lead to renal failure, coma, and
death.
Lithium levels exceed 3.0 mEq/L =
Dialysis
Key Points:
Valproic acid can cause hepatic failure resulting in fatality
Carbamazepine can cause aplastic anemia and agranulocytosis
Lamotrigine can cause Stevens Johnson syndrome.

Mood Stabilizing Drugs Nursing Responsibilities

⮚ Have serum levels monitored periodically
⮚ Take the medication with food to minimize nausea.
 For the fine hand tremors, ask the physician to prescribe a beta-blocker such as
Propranolol (Inderal).
To help minimize weight gain, get a balanced diet and get regular exercise. Expect
some weight gain.
Normal sodium intake (2-3 g/day)
Minimize side effects of sedation and drowsiness from anticonvulsant medications
by taking larger doses at bed time and smaller doses during the day.
If you are taking lithium, keep water intake in a normal range and avoid heavy
sweating, because this increases serum lithium levels rapidly.
Anti-Anxiety Drugs (Anxiolytics)
⮚ Used to treat:
● Anxiety disorders
● Insomnia
● OCD
● Depression
● Post-traumatic stress disorder
● Alcohol withdrawal
⮚ Benzodiapines have proved to be the most effective in relieving anxiety.
ANTI-ANXIETY DRUGS
Alprazolam (Xanax)
Chloidiazepoxide (Librium)
Clonazepam (Klonopin)
Chlorazepate (Tranxene)
Diazepam (Valium)
Flurazepam (Dalmane)
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)
Triazolam (Halcion)
Buspirone (BuSpar)
Anti-Anxiety Nursing Responsibilities
⮚ It is important for clients to know that anti-anxiety agents are aimed at relieving
symptoms, such as anxiety or insomnia, but do not treat the underlying
problems that cause the anxiety.
⮚ Benzodiazepines strongly potentiate the effects of alcohol
⮚ One drink may have the effect of three drinks (alcohol)
⮚ Avoid driving (drowsiness)
⮚ Benzodiazepine withdrawal can be fatal: once a course of therapy has been
started, benzodiazepines should never be discontinued abruptly without the
supervision of the physician
⮚ Take anxiolytic drugs only as prescribed
Stimulants
 ⮚ First used to treat psychiatric disorders
⮚ Before, they were used to treat depression
⮚ At present, they are used for attention deficit/hyperactivity disorder in
adolescents and children
Drugs
Side Effects:
Methylphenidate (Ritalin) ⮚ Anorexia
⮚ Weight loss
⮚ Nausea
Dextroamphetamine (Dexedrine) ⮚ Irritability
⮚ Dizziness
⮚ Dry mouth
Pemoline (Cylert) ⮚ Blurred vision
⮚ Palpitations

Key Point:
Pemoline
⮚ Can cause life-threatening liver failure
⮚ May require liver transplantation in 4 weeks from the onset of symptoms.
Stimulants Nursing Responsibilities
⮚ Never leave the supply of medication in a place the child can reach.
⮚ Nausea and vomiting: take medication at meal time
⮚ Growth suppression: Monitor the child’s weight and height
⮚ Try a dosage schedule that provides a dose of medication before beginning
routine tasks of concentration such as nightly homework
⮚ Dry mouth: Calorie-free beverages or sugar-free candy
⮚ Caffeine-free beverages; avoid chocolate and excessive sugar
⮚ Medications should be given in a manner that is not intrusive, nor should it
draw undue attention to the child.
Disulfiram (Antabuse)
⮚ Sensitizing agent that causes an adverse reaction when mixed with alcohol in
the body
⮚ Useful for persons who are motivated to abstain from drinking and who are not
impulsive.
⮚ Symptoms begin to appear after five to ten minutes and may last from 30
minutes to 2 hours.
● Facial and body flushing
● Throbbing headache
● Sweating
● Dry mouth
● Nausea
● Vomiting
● Dizziness
● Weakness
⮚ In severe cases, there may be chest pain dyspnea, severe hypotension,
confusion and even death.
Other side effects
⮚ Fatigue
⮚ Drowsiness
⮚ Halitosis
⮚ Tremor
⮚ Impotence
Nursing Responsibilities
Common products that mat contain alcohol
⮚ Shaving cream
⮚ Aftershave lotion
⮚ Cologne
⮚ Deodorant
⮚ OTC drugs (cough preparation)
⮚ Client must read the products carefully and select items that are alcohol-free.
Electroconvulsive Therapy
Functions
⮚ Treat depression in select groups such as clients who do not respond to
antidepressants
⮚ Pregnant women can safely have ECT with no harm to the fetus
⮚ Indicated to clients who are actively suicidal while waiting weeks for full effects
of antidepressant medication
Nursing Interventions Pre Procedure
⮚ NPO after midnight
⮚ Void prior to the procedure
⮚ I.V should be started for the administration of the medication
Nursing Interventions during Procedure
⮚ Clients receives short acting anesthetic so she is not awake during the
procedure
⮚ Receives muscle relaxant to reduce outward signs of seizure
⮚ The brain is monitored with EEG while the electrical stimulation is delivered
⮚ Following ECT the client may be mildly confused disoriented and may have
short term memory impairment.

Voltage of electrical current 70-150 volts

administered to the client
Length of electrical shock applied to the 0.5 to 2.0 seconds
patient
Usual number of treatments needed to 6-12 treatment
produce a therapeutic effects.
 Frequency of treatments There should be an
interval of 48 hours for
each treatment
Indication of effectiveness of ECT The occurrence of
generalized tonic-clonic
seizure
Indication for ECT Depression
Mania
Catatonic
Schizophrenia
Atropine Sulfate To decrease secretions
Anectine (Succinylcholine) To promote muscle
relaxation
Methohexitals Sodium (Brevital) Serve as an anesthetic
agent
Key Points:
Contraindications to ECT
⮚ Increased intracranial pressure
⮚ Recent fracture
⮚ Cardiac condition
⮚ Retinal detachment
⮚ Pregnancy
Need for consent prior to ECT
⮚ Yes, consent is needed
Common complications of ECT
⮚ Loss of memory
⮚ Headache
⮚ Apnea
⮚ Fracture
⮚ Respiratory depression
Nursing Responsibilities after ECT
⮚ The nurse or anesthesiologist mechanically ventilates the patient with 100%
oxygen until the patient can breathe unassisted
⮚ The nurse monitors for respiratory problems
⮚ ECT causes confusion and disorientation, thus it is important to help with
reorientation (time, place, person) as the patient emerges from this unconscious
state
⮚ Nurse might need to administer a benzodiazepine as needed
⮚ Observation is necessary until the patient is oriented and steady, particularly
when the patient first attempts to stand
⮚ All aspects of the treatment should be carefully documented for the patient’s
record.
Personality Structure
⮚ Freud conceptualized personality structure as having three components.
● ID
▪ Seeks instant gratification, causes impulsive, unthinking behavior,
and has no regard for rules or social convention
● Super Ego
▪ Values, and parental and social expectations, therefore it is
indirect opposition to the id.
● EGO
▪ Balancing or mediatıng force between the id and the superego. The
ego represents mature and adaptive behavior that allows a person
to function successfully in the world
Ego Defense Mechanism
⮚ RATIONALIZATION - Excusing own behavior to avoid guilt, responsibility,
conflict, anxiety or loss of self-respect.
Examples: Student blames failure on teacher being mean; Man say she beats
his wife because she does not listen to him.
⮚ REACTION FORMATION - Acting the opposite of what one thinks or feels.
Examples: Woman who never wanted to have children becomes a super-mom;
Person who despises the boss tells everyone what a great boss she is.
⮚ REGRESSION - Moving back to previous developmental stage in order to feel
safe or have needs met
Examples: Five-year-old asks for a bottle when new baby brother is being fed;
Man pouts like a four-year-old if he is not the center of his girlfriend's
attention.
⮚ REPRESSION - Excluding emotionally painful of anxiety-provoking thoughts
and feelings from conscious awareness
Examples: Woman has no memory of the mugging she suffered yesterday;
Woman has no memory before age 7 when she was removed from abusive
parents.
⮚ DISPLACEMENT - Ventilation of intense feelings toward persons less
threatening than the one who aroused those feelings
Examples: A person who is mad at the boss yells at his or her spouse
⮚ COMPENSATION - Overachievement-in one area to offset real or perceived
deficiencies in another area
Examples: Napoleon complex: diminutive man becoming an emperor; Nurse
with low self-esteem works double shifts so her supervisor will like her.
⮚ CONVERSION - Expression of an emotional conflict through the development of
a physical symptom usually sensorimotor in nature.
 Example: A teenager forbidden to see X-rated movies is tempted to do so by
friends and develops blindness, and the teenager is unconcerned about the loss
of sight
⮚ DENIAL - Failure to acknowledge an unbearable condition or failure to admit
the reality of a situation or how one enables the problem to continue
Examples: Diabetic eating chocolate candy; spending money freely when broke.
Waitıng 3 days to seek help for severe abdominal pain
Divisions of the Mind or Levels of Awareness
⮚ Freud believed that the human personality functions at three levels of
awareness. Conscious, Preconscious, Unconscious.
Conscious
⮚ Perceptions, thoughts and emotions that exist in the person’s awareness such
as being aware of happy feelings or thinking about a loved one
⮚ Part of the mind focused on awareness
Preconscious
⮚ Not currently in the person’s awareness, but he or she can recall them with
some effort.
⮚ Part of the mind that contains information that can be recalled at will
Example: An adult remembering what he or she did, thought, or felt as a child.
Unconsciousness
⮚ Realm of thoughts and feelings that motivate a person, even though he or she is
totally unaware of them
⮚ This realm includes most defense mechanisms and some instinctual drives or
motivation
⮚ It is the largest part of the mind; contains materials and information that can
never be recalled
Common Psychotherapeutic Interventions
Remotivation Therapy
⮚ Promotes expression of feelings through interactions facilitated by discussion of
neutral topics
⮚ Reality orientation for rehabilitative patients only and not for actively psychotic
patients
Music Therapy
⮚ Use of music to facilitate relaxation, expression of feelings and outlet of tension
Play Therapy
 ⮚ Enables the patient to experience intense emotion in a safe environment with
the use of play
Example: For victims of child abuse, give dolls.
Group Therapy
⮚ Therapeutic interactions of three or more patients with a therapist to relieve
emotional difficulties, increase self-esteem, develop insight and improve
behavior in relation with others.
⮚ Minimum number of members in a group is 3 while the ideal number is 8-10
Types of Group
⮚ Therapeutic Group
● To gain insight into their problems (i.e. Alcoholic Anonymous)
⮚ Socialization group
● To enhance interaction among patients
⮚ Life Review / Reminiscing Group
● To lessen isolation.
Milieu Therapy
⮚ Treatment by means of controlled modification of the patients' environment to
facilitate positive behavioral change
⮚ Nurse identifies what each patient needs from the therapeutic milieu, while
keeping in mind the needs of the larger patient group
Family Therapy
⮚ Focuses on the total family as an interactional system
⮚ Best suited for families where there is domestic violence
Psychoanalysis
⮚ Focuses on the exploration of the unconscious to facilitate identification of the
patient's defenses
⮚ Behavioral disorders are related to unresolved anxiety-provoking childhood
experiences that are repressed into the unconscious
⮚ Goal is to bring repressed experiences into conscious awareness and to learn
healthier means of coping with anxiety
⮚ Utilizes dream analysis and free association (verbalization of thoughts, without
censorship)

Hypnotherapy
⮚ Involves various methods and techniques to induce a trans state where the
patient becomes submissive to instructions
Humor Therapy
⮚ Use of humor to facilitate expression of feelings and to enhance interaction
⮚ Therapeutic laughing lessens the high levels of tension that often accompany
discussions of serious matters
Behavior Modification
⮚ Application of learning principles in order to change maladaptive behavior
⮚ It attempts to strengthen a desired behavior or response by reinforcement,
either positive or negative
Positive Reinforcement
⮚ If the desired behavior is assertiveness whenever the client uses assertiveness
skill in a communication group, the group leader provides positive
reinforcement by giving the client attention and positive feedback
Negative Reinforcement
⮚ Involves removing a stimulus immediately after a behavior occurs so that the
behavior is more likely to occur again.
For example, if a client becomes anxıous when waiting to talk in a group, he may
volunteer to speak first to avoid the anxiety.
Crisis and Crisis Intervention
⮚ Turning point in an individual’s life that produces an overwhelming emotional
response
Characteristics of a Crisis State
⮚ Highly individualized
⮚ Lasts for 4-6 weeks
⮚ Person affected becomes passive and submissive
⮚ Affects a person’s support system
Types of Crisis
⮚ Maturational or Developmental Crisis
✔ Expected, predictable and internally motivated events in the normal course
of life such as:
⮚ Leaving. Home for the first time; Getting married
⮚ Having a baby: Beginning a career
⮚ Growth; Parenthood

⮚ Situational or Accidental Crisis

✔ Unanticipated or sudden, unexpected, unpredictable and externally
motivated events that threaten the individual’s integrity such as:
⮚ Death of a loved one
 ⮚ Loss of a job
⮚ Physical and emotional illness in the individual family or member. Car
accident
Social Adventitious Crisis
⮚ Includes natural disasters-and acts of nature like
● Floods, Earthquakes, Hurricanes
● War Terrorist attacks: Riots
● Violent crimes such, as rape or murder
⮚ Phases of a Crisis
1. Denial initial reaction
2. Increased Tension
● Person recognizes the presence of a crisis and continues to do
activities of daily living
3. Disorganization
● Person is preoccupied with the crisis and is unable to do activities of
daily living
4. Attempts to Reorganize
● Individual mobilizes previous coping mechanisms
Crisis Intervention
⮚ A way of entering into the life situation of an individual, family, group or
community to help them mobilize their resources and to decrease the effect of a
crisis inducing stress
Goal: To enable the patient to attain an optimum level of functioning
Types of Crisis Intervention
⮚ Authoritative Crisis Intervention
✔ Designed to assess the person's health status and promote problem-solving
such as:
⮚ Offering the person new information knowledge or meanıng
⮚ Raising the person's self-awareness by providing feedback about
behavior
⮚ Directing the person's behavior by offering suggestions or courses of
action
⮚ Facilitative Crisis intervention
✔ Aim at dealing with the person's needs for empathetic understanding such
as:
⮚ Encouraging the person to identify and discuss feelings
⮚ Serving as a sounding board for the person
⮚ Affirming the person's self-worth
Primary Role of the Nurse in Crisis
⮚ Active and directive, the nurse has to assist the patient.
Rape
⮚ It is a crime of violence and humiliation of the victim expressed through sexual
means
⮚ It is the penetration of an act of sexual intercourse with a female against her
will and without her consent, whether her will is overcome by force, fear of
force, drugs, or intoxicants
⮚ It is also considered rape if the woman is incapable of exercising irrational
judgment because of mental deficiency or when she is below the age of consent.
⮚ According to Republic Act 8353, it refers to the insertion of the penis into the
mouth, vagina, anus, of a victim
⮚ It is generally considered as an act of hostility, anger or violence
Types of rape
⮚ Power Rape
● The intent of the rapist is not to injure the victim but to command and
master another person sexually
● The rapist has an insecure self-image and feelings of incompetence and
inadequacy
● The rapist is the vehicle for expressing power and potency.
● This is done to prove one's masculinity
⮚ Sadistic Rape
● Involves brutality
● The use of bondage and torture is not an expression of anger but necessary
for the rapist’s sexual excitement
● The assault is often eroticized and is sexually stimulating
● This is done to express erotic feelings
Rape Trauma Syndrome
⮚ Group of signs and symptoms experienced by a victim in reaction to a rape
⮚ Phases of the Rape Trauma Syndrome
● Acute Phase - shock, numbness and disbelief
● Denial Phase - victim’s refusal to talk about the event
● Heightened Anxiety – fear, tension, and nightmares
● Stage of Reorganization - victim’s life normalizes
Nursing Care for Rape Victims
✔ In the emergency setting, provide immediate emotional support
⮚ The nurse should allow the woman to proceed at her own pace and not rush
her through any interview or examination
Give as much control back to the victim as possible by allowing her to make
decisions, when possible, about whom to call, what to do next, what she
would like to be done, etc.
It is the victim's decision about whether or not to file charges and testify
against the perpetrator and the victim must sign consent forms before any
photographs of hair and nail samples are taken for future evidence
 ⮚ The priority in the care of a rape victim is the preservation of evidence
⮚ Prophylactic treatment for STDs is offered
⮚ Prophylaxis can be offered to prevent pregnancy
⮚ In some areas, HIV testing is strongly encouraged
⮚ Referrals to rape crisis centers are encouraged
Autism
⮚ Disorder characterized by impairment in communication skills, or the presence
of stereotyped behavior, interests and activities with associated impairment in
social interactions
⮚ More prevalent in boys than girls
⮚ Identified no later than 3 years of age
⮚ It is treatable but not curable
⮚ Does have a genetic link
Main Problem: Impaired Interpersonal Functioning
Manifestations
⮚ Display little eye contact
⮚ Few facial expressions towards others
⮚ They do not use gestures to communicate
⮚ Do not relate to peers and parents
⮚ Lack spontaneous enjoyment
⮚ No moods or emotional affect
⮚ Little intelligible speech
⮚ Stereotyped motor behaviors (hand-flapping, body twisting, head-banging)
⮚ Acts as deaf
⮚ No fear of danger
Management
Drug
⮚ Low-dose Antipsychotic
Tantrums
⮚ Involves head-banging
⮚ Provide safety
⮚ Helmet
⮚ Padded walls
⮚ Monitor behavior (1:1)
Communication
⮚ All vowels
⮚ Use of short sentences when talking to the child
Nutrition: Less Than Body Requirements
 ⮚ Provide well-balanced diet
⮚ Small frequent feedings
Routines
⮚ Provide consistency
Love & Belongingness
⮚ Family Therapy
Priority Nursing Diagnosis
⮚ Risk for Injury
Attention-Deficit Hyperactivity Disorder
⮚ Characterized by inattentiveness; over activity, and impulsiveness.
⮚ Common in: boys
⮚ Identified and diagnosed when the child begins preschool or school (before the
age of 7)
Common Etiological Factors
⮚ UNKNOWN
⮚ Neurologic impairment
⮚ Early malnutrition
⮚ Frontal lobe hypo perfusion
⮚ Use of drugs and exposure to alcohol and tobacco during pregnancy
Risk Factors
⮚ Family history of ADHD
⮚ Male relatives with antisocial personality disorder
⮚ Lower socioeconomic status
⮚ Gender (Male)
⮚ Marital or Family Discord

Manifestations
Inattentive Behaviors
 Misses details
Makes careless mistakes
Has difficulty sustaining attention
Doesn’t seem to listen
Does not follow through on chores
Has difficulty with organization
Avoids tasks requiring mental effort
Often loses necessary things
Is easily distracted by other stimuli
Is often forgetful in daily activities
Hyperactive Behaviors
Fidgets
Often leaves seat (during a meal)
Runs or climbs excessively
Can’t play quietly
Is always on the go; driven
Talks excessively
Blurts out answers
Interrupts
Can’t wait for turn
Is intrusive with siblings/playmates

Pharmacologic Therapy
Drugs Nursing Considerations
Methylphenidate ⮚ Monitor for appetite suppression
(Ritalin) and growth delays
⮚ Give regular tablet after meals
⮚ Alert client that full drug effect
takes 2 days
Dextroamphetamine ⮚ Monitor for insomnia
(Dexedrine) ⮚ Give last dose early afternoon
⮚ Full drug effect takes 2 days
Pelomine ⮚ Monitor for elevated liver function
(Cylert)
 ⮚ Drug may take 2 weeks for full
effect

Nursing Interventions for ADHD

⮚ Ensuring the child’s safety and that of others
● Stop unsafe behavior
● Provide close supervision
● Give clear directions about acceptable and unacceptable behavior
⮚ Improve role performance
● Give positive feedback for meeting expectations
● Provide a quiet place free of distractions for task completion
⮚ Simplifying instructions/directions
● Get the child’s full attention
● Break complex tasks into small steps
● Allow breaks
⮚ Structured daily routine
● Establish a daily schedule
● Minimize changes
⮚ Nutrition
● Provide finger foods
⮚ Client/Family education and support
● Listen to parent’s feelings and frustrations
Mental Retardation
⮚ Below average intellectual functioning
⮚ IQ less than 70
⮚ Significant limitations in areas of adaptive functioning
Causes
⮚ Hereditary (Tay - Sachs disease. Trisomy 21)
⮚ Pregnancy/Perinatal problems (fetal malnutrition)
⮚ Medical conditions of infancy
Levels of Mental Retardation IQ What can be done
Mild 55-69 Educable
Moderate 40-54 Trainable
Severe 25-39 Needs Close Supervision
Profound <25 Custodial Care
⮚ Educable
● Patient can be taught how to read and write.
⮚ Trainable
● Vocational skills (cooking, sewing, etc.)
 ⮚ Close Supervision
● Activities of daily living (brushing, wearing clothes)
⮚ Custodial Care
● Client is totally dependent
Nursing Interventions
⮚ Help parents accept a diagnosis of mental retardation
⮚ Consider the developmental or functional age and not the chronological age

Principles of Nursing Care

⮚ Repetition
⮚ Role Modeling
⮚ Restructuring the environment
Focus of Education for Mentally Retarded Patients
⮚ Reading
⮚ Writing
⮚ Basic Arithmetic
Anxiety
⮚ Stage of uneasiness or discomfort experienced to varying degrees frequently
coupled with doubts, fears, and obsessions.
⮚ Feeling of terror or dread; the most uncomfortable feeling a person can
experience
Mild Anxiety
⮚ Positive state of heightened awareness and sharpened senses allowing the
person to learn new behaviors and solve problems
⮚ The person can take in all available stimuli (enlarged perceptual field)
Moderate Anxiety
⮚ Decreased perceptual field (focus on immediate task only)
⮚ The person can learn new behavior or solve problems only with assıstance
Severe Anxiety
⮚ Feelings of dread or terror
⮚ The person cannot be redirected in to a task; he or she focuses only on
scattered details and has physiologic symptoms of tachycardia, diaphoresis,
and chest pain.
⮚ People with severe anxiety often go to emergency departments, believing they
are having a heart attack.
Panic Anxiety
 ⮚ Loss of rational thought, delusions, hallucinations and complete physical
immobility and muteness
⮚ The person may bolt and run aimlessly, often exposing himself or herself to
injury
Priority Nursing Diagnosis for Anxiety
⮚ Ineffective individual coping
⮚ Anxiety

Nursing Interventions
⮚ Calm the patient
⮚ Administer medications
⮚ Listen to the patient's concerns
⮚ Minimize environmental stimuli
Anxiety Disorder
⮚ Emotional illnesses characterized by fear, autonomic nervous system symptoms
and avoidance behavior
⮚ Diagnosed when anxiety no longer functions as a signal of danger or a
motivation for needed change but becomes chronic and permeates major
portions of the person's life resulting in maladaptive behaviors and emotional
instability
Symptoms of Anxiety Disorders
⮚ Agoraphobia
● Anxiety about or avoidance of places or situations from which escape might
be difficult or help might be unavailable
Symptoms:
⮚ Avoids being outside alone or at home alone
⮚ Avoids traveling in vehicles; impaired ability to work
⮚ Difficulty meeting daily responsibilities (e.g. grocery shopping, going to
appointments)
⮚ Panic Disorder
● It is characterized by recurrent, unexpected panic attacks that cause
constant concern.
⮚ Panic Attack
● It is the sudden onset of intense apprehension, fearfulness, or terror
associated with feelings of impending doom
Symptoms: A discrete episode of panic lasting 15 to 30 minutes with four or more of
the following
⮚ Palpitations
⮚ Sweating
 ⮚ Trembling or shaking
⮚ Shortness of breath
⮚ Choking
⮚ Chest pain or discomfort
⮚ Nausea
⮚ Derealization/depersonalization
⮚ Fear of dying or going crazy
⮚ Paresthesia
⮚ Chills of hot flashes
Social Phobia
It is characterized by anxiety provoked by certain types of social or performance
situations, which often leads to avoidance behavior
Symptoms
⮚ Fear of embarrassment or inability to perform
⮚ Avoidance or dreaded endurance of behavior or situation
⮚ Belief that others are judging him or her negatively
⮚ Significant distress or impairment in relationships, work, or social life
⮚ Anxiety can be severe or panic level
Management
⮚ Anti-anxiety medications
⮚ Social Skills training
Generalized Anxiety Disorder
⮚ It is characterized by at least 6 month of persistent and excessive worry and
anxiety
Manifestations
⮚ Apprehensive expectations more days than not for SIX (6) months or more
about several events or activities
⮚ Uncontrollable worrying
⮚ Significant distress or impaired social or occupational functioning
Three (3) of the following symptoms
⮚ Restlessness
⮚ Easily fatigued
⮚ Difficulty concentrating or mind going blank
⮚ Irritability
⮚ Muscle tension
⮚ Sleep disturbance
Medical Management
⮚ Buspirone (Buspar) and SSRI antidepressants
Acute Stress Disorder
⮚ It is the development of anxiety, dissociative and other symptoms within 1
month of exposure to an extremely traumatic stressor it lasts 2 days-to 4 weeks
Manifestations
⮚ Exposure to traumatic event, causing intense fear, helplessness, or horror,
marked anxiety symptoms or increased arousal
⮚ Significant distress or impaired functioning
⮚ Persistent re-experiencing of the event
⮚ Three of the following symptoms
● Sense of emotional numbing or detachment
● Feeling dazed
● Derealization
● Depersonalization
● Dissociative amnesia (inability to recall important aspect of the event)
Post-Traumatic Stress Disorder
⮚ It is characterized by the re-experiencing of an extremely traumatic event,
avoidances of stimuli associated with the event, numbing of responsiveness,
and persistent increased arousal
Manifestation
⮚ Exposure to traumatic event involving intense fear, helplessness or horror
⮚ Avoidance of memory-provoking stimuli and numbing of general responsiveness
⮚ Increased arousal (sleep disturbance, irritability or angry outbursts, difficulty
concentrating, hypervigilence, exaggerated startle response)
⮚ Significant distress or impairment
Psychiatric Management
⮚ Anti-anxiety Medications Diazepam(Valium)
● Oxazepam (Serax)
● Chlordiazepoxide (Librium)
● Chlorazepatedipotassium
● Alprazolam (Xanax)
⮚ Antidepressant Medications
⮚ Group Therapy
When to Administer Anxiolytic Drug
⮚ Best taken before meals, food in the stomach delays absorption
Side Effects of Anxiolytic Drugs
⮚ Drowsiness; Sedation. Poor coordınation: Impaired memory and clouded
sensorium
Client Teaching on Anxiolytic Drugs
 ⮚ Intake of alcohol and caffeine-containing foods alter the effect of the drug
⮚ It potentiates the effect of alcohol
⮚ Administer separately, it is incompatible with any drug.
Priority Nursing Diagnosis for Anxiety Disorder
⮚ Ineffective Individual Coping

Treatment of Anxiety Disorder

Cognitive Behavioral Techniques
⮚ Positive Reframing
● Turning negative messages into positive messages
● Instead of thinking, “My heart is pounding. I think I am going to die” the
client thinks, “I Can stand this. This is just anxiety. It will go away.”
Decatastrophizing
⮚ Involves the therapist’s use of questions to more realistically appraise the
situation
⮚ The therapist may ask: “What is the worst thing that could happen? Is that
likely? Could you survive that? Is that as bad as you imagine?”
⮚ The client uses thought stopping and distraction techniques to jolt himself from
focusing on the negative thoughts
⮚ Techniques that can break the cycle of negative thoughts include
● Splashing the face with water
● Snapping a rubber band worn on the wrist
Assertiveness Training
⮚ Helps the person take more control of the situation
⮚ Techniques help the person negotiate interpersonal situations and foster
self-assurance
⮚ They involve using “I” statements to identify feelings and to communicate
concerns or the needs of others
● Examples: “I feel angry when you turn your back while I’m talking”, “I want
to have five minutes of your time for an uninterrupted conversation about
something important”
Specific Phobia
⮚ Characterized by significant anxiety provoked by a specific feared object or
situation which leads to avoidance behavior.
Manifestations
⮚ Marked anxiety response to the object or situation
⮚ Avoidance or suffered endurance of object or situation
 ⮚ Significant distress impairment of daily routing, occupation or social
functioning
⮚ Adolescent and adults recognize their fear as excessive or unreasonable
Psychiatric Management
⮚ Anti-anxiety Medications
⮚ Systematic Desensitization
● The therapist progressively exposes the client to threatening object in a safe
setting until the client’s anxiety decreases
Personality
⮚ Can be defined as an ingrained, enduring pattern of behaving and relating to
self, others, and the environment: personality includes perceptions, attitudes,
and emotions
Categories of Personality Disorders
Cluster A
⮚ Odd and eccentric behavior
⮚ Includes paranoid schizoid, and schizotypal personality
Cluster B
⮚ Includes people who appear dramatic, emotional, or erratic
⮚ Includes antisocial, borderline, histrionic, and narcissistic personality
disorders
Cluster C
⮚ Includes people who appear anxious or fearful
⮚ Includes avoidant, dependent, and Obsessive-compulsive personality
disorders
Cluster A
Paranoid Personality Disorder
Symptoms/Characteristics
⮚ Mistrust and suspicion of others
⮚ Uses the defense mechanism of projection, which is blaming other people,
institutions or events for their own difficulties
Nursing Interventions
⮚ Approach these clients in a formal, business-like manner and refrain from
chit-chat and jokes (serious and straight forward approach)
⮚ Involve the client in treatment planning
⮚ Teach client to validate ideas before taking action.
Schizoid Personality Disorder
 Symptoms /Characteristics
⮚ Detached from social relationships
⮚ Restricted affect and little, if any emotion; aloof and indifferent, appearing
emotionally cold, uncaring, or unfeeling
⮚ Report no leisure or pleasurable activities because they rarely experience
enjoyment
⮚ Involve themselves more with things than people

Nursing Interventions
⮚ Focus on improved functioning of the client in the community
⮚ Assist the client to find a case manager one who helps the client to obtain
services and health care manage finances, etc.
Schizotypal Personality Disorder
Symptoms /Characteristics
⮚ Has social and interpersonal deficits marked by acute discomfort with and
reduced capacity for close relationships
⮚ Clothes are ill fitting do not match, and may be stained or dirty
⮚ Cognitive distortions include ideas of reference, magical thinking that he has
special powers, unfounded beliefs
Nursing Interventions
⮚ Development of self-care skills
⮚ Nurse encourages client to establish a daily routine for hygiene and
grooming
⮚ Improve community functioning and provide social skills training
Cluster B
Anti-Social Personality Disorder
Symptoms /Characteristics
⮚ Violation of the rights of others
⮚ Lying
⮚ Rationalization of own behavior
⮚ Thrill-seeking behaviors
⮚ Poor work history:
⮚ Consistent irresponsibility
Nursing Interventions
⮚ Promote responsible behavior
⮚ Limit setting
⮚ Consistent adherence to rules and treatment plan
 ⮚ The nurse should not become angry or respond to the client harshly or
punitively
⮚ Confrontation technique designed to manage manipulative or deceptive
behavior.
Example
Nurse: You've said you’re interested in learning to manage angry outbursts, but
you've missed the last three group meetings.
Client: Well, l can tell no one in the group likes me. Why should I bother?
Nurse: The group meetings are designed to help you and the others, but you
can't work on issues if you are not there.
Borderline Personality Disorder
Symptoms /Characteristics
⮚ Fear of abandonment, real or perceived
⮚ Unstable and intense relationships
⮚ Recurrent self-mutilating behavior or suicidal threats or gestures
⮚ Transient psychotic symptoms such as hallucinations, demanding self-harm
Nursing Interventions
⮚ Promote clients safety
⮚ Helping clients to cope, and control emotions
⮚ Cognitive restructuring techniques
⮚ Structure the time
⮚ Teach social skills
Histrionic Personality Disorder
Symptoms /Characteristics
⮚ With a pervasive pattern of excessive emotionality and attention-seeking
⮚ Clients are overly concerned with impressing others with their appearance
⮚ Dress and flirtatious behavior are not limited to social situations or
relationships but also occur in occupational and professional settings
Nursing Interventions
⮚ It would be more acceptable tost and at least two (2) feet away from the man
to shake hands
⮚ Teaching social skills and role-playing those skills in a safe, non-threatening
environment can help clients to gain confidence in their ability to interact
socially
⮚ Provide factual feedback about behavior
Narcissistic Personality Disorder
Symptoms /characteristics
 ⮚ Has a pervasive pattern of grandiosity, need for admiration, and lack of
empathy for others
Nursing Interventions
⮚ Provide a matter-of-fact approach
⮚ The nurse must not internalize such criticism or take it personally
⮚ She sets limits to rude or verbally abusive behavior and explains his or her
expectations from the clients.
⮚ Teach client any needed self-care skills
Cluster C
Avoidant Personality Disorder
Symptoms Characteristics
⮚ Has a pervasive pattern of social discomfort and silence, low self-esteem and
hypersensitivity to negative evaluation
⮚ They fear rejection, criticism, shame or disapproval
⮚ They remain aloof in their relationships and feel inferior to others
Nursling Interventions
⮚ Require, much support and reassurance from the nurse
⮚ The nurse can help them to explore positive self-aspects, positive responses
from others and possible reasons for self-criticism
Dependent Personality Disorder
Symptoms /Characteristics
⮚ Has a pervasive and excessive need to be taken care, of which leads to
submissive and clinging behavior and fears of separation
Nursling Interventions
⮚ Foster client's self-reliance and autonomy
⮚ Teach problem-solving and decision-making skills
⮚ Cognitive-restructuring techniques
Obsessive Compulsive Disorder
⮚ Involves obsessions (thoughts. Impulses or Images) that cause marked anxiety
and/or compulsions (repetitive behaviors or mental acts) that attempt to
neutralize anxiety
Symptoms/Characteristics
⮚ Preoccupation with orderliness, perfectionism and control
OBSESSIONS
Obsessions Compulsion
 Fear of Dirt and Germs Excessive Hand Washing
Fear of Burglary or Robbery Repeated Checking of and Door and Window Locks

Nursing Interventions
⮚ Encourage negotiation with others
⮚ Assist client to make timely decisions and complete work
⮚ Cognitive restructuring techniques

Eating Disorders
Anorexia Nervosa
⮚ Life-threatening eating disorder characterized by:
● Client’s refusal or inability to maintain a minimally normal body weight
● Intense fear of gaining weight or becoming fat
● Significantly disturbed perception of the shape or size of the body
● Refusal to acknowledge the seriousness of the problem
● Body Weight that is 85% less than expected for their age and height
Clinical Manifestations
● Fear of gaining weight
● Body Image disturbance
● Amenorrhea
● Depressed mood
● Social withdrawal
● Insomnia
● Feelings of ineffectiveness
● Limited spontaneity
● Complaints of constipation & abdominal pain
● Cold intolerance
● Lethargy
● Emaciation
● Dec BP, Dec Temperature, Dec PR
● Hypertrophy of salivary glands
● Elevated BUN
● Leukopenia & mild anemia
● Elevated liver function studies
Sub type
Binge eating
⮚ Consuming large amount of food in a discrete period of usually 2 hours or
less
Purging
 ⮚ Compensatory behaviors designed to eliminate food by means of
self-induced vomiting or misuse of laxatives enemas and diuretics
Note: Some clients with anorexia do not binge but engage in purging behaviors after
ingesting small amounts of food

Treatment
⮚ Focus on
● Weight restoration
● Nutritional rehabilitation
● Rehydration
● Correction of electrolyte imbalances
Drugs
⮚ Amitriptyline (Elavil) & Cyproheptadine (Periactin) for weight gain
⮚ Olanzapine (Zyprexia) = promotes weight gain and produces antipsychotic
effect
Individual Therapy
BULIMIA NERVOSA
⮚ Eating disorder characterized by recurrent episodes (at least twice a week for 3
months) of binge eating followed by inappropriate compensatory behaviors to
avoid weight gain such as purging, use of laxatives, diuretics, enemas, and
fasting.
⮚ Weight: usually in normal range, although some clients are overweight or
underweight.
⮚ Low self-esteem
Clinical Manifestations
⮚ Recurrent episodes of binge eating and purging
⮚ Selection of low calorie foods
⮚ Depressive and anxiety symptoms
⮚ Substance Use (alcohol and stimulants)
⮚ Loss of dental enamel
⮚ Chipped, ragged or moth-eaten appearance of teeth
⮚ Increased dental carries
⮚ Menstrual irregularities
⮚ Dependence on laxatives
⮚ Esophageal tears
⮚ Metabolic alkalosis (vomiting)
⮚ Metabolic acidosis (diarrhea)
 ⮚ Mildly elevated serum amylase levels
Common Nursing Diagnoses related to Eating Disorders
⮚ Body Image Disturbance
⮚ Self-esteem Disturbance
⮚ Ineffective Individual Coping

Nursing Interventions
Promote improved nutrition
Assume a calm, matter-of-fact attitude and positive expectation of the client
Behavior modification therapy
Promote effective individual coping with anxiety
Improved fluid volume