___________________________________________________________ Chapter 56 Psychiatric Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
50-Minute Lesson Plan
Lecture Outline 60minutes
Slide 24
4
&
Manifestations
• Characterized by excessive fear, anxiety, and related behavioral disturbances
• Signs and symptoms: increased heart rate, elevated blood pressure, sweaty palms,
Slide 25
Types of Anxiety Disorders
• Mild anxiety can be useful
• May motivate a person to take constructive action or focus attention on a particular
task
• Moderate anxiety often considered the optimal level for learning to take place
• As anxiety progresses to severe or panic levels, an individual’s ability to think clearly and
to solve problems become impaired
• All people experience anxiety
• For most it is episodic; does not interfere with day–to-day functioning
• Treated with benzodiazepines and SSRIs
TALKING POINTS:
• A person in a panic state may misperceive surrounding events altogether and may react
impulsively by running or striking out.
• When is a person determined to have an anxiety disorder?
Slide 26
Panic Disorder
• The person experiences recurrent panic attacks, which are episodes of intense
apprehension of variable length, at times to the point of terror, and are often accompanied
by feelings of impending doom
• Physical symptoms of severe anxiety, such as increased pulse, elevated blood pressure,
trembling, diaphoresis, shortness of breath, chest pain, and nausea also are present
Specific Phobia
• Patient experiences marked, persistent fear that is excessive, unreasonable or both
Slide 28
Agoraphobia
• The person is extremely fearful of situations outside the home
TALKING POINTS:
• Often includes fearfulness that the person may be in a place from which quick escape
would be difficult (e.g., a grocery store) or a place where help may be unavailable.
• How does a person usually cope with agoraphobia?
16 Chapter 56 Psychiatric Disorders ____________________________________________________________
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LESSON 56.2
Slide 29
Obsessive-Compulsive Disorder
• Recurrent obsessions (thoughts) or compulsions (behaviors), or both, that produce
distress, are time-consuming, and interfere with functioning
• Obsessions involve intrusive thoughts about unpleasant or even violent acts that a person
cannot stop
TALKING POINTS:
• What are examples of compulsions that may be experienced?
Slide 30
Posttraumatic Stress Disorder
• Cluster of symptoms following distressing event that is outside the range of normal
events; person experienced intense fear, helplessness, and/or horror
• Symptoms: reexperiencing the trauma through repeated and intrusive recall; avoiding
Slide 31
Acute Stress Disorder
• Person exposed to distressing event, outside of normal events
• Intrusion symptoms, negative mood, dissociative symptoms, avoidance symptoms,
arousal symptoms
Slide 32
Somatic Symptom Disorder
• Individual experiences multiple, current physical symptoms that are distressing, disrupt
daily life
• Disorder persistent, may involve pain
Slide 33
Conversion Disorder
• Symptoms may include blindness, deafness, or paralysis of the legs without a physiologic
cause
• Usually symptoms are neurologic and occur in response to some threatening or traumatic
event
___________________________________________________________ Chapter 56 Psychiatric Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
Slide 34
Illness Anxiety Disorder
• (Formerly known as hypochondriasis) Individuals convinced that they have a serious
medical problem in spite of the absence of any concrete medical findings
TALKING POINTS:
• Person will seek other opinions if one provider does not validate their concerns, and they
often take multiple prescription medications from various health care providers.
• Concern about the feared illness often becomes a central part of people’s lives and may
impair social, occupational, or other important areas of functioning.
• Are people with hypochondriasis aware that their concerns are excessive or
unreasonable?
Dissociative Disorders
• A change in identity, memory, or consciousness
Slide 36
Dissociative Disorders (cont.)
• In a sense, persons unconsciously dissociate or remove themselves psychologically from
anxiety-provoking situations
• Dissociative amnesia: a gap in memory, usually of a traumatic or stressful nature, that
is too extensive to be explained by normal forgetfulness
• Dissociative identity disorder is a relatively rare dissociative disorder in which two or
more distinct personalities exist within the person and repeatedly take control of the
person’s behavior
• Many patients report severe childhood abuse
TALKING POINTS:
• Even normal people may experience depersonalization under severe stress; they feel
they are outside of themselves or floating overhead watching what is happening, as if it
were happening to someone else.
• What are the five major types of amnesia?
Slide 37
Medical Treatment
• Drug therapy
• Anxiolytic (antianxiety)
• Benzodiazepines
TALKING POINTS:
• Side effects are those associated with sedation, such as drowsiness, fatigue, dizziness,
and confusion.
• What may occur with abrupt cessation of benzodiazepines?
18 Chapter 56 Psychiatric Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
6
Slide 38
Care of the Patient with Anxiety, Somatoform, or Dissociative Disorder
• Assessment
• Patient’s symptoms and objective observations help determine the presence and level
of anxiety (mild, moderate, severe, or panic). Relevant mental status examination
categories include motor activity, speech and language, and thought content
7
Care of the Patient with Anxiety, Somatoform, or Dissociative Disorder (cont.)
• Interventions
• Remain calm; speak firmly with short, simple instructions; and walk to a less
Slide 40
Care of the Patient with Anxiety, Somatoform, or Dissociative Disorder (cont.)
• Interventions
• Anxiety
• Ineffective coping
5
Slide 41
Schizophrenia
• 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
TALKING POINTS:
• Positive symptoms appear to reflect an excess or distortion of normal functions and
include delusions, hallucinations, problems with communication, and bizarre behavior.
Slide 42
Schizophrenia (cont.)
• Cause and risk factors
• The cause is not certain
• Stress-diathesis model
TALKING POINTS:
• What biologic factors are thought to influence the development of schizophrenia?
___________________________________________________________ Chapter 56 Psychiatric Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
4
Slide 43
Schizophrenia (cont.)
• Medical treatment: drug therapy
• Neuroleptic (antipsychotic), antiparkinsonian drugs
• Anxiolytics administered with the neuroleptics
• Side effects
• Agitation and akathisia
• Orthostatic hypotension
6
Slide 44
Schizophrenia (cont.)
• Assessment
• Appearance
• Activity
• Mood and affect
7
Slide 45
Schizophrenia (cont.)
• Interventions
• Acute confusion
• Disturbed sensory perception
• Impaired verbal communication
• Ineffective self-care management
Slide 46
4,
Schizoaffective Disorder
• Similar features to schizophrenia, with additional symptoms of major mood disorder
4
&
Mood Disorders
• Significantly elevated or depressed moods
• An episode of persistent depressed mood is major depression
TALKING POINTS:
• Major depression is one of the most common psychiatric disorders, with a 12-month
20 Chapter 56 Psychiatric Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
Slide 48
Mood Disorders (cont.)
• Cause and risk factors
• Definite causes have not been established
• Probable causes: neurotransmitter dysregulation, neuroreceptor deficits,
Slide 49
Mood Disorders: Medical Treatment
• Drug therapy
• Antidepressant medications
• Selective serotonin reuptake inhibitors (SSRIs), newer agent antidepressants
such as nefazodone (Serzone), venlafaxine (Effexor), and duloxetine (Cymbalta),
tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs)
• Manic medications
• Lithium or divalproex (Depakote)
TALKING POINTS:
• When administering medications, the nurse is responsible for ensuring that medication
has been swallowed, as opposed to being held in the mouth and later discarded or saved
Mood Disorders: Medical Treatment (cont.)
• Electroconvulsive therapy (ECT)
• Electrical current is introduced to the brain through electrodes placed on the temples
TALKING POINTS:
• This type of therapy most often is prescribed when other forms of therapy have failed with
people who are severely depressed.
• What are the key nursing interventions for the patient having electroconvulsive therapy?
7
Slide 51
Mood Disorders (cont.)
• Nursing Care of the patient with major depression: assessment
• Activity
• Mood and affect
___________________________________________________________ Chapter 56 Psychiatric Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
Slide 52
Mood Disorders (cont.)
• Nursing care of the patient with major depression
• Interventions
• Risk for self-directed violence
• Chronic or situational low self-esteem
• Imbalanced nutrition: Less than body requirements
• Disturbed sleep pattern
Slide 53
Mood Disorders (cont.)
• Nursing Care of the patient with Bipolar Disorder with Manic Episodes: Assessment
• Appearance
• Activity
Slide 54
Mood Disorders (cont.)
• Nursing care of the patient with bipolar disorder with manic episodes
• Interventions
• Risk for injury
• Risk for other-directed violence
• Imbalanced nutrition: Less than body requirements
• Disturbed sleep pattern
5
Cognitive Disorders
• Impairments in cognition or memory
Cognitive Disorders (cont.)
• Causes of delirium are meningitis, neoplasms, drugs ranging from alcohol to steroids,
6
Personality Disorders
• Avoidant personality disorder—social inhibition accompanied by feelings of inadequacy
and hypersensitivity to negative evaluation
TALKING POINTS:
• When personality traits become inflexible and dysfunctional, a person may have a
personality disorder.
• What are the essential features of a personality disorder?
22 Chapter 56 Psychiatric Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
Slide 58
Personality Disorders (cont.)
• Antisocial personality disorder—disregard for and violation of the rights of others
• Borderline personality disorder—instability in interpersonal relationships, self-image, and
affect; marked impulsivity
• Narcissistic personality disorder—grandiosity, need for admiration, and lack of empathy
Slide 59
Borderline Personality Disorder
• Person has unstable relationships, unstable self-image, and unstable mood
• Two theories
• First, because families of patients with this disorder have a greater history of
alcoholism, a genetic influence is thought to exist
• The second explanation is related to particular developmental experiences
7
Borderline Personality Disorder (cont.)
• Nursing care of the patient with borderline personality disorder: Assessment
• Mood, affect, feelings: patient may experience mood swings or chronic feelings of
Slide 61
Borderline Personality Disorder (cont.)
• Interventions
• Risk for self-directed violence/Risk for self-mutilation
• Impaired social interaction
• Disturbed personal identity
___________________________________________________________ Chapter 56 Psychiatric Disorders 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
Activities
Classroom Choose from below to make 30 minutes
4
DISCUSS
• Discuss anxiety disorders, including
physiologic and psychologic manifestations.
• Discuss panic disorder, agoraphobia,
obsessive-compulsive disorder, and
posttraumatic stress disorder.
• Discuss the symptoms and offer descriptions
of illness anxiety disorder.
• Discuss dissociative disorders.
PRACTICE
• Divide the class into small groups. Assign
each group an anxiolytic drug listed in Drug
Therapy (p. 1290). Using a drug reference,
have each group develop an information
sheet about its assigned medication. The
24 Chapter 56 Psychiatric Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
4
• Divide the class into groups. Using a drug
reference, have each group choose a class
of medication used to treat mood disorders.
Have the groups develop a summary of the
medication, including what behaviors and
symptoms it is used to treat, as well as any
potential side effects, special information,
and considerations about the medications.
5
DISCUSS
• Discuss schizophrenia. Describe the
disorder, define psychosis, and review the
cause and risk factors.
• Invite a psychiatric nurse to speak to the
class about the current thinking associated
PRACTICE
• Facilitate a class discussion about the cause
of mood disorders. Encourage students to
identify different etiologies. What is known
___________________________________________________________ Chapter 56 Psychiatric Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
6
DISCUSS
• Discuss main features of the mental status
examination, and what will be assessed with
patients with anxiety disorders,
schizophrenia, mood disorders, cognitive
disorders, and personality disorders.
PRACTICE
7
DISCUSS
• Discuss nursing care of the patient with an
anxiety disorder, somatoform disorder, or
dissociative disorder.
• Invite a psychiatric nurse to speak to the
class. Ask the nurse to discuss assessment
of patients with mental illnesses such as
anxiety disorders, mood disorders, or
personality disorders. Have the nurse
• Discuss nursing care of the patient with
major depression.
• Discuss nursing care of the patient with
bipolar disorder.
• Discuss cognitive disorders.
• Discuss the common causes of delirium and
common types of dementia.
• Discuss the essential features of a
personality disorder. Discuss examples of
26 Chapter 56 Psychiatric Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 56.2
7
PRACTICE
• Divide the class into groups. Describe the
implications for nursing interventions for
schizophrenia. Have the groups present the
information to the rest of the class and have
the class provide feedback.
• Divide the class into two groups. Have them
describe the implications for nursing
Critical Thinking Question
A 26-year-old male patient with schizophrenia is admitted to the psychiatric unit. He is
experiencing a paranoid delusion that the other patients on the unit are agents who are
trying to kill him because he is a foreign spy. What nursing interventions would be
appropriate in dealing with this patient’s delusions?
Instructor Notes/Student Feedback
___________________________________________________________ Chapter 56 Psychiatric Disorders 27
Introduction to Medical-Surgical Nursing, 6th ed.
56
Assessments for
Psychiatric Disorders
CHAPTER OBJECTIVES
Lesson 56.1:
2. Describe key strategies in communicating therapeutically.
3. Describe the components of the mental status examination.
Lesson 56.2:
4. Identify target symptoms, behaviors, and potential side effects for the following types of medications:
antianxiety (anxiolytic), antipsychotic, and antidepressant drugs.
6. Identify key features of the mental status examination and their relevance in anxiety disorders,
schizophrenia, mood disorders, cognitive disorders, and personality disorders.
7. Identify common nursing diagnoses, goals, and interventions for people with anxiety disorders,
schizophrenia, mood disorders, cognitive disorders, and personality disorders.
Assessments by Lesson & Objective
Lesson 56.1
1
Study Guide
• Part IA: 3, 5-7 (p. 383)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 4
2
Study Guide
• Part ID: 1-8 (p. 385)
• Part IIF: 28, 29 (p. 388)
Evolve Instructor Resources
• Test Bank: 3, 4
Evolve Student Resources
• NCLEX Review: 5, 10
3
Study Guide
• Part IA: 4 (p. 383)
Evolve Instructor Resources
• Test Bank: 5, 6, 29
• Open Book Quiz: 3, 4, 5
Evolve Student Resources
• NCLEX Review: 6
• Prioritization: 1
28 Chapter 56 Psychiatric Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
Lesson 56.2
4
Study Guide
Evolve Instructor Resources
• Test Bank: 11, 14, 15, 17, 22
• Open Book Quiz: 9
Evolve Student Resources
• NCLEX Review: 2, 8
5
Study Guide
• Part IIF: 18, 22, 24, 25 (p. 387)
Evolve Instructor Resources
• Test Bank: 16
Evolve Student Resources
6
Study Guide
• Part IA: 2 (p. 383)
• Part IB: 1-18 (p. 384)
• Part IIF: 1-6, 10, 14, 19-21, 23, 30 (pp. 386-388)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 1, 3
7
• Prioritization: 2
Study Guide
• Part IIF: 9, 12, 13, 15-17, 32 (pp. 386-388)
Evolve Instructor Resources
• Test Bank: 12, 19, 21, 22
Evolve Student Resources
Instructor’s Notes/Student Feedback