ASDN 253 Mental Health Nursing

Special Populations

 

 

Children

          Pervasive Developmental Disorders

Autism

-   delayed communication skills, lack of emotion, unable to

play spontaneously, stereotyped movements (self-stimulating)

                             -   75% have comorbid mental retardation

-         MMR vaccinations?

-         symptoms improve with age

-         “mainstreaming”

-         ex: Fauman, p. 32

-         NI:  promote language skills, maintain structure, meds

 

Rett’s Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder

 

http://www.autism-society.org/site/PageServer

 

 

          ADD & ADHD

-   “persistent pattern of inattention and/or hyperactivity and

impulsivity more common than generally observed in children the same age”

-         meds (stimulants)  Ritalin, Concerta, Metadate, Dexedrine, Adderall, Cylert

-  given divided doses - am & noon, or extended release

-  watch weight

 

-         NI:  simple instructions, set limits, establish structure &

routines, positive reinforcement

 

                   http://www.nimh.nih.gov/publicat/adhd.cfm

 

Adolescents

          Oppositional Defiant Disorder

“predominant abnormal behavior is defiance of adult authority with a negative, hostile attitude… no persistent violation of rights of others”

 

Conduct Disorder

“predominant abnormal behavior is the violation of rights of others or of generally accepted social rules”

 

-  Early diagnosis of either often leads to later diagnosis of Antisocial Personality Disorder (after age 18)

 

-  Ex: Fauman, p 52

 

-  NI:  (review p 498) limit setting with consequences, behavioral contracts, time out, establish structure, improve coping skills and self esteem, role model social skills

 

 

Elderly

          Delirium

-  acute, temporary

-  metabolic, infection, injury or medication causes

-  NI:  promote safety, reorient to reality, give realistic reassurances

 

Dementia

          -  chronic, progressive

-  memory loss, deteriorating language (apahasia), deteriorating motor

skills (apraxia), loss of recognition (agnosia), inability to think abstractly

 

                   Alzheimer’s – dementia with personality and behavioral changes

                   Pick’s – similar to Alzheimer’s, but earlier and more rapid course

                   Cruetzfeld-Jacob – caused by infectious encephalapathy, very rapid

         

Dementia common in Parkinson’s, Huntington’s, head trauma, vascular problems, HIV

 

-  NI:  promote safety, encourage supervised autonomy & self-esteem, routine & structure, use reality presentation & distraction when helpful, supportive touch, reminiscence, “going along”, “time away”

-          

Homeless & Incarcerated (p 79-82)

          Prisons – up to 15% of prisoners may be mentally ill

          Homeless – case worker support very important

 

 

References

 

Fauman, M. A. (1994).  Study Guide to DSM-IV.  Washington: American Psychiatric Press, Inc.

 

 

End of Course Footnotes

 

          Science vs Art in Nursing

                   Hopefully you have learned how to better relate to your patients

                   Tolerance & Understanding

                             use it in all areas of nursing

         

          Nursing is more than passing a test

                   Know where to "look it up"

                   Attitude, Communication, Critical Thinking, Skill

                   Students with the best grades aren't always the best nurses

 

          Be a life-long LEARNER

                   Learn something new every day

 

          Be an ADVOCATE

                   - for your patients and for nursing

 

 

CARING, COMPETENT, CONFIDENT!!!