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Psychological Integrity Part 3

  1. Use of psychoactive drugs (prescription or "street"): stimulants, depressants, hallucinogens, and narcotics

    1. Stimulants

      1. include cocaine, crack, amphetamines

      2. effects of abuse of stimulants

        1. psychomotor agitation

        2. mood swings

        3. tachycardia

        4. hypertension

        5. dilated pupils

        6. perspiration and chills

        7. insomnia

        8. impaired cognitive function

        9. seizures

        10. if discontinued, withdrawal  follows

      3. overdose may cause lethal cardiac or respiratory arrest

      4. emergency care of overdose on stimulants: cardiopulmonary support

    2. Depressants

      1. include barbiturates, tranquilizers, sedatives and hypnotics

      2. findings of depressant use

        1. slurred speech

        2. impaired cognitive function; confusion

        3. emotional lability

        4. lack of coordination

        5. cold and clammy skin

        6. produce withdrawal symptoms 

      3. overdose can lead to respiratory depression, coma

      4. emergency care of overdose

        1. respiratory support

        2. keep client awake and moving

    1. Narcotics

      1. include: heroin, morphine, meperidine, codeine, methadone

      2. findings

        1. euphoria

        2. tranquility

        3. drowsiness

        4. constricted pupils

        5. clouded sensorium

      3. overdose threatens life: depresses respiratory function and alters level of consciousness

      4. emergency care includes cardiopulmonary support (illustration 1   illustration 2   illustration 3 )

    2. Hallucinogens

      1. include: LSD, PCP, marijuana, mescaline, psilocybin

      2. findings

        1. tachycardia

        2. hypertension

        3. dilated pupils

        4. hallucinations

        5. nausea

        6. impaired attention and judgment

        7. aggressive behavior

      3. potentially life threatening

      4. potentially psychotic long-term effects

  2. Treatment: drug rehabilitation

  3. Nursing care in substance abuse

    1. Protect the client and others from harm

    2. Help client through drug rehabilitation as indicated

    3. Provide emotional support

    4. Help the client develop a support system

    5. Provide emergency care for overdose

  4. Autism
    1. Definition: syndrome in which child does not relate to people
    2. May become attached to objects

    3. Develops before age three

  5. Etiology unknown

  6. Findings

    1. Does not respond to human touch

    2. Lack of eye contact

    3. Talks poorly or not at all

    4. Ritualistic behavior

    5. Cannot deal with change

    6. Emotional lability

    7. May be self destructive (head-banging, hair pulling, finger/hand biting)

    8. Failure to develop friendships or play with other children

    9. Posture or gait abnormalities: poor coordination, tiptoe walking, peculiar hand movements (flapping, clapping)

  7. Treatment

    1. Special education

    2. May need full time care (institution)

  8. Nursing care

    1. Support parents emotionally

    2. Protect the child from self harm

    3. Help child with hygiene and feeding as indicated

    4. Maintain consistency in schedule

    5. Allow ritualistic behavior

  9. Abuse Syndromes
    1. Definition - abuse may be physical, sexual, psychological or physiological
    2. Victims powerless to stop abuse

    3. May be directed toward a child, a spouse, the elderly

    4. Rape is a violent sexual abuse

    5. Abusers

      1. often blame victim

      2. demonstrate poor impulse control

      3. have frequently been victims of abuse themselves

  10. Findings

    1. Physical abuse

      1. broken bones and/or dislocations

      2. welts, and/or bruises

    2. Sexual abuse

      1. bruising or bleeding in genital or anal area,

      2. pain or itching in genital area,

      3. rape, evidence of sexual intercourse,

      4. genitourinary infections

    3. General neglect

      1. malnutrition

      2. habitual behaviors: rocking, head banging

      3. learning disorders

      4. social isolation

      5. aggressive behavior

  11. Treatment

    1. In general, cases of abuse must be reported (refer to state statutes for variations)

    2. Removal of victim from source of abuse

    3. Protective services

    4. Directing abuser to help or therapy

  12. Nursing care

    1. Provide emotional support

    2. Document all signs of abuse

    3. File appropriate reports (report of suspected abuse is mandatory in most states)

    4. Assist in placement for protection

    5. Assist abuser in obtaining appropriate counseling

  13. Eating Disorders
  14. A subcategory of disorders that includes multiple types of eating behavior disturbances

  15. Types of eating disorders

    1. Anorexia nervosa

      1. weight loss through restriction of food intake leading to emaciation

      2. may involve purging behaviors

      3. tend to reject mature-appearing body

      4. tendency to asceticism

    2. Bulimia nervosa

      1. eating binges alternate with dieting or purging

      2. purging behaviors may include self-induced vomiting, misuse of emetics and cathartics or laxatives

      3. more likely than those with anorexia to show impulsive or chaotic behavior

      4. usually near normal weight

      5. tend to be outgoing and sensitive to others

      6. major issue: control self/environment through eating behaviors

      7. drive for thinness

      8. population at risk

        1. adolescents and young adults

        2. in industrialized countries

        3. models, dancers and gymnasts at higher risk

      9. potentially life threatening

  16. Etiology

    1. Psychoanalytic theory

      1. conflicts stem from oral phase of development

      2. clients often have anxious, compulsive mothers

      3. obsessive-compulsive control of body and life, via food

      4. controlling bodily functions is critical to client's attempt at self-control

    2. Interpersonal theory

      1. results from dysfunctional family relationships

      2. parents avoid their own conflicts by controlling child

      3. child's self-identity becomes blurred

      4. during adolescence parents become overcontrolling and demanding

      5. demands thwart client's attempts at autonomy

      6. adolescent attempts to control self through controlling food intake.

    3. Cognitive theory

      1. eating-disorder behaviors are learned

      2. society glorifies thinness

      3. for the adolescent or young adult, thinness equates with self-worth.

  17. Findings of eating disorder

    1. Personal relationships become superficial and distant

    2. Social contact avoided especially if food is involved

    3. Preoccupation with food, meal planning, caloric intake and methods to avoid eating

    4. Eats in private

    5. Mood irritable and defiant

    6. Exercises excessively

    7. Physical findings

      1. weight falls below 85% of normal

      2. bradycardia

      3. anemia

      4. amenorrhea

      5. decreased renal function

      6. dental problems

      7. fluid and electrolyte imbalances

      8. delayed skeletal maturation

  18. Treatment of eating disorders

    1. Objective: to correct underlying cause and prevent complications of weight loss

    2. Client may require hospital care

    3. Nutritional planning

    4. Psychotherapy: individual and/or family

    5. Group therapy

    6. Occupational therapy

    7. Recreational therapy

    8. If underlying depression, treat with antidepressants

  19. Nursing care

    1. Monitor weight as prescribed

    2. Monitor client's eating/record intake and output

    3. Administer nasogastric feedings if ordered

    4. Encourage oral hygiene

    5. Set limits on eating including time allotted for meals

    6. Stay with client during meals

    7. Accompany client to bathroom after meals to prevent self-induced vomiting

    8. Encourage client to express feelings

    9. Encourage socialization

    10. Monitor for findings of electrolyte imbalance or dehydration

    11. Assist client to identify strengths

    12. Teach client

      1. relaxation techniques

      2. alternative coping methods

      3. assertiveness skills