Interaction of Body and Mind Chapter 67 Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

1. Interaction of Body and MindChapter 67 Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Caring for Clients with Psychobiologic Disorders

2. Brain Structures

3. Limbic System • Controls Emotions and memory • Includes: • Thalamas– modulates movement, sensation, behavior, and emotions • Hypothalamus – controls the autonomic nervous system

4. Receptors • Found on the surface of cells throughout body and brain • Function: Sense and pick up chemical messengers in extracellular fluid • Chemical messenger: Specific key; Natural or synthetic; Neurotransmitters You hold the key To my receptor

5. Neurotransmitters • Endogenous chemical messengers • Synthesized in the neurons • Stored in the vesicles of the Axons • Bind momentarily to receptors on postsynaptic neurons • Broken down • Reuptake • Diluted

6. Neurotransmitters • Serotonin (5-HT) • Imbalances: depression, eating disorders, sleep disturbances, Obsessive–compulsive disorder • Dopamine (DA) • Excess: disorganized thought patterns, Schizophrenia • Deficient: Parkinson’s disease, impaired judgment • Norepinephrine (NE) • Excess: Neurodegenerative diseases • Deficient: depression • Acetylcholine (ACH) • Gamma-aminobutyric acid (GABA) • Glutamate (GT)

7. Neuropeptides • Separate type of neurotransmitter • Substance P • Transmits sensation of pain • Endorphins • Interrupt transmission of substance P. Promote feeling of well-being (morphine-like) • Neurohormones • Endocrine System

8. Receptors for neurotransmitters are found throughout CNS, endocrine, and immune systems • Mind and emotions can affect physical well being • Physical well-being can affect the mind and emotions

9. Psychobiologic illness • Biologic Factors • Neurotransmitters • Psychological Factors • Forces that shape behavior • Intrapersonal Development • Conflicts within oneself • Freud • Interpersonal Interaction • Consequences of social development • Relationships, Interactions, Social Systems • Erikson, Stack-Sullivan • Learning • Positive and Negative reinforcement • Skinner

10. Assessment Findings • Signs and Symptoms • Affect relationships, interfere with responsibilities • American Psychiatric Association • DSM-IV-TR • Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision) • Classifies psychiatric disorders • Psychological Tests • MMPI, MMPI-A, Beck, DAP, WAT, TAT, Rorschach • Diagnostic Findings • CT, MRI, EEG, PET, QEEG, Brain mapping • Mental Status Examination

11. Mental Status Examination • Physical appearance • Orientation • Attention and concentration • Short-term and long-term memory • Movement and coordination • Speech problems • Mood • Intellectual performance • Perception • Insight • Judgment • Thought content

12. Mental Status Examination • What is the year? • What is today date? • In what city are we in? • Spell globe backward • Repeat the following sentence: “A rolling stone gathers no moss.” • Write a sentence of your own choice. • Evaluate the sentence. • Does it have a subject, verb, object?

13. Medical and Nursing Management • Determined by the disorder • Drug therapy • Correcting the underlining biochemical abnormality • Psychotherapy • Talk therapy • Freudian • Cognitive therapy • Changing the patterns of thought • Self help books • Behavioral therapy • Behavior modification • Pavlov

14. Psychosomatic function • Role of Stress on Health • Stress implicated in development or exacerbation of • Autoimmune disorders • Thyroid conditions • Heart disease • Diabetes • Chronic pain • Functional and inflammatory disorders of the GI system • Anorexia nervosa • OCD • And on and on and on…

15. Stress • Eustress • Maintaining a healthy balance • Just right amount of stress • Distress • Ill-timed • unrelieved • General Adaptation Syndrome

16. Stress Response • Physiologic • Autonomic Nervous System • Sympathetic • Norepinephrine • Fight or flight • Parasympathetic • Frozen with fear • Psychologic • Coping Mechanisms • Temporarily avoid the emotional effects of a stressful situation • Used correctly they maintain psychological equilibrium • Overuse causes dysfunction • Hardiness

17. Psychosomatic Illnesses Psyche = Mind Soma = Body “Pertaining to the mind-body relationship” • Also known as stress-related disorders • These are actual medical conditions associated or aggravated by stress • Most illnesses have psychosomatic components

18. Biologic Factors • Stress affects the immune system • The brain sends messages directing the immune system’s actions • Immunopeptides • Cytokines • Function as neurotransmitters • Immune Cells • Secrete neurochemicals • Nerve cells • Connect the immune system to the brain

19. Psychological factors • Anger • Suppressing Anger • Compromised immune system • Excessive Expression of Anger • Heart disease • Dependence • Fear of rejection/abandonment • Heplessness • Powerless • Increase illness • Ambivalence • Unresolved conflicts • Affect immune systme

20. Assessment Findings • Signs and Symptoms • Stress-prone • Diagnostic Findings • Rule out other conditions

21. Medical and Nursing Management • Stress Management Techniques • Relaxation techniques • Coping strategies • Anger management • Assertiveness training • Support Groups • referral • Nutrition • Depending on individual

22. The Placebo Effect • Healing or improvement that takes place because the individual believes a treatment will be effective • Observed during research trials • We can not use placebos in practice

23. Caring for Clients with Anxiety DisordersChapter 68 Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Caring for Clients with Psychobiologic Disorders

24. Anxiety and Fear • Anxiety • A vague uneasy feeling, the cause of which is not readily identifiable. Evoked when a person anticipates nonspecific danger • Fear • A feeling of terror in response to someone or something specific that a person perceives as dangerous or threatening

25. Levels of Anxiety • Mild • Attention and sensory perception increased, reality intact, person feels in control. HR, BP, RR slightly increased, perspiration noticeable. Good for learning. • Moderate • Concentration slightly impaired, learning takes more effort, irritable, may feel inadequate. Hand or leg tremors, voice changes • Severe • Cannot concentrate or stay focused, person feels discomfort and incompetent. Palpitations, hyper-ventilation, limited communication • Panic • Thoughts fragmented, learning not possible, feel helpless, speech incoherent, dyspnea, tremors, diaphoresis

26. Anxiety • Anxiety disorders sometimes have familial patterns • Symptom manifestations caused whennorepinephrine floods the limbic system • Biochemical changes brought on by the ANS trigger physical arousal in cortex and neuroendocrine pathways • Biochemical mechanisms • Dysregulation of gamma-aminobutyric(GABA) • Depletion of serotonin

27. Anxiety Disorders • Psychobiologic illness that results from activation of the autonomic nervous system • Tends to be chronic • Appears without logical explanation • Sometimes leads to other psychobiologic conditions • Depression • Substance abuse • Binge eating disorder • Compulsive eating

28. Generalized Anxiety Disorder • Chronic worrying on a daily basis for 6 months or more. • Usually more than one focus of worry • Usually out of proportion with reality • Signs and symptoms of anxiety accompany client’s distress

29. Panic Disorder • Abrupt onset of physical symptoms • Intense apprehension, tachycardia, palpitations, chest pain, smothering, choking sensations, hyperventilation, lightheadedness, feeling of impending doom, fear of fainting, dying, losing control, or going insane • Lasts minutes to less than an hour then subsides • Often referred to as attacks, interrupt daily activities • First instinct is to escape to safety • Unexplained fight from work, school, etc • Learn to avoid events that trigger attacks • Can lead to phobias • Agoraphobia-fear of experiencing a panic attack in public

30. Phobic Disorder • Person manifests an exaggerated fear • Insects, animals, heights, flying, enclosed spaces, etc • Social Phobia • Common phobia • Client afraid they will be embarrassed or criticized

31. Post Traumatic Stress Disorder • Delayed anxiety response 3 months or more after an emotionally traumatic experience. • Must be extraordinarily severe to cause PTSD • Involve actual or threatened death or injury to self or others • Produce fear, helplessness, or horror • Psychic Numbing • Initially avoid dealing with the tragedy and detaches from the situation • Flashbacks • Memories or recurrent nightmares in which the client feels as if they are reliving the event.

32. Obsessive Compulsive Disorder • Performance of an anxiety-relieving ritual (compulsion) that relieves a disturbing, persistent thought (obsession). • Anxiety escalates if ritual is stopped, interrupted, altered, or forbidden. • Clients recognize their thoughts and behaviors are absurd, but they are helpless to stop independently. • May lead to problems in social relationships, failure in school, or loss of employment

33. Assessment Findings • Most Clients seek treatment for physical signs and symptoms • Palpitations • Increased BP, HR, RR • Chronic fatigue • Headaches • Sleep disturbances • Some will seek treatment due to unrealistic worries, flashbacks, performing rituals

34. Nursing Care • Building Trust • Be available and attentive • Avoid leaving anxious clients alone • Restoring Comfort • Providing relief. Asking client to suggest methods that may be personally comforting • Modifying Communication • Avoid interrupting anxious clients • Reduce distracting stimuli • Verbalize client’s right to privacy • You may offer a referral to a health professional such as a psychologist or social worker • Respect your client’s right not to discuss their anxieties and fears if they choose not to

35. Nursing Care • Adjusting Teaching • Limited attention and concentration • Provide simple and repeated directions • Determine level of comprehension • Reductions in sensory stimulation • Avoid expecting the client to show a great deal of self-reliance • Helping Problem-Solve • Step-by-step problem-solving process • Talking helps to process information and explore methods for dealing with problems • Avoid giving advise or influencing decisions • Advocate on the client’s behalf • Ensuring safety • Remain calm and reduce anxiety • One nurse interaction • Unstable client-avoid getting physically close

36. Medical Management • Drug Therapy • Reduce or block levels of norepinephrine • Normalize levels of serotonin • Avoid caffiene • Benzodiazepines • Xanax, Ativan, Valium • May lead to drug dependence • Abrupt discontinuation can lead to withdrawal symptoms • Nonbenzodiazepines • Buspar, Paxil, Luvox • beta-adrenergic blockers • Inderal, Tenormin, Lopressor • central-acting sympatholytics • Catapres, Aldomet, Wytensin

37. Medical Management • Cognitive Therapy • Alter irrational thinking, correct faulty belief systems, and replace negative self-statements with positive ones • Behavioral Therapy • Extinguish undesirable responses by learning other adaptive techniques • Desensitization-AKA exposure therapy

38. Caring for Clients with Mood DisordersChapter 69Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Caring for Clients with Psychobiologic Disorders

39. Mood Continuum and Mood Disorders • Mood • Overall feeling state. Continuum with extremes of emotions

40. Major Depression

41. Mood Disorders • Affect • Nonverbal behavior that communicates feelings • Euthymic • Normal moods • Manic • Frenzied state of euphoria • Depressed • A persistent sad mood

42. Major Depression • Reactive (Secondary Depression) • Attributed to a situation, usually self-limiting • Major Depression • Sad mood with no obvious relationship to events

43. Major Depression • Genetics • Prevalent among close blood relatives • Neuorotransmitterdysregulation • Imbalance of Serotonin, Norepinephrine, Dopamine • Neuroendocrine Imbalance • Changes in hormone levels (Cortisol, Thyroid) • Influence of the hypothalamus

44. Major Depression • Signs and symptoms • Persistent sad mood • Physiologic changes • Cognitive changes • SAD IMAGES • Diagnostic Findings • 5-HIAA • Blood levels of neurotransmittters • Clinical presentation • CT, MRI, PET • R/O thyroid, brain tumor, etoh/sedative use, withdrawal, hypoxia, side effects

45. Major Depression • Tricyclic antidepressants • block reuptake of serotonin and norepinephrine • Monoamine oxidase inhibitors (MAOIs) • Block enzyme that breaks down monoamines • Selective Serotonin reuptake inhibitors • Block reuptake of serotonin and some norepinnephrine • Serotonin norepinephrine reuptake inhibitors • Block reuptake of serotonin, norepinephrine and reduces sensitivity to glutamate • Atypical antidepressant drugs • Buproprion, maprotiline

46. Major Depression • Serotonin Syndrome • Excessive serotonin in the blood • Multiple classes of antidepressants • Not enough weaning time • Other serotonergic agonists combined with antidepressant therapies • Treatment • Temporarily withhold antidepressants

47. Major Depression • Psychotherapy • Psychodynamic • Cognitive • Behavioral • Electroconvulsive Therapy • Electric stimulus to one or both temporal regions, produce brief seizure • Vagus Nerve Stimulation • Deep Brain Stimulation • Transcranial Magnetic Stimulation

48. Seasonal Affective Disorder • Pathophysiology, Etiology • Prevalence: Winter months only; States north of 40 to 50 degrees of latitude • Primitive biologic response; Triggered by photoperiods; Melatonin • Assessment Findings: Bimodal depression; Cycles with the seasons • Winter: Sleepy, fatigued, lethargic; Irritable Unable to concentrate; Suicidal; Increased craving for carbohydrates; Poor social interaction

49. Seasonal Affective Disorder

50. Seasonal Affective Disorder • Assessment Findings: Spring • Lifting of spirits; Feeling energetic and motivated; Hyperactive; Euphoria; Remains until late fall • Medical Management • Phototherapy: Use of artificial light • Move to sunny location • Nursing Management