issues in mental health nursing

mental health nursing issue for special population including women child , victims

1. Mental Health Nursing Issues For Special Populations By Ms Neha Bhatt 1

2. PROBLEMS OF ADOLESCENTS l . Anxiety disorders 2. Conduct disorders 3. Mood disorders 4. Schizophrenia 5. Eating disorders 6. Deliberate self harm 7. Alcohol and substance abuse 8. Sexual problems 2

3. Nursing responsibility l . Assessment for high risk behavior 2. Provide medical treatment as ordered 3. Give support and behavioral therapies 4. Establish a therapeutic relation with client   5. Involve family members in planning and implementing therapies 6. Plan for appropriate referral services 7. Treat adolescent as individual client 8 Educate family on communication pattern 3

4. PROBLEMS OF WOMEN l. Premenstrual syndrome 2. Postpartum depression 3. Puerperal psychosis 4. Maternity blues 5.  Menopausal syndrome 4

5. PREMENSTRUAL SYNDROME It is a condition that affects a woman's emotions, physical health  and behavior just before her menstrual period. Start 5 to 11 days before menstruation and go away once menstruation begins. 5

6. PREMENSTRUAL SYNDROME The cause of PMS is unknown and change in hormone levels at the beginning of the menstrual cycle may caused PMS. Levels of estrogen and progesterone increase during certain times of the month which can cause mood swings, anxiety, and irritability . 6

7. Risk factors for premenstrual syndrome include A history of depression or mood disorders (such as postpartum depression or bipolar disorder) A family history of depression symptoms Breast swelling and tenderness, acne, food cravings, irritability, mood swings, cry spells 7

8. Management Diuretics Analgesics Oral contraceptive pills Ovarian suppressors Anti depressants ( sos ) General management Provide exercise Provide emotional support Provide enough sleep Adequate nutrition Avoid salt before menstrual period Avoid caffeine and alcohol 8

9. POSTPARTUM DEPRESSION Young age of mother, Low thyroid levels, Stress from work or home, Broken sleep patterns History of depression Positive family history of depression Anxiety about fetus, Problems with previous pregnancy It Can occur during pregnancy or within one year of delivery CAUSES 9

10. POSTPARTUM DEPRESSION Feeling irritable, Sadness, hopelessness, Crying spells, Avolition  Withdrawal from friends and family, Sleep disturbances, Less interest in baby Eating too little or too much Symptoms 10

11. POSTPARTUM DEPRESSION Treatment Counseling Cognitive therapy SSRI , TCA Good supervision and support 11

12. POSTPARTUM PSYCHOSIS Auditory / visual hallucinations, Delusions, Insomnia, Sleep disturbances Suicidal thought Obsessed thoughts of baby Agitation, Anger, Irrational guilt, Mood swings Most severe condition, Usually begins within 1- 2 days to 3 months of delivery. Symptoms 12

13. POSTPARTUM PSYCHOSIS Management Individual and group counseling Close follow up CBT Antipsychotics, ECT Psychotherapy General measures Exercise & rest Balance diet Support group help Don’t join work soon 13

14. MATERNITY BLUE Occurs mostly on 4th or 5th day after delivery in 30-85 % women Causes Prenatal depression, Low self esteem, Child care stress, Low social support, Poor marital relationship , Unplanned pregnancy Symptoms Dysphoria , Mood liability, Irritability, Hypochondriasis, Anxiety, Insomnia, Impaired concentration, Isolation, headache, 14

15. Management 1. Antipsychotic drugs 2. Mood stabilizers 3. Supportive intervention 4. CBT 5 Reassurance 6. Monitor and supervision 7. Nutritional management 8. Suicidal precautions 15

16. MENOPAUSAL SYNDROME Cessation of ovulation , generally occurs between 45-53 years of age. Hot flashes Sleep disturbances Vaginal atrophy and dryness SYMPTOMS Cognitive and affective disturbances like worrying , depression , anxiety , irritability , difficulty in concentration and decrease self confidence 16

17. MENOPAUSAL SYNDROME Management Hormonal replacement therapy Reassurance Psychological support Early identification of emotional problems and prompt treatment Counseling Psychotherapy 17

18. PROBLEMS OF ELDERLY Developmental tasks l . Establishing satisfactory living relationship 2. Adjusting to retirement income 3. Establishing comfortable routines 4. Maintaining marital and social relationship 5. Keeping active and involved 6. Staying in touch with other family members 7. Sustaining and maintaining physical and mental health 8. Finding meaning of life 18

19. Common mental health problems l . Depression 2. Dementia 3. Delirium 4. Paranoid disorders PROBLEMS OF ELDERLY 19

20. Maintain health by living a healthy lifestyle Provide them strong support social system Help them to adjust and adapt to change Avoid stress producing situation Plan for structured day Help them to Participate in activities such as employment or volunteering SOLVING PROBLEMS OF ELDERLY 20

21. VICTIMS OF VIOLENCE Forms of domestic violence 1 . Physical aggression, 2. Threats 3. Sexual abuse 4. Emotional abuse 5. Controlling or domineering 6. Intimidation 7. Neglect 8. Financial deprivation 21

22. Effect of violence Physical, social, emotional effects, Lowering self esteem, Loss of confidence, Avoidance , Mutism , Depression, Suicidal ideation 22

23. Prevention of violence Learn about type of violence that may occur Recognize early warning signs of violence Work on low self esteem issues Recognize obstacles to responding to violence Build support systems Open communication 23

24. VICTIMS OF ABUSE Types l . Physical abuse 2. Emotional abuse 3.Sexual abuse 4.Financial abuse 5.Neglect 24

25. VICTIMS OF ABUSE CAUSES Family violence Unsatisfactory schooling housing and environment, Parental factors, Mental illness, Marital disharmony, Crime, Chronic illness, Poverty, Poor interpersonal interactions 25

26. VICTIMS OF ABUSE CLINICAL FEATURES Multiple bruising, Burns, Abrasions, Bites, Torn lip, Low self esteem Anger, Guilt, Fear, Depression, anxiety, nightmares, Suicidal tendency, Unwanted pregnancy, Self harm, Social withdrawal hemorrhage, Fracture, Genital bleeding, Crying spells, New sexual behaviors in child, 26

27. Management l . Reassurance 2. Talk to parents regarding abuse 3. Treat external injuries 4. Help family to modify behavior 5. Never blame parents 6. Provide legal counseling to victim and family 7. Counseling and guidance 8. Provide reinforcement of healthy traits 9. Treat if Contagious diseases present 27

28. Handicapped They try to excel by compensation They usually are victims of teasing, bullying, casting, insulting remarks, and avoidance by others They experience low self esteem and disturbed body image Only few cope with disability and ignore it 28

29. Handicapped : Strategies to help Focus on what they can do at times Identify child's strength and promote them Keep expectations high, the child is capable of achieving Never accept rude or negative remarks towards these children. 29

30. Handicapped : Strategies to help Give compliment and positive encouragement for their achievements Make adjustments and accommodations when ever possible, for the child to participate in but Never pity them Encourage independent activities Ensure safe measures for the child 30

31. HIV/ AIDS Psychosocial issues related to the diagnosis Behavioral problems, Fear, Loss, Isolation, Resentment, Depression, Anxiety, Anger, Suicidal thoughts, Low self esteem Psychiatric syndromes due to HIV/ AIDS Depression, Anxiety, Paranoia, Mania, Irritability, Psychosis, Substance abuse, Insomnia, Suicidal ideation 31

32. HIV/ AIDS: Nursing management 1. Multidisciplinary team approach 2. Detailed neuropsychiatry assessment 3. Help patient change risky behavior 4. Provide counseling 5. Clarify doubts if needed 6. Explain window period 7. Review patient's assessment for own risk 8. Provide risk reduction information 32

33. HIV/ AIDS: Nursing management 9. Build rapport 10. Explore patients feelings 11. Implement psychosocial interventions 12. Provide safe sex information 13. Advise for regular medical monitoring 14. Teach about ART and nutritious diet  15. Enable social support networks for patient 33

34. Thank you 34