ANXIETY

⊗ Vague sense of impending doom Nursing Management:

⊗ Subjective response to stress ⊗ Calm
⊗ Is a state of apprehension, uneasiness, uncertainty or ⊗ Administer medications
tension experienced by an individual in response to an ⊗ Listen
unknown object or situation. ⊗ Minimize environmental stimuli

Signs and symptoms:

ANXIETY DISORDERS
Mild
⊗ Physical - ↑PR, RR, BP, pupillary dilatation, sweating Panic Disorder
⊗ Cognitive - Attentive and alert ⊗ An individual may suddenly experience frightening and uncomfortable
⊗ Emotional - Minimal use of defenses symptoms
⊗ May include terror, sense of unreality or fear of loosing control
Moderate ⊗ Attack: 1 minute and 1 hour
⊗ Physical - Nausea, Anorexia, Vomiting, Diarrhea, Constipation,
Restlessness Phobic Disorder
⊗ Cognitive - narrowed perceptual field & selective inattention ⊗ Phobia is an irrational fear of an object, place, activity or situation.
⊗ Emotional - use of any defense mechanism available ⊗ Avoidance will allow the individual to be free from anxiety.

SEVERE Examples:
⊗ Physical - s/sx becomes the flow of attention  Agoraphobia - fear of open places and of being alone in public places.
⊗ Cognitive – perceptual field is greatly narrowed, focus of attention is trivial  Social phobia - irrational fear of criticism, humiliation or embarrassment.
events  Acrophobia - fear of heights
⊗ Emotional – defense mechanism operate  Algophobia - fear of pain
 Claustrophobia - fear of enclosed place
PANIC
 Thanatophobia - fear of crowds
⊗ Physical – s/sx of exhaustion ignored
 Pathophobia - fear of disease
⊗ Cognitive – personality disorganized
 Monophobia - fear of being alone
⊗ Emotional – defense mechanism fail
Generalized Anxiety Disorder
Nursing Diagnoses: (GAD)
⊗ Ineffective individual coping ⊗ Unrealistic, excessive anxiety and is unable to control worry.
⊗ Anxiety ⊗ Clients may experience: fatigue, irritability, restlessness, muscle tension,
sleep disturbance

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 ⊗ Clients with ritualistic behavior (obsessive-compulsive disorder) should not
be prohibited or reprimanded.
⊗ Biofeedback, change of the scenery, therapeutic touch, hypnosis, massage
or relaxation exercises.
Obsessive Compulsive Disorder ⊗ Administer medications, as ordered.
⊗ Is characterized by recurrent obsessions and compulsions that interfere ANXIETY RELATED DISORDERS
with normal life.
Somatization Disorder
Obsession ⊗ Free floating anxiety disorder
⊗ Refers to persistent, painful intrusive thought, emotion or urge that one is ⊗ Clients:
unable to suppress or ignore.
 express emotional turmoil or conflict through physical symptoms.
Compulsion
 usually seek for repeated medical attention.
⊗ Refers to repetitious uncontrollable act and sometimes a purposeful act to
 may exhibit antisocial behavior and may attempt suicide.
prevent a certain mistake in an event or situation.
⊗ Associated with anxiety and depression
Post-Traumatic Stress Disorder (PTSD)
⊗ Is the delayed reaction of the person who has been involved or exposed to Conversion Disorder
a traumatic events. ⊗ A condition in which an anxiety-provoking impulse is converted
⊗ Symptoms of this disorder are: unconsciously into functional symptoms.
⊗ Conscious counterpart of malingering
 intense psychological distress
⊗ Examples: Paralysis, blindness, loss of touch or pain sensation, dyspnea,
 feeling of detachment or estrangement from others
seizures or convulsions
 insomnia
 decreased concentration
Hypochondriasis
 avoidance of thoughts and feelings ⊗ An individual presents an unrealistic or exaggerated physical complaints.
 recurrent distressing dreams
⊗ The person becomes, preoccupied with the fear of developing or having
 inability to recall an important aspect of the trauma
already a disease or illness in spite of medical reassurance.
Nursing Interventions
Body Dysmorphic Disorder
⊗ Calm and nonjudgmental approach to convey acceptance.
⊗ Preoccupation with an imagined defect in his or her appearance.
⊗ Use short and simple sentences or words.
⊗ Slight physical abnormality = excessive concern / anxiety
⊗ Help the client develop an increase tolerance to anxiety.
⊗ Help the client to: Dissociative Amnesia
 develop a problem-solving and coping skills of the client. ⊗ Inability to recall extensive amount of important information
 develop the ability to remain calm in anxiety-producing situations. ⊗ Caused by trauma
⊗ Approach: kind-firmness ⊗ Characterized by:
⊗ Systematic desensitization (phobic disorders)  Disorientation

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  Purposeless wandering  More common in women
 Impairment in ability to perform ADL ⊗ Narcissistic (boastful / superiority complex)
⊗ Rapid recovery generally occur  Grandiosity and need for constant admiration
 Exploitation of others for fulfillment of own desire

Anxious or Fearful Personality Disorder (Type C)

⊗ Avoidant (inferiority complex)
PERSONALITY DISORDERS
 Social inhibition
⊗ Are pervasive and inflexible patterns of functioning that is stable overtime,
 Feelings of inadequacy and sensitivity
and leads to distress or impairment.
 Low self-esteem
Types of Personality Disorders:  Social withdrawal in spite of a desire for affection and acceptance
⊗ Dependent (submissive)
Eccentric Personality Disorder (Type A)  Submissive clinging behavior related to excessive need to be cared for
⊗ Paranoid (Suspicious and distrustful) by others
 Persons who display pervasive and long stand suspiciousness  Lack of self-confidence
 More common in men  Perceive self as helpless and stupid
⊗ Schizoid (Socially distant and detached) ⊗ Obsessive-Compulsive (perfectionist)
 Pattern of detachment from social relationship  Preoccupied with orderliness, perfectionism, inflexibility, need to be in
 Chooses solitary activities control
 Topics are inanimate objects and ideas  Formal and serious interpersonal relationship
 Judgmental of self and others
⊗ Schizotypal (Odd and eccentric)
⊗ Passive-Aggressive
 “mild schizophrenia”
 Intentional inefficiency
 Acute discomfort in close relationships
 Passive resistance to demands for adequate performance in both
 Cognitive or perceptual distortion
occupational and social functioning
Dramatic-Erratic Personality Disorder (Type B)
Nursing Diagnosis:
⊗ Antisocial (aggressive and manipulative)
• Ineffective individual coping
 Pattern of disregard for the violation of the rights of others
• Self-esteem disturbance
 Low self-esteem

⊗ Borderline (destructive and unstable) DISORDERS COMMONLY DIAGNOSED TO CHILDREN

 Characterized by patterns of instability in relationships, self image and
mood AUTISM
 Self-mutilating behavior ⊗ Characterized by:
 Affective instability

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  impairment in communication skills ⊗ Repeat instructions as necessary.
 presence of stereotyped behavior, interests and activities. ⊗ Haloperidol - symptomatic relief for hyperactivity, stereotypical and self-
 associated with impairment on social interactions destructive behavior
⊗ treatable but not curable
⊗ more common among boys
⊗ usually diagnosed at age 2 MENTAL RETARDATION
⊗ Main problem: Interpersonal functioning ⊗ Not a mental illness.
⊗ Most acceptable cause: Biological factors - brain anoxia, intake of drugs ⊗ Problem of inadequate mental functioning.
⊗ Onset: 18
⊗ IQ below 70
⊗ Manifested by sub-average intellectual functioning in:
Signs and Symptoms ⊗ Communication
⊗ Odd play Self-care
⊗ Not cuddly Home living
⊗ Echolalia Social skills
Health and safety
⊗ Crying tantrums
⊗ Head towards anything Causes
⊗ Inanimate object attachment ⊗ HIV/ AIDS / rubella infection
⊗ Loves to spin objects / self ⊗ Alcoholic mother
⊗ Difficulty interacting with others ⊗ Thyroid deficiency
⊗ Wants blocks ⊗ Excessive lead poisoning
⊗ Acts as deaf ⊗ Damage to the brain
⊗ Resists normal teaching method / routine changes ⊗ Neurological / neurodevelopmental impairment
⊗ No fear of danger ⊗ Exact gestational age is not reached (premature)
⊗ Insensitive to pain ⊗ Opiate intoxication
⊗ No eye contact ⊗ Nutritional deficiency (lack in Folic Acid)
⊗ Giggling or silly laughing ⊗ Anoxia
⊗ Toxemia (pregnancy-induced hypertension)
Nursing Interventions
⊗ Environmental factors
⊗ Environment: safe & consistent
⊗ Severe RH incompatibility
⊗ Encourage the client to participate for self-care
⊗ Speak calmly when giving instructions
Levels:
⊗ Use simple words or phrases Level IQ Implication

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Mild/moron 51-70 o Difficulty adapting to school Causes: Intranatal factors
o Educable – needs assistance
Moderate/Imbecile 36-50 Poor awareness of needs of others Signs and Symptoms
Trainable – needs moderate supervision ⊗ Obstinacy
Severe/Idiot 20-35 o Unable to learn academic skills ⊗ Negativism
o Poor motor development and minimal ⊗ Egocentrism
speech
o Needs complete and close supervision ⊗ Fighting syndrome
Below o Has minimal capacity for sensorimotor
20 ⊗ Aggressiveness
function
o Needs custodial care with a totally ⊗ Tolerance is low
structured environment
⊗ Difficulty concentrating
Principles of Nursing Care ⊗ Excessive talking
⊗ Protective care ⊗ Fidgeting
Education of the family ⊗ Interrupt/intrudes on others
 Their involvement is an important factor in the plan of care to promote
⊗ Child exhibits hyperactivity
progress and to minimize the stress.
⊗ Repetition ⊗ Indulges in destructive behavior
⊗ Role modeling ⊗ Temper tantrums
⊗ Restructuring
⊗ Focus of Education
Nursing Diagnosis
 Reading • Potential for injury
 Arithmetic
 Writing Principles of Nursing Care:
⊗ Provide nutrition and safety
⊗ Environment:
ATTENTION DEFICIT HYPERACTIVITY DISORDER structured
⊗ Common in boys enable appropriate reaction to the environmental stimuli
⊗ Usually diagnosed before age 7 ⊗ Plan a firm and consistent environment in which limits and standards are
⊗ Problems: set.
⊗ Inattention
⊗ Hyperactivity Drug of choice : Methylphenidate (Ritalin)
⊗ Impulsivity

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DISORDERS COMMONLY DIAGNOSED TO ADULTS  loss of interests in activities

EATING DISORDERS
⊗ More common among females.

Causes:
⊗ Psychological factors
 Parental factors (domineering parents)
 Individual factors (conflict about growing up)
 Sociocultural factors

Anorexia Nervosa
⊗ Main sign: Morbid fear of gaining weight
⊗ Other signs:
 Sensitivity to cold temperatures
 Amenorrhea
 Deliberate self-starvation with weight loss
Findings: (for both)
 Denial of hunger
⊗ Weight loss of 15% or more of original body weight
 Obvious thinness but feels fat
⊗ Amenorrhea
 Lanugo all over the body
⊗ Social withdrawal and poor family and individual coping
 Loss of scalp hair
⊗ History of high activity and achievement in academics, athletics
⊗ Electrolyte imbalance
Bulimia Nervosa ⊗ Depression / distorted body image
⊗ Extreme measures to lose weight Nursing Diagnosis:
 uses diet pills, diuretics or laxatives ⊗ Body image disturbance
 purges after eating ⊗ Ineffective individual coping
 extreme exercise
⊗ Signs of purging Nursing Interventions:
 swelling of the cheeks or jaw area ⊗ Establish a trusting relationship
 cuts and calluses on the back of the hands and knuckles ⊗ Monitor vital signs
 teeth that look clear ⊗ Reinforce:
⊗ Peculiar signs  dietician’s prescription to accomplish realistic weight gain
 depression

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  treatment plan that establishes privileges and restrictions based on Sexual Dysfunction Disorders
compliance ⊗ Sexual Desire Disorders: have little or no sexual desire or have an
⊗ Decrease emphasis on foods, eating, weight loss or gain aversion to sexual contact.
⊗ Weigh client daily at the same time ⊗ Sexual Arousal Disorder: Individuals cannot complete the physiologic
⊗ Remain with the client after meal and for 1st four hours requirements for sexual intercourse
⊗ Set limit on time allotted for eating Examples
⊗ Encourage client to express feelings  Women cannot maintain lubrication
⊗ Promote feeling of control by  Men cannot maintain an erection
 participation in treatment ⊗ Orgasm Disorders: Inability to achieve orgasm phase
 independent decision making Example: Premature ejaculation
⊗ Sexual Pain Disorders: Individuals suffer genital pain (dyspareunias)
Example: Vaginismius
SEXUAL DISORDERS
⊗ Sexuality - is the result of biologic, psychological, social and experimental Paraphilia (Sexual Deviation)
factors that mold an individual's sexual development, self-concept, body ⊗ A term which generally refers to abnormal sexual behavior
image and behavior. ⊗ Lasts for 6 months leading to distress or impairment to functioning.

Phases of the Sexual Response Cycle

⊗ Desire Examples
 the ability, interest and willingness to receive sexual stimulation
⊗ Excitement / Arousal Anilingus tongue brushing the anus
 Result of psychological stimulation Bestiality or Zoophilia contact with the animals
 Example is fantasizing during the desire phase and foreplay which Coprophilia smearing feces on the partner
involves petting and fondling of erogenous zones or areas of the body Cunnillingus tongue brushing the vulva
that are particularly sensitive to erotic stimulation. Exhibitionism  Involves exposing one’s genitals to unsuspecting
⊗ Plateau strangers.
⊗ Orgasm Victims are usually women or children.
 formerly termed as climax  They are stimulated by the effect of shocking the
 the shortest stage in the sexual response cycle victim.
Fellatio inserting the penis into the mouth
 occurs when stimulation proceeds through the plateau stage to a point
where the body suddenly discharges accumulated sexual tension Fetishism inanimate / non-living objects or articles
Frotteurism  Touching or rubbing against the unsuspecting
⊗ Resolution phase
people.
 the final phase of sexual response
 Usually occurs in crowded places where escape is
 organs and body systems gradually return to the unaroused state
into the crowd is possible.
Masochism  Sexual gratification from experiencing pain

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  Involves the acts of being humiliated beaten,
restrained, or otherwise made to suffer
Necrophilia  involves the use of corpses SUBSTANCE-RELATED DISORDERS
Partialism  inserting the penis into the other parts of the body
Pedophilia Alcoholism
 use of prepubertal children
⊗ Is a chronic disease or a disorder characterized by excessive alcohol intake
 could be an actual sexual act or a fantasy
and interference in the individual’s health, interpersonal relationship and
 child is generally 13 years of age or younger
economic functioning. (WHO)
Sadism inflicting pain
⊗ Considered to be present when there is .1% or 10 ml for every 1000 ml of
Telephone Scatalogia  Involves telephoning someone and making lewd,
blood
obscene remarks or conversation.
 AKA sex on phone Signs of use:
Transvestism sexual excitement through wearing the clothing of a ⊗ .1-.2% - low coordination
woman
⊗ .2-.3% - presence of ataxia, tremors, irritability, stupor
Urophilia urinating on the partner
Voyeurism Act of observing unsuspecting person who is naked, in ⊗ .3 and above - unconsciousness
the process of disrobing, or engaging in sexual activity
Includes cyber-voyeurism Progression:
⊗ Pre-alcoholic Phase - starts with social drinking; tolerance begins to
develop
Gender Identity Disorder ⊗ Prodromal Stage - alcohol becomes a need; blockout's occur; denial
⊗ AKA Transexualism begins to develop
⊗ Believe that they were born as the wrong sex ⊗ Crucial - cardinal symptoms of alcoholism develops (loss of control over
⊗ Leads to persistent discomfort and feels inappropriate in the role of the drinking)
assigned sex. ⊗ Chronic Phase - the person becomes intoxicated all day

Nursing Interventions: Outcome:

⊗ Attitude: ⊗ Brain damage
 Accepting ⊗ Alcoholic hallucinosis
 Empathic
⊗ Death
 Non-judgmental
⊗ Accept his feelings related to sexuality
⊗ Have a private area to discuss fears or concerns about sexuality Behavioral problems:
⊗ Intervene to discuss self-esteem issues, anxiety, guilt, and empathy for ⊗ Denial
victims.
⊗ Dependency
⊗ Employ limit setting.
⊗ Demanding
⊗ Referral to the correct clinic.

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⊗ Destructive
⊗ Domineering Wernicke's Encephalopathy
⊗ An inflammatory hemorrhagic degenerative condition of the brain
Alcohol Withdrawal ⊗ caused by B1 deficiency
⊗ Occurs when an individual abruptly stops drinking after alcohol has become ⊗ Symptoms include:
a necessity of life to maintain functioning.  double vision
⊗ Symptoms include:  involuntary and rapid eye movements
 autonomic hyperactivity  lack of muscular coordination
 grand mal seizures  decreased mental function
 psychomotor agitation and anxiety
 increased hand tremors Nursing Diagnosis: Ineffective individual coping
 sleep disturbances (insomnia and nightmares)
Principles of Nursing Care:
 illusions hallucinations
⊗ Well lighted room
 hyperthermia
⊗ Diet as tolerated
 tachycardia (impending delirium tremens)
⊗ Monitor vital signs
Alcohol Withdrawal Delirium ⊗ Administration of glucose
⊗ AKA delirium tremens ⊗ Vitamins
 experienced within 24 to 72 hours after the last intake:
o agitation Alcohol Detoxification:
o elevated vital signs ⊗ Drug of Choice: Disulfiram (Antabuse) - delays the metabolism of alcohol
o illusions and hallucinations ⊗ Avoid alcohol-containing products
o restlessness ⊗ 3 S’s of detoxification:
o hyperalertness  Safety
o incoherent speech  Sedation
⊗ serious medical complications may occur if the client is left untreated  Supplement (Multivitamins, Vitamin B-complex, Vitamin C)

Korsakoff's Psychosis
⊗ Is a form of amnesia DRUG-RELATED DISORDERS
⊗ characterized
Cocaine-Related Disorders
 short-term memory loss
(Stimulants)
 Disorientation
⊗ Cocaine is a white powdered stimulant substance
 inability to learn new skills
⊗ Usually sniffed, snorted, smoked in a pipe or injected into a vein or
 confabulation
subcutaneous tissue.
⊗ Deficiency in vitamin B complex, especially B1 and B12.
⊗ Poor man’s cocaine:

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  Shabu (sha-boo)  unsteady gait
 reduced coordination and reflexes
⊗ Signs of use:  inability to think clearly
 panic attacks  impaired judgment
 insomnia ⊗ Classic sign: bloodshot eyes
 loss of appetite
 impaired thinking ⊗ In large doses, it may cause:
 cocaine psychosis  Hallucination
 agitation  Suicidal ideations
 dilation of the pupils  Delusions of invulnerability
 diaphoresis
 increase VS Long-term Goals:
⊗ Classic sign: Perforated nasal septum ⊗ Community resources
⊗ Can cause a sudden heart attack even in healthy young people. ⊗ Other coping means aside from denial
⊗ Personal responsibility for not drinking / drugs taking
Cannabis-Related Disorders (Cannabinoids)
⊗ Isolation
Marijuana ⊗ Nutrition
⊗ Can act as stimulant or depressant and is often considered to be a mild ⊗ Group therapy
hallucinogen with some sedative properties
⊗ Is not physically addicting but may lead to psychological dependence
⊗ Plant : cannabis sativa SCHIZOPHRENIA AND OTHER PSYCHOSES
⊗ Active component is Tetrahydocannabinol
SCHIZOPHRENIA
⊗ Routes of use:
• Is a serious psychiatric disorder
 Orally (capsules, tablets, on sugar cubes)
• One of the most profound disabling illness
 With food
• Not a single disease entity but a combination of disorders
 Smoked in a pipe or rolled as cigarette.
• "split mind"
⊗ Acts within 15 minutes
• characterized by:
⊗ Effects lasts approximately 2 to 4 hours
o impaired communication
⊗ Physiologic symptoms include
o loss of contact into reality
 increased appetite
o deterioration from a previous level of functioning
 excitement
• Nursing Diagnosis: Altered thought process
 drowsiness
 lowered body temperature • Most acceptable theory: Biologic Theory
 depression
Manifestations: Eugene Bleuler

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 • Associative looseness • Patients with minimal symptoms
• Autism
• Apathy
• Ambivalence General Nursing Interventions:
• Auditory hallucination ⊗ Establish:
Types Distinguishing features Nursing Interventions  a trusting relationship and provide acceptance
Disorganized Peculiar / bizarre behavior ⊗ Assist with ADL  a clear, consistent and open communication
Incoherence ⊗ Set limits
⊗ Encourage activity
Stereotyping ⊗ Decrease environmental stimuli
⊗ Present reality
⊗ Observe for suicidal ideation
Prognosis: Poor ⊗ Administer medications, as ordered.
Defense Mechanism:
Regression MOOD DISORDERS
Paranoid Hallucinations ⊗ Priority: safety of others
Ideas of reference ⊗ Deal with the HID Precipitating Factors
Delusion of persecution ⊗ Offer sealed foods / ⊗ Loss of a loved one
Suspiciousness unopened medicines ⊗ Major life events
⊗ Never displace outbursts of ⊗ Role strain
Prognosis: Good
emotions ⊗ Decreased coping resources
Defense Mechanism:
Projection ⊗ Explain procedures in ⊗ Physiological changes
simple ways
⊗ Never argue with the patient Common Types of Mood Disorder
Catatonic Wax flexibility ⊗ Priority: nutrition & ⊗ Bipolar I Disorder: May experience one or more of symptoms of manic
Stupor circulation episode
Negativism – mutism, rigidity, ⊗ Provide distraction ⊗ Bipolar II Disorder: May experience one or more symptoms of major
lack of response ⊗ Encourage activity depressive episode with hypomania
⊗ Major Depressive Disorder: May be coded as mild, moderate or severe
Prognosis: Good
with or without psychotic features.
Defense Mechanism:
Repression ⊗ Dysthymic Disorder
 Lesser severe than major depression
 No symptoms such as impaired communication, delusions and
Undifferentiated hallucinations
• Patients whose manifestation cannot be easily fitted into one or the ⊗ Cyclothymic Disorder
other type ⊗ DNOS (Depression Not Otherwise Specified) - lasts for 2 days-2 weeks
Residual

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Clinical Symptoms of Major Depressive Episode ⊗ ultimate form of self-destruction
⊗ Affect flat ⊗ "cry for help“
⊗ Weight change (gain or loss) ⊗ reunion wish or fantasy
⊗ Energy loss ⊗ progressive failure to adapt feelings of anger or hostility
⊗ Sad feelings / Social withdrawal ⊗ a way to end feelings of hopelessness and helplessness
⊗ Obvious sleep disturbances ⊗ an attempt "to save face" or seek a release to a better life
⊗ Memory loss Risk Factors
⊗ Emotional blunting ⊗ Sex (more female attempts suicide but more male commits suicide)
⊗ Unsuccessful previous attempt
Clinical Symptoms of Manic Episode
⊗ Talkative or pressured to keep talking ⊗ Identification with a dead family member
⊗ Inflated self-esteem or grandiosity ⊗ Chronic
⊗ Psychomotor agitation ⊗ Illness (e.g. Cancer)
⊗ Exhibit flight of ideas ⊗ Depression/Dependent personality
⊗ Decreased need for help ⊗ Age (18-25 and 40)/Alcoholism)
⊗ Distractibility ⊗ Lethality of previous attempt/Looses
Summary: Nursing Diagnosis: Risk for injury-Self directed
Mania Depression
Appearance Elated Sad Nursing care:
DM Projection Introjection ⊗ Safe environment
Attitude therapies Matter of fact Kind firmness
⊗ Always take overt or covert threats or attempts
Activity Non-stimulating Monotonous seriously
Never give anything that ⊗ Ventilation of feelings
requires attention
Priority NDx Risk for injury: Risk for injury: self- ⊗ Encourage activities
Directed at others directed
Nursing Management Individual therapies Group therapy ⊗ Monitor closely (one-on-one, 24/7)
Lithium Antidepressants ⊗ Empathy (show acceptance & appreciation)
Diet ECT

CONDITIONS COMMONLY DIAGNOSED IN THE ELDERLY

Suicide Alzheimer’s Disease

⊗ thought or act of taking one’s own life A chronic, progressive degenerative cognitive disorder.

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Marked by Dementia Depression - stage of silence
Main Pathology: presence of senile plaques - destroys neurons (decreased Acceptance - "Yes, it's me"
acethylcholline)
Nursing Diagnosis: Ineffective individual coping
Signs and Symptoms:
⊗ Aphasia – deterioration of language function Nursing Care:
⊗ Apraxia – impaired motor function ⊗ Be physically present
⊗ Agnosia – inability to recognize objects / people ⊗ Be non-judgmental
⊗ Encourage verbalization of feelings
⊗ Executive functioning - loss of abstract thinking
⊗ Allow the patient to cry
3 PHASES: ⊗ Recognize your own thoughts about death and dying
⊗ Forgetfulness - difficulty of remembering appointments
⊗ Advance - difficulty of remembering past events but not recent events
⊗ Terminal - death occurs in 1 year

Nursing Diagnosis: Altered thought processes

Nursing Care:
⊗ Priority: safety & security
⊗ Always reorient the client (clock & calendar)
⊗ Use color instead of numbers & letters
⊗ Consistency – 1 nurse to lessen confusion

CONCEPTS ON DEATH AND DYING

DEATH/D YING: Elizabeth Kubler-Ross

Stages:
Denial - "NO NOT ME"
Anger - "WHY ME"
Bargaining - "IF ONLY"

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