Pri'e » Nursing

DSM-5 Disorders and Criteria the Future of Psychiatric Diagnosis

Pri'e — Wed, 17 Feb 2010 16:44:40 +0000

DSM Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These are a few of the changes proposed by the DSM-5 Work Groups charged with revising psychiatry’s encyclopedia of mental disorders, the guidebook that largely determines where society draws the line between normal and abnormal, between eccentricity and illness, between self-indulgence and self destruction and, by extension, when and how patients should be treated.

Viewers will be able to submit comments until April 20, 2010. After that time, this site will be available for viewing only. the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be publish in May 2013, it’s will mark one the most anticipated events in the mental health field.

Proposed Draft Revisions to DSM 5 Disorders and Criteria can be found here

Symptoms Of Stroke

Pri'e — Fri, 05 Dec 2008 03:02:00 +0000

Am I Having a Stroke?

We go about day-to-day activities and take for granted the normal function of our bodies. We do not think about our hearts beating, our lungs breathing, or our brains functioning. Therefore, when we suddenly lose one of those functions, or somehow become focused on them, the resulting situation can be quite frightening. One of the hallmarks of a stroke, implied in the very word, is the sudden onset of symptoms. One second a person is normal, and the next is marked by some part of the body simply not responding to the usual commands being sent out from the brain. Recall that the three elements of a stroke have to do with (1) abrupt onset, (2) symptoms attributable to loss of blood flow in a single arterial territory, and (3) the duration of symptoms last at least twenty-four hours. Let’s focus on each of these elements separately.

ABRUPT ONSET

The sudden onset of symptoms helps to distinguish stroke from other neurological problems that can be confused with stroke. The weakness from a brain tumor could be the same as the weakness caused by a stroke, but the former usually begins slowly and progresses over time whereas the weakness from a stroke begins suddenly. The visual losses from a cataract, or an infection in the eye, also manifest themselves gradually, whereas the decreased vision from a stroke (or a TIA) begins abruptly. Therefore, this type of onset is very helpful to doctors in distinguishing the cause of one kind of neurological dysfunction from another. It is important to recognize, however, that some patients with stroke, especially the ischemic kind, may go to sleep normal and wake up with their neurological deficit. In this setting, although the precise time of onset cannot be firmly established, we presume that the neurological deficit began at some specific point in time during the night.

NEUROLOGICAL DYSFUNCTION IN A SINGLE ARTERIAL
TERRITORY

This component of the definition of stroke is also important in helping to define the condition. This is especially true in an ischemic stroke. If one artery has lost blood flow, the brain tissue that is supplied by that artery either ceases to function or functions poorly. The patient will have particular symptoms. We will

explore this concept further later in this chapter, but a patient with a left middle cerebral artery clot will have different symptoms than a patient with a right anterior cerebral artery clot. That is to say, the particular symptoms that an individual patient has are attributable to which part of the brain is not working correctly.

In a hemorrhage, some of the symptoms can be a result of pressure on more remote areas of the brain the nonspecific irritation caused by blood in the CSF. However, when there is a hematoma that has leaked into the brain tissue itself, the symptoms will be more or less focal based on which part of the brain is involved.

DURATION OF SYMPTOMS LASTS GREATER THAN TWENTYFOUR
HOURS

The final factor relates to how long the symptoms last. The classic distinction between a TIA and a stroke has to do with this factor of duration. However, this distinction has become less important over the past decade for several reasons. First, because there are treatments for acute ischemic stroke that have to be given within a very short period of time, in fact within three hours of onset, having a twenty-four-hour time distinction simply doesn’t make sense any more. Second, as doctors do magnetic resonance imaging (MRI) scans on more patients whose symptoms do not last twenty-four hours, they are finding that some of the patients whose symptoms have gone away have actually had a stroke (more about this in the next chapter). For both of these reasons, for patients who see their doctors in the first hours after symptom onset, the time duration is a less important part of the definition than the first two components.

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Pri'e — Thu, 04 Dec 2008 15:25:00 +0000

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Symptoms For Phobia

Pri'e — Wed, 03 Dec 2008 02:34:00 +0000

A phobia is a persistent and irrational fear of a specific object, activity, or situation resulting in an anxiety reaction. A phobia causes a compelling desire to avoid the perceived hazard. This avoidance usually results in an alteration of occupational or social functioning. The patient recognizes that his fear is out of proportion to any actual danger, but he can’t control it or explain it away. Panic attacks can be triggered by the phobia.

The three types of phobias are agoraphobia, the fear of being alone or of open space; social, the fear of embarrassing oneself in public; and specific, the fear of a single, specific object or situation, such as animals or heights.

Agoraphobia and social phobia tend to be chronic; however, new treatments are improving the prognosis. A social phobia typically begins in late childhood or early adolescence; a specific phobia usually begins in childhood. A specific phobia usually resolves spontaneously as the child matures.

About 7% of all Americans suffer from a phobic disorder. In fact, phobias are the most common psychiatric disorders in females and the second most common in males. More males than females experience social phobias, whereas agoraphobia and specific phobias are more common in women. Most phobic patients have no family history of psychiatric illness, including phobias

Symptoms For Phobia
The phobic patient typically reports signs of severe anxiety when confronted with the feared object or situation, or even the threat of it. A patient with agoraphobia, for example, may complain of dizziness, a sensation of falling, a feeling of unreality, loss of bladder or bowel control, vomiting, or cardiac distress when he leaves home. A patient who routinely avoids the object of his phobia may report a loss of self-esteem and feelings of weakness, cowardice, or ineffectiveness. If he hasn’t mastered the phobia, he may also exhibit signs of mild depression.

Agoraphobia without panic disorder
The patient has a fear of being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if he suddenly develops symptoms that could be incapacitating or extremely embarrassing. As a result of this fear, he either restricts travel or needs a companion when away from home, or he endures agoraphobic situations despite intense anxiety. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone, being in a crowd or standing in a line, being on a bridge, or traveling in a bus, train, or automobile;

The patient has never met the criteria for panic disorder.
The anxiety or phobic avoidance isn’t better accounted for by another mental disorder, such as social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, or separation anxiety disorder.

A social phobia
The patient has a persistent fear of one or more social situations in which he is exposed to possible scrutiny by others and fears that he may do something or act in a way that will be humiliating or embarrassing.

During some phase of the disturbance, exposure to the specific phobic stimulus almost invariably provokes an immediate anxiety response
The patient avoids the phobic situation or endures it with intense anxiety
The patient’s avoidant behavior interferes with occupational functioning or with usual social activities or relationships with others, or the patient experiences marked distress about having the fear.
The patient recognizes that his fear is excessive or unreasonable.
If the patient is younger than age 18, the duration is at least 6 months.
The fear or avoidance isn’t due to the direct physiologic effects of a substance or a general medical condition and isn’t better accounted for by another mental disorder.
If the patient has a general medical condition or another mental disorder, the person’s social fear is unrelated to the medical or mental condition.

A specific phobia
The patient has a persistent fear of an object or a situation other than fear of having a panic attack or of humiliation or embarrassment in certain social situations.

During some phase of the disturbance, exposure to the specific phobic stimulus almost invariably provokes an immediate anxiety response.
The patient avoids the object or situation or endures it with intense anxiety.
The patient’s fear or his avoidant behavior significantly interferes with his normal routine or his usual social activities or relationships with others, or the patient experiences marked distress about having the fear.
The patient recognizes that his fear is excessive or unreasonable.
If the patient is younger than age 18, the duration is at least 6 months.
The phobic stimulus is unrelated to the content of the obsessions of obsessive-compulsive disorder or the trauma of posttraumatic stress disorder.
The anxiety, panic attacks, or phobic avoidance associated with the specific object or situation isn’t better accounted for by another mental disorder.

NURSING PROCESS

Pri'e — Wed, 03 Dec 2008 02:33:00 +0000

The nursing process is a deliberate, problem-solving approach to meeting the health care and nursing needs of patients. It involves assessment (data collection), nursing diagnosis, planning, implementation, and evaluation, with subsequent modifications used as feedback mechanisms that promote the resolution of the nursing diagnoses. The process as a whole is cyclical, the steps being interrelated, interdependent, and recurrent.

STEPS IN THE NURSING PROCESS

Assessment; systematic collection of data to determine the patient’s health status and to identify any actual or potential health problems. (Analysis of data is included as part of the assessment. For those who wish to emphasize its importance, analysis may be identified as a separate step of the nursing process.)
Nursing diagnosis identification of actual or potential health problems that are amenable to resolution by nursing actions.
Planning: development of goals and a care plan designed to assist the patient in resolving the nursing diagnoses.
Implementation; ctualization of the care plan through nursing interventions or supervision of others to do the same.
Evaluation; determination of the patient’s responses to the nursing interventions and of the extent to which the goals have been achieved.

The ANA has recognized several standardized languages for nursing to document the nursing process and nursing care. Standardized languages are important for computerized documentation systems, for tracking care over the continuum, and for studying the impact of nursing care.
(http://www.nursingworld.org/nidsec)

Nursing Informatics

Pri'e — Wed, 03 Dec 2008 02:31:00 +0000

Nursing Informatics Defintions

Nursing informatics is using technology, research, and professional experience to manage nursing data, information, and knowledge to improve practice and deliver better health care.

Simpson, Roy (2006). In H. A. Park, P. Murray,& C. Delaney, C. (Eds.). Consumer-Centered Computer-Supported Care for Healthy People. Amsterdam, Netherlands: IOS Press, p 5

Roy Simpson (2006)

Candian Nurses Association (2003)

Nursing Informatics (NI): integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information, and knowledge to support clients, nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology. The goal of nursing informatics is to improve the health of populations, communities, families, and individuals by optimizing information management and communication. This includes the use of information and technology in the direct provision of care, in establishing effective administrative systems, in managing and delivering educational experiences, in supporting lifelong learning, and in supporting nursing research. http://www.cnia.ca/education.htm

ANA (1994)

In 1994, the ANA modified their definition in an effort to legitimize the specialty and guide efforts to create a certification examination:

“Nursing informatics is the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, research, and expansion of nursing knowledge. It supports the practice of all nursing specialties, in all sites and settings, whether at the basic or advanced level. The practice includes the development of applications, tools, processes, and structures that assist nurses with the management of data in taking care of patients or in supporting their practice of nursing”

Although the 1994 ANA definition continued to provide information on the role of the informatics nurse specialist, the concepts from the systems life cycle were replaced with a more generic discussion of the role of the informatics nurse specialist.