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ANXIETY
⊗ Vague sense of impending doom
⊗ May include terror, sense of unreality or fear of loosing control
⊗ Attack: 1 minute and 1 hour
⊗ Subjective response to stress
⊗ Is a state of apprehension, uneasiness, uncertainty or tension experienced by an Phobic Disorder
individual in response to an unknown object or situation. ⊗ Phobia is an irrational fear of an object, place, activity or situation.
Signs and symptoms: ⊗ Avoidance will allow the individual to be free from anxiety.

Mild Examples:

⊗ Physical - ↑PR, RR, BP, pupillary dilatation, sweating  Agoraphobia - fear of open places and of being alone in public places.
⊗ Cognitive - Attentive and alert  Social phobia - irrational fear of criticism, humiliation or embarrassment.
⊗ Emotional - Minimal use of defenses
 Acrophobia - fear of heights
Moderate  Algophobia - fear of pain
⊗ Physical - Nausea, Anorexia, Vomiting, Diarrhea, Constipation, Restlessness
⊗ Cognitive - narrowed perceptual field & selective inattention
 Claustrophobia - fear of enclosed place
⊗ Emotional - use of any defense mechanism available  Thanatophobia - fear of crowds

SEVERE
 Pathophobia - fear of disease
⊗ Physical - s/sx becomes the flow of attention  Monophobia - fear of being alone
⊗ Cognitive – perceptual field is greatly narrowed, focus of attention is trivial events
⊗ Emotional – defense mechanism operate Generalized Anxiety Disorder
(GAD)
PANIC ⊗ Unrealistic, excessive anxiety and is unable to control worry.
⊗ Physical – s/sx of exhaustion ignored ⊗ Clients may experience: fatigue, irritability, restlessness, muscle tension, sleep disturbance
⊗ Cognitive – personality disorganized
⊗ Emotional – defense mechanism fail Obsessive Compulsive Disorder
⊗ Is characterized by recurrent obsessions and compulsions that interfere with normal life.
Nursing Diagnoses:
⊗ Ineffective individual coping Obsession
⊗ Anxiety ⊗ Refers to persistent, painful intrusive thought, emotion or urge that one is unable to suppress or ignore.

Nursing Management: Compulsion

⊗ Calm ⊗ Refers to repetitious uncontrollable act and sometimes a purposeful act to prevent a certain mistake in an event
⊗ Administer medications or situation.
⊗ Listen
⊗ Minimize environmental stimuli Post-Traumatic Stress Disorder (PTSD)
⊗ Is the delayed reaction of the person who has been involved or exposed to a traumatic events.
ANXIETY DISORDERS ⊗ Symptoms of this disorder are:
 intense psychological distress
Panic Disorder  feeling of detachment or estrangement from others
⊗ An individual may suddenly experience frightening and uncomfortable symptoms  insomnia
 decreased concentration

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 avoidance of thoughts and feelings ⊗ Inability to recall extensive amount of important information
 recurrent distressing dreams ⊗ Caused by trauma
 inability to recall an important aspect of the trauma ⊗ Characterized by:
 Disorientation
Nursing Interventions  Purposeless wandering
⊗ Calm and nonjudgmental approach to convey acceptance.  Impairment in ability to perform ADL
⊗ Use short and simple sentences or words. ⊗ Rapid recovery generally occur
⊗ Help the client develop an increase tolerance to anxiety.
⊗ Help the client to:
 develop a problem-solving and coping skills of the client. PERSONALITY DISORDERS
 develop the ability to remain calm in anxiety-producing situations. ⊗ Are pervasive and inflexible patterns of functioning that is stable overtime, and leads to distress or impairment.
⊗ Approach: kind-firmness
⊗ Systematic desensitization (phobic disorders) Types of Personality Disorders:
⊗ Clients with ritualistic behavior (obsessive-compulsive disorder) should not be prohibited or reprimanded.
Eccentric Personality Disorder (Type A)
⊗ Biofeedback, change of the scenery, therapeutic touch, hypnosis, massage or relaxation exercises.
⊗ Administer medications, as ordered. ⊗ Paranoid (Suspicious and distrustful)

ANXIETY RELATED DISORDERS

 Persons who display pervasive and long stand suspiciousness
 More common in men
Somatization Disorder ⊗ Schizoid (Socially distant and detached)
⊗ Free floating anxiety disorder  Pattern of detachment from social relationship
⊗ Clients:  Chooses solitary activities
 express emotional turmoil or conflict through physical symptoms.  Topics are inanimate objects and ideas
 usually seek for repeated medical attention. ⊗ Schizotypal (Odd and eccentric)
 may exhibit antisocial behavior and may attempt suicide.  “mild schizophrenia”
⊗ Associated with anxiety and depression  Acute discomfort in close relationships
 Cognitive or perceptual distortion
Conversion Disorder
⊗ A condition in which an anxiety-provoking impulse is converted unconsciously into functional symptoms. Dramatic-Erratic Personality Disorder (Type B)
⊗ Conscious counterpart of malingering ⊗ Antisocial (aggressive and manipulative)
⊗ Examples: Paralysis, blindness, loss of touch or pain sensation, dyspnea, seizures or convulsions  Pattern of disregard for the violation of the rights of others
 Low self-esteem
Hypochondriasis
⊗ An individual presents an unrealistic or exaggerated physical complaints. ⊗ Borderline (destructive and unstable)
⊗ The person becomes, preoccupied with the fear of developing or having already a disease or illness in spite of  Characterized by patterns of instability in relationships, self image and mood
medical reassurance.  Self-mutilating behavior
 Affective instability
Body Dysmorphic Disorder
 More common in women
⊗ Preoccupation with an imagined defect in his or her appearance.
⊗ Slight physical abnormality = excessive concern / anxiety ⊗ Narcissistic (boastful / superiority complex)
 Grandiosity and need for constant admiration
 Exploitation of others for fulfillment of own desire
Dissociative Amnesia

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Anxious or Fearful Personality Disorder (Type C)

⊗ Not cuddly

⊗ Avoidant (inferiority complex) ⊗ Echolalia

 Social inhibition ⊗ Crying tantrums
 Feelings of inadequacy and sensitivity
 Low self-esteem ⊗ Head towards anything
 Social withdrawal in spite of a desire for affection and acceptance ⊗ Inanimate object attachment
⊗ Dependent (submissive)
⊗ Loves to spin objects / self
 Submissive clinging behavior related to excessive need to be cared for by others
 Lack of self-confidence ⊗ Difficulty interacting with others
 Perceive self as helpless and stupid ⊗ Wants blocks
⊗ Obsessive-Compulsive (perfectionist)
⊗ Acts as deaf
 Preoccupied with orderliness, perfectionism, inflexibility, need to be in control
⊗ Resists normal teaching method / routine changes
 Formal and serious interpersonal relationship
 Judgmental of self and others ⊗ No fear of danger
⊗ Passive-Aggressive
 Intentional inefficiency
⊗ Insensitive to pain
 Passive resistance to demands for adequate performance in both occupational and social functioning ⊗ No eye contact

Nursing Diagnosis: ⊗ Giggling or silly laughing

• Ineffective individual coping
• Self-esteem disturbance
DISORDERS COMMONLY DIAGNOSED TO CHILDREN
Nursing Interventions
AUTISM ⊗ Environment: safe & consistent
⊗ Characterized by:
⊗ Encourage the client to participate for self-care
 impairment in communication skills ⊗ Speak calmly when giving instructions
 presence of stereotyped behavior, interests and activities. ⊗ Use simple words or phrases
⊗ Repeat instructions as necessary.
 associated with impairment on social interactions
⊗ treatable but not curable
⊗ Haloperidol - symptomatic relief for hyperactivity, stereotypical and self-destructive behavior
⊗ more common among boys
⊗ usually diagnosed at age 2
MENTAL RETARDATION
⊗ Main problem: Interpersonal functioning ⊗ Not a mental illness.
⊗ Problem of inadequate mental functioning.
⊗ Most acceptable cause: Biological factors - brain anoxia, intake of drugs ⊗ Onset: 18
⊗ IQ below 70
Signs and Symptoms ⊗ Manifested by sub-average intellectual functioning in:
⊗ Odd play ⊗ Communication
Self-care

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Home living ⊗ Role modeling

Social skills ⊗ Restructuring
Health and safety ⊗ Focus of Education
Causes  Reading
⊗ HIV/ AIDS / rubella infection  Arithmetic
⊗ Alcoholic mother  Writing

⊗ Thyroid deficiency
⊗ Excessive lead poisoning
⊗ Damage to the brain ATTENTION DEFICIT HYPERACTIVITY DISORDER
⊗ Common in boys
⊗ Neurological / neurodevelopmental impairment ⊗ Usually diagnosed before age 7
⊗ Exact gestational age is not reached (premature) ⊗ Problems:
⊗ Inattention
⊗ Opiate intoxication ⊗ Hyperactivity
⊗ Nutritional deficiency (lack in Folic Acid) ⊗ Impulsivity

⊗ Anoxia Causes: Intranatal factors

⊗ Toxemia (pregnancy-induced hypertension)
Signs and Symptoms
⊗ Environmental factors ⊗ Obstinacy
⊗ Severe RH incompatibility ⊗ Negativism

Levels: ⊗ Egocentrism
Level IQ Implication
Mild/moron 51-70 o Difficulty adapting to school ⊗ Fighting syndrome
o Educable – needs assistance
Moderate/Imbecile 36-50 Poor awareness of needs of others ⊗ Aggressiveness
Trainable – needs moderate supervision
Severe/Idiot 20-35 o Unable to learn academic skills
⊗ Tolerance is low

o Poor motor development and minimal speech

o Needs complete and close supervision ⊗ Difficulty concentrating
Below 20 o Has minimal capacity for sensorimotor function ⊗ Excessive talking
o Needs custodial care with a totally structured environment
⊗ Fidgeting
Principles of Nursing Care
⊗ Protective care
⊗ Interrupt/intrudes on others
Education of the family ⊗ Child exhibits hyperactivity
 Their involvement is an important factor in the plan of care to promote progress and to minimize the stress.
⊗ Repetition ⊗ Indulges in destructive behavior

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⊗ Temper tantrums
Bulimia Nervosa
⊗ Extreme measures to lose weight
 uses diet pills, diuretics or laxatives
Nursing Diagnosis
 purges after eating
• Potential for injury
 extreme exercise
⊗ Signs of purging
 swelling of the cheeks or jaw area
 cuts and calluses on the back of the hands and knuckles
Principles of Nursing Care:  teeth that look clear
⊗ Provide nutrition and safety ⊗ Peculiar signs
⊗ Environment:  depression
structured  loss of interests in activities
enable appropriate reaction to the environmental stimuli
⊗ Plan a firm and consistent environment in which limits and standards are set.

Drug of choice : Methylphenidate (Ritalin)

DISORDERS COMMONLY DIAGNOSED TO ADULTS

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

 Denial of hunger
 Obvious thinness but feels fat
Findings: (for both)
 Lanugo all over the body
⊗ Weight loss of 15% or more of original body weight
 Loss of scalp hair

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⊗
⊗ Amenorrhea
Plateau
⊗ Orgasm
⊗ Social withdrawal and poor family and individual coping  formerly termed as climax
⊗ History of high activity and achievement in academics, athletics


the shortest stage in the sexual response cycle
occurs when stimulation proceeds through the plateau stage to a point where the body suddenly
⊗ Electrolyte imbalance discharges accumulated sexual tension
⊗ Resolution phase
⊗ Depression / distorted body image  the final phase of sexual response
 organs and body systems gradually return to the unaroused state
Nursing Diagnosis:
⊗ Body image disturbance
⊗ Ineffective individual coping Sexual Dysfunction Disorders

Nursing Interventions:
⊗ Sexual Desire Disorders: have little or no sexual desire or have an aversion to sexual contact.
⊗ Establish a trusting relationship ⊗ Sexual Arousal Disorder: Individuals cannot complete the physiologic requirements for sexual intercourse
⊗ Monitor vital signs Examples
⊗ Reinforce:  Women cannot maintain lubrication
 dietician’s prescription to accomplish realistic weight gain  Men cannot maintain an erection
treatment plan that establishes privileges and restrictions based on compliance

⊗ Decrease emphasis on foods, eating, weight loss or gain
⊗ Orgasm Disorders: Inability to achieve orgasm phase
Example: Premature ejaculation
⊗ Weigh client daily at the same time
⊗ Remain with the client after meal and for 1st four hours ⊗ Sexual Pain Disorders: Individuals suffer genital pain (dyspareunias)
⊗ Set limit on time allotted for eating Example: Vaginismius
⊗ Encourage client to express feelings
⊗ Promote feeling of control by Paraphilia (Sexual Deviation)
 participation in treatment ⊗ A term which generally refers to abnormal sexual behavior
 independent decision making ⊗ Lasts for 6 months leading to distress or impairment to functioning.

Examples

Anilingus tongue brushing the anus

Bestiality or Zoophilia contact with the animals
SEXUAL DISORDERS Coprophilia smearing feces on the partner
Cunnillingus tongue brushing the vulva
⊗ Sexuality - is the result of biologic, psychological, social and experimental factors that mold an individual's
Exhibitionism
sexual development, self-concept, body image and behavior.  Involves exposing one’s genitals to unsuspecting strangers.
Victims are usually women or children.
Phases of the Sexual Response Cycle  They are stimulated by the effect of shocking the victim.
⊗ Desire Fellatio inserting the penis into the mouth
 the ability, interest and willingness to receive sexual stimulation Fetishism inanimate / non-living objects or articles
⊗ Excitement / Arousal Frotteurism  Touching or rubbing against the unsuspecting people.
 Result of psychological stimulation  Usually occurs in crowded places where escape is into the crowd is possible.
 Example is fantasizing during the desire phase and foreplay which involves petting and fondling of Masochism  Sexual gratification from experiencing pain
erogenous zones or areas of the body that are particularly sensitive to erotic stimulation.  Involves the acts of being humiliated beaten, restrained, or otherwise made

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to suffer Progression:
Necrophilia  involves the use of corpses ⊗ Pre-alcoholic Phase - starts with social drinking; tolerance begins to develop
Partialism  inserting the penis into the other parts of the body
Pedophilia  use of prepubertal children ⊗ Prodromal Stage - alcohol becomes a need; blockout's occur; denial begins to develop
 could be an actual sexual act or a fantasy ⊗ Crucial - cardinal symptoms of alcoholism develops (loss of control over drinking)
 child is generally 13 years of age or younger
Sadism inflicting pain ⊗ Chronic Phase - the person becomes intoxicated all day
Telephone Scatalogia  Involves telephoning someone and making lewd, obscene remarks or
conversation. Outcome:

Transvestism
 AKA sex on phone
sexual excitement through wearing the clothing of a woman
⊗ Brain damage
Urophilia urinating on the partner ⊗ Alcoholic hallucinosis
Voyeurism Act of observing unsuspecting person who is naked, in the process of disrobing, or
engaging in sexual activity ⊗ Death
Includes cyber-voyeurism
Behavioral problems:
Gender Identity Disorder ⊗ Denial
⊗ AKA Transexualism
⊗ Believe that they were born as the wrong sex ⊗ Dependency
⊗ Leads to persistent discomfort and feels inappropriate in the role of the assigned sex. ⊗ Demanding
Nursing Interventions: ⊗ Destructive
⊗ Attitude:
 Accepting
⊗ Domineering
 Empathic
Alcohol Withdrawal
 Non-judgmental
⊗ Occurs when an individual abruptly stops drinking after alcohol has become a necessity of life to maintain
⊗ Accept his feelings related to sexuality
functioning.
⊗ Have a private area to discuss fears or concerns about sexuality
⊗ Symptoms include:
⊗ Intervene to discuss self-esteem issues, anxiety, guilt, and empathy for victims.
 autonomic hyperactivity
⊗ Employ limit setting.
 grand mal seizures
⊗ Referral to the correct clinic.  psychomotor agitation and anxiety
 increased hand tremors
SUBSTANCE-RELATED DISORDERS
 sleep disturbances (insomnia and nightmares)
Alcoholism  illusions hallucinations
⊗ Is a chronic disease or a disorder characterized by excessive alcohol intake and interference in the individual’s  hyperthermia
health, interpersonal relationship and economic functioning. (WHO)  tachycardia (impending delirium tremens)
⊗ Considered to be present when there is .1% or 10 ml for every 1000 ml of blood
Alcohol Withdrawal Delirium
Signs of use: ⊗ AKA delirium tremens
⊗ .1-.2% - low coordination  experienced within 24 to 72 hours after the last intake:
⊗ .2-.3% - presence of ataxia, tremors, irritability, stupor o agitation
⊗ .3 and above - unconsciousness o elevated vital signs
o illusions and hallucinations

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o
o
restlessness
hyperalertness
⊗ Cocaine is a white powdered stimulant substance
o incoherent speech ⊗ Usually sniffed, snorted, smoked in a pipe or injected into a vein or subcutaneous tissue.
⊗ serious medical complications may occur if the client is left untreated ⊗ Poor man’s cocaine:
 Shabu (sha-boo)
Korsakoff's Psychosis ⊗ Signs of use:
⊗ Is a form of amnesia  panic attacks
⊗ characterized  insomnia
 short-term memory loss  loss of appetite
 Disorientation  impaired thinking
 inability to learn new skills  cocaine psychosis
 confabulation  agitation
⊗ Deficiency in vitamin B complex, especially B1 and B12.  dilation of the pupils
Wernicke's Encephalopathy  diaphoresis
⊗ An inflammatory hemorrhagic degenerative condition of the brain  increase VS
⊗ caused by B1 deficiency ⊗ Classic sign: Perforated nasal septum
⊗ Symptoms include: ⊗ Can cause a sudden heart attack even in healthy young people.
 double vision
Cannabis-Related Disorders (Cannabinoids)
 involuntary and rapid eye movements
 lack of muscular coordination
Marijuana
 decreased mental function ⊗ Can act as stimulant or depressant and is often considered to be a mild hallucinogen with some sedative
properties
Nursing Diagnosis: Ineffective individual coping
⊗ Is not physically addicting but may lead to psychological dependence
Principles of Nursing Care: ⊗ Plant : cannabis sativa
⊗ Well lighted room ⊗ Active component is Tetrahydocannabinol
⊗ Diet as tolerated ⊗ Routes of use:
⊗ Monitor vital signs  Orally (capsules, tablets, on sugar cubes)
⊗ Administration of glucose  With food
⊗ Vitamins  Smoked in a pipe or rolled as cigarette.
⊗ Acts within 15 minutes
Alcohol Detoxification: ⊗ Effects lasts approximately 2 to 4 hours
⊗ Drug of Choice: Disulfiram (Antabuse) - delays the metabolism of alcohol ⊗ Physiologic symptoms include
⊗ Avoid alcohol-containing products  increased appetite
⊗ 3 S’s of detoxification:  excitement
 Safety  drowsiness
 Sedation  lowered body temperature
 Supplement (Multivitamins, Vitamin B-complex, Vitamin C)  depression
 unsteady gait
 reduced coordination and reflexes
DRUG-RELATED DISORDERS  inability to think clearly
 impaired judgment
Cocaine-Related Disorders ⊗ Classic sign: bloodshot eyes
(Stimulants)

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⊗ In large doses, it may cause: Prognosis: Poor

 Hallucination Defense Mechanism: Regression
 Suicidal ideations Paranoid Hallucinations ⊗ Priority: safety of others
 Delusions of invulnerability Ideas of reference ⊗ Deal with the HID
Delusion of persecution ⊗ Offer sealed foods / unopened medicines
Long-term Goals: Suspiciousness
⊗ Never displace outbursts of emotions
⊗ Community resources Prognosis: Good ⊗ Explain procedures in simple ways
⊗ Never argue with the patient
⊗ Other coping means aside from denial
Defense Mechanism: Projection

⊗ Personal responsibility for not drinking / drugs taking

Catatonic Wax flexibility ⊗ Priority: nutrition & circulation
⊗ Isolation Stupor ⊗ Provide distraction
Negativism – mutism, rigidity, lack of
⊗ Nutrition
response
⊗ Encourage activity

⊗ Group therapy
Prognosis: Good
Defense Mechanism: Repression
SCHIZOPHRENIA AND OTHER PSYCHOSES

SCHIZOPHRENIA Undifferentiated
• Is a serious psychiatric disorder • Patients whose manifestation cannot be easily fitted into one or the other type
Residual
• One of the most profound disabling illness
• Patients with minimal symptoms
• Not a single disease entity but a combination of disorders
• "split mind"
• characterized by: General Nursing Interventions:
o impaired communication ⊗ Establish:
o loss of contact into reality  a trusting relationship and provide acceptance
o deterioration from a previous level of functioning  a clear, consistent and open communication
• Nursing Diagnosis: Altered thought process ⊗ Set limits
⊗ Decrease environmental stimuli
• Most acceptable theory: Biologic Theory ⊗ Observe for suicidal ideation
⊗ Administer medications, as ordered.
Manifestations: Eugene Bleuler
• Associative looseness
• Autism MOOD DISORDERS
• Apathy
• Ambivalence Precipitating Factors
• Auditory hallucination ⊗ Loss of a loved one
Types Distinguishing features Nursing Interventions ⊗ Major life events
Disorganized Peculiar / bizarre behavior ⊗ Assist with ADL ⊗ Role strain
Incoherence ⊗ Encourage activity ⊗ Decreased coping resources
Stereotyping ⊗ Present reality ⊗ Physiological changes

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Activity Non-stimulating Monotonous

Common Types of Mood Disorder Never give anything that requires
⊗ Bipolar I Disorder: May experience one or more of symptoms of manic episode
attention

⊗ Bipolar II Disorder: May experience one or more symptoms of major depressive episode with hypomania Priority NDx Risk for injury:
Directed at others
Risk for injury: self-directed

⊗ Major Depressive Disorder: May be coded as mild, moderate or severe with or without psychotic features. Nursing Management Individual therapies Group therapy
⊗ Dysthymic Disorder Lithium Antidepressants
 Lesser severe than major depression Diet ECT
 No symptoms such as impaired communication, delusions and hallucinations
⊗ Cyclothymic Disorder
⊗ DNOS (Depression Not Otherwise Specified) - lasts for 2 days-2 weeks
Suicide
⊗ thought or act of taking one’s own life
⊗ ultimate form of self-destruction
Clinical Symptoms of Major Depressive Episode ⊗ "cry for help“
⊗ Affect flat ⊗ reunion wish or fantasy
⊗ progressive failure to adapt feelings of anger or hostility
⊗ Weight change (gain or loss) ⊗ a way to end feelings of hopelessness and helplessness
⊗ Energy loss ⊗ an attempt "to save face" or seek a release to a better life

⊗ Sad feelings / Social withdrawal Risk Factors

⊗ Obvious sleep disturbances ⊗ Sex (more female attempts suicide but more male commits suicide)

⊗ Memory loss ⊗ Unsuccessful previous attempt

⊗ Emotional blunting ⊗ Identification with a dead family member

⊗ Chronic
Clinical Symptoms of Manic Episode
⊗ Talkative or pressured to keep talking ⊗ Illness (e.g. Cancer)
⊗ Inflated self-esteem or grandiosity
⊗ Psychomotor agitation
⊗ Depression/Dependent personality

⊗ Exhibit flight of ideas ⊗ Age (18-25 and 40)/Alcoholism)

⊗ Decreased need for help
⊗ Distractibility
⊗ Lethality of previous attempt/Looses

Nursing Diagnosis: Risk for injury-Self directed

Summary:
Mania Depression
Nursing care:
Appearance Elated Sad
DM Projection Introjection ⊗ Safe environment
Attitude therapies Matter of fact Kind firmness
⊗ Always take overt or covert threats or attempts seriously
⊗ Ventilation of feelings

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⊗ Encourage activities
CONCEPTS ON DEATH AND DYING

DEATH/D YING: Elizabeth Kubler-Ross

⊗ Monitor closely (one-on-one, 24/7) Stages:
Denial - "NO NOT ME"
⊗ Empathy (show acceptance & appreciation) Anger - "WHY ME"
Bargaining - "IF ONLY"
Depression - stage of silence
Acceptance - "Yes, it's me"
CONDITIONS COMMONLY DIAGNOSED IN THE ELDERLY
Nursing Diagnosis: Ineffective individual coping
Alzheimer’s Disease
A chronic, progressive degenerative cognitive disorder. Nursing Care:
Marked by Dementia ⊗ Be physically present
Main Pathology: presence of senile plaques - destroys neurons (decreased acethylcholline) ⊗ Be non-judgmental
⊗ Encourage verbalization of feelings
Signs and Symptoms: ⊗ Allow the patient to cry
⊗ Aphasia – deterioration of language function ⊗ Recognize your own thoughts about death and dying
⊗ Apraxia – impaired motor function
⊗ Agnosia – inability to recognize objects / people
⊗ Executive functioning - loss of abstract thinking

3 PHASES:
⊗ 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

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