ENG.GNM-S.Y-PSY-PAPER-2022

Q-1

a) Define Mania.

Mania is a specific period characterized by an abnormally and persistently elevated, expansive, or irritable mood. This abnormal mood period lasts at least one week (or less if hospitalization is necessary). During mania, patients exhibit unusually elevated mood, inappropriate and increased excitement, increased irritability, severe insomnia, grandiosity, rapid speech, disconnected and racing thoughts, increased sexual desire, significantly elevated energy and activity levels, poor judgment, and inappropriate social behavior.

b) Explain types of Mania.

1. Hypomania

• Hypomania does not significantly impair social or occupational functioning or require hospitalization.
• The mood is cheerful and expansive, but irritability can surface quickly if desires are unmet.
• The hypomanic individual’s mood is very unstable and fluctuates.
• Increased self-confidence and assurance.
• Difficulty with goal-directed activities and easy distractibility.
• Increased motor activity.
• Friendly and social behavior but lacks deep personal connections.
• Talks excessively and laughs loudly.
• Socially aggressive, argumentative, and maintains unrealistic ambitions.
• Unable to tolerate criticism and exhibits frequent mood changes.

2. Acute Mania

• Symptoms are more intense than hypomania, significantly affecting social or occupational functioning, often requiring hospitalization.
• Persistent euphoria and elation, with a high, excited mood.
• Rapid thoughts and flight of ideas, with delusions of grandiosity (e.g., believing to be a great scientist).
• Increased motor activity and possible violent behavior.
• Constantly active but does not feel tired; struggles to eat peacefully, leading to weight loss.
• Possible hallucinations, though not common.
• Decreased attention and judgment.

3. Delirious Mania

• Acute mania with severe clouding of consciousness, though rare.
• Extremely delicate mental state, oscillating between despair and uncontrolled ecstasy or complete indifference.
• Cognitive and perceptual disorientation and confusion.
• Excessive religiosity, grandiosity, or delusions of persecution, with auditory or visual hallucinations.
• Extremely agitated and inconsistent behavior.
• Psychomotor activity is manic and characterized by purposeless movements, posing safety risks.
• Risk of injury, exhaustion, and death if untreated.

c) Describe nursing management of Mania.

Therapeutic Nursing Needs

• Administer medications prescribed by the psychiatrist.
• Always remember the five rights of medication administration.
• Observe and record any side effects or changes in the patient after administering medication.
• Monitor lithium levels if the patient is on lithium carbonate therapy.
• Explain and discuss Electroconvulsive Therapy (ECT) if prescribed and allow the patient to express their concerns.
• Advise patients on lithium therapy to reduce salt intake.

Physical Needs

• Encourage patients to reduce physical activity and get adequate sleep.
• Engage patients in activities that divert energy and focus, like knitting or making sock balls.
• Encourage playing games like carom, badminton, or tennis.
• Promote afternoon naps and 6-7 hours of sleep at night.

Safety and Security

• Ensure the patient’s safety to prevent injuries; dress any wounds if present.
• Maintain a calm environment to avoid additional stimulation.
• Control the patient’s behavior to prevent harm to others and impose activity restrictions if necessary.

Nutritional Needs

• Provide “finger foods” as manic patients are often restless.
• Encourage high fluid intake if on lithium therapy.
• Provide a high-calorie, high-protein diet.
• Monitor weight and maintain an intake-output chart as patients may not eat enough.

Improve Judgment and Concentration

• Assign daily tasks and monitor completion.
• Correct inappropriate behavior towards other patients.
• Interact with patients in a friendly manner and ignore undesirable behavior.
• Encourage reading or watching TV/movies.
• Start with small tasks and gradually increase complexity.

Improve Communication

• Communicate simply and briefly; avoid conflicts.
• Reward positive changes in communication.
• Engage patients with a smile but avoid humor at their expense.
• Monitor social interactions from the beginning.
• Foster a positive nurse-therapeutic relationship.
• Encourage social interactions and provide opportunities.
• Encourage patients to pursue hobbies.

Recreational Needs

• Initially, allow patients to play alone, then with a small group.
• Short and simple games are preferable.
• Engage patients in recreational activities like Sudoku, ludo, or snake and ladder.

Spiritual Needs

• Encourage patients to follow their religious practices.
• Facilitate conversations with clergy or religious leaders according to their beliefs.
• Allow solitary or group prayers.
• Celebrate festivals according to the patient’s religion, such as Diwali, Holi, Ramadan, Eid, or Christmas.

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Q-2

a) Define community mental health services.

Community Mental Health Services encompass the mental health needs of all individuals residing within a community. These services aim to promote mental health, prevent mental illnesses, and prevent conditions arising from substance abuse. In the UK, these services are known as Community Mental Health Teams, providing treatment and support to individuals with mental disorders within the community.

b) Write down the principles of community mental health nursing.

Principles of Community Mental Health Nursing

1. Holistic Approach:

• Focus on mind, body, and spirit, integrating these concepts in care.

1. Individualized Care:

• Provide care based on individual needs and circumstances, considering the social setting and conditions of the person’s family.

1. Community-Based Care:

• Work within the community, understanding its unique framework, clinical processes, and intervention strategies.

1. Promotion and Prevention:

• Promote mental health and prevent mental disorders within the community.

1. Collaboration and Coordination:

• Work with various community networks and target populations, emphasizing group interrelationships and daily living activities.

1. Non-judgmental and Supportive Environment:

• Provide care in a supportive manner without judgment, fostering a positive therapeutic relationship.

c) Describe the role of nurse in community mental health services.

Role of Nurse in Community Mental Health Services

1. Care Provider:

• Offer care to mentally ill patients and guide family members on how to care for them at home.

1. Educator:

• Educate the community on promoting mental health and preventing mental illness.
• Raise awareness about misconceptions regarding mental health through various programs.

1. Liaison:

• Act as a link between patients, their families, the mental health care team, and other community members.

1. Domiciliary Services:

• Conduct home visits to assess and provide care to community members, referring them to psychiatrists when needed.

1. Counselor:

• Provide counseling services to patients, their families, and the community during stressful situations or life events.

1. Coordinator:

• Facilitate coordination among mental health team members to ensure effective care delivery.

1. Advocator:

• Assist patients in decision-making and advocate for their rights.

1. Administrator:

• Organize community programs, determine locations for these programs, and provide necessary resources.

1. Evaluator:

• Evaluate the impact of various community programs on mental health.

1. Researcher:
   • Conduct research on diagnosis and treatment, observing patients and studying the effectiveness of interventions.

Q-2 a) Describe the principles of Psychiatric Nursing. 08

Patient is Accepted Exactly as He is

Acceptance means being unbiased or unjudgmental of any kind. Acceptance expresses a feeling of love and care. Acceptance does not mean absolute permissiveness, but the setting of positive behaviors to respect it as an individual human being

Patient is Accepted Exactly as He is

Acceptance means being unbiased or unjudgmental of any kind. Acceptance expresses a feeling of love and care. Acceptance does not mean absolute permissiveness, but the setting of positive behaviors to respect it as an individual human being

A. Being Non-judgmental and Non-punitive

Patient behavior is not determined as true or false, good or bad. The patient is not punished for his undesirable behavior. Punishments such as chaining, resetraining or, keeping in separate rooms and indirectly ignoring its presence or knowingly not paying attention or avoiding it. A nurse who shows acceptance does not reject a patient even when he behaves contrary to his expectations.

B. Being Sincerely Interested in the Patient.

Being sincerely interested in another person means considering the other person’s interest

 Studying the patient’s behavior patterns

Allowing him to make his own choices and decisions as far as possible

Be aware of his likes and dislikes.

Being honest with him.

 Give it time to listen to what it says.

Avoid sensitive topics and issues.

Identifying and reflecting the emotions that the patient can express – when the patient

C. Recognize and Reflecting on Feelings which Patient may Express

When the patient is talking, it is not important to note what content it contains, but what the feeling behind the conversation may be, which should be recognized and reflected.

D . Talking with Purpose

A nurse’s conversation with a patient should revolve around her needs, desires and interests. Indirect approaches such as reflexion, open questions (open ended question), focus on the issue, present reality are more effective when the problems are not clear.

E .Listening

Listening is an active process. The nurse must take time and energy (energy) to hear what the patient is saying. She must be a sympathetic listener and show genuine interest.

F Permitting patient to express strongly held feeling

The filling of strong emotions is very explosive. It is better to allow the patient to express his strong feelings without rejection or punishment.

2.Use Self understanding as therapeutic tools

A psychiatrist’s nurse must have a real self-awareness and be able to identify her own feelings and responses.

3.Consistency is used to contribute to patient security

This means that staff should take steps for patient safety during the ward routine

4.Reassurance should be given in a Subtle and Acceptable Manner –

Respiration builds the patient’s confidence. The nurse needs to explain and analyze the patient’s situation to reassure. 

5.Patient’s Behavior is Changed through Emotional Experience and not by Rational Interpretation Use Self understanding as therapeutic tools

Advising or rationalizing patients is not effective in changing behavior. Role-play and social-drama etc. can change his behavior 

6.Unnecessary Increase in Patient’s Anxiety should be Avoided

The following things should be taken care of so that there is no unnecessary worry in the patient 

The nurse should not show her concern.

Paying attention to the patient’s shortcomings.

The patient faces frequent failures.

Placing demands on the patient that he apparently cannot meet.

7. Objective Observation of Patient to Understand his Behavior

So that what the patient wants can be evaluated. Nurses should not mix their fillings, judgment opinions. 

8. Maintain Realistic Nurse-Patient Relationship (maintain a real nurse-patient relationship)

A real or professional relationship focuses on a person’s personal and emotional needs and not on the needs of the patient and nurse.

9. Avoid Physical and Verbal Force as Much as Possible (Do not force any kind of physical or mental force) The nurse should not give any kind of punishment if the patient is suffering from psychological trauma, besides, the nurse can study the behavior of the patient and prevent uncertain behavior. The nurse should do the procedure quickly and should not show the patient that she has an aversion. If the patient is restrained, tell the reason.Allowing positive changes in patient behavior to get along with others.
10. Nursing Care is Centered on the Patient as a Person and not on the Control of Symptoms There is some reason behind the behavior seen in a person that the nurse should understand why the symptoms of this behavior come from. The patient often shows the symptoms of different behavior in the same situation, so the nursing care patient should not be taken care of or considering his symptoms. keeping in mind
11. All Explanations of Procedures and other Routines are Given According to the Patient’s Level of Understanding

According to the understanding and need of the psychiatric patient, the routine and procedure should be explained so that his anxiety is removed to a great extent and everyone has the right to know the procedure to be done on him, so it should not be that he does not need to explain this.

12. Many procedures are Modified but Basic Principles Remain Unaltered – (Many procedures will be modified but this basic principal will remain the same)

Many procedures will be modified as per the patient’s requirement, the method will change but this basic principal will remain the same mainly to take care of the patient including his safety, security, therapeutic relationship, procedure etc……

Characteristics of a Mentally Healthy Person

1. Personal Philosophy of Life

A mentally healthy person develops their values considering societal demands. This philosophy guides them in various life activities.

2. Proper Sense of Self-Evaluation

Well-adjusted individuals know their abilities, motives, strengths, and limitations. They carefully evaluate their behavior and accept their mistakes.

3. Emotionally Mature

Such individuals are emotionally mature and stable, able to express and control their emotions appropriately.

4. Balanced Self-Regarding Sentiment

They have a proper sense of self-respect, considering themselves important members of the social group, contributing to its progress and welfare.

5. Socially Adjustable

Mentally healthy individuals understand the give-and-take nature of social life and know how to live within it effectively.

6. Realistic Approach

They have a realistic approach towards life’s problems, not fearing imaginary threats or difficulties.

7. Intellectually Sound

They have well-developed intellectual abilities, enabling independent thinking and proper decision-making.

8. Emotional Maturity

They possess mature emotional behavior, controlling emotions like fear, anger, and love according to accepted social standards.

9. Bravery Facing Failures

Life includes ups and downs. Mentally balanced individuals have enough courage and resilience to face failures in life.

10. Punctuality

Mentally healthy individuals have desirable social and healthy habits. They fulfill their commitments and are regular and punctual in their duties.

11. Self-Judgment

They use self-judgment to solve their problems, not relying on others’ judgments.

General Characteristics:

• They feel good about themselves.
• They are not overwhelmed by emotions such as fear, anger, love, jealousy, guilt, or anxiety.
• They have stable and satisfying personal relationships.
• They feel comfortable with other people.
• They can laugh at themselves and with others.
• They respect themselves and others even in disagreements.
• They can accept life’s disappointments.
• They can meet life’s demands and manage their problems when they arise.
• They make their own decisions.
• They shape their environment when possible and adjust to it when necessary.

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Definition of Therapeutic Communication and Techniques

Definition

Therapeutic communication is a process where a nurse engages in verbal and non-verbal communication with the client to understand the patient’s physical and mental status better.

Techniques

1. Observing
   Sharp observation during communication helps understand the patient’s emotions.
2. Listening
   The nurse should be an active listener, paying attention and nodding, making the patient feel heard.
3. Restating
   Repeating the main ideas and concerns expressed by the patient reassures them that the nurse is listening.
4. Questioning
   Asking clear, open-ended, and closed-ended questions to gather more information.
5. Clarifying
   Ensuring the nurse understands the patient’s statements and emotions correctly.
6. Focusing
   Concentrating on a single point to encourage the patient to provide more detailed information.
7. Silence
   Allowing the patient to speak without interruption, facilitating better expression.
8. Sharing
   Showing the patient that the nurse is thinking about them, for example, recalling a past conversation.
9. Broad Opening
   Encouraging the patient to select topics for discussion, promoting an open dialogue.
10. Linking
    Connecting two events or feelings expressed by the patient to understand their situation better.
11. Pinpointing
    Drawing attention to specific statements or actions of the patient to highlight discrepancies.
12. Providing Information
    Giving the patient necessary personal, social, and therapeutic information.
13. Suggesting
    Offering ideas or advice when needed.
14. Role Playing
    Acting out situations to help change attitudes and increase self-awareness.
15. Summary
    Summarizing the main themes and topics at the end of the communication session to facilitate further discussions.

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Qualities of a Psychiatric Nurse

1. Self-Confident

A nurse should have self-confidence to make decisions and provide holistic care in critical situations.

2. Empathy

The nurse should understand and share the feelings of others, comprehending their pain and distress.

3. Excellent Communication

Effective communication skills are crucial for understanding the patient’s condition and providing psychological support.

4. Non-Judgmental Attitude

Accepting patients as they are without any preconceived notions and providing care without bias.

5. Compassion

Being sensitive to the patient’s condition, earning their trust, and encouraging them to share their problems.

6. Intelligence

The nurse should be intelligent enough to detect problems early and provide appropriate care.

7. Emotional Stability

Remaining emotionally stable while working, with empathy but not being overwhelmed by others’ distress.

8. Devotion to Duty

Performing duties honestly and diligently, allocating sufficient time to patient care.

9. Calmness

Staying calm while communicating with patients and their relatives, even in stressful situations.

10. Patience

Maintaining patience during communication and care, especially with distressed patients.

11. Teamwork

Working collaboratively with mental health team members for better patient care.

12. Conflict Resolution

Having the capacity to resolve conflicts or problems effectively.

13. Good Listener

Listening attentively to the patient’s feelings, problems, and statements.

14. Keen Observation

Making sharp observations of any person or situation to identify the actual problem.

15. Punctuality

Being punctual and timely in performing tasks and duties.

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Short Answers

1. Prevention of Mental Retardation

Steps for Prevention:

1. Primary Prevention:

• Providing good antenatal, intranatal, and postnatal care.
• Universal immunization for the child (BCG, Polio, DPT, MMR).
• Immunization for mother and child against rubella.
• Folic acid supplements in the first trimester to prevent neural tube defects.
• Avoiding exposure to harmful substances, alcohol, nicotine, and cocaine during pregnancy.
• Using iodized salt to prevent iodine deficiency disorders.
• Genetic counseling for parents with risk factors.
• Health education to remove misconceptions and improve socio-economic conditions.
• Avoiding pregnancies before 21 and after 35 years and maintaining a minimum three-year gap between pregnancies.

1. Secondary Prevention:

• Early identification and treatment of preventable diseases (measles, rubella).
• Screening and treatment for conditions like hydrocephalus and galactosemia.
• Treating emotional and behavioral problems.

1. Tertiary Prevention:

• Using drug and behavior modification to solve physical and psychological problems.
• Hospitalizing and providing special care for severely mentally retarded patients.
• Educating and training mentally retarded children to prevent mental handicaps.

2. Antipsychotic Drugs

Classification:

1. First Generation (Typical Antipsychotics):

• Phenothiazines: Chlorpromazine, Perphenazine, Trifluoperazine, Thioridazine.
• Thioxanthenes: Chlorprothixene, Thiothixene, Flupenthixol, Zuclopenthixol.
• Butyrophenones: Haloperidol.
• Dibenzothiazepine: Quetiapine.

1. Second Generation (Atypical Antipsychotics):

• Clozapine, Risperidone, Olanzapine, Quetiapine, Ziprasidone.

1. Third Generation:

• Aripiprazole (Partial agonist of dopamine).

Mechanism of Action:

• Blocking D2 dopamine receptors in the brain to reduce the effects of dopamine, thereby alleviating psychotic symptoms.
• Atypical antipsychotics block both dopamine and serotonin receptors.

Indications:

• Schizophrenia, bipolar disorder, delusional disorder, psychotic depression, Asperger’s syndrome, PTSD, anxiety, insomnia, autism, OCD.

Contraindications:

• Hypersensitivity, severe hypotension, liver, renal

, or cardiac insufficiency, patients in a coma, history of agranulocytosis, epilepsy, pregnancy, lactation.

Side Effects:

• CNS: Drowsiness, sedation, dizziness, confusion, headache.
• Extrapyramidal: Dystonia, akathisia, Parkinsonism.
• Cardiovascular: Hypotension, tachycardia.
• GI: Constipation, nausea, vomiting.
• Endocrine: Galactorrhea, amenorrhea, weight gain.
• Dermatological: Photosensitivity, dermatitis.

3. Nursing Management of Suicidal Clients

Factors Contributing to Suicidal Tendency:

• Mental illness (depression, schizophrenia).
• Substance abuse (alcohol, drugs).
• History of suicide attempts.
• Family history of suicide or mental illness.
• Stressful life events (loss of loved ones, financial issues).
• Chronic illness or pain.
• Social isolation or lack of support.

Nursing Responsibilities:

• Assess the risk factors and level of suicidal intent.
• Create a safe environment by removing harmful objects.
• Establish a trusting relationship and encourage the patient to express feelings.
• Supervise the patient closely and ensure constant observation.
• Collaborate with mental health professionals for comprehensive care.
• Educate the family about the signs of suicide and preventive measures.
• Encourage the patient to participate in activities that promote self-worth and belonging.
• Provide medication and monitor its effects.
• Develop a crisis intervention plan and ensure follow-up care.

Q-3 Write short answers (Any Two) 2X6=12

1.Prevention of Mental Retardation.

Prevention Is Better Than Cure’
So before a condition occurs, we take steps to prevent it and prevent it from happening.

There are three types of prevention of mental retardation:

1) Primary prevention 2)Secondary prevention 3)Tertiary prevention

1) Primary prevention :

• Primary prevention involves preventing the causes and factors leading to mental retardation.
• To provide good antenatal, intranatal and postnatal care to the mother.
• Providing universal immunization to children. Like providing BCG vaccine, Polio vaccine, DPT vaccine and MMR vaccine.
• Immunization of mother and child against rubella to prevent mental retardation.
• Administration of folic acid medicine to the mother in the first trimester during the antenatal period. So that the neural tube defect in the child can be prevented.
• Asking the mother to avoid toxic substances, alcohol, nicotine and cocaine during pregnancy.
  -Preventing the mother from exposure to radiation.
• Providing nutritional supplementation during pregnancy.
• Use iodized salt to prevent iodine deficiency diseases.
• Genetic counseling of at-risk parents.
• To remove misconceptions in the community and provide health education to the people.
• To improve the socio and economic condition of the people.
• Avoid pregnancy before 21 years and after 35 years to prevent complications.
• Keeping the period between two pregnancies minimum three years.
• Preventing Rh isoimmunization in the mother.
• Screening of diseases like syphilis and rubella in pregnant women.
• Examining the fetus by amniocentesis, fetoscopy, biopsy and ultrasound.
• To treat childhood diarrhea, brain infections and protein energy malnutrition.
• To provide a proper environment for the mental development of the child.
• Prolonged exposure to lead affects brain development thus reducing pollution.
• Providing health education to the community for causes and prevention of mental retardation.

2) Secondary prevention :

• Early identification of preventable diseases like measles, rubella and their proper treatment.
• Identify conditions like hydrocephalus, galactosemia and provide treatment for them.
• To treat emotional and behavioral problems.

3) Tertiary prevention :

• Solving physical and psychological problems through drug and behavior modification.
• Hospitalize and provide special care to severe mentally retarded patients.
• Providing education and training to the mentally retarded child so as to prevent mental handicap.
• To send such children to special institutions where they are given education, training and given work according to their capacity.

2.Antipsychotic drug.

• Antipsychotic drug is also known as neuroleptic or tranquilizer.
• Antipsychotic drugs are used to treat psychotic disorders.
• The primary use of anti-psychotic drug is to treat schizophrenia and it is also useful in treating other psychotic disorders like mania, bipolar disorder.

classification of antipsychotic drug :

• First generation
• Second generation
• Third generation
• First generation:First generation antipsychotic drug is also known as typical antipsychotic drug.
  The first generation antipsychotic drug was discovered in 1950.
  which is a competitive inhibitor that blocks the d2 dopamine receptor.

• Phenothiazines :
  • Chlorpromazine
  • perphenazine
  • trifluoperazine
  • thioridazine

• Thioxanthenes :
  • chlorprothixene
  • thiothixene
  • flupenthixol
  • zuclopenthixol

• Butyrophenones :
  • haloperidol
• Dibenzot
  • quetiapine

2) Second generation : Second generation antipsychotic drugs are also known as atypicals. which blocks both serotonin and dopamine receptors.

• clozapine
• risperidone
• olanzapine
• risperidone
• quetiapine
• ziprasidone

3) Third generation :

• aripiprazole
• partial agonist of
  dopamine

Mechanism of action: Blocks the D2 receptor of the dopamine pathway in the brain so that dopamine becomes less effective and its effects are reduced.
Excessive dopamine release in the mesolimbic pathway leads to psychotic symptoms.
Hence anti-psychotic drugs block the D2 receptor and reduce the production of dopamine.
Atypical antipsychotics block both dopamine and serotonin receptors.

Indication :

– schizophrenia
– bipolar disorder
– delusional disorder
– psychotic depression
– Asperger’s syndrome
– post traumatic stress
disorder
– anxiety
– insomnia
– autism
– obsessive
compulsive disorder

Contraindication :

– hypersensitivity
– severe hypotension
– liver, renal & cardiac
insufficiency
– CNS depression
– cardiac dyscrasia
– Parkinson’s disease
– comatose
– bone marrow
depression

Side effects :

– extra pyramidal
symptoms
– hypotension
– tachycardia
– lethargy
– drowsiness
– tachycardia
– seizure
– nightmares
– constipation
– hyperprolectinemia
– blurring vision
– weight gain
– sexual dysfunction

Nursing responsibility:

• To maintain Five R before giving drug.
• Psychological assessment before administration of anti-psychotic drug.
• Checking whether extrapyramidal symptoms are present or not.
• Monitor blood pressure.
• To assess vital signs.
• Checking the level of prolactin in the blood.
• To check milk production in breast in female patient.
• To check whether the patient experiences any Edwards effect and discomfort.
• To maintain records and reports.

Extra pyramidal symptoms:

acute dystonia :Muscular spasms and involuntary muscle contractions occur in the neck, eyes, tongue and jaw.

Akathisia : It is a type of movement disorder characterized by restlessness so that the person cannot sit or stand.

pseudo Parkinsonism : Muscle rigidity and stiffness may be seen.

tardive dyskinesia : Involuntary and irregular muscle moments are seen. Too much is seen in the face.

neuroleptic malignant syndrome : A life threatening condition characterized by fever, muscle rigidity, autonomic dysfunction and disturbed mental status.

3.Anorexia Nervosa.

• The word anorexia means ‘absence of appetite’.
• Anorexia nervosa is an eating disorder. In which the person avoids food, and has a desire to be thin and such people have a fear of gaining weight.
• Such people eat less than 200 calories per day.

incidence It is more common in adolescent girls.
It is nine times more common in women than in men.

Types of Anorexia nervosa

1) Restricting type
2) Binge eating / Puring type

1) Restricting type A person in this type avoids food and exercises excessively to lose weight

2) Binge eating / Puring type In this type, the person eats food but vomits by putting a finger in the mouth and uses laxatives, diuretics, enemas.

Sign & symptoms

• Rapid weight loss
• Loss of muscle mass
• Thining of bones
• Russell’s sign:- (Russell’s sign- Scars on the knuckles due to self-induced vomiting)
• Swelling in cheek
• Enlarged salivary gland
• Food refuses
• Dehydration
• Elctrolyte imbalnce
• Low blood pressure
• Abnormal heart rhythm
• Slow heart rate
• Anemia
• Constipation
• Headache
• Fatigue
• Lethargy
• Fainting
• Dry skin
• Brittle hair and nail
• Insomnia
• Infertility
• Amenorrhea
• irregular menses
• Alkalosis

Investigation

• complete blood count
  
• electrolyte test
  
• bone density test
  
• thyroid function test
  
• ECG
  
• urine analysis
  
• kidney function test
  
• liver function test
  

Treatment of Anorexia nervosa

Goal :Restoring normal weight and food habit.

1) psychological therap

• ~ family therapy Family therapy is important for children and adolescents. In which a family member improves the food habit of a patient with anorexia.
• Motivational psychotherapy The patient is encouraged to gain weight and adopt good food habits.
• ~ Cognitive behavioral therapy Cognitive behavior therapy is used after weight restoration.
• ~ Behavioural therapy In this therapy, changes in the patient’s behavior are observed and focused on.

2) Antidepressants drug

Medicines from the Selective Serotonin Reuptake Inhibitors group are prescribed

E.g. : fluoxetine

3) nutritional supplements

Calcium and vitamin D supplements are given along with zinc supplements.

Nursing management

• To monitor vital signs
• Monitor weight.
• To provide nutritional diet so that nutritional deficiency does not remain.
• Giving a 3000 calorie diet throughout the day.
  Monitor complete blood count and serum electrolyte levels.
• Reassure the patient.

4.List out types of defense mechanism. Explain any four in detail.

Defense mechanisms are classified into two:

• 1) positive defence mechanism
• 2) negative defence mechanism

Positive defense mechanism

~ Compensation
~ Substitution
~ Sublimation
~ Rationalization
~ Repression
~ Undoing
~ Identification
~ Transference
~ Intellectualisation
~ Introjection

Negative defense mechanism

~ Suppression
~ Displacement
~ Projection
~ Regression
~ Fixation
~ Fantasy
~ Reaction formation
~ Conversion
~ Dissociation
~ Denial

Denial

• Denile means to deny.
• In this defense mechanism the person refuses to face reality. He refuses to accept reality.
• A person unconsciously uses this mechanism for some time.
• Example: A person is very near and dear to him passes away but he is not ready to accept that his loved one has passed away. A person only thinks that person is still alive.

Displacement

• Displacement means displacement
• In this defense mechanism the person unconsciously transfers their emotional filling to another person or object that is less dangerous.
• Example : A worker works in an office and his boss gets angry with him, this worker cannot say anything to the boss so he goes home and gets angry with his family member which is called displacement.
• A student nurse gets reprimanded by her senior A student nurse cannot be angry with her senior but will go home and punish her younger siblings.
  Does and itchy too

Rationalization

• Rationalization means rationalization.
• In this defense mechanism, the person gives logical reasons of his own failure, socially unacceptable things and behavior.
• Example: A girl not getting admission in nursing describes the nursing professor as bad.

Identification

• Identification means identification
• The identification mechanism is more used in children.
• In the identification mechanism, the person compares himself with a person he likes or a person in a superior position and shows similarities between himself and the opposite person.
• Example: When a girl is admitted to a hospital for a surgery, she is inspired by a girl nurse and thinks of becoming a nurse and compares herself with a nurse.

Q-4 Write short note (Any Three) 3X4=12

1.Nursing management of suicide attempted client –

1.Therapeutic Need Nursing Management

• Provide a comfortable environment to the patient and ask the relative of the patient to stay with him continuously
• The doctor administered the prescribed medicine. Watching for its side effects and keeping a record-report. Usually giving anti-depressant drugs to a suicidal patient.
• Conducting an MSE on the patient involves recording suicidal thoughts and plans as well as how lethal they are.
• Assisting and preparing the patient if ECT is to be administered

2.Physical Need Nursing Management

a.Safe Environment

• Keeping the patient under constant observation A nurse should be constantly there to care for him
• Glass articles, ropes, pajama and petticoat cords, net ties, etc. should be removed from the room.
  Long bed sheets should also not be used as they can be used for hanging
  Using paper dishes for food
• Electrical connections should not be kept open
• Medicines and instruments should be kept locked in the ward
• Care should be taken that the patient does not swallow more than one medicine
  A room should be provided near the nursing station

Personal Hygiene :- Encourage the patient to maintain his personal hygiene. Encourage him to change his clothes, take a bath, comb his hair, etc.

4.Nutritional lead Advise the patient to take diet and record its input and output

4.Psycho Social Need :-

Trusting Relationship Talk to the patient Listen to him calmly Bring out the positive things in him Let the patient visit his relative Try to create a positive attitude in him

Reducing suicidal ideation Encourage the patient to talk about his/her suicidal ideation and how to commit suicide etc.

Increase in self esteem Calling the patient by his name Acknowledging his positive points and positive achievements

Improve socialization The patient should never be left alone asking them to get out of bed slowly to meet people

Recreational Need Identify the patient’s favorite hobby or game Give him enough time for outdoor games even if he completes his hobby Give him success if he wins If he loses Accept without any disturbance

Spiritual Activities

Find out why the patient wants to die
Talk about what he would be able to do if he lived
Give him religious books to read and discuss religious books with him to help him recognize their quality

Group Therapy-

• Group therapy is a type of psychosocial therapy in which two or more (small group) patients are treated simultaneously by one or more therapists.
• Group therapy is used to treat psychological and emotional problems such as relieving distress, increasing self-esteem, and improving behavior and social relationships.

Aim of group therapy Helping the patient to resolve his emotional condition and providing anchorage for his personal development in the group.

principle group therapy

• ~ Group should have definite boundary.
• ~People in the group should be communicating with each other and having a relationship with each other.
• ~The group should have a maximum of 10 to 15 members so that the therapy is more effective.
• ~Duration of a group therapy session should not exceed 60 minutes.
• ~ Making easy and free communication in groups.
• ~Each group should have its own principles and rules.
• ~Each person in the group should have his own task and role.

Phases of group development

1) pre-affiliation phase In this phase the physical set up is prepared. In which place, time, type of group, session and duration etc. are decided.

2) Initial or orientation phase In this phase, group members get to know each other and the therapist.
In which goals, roles, rules and responsibilities are told.

3) working phase -In this phase group members work together to achieve goals and high communication is seen and group members share their personal feelings with each other.

4) Termination phase -In this phase, the therapy is completed in which the group experience is evaluated.
-Termination can lead to NCYT, regression and transference among group members.

Indication of group therapy

~ Relationship problem
~ Anxiety
~ Depression
~ Grief Loss
~ Emotional trauma
~ Low self esteem
~ While indie visuals When therapy fails
~ When the patient To be socialized need

contraindications of group therapy

~ Anti social patient
~ Severely depressed patient
~ Hallucinations and Delusions Patients with
~ Suicide Attempted Patient

Role of nurse

~ The nurse plays an important role as co-therapist and leader.
~ He behaves creatively and opportunistically while working with group members.
~ It helps group members to solve problems.
~ He works cooperatively with the therapist.
~ It assists the patient in the decision making process.

3.National Mental Health Programme –

The National Mental Health Program was launched in 1982 by the Government of India.
Maharashtra was the first state to implement the National Mental Health Programme.
Mental Illness is a Burden to the Community National Mental Health Program was created to remove the burden and strengthen the infrastructure.

Aims :

• Prevent and treat mental and neurological disorders and associated disabilities.
• Using Mental Health Technology to Improve General Health Services.
• Applying the principles of mental health to national development. So that the quality of life can be improved.

Objectives :

• Ensuring availability and accessibility of minimum mental health care especially for vulnerable groups and underprivileged sections in near future.
• Using mental health knowledge for social development and general health care.
• Enhancing community participation in providing mental health services and self-help efforts in the community.

Strategies :

• Integrating mental health with primary health.
• To provide tertiary care institutions for the treatment of mental disorders.
• To implement District Mental Health Program in all districts.

• To remove the stigma attached to mentally ill patients and to protect their rights.
• Facilitation of Psychiatric Unit and Psychiatric Hospital at grass root level.

Specific approaches :

• Dissemination of mental health skills to the periphery department.
  • Starting mental health care from grass root level.
  • Instead of focusing on mental health care in urban areas, focusing on rural
  • and peripheral areas (peripheral areas like subcentres, primary health centers).

• Appropriate Appointment of Tasks in Mental Health Care
• Performing tasks at all levels like Village Workers, Subcentres, Primary Health Centres, District Hospitals, Regional Hospitals.
• Equitable and Balanced Distribution of Resources
• To distribute resources in a balanced and equal proportion.
• Strengthening mental health services at all levels and distribution of resources.
• Integration
  • Integrating basic mental health services with general health care services.

• Linkage to Community Development – ​​To involve block, district and strata for implementation of mental health programme.

• Involving the community to prevent problems caused by alcohol, drug abuse.

• Utilization of Ex

• To utilize whatever mental health care infrastructure is there and provide minimum mental health care services there.
• Provision of Appropriate Task Oriented Training to the Existing Staff – To provide appropriate task oriented training to the staff providing mental health care services.

Componant of NMHP :

Village & sub enter level : To identify psychiatric disorders at village and sub-centre level and refer them to PHC or District Hospital.

Primary health center : PHC level to identify and treat minor psychiatric disorders and referral to district hospital if required.

District hospital : District hospitals have psychiatrists who diagnose and provide treatment for various mental disorders.

Teaching unit : In the teaching unit people are taught about mental health and how to maintain mental health.

Rehabilitation : Establishing rehabilitation centers and providing special rehabilitation services there.

Prevention : To prevent alcohol and substance abuse related problems.

Mental health training : To organize training programs where mental health training is provided to health care persons.

4.Mental Health Team–

• To promote mental health, members of various disciplines participate, known as mental health teams.
  • A mental health team consists of many members.
  • These include psychiatrists, general physicians, clinical psychologists, mental health nurses, nurse assistants, psychiatric social workers, dieticians, occupational, educational, art, musical, psycho drama and speech therapists.

Psychiatrist :

• A psychiatrist is a medical doctor who has special training in psychiatry.
• Who diagnoses and provides treatment for mental disorders. Prescribes various types of therapy and attends therapy sessions.

General physician :

• A General Physician has minimum MBBS and one year in Medicine and Surgery as House Officer.

Clinical psychologist :

• Graduation or Post Graduation in Psychology and Degree in Psychology. Help provide hospital and community mental health services.
• It helps in assessing the patient’s mental health needs and providing psychological therapy.

Mental health nurse :

• Along with staff nurse he/she should have done three or four years degree or diploma in psychiatric nursing. Which patients need nursing and provide polystic nursing care

Psychiatric social health worker :

• He should have done two or three years Diploma in Social Work. It is hired to provide social services that provide counseling and advice to referral patients.

Nurse assistant :

• Must have completed graduation and have education about his job.

Dietician :

• Must have Bachelor’s or Master’s degree in Nutrition field. It deals with nutritional counseling in nutritional disorders such as anorexia nervosa and bulimia nervosa.

Occupational therapist :

• Graduation or Post Graduation in Occupational Therapy. It teaches people to cope up with the situations they encounter in their daily life. Also includes rehabilitation services.

Art therapist :

• Must have done Graduation and Post Graduation in Art Therapy. Encourages the patient to create creative artwork and express his emotional conflicts and feelings.

Speech therapist :

• Should have done Graduation and Post Graduation in Speech Therapy. It provides speech therapy to treat speech disorders in children.

Psychodrama therapist:

• He should have done graduation and post graduation in the field of group therapy. It encourages people to express their feelings and emotions through roleplay.

Recreational therapist:

• Must have completed graduation and post graduation in recreation or activity therapy. It provides recreation therapy to help the patient draw his attention out of his thoughts, feelings, and emotions.

5.Role of nurse in primary level prevention of psychiatric illness.

Many things within the community affect mental health so community health nurse works for mental health promotion of mental health at community level prevention treatment of mental illness and rehabilitation here we will see the role of nurse in primary prevention which is as follows

Individual steps There are many drugs that can have side effects on the mother and her fetus, so avoid unnecessary and self-medication during pregnancy. Counseling if the child is physically or mentally challenged Support strengthening mother-child relationship

Participation in school health programs Community health nurses can detect abnormal behavior of children by going to school and take appropriate professional measures to correct it at the earliest.Teachers should learn to recognize any abnormal behavior in children so that such cases can be identified and referred immediately.

Family care Activities performed in the family in which there should be respect, love, trust and a sense of belonging between each family member. Family is an important medium for raising a child, so the child can be taught adjustment and coping skills from here. Problems related to mental health can be discussed and guidance can be given if there is no good relationship with each other at home, especially between husband and wife, marital guidance can be given.

Adolescence Care To Develop Mental Crisis When a child goes through adolescence, there are many hormonal and bodily changes that affect their mental health.

Changes according to age and socio-cultural

Apart from this, retirement and menopause is also a situation, death of an earner in the family, marriage break-up, etc., family crises are seen, there are many places such as Mental Hiding Clinic, First Aid Walking Clinic, which can handle this situation.

No programs for families for culturally disadvantaged families who live in communities whose living conditions are not good, who do not get food, education, health and any other recreation facilities, such people turn to alcoholism, drug addiction, crime and mental

PREVENTIVE MEASURES FOR THE SOCIETY To comfort the mother before the child is born To try to improve the content of the children’s education method To try to overcome the crisis Get and use different biological data i.e. white data

To do community development program thus in primary prevention nurse has the role of counselor educator, facilitator, advocate etc. In addition to informing the health workers working in the periphery for the prevention and promotion of mental health.

Q-5 Define following (Any Six] 6X2=12

1.Amnesia– Amnesia Means ‘Loss of Memory’
That means losing the ability to remember
Amnesia is an abnormal mental state in which memory and learning are affected such that the person does not remember anything that happened but his other cognitive functions are normal.

2.Circumstantiality – This involves a disturbance in the person’s thought process in which he or she infers extraneous and unnecessary things before answering the questions asked. A person talks unnecessarily before reaching his goal and finally reaches that goal.

3.Delusion- Delusions involve false beliefs about an external reality in which the person feels that evidence is stacked against him and that there is a conspiracy against him, all outside of the person’s educational and cultural background.
Dilution is commonly seen in patients with Skies of India.

4.Phobia- A phobia is a persistent, excessive and unrealistic fear of an object, person, animal, activity and situation.
A phobia is an irrational fear in which a person consciously avoids the feared activity, situation, or subject.

Example:
Fear of height – acrophobia
Fear of water – Aquaphobia

5.Enuresis- The word Enuresis is derived from the Greek word ‘enourein’ which means ‘to void urine’.
Enuresis is defined as the passing of urine in a wick at least twice on clothing or bed for three consecutive months or more in a child over five years of age that is repeated involuntarily and intentionally. Which is not seen due to any physical abnormality.

6.Obsession- Obsession is an unwanted, persistent and frequent occurrence of the same ideas, thoughts, impulses and images, due to which a person remains mentally disturbed.
The most common obsession is ‘fear of germs and contamination

7. Deja vu –In this one feels that he has seen this person, place or scene somewhere but does not know where and when. Actually it is seen for the first time.

8.Wernicke korsakoff Syndrome –

• Vanierk-Korsakoff syndrome is a neurological disorder caused by a deficiency of vitamin b1 thiamine.
• It has a triad of symptoms:
• -opthalmoplegia- (Paralysis is seen in the extraocular muscles in the eye.)

altered mental status ataxia – ataxia (problems in coordination)

Q-6(A) Fill in the blanks. 05

1.National mental health program was launched in________ (1982)

2.Therapeutic serum level of lithium is_______ (0.8-1.2 mEq /l )

3.________is a father of modern psychiatric. (phillip pinel )

4.Fear of high places is called_________ (Acrophobia-)

5.ECT stands for_________ (Electro Convulsion Therapy )

(C) State whether following statement are true or false 05

1. Excessive sleep is known as insomnia. wrong

2. Touching one’s body without consent is known as Battery correct

3.All mentally ill persons are dangerous. wrong

4 Clag association means impaired verbal communication correct

5 Ego works on pleasure principles. wrong