Psychobiologic disorders

Psychobiologic Disorders Part TwoPVN 123Mental Health Nursing

Cognitive DisordersDelirium

Dementia

Amnestic Disorders

Cognitive DisordersGroup of conditions characterized by disruption of:ThinkingMemoryProcessingProblem-solving

Treatment requires compassion and understanding of clients and families

Cognitive Disorders (DSM-IV-TR)DeliriumDementiaAmnestic disordersIs it Delirium or Dementia?DELIRIUMDEMENTIAOnsetRapid onset over short time (hours to days)Gradual deterioration of function (months to years)Clinical ManifestationsImpaired (may fluctuate throughout the day)MemoryJudgmentAbility to focusAbility to calculateLOC AlteredRestless / agitatedSundowning (confusion at night)Rapid personality changeSome hallucinations /illusionsUnstable vital signs (due to medical illness)Impaired (do not change throughout the day)MemoryJudgmentSpeech (aphasia)Ability to recognize familiar objects (agnosia)Executive functioning (managing daily tasksMovement (apraxia)LOC usually unchangedRestless / agitatedSundowningGradual personality changesStable vital signs (unless another illness present)CauseSecondary to another medical conditionInfection (older adults)Substance abuseCaused by chronic diseaseAlzheimersChronic alcohol abuseMay be caused by permanent head traumaOutcomeReversible ! (if prompt Dx and Tx)

Irreversible and progressiveStages of Alzheimers DiseaseStageClinical Manifestations1No impairment Normal FunctioningNo memory problemsNo problems evident to provider2Mild cognitive declineMay be normal age-related changes(early signs of Alzheimers)Forgetfulness (eyeglasses / wallet)No memory problems evident to provider / friends / co-workers3Mild cognitive deficits (memory/concentration)Measurable in clinical testingMild deficits (losing /misplacing important objectsDecreased ability to planDecreased attention spanDifficulty remembering words / namesDifficulty in social or work situations4Moderate cognitive declineClearly detected in clinical interview(mild / early stage Alzheimers)Personality changes (withdrawn / subdued)Obvious memory lossLimited knowledge/memory of recent occasions, events, personal historyDifficulty with planning and organizing (bill paying / managing money)Difficulty with complex mental arithmetic5Moderately severe cognitive decline(moderate stage Alzheimers)Increasing cognitive deficitsUnable to recall important details (address/phone number)Still able to remember information about self and familyDisoriented to time and place6Severe cognitive decline(mid-stage Alzheimers)Worsening memory problemsLoss of awareness of recent events and surroundingsCan recall own name but not personal historySignificant personality changes (delusions, hallucinations, compulsive behaviors)WanderingRequires assistance with ADLsDisrupted sleep/wake cycleIncreased urinary and fecal incontinenceViolent tendencies (potential danger to self and others)7Very severe cognitive decline(late-stage Alzheimers)Unable to respond to environmentUnable to speak or control movementUnrecognizable speechIncontinenceRequires assistance for eating / impaired swallowingGradual loss of ability to moveStupor or comaDeath (frequently related to choking or infection)Amnestic DisorderMay be secondary to substance abuse or other medical condition

No personality change or impairment in abstract thinking

Changes include:Decrease awareness of surroundingsInability to learn new information despite normal attentionInability to recall previously learned informationPossible disorientation to time and placeLabs / Tests / Screening ToolsCognitive DisordersLabs and Diagnostic TestsStandardized Screening ToolsSee handouts!Chest / skull XrayEEGECGLiver function studiesThyroid function studiesBrain neuro-imaging (CT / PET scan)UrinalysisSerum electrolytesMMSEMini-Mental State Exam

FASTFunctional Assessment Screening Tool

Global Deterioration Scale

Geriatric Depression ScaleShort form

Michigan Alcoholism Screening Test geriatric version

Nursing Care & CommunicationCognitive DisordersNursing CareCommunicationSelf-AssessmentNursing interventions focused on protection from injury and promoting dignity and quality of lifeRoom close to nurses stationLow level visual and auditory stimuliWell-lit environmentRoom with windowsTime orientationID braceletRestraints as last resortMedications PRNAgitation / anxietySafe physical environmentMemory aidsClocks/calendars/seasonal photosEye glasses and hearing aidsConsistent daily routineConsistent caregiversAdequate food and fluid intakeAllow for pacing and safe wanderingCover/remove mirrorsDecrease fear / agitationCalm and reassuringDont argue or question hallucinations / delusionsReinforce realityOrient to time/place/personIntroduce self with each new contactEye contactShort simple sentencesReminisceShort time frames for activities and instructionsLimit numbers of choices(eating / dressing)Avoid abstract thinking situationsAvoid confrontationEncourage family visitationMedicationsCognitive DisordersCommon Meds (use with caution in patients with asthma/COPD may cause bronchoconstriction)Aricept (donepezil)Exelon (rivastigmine)Razadyne (galantamine)

Increase acetylcholineImproves ability to perform self-careSlows cognitive deterioration (mild to moderate dementiaSide effectsNausea/diarrhea (about 10% of patients)BradycardiaNursing interventions / client educationMonitor GI side effects / fluid volume deficitsPromote fluid intakeDosage may be titrated to reduce symptomsMonitor pulse (teach family if client at home)Clients should be screened for underlying heart disease

Medication/Food Interactions

NSAIDS (aspirin)May cause GI Bleeding

Antihistamines/tricyclic antidepressants / antipsychoticsCan reduce therapeutic effects of AriceptMedication Nursing ConsiderationsCognitive DisordersCholinesterase Inhibitors

Start dosage low / gradually increase until side effects are no long tolerable med no longer beneficial

Monitor for adverse side effectsReinforce patient and family teaching

Taper med when discontinuingPrevents abrupt progression of symptoms

Monitor ability to swallow tabletsMeds are available in tables and oral solutionsAricept available in orally disintegrating tablet

Administer with or without food

Aricept has a long half-life (administered once daily at HS)Other cholinesterase inhibitors administered BID

Namenda (memantine)

Blocks calcium entry to nerve cellsSlows down brain cell deathOnly med approved for moderate to severe stages of AlzheimersCan be used concurrently with cholinesterase inhibitorAdminister with or without foodMonitor for common side effectsDizzinessHeadacheConfusionconstipation

Alternative Therapies / After Discharge Care / Client OutcomesCognitive DisordersAlternative Therapies

Estrogen therapy (women)May prevent AlzheimersNot useful for decreasing effects of pre-existing dementia

Ginkgo Biloba (herbal)Used by some to aid memoryPotential interactionsBleeding (with antiplatelet meds)Risk for seizures (combined with anti-seizure medications(lowers seizure threshold)After Discharge Care

Educate family/caregiversCare methodsAdapting home environment

Ensure safe home environment

Support caregiversClient Outcomes

Client will demonstrate improvement in cognition, memory, self care ability

Client will remain free from injuryQuick Quiz!How does Exelon (rivastigmine) work? What are the benefits of the medication for the client?Quick Quiz!A client who has moderately severe dementia is admitted to a long-term care facility. Which of the following findings should the nurse expect?_____No change in LOC_____Stable vital signs_____Daily changes in behavior_____Restlessness_____Disorientation

Substance and Other Dependencies

Substance Abuse

Substance Dependence

Non-Substance Dependency

Substance Abuse (Want It!)Repeated use of chemical substanceClinically significant impairment over 12 month periodIncludes at least one of the followingUnable to perform normal home/school/work dutiesTaking part in hazardous situation/risky behaviors while impairedDrivingRepeated problems caused by substance abuseLegal problemsLosing jobMissed time at workContinued use despite problems

Substance Dependence (Need It!)Repeated use of chemical substances Impairment over 12 month periodThree or more of the following:Presence of toleranceNeed for higher and higher dosagesWithdrawalStopping or reducing substance results in physical and psychological manifestationsTremorsHeadachesSubstance taken in larger amounts or for longer timeContinuing pain medication after pain ceasedPersistent, but unsuccessful desire to control useProgressively more time spent using and recovering from useReduction in social / occupational dutiesContinued use in the presence of related physical and psychological problems acknowledged by the client.

Non-Substance Related Dependency (Process Addictions)Dependence on a behaviorGamblingSexual behaviorsShopping / spendingInternet use

Defense MechanismsSubstance and Other DependenciesDenialMost commonI can quit whenever I want!Smoking doesnt really cause my problems!Can prevent client from seeking help

Risk FactorsGeneticsPredispositionLow self-esteemLow tolerance for pain/frustrationFew life successesRisk-taking tendenciesSociocultural TheoriesNative AmericansHigh alcohol abuse percentagesAsian GroupsLower alcohol abuse percentagesOlder clients may have history of alcohol abuse or develop patterns of abuse later in life due to stressorsLosing spouseRetirementSocial isolation

Data CollectionNursing history should include the following:Type of substance or compulsive behaviorPattern and frequency of substance useAmount of substance usedAge at substance abuse onsetChanges in use patternsPeriods of abstinencePrevious withdrawal symptomsDate of last substance use / compulsive behaviorReview of systemsBlack out or loss of consciousnessChanges in bowel movementsWeight loss / gainStressful situations experiencedSleep problemsChronic painConcern over substance abuseCutting down on consumption behaviorOlder AdultsAlcohol use leads to:FallsInjuriesMemory lossSomatic reports (headaches)Sleep changesDependence may include decreased ability for self careUrinary incontinenceSigns of dementiaMay show clinical manifestations at lower dosagesExposure to multiple medications in addition to psychological changes (age-related) raises likelihood of adverse effects

CNS DepressantsCan produce physiological and psychological dependenceMay have: (when taken concurrently)Cross tolerance (tolerant to the effects of a certain drug and develops a tolerance to another drug)Cross dependency ("addicted to everything)a person who is addicted to one drug (alcohol for example) can become addicted to any drug if they use itAddictive effectCommonly Abused SubstancesAlcoholBenzodiazepinesBarbituratesCannabisCocaineAmphetaminesNicotineOpioidsInhalantsHallucinogens

AlcoholAlcoholIntended EffectToxic EffectsWithdrawal S/SRelaxationDecreased social anxietyMaintaining calmBAC 0.08% = legal intoxicationMay be less 18yrs 0.35% (acute toxicity)Alters judgmentDecreases motor skillsDecreased LOCRespiratory arrestPeripheral collapsePotential for death (with large doses)Chronic use leads to:Cardiovascular damageLiver damage (fatty liver / cirrhosis)Erosive gastritisGI BleedingAcute pancreatitisSexual dysfunctionEffects usually start within 4 to 12 hours of the last intake of alcoholPeak after 24 to 48 hours (then subside)Clinical findings:Abdominal crampingVomitingTremorsRestlessnessInability to sleepIncreased HR/BP/TTonic-Clonic seizuresAlcohol Withdrawal Delirium2-3 days post cessationMay last 2-3 daysConsidered medical emergencyClinical manifestations:Severe disorientationPsychotic symptoms (hallucinations)Severe hypertensionCardiac dysrhythmiasDeliriumMay progress to deathBenzodiazepines/Barbiturates/ CannabisBenzodiazepines (diazepam [Valium] - can be taken orally or injectedIntended EffectsToxic EffectsWithdrawal S/SDecreased anxietySedationIncreased:Drowsiness / sedationAgitationDisorientationNauseaVomitingRespiratory depressionAntidote for toxicity= flumazenil (Romazicon)IVRapid dependenceAnxietyInsomniaDiaphoresisHypertensionPossible psychotic reactionsSeizure activity (sometimesBarbiturates (phenobarbital [Nembutal] / secobarbital [Seconal]) can be taken orally or injectedIntended EffectsToxic EffectsWithdrawal S/SSedationDecreased anxietyRespiratory depressionDecreased LOC (may be fatal)No antidote!Mild symptomsSame as with alcohol W/DSevere symptoms (similar to alcohol withdrawal)Life threatening convulsionsDeliriumCardiovascular collapseCannabis (marijuana, hashish [more potent] can be smoked or eatenIntended EffectsToxic EffectsWithdrawal S/SEuphoriaSedationHallucinationsDecrease nausea/vomiting secondary to chemoPain management for chronic painFocus only on one taskChronic use:Lung cancerChronic bronchitisOther respiratory effectsHigh doses:Paranoia (delusions/hallucinations)Some depressionCocaine/Amphetamines/NicotineCocaine can be inhaled (snorted), smoked, or injectedIntended EffectsToxic EffectsWithdrawal S/SRush of euphoria and pleasureIncreased energyMild toxicityIrritabilityTremorBlurred visionSevere effectsHallucinationsSeizuresExtreme feverTachycardia/Hypertension/Chest painPossible cardiovascular collapsePossible deathCharacteristic withdrawal syndromeOccurs within 1 hour to several days of cessationDepressionFatigueCravingExcess sleeping / insomniaDramatic and unpleasant dreamsPsychomotor retardation or agitationAmphetamines can be taken orally, smoked or injectedIntended EffectsToxic EffectsWithdrawal S/SIncreased energyEuphoria similar to cocaineImpaired judgmentPsychomotor agitationHyper vigilanceExtreme irritabilityAcute cardiovascular effectsTachycardiaElevated BP (could cause death)CravingDepressionFatigueSleeping (similar to cocaine)Not life threateningNicotine can be inhaled (cigarettes, cigars) or snuffed or chewed (smokeless tobacco)Intended EffectsToxic EffectsWithdrawal S/SRelaxationDecreased anxietyHighly toxic Acute toxicity only in children / nicotine exposed to pesticidesContains harmful chemicals (highly toxic / long term effects)Long term effectsCardiovascular diseaseHypertensionStrokeRespiratory diseaseSmokeless (irritation of oral mucosa / cancer)

Abstinence syndromeIrritabilityCravingNervousnessRestlessnessAnxietyInsomniaIncreased appetiteDifficulty concentratingOpioids/Inhalants/HallucinogensOpioids (heroin, morphine, hydromorphone [Dilaudid] can be injected, inhaled, or smokedIntended EffectsToxic EffectsWithdrawal S/SRush of euphoriaRelief from painDecreased respirations, LOC (may cause death)Antidote naloxone [Narcan] - IVAbstinence syndromeBegins with sweating/rhinorrheaProgresses to:Piloerection (gooseflesh)TremorsIrritabilityFollowed by:Severe weaknessNausea/vomitingMuscle and bone painMuscle spasmsUnpleasant but not life-threateningSelf-limiting (7 to 10 days)

Inhalants (amyl nitrate, nitrous oxide, solvents) sniffed, huffed or bagged (frequent users include children and teenagers)Intended EffectsToxic EffectsWithdrawal S/SEuphoriaDepends on the drugGenerally can cause CNS depressionClinical findings include:Psychosis (hallucinations)Respiratory depressionPossible deathNoneHallucinogens (lysergic acid diethylamide [LSD], mescaline [peyote], phencyclidine piperidine [PCP]) can be taken orally, injected or smokedIntended EffectsToxic EffectsWithdrawal S/SHeightened sense of selfAltered perceptionsvivid colorsPanic attacks and flashbacksVisual disturbances / hallucinationsCan occur intermittently for yearsNoneStandardized Screening ToolsMichigan Alcohol Screening Test (MAST)Addiction Severity IndexRecovery Attitude and Treatment EvaluatorBrief Drug Abuse Screen TestCAGE-AID Asks clients to determine how they perceive their current substance abuse

See Handouts

Nursing Care (during treatment)Self-assessment (nurse)Feelings about abusesThese can be transferred to the clientNonjudgmental approach by nurse is imperativeUse open-ended questions (When was your last drink?)Focus on safetySafe environmentClose observationReorientation to time/place/personAdequate nutrition and fluid balanceLow stimulation environmentAdminister withdrawal medications as prescribedMonitor for covert substance abuse during detoxProvide emotional support (clients and families)Reinforce teaching about codependent behaviorsInstruct clients and familiesAddiction Treatment goal of abstinenceRemove meds in the home that are not being usedNo sharing of medicationsBegin developing motivation and commitment for abstinence and recoveryEncourage self-responsibilityHelp clients develop an emergency plan (what to do and who to contact)Encourage attendance in self-help groups

Other Care and TreatmentDual diagnosisBoth mental health and substance abuse problemUse team approachIndividual psychotherapyGroup therapyFamily therapyPharmacology TherapyAlcohol WithdrawalValium, Ativan, Librium, Tegretol, CatapresAlcohol AbstinenceAntabuse, ReVia, CampralOpioid WithdrawalDolophine, Catapres, Subutex, SuboxoneNicotine WithdrawalWellbutrin, nicotine replacement (Nicorette/Nicotrol)

Nursing Considerations and Client Education:Monitor vital signs and neuro statusProvide for client safety and implement seizure precautionsEncourage adherence to treatment planAdvise clients taking Antabuse to avoid all alcoholCan lead to neuro and GI complicationsDischarge Care and Client OutcomesReinforce how to recognize S/S of relapse and factors that can contribute to relapseReinforce cognitive-behavioral techniques to maintain sobriety and find pleasure in activities other than using substancesHelp client develop communication skillsEncourage 12-step program

The client will verbalize coping strategies to use in times of stressThe client will remain substance freeThe client will remain free from injuryThe client will attend a 12-step program regularly

Quick Quiz!Which of the following medications should the nurse anticipate administering to help clients maintain their abstinence from alcohol?A.Ativan (lorazepam)B.Wellbutrin (Bupropion)C.Antabuse (Disulfiram)D.Catapres (Clonidine)Quick QuizWhich of the following is an adverse effect of hallucinogens such as LSD and PCP?

A.panic attacksB.hypothermiaC.constricted pupilsD.muscle flacidityEating DisordersAnorexia NervosaBulimia Nervosa

Watch a VideoMy Name is Anna

http://youtu.be/e3MDorE7BCU

Eating DisordersEating disorders recognized by DSM-IV-TRAnorexia NervosaBulimia NervosaMortality rate for eating disorders is highSuicide is a riskTreatment focuses on normalizing eating patterns and beginning to address issues raised by the illnessComorbidities includeMajor depressive disorderDysthymia (50-75%)OCDSubstance abuseAnxiety disorders

Anorexia NervosaPreoccupation with food and eating ritualsVoluntary refusal to eatExhibit morbid fear of obesityRefusal to maintain minimally normal body weight(85% of expected normal weight for the individual)Body image disturbanceOccurs most often in females Adolescence to young adulthood5% to 10% of clients with anorexia are maleTwo types:Restricting typeDrastic food restriction (no binging or purging)Binge-eating typeEngages in binge eating or purging behaviors

Bulimia NervosaRecurrent eating of large quantities of food over short period of time (bingeing)Followed by inappropriate compensatory behaviors to get rid of excess caloriesSelf-induced vomiting (purging)Most clients maintain a normal or slightly higher weightAverage age of onset in females = 15 to 18 yearsAbout 10% to 15% of clients are malesOnset generally occurs between 18 26 yearsBinging with use of excessive exercise is most commonTwo types:Purging Type Self-induced vomiting, laxatives, diuretics and/or enemasNonpurging Type:May compensate for binging through other meansExcessive exerciseMisuse of laxativesDiureticsEnemas

Risk FactorsFemaleFamily geneticsHypothalamic/neurotransmitter/hormonal/biochemical imbalanceDisturbance in SerotoninInterpersonal relationshipsPsychological influencesRigidity/ritualismSeparation/individualization conflicsFeeling ineffectiveHelplessnessDepressionDistorted body imageEnvironmental factorsPressure from societythe perfect bodyHistory of being a picky eater during childhoodParticipation in athleticsElite level of competititionMaleParticipation in sport where lean body is prized or necessaryBicyclingWrestlingHistory of obesity

Subjective / Objective DataNursing history should include:Clients perception of the issueEating habitsHistory of dietingMethods of weight controlValue attached to a specific shape / weightInterpersonal and social functioningDifficulty with impulsivity / cumpulsivityFamily and interpersonal relationshipsFrequently troublesome and chaotic, reflecting a lack of nurturingCommon Data FindingsObjective DataFindingsMental StatusCognitive distortionsOvergeneralizations (Other girls dont like me because Im fat)All-or-nothing thinking (If I eat any dessert, Ill gain 50 pounds)Catastrophizing (My life is over if I gain weight)Personalization (When I walk through the hospital hallway, I know everyone is looking at me)Emotional Reasoning (I know I look bad because I feel bloated)High interest in preparing food, but not eatingTerrified of gaining weightPerception is that he/she is severely overweight and sees image reflected in the mirrorMay exhibit low self-esteem / impulsivity/ difficulty with interpersonal relationshipsMay participate in an intense physical regimenVital SignsLow blood pressure with possible orthostatic hypotensionDecreased pulse and body tempWeightAnorexics body weight less than 85% of expected normal weightBulimics weight within normal range or slightly higherSkin / Hair / NailsAnorexics fine downy hair (lanugo) on the face and back / yellowed skin/ mottled / cool extremities / poor skin turgorHead / Neck / Mouth / ThroatBulimics enlarged parotid glands / dental erosion / caries (if purging)Cardiovascular SystemBulimics dysrhythmias / heart failure / cardiomyopathy / peripheral edemaMusculoskeletal SystemMuscle weaknessGastrointestinal SystemConstipation / self-induced vomiting / excessive use of diuretics or laxativesReproductive SystemAnorexics amenorrhea for at least three consecutive cyclesNutritional StatusElectrolyte imbalances and severe dehydrationCriteria for Treatment / Labs and DiagnosticsCriteria for TreatmentLabs and DiagnosticsRapid wt loss or wt loss > 30% of body weight over 6 monthsUnsuccessful weight gain in outpatient treatment for failure to adhere to treatment contractVital signsHR < 40 BPMSystolic BP < 70Temp < 98.6ECG changesElectrolyte disturbanceSevere depressionSuicidal behaviorFamily crisisCommon abnormalitiesHypokalemia (bulimics)Potassium loss from purgingIncreased aldosteroneSodium and water retentionResults from dehydrationAnemia / leukopenia/ lymphyocytosis Possible impaired liver function ( ^ enzyme levels)Possible ^ cholesterolAbnormal thyroid function tests^ carotene (causes yellow skin)Decreased bone densityPossible osteoporosisAbnormal blood glucose levelsECG changesElectrolyte ImbalancesHypokalemiaHyponatremiaHypochloremia Standardized Screening ToolsEating Disorders InventoryBody Attitude TestDiagnostic Survey for Eating Disorders

Google These!! Make notes! Then come back!!

Nursing CareHighly structured milieu (for those requiring intensive therapy)Maintain trusting nurse/client relationshipPositive approach and supportSupport self esteem and positive self imageEncourage client decision making and participation in plan of careEstablish realistic goals for weight gainPromote cognitive-behavioral therapiesCognitive reframingRelaxation techniquesJournal writingDesensitization exercisesMonitor vital signs, I&O, and weightUse behavioral contracts to modify behaviorsRewards for positive behaviorsMonitor during and after mealsMonitor for maintenance of exerciseReinforce self-care teachingProvide nutrition educationConsider clients preferencesEstablish a structured eating scheduleProvide small, frequent mealsDiet high in fiber, low in sodiumLimit high-fat and gassy foods at start of treatmentAdminister multivitamin and mineral supplementInstruct client to avoid caffeineMake arrangements for clients to attend individual, group, family therapy

Medications and other careMedicationsSelective Serotonin Reuptake Inhibitors (SSRIs)Prozac (fluoxetine)Client EducationMed may take 1 to 3 weeks for initial responseUp to 2 months for maximal responseAvoid hazardous activitiesNotify MD if sexual dysfunction occurs and is intolerableInclude registered dietician for nutritional and dietary guidanceAfter DischargeHelp to develop and implement a maintenance planEncourage follow-up treatmentEncourage support groupContinue individual and family therapy as indicatedWatch a VideoRole of Nutrition in Refeeding Syndrome (UNC Chapel Hill)

http://www.youtube.com/watch?v=wWTwAclznRw

Complications of Eating DisordersRefeeding SyndromeCirculatory collapseOccurs when clients compromised cardiac system is overwhelmed by a replenished vascular system after normal fluid intake resumes.

Nursing actions:Care for clients in hospital settingImplement refeeding for at least 7 daysMonitor serum electrolytes and administer fluid replacement as prescribedCardiac dysrhythmias, severe bradycardia, hypotensionMay be admitted to ICU until stable

Quick Quiz!A client is hospitalized on an eating disorders unit. The client has a history of and current diagnosis of bulimia nervosa. Which of the following should the nurse expect to find? (select all that apply)_____hyperkalemia_____amenorrhea_____ECG changes_____cool extremities_____peripheral edema_____yellowed skin_____body weight below the expected range_____tooth decay

Quick Quiz!A client who has bulimia has stopped vomiting on the unit and describes to the nurse feelings of being afraid of gaining weight. Which of the following is an appropriate response by the nurse?

A.As long as you stick to the diet you have here, you are not going to gain enough weight to worry about.

B.Forget about your weight for now. We are going to work on other problems while you are in the hospital.

C.I understand you have concerns about your weight, but tell me about your National Honor Society invitation. Thats quite an accomplishment.

D.You are not overweight, and well make sure you do not become overweight. We know that is important to you.SummaryIdentified common subjective and objective evidence associated with common mental health disordersAnxiety DisordersDepressionBipolar DisordersSchizophreniaPersonality DisordersCognitive DisordersSubstance and other dependenciesEating Disorders

Identified nursing interventions, therapies, screening tools, that may be utilized in the safe care, management, and health promotion, for individuals who experience these disorders.

Determined desired outcomes associated with these disorders

Assignment Due Day 2See Schedule for assignments due for next class

Next ClassQ&A ReviewPsychobiological DisordersPharmacology and Alternative Therapies

Test #1ATI practice test #1Graded open book (one hour time limit)PN Mental Health Online Practice 2011BID 5604197 - Password 5C6753P55

ATI Tutorial and QuizTake home assignment due Day 3May begin after completing testStudy!!! You can do it!!!