My Nursing Education

Running head: PSYCHOPATHOLOGY

Psychopathology Paper 1
H.F.C.C. Psychiatric Nursing 150
By Nancy Taji

Running head: PSYCHOPATHOLOGY
Diagnosis Bipolar Disorder: “Bipolar disorder is a severe biologic illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal.” (Lehne, 2004, p. 321)
The following is a short synopsis according to the DSM-IV-TR, “Criteria for Bipolar Disorder includes a distinct period of abnormality and persistently elevated, expansive, or irritable mood for at least:
• 4 days for hypomania
• 1 week for mania
During the period of mood disturbance, at least three or more of the flowing symptoms have persisted and have been present to a significant degree:
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual or pressure to keep talking
• Excessive involvement in pleasurable activities that have a high potential for painful consequences.” (American Psychiatric Association [APA], 2000).

Psychodynamics of the Disease: The onset of the disease usually occurs during late adolescence or in the mid twenties. However, the disease has been known to occur up into the fifth decade of life. The mood swings that accompany this disorder are of several types. They are as follows: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,
Running head: PSYCHOPATHOLOGY
impairment in normal social functioning usually requiring hospitalization; Hypomanic Episode, evidenced by a milder form of the Pure Mania, without the loss of normal functioning that would require hospitalization; Major Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death; the last episode associated with Bipolar disorders is the Mixed Episode in which, “patients experience symptoms of mania and depression simultaneously. The combination of high energy and depression puts them at significant risk of suicide.” (Lehne, 2004, p. 321)
Case Presentation: A Caucasian woman in her mid twenties presented signs and symptoms of self mutilation with a straight edge razor inflicted gash across her lower abdomen approximately six inches below the umbilicus. The depth of the gash just stopped at the abdominal fascia. The patient was sent from the emergency room to the
psychiatric floor. Upon meeting the patient one day after her admission to E.R., she appeared dressed in pajama bottoms and a t-shirt, shuffling down the hall in her socks. She was holding her abdomen with one hand and appeared in some discomfort. Her black hair was short and disheveled. When the patient arrived at her room she sat down on her bed. She acknowledged with blunted affect that she cannot stop self mutilation, and described how she cut herself through the muscles in her abdomen almost down to the fascia. Her voice was tremulous and fast paced. This could be due to the fact that she had just been given her first dose of Clozaril. She stated that her mouth was dry and that she needed to drink some water. She then went on to say that she was getting very sleepy. The client felt comfortable with the interview.
Running head: PSYCHOPATHOLOGY
She shared personal information in regards to being sexually abused by her bother beginning at the age of seven until the age of fifteen. Her brother was two years older than her and died in a automobile accident at the age of eighteen. She went on to say that her mother never knew or acknowledged the sexual abuse and that she could not tell her because the mother idolized the son. The client was receptive to cognitive reframing, however she was very critical of herself and stated that she felt worthless and ashamed. She appeared very tired and stated that she wanted to sleep.

Running head: PSYCHOPAHTOLOGY
Table 1
Textbook characteristics of Bipolar disorder versus client characteristics observed

Textbook Characteristics of Bipolar Disorder
1. Pure Manic Episode
2. Hypomanic Episode
3. Major Depressive Episode-
a.) Affective Flattening
b.) Alogia
c.) Avolition-apathy
d.) Anhedonia
4. Mixed Episode
5. Rapid-Cycling Bipolar Disorder- Patients experience four or Client Characteristics Observed

1. No current symptoms
2. Rapid breathing, rapid speech, however due to medication a client was concurrently exhibiting s
3. lethargy
4. Client acknowledged sadness/ worthlessness
a.) Facial expression flat
b.) Thoughts of dying, hard to focus
c.) Hair/clothes unkempt
d.) Expressed no interest in children or own

Running head: PSYCHOPATHOLOGY
Client’s Symptoms
1. Hypomania

2. Depression
a.) Affective Flattening
b.) Alogia
c.) Avolition & Apathy
d.) Anhedonia
3. Mixed Episode
4. Rapid Cycling

(Varcarolis, 2004, p. 485)

Nursing Interventions
1. Observe the client every 15 minutes while suicidal, remove all dangerous, sharp objects from room.
2. Reinforce that she is worth while,
a.) Assist the client in evaluating the positive as well as the negative aspects of her life
b.) Encourage the appropriate expression of angry feelings.
c.) Schedule regular periods of time throughout the day for recreational/occupational therapy, encourage client to groom self, offer praise for completing grooming.
d.) Ensure client’s participation in taking mood stabilizing medications. Watch client swallow medication.
3. Engage client in interpersonal therapies, cognitive-behavioral therapy,
4. Encourage client to attend group therapy, and journal episodes.
Running head: PSYCHOPATHOLOGY
Table 2
Medical Interventions, Bipolar Disorder
1. Drug therapy using
a.) Mood stabilizer
b.) Antidepressants
c.) Antipsychotics
2. Education and Psychotherapy
3. ECT
(Varcarolis, 2002, p. 483)

Clients Medical Interventions
1. Drug therapy includes
a.) Lithium 300mg every h.s.
b.) Not taking any
c.) Clozaril
2. Client is receiving psychotherapy, family counseling, group therapy while in hospital, and cognitive restructuring.
3. None

Running head: PSYCHOPATHOLOGY
References
Lehne, R. (2004). Pharmacology for Nursing Care. Missouri: Saunders
Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing: A Clinical
Approach. Pennsylvania: Saunders

Wednesday continuing on fluids and e-lytes
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

I. Respiratory Acidosis

A. Signs and symptoms
a. Acidosis signifies that H+ ions are prevalent and multiplying.
b. There are several reasons that H+ ions are present. Let us look at the bicarbonate ion, H2Co3. The bicarbonate ion is a very good buffer. It allows enzymatic reactions to take place without drastically altering the pH of the blood. Our blood must remain at a pH of between 7.35-7.45

2. Let’s take a look at what constitutes respiratory acidosis given a few scenarios
A. pH = 7.2
PCO2 = 25
HCO3- = 15

Here are the normals

pH = 7.35-7.45
pCO2 = 35-45 mm/hg
HCO3 – = 20-30 mmol/L

Now here’s how we do this
1. First look at the pH. Notice that it is 7.2 which is in the acidic range for the blood.
2. Now look at the pCO2, it is in the abnormal range. It is below the normal range. This means that the less pressure in the respiratory system the less CO2 present and more O2. But as the pressure decreases beyond the normal range we have a alkaline situation. This doesn’t match our pH. Could it be that the respiratory system is trying to compensate for the acidic situation occurring? Yes.
3. Now look at the bicarb- ion, it is in the abnormal range below the base normal of 20 mmol/dl. What does this mean? Well, it means that as the bicarbonate ion decreases the H+ proton increases.
4. Now let’s see what we have. What two values agree with each other? The answer to that would be the Acidic pH and the Acidic bicarbonate ion. Since they are both acidic, the term of the system is metabolic acidosis, and the respiratory system is trying to compensate.
5. So the system is partially compensated.
Let’s take a look at what happens in a system that is under Respiratory Alkalosis

pH [The body is in a state of alkalosis]

7.50 The body is
[trying to get back to normal]

7.47
[back to normal]

7.45

pCO2 [below normal]
alkaline

30mm hg [below normal]
alkaline

30mm hg [below normal]
alkaline

30mm hg

HCO3-
[normal range]

20 mmols/L
[below normal] becoming acidic

18 mmols/L
[farther below normal]more acidic

16 mmols/L
What’s
happening Respiratory Alkalosis
uncompensated Respiratory Alkalosis

Partially compensated We are still in respiratory alkalosis, however, the kidneys have Fully compensated by bringing the pH back to normal by releasing more H+ ions
The less CO2 in the respiratory system, the more alkaline it becomes. Or in other words the more HCO3- that is generated.

1. pH = 7.17

pCO2 = 98 mm hg

HCO3- = 38 mmols/L

Let’s see what’s happening here. First of all the pH is below normal which means that it is in the Acidic range.
Next, we look at the pressure in the lungs. We see that the pressure is very high. We know that as the pressure of CO2 increases, that it means that CO2 is multiplying in the lungs and creating a higher pressure. The more CO2 that we have, the more H2CO3 [carbonic acid] that is going to be made. Look at the bicarb ion. This is also elevated. However, if the bicarb ion[HCO3-] is elevated, this means that more base is being made. More base is being made in response to the acidic state of the body. So what is happening, is that the body is in Respiratory Acidosis, and the kidneys are trying to hang on to the bicarb ion to counter act the acid environment.

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Pathophysiology Paper One
Disorder: Coronary Artery Disease
Nursing 221 Medical/Surgical

Excerpt:

Diagnoses: “Coronary artery disease (CAD), and abnormal condition that may affect the heart’s arteries and produce various pathologic effects, especially the reduced flow of oxygen and nutrients to the myocardium. The most common kind of coronary artery disease is coronary atherosclerosis.” (Mosby’s Medical, Nursing, & Allied Health Dictionary, 2002, p.434)
Risk Factors: “Atherosclerosis is the most common cause of CAD and is linked to may risk factors- primarily elevated serum cholesterol levels, elevated blood pressure, and cigarette smoking. Blood levels of cholesterol and low-density lipoproteins have been associated with increased risk of CAD. Hypertension places chronic stress on the blood vessels and may initiate plaque deposition. Other risk factors include heredity, obesity, lack of physical activity, stress and diabetes mellitus.” (Sommers, M., Johnson, S., 2002, p.265)
The client a ninety two year old women, has been diagnosed upon admission with chronic atrial fibrillation with rapid ventricular rate.
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Excerpt from a term paper.
Pathophysiology Paper
Disorder: Coronary Artery Disease
First Year Nursing School Medical/Surgical

Diagnoses: “Coronary artery disease (CAD), and abnormal condition that may affect the heart’s arteries and produce various pathologic effects, especially the reduced flow of oxygen and nutrients to the myocardium. The most common kind of coronary artery disease is coronary atherosclerosis.” (Mosby’s Medical, Nursing, & Allied Health Dictionary, 2002, p.434)
Risk Factors: “Atherosclerosis is the most common cause of CAD and is linked to may risk factors- primarily elevated serum cholesterol levels, elevated blood pressure, and cigarette smoking. Blood levels of cholesterol and low-density lipoproteins have been associated with increased risk of CAD. Hypertension places chronic stress on the blood vessels and may initiate plaque deposition. Other risk factors include heredity, obesity, lack of physical activity, stress and diabetes mellitus.” (Sommers, M., Johnson, S., 2002, p.265)
The client has been diagnosed with diabetes mellitus, hypertension, and high cholesterol…….

No one will ask your GPA when you are saving someones life

Not everyone is an all A student.   Accept yourself for the effort that you put forth, knowing it is your best.  Do not look to those on the right or the left, just continue on your path and before you realize it, you will be a graduating nurse.

When you stop dreaming, you stop doing.  Never let anyone take away your dreams.  Dreams become a reality, and you will become a nurse.

American Nursing Today

Culturally Competent Care

By

Nancy Lydia Kimmel

R.N. Ph.D. C.H.M.M.

Immigration to the United States has never ceased. It is a continual process that brings a variety of rich cultures and knowledge this great country. Health care workers experience the vastness of cultural diversity more so than any other profession. Therefore, more than any other profession, health care workers, nurses and physicians in particular must be culturally sensitive to the patients needs.

As the population of the United States continues to increase, hospitals are more likely to see more patients that have cultural needs. Meeting the cultural needs of a patient is essential in treating the whole person. Enhancing a client’s mental and physical wellness is the responsibility of the nurse. The nurse must attempt to use all of the resources at their disposal to see that the client receives the care that they need. Nurses are faced with a great challenge when treating clients of various ethnicities. Hospital rules are not always congruent with the requests of patient’s families. Hospitals with set visiting hours may pose a problem the nurse who recognizes that the patient needs family members around them at all hours. Hospitals do not always cater to the patient’s diet. Hospitals in Dearborn Michigan now carry Halal food for the patients who are of the Islamic faith. The city of Dearborn has one of the highest populations of Arabic speaking peoples in the nation. Hospitals had to recognize that to give quality care, they had to be sensitive to the client’s needs. Nurses may not be able to change hospital protocol, but they can make a significant difference in how the patient views his or her health care. Therefore the nurse must make every effort to ensure that the patient’s needs are met. It may be to allow family to visit on off hours, or to have a plate of food brought in from home. Many cultures have a theory about sickness. In this theory, there are cold foods and hot foods. Each of these foods is used to treat a particular sickness. Preventing families from taking a integral role in their loved ones care could possibly impede the healing process, by adding additional stress. Stress has been known to cause numerous illnesses. The nurse must attempt to balance the care that the family gives while in the hospital with the rules and regulations of hospital protocol. This can be a fine line. However, the patient comes first. To facilitate an atmosphere where the client feels most comfortable is the goal of the nurse as well as the other medical staff. Of course one would not encourage food from home if the client had leukopenia, or their immune system was compromised. A nurse must possess the skill and compassion to facilitate the healing process from the first meeting. When the client cannot speak English the nurse should do their best to enlist an interpreter. Using a family member is not a wise choice, due to the fact that the family member may not know how to translate medical terms or may be selective in translating so as not to worry their loved one. Interpreters are usually employed by hospitals to assist medical personnel. Some hospitals have what is known as the “Blue Phone”. The Blue Phone is a direct line to an interpreter of choice for a specific language. The nurse merely has to hand the phone to the patient after explaining to the interpreter what the patient needs to know. Being a culturally sensitive nurse can bring about positive change and improve the healing process. The client will want to return to that hospital if they find it necessary, and will recommend other family members as well.

So You Finally Passed The Nursing Boards

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Congratulations! So you finally passed your boards, and now you are a real Registered Nurse. How does it feel, to have passed the final test of all tests? Great? Absolutely! Now what? Well, to begin, you need to celebrate. There are many loved ones that are also looking forward to taking part in the celebration. After all, they were your support through those trying years in nursing school. They stood by you, through your highs and lows. Yes, there were those low points. But now, it’s over. Now begins a new chapter in your life. No longer are you a student nurse, or a graduate nurse, you are a REGISTERED NURSE. Yeah baby! Did you know, that now you can actually practice anywhere in the United States?

The horizon is endless and you are in the driver’s seat with an unlimited gas card. Before all of this wonder and responsibility actually sinks in, it is time to do something nice for yourself. Do something that you have always wanted to do. It doesn’t have to be extravagant, nor does it have to be something that is going to break the bank, although there may not be much in the bank at this moment. It is the small things that can mean the most. Here are a few suggestions, go out with those special people in your life to a restaurant that you have always wanted to go to, spend a couple of days at a local hotel that has a pool, spa, and amenities for kids and adults, treat yourself to a manicure, a pedicure, a makeover, get your hair done, buy yourself a new outfit, go to a car dealership and test drive the most expensive car on the lot, but be sure you stop at a drive through gourmet coffee stand so that everyone will see you in your ride, go out to a park and just spend the day there, paint a picture, go out to the theater, or simply stay home and spend quality time with the ones you love. You have many things to talk about. Now you can let your guard down and speak your mind about all of the challenges in nursing school and how you managed to actually get to this point in your life. You need to vent and whether or not you realize it; you have stuff to vent about. It is a relief to be done with school. It was not an easy road. You put in many clinical hours doing the work of a Registered Nurse without pay.

You faced many personal challenges and challenging personalities. The frustrations that you had to overcome must be vented, because you overcame them all. Not everyone can make the journey to Registered Nurse. Remember, you did, and that is really a life accomplishment. Yes, you really did pass the NCLEX.. Those forty eight hours of waiting for those two words to show up on the testing web site, PASS, or FAIL,was more than anyone could stand, but you waited, with fear, anticipation and excitement, but probably more fear than excitement. Then to finally find out that you PASSED. Wow, talk about a rollercoaster ride. It’s over in less than one minute. You read the words on the computer screen, ” PASSED”, and then you draw a blank, as you sit there staring at the screen. You feel like you’re going to cry, no, laugh, no, just sit there in utter amazement wondering how you did it. Then it sinks in, minute after the next, and you say to yourself, “hey, I am an R.N., a Registered Nurse, a real Registered Nurse.” But you’re still not sure, until you actually get your license from the state. Wow, talk about paranoid. Yes, we all are. Your licensure from your state will only take a few days to arrive.

When it arrives, you see the number, it’s your number, so yes now your are for sure now that you are an real REGISTERED NURSE. Take time to let it sink in, go over all of your hurdles, look at all of your books and remember how many hours you put in studying day after day. The journey to becoming a Registered Nurse was a grueling and arduous road. It took courage, perseverance, patience, self control, time management, self sacrifice, diligence, fortitude and above all the love of helping ones fellow man, and yes, you did it. You are now in the ranks of one of the most noble professions, one that challenges the mind, soul, body and spirit, and one that never stops giving strength when you can actually see your efforts bringing forth wellness, dignity, and health.

Your true learning will soon begin, and you will experience nursing in all of its facets. Life is of course a learning experience, and you still have so much to learn. With all of that said, take some time, look at yourself in the mirror and say, “I like me, and I am proud of myself and of my accomplishments!”, and so you should be. You stand in the ranks with

those who came before you and laid the foundation on which you now stand such as Florence Nightingale You will also make your mark in the history of the nursing profession. But right now, it is time to celebrate.

Be Well,

In contrast, nurse education in the United States has almost exclusively been conducted within university schools, although it is unclear who offered the first degree level program. So far as known Yale School of Nursing became the first autonomous school of nursing in the United States in 1923. In Europe the University of Edinburgh was the first European institution to offer a nursing degree in 1972.