CMHN: Special Populations- Mental Health Issues


Special Populations- Mental Health Issues
l . Anxiety disorders
2. Conduct disorders
3. Mood disorders
4. Schizophrenia
5. Eating disorders
6. Deliberate self harm
7. Alcohol and substance abuse
8. Sexual problems
Nursing responsibility
l . Assessment for high risk behavior
2. Provide medical treatment as ordered
3. Give support and behavioral therapies
4. Establish a therapeutic relation with client  
5. Involve family members in planning and implementing therapies
6. Plan for appropriate referral services
7. Treat adolescent as individual client
8 Educate family on communication pattern
l. Premenstrual syndrome
2. Postpartum depression
3. Puerperal psychosis
4. Maternity blues
5.  menopause
Premenstrual syndrorne (PMS) is a condition that affects a woman's emotions, physical health  and behavior during certain days of the month generally just before her menstrual period.
PMS symptoms start 5 to 11 davs before menstruation and typically go away once menstruation begins.
The cause of PMS is unknown. However, many researchers believe that a change in hormone levels at the beginning of the menstrual cycle may be to blame.
Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxietv, and irritability .
PMS symptoms affect about 75 percent of menstruating women.
Risk factors for premenstrual svndrome include:
a history of depression or mood disorders. such as postpartum depression or bipolar disorder a family history of depression Symptoms
Breast swelling and tenderness, Acne, Food cravings, Irritability, Mood swings, Cry spells, depression
  • Diuretics
  • Analgesics
  • OCPs
  • Overian suppressors (danocrine)
  • Anti depressants (sos)
General management
  • Provide exercise
  • Provide emotional support
  • Provide enough sleep
  • Adequate nutrition
  • Avoid salt before menstrual period
  • Avoid caffeine and alcohol
Can occur during pregnancy or within one year of delivery
History of depression, Positive family history of depression, Anxiety about fetus, Problems with previous pregnancy, Young age of mother, Low thyroid levels, Stress from work or home, Broken sleep patterns Symptoms
Feeling irritable, Sadness, hopelessness, Crying spells, Avolition , Eating too little or too much  Withdrawal from friends and family, Sleep disturbances, Less interest in baby
Usually begins within 1-3 months of delivery
Auditory / visual hallucinations, Delusions, Insomnia, Sleep disturbances, Obsessed thoughts of baby Agitation, Anger, Irrational guilt, Mood swings
Occurs mostly on 4th or 5th day after delivery in 30-85 % women
Prenatal depression, Low self esteem, Child care stress, Low social support, Poor marital relationship,Unplanned pregnancy
Dysphoria, Mood liability, Irritability, Hypochondriasis, Anxiety, Insomnia, Impaired concentration, Isolation, headache,
Management (review from older units)
1. Antipsychotic drugs
2. Mood stabilizers
3. Supportive intervention
4. CBT
5 Reassurance
6. Monitor and supervision
7. Nutritional management
8. Suicidal precautions

Developmental tasks
l . Establishing satisfactory living relationship
2. Adjusting to retirement income
3. Establishing comfortable routines
4. Maintaining love, sex, and marital relationship
5. Keeping active and involved
6. Staying in touch with other family members
7. Sustaining and maintaining physical and mental health
8. Finding meaning of life
Common mental health problems
l . Depression
2. Dementia
3. Delirium
4. Paranoid disorders
( Symptoms and management from previous topics)

Forms of domestic violence
1 . Physical aggression,
2. Threats
3. Sexual abuse
4. Emotional abuse
5. Controlling or domineering
6. Intimidation
7. Neglect
8. Financial deprivation
Effect of violence
Physical, social, emotional effects, Lowering self esteem, Loss of confidence, Avoidence, Mutism, Depression, Suicidal ideation
Prevention of violence
Learn about type of violence that may occur
Recognize early warning signs of violence
Work on low self esteem issues
Recognize obstacles to responding to violence
Build support systems Open communication
l . Physical abuse
2. Emotional abuse
3.Sexual abuse
4.Financial abuse
Family violence, Unsatisfactory schooling, housing and environment, Parental factors, Mental illness, Marital disharmony, Crime, Chronic illness, Poverty, Poor interpersonal interactions
Clinical features
Multiple bruising, Burns, Abrasions, Bites, Torn upper lip, Subdural hemorrhage, Fracture, Genital bleeding, Crying spells, New sexual behaviors in child, Depression, anxiety, nightmares, Suicidal tendency, Low self esteem, Anger, Guilt, Fear, Unwanted pregnancy, STDs, Self harm, Social withdrawal
l . Reassurance
2. Talk to parents regarding abuse
3. Treat external injuries
4. Help family to modify behavior
5. Never blame parents
6. Provide legal counseling to victim and family
7. Counseling and guidance
8. Provide reinforcement of healthy traits
9. Treat if venereal diseases present

F. Handicapped
They try to excel by compensation
They usually are victims of teasing, bullying, casting, insulting remarks, and avoidance by others
They experience, low self esteem and disturbed body image
Only few cope with disability and ignore it
Strategies to help
Focus on what they can do at times
Identify child's strength and capitalize them
Keep expectations high, the child is capable of achieving
Never accept rude or negative remarks towards these children
Give compliment and positive encouragement for their achievements
Make adjustments and accommodations when ever possible, for the child to participate in  Never pity them
Encourage independent activities
Ensure safe measures for the child
Psychosocial issues related to the diagnosis
Behavioral problems, Fear, Loss, Isolation, Resentment, Depression, Anxiety, Anger, Suicidal thoughts, Low self esteem
Psychiatric syndromes due to HIV/ AIDS
Depression, Anxiety, Paranoia, Mania, Irritability, Psychosis, Substance abuse, Insomnia, Suicidal ideation
Nursing management
1. Multidisciplinary team approach
2. Detailed neuropsychiatry assessment
3. Help patient change risky behavior
4. Provide counseling
5. Clarify doubts if needed
6. Explain window period
7. Review patient's assessment for own risk
8. Provide risk reduction information
9. Build rapport
10. Explore patients feelings
11. Implement psychosocial interventions
12. Provide safe sex information
13. Advise for regular medical monitoring
14. Teach about ART and nutritious diet

15. Enable social support networks for patient



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item CMHN: Special Populations- Mental Health Issues
CMHN: Special Populations- Mental Health Issues
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