Friday, 5 January 2018



DEFENCE MECHANISMS / MENTAL MECHANISMS  :                                (PART -I)

DEFINITION:

Defense mechanism is a pattern of adjustment through which an individual relieves or decreases anxieties caused by an uncomfortable situation that threatens self- esteem.

 The positive use of these mechanisms is:

1.       To minimize anxiety
2.       To protect the ego
3.       To maintain repression


TYPES OF DEFENSE MECHANISMS

A. PRIMITIVE DEFENSE MECHANISMS
1.Denial
Denial is the refusal to accept reality or fact, acting as if a painful event, thought or feeling did not exist. 
It is considered one of the most primitive of the defense mechanisms because it is characteristic of early childhood development.
Many people use denial in their everyday lives to avoid dealing with painful feelings or areas of their life they don’t wish to admit.

Example: A person who is a functioning alcoholic will often simply deny they have a drinking problem, pointing to how well they function in their job and relationships.


2. Regression
Regression is the reversion to an earlier stage of development in the face of unacceptable thoughts or impulses.

Example: an adolescent who is overwhelmed with fear, anger and growing sexual impulses might become clingy and start exhibiting earlier childhood behaviors who has long since overcome, such as bedwetting. 

3. Dissociation
Our mental existence is continuous. We maintain a seamless flow of memories, consciousness, perception, and representation of both inner and external worlds. When we face horrors and unbearable truths, we sometimes "disengage". We lose track of space, time, and the continuum of our identity. People who have a history of any kind of childhood abuse often suffer from some form of dissociation. In extreme cases, dissociation can lead to a person believing they have multiple selves (”multiple personality disorder”). In extreme cases, some people develop a permanently rent personality and this is known as "Dissociative Identity Disorder (DID)". 

In this manner, a person who dissociates can “disconnect” from the real world for a time, and live in a different world that is not cluttered (associated) with thoughts, feelings or memories that are unbearable.

4. Projection   
One’s own unacceptable feelings and thoughts are expressed as if they are due to others. Its purpose is self-protection. The person who blames another person for his own mistakes is using the projection mechanism.

Example: spouse may be angry at their significant other for not listening, when in fact it is the angry spouse who does not listen. Projection is often the result of a lack of insight and acknowledgement of one’s own motivations and feelings.


5. Reaction Formation
Reaction Formation is the converting of unwanted or dangerous thoughts, feelings or impulses into their opposites.

Example: a woman who is very angry with her boss and would like to quit her job may instead be overly kind and generous toward her boss and express a desire to keep working there forever. She is incapable of expressing the negative emotions of anger and unhappiness with her job, and instead becomes overly kind to publicly demonstrate her lack of anger and unhappiness.


B.  LESS PRIMITIVE, MORE MATURE DEFENSE MECHANISMS
Less primitive defense mechanisms are a step up from the primitive defense mechanisms


6.Repression:
 it is often reffered to as ‘selective forgettng.
it is a more complicated mechanism in which unpleasant or unacceptable experiences, emotions or motivations are actively forced into the unconscious and kept there. Unacceptable feelings are unconsciously kept out of awareness.  The key to repression is that people do it unconsciously, so they often have very little control over it. 
“Repressed memories” are memories that have been unconsciously blocked from access or view.

Example: a man is jealous of his good friend’s success but is unaware of his feelings of jealously.in the previous section. Many people employ these defenses as adults, and while they work okay for many, they are not ideal ways of dealing with our feelings, stress and anxiety. If you recognize yourself using a few of these, don’t feel bad – everybody does.


7. Displacement
Displacement is the redirecting of thoughts feelings and impulses directed at one person or object, but taken out upon another person or object.

example is the man who gets angry at his boss, but can’t express his anger to his boss for fear of being fired. He instead comes home and kicks the dog or starts an argument with his wife. The man is redirecting his anger from his boss to his dog or wife.

8. Intellectualization
Intellectualization is the overemphasis on thinking when confronted with an unacceptable impulse, situation or behavior 

 Example: A person who has just been given a terminal medical diagnosis, instead of expressing their sadness and grief, focuses instead on the details of all possible fruitless medical procedures.


9. Rationalization 
Rationalization is putting something into  a different explanation for one’s perceptions or behaviors in the face of a changing reality.

Example: A woman who starts dating a man she really, really likes and thinks the world of is suddenly dumped by the man for no reason. She reframes the situation in her mind with, “I suspected he was a loser all along.”

10. Undoing
Undoing is the attempt to take back an unconscious behavior or thought that is unacceptable or hurtful. By “undoing” the previous action, the person is attempting to counteract the damage done by the original comment, hoping the two will balance one another out.

Example: After realizing you just insulted your significant other unintentionally, you might spend then next hour praising their beauty, charm and intellect.

Sunday, 23 April 2017

Heart Anatomy
§Approximately the size of  fist
§Location
§Superior surface of diaphragm
§Left of the midline
§Anterior to the vertebral column, posterior to the sternum



Coverings of the Heart: Anatomy
§Pericardium – a double-walled sac around the heart composed of:
        A superficial fibrous pericardium
        A deep two-layer serous pericardium
        The parietal layer lines the internal surface of the fibrous pericardium
        The visceral layer or epicardium lines the surface of the heart
       They are separated by the fluid-filled pericardial cavity
§Epicardium – visceral layer of the serous pericardium
§Myocardium – cardiac muscle layer forming the bulk of the heart
§Endocardium – endothelial layer of the inner myocardial surface
External Heart: Major Vessels of the Heart (Anterior View)
  §Vessels returning blood to the heart include:
        Superior and inferior venae cavae
        Right and left pulmonary veins
  §Vessels conveying blood away from the heart include:
        Pulmonary trunk,     which splits into right and left pulmonary arteries
        Ascending aorta (three branches) –
        Brachiocephalic
        Left common carotid
        Subclavian arteries
External Heart: Vessels that Supply/Drain the Heart (Anterior View)
§Arteries – right and left coronary (in atrioventricular groove), marginal, circumflex, and anterior interventricular arteries
§Veins – small cardiac, anterior cardiac, and great cardiac veins


External Heart: Major Vessels of the Heart (Posterior View)
§Vessels returning blood to the heart include:
Right and left pulmonary veins
Superior and inferior venae cavae
§Vessels conveying blood away from the heart include:
Aorta
Right and left pulmonary arteries
External Heart: Vessels that Supply/Drain the Heart (Posterior View)
§Arteries – right coronary artery (in atrioventricular groove) and the posterior  interventricular artery (in interventricular groove)
§Veins – great cardiac vein, posterior vein to left ventricle, coronary sinus, and middle cardiac vein


Gross Anatomy of Heart: Frontal Section



 Atria of the Heart
§Atria are the receiving chambers of the heart
§Each atrium has a protruding auricle
§Pectinate muscles mark atrial walls
§Blood enters right atria from superior and inferior venae cavae and coronary sinus
§Blood enters left atria from pulmonary veins

nurses adda nurses adda nurses adda 
Ventricles of the Heart
§Ventricles are the discharging chambers of the heart
§Papillary muscles and trabeculae carneae muscles mark ventricular walls
§Right ventricle pumps blood into the pulmonary trunk
§Left ventricle pumps blood into the aorta
Pathway of Blood Through the Heart and Lungs
§Right atrium à tricuspid valve à right ventricle
§Right ventricle à pulmonary semilunar valve à pulmonary arteries à lungs
§Lungs à pulmonary veins à left atrium
§Left atrium à bicuspid valve à left ventricle
§Left ventricle à aortic semilunar valve à aorta
§Aorta à systemic circulation
Pathway of Blood Through the Heart and Lungs


Coronary Circulation
§Coronary circulation is the functional blood supply to the heart muscle itself
§Collateral routes ensure blood delivery to heart even if major vessels are occluded
Coronary Circulation: Arterial Supply

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Heart Valves
§Heart valves ensure unidirectional blood flow through the heart
§Atrioventricular (AV) valves lie between the atria and the ventricles
§AV valves prevent backflow into the atria when ventricles contract
§Chordae tendineae anchor AV valves to papillary muscles
Heart Valves
§Semilunar valves prevent backflow of blood into the ventricles
§Aortic semilunar valve lies between the left ventricle and the aorta
§Pulmonary semilunar valve lies between the right ventricle and pulmonary trunk
nurses adda nurses adda 
Note: Images are subjected for representative purposes only.

Wednesday, 19 April 2017

MANIA

MANIA

An abnormally elevated mood state characterized by such symptoms as
      Inappropriate elation
      Increased irritability
      Severe insomnia
      Grandiose notions
      Increased speed or volume of speech
      Disconnected & racing thoughts
      Increased sexual activity level
      Poor judgment and appropriate social behavior

HYPOMANIA
      Lesser degree of mania
      Mild elevation of mood
      Increased sense of   psychological wellbeing  and happiness , not keeping with ongoing events.

PREDISPOSING FACTORS
      Biological theories
      Psychosocial theories
      The transactional model

BIOLOGICAL THEORIES
      Genetics
      Biochemical influences
ü  Biogenic amines
ü  electrolytes
      Physiological influences
ü  Brain lesions
ü  Medication side effects
  PSYCHOSOCIAL THEORIES
      Importance declined
      Mania is viewed as  disease of brain with biological etiologies






CLINICAL FEATURES
The underlined characteristics are:-
      Elevated mood
      An increase in quantity & speed of physical & mental activity

AFFECTIVE SYMPTOMS
      Elevated mood: it has 4 stages depending on severity of manic episodes
      EUPHORIA (stage-I) : increased sense of psychological well being & happiness not in keeping with ongoing events
      ELATION (stage-II) : moderate elevation of mood with increased psychomotor activity
      EXALTATION (stage-III) : intense elation of mood with Delusions of Grandeur.
      ECSTASY (stage-IV) : severe elevation of mood , intense sense of rapture or blissfullness seen in delirious or stuporous mania
      Elevated mood
      Expensiveness
      Humorousness
      Inflated self esteem
      Intolerance of criticism
      Lack of shame or guilt
      Sometimes irritable mood is predominant
      May shift from Euphoria to Depression or Anger

BEHAVIORAL SYMPTOMS
      Aggressiveness
      Grandiose acts
      Hyperactivity
      Increased motor activity
      Irresponsibility
      Irritability
      Argumentativeness
      Poor personal grooming
      Provocativeness
      Increased social activity
      Dressed up in gaudy or  flamboyant clothes
      Sexual hyperactivity

COGNITIVE SYMPTOMS
      Ambitiousness
      Denial of realistic danger
      Easily distracted
      Flight of ideas
      Uses playful language  
      Speaks loudly
      Delusions of grandeur
      Delusion of persecution
      Lack of judgment
      Distractibility


PHYSIOLOGICAL SYMPTOMS
      Dehydration
      Inadequate nutrition (due to over-activity)
      Little need of sleep
      Weight loss

CLASSIFICATION
      By ICD-10
      F-30 = manic episode

DIAGNOSIS
      ICD-10
      Psychological tests as Young mania Rating Scale
      MSE

MENTAL STATUS EXAMINATION
      GENERAL APPEARANCE & BEHAVIOR:-
      Psychomotor agitation  ; sitting still is difficult
      may wear clothes that reflect elevated mood---brightly colored clothes, flamboyant, attention-getting, Pressured speech
      Interrupts and cannot listen to others

Mood & affect
      Euphoric, grandiosity, and false sense of well-being.
      Mood is quite labile.

Thought process and content
      flight of ideas
      Cannot connect concepts and jump from one subject to another
      Circumstantiality and Tangentiality
      Do not consider risks or personal experience, abilities or resources.
      Some experience psychotic features– grandiose delusions

Sensorium and intellectual processes
      Oriented to person and place but rarely to time
      Intellectual function is difficult to assess during the manic phase
      Claims to have many abilities that they do not possess
      Impaired ability to concentrate or pay attention
      If psychotic—may experience hallucination

Judgment and insight
      Easily angered and irritated
      Impulsive and rarely think before acting or speaking
      Insight is limited---believes they are “fine” and have no problems
      Blames any difficulties on others

Self-concept
      Exaggerated self-esteem—believes they can accomplish anything
      A false sense of well being

Roles and Relationships
      Rarely can fulfill role & responsibilities.
      Have trouble at work or school---too distracted and hyperactive to pay attention to children or ADLs.
      Begins many tasks or projects but completes few.

Physiologic and self-care considerations
      Can go days w/o sleep or food and not even realize they are hungry or tired
      Unwilling to stop or unable to rest or sleep
      Ignores personal hygiene
      destroy valued items
      May physically injure themselves
      Tend to ignore or be unaware of health needs


TREATMENT
      Pharmacotherapy
      Electro-convulsive therapy
      Psychological treatment

PSYCHOPHARMACOLOGY
      MOOD STABILIZERS
      Antimanic - Lithium
      Anticonvulsant - clonazepam, valproic acid
      Calcium channel blocker - verapamil

      ANTIPSYCHOTICS
      Olanzapine, Risperidone, Quetiapine
Chlorpromazine, Haloperidol

      SEDTIVES/HYPNOTICS
      benzodiazepines

NURSING MANAGEMENT
      ASSESSMENT :- 
      Severity of disorder.
      Knowing the causes.
      Resources available.
      Judging the effect of  patient’s behavior on other people.
      MSE

Nursing Diagnosis
      Risk for injury related to extreme hyperactivity
      Risk for violence r/t manic excitement
      Imbalanced nutrition less than body requirement related to refusal
      Impaired social interaction r/t egocentric behaviour
                                         
                                                    THANKS