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

nurses adda nurses adda nurses adda 
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