Psychiatric Care For Elderly

In many country more and more people are becoming of age, the extended family way of living is changing in to a more individual way of living and family members don’t live in the same village or city anymore. Family planning ,finding jobs, different ways of living and tradition and culture are making that people have to look for a new balance in life.In a few decades there has been a very big change in the way people are living, and the life expectancy is increasing . It also means that people will have health problems, need information about health promotion and guidance to stay healthy.
As a nurse we have different roles:
you are a nursing professional, a director, designer, coach and professional practitioner.

It means you have to combine theory, experience, social skills and personal qualities to make sure that your psycho geriatric patient is feeling well, has a safe environment . You have to be able to work in a multidisciplinary way, work evidence based, patient centered and cope with family members, stress, change psychogeriatric is becoming a very important issue, and for nurses a big challenge.
People becoming of age can develop problems:

Caused by aging, stress, health and coping:

• problems with hearing and vision
• short term and long term memory
• loneliness
• suspicious behavior

Caused by psychogeriatric disorders:

• dementia
• Restless behavior
• Disorientation
• Memory disorders
• Aggression

caused by mental health disorders:

• Aggressive behavior
• Hallucination
• Wondering

Caused by anxiety disorders:

• panic disorders
• phobias
• obsessive compulsive disorders

This behavior can be observed when a person is still at home, living with the family, in day care centers, homes for the elderly, nursing homes, hospitals and psychiatric hospitals. So nurses must develop skills to observe and diagnose to come to the right diagnoses and guidance of the patient and the family. Keeping your patient in his own environment for as long as possible is an important goal, guidance, helping family to cope with the situation can prevent that the patient must go to a nursing home or hospital

Nursing therapeutic climate:
There are different approaches in psychogeriatric.
For patients that need guidance use the reality and orientation training
For patients that need care we use Validation therapy
For patients that need nursing we use Activating senses and relaxation. Snoozling developed for mentally retarded persons is also very effective for patients with psychogeriatric problems.
At the moment the emotion oriented approach is introduced because it gives patients the feeling that they are accepted, feel safe and the approach follows the needs of the patient

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NANDA nursing diagnosis and behaviors that correspond in psychiatric nursing

Behavior of patients is one of the data required in nursing Assessment. behavior Assessment is the most important basis in nursing care planning for patient with mental Disorders, behavioral changes are the first symptoms of the disease in some mental Disorders. Following is a list of common Behavior of mental Disorders and related NANDA nursing diagnosis which correspond to the behaviors and which may be used in Nursing care plans for the client in psychiatric nursing:

Behaviors:
Aggression, hostility, Manic hyperactivity
NANDA Nursing Diagnosis:
Risk for injury; Risk for otherdirected violence

Behaviors:
Anorexia or refusal to eat
NANDA Nursing Diagnosis:
Imbalanced nutrition: Less than body requirements

Behaviors:
Difficulty making important life decision
NANDA Nursing Diagnosis:
Decisional conflict

Behaviors:
Anxious behavior
Ritualistic behaviors
NANDA Nursing Diagnosis:
Anxiety (Specify level)

Behaviors:
Confusion; memory loss
NANDA Nursing Diagnosis:
Confusion acute/Confusion chronic; Disturbed thought processes

Behaviors:
Delusions
NANDA Nursing Diagnosis:
Disturbed thought processes

Behaviors:
Difficulty with interpersonal relationships
Seductive remarks; inappropriate sexual behaviors
NANDA Nursing Diagnosis:
Impaired social interaction

Behaviors:
Denial of problems
Substance use (denies use is a problem)
NANDA Nursing Diagnosis:
Ineffective denial

Behaviors:
Depressed mood or anger turned inward
NANDA Nursing Diagnosis:
Complicated grieving

Behaviors:
Disruption in capability to perform usual responsibilities
NANDA Nursing Diagnosis:
Ineffective role performance

Behaviors:
Difficulty accepting new diagnosis or recent change in health status
NANDA Nursing Diagnosis:
Risk for injury
Risk-prone health behavior

Behaviors:
Dissociative behaviors depersonalization, derealization
NANDA Nursing Diagnosis:
Disturbed sensory perception

Behaviors:
Depressed mood or anger turned inward
NANDA Nursing Diagnosis:
Complicated grieving

Behaviors:
Detoxification; withdrawal from substance
NANDA Nursing Diagnosis:
Risk for injury

Behaviors:
Expresses anger at God
NANDA Nursing Diagnosis:
Spiritual distress

Behaviors:
Expresses feelings of disgust about body or body part
NANDA Nursing Diagnosis:
Disturbed body image

Behaviors:
Fails to follow prescribed therapy
NANDA Nursing Diagnosis:
Ineffective therapeutic regimen management

Behaviors:
Expresses lack of control over personal situation
NANDA Nursing Diagnosis:
Powerlessness

Behaviors:
Flashbacks, obsession with traumatic experience, nightmares
NANDA Nursing Diagnosis:
Post trauma syndrome

Behaviors:
Highly critical of self or others
NANDA Nursing Diagnosis:
Low self-esteem

Behaviors:
Hallucinations
NANDA Nursing Diagnosis:
Disturbed sensory perception

Behaviors:
Inability to meet basic needs
NANDA Nursing Diagnosis:
Self-care deficit

Behaviors:
Insomnia or hypersomnia
NANDA Nursing Diagnosis:
Disturbed sleep pattern

Behaviors:
Loose associations or flight of ideas
NANDA Nursing Diagnosis:
Impaired verbal communication

Behaviors:
Manipulative behavior
Physical symptoms as coping behavior
Substance use as a coping behavior
NANDA Nursing Diagnosis:
Ineffective coping

Behaviors:
Multiple personalities; gender identity disturbance
NANDA Nursing Diagnosis:
Disturbed personal identity

Behaviors:
Loss of a valued entity, recently experienced
NANDA Nursing Diagnosis:
Risk for complicated grieving

Behaviors:
Orgasm problems with lack of sexual desire
NANDA Nursing Diagnosis:
Sexual dysfunction

Behaviors:
Overeating
compulsive
NANDA Nursing Diagnosis:
Risk for imbalanced nutrition: More than body requirements

Behaviors:
Projection of blame; rationalization of failures denial of personal responsibility
NANDA Nursing Diagnosis:
Defensive coping

Behaviors:
Phobias
NANDA Nursing Diagnosis:
Fear

Behaviors:
Potential or anticipated loss of significant entity
NANDA Nursing Diagnosis:
Grieving

Behaviors:
Self-inflicted injuries
NANDA Nursing Diagnosis:
Self-mutilation/Risk for selfmutilation

Behaviors:
Sexual behaviors difficulty,limitations, or changes inreported dissatisfaction
NANDA Nursing Diagnosis:
Ineffective sexuality patterns

Behaviors:
Stress from caring for chronically ill person
NANDA Nursing Diagnosis:
Caregiver role strain

Behaviors:
Stress from locating to new environment
NANDA Nursing Diagnosis:
Relocation stress syndrome

Behaviors:
Suicidal
NANDA Nursing Diagnosis:
Risk for suicide; Risk for selfdirected violence

Behaviors:
Suspiciousness
NANDA Nursing Diagnosis:
Disturbed thought processes; ineffective coping

Behaviors:
Withdrawn behavior
NANDA Nursing Diagnosis:
Social isolation

Behaviors:
Vomiting, excessive, selfinduced
NANDA Nursing Diagnosis:
Risk for deficient fluid volume

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