[kittyhawk]

Well...down to the wire. Next week is my last week for the 1st year!!! I take exam 5 on Tuesday. For trauma/head injury and they threw in some psych stuff (mood disorders/depression/bi polar/suicide/schizophrenia) for fun!

I'm getting stuck on how to recognize the difference in nursing dx for Alteration in thought content vs Alteration in thought processes for the schizophrenic. This instructor is really tricky and I know she'll give a scenario and ask which one is it.

I have a sample of for thought content "people are spying on them" and for thought processes "pt can't communicate without thought blocking" Honestly either looks like it could be reversed for diagnosis and I can't tell the difference

she also has for "content of thought" delusions, ideas of reference, paranoid, grandeur, somatic, thought broadcasting. And for "form of thought" associated looseness, neologisms, concrete thinking, world salad, circumstantiality, tangentiality, mutism, perservation, thought blocking, and poverty of speech!

Is the difference down to what people have in their head vs how they communicate? I don't know if "form of thought" is the same as alt in thought processes...Anybody help?

[Daytonite]

Psych is not my area and, honestly, I don't use Disturbed Thought Processes hardly ever. Alteration in Thought Content is something your instructor gave you and is not a NANDA diagnosis.

A thought process is the thinking structure the patient uses to finally end up with the behavior he performs; his action. Associated looseness, neologisms, concrete thinking, world salad, circumstantiality, tangentiality, mutism, perservation, thought blocking, and poverty of speech are manifestations (symptoms) of altered thought processes.

Thought content is the substance (ideas) that make up the thinking or reasoning. So, paranoia, grandeur, somaticism, thought broadcasting would be ideas that the patient has based his thinking on. It literally becomes the central core of their thinking. Their whole life and existance revolves around the idea. They assess and make decisions in their life based on the ideas that they believe, but there is a point when it becomes pathological (Ex: paranoia). It is the framework that bends and shapes their entire thinking process. For example, someone who is paranoid sees everything about the world through paranoid "eyes". It is the same with an egomaniac--everything will be seen to be how it equates to them.

Make sense now?

[kittyhawk]

THANK YOU!!!

Yes, perfect sense (well as perfect as you can get in abnormal psych! )

This section is killing me, the rotation I went through, just everything about it. I did really, really well in basic psych but all of the divisions and subtypes of schizophrenia and just the mood disorders in general. I had no idea about cyclothymia and dysthymic depression and just how subtle the lines are between them and mdd or hypomania!!! My instructor is really tough, there's 2 of them that specialize here and they fashion the tests as if we are really going into psych nursing, we have many failing this semester b/c of it

I'm one that isn't going to make excuses though, if that's how she structures and wants things then I'll play along, I want to do what it takes...this helps much...thanks again.

(interesting that she "made up" another catagory though, I'm not surprised, she thrives on the minute differences and it can be frustrating)

[Daytonite]

Originally Posted by kittyhawk

This section is killing me. . .(interesting that she "made up" another category though, I'm not surprised, she thrives on the minute differences and it can be frustrating)

That stuff was hard for me too. I'm med/surg, but I ended up on a unit that took on detox patients which translated to us getting every nut job that was admitted to the hospital transferreed to our unit (this is the way community hospitals think).

Anyway, kiddo, this business of people "making up" diagnoses, which by the way, is perfectly OK with NANDA, is why I'm always preaching about learning how to care plan by using the nursing process. My professors in my BSN program years ago before NANDA had clearly established the taxonomy had us writing our own nursing diagnoses. I had no understanding of what I was doing at the time. But I do now.

Please, if you have a review session before the final, ask these instructors to go over their definitions and defining characteristics (symptoms) of these diagnoses that they have added for use with psych patients. It will help clarify these specific psychiatric nursing problems.

I also worked on a neuro unit early in my career where we had a lot of head trauma patients. I remember that we were able to shut the water off in the individual rooms because the head injury patients were often on fluid restrictions and would guzzle any water they could get their hands on including the water from flower arrangements and we caught more than one drinking their container of mouthwash! I saw every kind of seizure there was and will never forget the "wild" look about people with concussions.

Good luck with your test.