all right today we're going to go over mood and aect and make sure y the screen is sharing okay so when we talk about mood and affect um the main things we want to go over today are going to be figuring out a differentiation between um how we're going to assess um mood and affect what do we look for in the patients we want to be able to summarize the characteristics of normal mood normal affect and then um explaining the types of mood Spectrum disorders and we're also going to go over some of the characteristics um of mood NAIC some of the defining characteristics so first of all when we talk about our moods um we want to think about our I'm sorry this is bugging me that I can't see the the correct thumbnail okay um we want to look at our self-concept an individual self-concept so what that is is how an individual sees themselves you they may ask the question like who am I right and if you had to answer that question that would give you an idea of kind of how you visualize yourself and that self- visualization or self-concept is influenced by a lot of different things um you know your relationships to others are going to influence how you see yourself do you see yourself as a brother a sister a mother a daughter um also the um level of development that you're at so when you're a teenager you may see yourself a certain way than you do when you're an older adult um the way that you are physically like you're if you're in a good health state or if you are experiencing an illness or a hospitalization that can also impact how you view yourself um all of these things just kind of combined to make up how we come up with the answer to the question who am I and kind of the big picture takeaway thing here to focus on is that there are four main components of the self-concept and they do kind of bleed into one another but it's good to recognize what those four are and what they mean so you have your body image Your Role performance personal identity and self-esteem and so your body image is going to be like how do you see yourself would you say oh I'm really overweight or I have a my nose is too big or whatever um or is it a a more positive body image talk where you're saying oh I really think I have great strong legs I'm really grateful for those and I I love the color of my eyes you know what do you see when you look in the mirror that's your body image Your Role performance is where how you see yourself in the situations that you're placed in so right now you're a nursing student right so are you fulfilling that role performance do you show up to class are you studying for tests um are you performing well in that role and people can have many different roles at the same time right it's not like you're only a nursing student right now you're probably a nursing student and also um a friend or a a coworker to others um so you can have a lot of different roles but how you perform in those roles kind of helps to make up how you see yourself um personal identity is uh just a little bit more about again self- visualization and um how you relate to others within your sphere and then self steam is looking mostly at just how you view yourself is it positive or negative um and that can be impacted by a variety of factors um your self-esteem can fluctuate of course there may be some days where you feel like you're you know you're wearing a new outfit and you did good on a test and uh things are going your way and so you generally feel good about yourself there may be other times where you know you're struggling to to view yourself in a positive light and that's where your self-esteem comes in all right psychosocial nursing diagnosis so when we have um individuals that come in and they are experiencing some sort of variation in their mood um maybe they're feeling down or not like themselves or they're having a difficult time coping with the situation they're in there are different nursing diagnoses that are going to be able to be applied to these patients as nurses we can't diagnose someone with depression um so we're not going to say oh this person has depression um that's not our role but there are still things we can look out for um there may be individuals who you know come in and maybe they they just moved to New Orleans because they're here on a a work visa and they're far away from their friends from everything they know from people who speak their native language and then they break their leg at work and now you know in the hospital you may diagnose that individual with having a risk for loneliness because they are kind of detached and maybe they're struggling because of that um isolation that they're feeling uh another possible nursing diagnosis you may feel would be adequate for an individual could be compromised family coping this could be like if you know a a parent um finds out that their child has a terminal illness they may not be able to cope with that um and you might see that in the way that they act um the things they say some of the Expressions on their faces those can all be indicators that they're not coping well uh and then another example could be role conflict so you could diagnose um rooll lict as a nursing diagnosis meaning that the patient is having a tough time dealing with their role performance and they may have some impairments that don't allow them to carry out what they think they should be able to so you know there may be um like a for example a new mother who's now in the hospital and she you know is struggling with a an illness and so she's not able to care for her new baby and maybe she feels like she's not performing well as a mother even though you know she has to take care of herself too so there's some conflict there in the roles that she has taken on these are just examples of nursing diagnoses these are not all of them these are just a couple um but I just point these out to show that when you have someone who is dealing with um impaired mood there are going to be different things to look out for as nurses there um is always assessment taking place you're always assessing the situation assessing the patient and so you want to be aware of the fact that their mood and affect are things that are important to look out for as well when I say mood and AIC mood you know is how an individual is feeling and expressing that feeling and emotion and um affect would be how they're displaying it so for example if um if I come into the room and I'm sulking and I'm kind my head is hung low and I look up at you with kind of these eyes my affect is you know sad I I I appear low down um and my mood would you know would be a something that you could kind of characterize based on the a based on um maybe some of the things I say and verbalize to you maybe some of the behaviors that I you know put into effect so you you see that I didn't take a shower this morning and I am just kind of zoned out and that could be um a way that you can kind of assess what's going on okay anyways so like I was just saying when someone has a psychosocial situation going on that's affecting their mood um we're going to uncover these by being observant so what's the patient doing are they crying are they laughing are they smiling are they frowning um how do they appear are they sulking in the corner are they waving to everyone who walks past their door um what what are they doing right so observe the behaviors that you're seeing the patient um partake in and then also you want to listen because a lot of times patients will make statements that kind of align with the situation or that don't align with the situation so you know if somebody is going through a tough time you do expect them to maybe feel a little bit down about it or to have some doubts or frust ations or fears um but there's kind of a a spectrum of of what we expect and then what's beyond our expectations so you know if a patient comes back from a surgery and there was a complication and now they're learning that they're going to have to go back into surgery you know for them to say something like man this is really frustrating like I really thought we would have taken care of this with the first surgery that's a pretty expected response but if a patient says something like you know know well I hope I die on the operating table this this time well that's that's a bit more than what we would you know hope someone would be feeling at this point we expect them to have some frustration and sadness and maybe anger um or hopelessness but not to that extent um so we want to be able to listen for those responses and see if there's any safety issues we need to be aware of um and also sometimes the things that people don't say are good indicators of how they're feeling you know you you ask someone how their day is going and they say and they leave it at that right um that's not very promising the things that are not said can also be pretty um indicative of how things are going all right another um type of mood uh situation that somebody could be experiencing would be anxiety so basically anxiety is an anticipation of a threat it's the fear of something happening rather than um an actual issue occurring in the moment that somebody is dealing with so uh anxiety levels can fluctuate they can last for a long period of time they can last for a short period of time you can have high anxiety it could be low anxiety the Spectrum kind of can go um from low to high and back down so you may um experience mild anxiety which is normal that's kind of your everyday anxiety and and we actually need that that's what helps to kind of push us to set goals to um be on top of it right if you felt no anxiety For an upcoming exam it would be abnormal because we would think well you know aren't you a little concerned don't you want to have uh a goal you're trying to achieve and you may be a little anxious or um worked up about achieving that goal that's normal but it shouldn't be something that's causing you emotional distress so if the emotional distress is taking place that's beyond um your everyday mild anxiety moderate anxiety is when you're going to become more focused on the anxiety than what's going on around you you may have um an increased heart rate or some muscle tension right you're clenching your jaw or your fists or you're kind of um you know zoned out with what's going on in the periphery because you're more focused on the particular thing that's causing anxiety and then we just go from there um so a severe anxiety situation would be when somebody is um unable to relax they're just solely focused on the source of the anxiety and you may see those um physical symptoms kind of increase so more than just a a slight increase in heart rate you're having like palpitations right you're trembling maybe you're having diarrhea um because you're just so focused on that one source of anxiety whatever it is that's causing that that stress and then lastly we have the Panic State and this is when someone is unreasonable they can't be rationed uh uh reasoned with I don't know why I said rationed with um oh because they're being irrational so um this is when they're going to have feelings of impending doom there could be labored breathing um severe trembling kind of an increased manifestation of some of those severe symptoms when we go into the panic mode and then if we take a look at depression um this is uh one of our mood Spectrum disorders and some things to know are that depression is a maladaptive response so um when we have like the the low's the blues right um it's normal that things are going to put us down a little bit sometimes we're going to experience in dependent lifestyle or life um events that may cause us to feel down or low right you do poorly on um a job performance review or you find out that you didn't get you know whatever it was you were trying to get that can make you feel a little down but depression is going to be something that is um on that deeper level where you experience a sense of emptiness there's kind of that feeling of hopelessness um some of the things that can lead to depression or can cause depression would be a family history of depression low self-esteem learned helplessness disability traumatic loss sleep disturbances and more so there's a lot of things that can trigger um depression in an individual um but again we're not diagnosing people as depressed we just look for those signs that it may be present and we want to be able to see if there's any nursing diagnoses that that we may be able to put into play that can help keep that patient safe so if somebody is feeling hopeless you know they they verbalize feelings of hopelessness like H there's really no point I'm not going to get any better they might be feeling hopeless what do we need to do we want them to stabilize we want them to um find a sense of Peace in something so that they can feel a little more stability in their life and not feel so down suicide risk if we um have the nursing diagnosis of suicide risk we need to see what kind of safety measures we need to put into play to keep that individual safe from self harm so when we have a patient who um is showing signs of depression or who has depression and is experiencing that that low um we want to make sure we listen to the patient maybe they're not ready to talk but we want to be able to create a space where we are more um more of the listener than the talker right because a lot of times we think we have all the solutions and we want to say oh here's how you're going to solve your problem um and we want to fix it for them but basically we just want to create a space where we can um let them do the talking let them share how they're feeling and express what's going on and then we can you know just make any observations that we see and make sure that if things do change that we are aware of that for safety purposes um the older adult population is one to keep an eye on when it comes to depression because many times older adults are going to go undiagnosed with depression um why do you think give you a second to think about that maybe some of the reasons you thought of um align with kind of what what we know which is that a lot of times the older adult population um experiences isolation due to lack of Transportation or um lack of ability to get around um also older adults if you think about some of those self-concepts that we talked about earlier um some of those may be shifting and they may be having a tough time with their self-concept and their personal identity their roles you know if if as it are they as valuable in society they may ask themselves what are they doing um are they fulfilling roles like they used do they you know a retired individual may have found a lot of joy in the work they were doing and now they're retired they don't have that role of being an employee or a manager or a whatever they were doing before um so that can change and then self-esteem can change you know they may feel like oh I was more beautiful when I was younger or I had more strength when I was younger I could do more so there's a lot of things that um need to be dealt with and an individual needs to cope with as they they age and a lot of times that isn't addressed and so we see that though undiagnosed uh another mood Spectrum Disorder so we have depression on the one hand which is where we have the lows um another mood Spectrum Disorder we have is bipolar disorders when a person has bi a bipolar disorder they're going to experience um alternating periods of depression and Mania so Mania is our extreme energy or raising thoughts someone is very excitable um they may be talking faster than they can think and so it all comes out very jumbled um acting unlike themselves right very just excitable uh so whereas depression is simply depression and that's the main mood that's being portrayed uh with bipolar disorder we have depression and Mania and so those are going to alternate um with a bipolar one diagnosis you're going to see that the individual has had one or more episodes of mania severe enough to require hospitalization this is the type of bipolar um disorder where psychosis is more prevalent and then in bipolar 2 uh they may have had one or more episodes of hypomania so a less severe manic episode maybe they didn't need to go to the hospital but they were just you know they couldn't sleep for a couple days and they were really bouncing off the walls but they were able to restabilize without hospitalization um and then depressive episodes as well so when we have someone who um has a bipolar disorder and and they're in a state of mania we want to make sure that we're decreasing the stimuli so we want to dim the lights speak softly slowly turn off any loud music um televisions you know decrease the distractions and the external s Uli because they already have a lot of internal stimuli going on so we just are trying to make things as mellow as possible so I know this was kind of a lot in a short amount of time but um let's go over a little practice question so a nurse enters the room of a patient with a new ostomy and the patient states I'm so over this whole situation this whole ostomy thing is the worst what's the first step the nurse should take a gather ostomy supplies for the patient to take home upon discharge B continue to listen to the patient C call the provider to come to the bedside and provide patient education or D say emies can be really intimidating they're scary at first but you will get used to it what do you guys think all right I'm G to give you the answer now B so the answer is that we want to listen we want to listen to the patient uh because like I said you know when somebody is dealing with a tough situation and they're trying to cope we want to make sure that we give them that space to express themselves first that's our priority after we finish listening to them um and you know we've kind of explored that then we can go and you know do some of these other things like get supplies and make sure they're educated um the reason why we don't want to I'll go back here the reason we don't want to say that ostomies can be really intimidating they're scary at first but you'll get used to it is that we don't know if they're going to get used to it right um we may want we may be tempted by that answer because we want to sympathize with the patient but um we don't want to say you know that we know exactly how they're feeling or what they're going through um it's again like like I said you know a lot of times we want to provide answers and comfort um but sometimes it can come off as being false Comfort a false sense of hope because we don't know that they'll get used to it it may they may struggle with it every day um so rather than tell them how something is going to be for them we just want to make sure we're listening to them all right and then here's one more for you patient recently underwent knee surgery and is now refusing to attempt to ambulate the patient states I used to teach aerobics classes I guess I'll have to find a new job I've let my whole fitness group down which component of self-concept is the patient struggling with the most body image role performance personal Identity or self-esteem all right so let's go over the answer B role performance the patient's not coping with the fact that there is going to be a conflict in the role that they expect themselves to be able to fulfill so they see themselves as an aerobic instructor that's um the role that they have they're talking about letting the group down right um so like I said there's going to be some of these that bleed into each other and if you read uh through the book The the chapter has a little bit more if you want to go more in depth on some of those but basically you know all of these self-concepts make up how we view ourself so it is easy to kind of mix them up and say oh yeah that was actually you know that well that kind of leads to their self-esteem issues it's like yeah it it does um but because we specifically talked about a role that they cannot participate in it's going to be that role performance for this particular question um but it the whole person is is made up of those different or the whole personal view or self-concept view is made up of those four different indicators and they are similar so I I I admit that they're similar but um hopefully this was at least a little bit helpful in giving you a slightly better understanding of some of the mood and affect situations you may come across in nursing um I appreciate you guys taking the time to listen and definitely reach out in the discussion board if you have any questions or things you want to comment on if there's any clarification you need um from what you read in the book that goes along with what was discussed here today thank you very much