Professional Documents
Culture Documents
Overview:
A. Psychiatric Nursing
• Mental health
• Primary purpose is to promote mental health
• Not curable, only to reduce the symptoms
D. Tool Used By The Nurse : Therapeutic use of self acquired thru self-
awareness
E. Levels Of Prevention:
3 Levels Of Prevention:
1.) Primary
•
Promote mental health (Healthy)
• Remove factors before they can cause illness
Ex. Stress reduction
Health Teachings/Community
Teachings/Community Demographics
Support System
Accident Prevention
2.) Secondary
• Lessen the duration of mental illness (ill)
Ex. Suicide Prevention
Crisis Intervention/ Treatment & Diagnosis
Providing Psychotherapy & Milieu Therapy
3.) Tertiary
• Function to become independent
Ex. Rehabilitation Centers/ Al anon
Relapse Avoidance
F. Stages Of Interaction
1. Self-Awareness
2. Self-Actualization
–Self-fulfillment or self-realization
3. Perception Of Reality
4. Autonomous Behavior:
– Independence, decision-making ability
6. Integrative Capacity
- Time to evaluate frustrations
- Ability to solve conflicts:
*Conflict—presence of 2 goals
resolved through
BELIEFS FEELINGS
BEHAVIOR
Create the
* Per sonare ------- “to sound through”--- The sum total of traits w/c are
unique
I sex”
D
IMPULSIVE Part
WANT TO
Operates on “PLEASURE PRINCIPLE”
Instinctual drive: “Eat, urinate, have
S
it now”
UPEREGO “CONSCIENCE”
SHOULD NOT Higher self, ideal ego
MALL VOICE OF GOD Tells you what is right or wrong
The censoring part, the moral values
What makes you a perfectionist, rigid &
righteous
Ex. I should not eat yet…..
Function:
1. Inhibit the ID impulse
E
Operates on “REALITY PRINCIPLE”
GO In touch with reality
XECUTIVE The self, self-identity
Arbiter
8. Reduces anxiety
*The ability to tolerate frustration based on the balance of the 3 functions:
Imbalance -----Maladaptive Behavior
1. 2.
ID SUPEREGO
SUPEREGO ID
EGO EGO
3.
ID SUPEREGO
EGO
3 Levels of Awareness:
> Highest level of Awareness
CONSCIOUS > Contains all experiences that can be
recalled voluntarily
> Forgotten
> Experiences that cannot be recalled
UNCONSCIOUS
Ex. Dreams, accidents, anxieties
& phobias
> Where traumatic experiences are
stored (Repression)
Ex. Birth Trauma (the cause of 1st
anxiety)
*The ID, Ego & Superego -----all resides in the unconscious & operates on
different levels of the mind
Except the ego when dealing with reality----resides on the
---conscious
“ Survival”
All ID
Cry, suck mouth
Biting, Thumb sucking & Nail biting-----------------all normal in infancy
Dependent, Helpless----------------needs to develop sense of trust, sense of
security
Concerns: Punishment
Cleanliness
Habit-training Stage
SE SE
Anal Retentive Anal
Expulsive
(Obsessive-Compulsive)
(Antisocial)
3. PHALLIC STAGE 3 years – 6 years old
Focus:
P HALLIC
ENIS
ARENT
RE - SCHOOLER
Genitals------Penis only
Development of Gender Identity Sense of Being
Masculine/Feminine
R
A
W
EADING
ITING
ITHMETIC
Sublimation – placing sexual energies
(feelings) toward
more productive endeavors
G
Focus: Genitals
Emergence of LUST ENITAL
The Heterosexual Stage ISING
Sense of Identity
AMBIVALENCE: Child Adult
Freud Significa
Stage (+) (-) Factor nt
Person
12 – 20 Genit Opposite
Peers
years al Identity Role Confusion Sex
(Major
(Adolescen (Self-Actualized) (Identity Crisis)
factor in
ce) (Self-Direction)
the dev’t
of beliefs
Compensation
Inferiority Vs. Superiority Concept
9. HARRY STACK SULLIVAN-----Theory Of Interpersonal Relationships
Builder Of Self-Esteem
Motivation
Stages:
1. Infancy--------------- 0-18 months
Mouth
3. Juvenile----------------6-9 y/o
Competitive
IV. PSYCHOPHARMACOLOGY
I NTEGRATION ------2nd------analyze
M OTOR ------3rd------action
Spinal cord ♥ HR ↑ ↓
RR ↑ ↓
Motor Nerves
GI ↓ dry mouth ↑
moist mouth
constipation diarrhea
Ach GU ↓ retention ↑
frequency
Acetylcholine – “on” switch of muscle
(transmits message to the muscle) Neuro Epinephrine/
Acetylcholine
Transmitter Norepinephrine
Synapse Pupils Midriasis Myotic
Blood Vessel Vasoconstriction
Vasodilatation
BP Increased
Decreased
Muscle Fiber
A- anxiety
P- psychotic
ANTI C-cholinergic
D- depressants
V. DEFENSE MECHANISMS
Mental mechanisms
Coping Mechanisms from stress
Patterns of adjustment
Affects/Interferes with ADL--------harm to self or others
Operates on the unconscious level
Results to
Undoing Doing opposite of what you have done (Action & then
amends)
Ex. Show true feeling then feels guilty after doing it
Alteration in--------Memory
Identity
Consciousness
To reduce/avoid anxiety
Categories:
1. Psychogenic Amnesia------loss of
memory
3. Multiple Personality
Dissociative identity
disorder
2 or more personalities
4. Depersonalization
Unreality to oneself
With altered sense of self
Neuroses Psychoses
THERAPEUTIC NON-THERAPEUTIC
• Offering Self
• Ignoring patient’s feelings or
emotions
“I’ll sit with you”
“Don’t worry be happy”
“I’ll stay with you”
• Restating • Advising
Client: “I’m sad.” “You should do this.”
Nurse: “You’re sad?” “In my opinion…”
• Refocusing
“ We were talking about the • Commanding client
exam….”
• Clarification
“What do you mean by • Do not impose your opinion
plooplank?”
VIII. ANXIETY
- Vague sense of impending doom
- Afraid of the unknown
- Present is the anticipation of danger
- A feeling of uneasiness---------vague
apprehension------uncertainty
A. ASSESSMENT:
Level of Anxiety
F
I
E
L
D
2 Types:
Agoraphobia - Fear of open spaces > Outstanding
Sign of Panic Disorder
Trauma
Disasters
Victims Survivors
Rape
War (not forever)
Others
Flashbacks : > 1
month
Nightmares
4.) MALINGERING
- Pretending to be sick (Conscious)
- No organic basis
- Intentional
*Primary gain – the result you get when you manifest certain behavior
that ↓ anxiety
(Ex. Escape from Teacher)
Physiology:
ANXIETY
“I am sick”
Unconscious
Not pretending but no organic basis Major Sign:
DOCTOR
SOMATOFORM HOPPING
(unconscious) Favorite pastime of
people suffering
Affects the 3 system
Psycho physiologic
Real illness, real Sx & pain with organic basis
Physiology: ↑ ANXIETY
SNS PNS
Stress ulcer
Physiology:
8.) PHOBIA
Irrational fear
Tx:
BEHAVIORAL THERAPY:
Individual Therapy
1.
Hypnosis--------------------Relaxed state
2.
Free Association----------Ideas shared to psychoanalyst
3.
Catharsis--------------------Free to express feelings
4.
Transference---------------Patient feels something for
psychoanalyst
5. Counter transference-----Rn feels something for patient
IX. EATING DISORDERS
ANOREXIA BULIMIA
Diet, diet, diet Eating Pattern Eat, Eat…induce vomiting
Underweight, < 85% of
Weight Normal weight
body weight
3 months amenorrhea Menstruation Irregular menstruation
Failure To Recognize Knowledge Knows the Problem But
NURSING CONSIDERATIONS
Bulimic induces vomiting & tends to
NURSING ALERT abuse laxatives
• Most fatal Assess for:
complication: Dental caries
ARRHYTHMIAS Wounded knuckles
Vomiting - Risk for metabolic
alkalosis
MANAGEMENT:
Priority: Target weight gain & Monitor eating pattern & weight
RELATED DISORDERS:
X. PERSONALITY DISORDERS
Cluster A
PARANOID Suspicious
Violent
OBSESSIVE-COMPULSIVE Organized
Constancy in Environment
Perfectionists------Provide time to do rituals
OTHER CATEGORIES:
THEORIES OF CAUSATION:
> Stress Diathesis Model - Stressful living pushes person to escape into
fantasy
“Far better to be king in your fantasy world” idea
> Genetic Vulnerability - Runs in families; genetic component
(biological)
> Unknown
> Physiological Finding: ↑Dopamine in schizophrenic clients
Physiology:
ACH “ON” switch D “OFF” switch
↑ACH
↑ACH ↑Dopamine
ACH D
↓ACH
D ↓Dopamine ACH
Parkinso Schizophr
n’s enia
ANTICHOLINER DOPAMINERGI
GICS CS
A Parlodel
kineton Larodop
A rtane a
• Photosensitivity
Teach patient to use sunscreen, wide-brimmed hat when going out
• Agranulocytosis (↑ monocytes, ↑ lymphatic)
Teach client to report SORE THROAT (1st sign of Blood Dyscrasia)
Hypersensitive Reactions Ex. Allergy
↓ Epinephrine ------Hypotension
Endocrine-------------M = Gynecomastia F = Enlargement of breast & ↑ libido
Arrythmia
Blurring of vision, Opacity of the lens, retinitis
Pruritus, dermatosis, rashes, eczema, dermatitis & hyperpigmentation
A
1. Appropriate
FFECT External manifestation (feelings & 2. Inappropriate
emotion)
3. Flat (none)
4. Blunt
MBIVALENCE Pull between 2 opposing forces
(incomplete)
UTISM Self-absorbed, Trapped in own world
SSOCIATIVE LOOSENESS Unrelated ideas
B. SYMPTOMS
S & Sx OF SCHIZOPHRENIA
2 Types
POSITIVE
NEGATIVE
Hyperactive
Hypoactive
Sociable
Withdrawn
Talkative
Quiet
Restless
Flat Affect
Queen of the World
Apathy
Flight of ideas PARANOID
Poverty of
(Hallucinattion,Illusion, • Uses Projection
words
Delusion)
Problems with:
• Mistrust-------Suspicious
N.I.
1. Develop Trust:
C. TYPES OF SCHIZOPHRENIA Orientation
2. One-to-one
interaction
SCHIZOPHRENIA 3. Short but frequent
visits
4. Foods in sealed
container
DISORGANIZED Meals wrapped
• Inappropriate affect CATATONIC
5. Consistent Approach
(sad but smiles) • Ambivalence
• Flat affect • Waxy
• Scared/Withdrawn/Viol
• Disorganized flexibility
ent
speech/manner • “No” (Rebel)
(flight of ideas) • Negativism N.I.
Created by Niňa E. Tubio 25
• Hebephrenic 1. Keep door open
(giggling) 2. Don’t touch patient
3. Establish Eye
UNCLASSIFIED
or
UNDIFFERENTI
ATED
• Mixed
classification
s
RESIDUAL • Cannot be
• No more (+) or (-) classified
Sx
• Social Withdrawal
• Withdrawn
P ilosopo
roverb
MANAGEMENT TECHNIQUE
H
Auditory hallucinations are
ALLUCINATIONS common. IMPORTANT: Also
ask what the voices are
saying because 10% of
A
schizophrenic clients are
CKNOWLEDGMENT
“I know the voices are real to you…”
D IVERSION
“Let’s go to the garden.”
IRECTIVE
A
nomia Don’t know name of object
gnosia Problem with senses (smell, taste , hear, touch)
phasia Can’t say it
praxia Can’t do it
D
issociative Fugue Takes a new personality from a far
away place.
New Place, New Identity
issociative Identity Disorder Multiple Personality
issociative Amnesia Don’t know who/where I am
epersonalization Believe that they are not persons
anymore
+ Perseveration “I want to talk about something,
this is what I want to do…."
Unresponsive to people
Echolalia
Poor eye contact
Cannot express feelings verbally----root of self-directed
violence/self-mutilation
Boys > Girls
ASSESSMENT: ABC’s
BEHAVIOR Repetitive
Ritualistic
COMMUNICATION Echolalia
Incomprehensible/Difficulty communicating
* Can’t cry for help; usually hurts self to get
attention
*Talk slowly to autistic child
PLANNING/ IMPLEMENTATION:
BEHAVIOR Clumsy
Hyperactive
Impatient, Easily Distracted
PLANNING/ IMPLEMENTATION
MILIEU THERAPY
S
Tructure ----Provide place to study,eat,play,bath
Chedule ----Time for everything
et limits
afety Medical Mgt:
RITALIN
↓ judgment
↑ judgment
S/Sx of ADHD
3. MENTAL RETARDATION Ritalin ( a stimulant)
Severe: 20-35
B
Burns
Bruises
Bone Fractures (Bungi)
Body of Evidence should not be lost ( Don’t bathe child, Don’t brush
teeth)
BANTAY BATA 163
A. BIPOLAR
2 poles------ Happy (dominant) & Sad
Too self-actualize
MANAGEMENT:
↑ NE
I ncrease urination
N
3 Signs of Lithium
Toxicity ausea, vomiting, diarrhea
a ( ↑ sodium intake to
correct FVD)
(Na: 135-145 mEq/L)
T remors, fine hand
H ydration
l/day
3
Kiidneys I ncrease
“PUPU”
Check first before
beginning therapy
(BUN, Creatinine) U
Only 90% absorb by
iidneys
kidneys M outh, dry *
* Lithium absorbs
water
Denial
Anger
Bargaining
Depression
2 wks or more is a sign of MAJOR CLINICAL
DEPRESSION
Acceptance
ASSESSMENT
↓ Self –
5 Actualization
↓ Self –esteem Give Simple TASK
4
3 Withdrawn
1. Give Antidepressants
Pre-ECT:
N npo for 6 hrs.
B barbiturates
Post-ECT:
Side-lying position---Lateral
ALONE
SUICIDE TRIAD:
LOSS
OF
SPOUSE JOB
D irect Question/Approach
“Do you plan to commit suicide?”
rregular
I nterval Visit frequently but should not be
predictable
Created by Niňa E. Tubio 35
Most suicides are done in the early morning &
E ndorsement
arly AM
during endorsement
Close Surveillance
XVI. SUBSTANCE ABUSE
Types of ADDICT:
1. Nervous 2. Depressed
Alcohol
Cocaine
INE
Barbiturates
Opiates Morph Hallucinogen
Narcotic Code Amphetamines
Marijuana Hero
STOP UPPERS
Antidote: NARCAN (narcotic antagonists)
Crash Syndrome
Suicide
OVERDOSE WITHDRAWAL
Alcohol
↓ HR ↑ HR
↓ BP ↑ BP Sx of WITHDRAWAL:
Sx Of OVERDOSE to 2
↓ RR ↑ RR Types:
LOC (coma) ↑seizures 1. Know if drug is Upper or
Cocaine Downer
1. Identify if drug is Upper or
↑ HR ↓ HR Downer 2. Check for opposite effect &
↑ BP ↓ BP 2. Check Effect
↑ RR ↓ RR 3. Sx of Withdrawal
↑seizures LOC (coma)
Narcotic Antagonist:
Narcan (Naloxone HCl) Drug of choice for Overdose
ALCOHOLISM
Physiology: ALCOHOL
D ENIAL
EPENDENCE
“I am not an alcoholic”
“I can’t live without you”
A
alcohol intake before
giving Anatabuse:
VOIDs ALCOHOL There should be a
VERSION THERAPY 12 – HOUR INTERVAL
LCOHOLICS ANONYMOUS NEVER take alcohol
NTABUSE (Disulfiram) with antabuse OR ELSE
Nausea & Vomiting
B
Problems of Alcoholics: 1 VIT. DEFICIENCY(Thiamine)
Monitor for:
WERNICKE’S
C OMPLICATIONS ENCELOPATHY
(motor problems)
KORSAKOFF’S
SNS stimulation
Within 24-72˚
of withdrawal
D ELIRIUM TREMORS
Tremors, Hallucinations, Provide well-lit room
Illusions to avoid
&
F ORMICATION
AMILY THERAPY
Feeling of “bugs crawling under
the skin”
Elixir (alcohol-based)
P ANTI-ANXIETY AGENTS
H
V alium M iltown
A
L ibrium E quanil
R
A tivan V istaril
M
S erax A tarax
A
T ranxene I nderal
B uspar
M
O (Used also for Alcohol Withdrawal) “VLAST ME
M VAIB”
E
N
T
S THE AUTONOMIC NERVOUS SYSTEM
ANXIETY
ANTI If ABRUPT Withdrawal:
E/ NE
CHOLINERGIC Rebound phenomenon
Constipation Within 1 wk
Retention
Dry mouth
Blurred vision Seizures D
ANTI-ANXIETY WITHDRAWAL
AGENTS E
P
*Effects of E
↑ GABA Recommended:
GABA: N
Gradual
Drowsiness D
Withdrawal
Orthostatic E
Tapered dose
Hypotension N
C
*Contraindicati E
ons
No coffee
RELAXED No alcohol
Do not drive
To prevent Orthostatic
Hypotension:
S it
D angle
S tand gradually
ANTI-DEPRESSANTS
A sendin A ventyl
N orpramin V ivactil
T ofranil E lavil
S inequan P
rozac (ssri)
A nafranil P axil
↑ Serotonin ↓ Serotonin
Give
A vocado F ernented
foods
ged cheese P ickles
B eer reserved
foods
C ogentin B enadryl
A rtane L arodopa
P arlodel E
ldedpryl
A kineton S
ymmetrel
2 CLASSIFICATION
ANTICHOLINERGICS DOPAMINERGICS
ABC PLSE
A kineton, Artane P arlodel
B enadryl L arodopa
C ogentin S ymmetrel
E ldepryl
ANTI-PSYCHOTICS
S tellazine C lozaril
S erentil M ellaril
T horazine H aldol
T rilafon P
rolixin
TRANQUILIZERS
2 Types
Minor Major
Anxiolytics (ANTI-AXIETY) Neuroleptics (ANTI-
PSYCHOTIC)
Valium Thorazine
Anxionil Haldol
Ativan Serenace
Tranxene Mellaril
Xanax Trilafon
Serax Proloxin
Librium Modecate
Equanil Clozaril
RELAXED
SSRI
PPZ
↑ Serotonin
only
Anticholinergic
S/E
Constipation
Retention
Male Erectile
↑ Serotonin ANTI-DEPRESSANTS Dysfuncion
TCA /NE
ANTSAVE
↑ all
NO to Tyramine ↓Serotonin
MAOIs or else
MNP HYPERTENSIVE
CRISIS
DEPRESSI
Temporal Exclusions By
Somatoform
General & Other Other
Disorder Other Exclusions
Description Requireme Psychiatric
(DSM-IV)
nts Illness
Note.—To qualify for this category of diagnoses, the symptoms must cause clinically
significant distress or impairment in social, occupational, or other areas of functioning.