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Psychiatric Nursing

Psychiatric Nursing

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Published by: Nimrod on Oct 24, 2009
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PSYCHIATRIC NURSING
PSYCHIATRIC NURSING
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A specialized area of nursing practice employing theories of human behavior as itsscience and purposely use of self as its art.
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Includes the continuous and comprehensive services necessary for the promotion of optimal mental health, prevention of mental illness, health maintenance, managementand referral of mental and physical health problems, the diagnosis and treatment of mental disorders and their sequela, and rehabilitation
BASIC PRINCIPLES OF PSYCHIATRIC NURSING
Accept and respect the client regardless of his behavior.
Limit or reject the inappropriate behavior but not the individual
Encourage and support expression of feelings
in a safe and non-judgmentalenvironment.
Increase verbalization, decreases anxiety.
Behaviors are learned.
All behavior has meaning.
INTERDISCIPLINARY TEAM PRIMARY ROLES
Psychiatrist:
The psychiatrist is a physician certified in psychiatry by the American Board of Psychiatry and Neurology, which requires 3-year residency, 2-years of clinical practice, andcompletion of an examination. The primary function of the psychiatrist is diagnosis of, mentaldisorders and prescription of medical treatments.
Psychologist: 
The clinical psychologist has a doctorate (Ph.D.) in clinical psychology and isprepared to practice therapy, conduct research, and interpret psychological tests.Psychologists may also participate in the design of therapy programs for groups of individuals.
Psychiatric nurse:
 The registered nurse gains experience in working with clients with psychiatric disorders aftergraduation from an accredited program of nursing and completion of the licensure examination. The nursehas a solid foundation in health promotion, illness prevention, and rehabilitation in all areas, allowing himor her to view the client holistically. The nurse is also an essential team member in evaluating theeffectiveness of medical treatment, particularly medications. Registered nurses who obtain a master’sdegree in mental health may be certified as clinical specialist or licensed as advanced practitioners,depending on individual state nurse practice acts. Advanced practice nurses are certified to prescribedrugs in many states.
Psychiatric social worker:
Most psychiatric social workers are prepared at the master’s level, and they are licensed insome states. Social workers may practice therapy and often have the primary responsibility for workingwith families, community support, and referral.
Occupational therapist: 
Occupational therapist may have an associate degree (certified occupational therapyassistant) or a baccalaureate degree (certified occupational therapist). Occupational therapy focuses onthe functional abilities of the client and ways to improve client functioning such as working with arts andcrafts and focusing on psychomotor skills.
Recreation therapist:
 Many recreation therapists complete a baccalaureate degree, but in some instances personswith experience fulfill these roles. The recreation therapist helps the client to achieve a balance of workand play in his or her life and provides activities that promote constructive use of leisure or unstructuredtime.
Vocational rehabilitation specialist: 
Vocational rehabilitation includes determining clients’ interests and abilities and matchingthem with vocational choices. Clients are also assisted in job-seeking and job-retention skills, as well as
 
pursuit of further education if that is needed and desired. Vocational rehabilitation specialists can beprepared at the baccalaureate or master’s level and may have different levels of autonomy and programsupervision based on their education.
3 LEVELS OF PSYCHIATRIC NURSING (Levels of Health)
I.
PrimaryObjective: PROMOTION & PREVENTIONA. Client and Family Teaching (Health Teaching)1.Teaching adolescent in preventing contracting STDsCHLAMYDIA: #1 STD in the U.S.#1 Sign: Greenish & purulent urethral dischargePID (Pelvic Inflammatory disease) #1 cause of sterility inwomen#1 Drug of choice Erythromycin2nd drug of choice Cephalosporin
 
2. Teaching pregnant women relaxation techniquesObjective: to prevent complication in labor, fetal distress, perineal laceration(also can be prevented by Kegel’s exercise)Stage I of labor (LAT-CAP)L atentC chest breathingA ctiveA bdominal breathingT ransitionalP ant blow breathing3. Teaching couples on contraceptives BON (Barrier, Oral Contraceptive,Natural)Barrier- CONDOMOral - ArtificialNatural- not for M A M (Malnourished,Anemics & Menses irregular)4. Conducting rape prevention classes is an example of primary level of prevention.B. Herbal MedicinesC. Psychosocial Support – family/friends/peersNeeds most support (ASA): Addicts, Suicidal, Alcoholics,Suicide = Major depression, despair, hopeless, powerlessProne: MaleAge bracket prone for suicide#1. Adolescent (identity crisis)2. Elderly (ego-despair)3. Middle age men (40 y.o. above)4. Post partum depression(7days/2-4 weeks)D. Giving VaccinesII. Secondary: Screening, Diagnosis & Immediate TreatmentA.Screening> Denver Development Screening Test (DDST) #1 test for PDD
 
Pervasive Development Disorder (PPD)1. Autism: Age of onset (3 y.o.)2. ADHD: Age of onset (6 y.o.)Diet: Finger Food (high caloric, high CHO)Rx: Ritalin (Methylphenidate); dextroamphetamine (Dexedrine)3. Conduct disorder: Age of onset (6 y.o.)
B.
Suicide Prevention / Intervention
 
Impending signs of Suicide1. Sudden elevation of mood/sudden mood swings2. Giving away of prized possessions3. Delusion of Omnipotence (divine powers)Used by SS (Suicidal, Schizophrenia)4. When the patient verbalizes that the 2nd Gen TCA is working.less than 2-4 wks (telling a lie)
Suicide Interventions
:
1.One-on-one supervision and monitoring2.No suicide contract – 24 hrs monitoring- Patient is required to verbalize suicidal ideas3.Non metallic/plastic/sharp objects: ex. belts, curtains
4.
Avoid dark places
 
C. Case Finding (Epidemics)/Contact Tracing (STDs)D. Crisis InterventionObjective: To return the client to its normal functioning or pre crisis level.Duration: (4-6 wks)Disorganization is a phase in the crisis state which is characterized by the feelings of great anxiety and inability to perform activities of daily livingA patient in crisis is passive and submissive, so the nurse needs to be active and shoulddirect the patient to activities that facilitate coping.
Types of Crisis:1. Developmental Maturation Crisis- Adolescence (identity crisis)- Mid-life crisis;- Pregnancy- Parenthood2. Situational / Accidental crisis- Most common: Death of a loved oneNSG DX: Ineffective Individual Coping/ Denial- ex. murder, abortion , rape and fire3. Adventitious – calamity, disasterex. World War I & II, epidemic, tsunami

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