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Psychiatric Nursing 2

Psychiatric Nursing 2

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St. Louis Review Center
MENTAL HEALTH
"A state of well-being where a person can realize his or her own abilities to cope with the normalstresses of life and work productively." (
WHO
)
Balance in person’s internal life and adaptation to reality.
State of well-being in which a person is able to realize his potentials.Criteria for Mental Health:
Self-awareness
Ability to:
recognize one’s thoughts feelings, asset potentials and weakness.
experience genuine feelings as anger, happiness, resentment
leads to self-acceptance, self-understanding in order to understand others
Autonomy
: ability to function independently and function with others
Perceptive ability
Awareness of stimuli, reality orientation.
Orientation to: Time, Place, Person
Integral capacity
: Ability to harmonize psychic forces (id, ego, super ego).
Self-actuation
Ability to adopt to life changes, happy to work with others
Satisfaction in every endeavor 
Genuine cooperation
Mastery of one’s environment:
Awareness of the changes around him
MENTAL HYGIENE
a science that deals with: Promotive, Preventive, Curative, Rehabilitative aspects of care.
MENTAL DISORDER
A medically diagnosable illness which results in significant impairment of one's cognitive, affective or relational abilities and is equivalent to mental illness.Criteria for Mental Disorder:
Dissatisfaction with:
one’s characteristics, abilities and accomplishments
one’s place in the world
Ineffective:
interpersonal relationship
coping or adaptation to the events in one’s life
MENTAL ILLNESS
A state in which an individual shows deficit in functioning and is unable to maintain personalrelationship.
State of imbalance characterized by a disturbance in a person’s thoughts, feelings and behavior 
Factors that increase the risk are: Crises, Abuses, Poverty
Historical View of Mental Illness
In the past, mental illness has been viewed as:
Demonic possession
Influence of ancestral spirits
Result of violating taboo or neglecting cultural, ritual, and spiritual condemnation
Period of Enlightenment (1745-1886)
Lunatics were restrained in iron menacles
Mentally ill were exhibited as diversion and entertainment for the public
Establishment of asylums
Opening of state hospitals for mentally ill.
Period of Scientific Study
Psychoanalysis by Sigmund Freud
Psychotropic Drugs (1950)
Use of chlorpromazine and imipramine
Mental illness is caused by chemical imbalance in the brain.
The Decade of the Brain (1990)
Focused on the connections between mental illness and biological malfunction in the brainand the neuroendocrine-immune system.
Biological views holds that biological defects are responsible for certain serious mental illness.
Diagnosis of Mental Illness
 
Use of the Diagnostic and Statistical Manual of Mental Illness (DSM-IV)
Provides diagnostic criteria for each mental disorder and a system of 5 axes to give a comprehensiveview of the client’s mental illness.
Axis I
: The clinical disorder that is the focus of treatment
Axis II
: Personality disorders and mental retardation
Axis III
: Medical conditions
Axis IV
: Psychosocial and environmental problems
Axis V
: Global assessment of functioning (GAF)
PSYCHIATRIC NURSING
Importance:
An interpersonal process
Concerned with all the aspects of care
Both a Science and an Art
Science – uses different theoriesPsychiatric Nursing: Lecture Aid Page 1
 
St. Louis Review Center
Art - therapeutic use of self 
Clientele:
Individual, family and the community
Both mentally healthy and mentally illMain tool of the nurse: Therapeutic use of Self Characteristics of a Good Psychiatric Nurse:
Empathy
Genuineness
Congruence
Unconditional positive regardRoles of the Nurse in Psychiatric Setting:
Clinician
Collaborator 
Counselor 
Healthy role model
Parent surrogate
Patient advocate
Reality based
Researcher 
Socializing agent
Teacher 
Technician
Therapist
Ward manager 
Levels of Interventions in Psychiatric NursingLevelDescriptionExamplesPrimary
Aimed at altering the stressors through:
promotion of mental health
lowering the rate of cases
Health education
Information dissemination
Counseling
Secondary
Interventions that limits the severity of a disorder thorugh:
Case finding
Prompt treatment
Crisis intervention
Drug administration
Tertiary
Aimed at reducing the disability after a disorder through:
Prevention of complication
Active program of rehabilitation
Alcoholics anonymous
Occupational therapy
THE PSYCHIATRIC SETTINGAdmitting a Client in the Psychiatric Setting
Areas to be assessed:
H
ealth perception
O
rientation
M
etabolic pattern
E
limination pattern
C
ognitive pattern: Judgment, Insight, Memory
A
ctivity and exercise pattern
T
hought process
S
leep-rest pattern
LEGAL ASPECTS OF PSYCHIATRIC NURSING
Types of Admissions:
Voluntary
Persons admit themselves
Client consents to all treatment
Client can refuse treatment, including drugs, unless danger to self or others
Involuntary
Judicial process
Initiated when someone files a petition
Certification of the likelihood of serious harm to self or others, or unable to care for self 
Under 18, parents can confine with confirmation by a neutral fact finder 
Must be released at end of statutory time or put on voluntary status or have a hearing
Judicial Precedents
Unless incompetent, client maintains all previous rights
Insanity as a Defense
Insanity : determined in court; legal terminology
McNaughten Rule
“At the time of the crime, the individual didn’t know the nature and quality of the act or didn’t know right fromwrong.” 
COMMON BEHAVIORAL SIGNS AND SYMPTOMSDisturbance in Perception
Illusion - misperception of an actual external stimuli
Hallucination - false sensory perception in the absence of external stimuli
Psychiatric Nursing: Lecture Aid Page 2
Management:
Acknowledge the feelings
Reorient to reality
Provide distractions
 
St. Louis Review Center
Neologism
- pathological coining of new words
Circumstantiality
- over inclusion of details
Word salad
- incoherent mixture of words and phrases
Flight of ideas
- shifting of one topic from one subject to another in a completely unrelated way
Looseness of Association
- shifting of a topic from one subject to another in a somewhat related way
Verbigeration
- meaningless repetition of word or phrases
Perseveration
- persistence of a response to a previous question
Echolalia
- pathological repetition of words of others
Clang association
- the sound of the word gives direction to the flow of thought
Delusion
- false belief which is inconsistent with one's knowledge and culture
Grandeur - is an exaggerated belief of identity
Nihilistic - the client denies the existence of self or part of self 
Persecution - belief that he or she is the object of environmental attention and being singledout for harassment
Self-depreciation - worthlessness or hopelessness
Somatic - false belief to body function.
Disturbances of Affect
Inappropriate affect
- disharmony between the stimuli and the emotional reaction
Blunted affect
- severe reduction in emotional reaction
Flat affect
- absence or near absence of emotional reaction
Apathy
- dulled emotional tone
Disturbances in Motor Activity
Echopraxia
- the pathological imitation of posture/action of others
Waxy flexibility
- maintaining the desired position for long periods of time without discomfort
Akinesia
- loss of movement
Bradykinesia
- slowness of all voluntary movement including speech.
Ataxia
- loss of coordinated movement
Disturbances in Memory
Confabulation
- filling in of memory gaps
Amnesia
- inability to recall past events
Anterograde
- immediate past
Retrograde
- distant past
Deja vu
- feeling of having been to place which one has not yet visited
Jamais vu
- feeling of not having been to a place which one has visited
Dementia
 
gradual deterioration of intellectual functioning
results in the decreased of capacity to perform ADL
Other behavioral signs & symptoms
 
Agitation
- severe anxiety associated with motor restlessness.
Agnosia
- inability to recognize and interpret sensory stimuli.
Akathisia
- subjective feeling of muscular tension, restlessness and pacing repeated sitting andstanding.
Ambivalence
- presence of two opposing feelings at the same time.
Aphasia
- inability or difficulty to speak or recall words
Apraxia
- inability to carry out specific task or activity.
Delirium
refers to acute change or disturbance in a person's: LOC, cognition, emotion , perception
Depression
- feeling of sadness
Derealization
- feeling of strangeness towards the environment.
Dysthymia
- persistent state of sadness
Elation
(euphoria)- a feeling of high degree of confidence, boastfulness and joy with increase motor activity.
Narcolepsy
- sleep disorder characterized by frequent irresistible urge to sleep with episodes of cataplexy (sudden loss of muscle power)
USE OF APPROPRIATE COMMUNICATION TECHNIQUESCommunication
: reciprocal exchange of ideas between or among personsModes:
Verbal - written/spoken
Non-verbal - posture, tone of voice, facial expressionTypes of Non-verbal communication:
Kinesis
body movement
eye contact
gestures
Paralanguage
voice quality
non-language vocalization (crying, sobbing, moaning)
Proxemics – law of space relationship
Touch – physical act
Cultural artifacts
Meta communicationPsychiatric Nursing: Lecture Aid Page 3

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