• Types of Losses

1. Physiologic
2. Safety loss
3. Loss of security/ sense of belonging
4. Loss r/t self actualization
• Models of Grief
1. Engel’s Model
 Shock and disbelief
• Refuse to accept loss
• Shows intellectual acceptance but with emotional penal
 Developing awareness
• Reality and meaning of loss surfaces into consciousness
 Restitutions
• Works of mourning that includes ritual
 Resolving loss
• Focus is in the thoughts of deceased
 Idealization
• Repressing all negative feelings towards the deceased
 Outcotie
• Reduces psychological dependence on the deceased
• Interest in new relationship resumes
(Resolution takes 1 year or longer)

2. Parkes Model ( 4 stages of Grief)

1. Numbness- brief denial as a psycho defense
2. Yearning- last several months with intense psycho distress with thought focused
on the deceased
3. Disorganization- severe depression, social withdrawal
4. Reorganization- begins 6-9 mos, renewal of interest
(Profession though the stages of grief normally takes 2 yrs/ longer)
3. Grief Cycle Model
1. Shock- drop/ lower level of functioning
2. Protest- intense psycho-logical dependence to others
3. Disorganization- lowest level of functioning
4. Re-organization- comfortable remembering the decease

Anxiety
- Subjective emotional state occurring when ego is threatened and provoked by
the unknown
- Vague uneasiness that precedes all new experiences
Levels of Anxiety
1. Mild (+2)
- Productive level - restless Assist client
- Wide perceptual field - forgetting to tolerate
- Attentive/ alert - diff. to sleep anxiety
 2. Moderate (+3)
• Narrowed perceptual field - muscle tension -reduce
• Selectively attentive - diaphoresis anxiety
• Disorganized thoughts with events - ↑ hr, ↑ pr, ↑ rr -help client to
-freq. Urination understand
3. Severe (+3) anxiety
• Scattered perceptual field - headache - Help
• Cant complete task - n/v client to
• Behaviour focused to relieve - diarrhea channel
anxiety - palor anxiety
• Cries, dreaded - ↑hr, rr, bp - Lower
anxiety
4. Panic (+4)
• Person is overwhelmed - run
• Focused on self - dilate pupils Supportive
• Loss of rational thoughts - ↑ rr,bp,hr Protective
• Can’t communicate verbally - immobile, mute
• ? delusions/ hallucinations

• Coping with Anxiety

1. Adaptive- solves the problem!
2. Palliative- ↓problem (does not solve!)
3. Maladaptive- unsuccessful attempts
4. Dysfunctional- minimal fxn is difficult
• Anxiety disorders
1. Panic disorder
• Recurrent, unexpected panic attack, cause unwatering coo cern
(Intense anxiety, sob, dizziness, diaphoresis, palpitation, etc.)
2. Social pobia
3. Specific pobia
4. Old
5. Post traumatic stress disorder
6. Generalized anxiety disorder- frequent uncontrollable loorrying
7. Acute stress disorder- deut of anxiety, within 1 month of exposure to an
extremely traumatic
8. Agoraphobia- avoidance of places

Schizophrenia
• -----------------------
• Schizophrenia (blouler)- splitting of mood
• ----------------------------------
• Different theories
1. Genetic
• 50% chance for other identification
 • 15% for fraternal twin
2. Psychodynamic
• Poor care giving leads to psychic alterations ( Freud Bleuwer)
• Loss of ego boundaries
• Family relationship
3. Neurobiological
• Brain changes (pre-portal, limbic, basal ganglia)affecting languages and
memory
• Imbalance ( dopamine, norepi, serotonin, acetycoholinr, GABA)

• Signs/ symptoms
Catatonic!
1. Catatonic/ stupor- waxy flexibility
2. Mutisa (extreme negativism)
3. Echolalia (repeat worry)
4. Echopraxia (mimic actions of othrs)
Disorganized
1. Confusion
2. Disorganized thoughts, speech, thoughts, behaviour
Paranoid!
1. Systematic persecutory delusions, auditory hallucinations, delusions of
stranders, anger, violence
Undifferentiated
1. Pronounced delusions, hallucination, confusions, disorganized thinking

• Types of Delusions
1. Persecutions/ paranoid
2. Granoiose delusions- feeling artista!
-clamming associated with famous people
3. Religious
4. Somatic- contradict to active bodily fxn
5. Referential- media have special meaning

• Types of Hallucinations
1. Auditory
2. Visual
3. Olfactory
4. Tactile
5. Gustatory (taste)
6. Cenasthetic
7. Kinaesthetic

• Sleuler’s 4 A’s of schizophrenia

1. Associative looseness- lack of logical thought
2. Affective disturbance- flat, blunted, socially inappropriate
 3. Ambivalence- presence of strong conflicting feelings
4. Autism- extreme retreat from reality

• ----- Nsg Interventions

1. Agitation
- Remove case
- Grammar stimulants DO!
- Inductor physical comforts
- Drugs (as oriented)
- Display anger, frustration, encouragement DONT!
- Criticize, argue
2. Delusions
- Explain frogures
- Provide space
- Eye contact DO!
- Consistent
- Realistic goal
- Touch with warning
- Whisper/ laugh
- Argue, disapproving delusions
DONT!
- Reinforce delusions
3. Hallucinations
- ↓environment stimuli
- Identify contribution factors DO!
- Monitor command hallucinations
- Present reality
- Participate DONT!