MENTAL HEALTH  one’s characteristics, abilities and accomplishments

 "A state of well-being where a person can realize his or her own abilities to  one’s place in the world
cope with the normal stresses of life and work productively." (WHO)  Ineffective:
 Balance in person’s internal life and adaptation to reality.  interpersonal relationship
 State of well-being in which a person is able to realize his potentials.  coping or adaptation to the events in one’s life

Criteria for Mental Health:

 Self-awareness MENTAL ILLNESS
 Ability to:  A state in which an individual shows deficit in functioning and is unable to
 recognize one’s thoughts feelings, asset potentials and weakness. maintain personal relationship.
 experience genuine feelings as anger, happiness, resentment  State of imbalance characterized by a disturbance in a person’s thoughts,
 leads to self-acceptance, self-understanding in order to understand feelings and behavior
others  Factors that increase the risk are: Crises, Abuses, Poverty
 Autonomy: ability to function independently and function with others
 Perceptive ability
 Awareness of stimuli, reality orientation. Historical View of Mental Illness
 Orientation to: Time, Place, Person  In the past, mental illness has been viewed as:
 Integral capacity: Ability to harmonize psychic forces (id, ego, super ego).  Demonic possession
 Influence of ancestral spirits
 Self-actuation
 Result of violating taboo or neglecting cultural, ritual, and spiritual
 Ability to adopt to life changes, happy to work with others
condemnation
 Satisfaction in every endeavor
 Genuine cooperation  Period of Enlightenment (1745-1886)
 Lunatics were restrained in iron menacles
 Mastery of one’s environment: Awareness of the changes around him
 Mentally ill were exhibited as diversion and entertainment for the
public
 Establishment of asylums
MENTAL HYGIENE
 Opening of state hospitals for mentally ill.
 a science that deals with: Promotive, Preventive, Curative, Rehabilitative  Period of Scientific Study
aspects of care.
 Psychoanalysis by Sigmund Freud
 Psychotropic Drugs (1950)
MENTAL DISORDER
 Use of chlorpromazine and imipramine
 Mental illness is caused by chemical imbalance in the brain.
 A medically diagnosable illness which results in significant impairment of
 The Decade of the Brain (1990)
one's cognitive, affective or relational abilities and is equivalent to mental
 Focused on the connections between mental illness and biological
illness.
malfunction in the brain and the neuroendocrine-immune system.
 Biological views holds that biological defects are responsible for
Criteria for Mental Disorder:
certain serious mental illness.
 Dissatisfaction with:

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Diagnosis of Mental Illness  Researcher
 Use of the Diagnostic and Statistical Manual of Mental Illness (DSM-IV)  Socializing agent
 Provides diagnostic criteria for each mental disorder and a system of 5  Teacher
axes to give a comprehensive view of the client’s mental illness.  Technician
 Axis I: The clinical disorder that is the focus of treatment  Therapist
 Axis II: Personality disorders and mental retardation  Ward manager
 Axis III: Medical conditions
 Axis IV: Psychosocial and environmental problems Levels of Interventions in Psychiatric Nursing
 Axis V: Global assessment of functioning (GAF)
Level Description Examples
Primary Aimed at altering the stressors  Health education
PSYCHIATRIC NURSING through:  Information
 promotion of mental health dissemination
 An interpersonal process  lowering the rate of cases  Counseling
 Concerned with all the aspects of care Secondary Interventions that limits the severity of  Crisis intervention
 Both a Science and an Art a disorder thorugh:  Drug administration
 Science – uses different theories  Case finding
 Art - therapeutic use of self  Prompt treatment
 Clientele: Tertiary Aimed at reducing the disability after  Alcoholics
 Individual, family and the community a disorder through: anonymous
 Both mentally healthy and mentally ill  Prevention of complication  Occupational therapy
 Active program of rehabilitation
Main tool of the nurse: Therapeutic use of Self

Characteristics of a Good Psychiatric Nurse: THE PSYCHIATRIC SETTING

 Empathy Admitting a Client in the Psychiatric Setting
 Genuineness
 Congruence Areas to be assessed:
 Unconditional positive regard  Health perception
 Orientation
Roles of the Nurse in Psychiatric Setting:  Metabolic pattern
 Clinician  Elimination pattern
 Collaborator
 Counselor  Cognitive pattern: Judgment, Insight, Memory
 Healthy role model  Activity and exercise pattern
 Parent surrogate  Thought process
 Patient advocate  Sleep-rest pattern
 Reality based

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 LEGAL ASPECTS OF PSYCHIATRIC NURSING
Management:
Types of Admissions:
 Acknowledge the feelings
 Voluntary
 Reorient to reality
 Persons admit themselves
 Provide distractions
 Client consents to all treatment
 Client can refuse treatment, including drugs, unless danger to self or
others  Neologism - pathological coining of new words
 Involuntary  Circumstantiality - over inclusion of details
 Judicial process  Word salad - incoherent mixture of words and phrases
 Initiated when someone files a petition  Flight of ideas - shifting of one topic from one subject to another in a
 Certification of the likelihood of serious harm to self or others, or somewhat related way
unable to care for self  Looseness of Association - shifting of a topic from one subject to another
 Under 18, parents can confine with confirmation by a neutral fact in a completely unrelated way
finder  Verbigeration - meaningless repetition of word or phrases
 Must be released at end of statutory time or put on voluntary  Perseveration - persistence of a response to a previous question
status or have a hearing  Echolalia - pathological repetition of words of others
‘  Clang association - the sound of the word gives direction to the flow of
thought
Judicial Precedents
 Delusion - false belief which is inconsistent with one's knowledge and
Unless incompetent, client maintains all previous rights
culture
 Grandeur - is an exaggerated belief of identity
Insanity as a Defense
 Nihilistic - the client denies the existence of self or part of self
 Insanity : determined in court; legal terminology  Persecution - belief that he or she is the object of environmental
attention and being singled out for harassment
McNaughten Rule  Self-depreciation - worthlessness or hopelessness
“At the time of the crime, the individual didn’t know the nature and quality of the  Somatic - false belief to body function.
act or didn’t know right from wrong.”
Disturbances of Affect
 Inappropriate affect - disharmony between the stimuli and the emotional
COMMON BEHAVIORAL SIGNS AND SYMPTOMS
reaction
 Blunted affect - severe reduction in emotional reaction
Disturbance in Perception
 Flat affect - absence or near absence of emotional reaction
 Illusion - misperception of an actual external stimuli
 Apathy - dulled emotional tone
 Hallucination - false sensory perception in the absence of external
stimuli
Disturbances in Motor Activity
 Echopraxia - the pathological imitation of posture/action of others

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 Waxy flexibility - maintaining the desired position for long periods of time USE OF APPROPRIATE COMMUNICATION TECHNIQUES
without discomfort
 Akinesia - loss of movement Communication: reciprocal exchange of ideas between or among persons
 Bradykinesia - slowness of all voluntary movement including speech.
 Ataxia - loss of coordinated movement Modes:
 Verbal - written/spoken
Disturbances in Memory  Non-verbal - posture, tone of voice, facial expression
 Confabulation - filling in of memory gaps
 Amnesia - inability to recall past events Types of Non-verbal communication:
 Anterograde - immediate past  Kinesis
 Retrograde - distant past  body movement
 Deja vu - feeling of having been to place which one has not yet visited  eye contact
 Jamais vu - feeling of not having been to a place which one has visited  gestures
 Dementia  Paralanguage
 gradual deterioration of intellectual functioning  voice quality
 results in the decreased of capacity to perform ADL  non-language vocalization (crying, sobbing, moaning)
 Proxemics – law of space relationship
Other behavioral signs & symptoms  Touch – physical act
 Agitation - severe anxiety associated with motor restlessness.  Cultural artifacts
 Agnosia - inability to recognize and interpret sensory stimuli.  Meta communication
 Akathisia - subjective feeling of muscular tension, restlessness and pacing  based on role expectations
repeated sitting and standing.  hidden meaning of words
 Ambivalence - presence of two opposing feelings at the same time.
 Aphasia - inability or difficulty to speak or recall words Elements:
 Apraxia - inability to carry out specific task or activity.
 Delirium
 refers to acute change or disturbance in a person's: LOC, cognition, FEEDBACK
emotion , perception
 Depression - feeling of sadness
 Derealization - feeling of strangeness towards the environment.
 Dysthymia - persistent state of sadness
Message
 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 (Channel)
sleep with episodes of cataplexy (sudden loss of muscle power)
(Context)
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Therapeutic Communication: a way of interacting in a purposeful manner to Encouraging comparison Has this ever happened before?
promote the client’s ability to express his thoughts and feelings openly. Encouraging description How do you feel when you take your
medication?
Essentials for a Therapeutic Communication:
 Genuineness Encouraging evaluation Does participating in group therapy enable you
E
 Respect G R A T to discuss your feelings?
 Empathy Exploring Tell me more about your job. Would you
 Attentive listening describe your responsibilities?
 Trust (rapport) Focusing (assisting a patient to explore specific topic)
Giving broad openings or Is there something you'd like to do?
asking open-ended
Barriers to a Therapeutic Communication questions
 Belittling Informing (giving needed facts)
 Interrupting / ignoring I'll be your nurse for today, from 7:00 until 3:00
 Giving advice this afternoon.
Making observations You appear to be angry. / I noticed that you're
 Social response trembling.
 Changing the subject Offering general leads Go on. / You were saying…
 Approving / disapproving Restating Client: I can't sleep, I stay awake all night.
Nurse: You can't sleep at night, (restating)
 Moralizing
Summarizing During the past hour, we talked about your plans
for the future, they include...
Using silence (to induce thought, pacing, acceptance)
Validating (confirming one's observation)
“So you mean . . .”
Examples: Therapeutic Technique Voicing doubt I find that hard to believe.
Technique Example
Accepting Yes, that must have been difficult for you. Examples: Non-therapeutic Technique and Ineffective Communication
Acknowledging or giving I noticed that you've fixed your bed. Agreeing and disagreeing “I think you did the right thing.”
recognition Advice “You should.….”
Asking direct questions How does your wife feel about your Belittling "Don't be concerned, evervone feels like that".
hospitalization? Defending "All doctors here are simply great".
False reassurance "Don't worry, everything will be all right".
Clarifying I'm not sure that I understand what you are Focus on caregiver’s “I feel that way too.”
trying to say. feeling
Confronting or presenting I see no bats flying in this room. Judging "It's your own mistake".
reality

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 NURSE – PATIENT RELATIONSHIP

Working / Therapeutic Phase:

 it is highly individualized
 identification and resolution of the patient's problems
 more structured than the orientation phase
 the longest and most productive phase
 limit setting must be employed
 planning and implementation

Problems:
Hildegard Peplau
 Transference
 the development of an emotional attitude towards the nurse
Phases:
 positive or negative
Pre-Interaction Phase  Counter transference – experienced by the nurse / therapist
 begins when the nurse is assigned/chooses a patient
Termination Phase
 patient is excluded as an active participant
 Evaluate the summary of progress
 nurse feels certain degree of anxiety
 Reinforce change and strength of patient
 includes all of what the nurse thinks and does before interacting with the
 Give rewards for the cooperation during interaction
patient
 Encourage expression of feelings about termination of the relationship
 develop self-awareness
 Terminate the relationship without giving promises
 data gathering, planning for first interaction

Orientation phase
 when the nurse-patient interacts for the first time
 establish of contract with the patient
 establish of trust and rapport
 learn about the patient and his initial concerns and needs
 encourage the patient to feel comfortable with the meeting
 conduct initial interview
 manage present emotion of the patient
 provide support and empathy of the patient’s feelings
 assure of confidentiality

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  overeating, smoking, nail-biting
THEORIES OF HUMAN DYNAMICS
Nursing Implication:
Psychosexual Development : Sigmund Freud  Provide oral stimulation by giving pacifiers
 Breastfeeding may provide more stimulation.
Levels of Consciousness  Do not discourage thumb sucking

Anal Stage (2-4 years)

 Children's attention is focused on the anal region.
 Pleasure: elimination.
 Covers the ideal age for "toilet training" (2 1/2 years)
 2 concepts:
 Holding on
 Letting go

Possible problems:
 Compulsive need to be clean and orderly.
 Frugality and stinginess
3 Psychic Energies  Greed
 Insistence on doing things at one's own rate at the expense of others
Id  Rigid training
Ego  Excessive messiness and disorderly habits.
Superego
Nursing Implication: Help children achieve bowel and bladder control without
 Libido - are the instinctual drives undue emphasis on its importance.
 Regression and fixation are common terms in this theory.
 Gave prominence to sexual feelings: defined "sex" as anything that gives
gratification
Phallic Stage (4-6 years)
 Pleasure: genital region.
Stages:  activities associated with stroking and manipulating their sex organs.
 Oedipus complex
Oral Stage (0-2 years)  Electra complex
 The area of gratification is the mouth  Concepts
 Pleasures: sucking activities like fingers, toes or nipples  Onset of “normal homosexuality”
 Dissatisfaction: resurface at a later

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Nursing implications: Stages:
 Accept child's sexual interest
 Help the parents answer child's questions about birth or sexual differences. Stage 1:
Period of Life Infant, 0-18 months, (Hope)
Latency Stage (6 to 12 years) Psychosocial Crisis Trust vs. Mistrust
 Period of calmness / stable period.
Relationship with Maternal person
 Many of the disturbing behaviors are buried in the subconscious mind.
 Their energies are absorbed by the concerns in school, peers, sports and Positive Resolution o Reliance on the caregiver
other recreational activities o Development of trust in the environment
Negative Resolution o Fear, anxiety and suspicion
Nursing Implication: Help the child have positive experiences. o Lack of care, both physical & psychological by
caretaker leads to mistrust of environment
Genital Stage (12 years & up)
 Oedipal feelings are reactivated toward opposite sex Stage 2:
 The person is on his way in establishing a satisfying life of his own Period of Life Toddler, 18 mos. to 3 years
(Willpower)
Nursing Implication: Psychosocial Crisis Autonomy vs. Shame/doubt
 Provide appropriate opportunities for the child to relate with opposite sex. Relationship with Paternal person
 Allow child to verbalize feelings about new relationships.
Positive Resolution o Sense of self-worth
o Assertion of choice and will
Psychosocial Development Theory: Erik Erikson o Environment encourages independence, leading to
sense of pride
 Childhood is very important in personality development. Negative Resolution o Loss of self-esteem
 Rejected Freud's attempt to describe personality solely on the basis of o Sense of external control may produce self-doubt in
sexuality, others
 believed that social factors greatly affect
 felt that personality continued to develop beyond five years of age. Stage 3:
Period of Life Preschool, 3 to 6 years (Purpose)
Psychosocial Crisis Initiative vs. Guilt
Identified 8 developmental stages throughout the whole life cycle.
Relationship with Family
 Stages 1-5 - childhood and adolescent
 Stages 6-8 - Adulthood Positive Resolution The ability to learn to initiate activities, to enjoy
achievement and competence
Negative Resolution
o The inability to control newly developed power
o Realization of potential failure leads to fear of
punishment and guilt

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 Negative Resolution Self-indulgence and resulting psychological
Stage 4 impoverishment
Period of Life Schooler, 6 to 12 yrs. (Competence) Stage 8:
Psychosocial Crisis Industry vs. Inferiority Period of Life Late Adult, 54 yrs. to death, (Wisdom)
Relationship with Neighbors/School Psychosocial Crisis Integrity vs. Despair
Positive Resolution o Learning the value of work Relationship with Mankind
o Acquiring skills and tools of technology Positive Resolutiono Acceptance of one’s life
o Competence helps to order life and make things o Realization of the inevitability of death
work o Feeling of dignity and meaning of existence
Negative Resolution Repeated frustrations and failures lead to feelings of Negative Resolution Disappointment of one’s life and desperate fear of
inadequacy and inferiority that may affect their view of death
life
Stage 5: Cognitive Development Theory: Jean Piaget
Period of Life Adolescent, 12 to 18 yrs, (Fidelity)
Psychosocial Crisis Identity vs. Role confusion Stages:
Relationship with Peer group
Sensorimotor (0-2 years)
Positive Resolution Experiments with various roles in developing mature
individuality  Reflex to complex
Negative Resolution Pressures and demands may lead to confusion about  Begins to organize visual images and control motor responses.
self  Coordinates sensory impressions.
 Pre-verbal stage
Stage 6:
Period of Life Young Adult, 18 to 54 yrs., (Love) Preoperational Stage (2-7 years)
Psychosocial Crisis Intimacy vs. Isolation  Transitional period
Relationship with Partners in friendship  Egocentric and irreversible thinking
Positive Resolution o A commitment to others  Words become symbols for objects – symbolic thinking
o Close heterosexual relationship and procreation  Formation of ideas of categorization.
Negative Resolution Withdrawal from such intimacy, isolation, self-  Lack of ability to go back and rethink a process or concept.
absorption and alienation from others  Mental image – the symbolic process which are evident in plays
Stage 7:  Construction of verbal schemas – preconcepts
Period of Life Middle Adult, 24 to 54 yrs., (Care)
Concrete Operations (7 – 11 years)
Psychosocial Crisis Generativity vs. Self-absorption
 Thinking appears to be stabilized
Relationship with Partner o ability to think of the possible consequences of actions
Positive Resolution o The care and concern for the next generation  Logical implications
o Widening interest in work and ideas

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Formal Operations arbitrariness of social based on agreement and contracts.
(11 years to adulthood) and legal conventions. Stage 6
 Full patterns of thinking  The individual attempts  Morality is based on respect for others
 Ability to use logic and symbolic processes to define moral values rather than on personal desires.
o mathematical and scientific reasoning that are separate from  The individual conforms to both social
 Combinatorial thinking - multidimensional approach group norms. standards and to internalized ideals to
o hypothetic or hypothetico-deductive reasoning avoid self-condemnation rather than to
avoid social censure.

Moral Development Theory: Laurence Kohlberg

Other Theories
Level One Stage 1
(Preconventional Morality)  Behavior is based on the desire to avoid Behavioral Model (Ivan Pavlov, John Watson, B. F. Skinner)
 Children’s judgments severe physical punishment by a superior  Behavior is:
are based on external power.  a response to a stimulus from the environment
criteria.  Right or wrong is based on consequences to  learned and retained by positive reinforcement
 Standards of right and him.
wrong are absolute and  Punishment = wrong act Interpersonal Model (Harry Stack Sullivan)
laid down by authority.  Focused on the role of the environment and interpersonal relations as
Level Two (Conventional Stage 2
the most significant influences on a individual’s development.
Morality)  Actions are based largely on satisfying one’s
 Children’s judgments own personal needs.
 Anxiety is communicated interpersonally.
are based on the norms Stage 3
and expectations of the  Good behavior is that which pleases others Human Motivational Need Model. (Abraham Maslow)
group. and judgments are based on intentions.  Hierarchy of needs in order of importance
 Children conform to rules to win the approval  Primary needs (physiologic) need to be met prior to dealing with higher
of others and to maintain good relationships. level needs.
Stage 4
 What is right is what is accepted. Psychobiologic Model
If the social accepts rules as appropriate for all  Focus is in mental illness as a biophysical impairment.
group members, children will conform to them to  Human behavior is influenced by genetics, biochemical alterations and
avoid social disapproval and censure function of brain and CNS.
Level Three Stage 5
 The stress response is a neuroendoctine response.
(Post Conventional  Behavior recognizes the laws as arbitrary
Morality) and changeable.
Important structure (limbic system):
 The individual  For aspects of life not governed by laws,
recognizes the  Thalamus – regulates activity, sensation, emotion
right and wrong are personal decisions

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 Hypothalamus – themoregulation, appetite control, endocrine function,  Gama-Aminobutyric Acid
appetite control, impulsive behavior associated with feelings of anger, rage  An inhibitory neurotransmitter
or excitement.  Associated to treat anxiety and induce sleep.
 Hippocampus and amygdale – emotional arousal and memory
 Neurons – basic functioning unit of the CNS
 Neurotransmitters PSYCHOTHERAPY
 Chemical substances manufactured in the neuron
 Aid transmission of information throughout the body  Is a process in which a person enters into a contract to interact with a
 Dopamine therapist to relieve symptoms, resolve problems in living, seek personal
 An excitatory neurotransmitter growth
 Located primarily at the brain stem
 Involved in control of complex movements, motivation, cognition and
regulation of emotional responses INDIVIDUAL THERAPY: Is a confidential relationship between client and
 Associated with pyschosis and Parkinson’s disease therapist.
 Catecholamines (norepinephrine and epinephrine)  Hypnotherapy: Involves various methods and techniques to induce a
 Norepinephrine trance state where the patient becomes submissive to instructions
 Attention, learning and memory, sleep and wakefulness  Humor therapy: Use of humor to facilitate expression of feelings and to
 Excess of this is associated with anxiety, memory loss, social enhance interaction
withdrawal and depression.  Psychoanalysis: Focuses on the exploration of the unconscious, to
 Epinephrine – responsible in the fight or flight mechanism facilitate identification of the patient's defenses
 Serotonin
 An inhibitory neurotransmitter GROUP THERAPY
 Derived from tryptophan  minimum number : 3
 Involved in control of food intake, sleep and wakefulness, pain  Ideal number :8-10
control, sexual behavior and emotions
 Involved in anxiety and mood disorders, schizophrenia and its  Advantages:
symptoms o decreases isolation
 Histamine o decreases dependence
 Primarily involved in immunity and allergic reactions o develops coping skills
 Some psychotropic drugs are block by histamine o develops interpersonal learning
 Acetylcholine o develops opportunities for helping others
 Affects sleep-wake cycle o develops ability to listen to other members
 Associated with Alzheimer’s disease
 Glutamate  Remotivation Therapy: Promotes expression of feeling through interaction
 An excitatory neurotransmitter facilitated by discussion of neutral topics
 At high levels, it can cause neurotoxicity.  Family therapy: A method in which family members gain:
 Associated with Alzheimer’s and Huntington’s disease o insight into the problems

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 o improve communication
o improve functioning of individual members as well as the family as a
whole.
o It focuses on the total family as an interactional system
 Milieu Therapy
 A therapeutic environment is organized to:
o encourage and assist the client to control problematic behavior
o function within the range of social norms
 Play therapy
 Effective for children suffering from maladjustment or behavior disorder.
 The child is usually placed in a play room
 Purpose - to discover the causes of the child's conflict through
observation of his play and to interpret it to the child.
 Recreational therapy
 Uses activities which vitalize the patient's interest and help him or her to
relax and feel refreshed.
 Example: Playing baseball may be prescribed for as a means of
expressing hostility in a group.
 Occupational therapy: Uses any mental or physical activity prescribed or
guided to aid an individual's recovery from a disease or injury.
 Musical therapy
 Involving the music which allows the child or adolescent to express
herself or himself.
 Also effective with those who have difficulty communicating.
 Art therapy: Clients are encouraged to express their feelings or emotions
by painting, drawing or sculpture.
 Psychodrama therapy: Patients dramatizes their emotional problems in a
group setting.
 Behavior Therapy
 Is a mode of treatment that focuses on modifying observable (overt) and
quantifiable behavior
 Systematic manipulation of the environment and variables thought to be
functionally related to the behaviors.
 Limit Setting
a.n.g./n.a.l. PSYCHIATRIC NURSING
o Therapist gives an advanced warning of the limit and the
consequences will follow if the client does not adhere to the limit.
o The consequences should occur immediately after the client has
exceeded the limit
o Consistency must occur with all personnel.
o Purposes:
o Minimizes manipulation and splitting of the staff.
o Provide a framework for the client to function in and enable a
client to learn to make requests.
 Systematic Desensitization
o Clients are exposed slowly to a feared object or a thing that inhibits
anxious responses and taught ways to relax.
o Effective in treating phobias.
 Implosive therapy
o The clients are exposed abruptly to intense forms of anxiety
producers, either in imagination or in real life
 Cognitive Behavior therapy
o Uses confrontation as a means of helping the clients restructure or
rearrange irrational beliefs, maladaptive thinking, perception-, and
behaviors.
o Used for depression and adjustment difficulties.
 Biofeedback
o Teaches the client to control or change aspects of their internal
environment.
 Aversion therapy
o Uses unpleasant or noxious stimuli to change inappropriate
behavior.
o Examples
o Antabuse to treat alcoholics
o Showing films to drivers who are arrested for speeding or driving
while under the influence of alcohol or drugs.
 Assertiveness Training
o Clients are encouraged and taught how to appropriately relate to
others
o Teaches the individual to ask for what is beneficial to both mentally
ill and mentally healthy persons.
Page 12 of 32
  Token-economy: Utilizes the principle of rewarding desired behavior to  Watch out for complications:
facilitate change. o Memory loss
o Headache
o Apnea
ELECTROCONVULSIVE THERAPY (ECT) o Respiratory depression
 Exact mechanism is unknown o Fracture
 Requires a consent
 Usually given at 70-150 volts for about .5-2 seconds BASIC CONCEPTS ON PSYCHOPHARMACOLOGY
 Effectivity: 6-12 treatments with at least 48 hour interval
 Indicator of effectiveness: tonic-clonic seizure MAJOR TRANQUILIZERS/ ANTIPSYCHOTICS
 Indication: Schizophrenia and Other Psychosis
Indications of use:  Desired effect: control of symptoms
 Depression  Best taken after meals
 Mania
 Catatonic schizophrenia Examples:
Contraindications (not absolute)  Haloperidol (Haldol)  Fluphenazine (Prolixin)
 Fever  Unhealed fracture  Prochlorperazine (Compazine)  Chlorpromazine (Thorazine)
 Increased ICP  Retinal detachment
 Cardiac conditions  Pregnancy Side effects: Nursing Action
 TB with history of hemorrhage Blurred vision Avoid driving
Dry mouth Give sugarless gum
Before the procedure: Tachycardia, palpitation, constipation, Monitor & report
 Diagnostic procedures urinary retention
o X-ray Photosensitivity Don’t expose skin to sunlight
o ECG Orthostatic hypotension Monitor BP
o EEG Advise gradual change in position
 Drugs given Extra Pyramidal Symptoms Report at once
o Atrophine sulfate (decrease secretions) o Pseudoparkinsonism
o Anectine (Succinylcholine) – relax muscles o pill-rolling tremors
o Methohexital Na (Brevital) - anesthetic mask-like face
During the procedure: o cog-wheel rigidity
 Observe for tonic-clonic seizure o propulsive gait
After the procedure: o Akathisia - restless leg syndrome
 Position o Dystonia - defect in muscle tone
 Check vital signs
 Reorient the client Adverse effect: report promptly
 Tardive dyskinesia - lip smacking

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 Agranulocytosis  Monitor I & O
o Assess for:  Monitor for signs of increased IOP
 Fever
 Sore throat
 Lab data: WBC count
 Hepatotoxicity MAO INHIBITORS
o Assess for ALT & AST Indication: refractory depression

MINOR TRANQUILIZERS/ ANXIOLYTICS Examples:

 Common indication: Anxiety disorders  Tranylcypromine (Parnate)
 Desired Effect: Decreased anxiety, adequate sleep
Examples:
 Diazepam (Valium)  Chlorazepate Dipotassium
 Phenelzine (Nardil)
 Isocarboxazid (Marplan) PaN aM a
 Oxazepam (Serax) (Tranxene) Nursing Implications:
 Chlordiazepoxide (Librium)  Alprazolam (Xanax)  Best taken after meals
 Report headache; it indicates hypertensive crisis
Nursing Implications:  Avoid tyramine containing foods like:
 Best taken before meals  Avocado
 Advise to avoid driving  Banana
 Avoid alcohol and caffeine-containing foods  Cheddar and aged cheese
 Administer it separately with any drug  Soysauce
 Preserved foods
 Effectivity: 2-3 weeks
ANTIDEPRESSANTS  Monitor the BP
Desired effects: increased appetite, adequate sleep  There should be at least a two-week interval when shifting from one anti-
depressant to another

Tricyclic Antidepressants Selective Serotonin Reuptake Inhibitors

Examples: Examples:
 Imipramine (Tofranil)  Amitriptyline (Elavil)  Fluoxetine (Prozac)  Paroxetine (Paxil)
 Celatopram (Celexa)  Fluvoxamine (Luvox)
Nursing Implications:  Sertraline (Zoloft)
 Best given after meals
 Effectivity: after 2-3 weeks Nursing Implications:
 Check the BP, it causes hypotension  Avoid the use of:
 Check the heart rate, it causes cardiac arrythmias  diazepam

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  Alcohol  A state produced by a change in the environment that is perceived as
 Tryptophan challenging, threatening or damaging to the person’s dynamic equilibrium.
 Monitor PTT, PT (Smeltzer, 1992)
 Never give to pregnant / lactating mothers.

ANTI-MANIC AGENT Adaptation

 A constant ongoing process that occurs along time continuum, beginning
Examples: with birth and ending with death. (Smeltzer, 1992)
 Lithium Citrate (Cibalith – S)  Lithium Carbonate (Eskalith,  A continuous process of seeking harmony in an environment.
Lithane, Lithobid)
Types of Adaptation:
Nursing implications:
 Best taken after meals General Adaptation Syndrome (GAS)
 Increase intake of:  Involves the whole body in response to stress.
 fluids (3 L /day)  Compared to life process as it focuses on the “wear and tear of the body
 sodium (3 gm/day) tissues.
 Avoid activities that increase perspiration
Phases:
 Never give to pregnant mothers
 Alarm
 Effectivity: 10-14 days
o Acute phase of the syndrome
 Antipsychotic is administered during the first 2 weeks
o Characterized as the “flight and fight” reaction
 Therapeutic level:.5-1.5 meq/L
o Defensive by nature but self-limiting
 If ineffective: Tegretol
o If stress is intense, it may lead to death.
 Signs of toxicity:
o Vomiting  Resistance
o Characterized as the state of adaptation
o Anorexia
o Person moves back to homeostasis
o Nausea
 Exhaustion
o Diarrhea
o Result of a prolonged exposure to stress and adaptive mechanisms can
o Abdominal cramps
no longer persist.
o Lightheadedness (late)
 Antidote: Mannitol Local Adaptation Syndrome
 Refers to inflammatory response and repair processes that occur at the
STRESS local site of tissue injury.

 A nonspecific response of the body to any demand made upon it. (Hans Eustress - positive stress
Selye, 1936)
Distress

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 Negative stress
 Damaging stressors which may result in various physical and emotional
disorders such as: anxiety, frustration, insecurity, aimlessness
CRISIS AND CRISIS INTERVENTION
 A situation that occurs when an individual's habitual coping ability becomes
ineffective to meet the demands of a situation.
 As a serious interruption and disturbance of one's equilibrium or
homeostasis
 Leads to potentially dangerous, self-destructive or socially unacceptable
behavior.
CRISIS INTERVENTION
 Major Goal:
o Restore the maximum level of functioning (pre-crisis state)
o It is an active but temporary entry into the life situation of an individual
or a family during a period of stress.
o A way of entering into the situation to help them mobilize their resources
and to decrease the effect of stress.
Domestic Violence Requiring Crisis Intervention:

Characteristics RAPE
 Highly individualized  Nonconsensual sexual penetration of an individual, obtained by force or
 Self-limiting: 4-6 weeks threat, or in cases in which the victim is not capable of consent.
 Person affected becomes passive and submissive
 Affects a person’s support system Kinds of Rape
 Power – to prove masculinity
 Anger – means of retaliation
Type Description Example  Sadistic – to express erotic feelings
Maturational/developmental expected, predictable Puberty, adolescence,
crisis and internally young adulthood, Silent Rape Syndrome
motivated marriage, or the aging  Is a maladaptive reaction to rape
process.  The victim:
Situational/accidental Unexpected, Economic difficulty,  fails to disclose information about the rape
unpredictable and illness, accident, rape,  is unable to resolve feelings about the sexual assault
externally motivated divorce or death  Results to increase anxiety and may develop a sudden phobic reaction.

Social crisis Due to acts of nature Natural calamities Rape Trauma Syndrome (RTS)
 Refers to a group of signs and symptoms experienced by a victim in
reaction to rape
Phases
 Denial Phases:
 Increased Tension  Acute Phase – shock, numbness, disbelief
 Disorganization  Denial – refusal to discuss the event
 Attempts to reorganize  Heightened Anxiety – fear, tension, nightmares
 Stage for full reorganization  Stage of Reorganization

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 Characteristics of Abusive Parents:
 They come from violent families
Battered Wife Syndrome (BWS)  They were also abused by their parents
 A form of cyclic domestic violence  They have inadequate parenting skills
 Men: low self-esteem  They are socially isolated because they don't trust anyone
 Women: Dependent personality disorder  They are emotionally immature
 They have negative attitude towards the management of the abused

Warning signs of Child Abuse / Neglect:

 Child’s excessive knowledge on sex and abusive words
 Hair growth in various lengths
 Inconsistent stories from the child and parent/s
 Low self-esteem
 Depression

 Apathy
 Bruised or swollen genitalia; tears or bruising of rectum or vagina
 Unusual injuries for the child’s age and development
 Serious injuries (fractures, burns, lacerations)
Child Abuse  Evidence of old injuries not reported
 Is an act of omission of responsibility or commission in which intentional
harm is inflicted on a child. Republic Act 7610
(Anti Child Abuse Law)
Components of Omission:  Required reporting of suspected cases
 Child abandonment – leaving the child physically  Report cases to the nearest authorities within 48 hours
 Child neglect - lack of provision of those things which are necessary for the
child's growth and development Assessment, Planning and Nursing Actions for Crisis
 Primary concerns:
Types of Commission: o Physical injuries
Physical Abuse o Alleviation of psychological trauma
 Is an intentional physical harm inflicted on a child by a parent or other  Nurse should display:
person. o Sensitivity
o Attitude (Nonjudgmental)
Emotional abuse - insult and undermining one's confidence o Confidentiality
o Respect
Sexual abuse - abuse in the form of sexual contact
o Empathy

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 o Dignity o the redirection of feelings to a less threatening object
 Evidences are important: o An adolescent boy, after an argument with his father, goes to the room
o stained clothing and kicked his room’s door.
o fingernail scrapings
o mouth or anal smears containing semen  Fantasy
 Intervention focuses family as a unit. o Conscious distortion of unconscious feelings or wishes
 If the victim is a child: Play and art therapy o A boy who is being bullied by his friends wished he had the power of
DEFENSE MECHANISM Wolverine.

 These are automatic and usually unconscious processes or act by the  Fixation
individuals to: o An unhealthy mechanism which is an arrest of maturation at certain
o reduce or cope anxiety or fear stages of development.
o resolve emotional or mental conflict o A boy never overcame being fully reliant from his mother.
o protect one's self-esteem
o protect one's sense of security  Introjection
 Becomes pathologic when overused. o Symbolic assimilation or taking into oneself a love/hatred object.
 Used by both mentally healthy and mentally ill individuals Derived from the word "introject" which literally means to take into or
ingest.
o Common to depressed clients.
Common Defense Mechanisms Used:
 Compensation
o An attempt to overcome a real or imagined short coming, inferiority,  Identification
inabilities and weaknesses. o An individual integrates certain aspects of someone else's personality
o A blind woman becomes proficient in playing piano. into one's own.
o A young school teacher adopts his former mentor's teaching style when
 Conversion conducting class sessions.
o Emotional problems are converted to physical symptoms
o A student unprepared for a report suffered headache the day she is  Intellectualization
supposed to deliver her report. o An overuse of intellectual concepts by an individual to avoid expression
of feelings
 Denial o A man who was asked to share a memorable experience about his
o Failure to acknowledge an intolerable thought, feeling, experience or grandmother who died discussed the stages of death and dying by
reality Elizabeth Kubler Ross.
o A middle-aged man after being admitted to the CCU because of an AMI,
insists that he is in the hospital for just a diagnostic work-up.  Projection
o Attributing to others one's unconscious wishes/fear.
 Displacement o Literally, this means to "throw off.

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 o A student who failed a subject blames his failure on poor teaching.
 Reaction – Formation
o Expression of feeling that is the direct opposite of one's real feeling.
o Also referred to as overcompensation.
o A student who dislikes one of her classmates may act or show concern
toward her.
o A boy walked out from the group and said "I have to go now", when he
was asked what was happened to their relationship with his girlfriend.
 Substitution
o Replacing the desired unattainable goal with one that is attainable
o A woman who failed the nursing board exam 3 times, worked as a
nursing aide just to be in the hospital.

 Rationalization  Sublimation
o An individual finds a justifiable cause and acceptable reasons just to be o The redirection of unacceptable instinctual drive with one that is socially
saved from an embarrassing and anxiety producing thoughts or acceptable
situations. o Instead of harming his mother, a man expressed his anger by
o A basketball player claims that he missed the shot and lost the game composing a song.
because of the distractions made by the audience.
 Symbolization
 Regression o Less threatening object is used to represent another
o Is the turning back to earlier patterns of behavior in solving personal o A woman, missing her husband finds comfort in hugging her son who
conflicts. looks like his father.
o Commonly seen to schizophrenic patients
o A person who becomes ill in the face of disappointment has regressed  Undoing
to a form of childish behavior. o An attempt to erase an act, thought, feeling, guilt or desire
o A man gives her wife a bunch of roses after their argument last night.

 Repression
o It is the involuntary or unconscious forgetting of an unpleasant ideas or ANXIETY
impulses.  Vague sense of impending doom
o During the nurse-patient relationships, patients often unconsciously  Subjective response to stress
avoid discussing those experiences producing anxiety which are  Is a state of apprehension, uneasiness, uncertainty or tension experienced
emotionally difficult to verbalize. by an individual in response to an unknown object or situation.

 Suppression Signs and symptoms:

o Permits the individual to store away or consciously forget the
unpleasant, painful and unacceptable thoughts, desires, experiences Mild
and impulses.  Physical - ↑PR, RR, BP, pupillary dilatation, sweating
o "I'll think it about tomorrow", "I'd rather go now", "Can we change the  Cognitive - Attentive and alert
topic?"  Emotional - Minimal use of defenses

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Moderate Examples:
 Physical - Nausea, Anorexia, Vomiting, Diarrhea, Constipation,  Agoraphobia - fear of open places and of being alone in public places.
Restlessness  Social phobia - irrational fear of criticism, humiliation or embarrassment.
 Cognitive - narrowed perceptual field & selective inattention  Acrophobia - fear of heights
 Emotional - use of any defense mechanism available  Algophobia - fear of pain
 Claustrophobia - fear of enclosed place
SEVERE  Thanatophobia - fear of crowds
 Physical - s/sx becomes the flow of attention  Pathophobia - fear of disease
 Cognitive – perceptual field is greatly narrowed, focus of attention is trivial  Monophobia - fear of being alone
events
 Emotional – defense mechanism operate Generalized Anxiety Disorder
(GAD)
PANIC  Unrealistic, excessive anxiety and is unable to control worry.
 Physical – s/sx of exhaustion ignored  Clients may experience: fatigue, irritability, restlessness, muscle tension,
 Cognitive – personality disorganized sleep disturbance
 Emotional – defense mechanism fail
Obsessive Compulsive Disorder
Nursing Diagnoses:  Is characterized by recurrent obsessions and compulsions that interfere
with normal life.
 Ineffective individual coping
 Anxiety
Obsession
Nursing Management:
 Refers to persistent, painful intrusive thought, emotion or urge that one is
 Calm
unable to suppress or ignore.
 Administer medications Compulsion
 Listen  Refers to repetitious uncontrollable act and sometimes a purposeful act to
 Minimize environmental stimuli prevent a certain mistake in an event or situation.
ANXIETY DISORDERS
Post-Traumatic Stress Disorder (PTSD)
Panic Disorder  Is the delayed reaction of the person who has been involved or exposed to
 An individual may suddenly experience frightening and uncomfortable a traumatic events.
symptoms  Symptoms of this disorder are:
 May include terror, sense of unreality or fear of loosing control  intense psychological distress
 Attack: 1 minute and 1 hour  feeling of detachment or estrangement from others
 insomnia
Phobic Disorder  decreased concentration
 Phobia is an irrational fear of an object, place, activity or situation.  avoidance of thoughts and feelings
 Avoidance will allow the individual to be free from anxiety.  recurrent distressing dreams
 inability to recall an important aspect of the trauma

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  The person becomes, preoccupied with the fear of developing or having
Nursing Interventions already a disease or illness in spite of medical reassurance.
 Calm and nonjudgmental approach to convey acceptance.
 Use short and simple sentences or words. Body Dysmorphic Disorder
 Help the client develop an increase tolerance to anxiety.  Preoccupation with an imagined defect in his or her appearance.
 Help the client to:  Slight physical abnormality = excessive concern / anxiety
 develop a problem-solving and coping skills of the client.
 develop the ability to remain calm in anxiety-producing situations. Dissociative Amnesia
 Approach: kind-firmness  Inability to recall extensive amount of important information
 Systematic desensitization (phobic disorders)  Caused by trauma
 Clients with ritualistic behavior (obsessive-compulsive disorder) should not  Characterized by:
be prohibited or reprimanded.  Disorientation
 Biofeedback, change of the scenery, therapeutic touch, hypnosis, massage  Purposeless wandering
or relaxation exercises.  Impairment in ability to perform ADL
 Administer medications, as ordered.  Rapid recovery generally occur

ANXIETY RELATED DISORDERS PERSONALITY DISORDERS

 Are pervasive and inflexible patterns of functioning that is stable overtime,
Somatization Disorder and leads to distress or impairment.
 Free floating anxiety disorder
 Clients: Types of Personality Disorders:
 express emotional turmoil or conflict through physical symptoms.
 usually seek for repeated medical attention. Eccentric Personality Disorder (Type A)
 may exhibit antisocial behavior and may attempt suicide.  Paranoid (Suspicious and distrustful)
 Associated with anxiety and depression  Persons who display pervasive and long stand suspiciousness
 More common in men
Conversion Disorder  Schizoid (Socially distant and detached)
 A condition in which an anxiety-provoking impulse is converted  Pattern of detachment from social relationship
unconsciously into functional symptoms.  Chooses solitary activities
 Conscious counterpart of malingering  Topics are inanimate objects and ideas
 Examples: Paralysis, blindness, loss of touch or pain sensation, dyspnea,  Schizotypal (Odd and eccentric)
seizures or convulsions  “mild schizophrenia”
 Acute discomfort in close relationships
Hypochondriasis  Cognitive or perceptual distortion
 An individual presents an unrealistic or exaggerated physical complaints.
Dramatic-Erratic Personality Disorder (Type B)

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 Antisocial (aggressive and manipulative)
 Pattern of disregard for the violation of the rights of others
 Low self-esteem DISORDERS COMMONLY DIAGNOSED TO CHILDREN

 Borderline (destructive and unstable) AUTISM

 Characterized by patterns of instability in relationships, self image and  Characterized by:
mood  impairment in communication skills
 Self-mutilating behavior  presence of stereotyped behavior, interests and activities.
 Affective instability  associated with impairment on social interactions
 More common in women  treatable but not curable
 Narcissistic (boastful / superiority complex)  more common among boys
 Grandiosity and need for constant admiration  usually diagnosed at age 2
 Exploitation of others for fulfillment of own desire  Main problem: Interpersonal functioning
 Most acceptable cause: Biological factors - brain anoxia, intake of drugs
Anxious or Fearful Personality Disorder (Type C)
 Avoidant (inferiority complex) Signs and Symptoms
 Social inhibition  Odd play
 Feelings of inadequacy and sensitivity  Not cuddly
 Low self-esteem
 Echolalia
 Social withdrawal in spite of a desire for affection and acceptance
 Crying tantrums
 Dependent (submissive)
 Head towards anything
 Submissive clinging behavior related to excessive need to be cared for
by others  Inanimate object attachment
 Lack of self-confidence  Loves to spin objects / self
 Perceive self as helpless and stupid  Difficulty interacting with others
 Obsessive-Compulsive (perfectionist)  Wants blocks
 Preoccupied with orderliness, perfectionism, inflexibility, need to be in  Acts as deaf
control  Resists normal teaching method / routine changes
 Formal and serious interpersonal relationship  No fear of danger
 Judgmental of self and others  Insensitive to pain
 Passive-Aggressive  No eye contact
 Intentional inefficiency  Giggling or silly laughing
 Passive resistance to demands for adequate performance in both
occupational and social functioning Nursing Interventions
 Environment: safe & consistent
Nursing Diagnosis:  Encourage the client to participate for self-care
 Ineffective individual coping  Speak calmly when giving instructions
 Self-esteem disturbance

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 Use simple words or phrases o Educable – needs assistance
 Repeat instructions as necessary. Moderate/Imbecile 36-50 Poor awareness of needs of others
 Haloperidol - symptomatic relief for hyperactivity, stereotypical and self- Trainable – needs moderate supervision
destructive behavior Severe/Idiot 20-35 o Unable to learn academic skills
o Poor motor development and minimal
speech
MENTAL RETARDATION o Needs complete and close supervision
 Not a mental illness. Below o Has minimal capacity for sensorimotor
 Problem of inadequate mental functioning. 20 function
 Onset: 18 o Needs custodial care with a totally
 IQ below 70 structured environment
 Manifested by sub-average intellectual functioning in:
 Communication
Self-care Principles of Nursing Care
Home living  Protective care
Social skills Education of the family
Health and safety  Their involvement is an important factor in the plan of care to promote
progress and to minimize the stress.
Causes  Repetition
 HIV/ AIDS / rubella infection  Role modeling
 Alcoholic mother  Restructuring
 Thyroid deficiency  Focus of Education
 Excessive lead poisoning  Reading
 Damage to the brain  Arithmetic
 Neurological / neurodevelopmental impairment  Writing
 Exact gestational age is not reached (premature)
 Opiate intoxication
 Nutritional deficiency (lack in Folic Acid) ATTENTION DEFICIT HYPERACTIVITY DISORDER
 Anoxia  Common in boys
 Toxemia (pregnancy-induced hypertension)  Usually diagnosed before age 7
 Environmental factors  Problems:
 Severe RH incompatibility  Inattention
 Hyperactivity
Levels:  Impulsivity
Level IQ Implication
Mild/moron 51-70 o Difficulty adapting to school Causes: Intranatal factors

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Signs and Symptoms Causes:
 Obstinacy  Psychological factors
 Negativism  Parental factors (domineering parents)
 Egocentrism  Individual factors (conflict about growing up)
 Sociocultural factors
 Fighting syndrome
 Aggressiveness Anorexia Nervosa
 Tolerance is low  Main sign: Morbid fear of gaining weight
 Other signs:
 Difficulty concentrating  Sensitivity to cold temperatures
 Excessive talking  Amenorrhea
 Fidgeting  Deliberate self-starvation with weight loss
 Interrupt/intrudes on others
 Denial of hunger
 Child exhibits hyperactivity
 Obvious thinness but feels fat
 Indulges in destructive behavior  Lanugo all over the body
 Temper tantrums  Loss of scalp hair

Nursing Diagnosis Bulimia Nervosa

 Potential for injury  Extreme measures to lose weight
 uses diet pills, diuretics or laxatives
Principles of Nursing Care:  purges after eating
 Provide nutrition and safety  extreme exercise
 Environment:  Signs of purging
structured  swelling of the cheeks or jaw area
enable appropriate reaction to the environmental stimuli  cuts and calluses on the back of the hands and knuckles
 Plan a firm and consistent environment in which limits and standards are  teeth that look clear
set.  Peculiar signs
 depression
Drug of choice : Methylphenidate (Ritalin)  loss of interests in activities

DISORDERS COMMONLY DIAGNOSED TO ADULTS

EATING DISORDERS
 More common among females.

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  Remain with the client after meal and for 1st four hours
 Set limit on time allotted for eating
 Encourage client to express feelings
 Promote feeling of control by
 participation in treatment
 independent decision making

SEXUAL DISORDERS
 Sexuality - is the result of biologic, psychological, social and experimental
factors that mold an individual's sexual development, self-concept, body
image and behavior.

Phases of the Sexual Response Cycle

 Desire
 the ability, interest and willingness to receive sexual stimulation
Findings: (for both)  Excitement / Arousal
 Weight loss of 15% or more of original body weight  Result of psychological stimulation
 Amenorrhea  Example is fantasizing during the desire phase and foreplay which
 Social withdrawal and poor family and individual coping involves petting and fondling of erogenous zones or areas of the body
that are particularly sensitive to erotic stimulation.
 History of high activity and achievement in academics, athletics
 Plateau
 Electrolyte imbalance
 Orgasm
 Depression / distorted body image
 formerly termed as climax
 the shortest stage in the sexual response cycle
Nursing Diagnosis:
 occurs when stimulation proceeds through the plateau stage to a point
 Body image disturbance
where the body suddenly discharges accumulated sexual tension
 Ineffective individual coping  Resolution phase
 the final phase of sexual response
Nursing Interventions:  organs and body systems gradually return to the unaroused state
 Establish a trusting relationship
 Monitor vital signs
 Reinforce: Sexual Dysfunction Disorders
 dietician’s prescription to accomplish realistic weight gain  Sexual Desire Disorders: have little or no sexual desire or have an
 treatment plan that establishes privileges and restrictions based on aversion to sexual contact.
compliance
 Sexual Arousal Disorder: Individuals cannot complete the physiologic
 Decrease emphasis on foods, eating, weight loss or gain
requirements for sexual intercourse
 Weigh client daily at the same time

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 Examples  child is generally 13 years of age or younger
 Women cannot maintain lubrication Sadism inflicting pain
 Men cannot maintain an erection Telephone Scatalogia  Involves telephoning someone and making lewd,
 Orgasm Disorders: Inability to achieve orgasm phase obscene remarks or conversation.
Example: Premature ejaculation  AKA sex on phone
 Sexual Pain Disorders: Individuals suffer genital pain (dyspareunias) Transvestism sexual excitement through wearing the clothing of a
Example: Vaginismius woman
Urophilia urinating on the partner
Paraphilia (Sexual Deviation) Voyeurism Act of observing unsuspecting person who is naked, in
 A term which generally refers to abnormal sexual behavior the process of disrobing, or engaging in sexual activity
 Lasts for 6 months leading to distress or impairment to functioning. Includes cyber-voyeurism

Examples Gender Identity Disorder

 AKA Transexualism
Anilingus tongue brushing the anus  Believe that they were born as the wrong sex
Bestiality or Zoophilia contact with the animals  Leads to persistent discomfort and feels inappropriate in the role of the
Coprophilia smearing feces on the partner assigned sex.
Cunnillingus tongue brushing the vulva
Exhibitionism  Involves exposing one’s genitals to unsuspecting
strangers. Nursing Interventions:
Victims are usually women or children.  Attitude:
 They are stimulated by the effect of shocking the  Accepting
victim.  Empathic
Fellatio inserting the penis into the mouth  Non-judgmental
Fetishism inanimate / non-living objects or articles  Accept his feelings related to sexuality
Frotteurism  Touching or rubbing against the unsuspecting  Have a private area to discuss fears or concerns about sexuality
people.  Intervene to discuss self-esteem issues, anxiety, guilt, and empathy for
 Usually occurs in crowded places where escape is victims.
into the crowd is possible.  Employ limit setting.
Masochism  Sexual gratification from experiencing pain  Referral to the correct clinic.
 Involves the acts of being humiliated beaten,
restrained, or otherwise made to suffer
Necrophilia  involves the use of corpses SUBSTANCE-RELATED DISORDERS
Partialism  inserting the penis into the other parts of the body
Pedophilia  use of prepubertal children Alcoholism
 could be an actual sexual act or a fantasy

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 Is a chronic disease or a disorder characterized by excessive alcohol intake  Symptoms include:
and interference in the individual’s health, interpersonal relationship and  autonomic hyperactivity
economic functioning. (WHO)  grand mal seizures
 Considered to be present when there is .1% or 10 ml for every 1000 ml of  psychomotor agitation and anxiety
blood  increased hand tremors
 sleep disturbances (insomnia and nightmares)
Signs of use:  illusions hallucinations
 .1-.2% - low coordination  hyperthermia
 .2-.3% - presence of ataxia, tremors, irritability, stupor  tachycardia (impending delirium tremens)
 .3 and above - unconsciousness
Alcohol Withdrawal Delirium
Progression:  AKA delirium tremens
 Pre-alcoholic Phase - starts with social drinking; tolerance begins to  experienced within 24 to 72 hours after the last intake:
develop o agitation
 Prodromal Stage - alcohol becomes a need; blockout's occur; denial o elevated vital signs
begins to develop o illusions and hallucinations
 Crucial - cardinal symptoms of alcoholism develops (loss of control over o restlessness
drinking) o hyperalertness
 Chronic Phase - the person becomes intoxicated all day o incoherent speech
 serious medical complications may occur if the client is left untreated

Outcome:
 Brain damage Korsakoff's Psychosis
 Alcoholic hallucinosis  Is a form of amnesia
 Death  characterized
 short-term memory loss
 Disorientation
Behavioral problems:  inability to learn new skills
 Denial  confabulation
 Dependency  Deficiency in vitamin B complex, especially B1 and B12.
 Demanding
 Destructive Wernicke's Encephalopathy
 Domineering  An inflammatory hemorrhagic degenerative condition of the brain
 caused by B1 deficiency
Alcohol Withdrawal  Symptoms include:
 Occurs when an individual abruptly stops drinking after alcohol has become  double vision
a necessity of life to maintain functioning.  involuntary and rapid eye movements

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  lack of muscular coordination  cocaine psychosis
 decreased mental function  agitation
 dilation of the pupils
Nursing Diagnosis: Ineffective individual coping  diaphoresis
 increase VS
Principles of Nursing Care:  Classic sign: Perforated nasal septum
 Well lighted room  Can cause a sudden heart attack even in healthy young people.
 Diet as tolerated
 Monitor vital signs Cannabis-Related Disorders (Cannabinoids)
 Administration of glucose
 Vitamins Marijuana
 Can act as stimulant or depressant and is often considered to be a mild
hallucinogen with some sedative properties
Alcohol Detoxification:  Is not physically addicting but may lead to psychological dependence
 Drug of Choice: Disulfiram (Antabuse) - delays the metabolism of alcohol  Plant : cannabis sativa
 Avoid alcohol-containing products  Active component is Tetrahydocannabinol
 3 S’s of detoxification:  Routes of use:
 Safety  Orally (capsules, tablets, on sugar cubes)
 Sedation  With food
 Supplement (Multivitamins, Vitamin B-complex, Vitamin C)  Smoked in a pipe or rolled as cigarette.
 Acts within 15 minutes
 Effects lasts approximately 2 to 4 hours
DRUG-RELATED DISORDERS  Physiologic symptoms include
 increased appetite
Cocaine-Related Disorders  excitement
(Stimulants)  drowsiness
 Cocaine is a white powdered stimulant substance  lowered body temperature
 Usually sniffed, snorted, smoked in a pipe or injected into a vein or  depression
subcutaneous tissue.  unsteady gait
 Poor man’s cocaine:  reduced coordination and reflexes
 Shabu (sha-boo)  inability to think clearly
 impaired judgment
 Signs of use:  Classic sign: bloodshot eyes
 panic attacks
 insomnia  In large doses, it may cause:
 loss of appetite  Hallucination
 impaired thinking  Suicidal ideations

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  Delusions of invulnerability Prognosis: Poor
Defense Mechanism:
Long-term Goals: Regression
 Community resources Paranoid Hallucinations  Priority: safety of others
 Other coping means aside from denial Ideas of reference  Deal with the HID
 Personal responsibility for not drinking / drugs taking Delusion of persecution  Offer sealed foods /
 Isolation Suspiciousness unopened medicines
 Nutrition  Never displace outbursts of
 Group therapy Prognosis: Good emotions
Defense Mechanism:  Explain procedures in
Projection simple ways
SCHIZOPHRENIA AND OTHER PSYCHOSES  Never argue with the patient

SCHIZOPHRENIA Catatonic Wax flexibility  Priority: nutrition &

 Is a serious psychiatric disorder Stupor circulation
 One of the most profound disabling illness Negativism – mutism, rigidity,  Provide distraction
lack of response  Encourage activity
 Not a single disease entity but a combination of disorders
 "split mind"
Prognosis: Good
 characterized by: Defense Mechanism:
o impaired communication Repression
o loss of contact into reality
o deterioration from a previous level of functioning
 Nursing Diagnosis: Altered thought process Undifferentiated
 Most acceptable theory: Biologic Theory  Patients whose manifestation cannot be easily fitted into one or the
other type
Manifestations: Eugene Bleuler Residual
 Associative looseness  Patients with minimal symptoms
 Autism
 Apathy
 Ambivalence General Nursing Interventions:
 Auditory hallucination  Establish:
 a trusting relationship and provide acceptance
Types Distinguishing features Nursing Interventions  a clear, consistent and open communication
Disorganized Peculiar / bizarre behavior  Assist with ADL  Set limits
Incoherence  Encourage activity  Decrease environmental stimuli
Stereotyping  Present reality  Observe for suicidal ideation
 Administer medications, as ordered.

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  Exhibit flight of ideas
MOOD DISORDERS  Decreased need for help
 Distractibility
Precipitating Factors
 Loss of a loved one Summary:
 Major life events Mania Depression
 Role strain Appearance Elated Sad
 Decreased coping resources DM Projection Introjection
 Physiological changes Attitude therapies Matter of fact Kind firmness
Activity Non-stimulating Monotonous
Common Types of Mood Disorder Never give anything that
 Bipolar I Disorder: May experience one or more of symptoms of manic requires attention
episode Priority NDx Risk for injury: Risk for injury: self-
 Bipolar II Disorder: May experience one or more symptoms of major Directed at others directed
depressive episode with hypomania Nursing Individual therapies Group therapy
 Major Depressive Disorder: May be coded as mild, moderate or severe Management Lithium Antidepressants
with or without psychotic features. Diet ECT
 Dysthymic Disorder
 Lesser severe than major depression Suicide
 No symptoms such as impaired communication, delusions and  thought or act of taking one’s own life
hallucinations  ultimate form of self-destruction
 Cyclothymic Disorder  "cry for help“
 DNOS (Depression Not Otherwise Specified) - lasts for 2 days-2 weeks  reunion wish or fantasy
 progressive failure to adapt feelings of anger or hostility
Clinical Symptoms of Major Depressive Episode
 a way to end feelings of hopelessness and helplessness
 Affect flat
 an attempt "to save face" or seek a release to a better life
 Weight change (gain or loss)
 Energy loss Risk Factors
 Sad feelings / Social withdrawal  Sex (more female attempts suicide but more male commits suicide)
 Obvious sleep disturbances  Unsuccessful previous attempt
 Memory loss  Identification with a dead family member
 Emotional blunting  Chronic
 Illness (e.g. Cancer)
Clinical Symptoms of Manic Episode
 Depression/Dependent personality
 Talkative or pressured to keep talking
 Age (18-25 and 40)/Alcoholism)
 Inflated self-esteem or grandiosity
 Lethality of previous attempt/Looses
 Psychomotor agitation

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  Always reorient the client (clock & calendar)
Nursing Diagnosis: Risk for injury-Self directed  Use color instead of numbers & letters
 Consistency – 1 nurse to lessen confusion
Nursing care:
 Safe environment CONCEPTS ON DEATH AND DYING
 Always take overt or covert threats or attempts
seriously DEATH/D YING: Elizabeth Kubler-Ross
 Ventilation of feelings Stages:
 Encourage activities Denial - "NO NOT ME"
Anger - "WHY ME"
 Monitor closely (one-on-one, 24/7) Bargaining - "IF ONLY"
 Empathy (show acceptance & appreciation) Depression - stage of silence
Acceptance - "Yes, it's me"
CONDITIONS COMMONLY DIAGNOSED IN THE ELDERLY
Nursing Diagnosis: Ineffective individual coping
Alzheimer’s Disease
A chronic, progressive degenerative cognitive disorder. Nursing Care:
Marked by Dementia  Be physically present
Main Pathology: presence of senile plaques - destroys neurons (decreased  Be non-judgmental
acethylcholline)  Encourage verbalization of feelings
 Allow the patient to cry
 Recognize your own thoughts about death and dying
Signs and Symptoms:
 Aphasia – deterioration of language function
 Apraxia – impaired motor function
 Agnosia – inability to recognize objects / people
 Executive functioning - loss of abstract thinking

3 PHASES:
 Forgetfulness - difficulty of remembering appointments
 Advance - difficulty of remembering past events but not recent events
 Terminal - death occurs in 1 year

Nursing Diagnosis: Altered thought processes

Nursing Care:
 Priority: safety & security

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 ---END---

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