NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*MIDWIFERY*MEDTECH

LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM

NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

HANDOUTS
PSYCHIATRIC NURSING
Prepared by: Prof. Archie D. ALviz, RN, RM, MAN

Elements of Therapeutic Relationship

T
R
U
S
T

Therapeutic Communication: Elements

1. Sender- the source of message
2. Message- the information transmitted
3. Receiver- recipient of message
4. Feedback- receiver’s response to the message

NON- VERBAL COMMUNICATION

1. Proxemics- the “physical space” between the sender and receiver
2. Kinetics- the body movements such as gestures, facial expressions and mannerisms
3. Touch- intimate physical contact
4. Silence
5. Paralanguage- “voice quality” (tone, inflection) or how a message is delivered

Verbal Communication

Offering self
Active listening
Exploring
Broad openings
Making observation
Summarizing
Encouraging description of perception
Presenting reality
Reflecting
Restating
General leads
Focusing

Spheres
ID
EGO
Superego
Defense mechanisms
• Repression
• Suppression
• Reaction formation
• Rationalization
• Projection
• Compensation
• Denial
• Displacement
• Regression
• Undoing
• Conversion
• Intellectualization
• Substitution
• Identification
• Introjection
• Sublimation

Crisis
• Maturational or developmental
• Situational
• Adventitious or social

Stages of death and dying

D
A
B
D
A

Disturbances of Appearance
• Automatism – repeated purposeless behaviors
• Psychomotor retardation – slowed movements
• Waxy flexibility – maintenance of awkward posture
• Echopraxia – purposeless imitation

Disturbances in Communication
• Mutism – negativism
• Circumstantiality – beating around the bush, with answer
• Tangentiality – do not arrive to the answer
• Stilted language – flowery
• Flight of ideas
• Loose association
• Perseveration
• Echolalia
• Palilalia
• Verbigeration
• Coprolalia
• Neologism
• Blocking – sudden cessation of thought
• Word salad
 • Clang association

Disturbances in Perception
• Delusions
• Magical thinking
• Paranoia – extreme suspiciousness
• Religiousity – obsession in religious ideas
• Phobia – irrational fear
• Obsession – persistent thought
• Preoccupation-idea with intense desire
• Compulsion – persistent action
• Though broadcasting – others know what I am thinking
• Delusions of reference

Levels of Anxiety
Mild
Moderate
Severe
Panic

Anxiety Related Disorders

Generalized anxiety disorder

- “worry worm”
- no apparent reason
- 6 months
- no phobias, panic attacks or OC manifestations
S/sx:
- palpitations
- Headache
- insomia
- chest pain
Management:
- assist in problem solving
- teach coping behaviors
- Benzodiazepines

Panic Disorder
-recurrent
-unpredictable
Panic attacks:
a. Trembling
b. Racing heart
c. Chest pain
d. DOB
e. Choking sensations
f. numbness
Management:
- assist in problem solving
- teach coping behaviors
DOC: Benzodiazepines
Other meds: Beta Blockers, MAOIs, SSRI
Anti-histamines – if with addiction to Benzo

PTSD
- manifestations more than 4 weeks after acute-stress disorder
- RECURRENT flashbacks of memories and images
- RE-EXPERIENCING OF TRAUMA
- defense mechanism: DISPLACEMENT
- FLASHBACK-recurrent intrusive thoughts
S/sx:
- starts with GENERAL NUMBING to SOMATIC SYMPTOMS:
a. Irritability
b. Aggressiveness
c. Depression
d. Anger
e. Social withdrawal

Management:
- assist in gaining control over angry impulses
DOC: Benzodiazepines
Other Meds: Beta blockers, anti-histamines