Milieu Management:

Helps patient recover from psychiatric and mental health problems

 The env’t should function to protect the pt from destructive influences
 It should maximize opportunities for patients to learn something about themselves and their
problems in daily living

Elements of the therapeutic Milieu:

 Safety
o Physical protections – safety from physical harm through the management of risks in the
env’t
o Body search
 Psychological protection
o Involves the nurses active intervention to prohibit verbal abuse ridicule or harassment
of patients
o Maintain client’s patience dignity and worth.
o No name calling.
 Structure
o Refers to the physical env’t, rules, and daily schedules of treatment activities
 Norms
o Specific expectations of behavior that permeate the treatment environment
o Guidelines and policies
o Helps in guiding their behavior
 Limiting Setting
o Reinforces the norm of making rules and expectations clear
o When the violate a rule, there is a sanction or consequence
o Negative reinforcement with violation of rules
 Loss of privileges
o Limit setting of the undesirable behavior of the client
 Balance
o Process of gradually allowing independent behaviors in a dependent situation
o Allowing independent behavior - Start to do things on their own with supervision

Psychopharmacologic Interventions
1. antipsychotics
2. antidepressants - tricyclic MAO, Selective Serotonin inhibitors, Atypical Anti-depressants
3. antimanic,
4. anti-convulsant, decrease hyperactivity
5. Anti-anxiety
Pharmacologic Treatment for Anxiety Related disorders
 Indicated for a short period of time, manage acute symptoms
 Anxiety is normal – when used as a response to psychological distress
 Pathologic when it comes a way of life
o Alters ADLs
o Occupational and Social responsibilities

Anxiety related Disorders:

1. General Anxiety Disorder - exist for 6 mos
2. Panic Disorder – spontaneous
3. Phobia – irrational fear
Obsessive Compulsive and related Disorder:
1. Piling up of anxiety = results to obsession
2. To Reduce anxiety, you do compulsion = paulit ulit gagawin
3. Hoarding behavior
4. Hair pulling, nail biting
Trauma and stress related disorder
1. PTSD
a. War veteran – highly anxious, very alert
b. Critical incidence stress debriefing
Various dissociative disorder: Went through traumatic events, affects personality and conciousness
1. Dissociative Amnesia = assume a new identy and personality
2. Multiple personalities
3. Personalization – detached from yourself
Somatic Symptom Illnesses: Anxiety is manifested in the body
1. Conversion Disorder
2. Illness Anxiety – aka hypochondriasis
a. Over interpretation of illnesses
3. Symptom Disorder
a. Involvement of several body system
4. Pain disorder
a. Masakit lahat sa katawan
Medications:
 Anti – Anxiety medications
o Elevate the GABA that brings about a calming effect
o Potentiate inhibitory effects of GABA – slows down transmission of impulse from neuron
to another
Manifestations:
 Relaxed – no muscle tension
  Normal and stable VS
Benzodiazepines:
 Diazepam

SE:
 CNS depressant – promote safety as it affects respi rate
 No stimulants – counter the effect of the drug
 No depressants – potentiate the effect of the drug
o Decrease deep tendon reflex – may lead to death
 Postural Hypotension
o Check the bp, if bp decreases by at least 20mmHg hold the drug
o Dahan dahan daw (slowly assume body positions)
 Lying down
 Sitting
 Standing
 Walking
Anticholinergic SE:
 Drying of the mouth
o Increase fluids
o Oral hygiene
o Sour candies
 Nausea
o Take with meals
 Blurring of Vision
o Promote safety
 Constipations
o Increase fiber and fluid intake
 Urinary retention
o Palpate the hypogastric are to differentiate distention from suppression

AE:
 Physical and Psychological dependence
o Take the meds for not more than 3 weeks
o If there is a need to stop taking it, there should be gradual withdrawal
o Tapered so that the body gets used to it
o Psychological dependence
 You want to continue taking to avoid withdrawal
 Tolerance – prolonged used, body gets to used to the amount
 Paradoxical Excitement
o Refer to the attending physician
o Opposite therapeutic effect, (cns dep becomes cns excitement)
 Alternative Medications (Serve as Maintenance meds)
o Tricyclic Antidepressants (TCA)
o Selective Serotonin Reuptake Inhibitors