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CHARACTERISTICS
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Science in Psychiatric Nursing.
 the use of different theories
in the practice of nursing,
serves as the science of
psychiatric nursing.

Art in Psychiatric Nursing.


 =he therapeutic use of self is
considered as the art of
psychiatric nursing.

   
‰ ët is the science that deals with
measures to promote mental
health, prevent mental illness
and suffering and facilitate
rehabilitation.
CORE CONCEPT
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Gestalt therapy v| 
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Examples of Cognitive technique

1. Cognitive restructuring ± teaching the


client maladaptive thoughts through
positive self-statements and refuting
irrational beliefs.
2. Thought s stopping ± the client is
taught to consciously to say ³stop´ to
maladaptive thoughts.
|SYCHOBIOLOGY
- ës the scientific study of the
relationships among the structure
and function of the brain,
biochemical and hormonal
processes, genetics, environmental
experiences, and human behavior
Neuroanatomy and Behavior
1. Frontal lobe ± is responsible for higher
order thinking, abstract reasoning,
decision ±making, speech, and voluntary
muscle movements. Dysfunction is
associated with illogical and psychotic
thinking, uninhibite behaviors and
incoherent speech.
2. Occipital lobe ± is responsible for visual
function. Dysfunction is associated with
illusions and visual hallucinations.
X. Temporal lobe ± is responsible for
judgment, memory, smell, sensory
interpretation, and understanding
sound. Dysfunction is associated
with aggressive and violent
behaviors, olfatory and auditory
hallucinations and language
abnormalities.
Diencephalon ± is embedded in the cerebrum
is superior to the brain stem. ët is composed
of several structures:
1. Hypothalamus ± is the main visceral
control center of the body and is vitally
important to homeostasis. ët regulates the
autonomic nervous system, body
temperature, food intake, water balance,
biologic rhythms and drives, and
hormonal output of the anterior pituitary
gland
2. Thalamus ± receives and relays sensory
information and plays a role in memory
and in regulating mood.

X. Limbic system ± comprises the limbic


lobe and the numerous structures
functioning with it, including the frontal
cortex, hypothalamus, amygdala,
hippocampus, brain stem, and
autonomic nervous system. Called the
emotional brain the limbic system
emotional responses
Neurotransmitters and receptor sites
r. Neurotransmitters are chemical
messengers that carry an inhibitory or
stimulating message from one neuron to
another across the space between these
(synapse). Many psychiatric disorders are
associated with abnormal interactions
between neurotransmitter system.
‰ Serotonin ± is involved in depressive and
anxiety disorders, and possibly in eating
disorders. Many antidepressants increase
levels of serotonin at synaapses.
‰ Dopamine ± is involved in schizophrenic
disorders. Many antipsychotic drugs block
dopamine at the post synapse to prevent it
from binding to its receptors.
‰ Norepinephrine ± is a catecholamine
neurotransmitter of the symphatetic nervous
system, which mediates emergency response.
Changes in norepinephrine levels are
associated with depressive disorders,
including bipolar disorders.
‰ Gamma aminobutyric acid (GABA) ± is
an inhibitory neurotransmitter. Antianxiety
drugs increase effects of GABA.
‰ Acetylcholine ± is a major neurotransmitter
of the parasympathetic nervous system,
which controls muscles, memory, and
coordination. Changes in acetylcholine are
associated with Alzheimer disease
Hormonal Influence
‰ Hypothalamic-pituitary-adrenal axis (H|A)
has been found to be hyperactive in individuals
with depressive disorders.
‰ ïnderactive thyroiid gland ± is linked to
depression
‰ Stress response ± is a neuroendocrine
response, that causes significant release of
hormones, which affects multiple body
systems and can lead to psychological and
physiological symptoms.

Biology and Environment. Research is


ongoing about how an individual¶s affects
brain development and functioning.
‰ Early life experiences (e.g. psychological
and physical abuse) can alter brain
structure and affect production of hormones
and neurotransmitters, which can be related
to symptoms of mental disorders in later life.
‰ Seevere abuse in early life (e.g., physical
or sexual abuse in infancy and early
childhood) can permanently increase gene
expression for corticotropin-releasing factor
(CRF) and increase risk for depression in
adulthood
Úindling model proposes that repeated
environmental lead to progressively greater
nueral responsiveness, which changes brain
excitability and therefore behavioral
responses o, ver time (Post, r ). Example,
an early life experience can contribute to an
initial experience of mental illness, which is
hypothesized to increase sensitivity of the
brain and thus predispose to later episodes
of mental illness, given continued life
stressors.
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CRISISANDCRISIS
INTERVENTION

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COMMON BEHAVIORAL SIGNS
AND SYMPTOMS
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THERA|EïTIC RELATIONSHI|S
ët is a nurse-client interaction that is
directed toward enhancing the client¶s well
being. The client coul be an individual,
family or community.
Elements of the therapeutic relationships
1. Contract ± time, place, settings and the
purpose of the meetings as well as the
conditions for termination are established
between the nurse and the client.
2. Boundaries ± The therapeutic nature of
the relationships (as it differ from social
relationships) are established.
Roles of participants are clearly defined.
The nurse is considered as a professional
helper.
The client¶s needs and problems are the
main concern.
X. Confidentiality ± This is the basic
condition that the nurse should maintain in
the therapeutic relationships
The nurse shares client¶s information to
those who have a direct participation in the
client¶s care.
The nurse shall ask a written permission
from the client to share information to others
that is outside the health care team.
m. Therapeutic nurse behaviors ± Are
behaviors that a nurse must maintained
during the relationships and should be
consistent with the following:
˜elf-awareness
Unconditional positive regard (respect)
Empathy
Cultural sensitivity
Collaborative goal setting
responsible ethical practice
| 
|

 | 
à Begins when the nurse is
assigned to a patient.
à hase of  in which the
patient is excluded as an active
participant
à urse feels certain degree of
anxiety
à ëncludes all of what the nurse
thinks and does before interacting
with the patient
à Major task of the nurse: develop
self awareness
à Data gathering, planning for
first
interaction

j*   


 Begins when the nurse and the
patients interacts for the first
time
à arameters of the relationship
are laid
à urse begins to know about
the patient
à Major task of the nurse:
develop a mutually acceptable
contract
à Determine why the patient
sought help
à stablish rapport, develop
trust, assessment
  | 
à ët is highly individualized
à More structured than the
orientation phase
à =he longest and most
productive phase of the 
à imit setting is employed
à Major task: ëdentification and
resolution of the patient s
problems
à lanning and implementation
*    
‰ ët is a gradual weaning process
à ët is a mutual agreement
à ët involves feelings of anxiety
à ët should be recognized in the
orientation phase
à Major task: to assist the patient
to review what he has learned and
transfer his learning to his
relationship with others
‰ ' 


à When goals have been
accomplished
à When the patient is emotionally
stable
à When the patient exhibits
greater independence
à When the patient able to cope
with anxiety separation, fear and
loss
+ , -
‰ radually decreased interaction
time
à Focus on future oriented topics
à ncourage expression of feelings
à Make the necessary referral
BASIC ELEMENTS
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Criteria of successful communication:
$
  
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Nonverbal Aspects of therapeutic
Communication
‰ Úinetics are body movements, such as
postures, facial expressions, and
mannerisms
‰ Proxemics ± are the physical spaces
between communicators
- intimate space ± o to r inches
- r inches to 4 feet
- social space ± more than 4 feet to r
feet
- Public space ± more than r feet
‰ Touch ± can be use as therapeutic
communication provided that the nurse
should analyze the client¶s condition and the
client¶s likely response (should be use with
cautions). ˜pecially to clients who are
paranoid and mistrustful.
Common problems in
communication
à Dysfunctional
communication
à Double blind communication
à Differences between the
denotative and connotative
meaning.
à ëncongruent communication.
Common Techniques in
Communication
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To Establish Rapport and Build


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information
COMMON PROBLEMS AFFECTING
COMMUNICATION
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à rimary 6 interventions aimed at
the promotion of mental health
and lowering the rate of cases by
altering the stressors
xamples: Health education
ënformation dissemination
Counseling
econdary 6 ëntervention that
limit the severity of a disorder
=wo components
1. Case finding
2. rompt treatment
xamples: Crisis intervention
dministration of medications
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=àanquilizeà antip choticneuàoleptic
Common indication : chizophrenia
xamples:
$% &
"#$
Haloperidol (Haldol)
rochlorperazine (Compazine)
Fluphenazine (rolixin)
Chlorpromazine (=horazine)
'&"#$
Clozapine (Clozaril)
lanzapine (Zyprexa)
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Check the B, the drug causes
hypotension. bserve for ,
check the CBC, drug causes
leukopenia
=arget: Dopamine
j|(!%) !
ëndication:  (xtrapyramidal
yndrome)
=wo =ypes:
1. DMë ëC DU
x: mantadine (ymmetrel)
evodopa
evodopaÿCarbidopa (inemet)
´
 ð  
Î
x: =rihexylphenidyl HC
(rtane)
Biperiden Hydrochloride
(kineton)
Benztropine Mesylate (Cogentin)
Diphenhydramine Hydrochloride
(Benadryl)
à ntiparkinsonian drug
Muscles become less stiff;
decreased pillÿrolling tremors
à Best taken after meals
à void driving, the drug causes
blurred vision
à Check the B, the drug may
cause hypotension


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Common indication: nxiety D/
x: Diazepam (alium)
xazepam (erax)
Chlodiazepoxide (ibrium)
Chlorazepate Dipotassium
(=ranxene)
lprazolam (
anax)
à ntianxiety; given as muscle
relaxant to patient s in traction
à Decreased anxiety, adequate sleep
à Best taken before meals, food in
the stomach delays absorption
à void driving, intake of alcohol
and caffeine containing foods, since
it alters the effect of drug
à dminister it separately, it is
incompatible with any drug
Î
"$%#!!!
xamples: ëmipramine
Hydrochloride
(=ofranil)
mitriptyline (lavil)

à =ricyclic antiÿdepressant; prevents


the reuptake of norepinephrine
à ëncreased appetite; adequate sleep
à Best given after meals
à =herapeutic effects may become
evident only after 2 6 weeks of
intake
à Check B, it causes hypotension,
Check the heart rate, it causes cardiac
arrythmias, it also causes
constipation.
à=arget: orepinephrine
erotonin
%#!! 
-!
x: =ranylcypromine (arnate)
henelzine ( adril)
ësocarboxazid (Marplan)
à ntidepressant M
inhibitors
à ëncreased appetite; adequate
sleep
à Best taken after meals
à -   &   Y
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3 
.  
ithium Carbonate
à ntiÿ Manic
à Decreased hyperactivity
à Best taken after meals
à ëncrease fluid intake (  / day)
and sodium intake ( gm / day).
void activities that increase
perspiration
à ët takes 10 6 14 days before
therapeutic effect becomes evident.
ntipsychotic is administered during
the first two weeks to manage the
acute symptoms of mania until
lithium takes effect.
Monitor serum level, normal is 0.5 6
1.5 meq/, =herpeutic level is 0.8 6
1.2 meq/ U,

ë,Më=ë , W ,
DëH,  D BDMë 
CM indicates ithium =oxicity,
Mannitol is administered if toxicity
occurs.
C=ÿC Uë
=H
à Mechanism of action: Unclear at
present.
à oltage applied to the patient:
70 6 150 volts
à Duration of application: 0.5 6 2
seconds
à Usual number of treatments to
produce therapeutic effect: 6 6 12
treatments
à Frequency of treatments: n
interval of 48 hours for each
treatment.
à ëndications of effectiveness:
eneralized tonicÿclonic seizure
à ëndication for C=: Depression,
Mania, Catatonic chizophrenia
à Contraindication to C=: Fever,
ëncreased ëC, Cardiac problems,
=B with history of hemorrhage,
ecent fracture, etinal
detachment, regnancy.
à Consent needed prior to C=:

%#
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tropine ulfate 6 to decrease
secretions
nectine (uccinylcholine) 6 to
promote muscle relaxation
Methohexital odium (Brevital) 6
serve as an anesthetic agent
  |ð 
 2 oss
of memory, Headache, pnea,
Fracture (ong Bones), espiratory
depression.

  E`! E
E` E

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FMë =H 6 a method
of psychotherapy which focuses
on the total family as an
interactional system

àMëëU =H 6 consists of


treatment by means of controlled
modification of the patients
environment to facilitate positive
behavioral change.
àU =H 6
treatment modality involving
therapeutic interactions of
three or more patients with a
therapist to relieve emotional
difficulties, increase selfÿ
esteem, develop insight and
improve behavior in relation
with others. =he minimum
number of members in a group
therapy is , while the ideal
number is 8 6 10.
à CH  ë 6 a method of
psychotherapy which focuses on
the exploration of the
unconscious, to facilitate
identification of the patient s
defenses.
à H  =H 6 a
therapeutic modality which
involves various methods and
techniques to includes a trance
state where the patient becomes
submissive to instructions.
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!E ! !E `EL!E

`E`

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 is a vague feeling of
rea that is unwarrante  the
situation, with no ientifiale
stimulus, accompanie  feelings
of uneasiness an apprehension.
.
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