BASIC CONCEPTS IN PSYCHIATRIC NURSING MENTAL HEALTH ‡ Balance in a persons¶ internal life and adaptation to reality.

‡ A state of well being in which a person is able to realize his potentials. Characteristics : ‡ attitude of self-acceptance ‡ growth, development and self-actualization ‡ integrative capacity ‡ autonomous behavior ‡ perception of reality ‡ environmental mastery

MENTAL ILLNESS ‡ A state of imbalance characterized by a disturbance in a persons¶ thoughts, feelings and behavior. ‡ Poverty abd abuses are major factors which increases the risk of mental illness in the home. PSYCHIATRIC NURSING ‡ Interpersonal process whereby the professional nurse practitioner through the use of self, assist an individual family, group or community to promote mental health, to prevent mental illness and suffering, to participate in the treatment and rehabilitation of the mentally ill and if necessary to find meaning in these experiences. ‡ It is both Science and an Art. 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. ‡ The therapeutic use of self is considered as the art of psychiatric nursing. Core of Psychiatric Nursing. ‡ The interpersonal process, that is, the human to human relationship, is the core of psychiatric nursing. Clientele in Psychiatric Nursing. ‡ The individual, family, and the community, both mentally healthy and mentally ill. Mental Hygiene. ‡ It is the science that deals with measures to promote mental health, prevent mental illness and suffering and facilitate rehabilitation.

It is the positive use of one¶s self in the process of therapy.THERAPEUTIC USE OF SELF SERVES AS THE NURSES¶ MAIN TOOL.It requires self-awareness. .THERAPEUTIC USE OF SELF . BASIS OF THERAPEUTIC USE OF SELF JOHARIS WINDOW Known to self Known to others Not known to others Public self I Private self III Not known to self Semi-public self II Area of the unknown IV . CORE CONCEPT .

METHODS USE TO INCREASE SELF AWARENESS ‡ ‡ ‡ ‡ INTROSPECTION DISCUSSION ENLARGING ONE¶S EXPERIENCE ROLE PLAY CORE CONCEPTS ON THE CARE OF PSYCHOTIC PATIENT. . Disturbances in perception: Illusion ± misperception of an actual external stimuli. 2. Circumstantiality ± over inclusion of details. Disturbances in thinking: Neologism ± pathological coining of new words. Hallucination ± false sensory perception in the absence of external stimuli. Word salad ± incoherent mixture of words and phrases. Verbigeration ± meaningless reception of words or phrases. Perseveration ± persistence of a response to a previous question. COMMON BEHAVIORAL SIGNS AND SYMPTOMS 1.

Clang association ± the sound of the words gives direction to the flow of thought. Disturbances of affect. 3. Inappropriate affect ± disharmony between the stimuli and the emotional reaction. Ambivalence ± presence of two opposing feelings. Looseness of association ± shifting of a topic from one subject to another in a completely unrelated way. Depersonalization ± feeling of strangeness towards one¶s self Derealization ± feeling of strangeness towards the environment . Blunted affect ± severe reduction in emotional reaction.Echolalia ± pathological repetition of words of others. Flight of ideas ± shifting of one topic form one subject to another in a somewhat related way. Apathy ± dulled emotional tone. Delusion ±false belief which is inconsistent with one¶s knowledge and culture and cannot be corrected by reasons. Flat affect ± absence or near absence of emotional reaction.

Disturbances in motor activity Echopraxia ± the pathological imitation of posture/action of others. Anterograde amnesia ± loss memory of the immediate past. Confabulation ± filling in memory gap. Jamais vu ± feeling of not having been to a place which one has visited. Amnesia ± inability to recall past events. . Retrograde amnesia ± loss of memory of the distant past. Déjà vu ± feeling of having been to place which one has not yet visited. 5.4. Waxy flexibility ± maintaining the desired position for long periods of time without discomfort. Disturbances in memory.

‡ Receiver ± recipient of information. ‡ Context ± the setting of communication.CORE CONCEPTS ON THERAPEUTIC COMMUNICATION. Communication ± refers to the reciprocal exchange of ideas between or among persons. Elements of Communication: ‡ Sender ± originator of information. ‡ Message ± information being transmitted. ‡ Channel ± mode of communication. Criteria of successful communication: ‡ Feedback ‡ Appropriateness ‡ Flexibility ‡ Efficiency . ‡ Feedback ± return response.

Example: ³I noticed that you combed your hair today.Giving information: responding with the needed facts. ‡ Incongruent communication. . Common techniques in communication To initiate conversation: .´ To establish rapport and build trust .Use of silence: refraining from sppech to give the patient a time to sort out thoughts and feelings. . Example: ³Is there anything that you want to talk about?´ .Common problems in communication ‡ Dysfunctional communication ‡ Double blind communication ‡ Differences between the denotative and connotative meaning.Giving recognition: focusing on the positive aspects of the patients personality.Giving broad openiong: giving the patient an opportunity to set the direction of the conversation.

Focusing: assisting a patient to explore a specific topic.Relflecting: directing back ideas.Restating: repeating what the patient had said.´ .Validating: confirming one¶s observation. Perhaps if we talk about it. Example: ³You feel tense when you fight. it will help you to decide. Example: ³Are you saying that«´ .Summarizing: developing a concise resume of what has transpired . feelings and content.´ . Example: Patient: ³I can¶t decide about«´ Nurse: ³Let¶s talk about that.To gather information . .

NURSE PATIENT RELATIONSHIP . time limited and professional.Series of interaction between the nurse and patient in which the nurse assist the patient to attain positive behavioral change. focused on the needs of the patient. BASIC ELEMENTS Trust Rapport Unconditional positive regard Setting limits Therapeutic communication PHASES A. planned. . PRE-INTERACTION PHASE ‡ Begins when the nurse is assigned to a patient. CHARACTERISTICS ‡ It is goal directed.

develop trust. ORIENTATION PHASE ‡ Begins when the nurse and the patients interacts for the first time ‡ Parameters of the relationship are laid ‡ Nurse begins to know about the patient ‡ Major task of the nurse: develop a mutually acceptable contract ‡ Determine why the patient sought help ‡ Establish rapport. planning for first interaction B.‡ Phase of NPR in which the patient is excluded as an active participant ‡ Nurse feels certain degree of anxiety ‡ Includes all of what the nurse thinks and does before interacting with the patient ‡ Major task of the nurse: develop self awareness ‡ Data gathering. WORKING PHASE ‡ It is highly individualized ‡ More structured than the orientation phase ‡ The longest and most productive phase of the NPR . assessment C.

TERMINATION PHASE ‡ It is a gradual weaning process ‡ It is a mutual agreement ‡ It involves feelings of anxiety ‡ It should be recognized in the orientation phase ‡ Major task: to assist the patient to review what he has learned and transfer his learning to his relationship with others ‡ Evaluation When to Terminate? ‡ When goals have been accomplished ‡ When the patient is emotionally stable ‡ When the patient exhibits greater independence ‡ When the patient able to cope with anxiety separation.‡ Limit setting is employed ‡ Major task: Identification and resolution of the patient¶s problems ‡ Planning and implementation D. fear and loss .

‡ The nurse should focus on the patient¶s behavior non-judgmentally. while assisting the patient to learn more adaptive ways of coping .How to Terminate? ‡ Gradually decreased interaction time ‡ Focus on future oriented topics ‡ Encourage expression of feelings ‡ Make the necessary referral COMMON PROBLEMS AFFECTING COMMUNICATION ‡ Transference ± the development of an emotional attitude of the patient either positive or negative towards the nurse ‡ Resistance ± development of ambivalent feeling towards selfexploration ‡ Counter transference ± transference as experienced by the nurse PRINCIPLES OF CARE IN PSYCHIATRIC SETTINGS ‡ The nurse views the patient as a Holistic human being with interdependent and interrelated needs ‡ The nurse accepts the patient as a unique human being with inherent value and worth exactly as he is.

‡ The nurse should explore the patient¶s behavior for the need it is designed to meet and the message it is communicating ‡ The nurse has the potential for establishing a nurse-patient relationship with most if not all patients ‡ The quality of the nurse-patient relationship determines the degree of change that can occur in the patient¶s behavior. Case finding 2. LEVELS OF INTERVENTIONS IN PSYCHIATRIC NURSING ‡ Primary ± interventions aimed at the promotion of mental health and lowering the rate of cases by altering the stressors Examples: Health education Information dissemination Counseling ‡ Secondary ± Intervention that limit the severity of a disorder Two components 1. Prompt treatment Examples: Crisis intervention Administration of medications .

Prevention of complication 2. Active program of rehabilitation Examples: Alcoholic anonymous Occupational therapy CHARACTERISTICS OF A PSYCHIATRIC NURSE ‡ Empathy ± the ability to see beyond outward behavior and sense accurately another persons¶ inner experiencing ‡ Genuineness/Congruence ± ability to use therapeutic tools appropriately ‡ Unconditional positive regard ± RESPECT ROLES OF THE NURSE IN PSYCHIATRIC SETTINGS ‡ Ward manager ± creates a therapeutic environment ‡ Socializing agent ± assists the patient to feel comfortable with others ‡ Counselor ± listens to the patient¶s verbalizations ‡ Parent surrogate ± assists the patient in the performance of activities of daily lining .Tertiary ± interventions aimed at reducing the disability after a disorder Two components 1.

H ± ow will you know if the medicaiton is effective. What is your assessment parameters in monitoring the effects of the drug. .‡ Patient advocate ± enables the patient and his relatives to know their rights and responsibilities ‡ Teacher ± assists the patient to learn more adaptive ways of coping ‡ Technician ± facilitates the performance of nursing procedures ‡ Therapist ± explores the patient¶s needs. problems and concerns through varied therapeutic means ‡ Reality base ± enables the patient to distinguish objective reality and subjective reality ‡ Healthy role model ± acts as a symbol of health by serving as an example of healthful livings BASIC CONCEPTS ON PSYCHOPHARMACOLOGY C ± heck why the medication is given and know the classification of the drug. In other words you should know the purpose why the medication is given.

C ± lient teaching tips. and some on an empty stomach.E ± xactly what tome should the medication be given. Other drugs may also be taken without regard to meals. Major tranquilizers/antipsychotic/neuroleptics Common indication : Schizophrenia Examples: Haloperidol (Haldol) Prochlorperazine (Compazine) Fluphenazine (Prolixin) Chlorpromazine (Thorazine) Clozapine (Clozaril) Olanzapine (Zyprexa) . You should be able to give instructions related to the therapeutic and side effects of the drug. You should be able to identify interventions to counteract the adverse/side effects of the drug. some after meals. You should know all of these. Psychopharmacolgic agents A. What would you tell your patient to expect. K ± eys to giving it safely. Some drugs are best taken with meals.

check the CBC. ANTICHOLINERGIC DRUGS Examples: Trihexylphenidyl (Artane) Biperiden Hydrochloride (Akineton) Benztropine Mesylate (Cogentin) Diphenhydramine Hydrochloride (Benadryl) .C ² Antipsychotic H ² Decreased delusions. K ² check the BP. hallucinations. and looseness of association E ± Best taken after meals C ² Report sorethroat and avoid exposure to sunlight. Report elevated temp. it indicate Neurologic Malignant Syndrome. drygs cause leukopenia B. the drug causes hypotension. Anti-parkinsonian drugs Indication: EPS (Extrapyramidal Syndrome) Two Types: 1. and muscle rigidity. DOPAMINERGIC DRUGS Examples: Amantadine (Symmetrel) Levodopa Levodopa-Carbidopa (Sinemet) 2. Observe for EPS.

adequate sleep E ± Best taken before meals. given as muscle relaxant to patient¶s in traction H ± Decreased anxiety. decreased pill-rolling tremors E ± Best taken after meals C ± Avoid driving. since it alters the effect of drug K ± Administer it separately.C ± Antiparkinsonian drug H ± Muscles become less stiff. Minor Tranquilizers/Anxiolytics Common indication: Anxiety disorders Examples: Diazepam (Valium) Oxazepam (Serax) Chlodiazepoxide (Librium) Chlorazepate Dipotassium (Tranxene) Alprazolam (Xanax) C ± Antianxiety. food in the stomach delays absorption C ± Avoid driving. the drug may cause hypotension C. the drug causes blurred vision K ± Check the BP. it is incompatible with any drug . intake of alcohol and caffeine containing foods.

D. adequate sleep E ± Best taken after meals . it causes hypotension. Check the heart rate. prevents the reuptake of norepinephrine H ± Increased appetite. Antidepressant MAO inhibitors Examples: Tranylcypromine (Parnate) Phenelzine (Nadril) Isocarboxazid (Marplan) C ± Antidepressant MAO inhibitors H ± Increased appetite. Tricyclic Antidepressants Examples: Imipramine Hydrochloride (Tofranil) Amitriptyline (Elavil) C ± Tricyclic anti-depressant. it causes cardiac arrythmias E. adequate sleep E ± Best given after meals C ± Therapeutic effects may become evident only after 2 ± 3 weeks of intake K ± Check BP.

C ± Report headache. There shoulb be at least a two week interval when shifting from one antidepressant to another F. avoid tyramine containing foods like: Avocado Banana Cheddar and aged cheese Soy sauce and preserved foods It takes 2 ± 3 weeks before initial therapeutic effects become noticeable K ± Monitor BP. Anti ² Manic agent Lithium Carbonate C ± Anti. it indicates hypertensive crisis.Manic H ± Decreased hyperactivity E ± Best taken after meals C ± Increase fluid intake (3L / day) and sodium intake (3 gm / day) Avoid activities that increase perspiration K ± It takes 10 ± 14 days before therapeutic effect becomes evident Antipsychotic is administered during the first two weeks to manage the acute symptoms of mania until lithium takes effect. .

Cardiac problems. Retinal detachment. AND ABDOMINAL CRAMPS indicates Lithium Toxicity.Monitor serum level. Increased ICP. NAUSEA. Recent fracture. Mania.5 meq/L. normal is 0.5 ± 1. TB with history of hemorrhage. Voltage applied to the patient: 70 ± 150 volts Duration of application: 0. Consent needed prior to ECT: YES . Pregnancy. Mannitol is administered if toxicity occurs. DIARRHEA.5 ± 2 seconds Usual number of treatments to produce therapeutic effect: 6 ± 12 treatments Frequency of treatments: An interval of 48 hours for each treatment. Catatonic Schizophrenia Contraindication to ECT: Fever. Indications of effectiveness: Generalized tonic-clonic seizure Indication for ECT: Depression. ELECTRO-CONVULSIVE THERAPY Mechanism of action: Unclear at present. ANOREXIA VOMITING.

5 Different Steps 1. Appreciation of the works of the world 5. Climate of acceptance 2. . COMMON PSYCHOTHERAPEUTIC INTERVENTIONS ‡ REMOTIVATION THERAPY ± treatment modalitythat promotes expression of feeling through interaction facilitated by discussion of neutral topics. expression of feelings and outlet of tension. Creating of bridge of reality 3. Apnea. Headache. Fracture. Respiratory depression. Climate of appreciation ‡ MUSIC THERAPY ± involves the use of music to facilitate relaxation. Sharing the world we live in 4.Medication prior to ECT ‡ Atropine Sulfate ± to decrease secretions ‡ Anectine (Succinylcholine) ± to promote muscle relaxation ‡ Methohexital Sodium (Brevital) ± serve as an anesthetic agent COMMON COMPLICATION: Loss of memory.

‡ FAMILY THERAPY ± a method of psychotherapy which focuses on the total family as an interactional system. . ‡ MILIEU THERAPY ± consists of treatment by means of controlled modification of the patients environment to facilitate positive behavioral change. develop insight and improve behavior in relation with others. to facilitate identification of the patient¶s defenses. ‡ HYPNOTHERAPY ± a therapeutic modality which involves various methods and techniques to includes a trance state where the patient becomes submissive to instructions. increase self-esteem.‡ PLAY THERAPY ± treatment modality which enables the patient to experience intense emotion in a safe environment with the use of play. ‡ PSYCHOANALYSIS ± a method of psychotherapy which focuses on the exploration of the unconscious. The minimum number of members in a group therapy is 3. ‡ GROUP THERAPY ± treatment modality involving therapeutic interactions of three or more patients with a therapist to relieve emotional difficulties. ‡ HUMOR THERAPY ± involves the use of humor to facilitate expression of feelings and to enhance interaction. while the ideal number is 8 ± 10.

‡ TOKEN-ECONOMY ± an example of behavior modification technique which utilizes the principle of rewarding desired behavior to facilitate change. ‡ AVERSION THERAPY ± an example of behavior modification in which a painful stimulus is introduced to bring about an avoidance of another stimulus with the end view of facilitating change in behavior. until the undesirable behavior disappears or is lessened. ‡ DESENSITIZATION ± periodic exposure of the individual to a feared object. The main focus of cognitive therapy is depressive disorders . ‡ COGNITIVE THERAPY ± short term structured therapy between the patient and the therapist oriented towards present problems and solutions.‡ BEHAVIOR MODIFICATION ± a therapeutic intervention involving the application of learning principles in order to change maladaptive behavior.

PHASES OF BWS ‡ Tension building phase involves minor battering incidents ‡ Acute battering incident more serious form of battering ‡ Aftermath/honeymoon stage the husband becomes loving and gives the wife hope PRIORITY CARE OF THE BATTERED WIFE ‡ Provision of shelter . ‡ The most common trait of abusive men is low self-esteem. ‡ The most common trait of the abused women is dependence. CHARACTERISTICS OF ABUSIVE HUSBANDS ‡ They usually come from violent family. ‡ They have a strong feeling of inadequacy. dependent and non-assertive. humiliation and other forms of aggression.BATTERED WIFE SYNDROME (BWS) ‡ Cycle of domestic violence characterized by wife beating by the husband. ‡ They are immature.

Child abandonment 2. SEXUAL ABUSE ‡ Abuse in the form of unwanted sexual contact . NEGLECT ‡ Lack of provision of those things which are necessary for the child¶s growth and development 2 COMPONENTS 1.CHILD ABUSE ‡ Abuse ± is what happens when an older adult takes advantage of his authority over a younger child. VIOLENCE ‡ Refers to the use of force. Child neglect PHYSICAL ABUSE ‡ Abuse in the form of inflicting pain EMOTIONAL ABUSE ‡ Abuse in the form of insults and undermining one¶s confidence.

‡ Report cases to the barangay officers. No reaction D ² epression E ² xcessive knowledge of sex S ² elf esteem is low PRIORITY IN CHILD ABUSE ‡ R. ‡ They are emotionally immature ‡ They have negative attitude towards the management of the abused INDICATORS OF CHILD ABUSE S ² erious injuries in various stages of healing H ² ealthy hair in various length A ² pathy.A. police within 48 hours. DSWD personnel. the anti child abuse law requires reporting of suspected cases to authorities.CHARACTERISTICS OF ABUSIVE PARENTS ‡ They come from violent family ‡ They were also abused by their parents ‡ They have inadequate parenting skills ‡ They are socially isolated because they don¶t trust anyone. 7610. .

FAMILY STUDIES ‡ Anxiety can run in families. causes anxiety.ANXIETY ‡ Vague sense of impending doom ‡ subjective emotional response to stress. INTERPERSONAL THEORY ‡ Cause of anxiety is fear of interpersonal rejection BEHAVIORAL THEORY ‡ Anxiety is a product of frustration. CONFLICT THEORY ‡ Presence of two opposing drives. BIOLOGIC THEORY ‡ Anxiety may accompany physical and physiological ailments. . LEARNING THEORY ‡ Exposure to early life fearful experiences causes anxiety. ETIOLOGY PSYCHOANALYTIC THEORY ‡ Anxiety is caused by a conflict between the Id and the Superego.

DELIRIUM AND DEMENTIA DELIRIUM ‡ DEMENTIA Loss/impiarment of memory Chronic Exclusive in the elderly Clear sensorium Irreversible Poor prognosis Disorientation ‡ Acute ‡Involves young and old ‡ Clouded sensorium ‡ Reversible ‡ Good prognosis .

Common signs and sypmtoms Aphasia ± inability to talk Agnosia ± inability to recognize objects Apraxia ± inability to perform ADL Amnesia / Memory loss / Mnemonic disturbance 3 Phases Forgetfulness phase ± difficulty of remembering appoinments Advance phase ± difficulty of remembering past events but not recent events Terminal phase ± death occurs in 1 year. Main Pathology ‡ presence of senile plaques that destroys neurons leading to decreased acetylcholine.Alzheimer·s Disease ‡ a type of dementia that frequently affects the elderly. Priority Nursing Diagnosis Altered thought processes Primary need of the patient Reorientation .

2% (low coordination) ‡ .2 -.1% or 10 ml for every 1000 ml of blood. 3% (presence of ataxia. stupor ‡ .1 ± . tremors.3 and above (unconsciousness) Etiological theories Psychoanalytic theory . . irritability.due to a learned behavior Biological theory . What happens at level? ‡ .due to effects of mass media.ALCOHOLISM ‡ WHO defines alcoholism as a chronic disease or a disorder characterized by excessive intake and interference in the individuals health. interpersonal relationship and economic functioning. ‡ Considered to be present when there is .due to fixation in the oral stage Learning theory .due to inherited traits Socio-cultural theory .

visual and tactile ‡ Increased vital signs ‡ Tremors ‡ Sweating and Seizure . denial begins to develop Crucial phase ± Cardinal symptoms of alcoholism develops (loss of control over drinking) Chronic phase ± the person becomes intoxicated all day. Outcomes of alcoholism ‡ Brain damage ‡ Alcoholic hallucinosis ‡ Death Common behavioral problems ‡ Denial ‡ Dependency ‡ Demanding ‡ Destructive ‡ Domineering Withdrawl signs and symptoms ‡ Halucinations. blackout¶s occur.Phases of progression of alcoholism Pre-alcoholic phase ± starts with social drinking Prodromal phase ± alcohol becomes a need.

Common defense mechanism ‡ Denial ‡ Rationalization ‡ Isolation ‡ Projection .

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