22108028 psychiatric nursing reviewer

8/8/2019 22108028 Psychiatric Nursing Reviewer

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A- affectB- behaviorC- communication

Alteration HOMEOSTATISP- perceptionP- personalityB- behaviorE- emotionsT- thought

AffectS- self-awarenessI- interpersonal relationship

R- reality presentation (+ affirmation)A- activities of daily living

A. MENTAL HEALTH- ability of the individual, family and community

to respond adaptively to the internal and externalstressors

B. POPULATION is at RISK to DEVELOP

1. Genetic predisposition2. Poor access to health care3. Poverty4. Misusing substances5. Undergoing lifestyle changes

Ex. : early pregnancy6. Victims of violence7. Elderly people

Ex.: dementia, delirium, alzheimers dse.

C. PSYCHIATRIC NURSING- interpersonal process between the nurse andpatient to promote and maintain optimum level

of functioning

D. CONCEPT of PSYCHIATRIC NURSINGPsychiatric Mental Health Nursing

8 Human Responses:1. activity2. cognitive level3. environment4. emotions5. interpersonal6. intrapersonal: talking to self; visual imaging7. own perception8. physiologic

Levels of Care1. PRIMARY

- altering risk factors to hinderdevelopment of mental illnessex:

a. client and family teachingb. stress reductionc. psychosocial support

2. SECONDARY- reducing the effects of mental illnessex:

a. psychiatric screening/evaluationb. crisis interventionc. suicide prevention: suicidal

ideationd. counselinge. emergency nursing care

3. TERTIARY- minimizing the long term residualeffects of mental illness

ex:a. rehabilitation programb. vocational trainingc. after care supportd. partial hospitalization

CONCEPTUAL FRAMEWORK of PSYCHCARE

- organizing and better understanding of

the psychiatric care- helps the nurse to make a rational

systematic approach of the nursing care

Classification:1. PSYCHODYNAMIC FRAMEWORK

- focuses on the conflict, anxiety anddefenses- process that makes the patient

conscious (dream analysis)- TRANSFERENCE ANALYSIS

- focuses on intrapsychicprocess

a. Psychosexual Stages- Freudb. 8 Developmental Stages- Ericksonc. Personality Dynamics-

psychoanalytic- topography/ iceberg of the

mind- components of personality

*ID, EGO, SUPEREGO- defense mechanism

2. BEHAVIORAL FRAMEWORK (Skinner)- focuses on learned behavior- person is shaped by own environment- behavior: REWARD and

PUNISHMENT- anxiety, behavioral problems*systematic desensitization

3. INTERPERSONAL FRAMEWORK (Sullivan)- personality development- result to interaction with significant

others- focus in interpersonal relationship

4. HUMANISTIC/EXISTENTIAL FRAMEWORK- focuses on human experiences


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- human beings are responsible for theirown behavior

- lack of self-awareness* GESTALT THERAPY

- patient is assisted by means of roleplaying to express feeling

5. BIOMEDICAL FRAMEWORK- focuses on the disease process or approach- brought about by

a. Neurotransmitter Theory- depression: serotonin mania: serotonin- dementia: dementia- depression: epinephrine; mania:

norepinephrine

TOPOGRAPHY of the MIND1. CONSCIOUS

- awake- part of the mind that functions during thinking- here and now; responds to self or I- memories or ideas can be recalled withoutexerting effort

2. SUBCONSCIOUS- stored in the mind but partially forgotten- ideas can be recalled but with exerting effort- tip-of-the-tongue experience

3. UNCONSCIOUS- largest part of the mind- gives greatest influence in the personality of

the person- serves as storehouse of all the memories- can be expressed by means of dreams, slip ofthe tongue, unexplained behavior, jokes or lapseof memories

COMPONENTS of PERSONALITY

1. ID- unconscious part of the person- focuses on biologic drives; primitive- part of the personality in which we are bornbecause it was developed during the infancystage of development

- PLEASURE PRINCIPLE* if id is dominant, it needs superego or conscience* disorders: Mania, Antisocial and Narcissism

2. EGO- REALITY PRINCIPLE- corresponds to self or I- integrator of the personality- mediator between the id and superego- develops during toddlerhood stage

* disorder: Schizophrenia (ego distortion)

3. SUPEREGO- conscience- MORALITY PRINCIPLE- with parental directions of censoring force

- develops during PRE-SCHOOL AGE

a. STRICT SUPEREGO- personality is rigid

- unhappyb. WEAK/DEFECTIVE SUPEREGO- guilt feeling

- antisocial behavior;* if superego is dominant, it needs the

id*disorder: Obsessive-Compulsive Disorder and

Anorexia NervosaAGE FREUD ERICKSON SULLIVAN PIAGET

0-18 mos. - ORAL

STAGE

- gratification

by means oftaking

everything in

- needs of

infants are

primarily

centered into

the lips,

mouth and

tongue

- ID is

dominant

*maternal

deprivation:

infant is not

given milk

- TRUST vs.

MISTRUST

- special or

significantperson:

Mother

- tolerates

small doses of

frustration

- need for

security

- Sensorimotor

- gradual

increase in the

ability to thinkand use

language

1 - 3

yrs.

- ANAL

STAGE

- gratification

throughelimination

and retention

of feces

- mother:

superego

- Ambivalence

- toilet

training: when

present, child

becomes OC

-

AUTONOMY

vs. SHAME &

DOUBT- principle of

struggling of

holding on

and letting go

- special

figure:

PARENTS

- develop self-

esteem

- Pre-

operational

- Pre-

conceptual- use of

symbols with

literal

interpretation

3-6 yrs. - PHALLIC

STAGE

- interest is

focused on

his/her own

body

- penis envy

- Oedipus or

ElectraComplex

- INITIATIVE

vs. GUILT

6-12 yrs.

12-18

yrs.

18-25

yrs.

25-45

yrs.

45 &

above

THERAPEUTIC COMMUNICATION- process in which the nurse consciously utilizes

the principle of communication in a goal-directed

framework

Best responses:1. here and now events2. more of the what than the why questions3. orientation and presentation of reality4. description rather than judging5. maintenance of biological integrity6. actual observation7. nursing intervention

8. sharing of information exploring alternatives


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NURSE-PATIENT REALTIONSHIP

Therapeutic vs. Social Relationship

Therapeutic Relationship- focuses on personal and emotional needs of

the client

Social Relationship- focuses on the needs and emotions of both the

nurse and patient

PHASES of NURSE-PATIENT INTERACTION

1. ORIENTATION PHASE- introduction and role definition- establishment of trust- clarify therapeutic parameters

a. Assessment- must be completed within 24 hours- set the contract with the client- start the establishment of discharge plan- brief but frequent interactions

2. WORKING PHASE- promotes problem-solving approach- discussion between the nurse and patient- nurse had established trust from the patient- patient is cooperative- nurse already teaches patient the new copingstrategies

3. TERMINATION PHASE- time of evaluation- nurse already start summarizing theaccomplishment and regrets

- called SOLIDIFICATION of SEPARATION- nurse says good bye- patient feels grief and anger towards the nurse- circumstance: SUICIDE due to anxiety

EGO DEFENSE MECHANISM- unconscious protective barriers that are used

to manage instinct and affect in facing difficult situations- except for the defense mechanism of

suppression (because its the only defense mechanismoperating in the conscious level)

Purpose:1. self security protection2. anxiety reduction3. mental conflict resolution4. increase self-esteem protection

A. REPRESSION

- involuntary; automatic; submerging of thepainful experiences- called UNCONSCIOUS FORGETTING- usually used by patients with CatatonicSchizophrenia

B. SUPPRESSION- also called extensional exclusion of forbiddenideas- called CONSCIOUS FORGETTING- ex: a rape victim consciously forgets theexperience

C. RECATION-FORMATION- assuring the attitude or behavior that oneconsciously regrets- usually used by manic patients

D. RATIONALIZATION- attempting to modify or justify the unacceptableneeds- always use the word because to maintain

self- respectE. UNDOING

- actual or symbolic attempt- erase previous experiences that cause the guilt

feelings- repair feelings that created the guilt feelings

F. PROJECTION- attributing ones own unacceptable behavior toothers- blames others- escape goat

G. COMPENSATION- attempting to make-up or off-set deficiencies

by means of developing other personal qualitiesH. INTELLECTUALIZATION

- overuse of intellectual concepts to avoid thereal or effective expressions of the feelings

I. IDENTIFICATION- attempting to pattern or resemble thepersonality of the admired person

J. CONVERSION- transforming an emotional problem into

physical signs and symptoms

Manifestations of MI

1. Alteration n Perceptiona. Hallucination

- false sensory perception- involve any of the 5 senses

a.1. Auditory- command hallucination- (Schizophrenia)

a.2. Tactile- common among alcoholics and drugaddicts

- bugs are crawling under my skina.3. Visual- common among alcoholics and drug

addicts


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a.4. Gustatory- common among patients withdelirium

a.5. Olfactory- common among patients withdelirium

- I smell scents of roses

Nursing Interventions:1. Assess auditory hallucination: What are the

voices telling you?2. Acknowledge the feelings of the client: It

must be frightening to you3. Present reality4. Distract the patient

b. Illusion- misinterpretation of an external stimuli- ex: white lady is staring at mepointing to

the window

Nursing Interventions:1. Remove the stimulus2. Disturbance in cognition or thought process

2. Disturbance in Cognition or thought processa. Delusion

- false belief with or without the stimulus

a.1. Reference- everything that occurs in theenvironment has a direct significance of oneselfa.2. Persecution- directed to the people orinstitutiona.3. Erotomania- everybody is in love with him orhera.4. Gradiosity- inflated with self worth, powerand knowledge

b. Ideas of Reference- misinterpretation of other peoples actions- with stimulus- ex: they talk and write about me

I will not touch this food because when Itouch it, you might hurt me

c. Looseness of Association- shifting from one topic to another which has nomeaning

d. Flight of Ideas- has context or content

e. Neologism- coining of new words- common in Schizophrenia patients

f. Word Salad- chaining of new words- without coherent thought

g. Clang Association- rhyming of the words- poetic responses

h. Concrete Association- philosophical answering

3. Disturbance in Memorya. Anterograde Amnesia

- recent memory loss- common to patients who have just undergoneECT

Nursing Ix.:- Re-orientation: use of clock or calendar

b. Retrograde Amnesia- remote memory loss- common among patients with dementia

Nursing Ix;:- REMINISCNECE THERAPY* use of diary and photographs

4. Disturbance in Affecta.Flat- giving no response to questions

b. Blunt- giving minimal response to questionsc. Inappropriate- giving response opposite to the

questionsd. Labile- characterized by mood changes with an

exaggerated affect

5. Disturbance in Behaviora, Negativism

- doing the exact opposite of whats being saidor asked

b. Automatic Obedienceb.1. Echolalia- repeats the last word said by the

nurse

b.2. Echopraxia- repeats the last action done bythe nurse

c. Stereotypingc.1. Verbigeration- repeats the particular words or

phrasesc.2. Manerisms- peculiar movement or gesture

CRISIS- situation that occurs when an individuals

habitual coping ability becomes ineffective to meet thedemands of the situation

Characteristics:1. highly individualized2. lasts from 4-6 weeks3. person becomes passive and submissive4. affects the support system

Types of Crisis1. MATURATIONAL/ DEVELOPMENTAL

- crisis that is expected or predictable


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- motivated by interval environment- ex: parenthood

2. SITUATIONAL/ACCIDENTAL- unexpected or unpredictable- motivated by external factors or environment- ex: car accident

3. SOCIAL- due to acts of nature- ex: typhoon or earthquake

Phases of Crisis1. Denial- initial reaction2. Increased tension- person recognizes the

presence of crisis but still continues the ADLs3. Disorganization- person is preoccupied with the

crisis situation4. Attempt to reorganize- person mobilizes the

previous coping mechanism

Conditions requiring intervention

A. Rape Trauma Syndrome (RTS)- group of signs and symptoms experienced bythe victim in reaction to rape

RAPE- insertion of the penis into the vagina,

mouth or anus as a sign of violence and/oraggression (RA 8353)

- sign of retaliation- insertion of any object into the vagina,

mouth or anus- act of hostility or violence

Elements of Rape1. use of threat2. lack of consent from the victim3. actual penetration of the penis into the

vagina

Types of Rape1. POWER- done to prove ones masculinity2. ANGER- done as a means of retaliation3. SADISTIC- done to express erotic feelings

Stages of RTS1. Acute- characterized by shock, numbness

and disbelief2. Denial- characterized by the victims refusal to

talk about the incident3. Heightened Anxiety- characterized by fear, t

and nightmare4. Re- organization- characterized by the

normalization of the victims life

Crisis Interventions:

1. Let the patient verbalize his or her feelingsand emotions

2. Preserve the evidence**

B. Battered Wife Syndrome (BWS)- a cycle of violence characterized by wife

beaten by the husband as a sign of humiliation andaggression

Decreased Self-esteem: common trait ofabusive husbandDependency: common trait if an abused wife

Elements of Battered Wife Syndrome1. Men usually came from violent families2. Husbands/men who are immature,

dependent and non-assertive3. Husbands are with strong feeling of

inadequacies or insecurities

Stages of the Battered Wife Syndrome1. TENSION-BUILDING PHASE- involvement of

the minor battering incident

2. ACUTE BATTERING INCIDENT- characterizedby a more serious form of battering

3. AFTERMATH/HONEYMOON PHASE- husbandbecomes loving and gives wife hope

Crisis Intervention:1. Provision of the shelter

PSYCHOSIS NEUROSIS

Realityorientation

Absent Present

Etiology Organic psychosocial Due to anxiety

Types a. organic- cause isspecific

b. psychoactivesubstancesc. medicald. functional- cause isunknown;mood/thought

a. anxiety relateddisorders

b. different phobicdisordersc. somatoformdisorders

Signs andsymptoms

HallucinationIllusionDelusion

CompulsionObsessionPhobia

Interventions Present realityAcknowledge feelings

Explore feelings

Hospitalization In Out

Treatment Administration of AntipsychoticsECT

Psychotherapy

AntianxietyPsychotherapy

ANXIETY- subjective emotional state occurring when the ego isbeing threatened by the unknown condition

Levels of Anxietya. MILD- patient is still alert, motivated and

attentiveb. MODERATE- patient has narrowing

perception, selective inattention and physicaldiscomfort

c. SEVERE- patient has automatic behavior butwith r marked reduction of senses

d. PANIC- patient is overwhelmed


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Anxiety Related Disorders1. Generalized Anxiety Disorders (GAD)

- characterized by restlessness, fatigue, irritability andinability to concentrate- lasts for 6 months

Nursing ix:* Provide a calm and quiet environment

2. Obsessive-Compulsive Disorder (OCD)

- characterized by ritualistic behavior- defense mechanism of undoing

Nursing ix:* Never interfere with the behavior of the client

3. Post-traumatic Stress Disorders- characterized by flashback and recurrent recollection oftraumatic events

Nursing ix:* Provide a safe environment

Anxiety Reducing Techniques1. Cognitive-Behavioral techniques

- assesses the clients belief system

- done by means of dialogue or self-talk

2. Systematic Desensitization- slowly and progressively exploring the client to thesituation that evokes anxiety

3. Progressive Relaxation- visual imagery- allows relaxation response

PERSONALITY DISORDERS- spectrum of maladaptive traits influenced by

psychological and emotional disturbance and impairedinterpersonal relationship

- EGO SYNTONIC- comfortable for the individual but notfor others

1. Class A- odd/ eccentric behavior- devt root: INFANCY STAGE

a. PARANOID- suspiciousness, fear, irritability, jealousy- secretive individuals- blames others- argumentative- uses PROJECTION

b. SCHIZOID- alone, cold, aloof, introverted personality sincechildhood

- humorless, daydreaming- with outside thinking due to emotional

detachmentc. SCHIZOTYPAL- intellectually diminished, withdrawn,

unattached to society

2. Class B- dramatic/ erratic personality disorder- devt root: SCHOOL AGE

a. Histrionic- OC, dramatic, seductive, flirty with others,manipulative, seeks attention

b. Narcissistic- I, me, myself- sense of self-importance- with grandiosity- exhibitionist, lack of empathy, pre-occupation

with fantasies, power, beauty(because of strong need for admiration)

c. Borderline- impulsive, self-damaging, unstableinterpersonal relationship, chronic feeling of

emptiness/boredomd. Antisocial- evil personality

- resists the authority, without rules andregulations; inability to feel guilt feelings

- does not learn from past experience- charming, lacks judgment, self-centered- uses RATIONALIZATION

3. Class C

- with fear and anxiety- devt root: TODDLERHOOD STAGE

a. Avoidant- loner, fear of negative evaluation, timid, withsocial discomfort

b. Dependent- submissive, decreased self-esteem, passiveand helpless

c. Passive-Aggressive- frequent outburst, temper tantrums(happens if person is

frustrated), resist demands foradequate performance

d. Obsessive-Compulsive- perfectionist, pre-occupied with therules and regulations, inflexible

characteristics- behavior contains many rituals

Nursing Diagnoses:a. Anxiety r/t difficulty in interpersonal relationshipb. Ineffective individual coping r/t inability to tolerate

frustrationsc. Social isolation r/t absence of meaningful

relationshipd. Ineffective family coping

Planning and Implementation:a. Place realistic limits on the clients behaviorb. Maintain consistency and concernc. Protect individual from othersd. Accept individual as a person

SEX- something we doSEXUAL HEALTH- integration of somatic, intellectual, socialaspects of social being

SEXUAL DISORDERSTypes:1. Alteration in gender identity

a. Transexualism- persistent discomfort about sex assignment- characterized by confusion in learning about

gender or rolesb. Gender Identity Disorder in Childhood

- characterized by persistent and intensedistress at ones sex

2. Alteration in Sexual Orientation

a. Ego-dystonic Homosexuality- characterized by weak heterosexual arousal- unwanted homosexual pattern

3. Alteration in Sexual Behaviora. Sexual acting-out

- characterized by distured conduct by meansof making sexually provocative remarks

- with extramarital affairs- inadequate interpersonal skills- with high sexual drive

b. Paraphilias- more of the sexual urge or fantasies which aredirected to non-human objects, pain, non-

concepting person, children


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Types:b.1. Fetishism

- sexual fantasies or gratification by means ofsubstitution of inanimate objects

which are connected to the genitalsb.2. Pedophilia

- sexual fantasies or gratification by means ofattraction to children which serve as

the sex objectsb.3. Voyeurism

- sexual fantasies or gratification by means ofwatching the sexual play of others,accompanied by masturbation

b.4. Necrophilia- sexual fantasies or gratification by means of

sexual relations with a dead bodyb.5. Zoophilia

- sexual fantasies or gratification is directed toanimals

b.6. Telephone Scatologia/Scalogia (SOP)- sexual fantasies or gratification is directed

towards lewdness on the telephoneb.7. Frotteurism

- sexual fantasies or gratification by means oftouching or rubbing the non-

consenting person

- usually done in crowds or public transporation

SEXUAL ADDICTION- characterized by recurrent, compulsive, self-distarctivebehavior- includes compulsive masturbation

Nursing Diagnoses:1. Anxiety r/t threat to security and fear

discovery2. Altered sexual patterns3. Sexual dysfunction4. Altered family process5. Ineffective individual coping

Plan of Care:1. Accept individual as a person who is in emotional pain2. Protect individual from others3. Avoid punitive remarks4. Set limits on the individuals sexual acting-out5. Provide diversional activities6. Sexual counseling

22108028 psychiatric nursing reviewer

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