mental health nursing ii nurs 2310 unit ii growth and development in mental health
TRANSCRIPT
Mental Health Mental Health Nursing IINursing II
NURS 2310NURS 2310
Unit IIUnit II
Growth and Growth and Development in Development in Mental HealthMental Health
Objective 1Objective 1
Reviewing Maslow’s Hierarchy of Needs
Objective 2Objective 2
Exploring the concepts and theories associated with personality development
Personality = The combination of character, behavioral, temperamental, emotional, and mental traits that is unique to each specific individual.
Temperament = Inborn personality characteristics that influence an individual’s manner of reacting to the environment, and ultimately his or her developmental progression.
Psychoanalytic TheoryPsychoanalytic TheoryFreud believed an individual’s basic
character isformed by the age of 5, and includes thesecomponents: Id
– Instinctual drives Ego
– Mediator Superego
– Ego Ideal internalized value system
– Consciousness
Theory of Psychosocial Theory of Psychosocial DevelopmentDevelopment
Erikson studied the influence of social processes on the development of the personality
Individuals struggle with developmental crises throughout the life cycle
Specific tasks in each stage must be completed for emotional growth to occur
Objective 3Objective 3
Reviewing Erikson’s Stages of Development
Stage 1Stage 1Trust vs. MistrustTrust vs. Mistrust
Age: Birth to 18 months Major Task: Develop a sense of trust
in others Mastery: Trust in people and the
environment Characteristics: Social attachment Concerns: Emotional dissatisfaction,
suspiciousness, difficulty with interpersonal relationships
Stage 2Stage 2Autonomy vs. Shame and Autonomy vs. Shame and
DoubtDoubt Age: 18 months to 3 years Major Task: Learn self-control Mastery: Pride in self Characteristics: Self-control, language
development, fantasy play Concerns: Lack of self-confidence, lack
of pride in the ability to perform, a sense of being controlled by others, rage against self
Stage 3Stage 3Initiative vs. GuiltInitiative vs. Guilt
Age: 3 to 6 years Major Task: Initiate spontaneous activities Mastery: Able to initiate activities and
enjoy learning Characteristics: Early moral development,
self-esteem, group play, egocentrism Concerns: Feelings of inadequacy and
guilt, accepting of liability in situations for which individual is not responsible
Stage 4Stage 4Industry vs. InferiorityIndustry vs. Inferiority
Age: 6 to 12 years Major Task: Develop necessary social
skills Mastery: Acquire skills for, and develop
competence in, work Characteristics: Friendship, skill learning,
self-evaluation, team play Concerns: Difficulty in interpersonal
relationships caused by feelings of inadequacy
Stage 5Stage 5Identity vs. Role ConfusionIdentity vs. Role Confusion
Age: 12 to 20 years Major Task: Integrate childhood
experiences into a personal identity Mastery: Strong group identity,
readiness to plan for the future Characteristics: Physical maturation,
sexual relationships, membership in peer group
Concerns: Self-consciousness, doubt, and confusion about one’s role in life
Stage 6Stage 6Intimacy vs. IsolationIntimacy vs. Isolation
Age: 20 to 30 years Major Task: Develop commitments to
others and to a career Mastery: Form close relationships and
share with others Characteristics: Stable relationships,
childbearing, work Concerns: Withdrawal, social isolation,
inability to form lasting relationships
Stage 7Stage 7Generativity vs. StagnationGenerativity vs. Stagnation
Age: 30 to 65 years Major Task: Establish a family and
become productive Mastery: Nurturing children or helping the
next generation in other ways Characteristics: Nurturing of close
relationships, managing career/household Concerns: Lack of concern for the welfare
of others, total preoccupation with self
Stage 8Stage 8Integrity vs. DespairIntegrity vs. Despair
Age: 65 years and older Major Task: View one’s life as meaningful
and fulfilling Mastery: Sense of fulfillment about life,
sense of unity with self and others Characteristics: Promote intellectual
vigor, redirect energy to new roles and activities
Concerns: Self-contempt and disgust with how life has progressed
Objective 4Objective 4
Recalling the majorfunctions controlled byvarious areas of the brain
CerebrumCerebrum Frontal lobes
– voluntary body movement– movements that control speaking,
thinking, and judgment formation Parietal lobes
– perception & interpretation of most sensory information
– touch, pain, taste, and body position Temporal lobes
– auditory functions– short-term memory
Occipital lobes– visual reception and interpretation
DiencephalonDiencephalon
Thalamus– integrates all sensory input except smell
Hypothalamus– regulates the pituitary gland– regulates appetite and temperature
Limbic system– associated with fear, anxiety, anger,
aggression, love, joy, hope, sexuality, and social behavior
MesencephalonMesencephalon – integration of reflexes (visual, auditory,
righting)
PonsPons – respiration – skeletal muscle tone
MedullaMedulla – regulates heart rate, blood pressure, and respiration – swallowing, sneezing, coughing,
vomiting reflexes
CerebellumCerebellum – involuntary movement, such as the
coordination/maintenance of posture
NeurotransmittersNeurotransmitters – essential functions of human emotion
and behavior
– many psychotropics work here – categories of neurotransmitters include
cholinergics, monoamines, amino acids, and neuropeptides
Neurotransmitters (cont’d)Neurotransmitters (cont’d)Cholinergics Acetylcholine
– 1st chemical to be identified as neurotransmitter
– involved in disorders of motor behavior and memory
Monoamines Norepinephrine
– fight-or-flight syndrome Dopamine
– physical activation of the body Serotonin
– levels dictate heightened or lowered sense of arousal
Neurotransmitters (cont’d)Neurotransmitters (cont’d)Amino Acids Gamma-aminobutyric acid (GABA)
– decreased levels in anxiety and movement disorders
– Huntington’s disease, epilepsy Glutamate
– decreased receptor activity can induce psychotic behavior
Neuropeptides Somatostatin
– low concentrations in Alzheimer’s disease
Autonomic Nervous SystemAutonomic Nervous System Sympathetic nervous system
– dominant during stressful situations– fight-or-flight response– increases cardiac and respiratory activity,
and decreases GI functioning– involves acetylcholine and norephinephrine
Parasympathetic nervous system– dominant in the nonstressful or relaxed state– promotes efficient GI functioning– maintains heart and respirations at resting
rate– involves acetylcholine
Objective 5Objective 5
Reviewing diagnostic procedures used to detect altered brain function
Electroencephalography (EEG)– measures brain electrical activity– detects dysrhythmias, asymmetries, and
suppression of brain rhythms– epilepsy, metabolic disorder,
degenerative disease
Computed tomographic (CT) scan– measures accuracy of brain structure– identifies anatomical differences– schizophrenia, organic mental disorders,
bipolar disorder
Magnetic resonance imaging (MRI)– measures anatomical and biochemical
status of various segments of the brain– detects changes in myelination– schizophrenia
Positron emission tomography (PET)– measures specific brain activity and
functioning– identifies problems with blood flow,
oxygen utilization, glucose metabolism, and neurotransmitter/receptor interaction
Objective 6Objective 6
Discussing commonly used physiological and
psychological tests utilized in evaluating the function of the
brain
Physiological TestsPhysiological Tests
Basic Metabolic Profile (BMP)– electrolytes– glucose
Complete Blood Chemistry (CBC)
Thyroid Panel
Urinalysis
Mental Status Examination Mental Status Examination (MSE)(MSE)
Describes all areas of mental functioning: Appearance Mood and affect Speech and language Thought content Perceptual disturbances Insight and judgment Sensorium Memory and attention General intellectual level
Objective 7Objective 7
Reviewing the steps of the nursing process in the
psychiatric/mental health setting
The Nursing Process:
Provides a systematic framework for the delivery of nursing care
Consists of six steps
Uses a problem-solving approach
Accepted as nursing’s scientific methodology
Assessment = a systematic, dynamic process by which the nurse, through interaction with the client, significant others, and health care providers, collects and analyzes data about the client.
Data may include the following dimensions:-- Physical -- Psychological-- Sociocultural -- Spiritual-- Functional Abilities -- Cognitive-- Developmental -- Economic-- Lifestyle
Diagnosis = clinical judgments about individual, family, or community responses to actual or potential health problems and/or life processes.
A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.
Outcome Identification = measurable, expected, patient-focused goals that translate into observable behaviors.
Planning = developed by the nurse and negotiated among the patient, nurse, family, and health care team; prescribes evidence-based interventions to attain expected outcomes.
Implementation = putting in place interventions identified in the plan of care.
Evaluation = the process of determining both the client’s progress toward the attainment of expected outcomes and the effectiveness of nursing care.
In the psychiatric/mental health setting –
Nursing care is always goal-directed Nursing diagnoses are prioritized
according to life-threatening potential– Maslow’s Hierarchy of Needs– Concept mapping
Documentation– SOAP notes– SBAR charting– DAR (data/action/response)
Objective 8Objective 8
Describing the nurse’s role in psychiatric evaluation
Assessment Observation
– Thought processes– Behaviors
1:1– Mood scale– Subjective data
Diagnosis (NANDA)Evaluation Documentation Treatment planning
Objective 9Objective 9
Examining documentation practices of the
psychiatric/mental health nurse
Problem-oriented recording (SOAPIE): Subjective data = information gathered
from what the client, family, or other source has said or reported
Objective data = information gathered by direct observation
Assessment = nurse’s interpretation of the subjective and objective data
Plan = actions/treatment to be carried out
Intervention = nursing actions actually carried out
Evaluation = assessment of the problem following nursing interventions
Focus charting (DAR and AIR): Data = information that supports the
focus or describes pertinent observations Action = nursing actions that address the
focus Response = description of client’s
response to any part of the medical or nursing care
_____________________________________ Assessment = observations about the
client Intervention = nursing actions that
address the observations Response = client’s response to actions
Objective 10Objective 10
Defining the DSM-IV-TR and identifying its relevance to psychiatric nursing practice
Defining the DSM-VDefining the DSM-V
The DSM-V is a handbook for mental health professionals that lists different categories of mental disorders and the criteria for diagnosing them
The manual has been revised six times since its inception
Organizes each psychiatric diagnosis according to different aspects of a specific disorder or disability
Relevance to Nursing PracticeRelevance to Nursing Practice
Provides uniformity and consistency in psychiatric diagnoses
Groups diagnoses by characteristics according to specific criteria
Allows health care team to provide treatment based on diagnostic classification
Used by the nurse to organize patient care and determine appropriate priority psychiatric nursing diagnosis