Documente Academic
Documente Profesional
Documente Cultură
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.
CORE CONCEPT
Known to others
Public self
I
Semi-public self
II
Not known to
others
Private self
III
Psychiatry
field of medicine: a medical specialty concerned
with the diagnosis and treatment of disorders
that have primarily mental or behavioral
symptoms and with the care of people having
such disorder.
Psychiatric Nursing
Is an interpersonal process that promotes and
maintains behavior that contributes to integrated
functioning. It is a specialized area of nursing
practice employing theories of human behavior
as its science and purposeful use of self as it art.
Is the specialty of nursing that cares for people of
all ages with mental illness or mental distress
such as psychosis,depression
DEFENSE MECHANISM
DEFENSE
MECHANISM
COMMON
EXAMPLE
PATIENT
EXAMPLE
REPRESSION
- Unconscious
and involuntary
forgetting of
painful ideas,
events and
conflicts.
A car accident
victim is unable
to remember
the details of
the impact, but
was aware of
the time.
Mrs. Jose, a
victim of incest,
does not know
why she has
always hated
her uncle.
SUPPRESSION
voluntary
exclusion from
awareness,
anxiety-producing
feelings, ideas,
and situations.
A student
states, I
cannot think
about my
wedding
tonight. I have
to study.
Michelle tells
the nurse that
she is not
ready to talk
about her
recent
separation.
DENIAL
unconscious
refusal to admit
an unacceptable
idea or behavior.
A student
refuses to
admit that she
is flunking a
course despite
a 65 on the
midterm
exam.
RATIONALIZATION
attempts to make or
prove that ones feelings
or behaviors are
acceptable.
A student
states, I got a
70 on the test
because the
questions are
confusing.
Mr. Honorio, a
paranoid
schizo, states
that he cannot
go to work
because he is
afraid of his
co-workers.
INTELLECTUALIZATION
using only logical
explanations without
feelings or an affective
component.
An older adult
is asked to
share her
feelings on
death. She
reviews all the
stages of DD.
Mrs. Mana
talks about her
sons death
and bout with
cancer without
showing any
signs of
sadness.
IDENTIFICATION
a conscious or
unconscious
attempt to model
oneself after a
respected person.
COMPENSATION
covering up for
a weakness by
overemphasizing
or making a
desirable trait.
An academically
weak HS student
becomes a star in
the school play.
A schizo patient
who is unable to
talk to other
patients becomes
known for his
expressive poetry.
INTROJECTION
unconsciously
incorporating
wishes, values,
and attitudes of
others as if they
were your own.
While her
mother is
gone, a young
girl disciplines
her brother
just like her
mother.
Without
realizing it, a
patient talks
and acts like his
therapist,
analyzing other
patients.
PROJECTION blaming
someone else
for ones
difficulties or
placing ones
unethical
desires on
someone else.
A teenager
comes home
late from a
date and
states that her
friends did not
bring her
home on time.
Kathy states
that she used
marijuana while
on pass
because her
boyfriend made
her smoke it.
REACTION
FORMATION - a
conscious
covering
behavior that is
the exact
opposite of an
unconscious
feelings.
An older
brother who
dislikes his
younger
brother sends
him gifts for
every holiday.
Maria, who
unconsciously
hates her
mother,
continuously
tells staff how
wonderful her
mother is.
SUBLIMATION
channeling
instinctual
drives into
acceptable
activities.
An adolescent
arrested once
for stealing
later opens
business
installing
security
A former victim
of violence
joins the VACC
and
encourages
others to do
the same.
DISPLACEMEN
T discharging
pent-up feelings
to a less
threatening
object.
Redirecting
emotions or
impulses to
others
A husband
comes home
and yells at
his wife after a
bad day at
work.
Mrs. Fa screams
at another
patient after
being told by
her psychiatrist
that she cannot
have a weekend
pass.
CONVERSION
the unconscious
expression of
intrapsychic
conflict
symbolically
A student
awakens with
a migraine the
morning of a
final exam and
feels to ill to
Mr. Jeff
suddenly
develops
impotence after
his wife
discovers he is
UNDOING /
RESTITUTION
doing
something to
counteract or
make up for a
transgression or
wrongdoing.
REGRESSION
return to an
earlier and
more
comfortable
developmental
level.
FANTASY - A person
uses non-rational
mental activity to
escape from daily
pressures and
responsibilities.
SYMBOLIZATION
representing an idea
of object by a
substitute object of
sign.
A housewife
faced with a sink
full of dirty
dishes dreams
she has a live-in
maid.
A schizo pt
escapes the
real world by
hallucinations.
1. Disturbances in perception:
Illusion misperception of an actual external stimuli.
Hallucination false sensory perception in the absence of external
stimuli.
2. Disturbances in thinking:
Neologism pathological coining of new words.
Circumstantiality over inclusion of details.
Word salad incoherent mixture of words and phrases.
To gather information
- Focusing: assisting a patient to explore a specific topic.
Example: Patient: I cant decide about
Nurse: Lets talk about that. Perhaps if we talk about it, it
will help you to decide.
- Validating: confirming ones observation.
Example: Are you saying that
- Relflecting: directing back ideas, feelings and content.
Example: You feel tense when you fight.
- Restating: repeating what the patient had said.
- Summarizing: developing a concise resume of what has transpired
Touching
a client may be
comforting and
supportive if it is
permitted and
welcome; nurse must
evaluate whether the
client perceives touch
as positive or
threatening and
unwanted and should
never assume that
touching a client is
acceptable
CHARACTERISTICS
BASIC ELEMENTS
Trust
Rapport
Unconditional positive regard
Setting limits
Therapeutic communication
PHASES
A. PRE-INTERACTION PHASE
B. 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, develop trust, assessment
C. WORKING PHASE
It is highly individualized
D. 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?
How to Terminate?
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 patients 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
PSYCHOPHARMACOLOGY
BASIC CONCEPTS ON
PSYCHOPHARMACOLOGY
Psychopharmacolgic agents
A. Major tranquilizers/antipsychotic/neuroleptics
Common indication : Schizophrenia
Examples:
Haloperidol (Haldol)
Prochlorperazine (Compazine)
Fluphenazine (Prolixin)
Chlorpromazine (Thorazine)
Clozapine (Clozaril)
Olanzapine (Zyprexa)
ANTIPSYCHOTIC/
NEUROLEPTIC DRUGS
ANTIPSYCHOTIC/
NEUROLEPTIC
DRUGS
Typical
ANTIPSYCHOTIC/
NEUROLEPTIC
DRUGS
Typical
ANTIPSYCHOTIC/
NEUROLEPTIC DRUGS
Typical
Chlorpromazine (Thorazine),
Fluphenazine (Prolixin),
Haloperidol (Haldol),
Thioridazine (Mellaril) =>
classified as Phenothiazines
ANTIPSYCHOTIC/
NEUROLEPTIC DRUGS
ANTIPSYCHOTIC/
NEUROLEPTIC DRUGS
Antipsychotics in General
Indications: psychosis (Bipolar,
Schizophrenia, Autism)
Contraindications: hypotension, CAD,
glaucoma, PUD, urinary, intestinal
obstruction
ANTIPSYCHOTIC/
NEUROLEPTIC DRUGS
ANTIPSYCHOTIC/
NEUROLEPTIC DRUGS
ANTICHOLINERGICS
oppose the effects of acetylcholine in the
substantia nigra and corpus striatum
Synthetic drugs (greater affinity to CNS than
other Anti-Chs)
General side effects: slowed GI motility, dry
mouth, constipation, urinary retention, blurred
vision, dilated pupils, disorientation, decreased
sweating
Benztropine (Cogentin), Biperiden
(Akineton), Diphenhydramine (Benadryl)
Used as adjunct to levodopa in managing
parkinsonism
ANTICHOLINERGICS
Contraindications: allergy, glaucoma,
GI obstruction, prostatic hypertrophy,
Myasthenia Gravis
Drug interactions: TCA,
Phenothiazines => increased
toxicity, paralytic ileus
DOPAMINERGICS
DOPAMINERGICS
DOPAMINERGICS
DOPAMINERGICS
Contraindications: glaucoma, skin
lesions (levodopa may cause melanoma)
SIDE EFFECTS: ataxia, hand tremors,
weakness, agitation, anxiety, anorexia,
nausea, dry mouth, flushing, urinary
retention
Drug interactions: MAOI potentiating
effects, increased risk of hypertensive
crisis; VITAMIN B6 decreased efficacy
DOPAMINERGICS
Nursing Considerations
Give drug with meals
Promote safety (due to CNS side effects)
Advise client not to eat foods rich in
Vitamin B6 (tuna, pork, dried beans, liver)
Monitor hepatic, renal, and hematological
tests
Allow patient to void prior to
administering the drug
ANTICHOLINERGICS
Nursing Considerations
Decrease/discontinue drug if there is
severe dryness of mouth
Establish safety precautions
Give drug with meals
Neuroleptic Malignant
Syndrome
life- threatening neurological disorder most
ANTIPSYCHOTIC/
NEUROLEPTIC
DRUGS
Nursing Considerations
C Antipsychotic
H Decreased delusions, hallucinations, and
looseness of association
E Best taken after meals
C Report sorethroat and avoid exposure to
sunlight. Report elevated temp. and muscle
rigidity, it indicate Neurologic Malignant
Syndrome.
K check the BP, the drug causes hypotension.
Observe for EPS, check the CBC, drygs cause
leukopenia
B. Anti-parkinsonian drugs
Indication: EPS (Extrapyramidal Syndrome)
Two Types:
1. DOPAMINERGIC DRUGS
Examples:
Amantadine (Symmetrel)
Levodopa
Levodopa-Carbidopa (Sinemet)
2. ANTICHOLINERGIC DRUGS
Examples:
Trihexylphenidyl (Artane)
Biperiden Hydrochloride (Akineton)
Benztropine Mesylate (Cogentin)
Diphenhydramine Hydrochloride (Benadryl)
C Antiparkinsonian drug
C. Minor Tranquilizers/Anxiolytics
Common indication: Anxiety disorders
Examples: Diazepam (Valium)
Oxazepam (Serax)
Chlodiazepoxide (Librium)
Chlorazepate Dipotassium (Tranxene)
Alprazolam (Xanax)
C Antianxiety; given as muscle relaxant to patients in
traction
H Decreased anxiety, adequate sleep
E Best taken before meals, food in the stomach delays
absorption
C Avoid driving, intake of alcohol and caffeine
containing foods,
since it alters the effect of drug
K Administer it separately, it is incompatible with any
drug
ANTIDEPRESSANTS:
MONOAMINE OXIDASE
INHIBITORS (MAOIS)
MONOAMINE OXIDASE
INHIBITORS (MAOIS)
Indications: depression that is unresponsive to
other antidepressants
Side effects: dizziness, vertigo, HA,
overactivity, tremors, weakness, drowsiness,
fatigue, sweating, orthostatic
hypotension, dry mouth, diarrhea, edema
Adverse: HYPERTENSIVE CRISIS
Drug interactions: other anti-depressants hypertensive crisis, coma, convulsions
(TCA); sympathomimetics additive effect
MONOAMINE OXIDASE
INHIBITORS (MAOIS)
MONOAMINE OXIDASE
INHIBITORS (MAOIS)
Nursing Considerations
Onset of therapeutic effect is within 2-4
weeks of treatment
Monitor BP closely, including other signs
of HTN such as severe headache
Have Phentolamine or other adrenergic
blocker on standby
Teach client about foods that are rich in
tyramine
D. Tricyclic Antidepressants
Examples: Imipramine Hydrochloride (Tofranil)
Amitriptyline (Elavil)
C Tricyclic anti-depressantprevents
H Increased appetite; adequate sleep
E Best given after meals
C Therapeutic effects may become evident only after 2
3 weeks of intake
K Check BP, it causes hypotension, Check the heart rate,
it causes
cardiac arrythmias
ANTIDEPRESSANTS:
TRICYCLIC
ANTIDEPRESSANTS
ANTIDEPRESSANTS:
TRICYCLIC ANTIDEPRESSANTS
Indications: anxiety, sleep disturbances,
Indications: anxiety, sleep disturbances,
enuresis
Contraindications: allergy, MI, concurrent MAOI
use
Side effects: Sedation, fatigue, hallucinations,
disorientation, visual disturbances, weakness,
weight loss,
ANTIDEPRESSANTS:
TRICYCLIC ANTIDEPRESSANTS
ANTIDEPRESSANTS:
TRICYCLIC ANTIDEPRESSANTS
Nursing Considerations
Ideally given at bedtime
Limit access to suicidal patients =>
risk for overdose
Provide comfort measures
SELECTIVE SEROTONIN
REUPTAKE INHIBITORS (SSRIS)
SELECTIVE SEROTONIN
REUPTAKE INHIBITORS (SSRIS)
SELECTIVE SEROTONIN
REUPTAKE INHIBITORS (SSRIS)
Nursing Considerations
establish suicide precautions
offer support if patients experience
sexual dysfunction
ANTIMANIC DRUGS
ANTIMANIC DRUGS
Action of Lithium: alters sodium
transport in nerve and muscle cells;
inhibits NE and Dopamine release =>
modulates the responsiveness of
hyperactive neurons
Contraindications: renal or cardiac
disease, history of leukemia, sodium
depletion, dehydration and diuretics use
! Lithium depletes sodium reabsorption =
severe hyponatremia
ANTIMANIC DRUGS
ADVERSE EFFECTS:
Mild toxicity CNS symptoms such as lethargy,
slurred speech, muscle weakness and fine tremor,
POLYURIA, beginning of gastric toxicity (NAUSEA,
VOMITING, DIARRHEA) => lithium levels < 1.5
mEqs/L
ANTIMANIC DRUGS
ELECTRO-CONVULSIVE THERAPY
Mechanism of action: Unclear at present.
Voltage applied to the patient: 70 150 volts
Duration of application: 0.5 2 seconds
Usual number of treatments to produce
therapeutic effect: 6 12 treatments
Frequency of treatments: An interval of 48 hours for each treatment.
Indications of effectiveness: Generalized tonic-clonic seizure
Indication for ECT: Depression, Mania, Catatonic Schizophrenia
Contraindication to ECT: Fever, Increased ICP, Cardiac problems,
TB with history of hemorrhage, Recent fracture, Retinal detachment,
Pregnancy.
Consent needed prior to ECT: YES
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, Headache, Apnea,
Fracture, Respiratory depression.
ANTIMANIC DRUGS
Nursing Considerations
Give with meals
Maintain adequate salt and fluid
intake
Provide safety measures
COMMON PSYCHOTHERAPEUTIC
INTERVENTIONS
BEHAVIOR
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.
NEGLECT
Lack of provision of those things which are necessary for the childs
growth and development
2 COMPONENTS
1. Child abandonment
2. Child neglect
PHYSICAL ABUSE
Abuse in the form of inflicting pain
EMOTIONAL ABUSE
Abuse in the form of insults and undermining ones confidence.
SEXUAL ABUSE
Abuse in the form of unwanted sexual contact
ANXIETY
DELIRIUM
Disorientation
Acute
Involves young and old
Clouded sensorium
Reversible
Good prognosis
DEMENTIA
Loss/impiarment of
memory
Chronic
Exclusive in the elderly
Clear sensorium
Irreversible
Poor prognosis
Alzheimers Disease
a type of dementia that frequently affects the elderly.
Main Pathology
3 Phases
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 .1% or 10 ml for every 1000 ml of
blood.
Etiological theories
Psychoanalytic theory
- due to fixation in the oral stage
Learning theory
- due to a learned behavior
Biological theory
- due to inherited traits
Socio-cultural theory
- due to effects of mass media.
Outcomes of alcoholism
Brain damage
Alcoholic hallucinosis
Death