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Basic Concepts in Psychiatric Nursing
Basic Concepts in Psychiatric Nursing
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 through the use of self, assist an individual
practitioner
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.
• The therapeutic use of self is considered as the art of
Mental Hygiene.
CORE
-CONCEPT
It is the positive use of one’s self in the process of therapy.
- It requires self-awareness.
3. Disturbances of affect.
Inappropriate affect – disharmony between the stimuli and the
emotional reaction.
Flat affect – absence or near absence of emotional reaction.
Apathy – dulled emotional tone.
Blunted affect – severe reduction in emotional reaction.
Ambivalence – presence of two opposing feelings.
Depersonalization – feeling of strangeness towards one’s self
Derealization – feeling of strangeness towards the environment
4. Disturbances in motor activity
Echopraxia – the pathological imitation of posture/action of others.
Waxy flexibility – maintaining the desired position for long periods of
time without discomfort.
5. Disturbances in memory.
Confabulation – filling in memory gap.
Amnesia – inability to recall past events.
Anterograde amnesia – loss memory of the immediate past.
Retrograde amnesia – loss of memory of the distant past.
Déjà vu – feeling of having been to place which one has not yet
visited.
Jamais vu – feeling of not having been to a place which one has
visited.
CORE CONCEPTS ON
THERAPEUTIC
COMMUNICATION
. ommunication – refers to the reciprocal exchange of ideas between
C
or among persons.
Elements of Communication:
• Sender – originator of information.
• Message – information being transmitted.
• Receiver – recipient of information.
• Channel – mode of communication.
• Feedback – return response.
• Context – the setting of communication.
CHARACTERISTIC
S
• It is goal directed, focused on the needs of the patient, planned,
time limited and professional.
BASIC ELEMENTS
Trust
Rapport
Unconditional positive regard
Setting limits
Therapeutic communication
PHASES
A. PRE-INTERACTION PHASE
• Begins when the nurse is assigned to a patient.
• 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, planning for first interaction
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
• More structured than the orientation phase
• The longest and most productive phase of the NPR
• Limit setting is employed
• Major task: Identification and resolution of the patient’s problems
• Planning and implementation
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?
• 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, fear and loss
How to Terminate?
• Gradually decreased interaction time
• Focus on future oriented topics
• Encourage expression of feelings
• Make the necessary referral
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.
H – ow will you know if the medicaiton is effective. What is your
assessment parameters in monitoring the effects of the drug.
E – xactly what tome should the medication be given. Some drugs are
best taken with meals, some after meals, and some on an empty
stomach. Other drugs may also be taken without regard to meals.
You should know all of these.
C – lient teaching tips. What would you tell your patient to expect. You
should be able to give instructions related to the therapeutic and
side effects of the drug.
K – eys to giving it safely. You should be able to identify interventions
to counteract the adverse/side effects of the drug.
Psychopharmacolgic
agents
A. Major tranquilizers/antipsychotic/neuroleptics
Common indication : Schizophrenia
Examples:
Haloperidol (Haldol)
Prochlorperazine (Compazine)
Fluphenazine (Prolixin)
Chlorpromazine (Thorazine)
Clozapine (Clozaril)
Olanzapine (Zyprexa)
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
H – Muscles become less stiff; decreased pill-rolling tremors
E – Best taken after meals
C – Avoid driving, the drug causes blurred vision
K – Check the BP, the drug may cause hypotension
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 patient’s 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
D. Tricyclic Antidepressants
Examples: Imipramine Hydrochloride (Tofranil)
Amitriptyline (Elavil)
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
CHARACTERISTICS OF ABUSIVE
HUSBANDS
• They usually come from violent family.
• They are immature, dependent and non-assertive.
• They have a strong feeling of inadequacy.
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
VIOLENCE
• Refers to the use of force.
NEGLECT
• Lack of provision of those things which are necessary for the child’s
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 one’s confidence.
SEXUAL ABUSE
• Abuse in the form of unwanted sexual contact
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.
• They are emotionally immature
• They have negative attitude towards the management of the abused
ETIOLOGY
PSYCHOANALYTIC
THEORY
• Anxiety is caused by a conflict between the Id and the Superego.
INTERPERSONAL
THEORY
• Cause of anxiety is fear of interpersonal rejection
BEHAVIORAL THEORY
• Anxiety is a product of frustration.
LEARNING THEORY
• Exposure to early life fearful experiences causes anxiety.
CONFLICT THEORY
• Presence of two opposing drives, causes anxiety.
BIOLOGIC THEORY
• Anxiety may accompany physical and physiological ailments.
FAMILY STUDIES
• Anxiety can run in families.
DELIRIUM AND
DEMENTIA
DELIRIUM DEMENTIA
• Disorientation Loss/impiarment of
memory
• Acute Chronic
•Involves young and old Exclusive in the elderly
• Clouded sensorium Clear sensorium
• Reversible Irreversible
• Good prognosis Poor prognosis
Alzheimer’s
Disease
• a type of dementia that frequently affects the elderly.
Main Pathology
• presence of senile plaques that destroys neurons leading to decreased
acetylcholine.
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.
Priority Nursing
Diagnosis
Altered thought processes
Primary need of the patient
Reorientation
ALCOHOLIS
M
• 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.
What happens at
•level?
.1 – .2% (low coordination)
• .2 -. 3% (presence of ataxia, tremors, irritability, stupor
• .3 and above (unconsciousness)
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.
Phases of progression of
alcoholism
Pre-alcoholic phase – starts with social drinking
Prodromal phase – alcohol becomes a need; blackout’s occur; 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, visual and tactile
• Increased vital signs
• Tremors
• Sweating and Seizure
Common defense
•mechanism
Denial
• Rationalization
• Isolation
• Projection