Psychiatric Nursing

NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO

THEORY OF COGNITIVE DEVELOPMENT continue to exist when

➢ Who was Piaget? they are not in the
▪ Jean Piaget was born in 1896 in Neuchatel, infants direct line of
Switzerland, and died in 1980 in Geneva, sensory or motor
Switzerland action
▪ At age 11, he wrote a paper on an albino • the understanding of object
sparrow, which was published and was the permanence marks the change
start of his famous career into..
▪ After graduating high school, he attended the Characterized by:
University of Zurich, where he became • Intuitive Thought – logic bases
interested in psychoanalysis only on experience
▪ He married in 1923 an had three children, • Symbolism in play
Jacqueline, Lucienne, and Laurent o Symbolic Play: use on
▪ Piaget studied his children’s intellectual object to stand for another
development from infancy. o Fantasy play: pretend to
▪ While studying his children, Piaget developed be something, or pretend
theories concerning how children learn activities that are
▪ His theory of Cognitive Development consists impossible
of four stages of intellectual development o Make-believe play -use
4 STAGES OF COGNITIVE DEVELOPMENT toys as props
• Babies are stuck in the HERE AN • Egocentrism (self-centered)
NOW world. They “know the STAGE 2: o Child’s inability to take in
world only in terms of their own Preoperation others perspective
sensory input (what they see, al Thought (2- o Ex. THREE MOUNTAIN
smell, taste, touch, and hear) 7 years) TEST
their physical or motor actions • Lack of conservation
on it (e.g sucking, reaching, o According to Piaget,
grasping) Operations = reversible
• Babies lack representational mental actions
thought or able to think o Thus, the preoperational
STAGE 1: through the use of symbols stage is marked by
Sensorimotor o Can you think without children’s lack of
Thought (0-2) words? conservation “concept that
NO OF COURSE NOT! certain basis properties of
• That’s why Piaget says babies an object (e.g volume,
cannot think! mass, and weight)
• Evidence of representational remains the same even if
thought emerges from the use its physical appearance
of language and changes
o Object permanence o EX. Equal amount of H20
▪ The fact that objects, ▪ A preoperational child
events, or even people would conclude that

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Psychiatric Nursing
NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO

the tall skinny glass ➢ 5 IMPORTANT HIGHER-LEVEL

had more water COGNITIVE ABILITIES
because the level of • Ability to
water was higher plant
• The understanding of systemati
conservation principles sends HYPHOTHETICO- c tests to
the precious little child right into DEDUCTIVE explore
the world of.. REASONING multiple
• Logic is “still tied closely to variables.
concrete materials, contexts, • It means
and situations” scientific
CHARACTERIZED BY STAGE 4: reasoning
• Reversibility Formal • Thought
o relates to the Operational about
CONSERVATION Thought (12 ABSTRACT things
EXPERIMENT. and UP) THOUGHT that are
o Children in the concrete not real
operational stage or
understand that if you tangible
reverse the action (pour • Direction
the water amount into the of
same size cups), then the thinking
water amount REMAINS about
STAGE 3: THE SAME. reality
Concrete • Logical Abilities: class and
Operational inclusion possibility
Thought (7-11 o EX. *a picture of 4 dogs SEPARATING reverses;
years) and 3 cows” ARE THERE REALITY FROM really is
MORE DOGS OR POSSIBILITY thought
ANIMALS? as only
o Through understanding one of
class inclusion, children in many
the concrete operational possible
stage know that dogs outcomes
belong to the larger or how
CATEGORY of ANIMALS. things
could be
• Thinking
about
COMBINATIONA multiple
L LOGIC aspects
and

GUMADE, GJL 2
Psychiatric Nursing
NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO

combinin height, weight, and

g them appearance)
logically o Looks comfortable/
to solve uncomfortable
problems o Physical Health
• Thinking o Grooming
REFLECTIVE about o Hygiene
THINKING your own o Self-Care
thinking o Dressing (adequate,
➢ What if a child does not develop as Piaget appropriate)
explained? o Facies (non-verbal
o In most cases, children with cognitive expression of mood)
disabilities do not successfully complete all of B. Attitude towards the
Piaget’s Stages of Cognitive Development Examiner
• COGNITIVE DISABILITIES o Cooperation/
o Down Syndrome (Trisomy 21) guardedness/
▪ Is a common example of a cognitive evasiveness/
disability hostility
o Common Aspects of Down Syndrome o Attentiveness
▪ Sleep related difficulties o Shows
▪ Autism spectrum conditions interest/appearance
▪ Problem solving difficulties disinterested
▪ Cognitive skills decreased C. Comprehension
▪ Attention deficit disorders o Intact/impair ed
▪ Restlessness (partially/fully)
▪ Anxiety o Gait and Posture
▪ Repetitive obsessive-compulsive behavior o Normal or
abnormal (way of
sitting, standing,
MENTAL STATUS EXAMINATION walking, lying)
MENTAL STATUS E. Motor Activity
• Mental Status is the total expression of a o Increased/de
person’s emotional responses, mood, cognitive creased
function, and personality o Excitement/S tupor
MENTAL HEALTH STATUS COMPONENTS o Abnormal
Involuntary
A. General Appearance Movements (AIMs)
General Appearance o Body build and tics, tremors
and Behavior physical o Restlessness/
appearance akathisia
(approximate o Catatonic signs
(mannerisms,

GUMADE, GJL 3
Psychiatric Nursing
NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO
stereotypes,
posturing, waxy
flexibility,
negativism,
ambitendency,
automatic
obedience, echo-
praxia,
psychological
pillow)
o Conversion and
dissociative signs
(pseudo seizures,
possession states)
o Social withdrawal,
autism
➢ PSYCHOLOGICAL
PILLOW
o A sign of catatonia
in which the patient
holds her head a
few centimeters
above the bed or
pillow.
o It is a symptom of
catatonia and can
last for many hours.
F. Social Manner
o Increased,
decreased, or
inappropriate G.
Rapport
o Whether a working
empathic
relationship can be
established with the
patient should
mentioned
H. Hallucinatory Behavior
o Smiling or crying
without reason
o Muttering/taking to
self (non-social
speech)
o Odd gesturing in
response to
auditory or visual
hallucinations
B. Rate and Quantity
of Speech
o Whether speech is
present or absent
(mutism)
o If present, whether
it’s spontaneous
o Productivity is
increased or
decreased
o Rate is rapid or
slow
o Pressure of speech
Speech or poverty of speech
B. Volume and Tone of
Speech
o Increased/de
creased C. Flow
and Rhythm of
Speech
o Smooth/ hesitant
o Dysprosody
o Blocking (sudden)
o Circumstantiality
o Tangentiality,
loosening of
associations
o Verbigeration,
perseveration
o Stereotypes
(verbal)
o Flight of ideas,
clang associations
GUMADE, GJL 4
Psychiatric Nursing
NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO

➢ Affect is outward content of speech,

expression of person’s thought block
current feeling state o Continuity of
➢ Mood is sustained thought is assessed
emotional state; Overall o Whether the
General Mood thought processes
➢ In addition to nonverbal are relevant
mood observed, the o to the questions
patient is asked about asked
present “mood”. This is o Any loosening of
recorded as subject association,
affect while the tangentiality,
observed emotional circumstantiality,
change is described as illogical thinking,
objective affect perseveration,
Mood and Affect ➢ Mood is described as: verbigeration is
o Relaxed, happy, noted
anxious, angry, B. Content of Thought
depressed, o Obsessions and
hopeless, hopeful, content of phobias;
apathetic, euphoric, ideas and delusions
euthymic (normal/ of persecutions,
even mood) elated, reference, grandeur,
irritable, fearful, silly love, jealousy
o Anhedonia may (infidelity), guilt,
occur in both nihilism
schizophrenia and o Hypochondriacal
depression symptoms,
➢ AFFECT: How do they hopelessness,
appear to you? MOOD: helplessness,
Asks the patient directly worthlessness, and
how he/she feels suicide should be
A. Stream and Form of explored
Thought o Delusions of control,
o Stream and form of thought insertion,
thought overlaps withdrawal, and
Thought with examination of broadcasting,
“speech” neologisms
o Spontaneity, Perception A. Hallucinations
productivity, flight of o Auditory, visual,
ideas poverty of olfactory, gustatory,
or tactile. Auditory

GUMADE, GJL 5
Psychiatric Nursing
NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO

hallucinations patient to repeat

should be further digits forwards and
inquired. backwards
B. Illusions and D. Concentration
Misinterpretations o Can the patient
o Visual, auditory, or concentrate
in other sensory o Ease of
fields, whether distractibility
occur in clear o Ask to subtract
consciousness or serial sevens from
not hundred (100-7
C. Depersonalization and test), or serial
Derealization threes from forty
D. Somatic Passivity (40-3 test), or to
Phenomenon count backwards
o Strange sensations from 20,
imposed by o Enumerate the
“somebody" months or days of
E. Others the week in the
o Autoscopy, reverse order
abnormal vestibular o Note down the
sensations, sense of answers and the
presence should be time taken to
noted here perform the tests
Cognition or A. Consciousness E. Memory
Neuropsychiatric o Conscious/v o Immediate
Assessment confusion/ Retention and Recall
clouding/delirium/ (IR and R)
stupor/coma o Recent
o Any disturbance of o Remote
consciousness F. Intelligence
should be rated on o Ask questions about
Glasgow Coma general information,
Scale keeping in mind the
B. Orientation patient’s
o Whether the patient educational and
is well-oriented to social background,
time, place, person his experiences, and
C. Attention interests
o Is the attention o Test for reading and
easily aroused and writing
sustained. Ask the

GUMADE, GJL 6
Psychiatric Nursing
NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO

o Give simple tests of o 2. Slight

calculation awareness of
G. Abstract Thinking being sick and
o Assesses patient’s needing
concept formation. o 3. Awareness of
The methods used being sick but
are: blaming it on
o Proverb Testing: others, on
Asking the meaning external factors,
of simple proverbs or on organic
o Similarities & factors
Differences: o 4. Awareness
Between familiar that illness is
objects due to
A. Personal Judgment something
B. Social Judgment unknown in the
o Is observed during patient
the hospital stay o 5. Intellectual
and during the insight
interview session o 6. True
C. Test Judgment emotional
Judgement o Is assessed by insight
asking the patient Loss and Grieving
what he would do in ➢ Grief
certain test o Refers to the subjective emotions and
situations. affect that are a normal response to the
o Judgment is rated experience of loss
as ➢ When people facing
good/intact/normal an imminent loss
or poor/ ANTICIPATORY begin to grapple
impaired/abnormal GRIEVING with the very real
➢ Patient’s degree of possibility of the loss
awareness and or death in the near
understanding that they future
are ill ➢ Grief over a loss that
Insight LEVELS OF INSIGHT is not or cannot be
• Insight is rated on a DISENFRACHISED acknowledge d
6- point scale from GRIEVING openly, mourned
one to six publicly or
o 1. Complete supported socially.
denial of illness COMPLICATED ➢ When a person is
GRIEVING void of emotion,

GUMADE, GJL 7
Psychiatric Nursing
NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO

grieves for MATURATIONAL/ ➢ Normal expected

prolonged periods, DEVELOPMENTAL crisis that runs
has expressions of through age
grief that seem SITUATIONAL ➢ Unexpected and
disproportion ate to sudden
the event. ADVENTITIOUS ➢ Calamities, war
➢ Grieving which ➢ CHARACTERISTICS OF CRISIS STATE
DYSFUNCTIONAL extends from 4 to 6 o Highly individualized
GRIEVING weeks leading to o Lasts for 4-6 weeks
CRISIS o Self-limiting
o Person affected becomes passive and
➢ LOSS submissive
o Physiologic Loss o Affects a person’s support system
o Safe and Security Loss ➢ CRISIS MANAGEMENT
o Love and Belongingness Loss o Role of the nurse is to return the client to
o Self-Esteem Loss its pre-crisis state by assisting and guiding
o Self-actualization Loss them until they achieved their OLOF.
➢ GRIEING PROCESS o Goal: to enable patient to attain an OLOF
o Denial o Nurse”s Primary Role: Active and
o Anger Directive
o Bargaining ➢ PHASES OF A CRISIS
o Depression o Pre-crisis: State of equilibrium
o Acceptance o Initial Impact (may last a few hours to a
➢ INTERVENTIONS few days): High level of stress,
o Explore client’s perception and meaning of helplessness, inability to function socially
the loss o Crisis (may last a brief or prolonged
o Allow adaptive denial period of time): Inability to cope,
o Assist client to reach out for and accept projection, denial, rationalization
support o Resolution: attempts to use
o Encourage client to examine patterns of problemsolving skills
coping in past and present situation of loss o Post crisis: may have OLOF or may have
o Encourage client to care for himself symptoms of neurosis, psychosis
o Offer client food without pressure to eat ➢ STEPS IN CRISIS INTERVENTION
o Use effective communication o Identify the degree of disruption the client
Crisis and Management is experiencing
➢ CRISIS o Assess the client’s perception of the event
o Situation that occurs when an individual’s Formulate nursing diagnoses
habitual coping ability becomes ineffective o Involve the patient and family if applicable
to merit demands of a situation with planning
TYPES OF CRISIS o Implement interventions- new and old
coping mechanisms
o Evaluate-reassessment, reinforcement

GUMADE, GJL 8
Psychiatric Nursing
NCM 117/ LECTURE/ THEORY OF COGNITIVE DEVELOPMENT AND MSE / PPT BASED FROM PROF. ROLANDO FAUSTO

GUMADE, GJL 9