Psychiatric

Nursing

Joshua W. Atienza, USRN

Mental health
and
adaptation to conflicts both
,

Traits OF a mentally healthy client

has mechanism resilience
- a
good coping =

mechanism
-
Doesn't rely too much on defense

Focus on self development

-

her control
-
Control things that are within his /

communication
↳ Best intervention to resolve mental health issues

Communication Non therapeutic

-

Types Of
Making Judgement
Providing acknowledgement Asserting personal opinion
ended questions
using open advice
Giving personal
Restating ( Form of listening)
Belilting ( hamama )
Iiit

Summarizing
you need to listen Asking why
SileneEmpathy

Defence Mechanisms
: to protect the
ego and maintain psychological homeostasis
purpose
Type OF defense mechanisms
anxious Feeling
turns into a physical symptom
1- Conversion
=

Keeps on denying lips

2. Denial
=

common in
alcoholic patients stimuli
to a non provoking
Displacement channelling of an anger feeling anxious
-

3-
to escape an Feeling
OF identity
4. Identification changing
=

Excuse makers
g. Rationalization
=

6. Introjection Blaming oneself =

4 suicide
Related to depression =

=
cause : how self esteem

7. Substitution
=
Real quick change of plans
Blaming others
8. Projection =

in anxiety provoking situation

hurtful Feelings
g. Dissociation
=
Removing of

Conscious forgetting
Suppression
=

10 .

RAPE victims
common in
=

11
.

Repression =
Forgetting
Unconscious
=
Risk For multiplepersonality disorder
actions into acceptable actions
12 .
Sublimation = changing of unacceptable
=
Needs a matured mind
An attempt to overcome deficiencies
13 .

Compensation =

)
=
Napoleon complex ( overcompensation
comfortable developmental stage
.

back to
14 Regression =
Going
behavior
= Common problem Hoarding
:

15 .
Reaction Formation =
expression of an opposite Feelings
= common in borderline ( splitting)

16 .

Undoing =
Hug as Ka may
=
Common in any Form of abuse
Psych mental health setting
* Nurse -
client relationship
a) Voluntary admission
-
has an Informed consent
-
client retains poll civil rights
b) Involuntary admission
-
still has Informed consent
loses to refuse treatment if (f) Aggressive behavior
-

right
Grounds For Involuntary admission
-

Neglect
-
not intact in reality

phases of Nurse
-
client Relationship

a) pre orientation phase

-

* FOWV self awareness : -

↳ to avoid
> Tran Ference

[ ☐
> counter
Methods
-
transference

> Johari 's window

> Meditation

b) Orientation phase
* Tows :
setting of contract
↳ Specific
Measurable
Attainable
Realistic
Time bounded -

* Termination phase should be emphasized properly

c) Working phase
↳ Duration : Depends on the client 's coping mechanism
* Tows :

I '
Assessment
-

Appearance Dse :
Possible
¥j¥eahdm÷→ -

-
Bipolar
schizo
Possible Problem
: Delusions
think)
Thought content ( what you
☐
: world salad
-

How you think) → Possible problem

-

Thought process ( Neologism

confabulations Crlt alcoholism]
Flight OF ideas

Looseness OF association
Motor response → echolalia
clang Association
-

echo pharxia
Catatonia [ Waxy flexibility)
2- Therapies

a.) Millien therapy (environment)

b.) Psychotherapy
c.) Behavioral therapy
operant conditioning
-
- Desensitization
↳ BE skinner - Aversion therapy
behavior
↳
↳ (f)
Improvement of

reinforcement [reward) Modeling therapy =

personality
disorder
-

reinforcement ( punishment)
f)
-

Classical conditioning
↳ Ivan Pavlov
↳ stimuli response
 d) Cognitie behavioral therapy
and action connection V
↳ Thought

Reminince Therapy

e) Group therapy
-

Same goal
-
8 to to members

f) Family therapy

D- Termination phase
↳ Firm and Final
↳ Evaluation

Oct)
common psyh DIO ( Avg
-

1- Anxiety
of the
↳ Fear unknown
mechanism
↳ cause :
poor coping
↳ Levels of anxiety
a) Mild =
good pressure
physically present mentally absent
b) Moderate
=
,

c) severe = narrowed perception

↳ panic Anxiety → stay with the patient
psych emergency stay calm
instruction
Management :
simple
-

encourage verbalization
-
Consider CBT and Millien
-
Meds : Anxiolytic✓
 Psychiatric Nursing
that revokes in how to manage adversities (challenger)
* Mental Health
-
aspect of life
Resilience
* Good coping mechanism
-

Health
Mortal Enemies of mental
stress Risk For

2g psychological
Disorder
-

Fatigue
-

-
Anxiety
-
substance abuse
life
Developmental stages OF libido (natural energy)
→
* not
satisfied
Fixation
↳ can affect the behavior
Freud →

psychosexual Sigmund
=

in life
→ Virtue (t) outlook
Erik Erikson
psychosocial virtue G) outlook in life
=

Age Group :
months)
1- Infancy ( 0-18
oral stage
feeding
]
-

Freud =)
met
-

sucking if not property

I
crying
-

Fixation Coral
)
Smoking
Alcoholism
Nail biting
Overeating
Overtaking
Trust us . Mistrust
Fixation Anxiety

fixat
Erikson cover twst)
↳ panic Anxiety
Paranoid Personality
Gullible
↳ personality Disorder
:

months to 3 yrs old

) 18
(no conscience development
2. Toddler
Anat stage
Freud Guided by parents panic
toilettraining =

OCD , anxiety disorder phobia ,

,

* • strict -

Antisocial
Discipline • Lax -

and doubt
Autonomy us shame
ti
.

Erikson
ti Inferiority complex
sense of Independence
+
Good leadership skills

Old) Development OF 00ns" "

"
Initiative vs Guilt
3. Pre school (
3- 64N
-

Energon ±
-

ovriositn t,
Phallic stage unresolved sadness
Freud sense of
↳ Inferiority complex
-

Age OF Atiosity creativity

complexes
-

-
Mom and son = Oedipus
Electra
- Dad and Daughter =

showing of genetohv
 4- School Age (6- layn )
Latent stage [ Quiet
Freud diversion at activities
+ libido due to

Erickson = > Industry us .

Inferiority
ti
t, * self esteem
competitive

5. Adolescent
+ libido towards other people ( relationship)
Genital →
Freud
Erickson > Identity us Role confusion .

↳ maturity 4
=

f. -
Poor maturity
-

Good maturity -
short-term goals
longterm goals
-

35 yrs old )
6- Early Adulthood Cao
-

Isolation
Erickson Intimacy us .

ti
ti pessimistic
know the
concept OF love

old)
7. Middle Adulthood ( 35-60 yrs
Erickson Genemtivity vs. stagnation
Infinity and beyond )
8- Late Adulthood 160
-

Erickson Ego integrity

,
vs -

Despair
ti t,
Achievements Regrets
Repiréssioh
*
Involutional
Melancholia
BY : Sigmund Freud
Psychoanalytical Theory [ Behavior)
SUPEREGO
ID "
" EGO
WANTS
-

pleasure Balance - Conscience

-
Animal instiut +, -
Instinct
Due to stressors

Y III.
You.at
Narcissistic
Imbalance 0=90
¥
Ambivalent Feeling
good Depression
Anorexia nervosa

Addictions
Do not know Right bi Wrong ↳ antisocial
Anhedonia shizophreniform Histrionic
y,
↳ Lack OF schizoid
Disrupted reality schizotypal
pleasure y,
of manifestation
one
schizophrenia
-

OF Shizo

Models of care

1. Miller therapy
Therapeutic
environment 3. Behavior modification
disorder
-

-
Indications :
Indication : Conduct
Anxiety disorder
-

* Antisocial
Phobia vnwndition stimulus
2 theories : Pavlov
* 's -

disorder condition
operant
Eating
-

B. f. skinner
-

* Alcoholism
* Rape victim

2. Psychotherapy
-

Hypnotism (Therapeutic child behaviour to present behavior

reconnection of
-

purpose :
 Therapy
4. Cognitive Behavioral
Thought to action
- reconnection of

Disease :
* OCD
* Alzheimer
* Panic
* Phobia

5. Group therapy
-

8€70 members
-
Same goal
-

Common : Alcoholic patient ( AAA )

Psych Disorder
:

of
the unknown
1) Anxiety -
Fear mechanism
: Impaired coping Acid)
( Gaba aminobutyric
cause
t, GABA
F tows A
attention
Levels :
Mild -

T Focus I attention
moderate ay calm
-

severe
-
panic management s * ay alert
with the client
stay
Anxiety Disorder than le months
( overthinking )
Anxiety grater
anxiety Disorder
-

a) Generalized
OCD -1>
b) ¥ ↳ Compulsion (Actions)
obsession + Affecting Disorder
(Thoughts) =

ADV's

c) Phobia -
irrational Fear
☒Heights Acrophobia
-

Arachnophobia
*
Spider
-

* closed claustrophobia
-

spaces
* Dark
-
Nyctophobia
* Fire
-
Pyro phobia Esetaloprdm
* Water
-
Hydrophobia
Agoraphobia
open spaces
depressant
-

* nti
management :
2-4 Weeks
1- Acceptance ↳ medication :

2. Relaxation Technique
therapy to lithium
Dairy contraindicated
3.
)
Desentization (Exposure
-

CBT
-
Miller Therapy
4. medication
↳ Anxiolytics C Benzodiazepine)

Traumatic Stress Disorder

2.) Post
Risk Factor :
War

}
Unpredictable
Accidents I
Rape Overweening
Violence
Disaster
Natural

slsx
Management :

to reality
Detachment - Be non judgemental
Emotional numbness
verbalization (tell me more )
outburst Encourage
-

Anger
Depression →
Nightmares -
Assist in CBT
sleep disturbance ☐ Flashback
support groups
-

Hyper vigilance
Obvious weight loss
1 month
Trauma grater than
 3 Bipolar Disorder
moods
Combination of 2 distinct Suicidal thoughts
) ( + monoamine, Distured sleeping pattern
-

T%IoEÉin(monoamine
'

flight of ideas Maniu Depression -

☒ calories carbohydrates , protein

Cause Faulty Family
-

introjection ( self Hamming)

,

- Distanced Sleeping :
1 on 1 -

pattern ( ecetalopram)
-

finger Foods
Dynamics
antidepressant management :
SHX :
Restless
the go )
2-4 Weeks judgment
-

( on a. no

Delusion OF Grandeur
-

manipulative Melancholia Acknowledge simple accomplishment

* Involutional b.
-

Delusion of Grandeur
10h1 interaction ↳ elderly depression woe : log period of antidepressant
-

Fixedtalse
c.
Types Of Depression
Management
:
Belief 2 Wks
i. Major depression
-

a. set limit 24 "

Dsythymia
-

a.

b. establish good 3. Functional Depression

habits 4. postpartum blues
sleeping is Uniate
c- Noncom
" " te
→ each personality
activities
4. Personality Disorder theories
common
d. lithium cause : Up bringing -

unstable neon transmitter

1.
Hereditary upbringing / heredity
-

a.
-
Environment 3 .
Environment
Neurochemical Imbalances
depression
-

4- History of
Types :
Weird odd introverts
Cluster A (Bizarre)
→ ,
,

* schizoid -
towner -
weird rituals * Paranoids
Introvert alone suspicion
Highly
-
- Lives
-

-
only me
Not socializing ADHD
Atomoxetihe
-

*
schizotypal
↳ schizoid 1- Magical thinking Cstraltera)
Chester B [Emotional)
* Narssisliu - loves admiration
- not a big Fan of followback
-

self centered
* Histrionic
-

Attention seeker
-
Extrovert
-
social climbers
-

High Expectation

* Borderline
Manipulative
Unstable relationship
suicidal
emotions
Extreme
* Antisocial
RH to improper toilet
law violators
) fodder hood
-

Arsonists ( Pyromaniacs training during

.

-
Murderer
-
Rapist
Chester C C Anxious)
have self decision
Dependent -

clingy
- Doers 't management :
*

Perfectionist Acceptance
Obsessive Compulsive
-

*
Personality Disorder -
Doesn't want friendships -
Antidepressant
self awareness
being criticized Role playing =

Avoidant Fear OF
-

*
-

sensitive to rejection communication

-
-

therapeutic
-
set limits
-
suicidal precaution
 Munchausen syndrome
-

Factitious disorder
-

Fake news
2 types of Ms

1. primary Munchausen syndrome

-
Fake symptoms by means OF
a- Inflicting pain
lab results
b- changing of

Mgt :

-
Accept
-
Verbalization OF Feelings

2. Munchausen syndrome by proxy

another
-

Fake symptoms by using person

-
( mother imposturing)

Mgt
.

legal
- action

Anxiety
-

Fear of the unknown

3 Types

1. Mild
2. moderate
3- Serene / panic
Mgt stay calm
.

the patient
stay with
simple Instructions
General management for anxiety
1.
Encourage verbalization
2- Anxiolytic
3- Therapy : CBT and milieu therapy

Anxiety disorders
1. OCD
affected ADL's
-

Obsession 1- Compulsion =

* symmetry
* Germ theory

Management :

Accept
-

Encourage verbalization
-

Adjust the ritualistic manners

gradually Tourette syndrome
2. Phobia -
Tio related problem
- Irrational fear Ip involuntary repetitive problems
-
some
how related to : stress related problem

Risk factors :
-
Genetics
- Neurochemical Imbalance

Management :

Acceptance
provide stress management
-

provide safety
-
 Disorder
Attention Deficit Hyperactive
children ( 6- 12 yrs old) school age
-
Common in

causes :
- Neurochemical imbalance
-

Frontal lobe dysfunction

-

Hereditary
SIS ✗
"

Impulsive ( ID)
"
wants
Hyperactive
Inattention

Nsg DX :

a. Risk For injury

than body requirements
b. Imbalance nutrition less

Management :
-

prioritize safety
-
Nutritional needs should be meet "
" balloon
-
Diversion at activities =
blowing up of a
"
to marathon
encourage the child
in the
join
"

medication :
* stimulants
-

methylphenidate ( Ritalin )
- Adderall
-
Stratterra
consider :

/ Before lunch
-

Administering time Before breakfast

-
side effect : Insomnia
retardation)
-
Assess V15 and height and weight ( growth

Autism Spectrum Disorder

in communication
-

problem
2 yrs old
-

early diagnosis age of

Risk Factors :

Genetics
Birth defects due to teratogenic exposure

slsx
-
Impaired verbal communications
-

poor sense of judgement

-
Hallmark signs
> Head banging
> self
spinning -

-
They want to play alone
-
easily distracted
Management
-
prioritize safety * No Lex
Answer :

provide helmet the nursing station

far from
-

-
Thera -
com silence
:

offering once self

-

speech therapy
-

prioritize nutritional activities

-
structured activities
 Side notes :

Substance Abuse stimulants

Uppers -

1. Alcoholism 1- cocaine
is DENIAL
Defense mechanism 2 methamphetamine
- .

-
Related to oral Fixation 3- Ecstasy " "

Hallucinogen cannabis
4- sativa
therapy
a. alcohol withdrawal
-
to measure or assess the withdrawal effect of alcohol Downers -
Depressants
Barbiturates C- barbital )
signs of withdrawal
1 .

↳ anesthesia / Muscle relaxant

1- Tachycardia
2- Alcohol
2- Tachypnea

Tremens ) 3 days and about z Opiods

( Delirium
.

3. Seizure
alcohol
4- Alter Lou 4 .
Narcotics

Management :
harm )
1. Promote structured environment (Free From
benzodiazepine ( Anxiolytic s)
2- Give
-
cholordiazepoxide ( Librium )
b. Aversion therapy
Goal make alcohol
: drinking painful
tips to remember
:

1- Medication : Disulfiram Canterbury

Avoid foods and beverages
with alcohol
2-

example : commercial mouthwash

cream
shaving
vanilla extract
vinegar
interaction
> Disulfiram alcohol -

dwg
Hypotension
-

Facial flushing
-

NIV
-

chest pain
tremors
-

Diaphoresis
-

c. Rehabilitation
ADL 's
Goal :
perform normal
lips to remember
Group therapy
-

9- Goal =
acceptance
b. Initial reaction = anxious

c. members = 8- 10 members

d. Common groups
Alcoholic Anonymus ( AAA )
-

alcoholics )
-
Al anon ( spouses of
-

alcoholics)
-
A lateen ( children OF

abuse drug
2. Common per substance
manifestations
station Bloodshot eyes / Weight gain
cannabis
=
*

* Shabir weight loss=

* Heroine =
pinpoint pupils
* Cocaine =
perforated nasal septum
 Eating Disorder
Slsx :
Management
Feed
Anorexia Nervosa
-

Amenorrhea -

target weight 3- slbslwk

-

self starvation No appetite check weight everyday

-

stay with the client port meal

-

Obvious weigh boss

Risk factor :
adolescent
•
Reduce ideation
Female (Common )
)
• Emaciated ( cachexia muscle wasting
↳ serene

✗ enstomia
•
high expectations
•
peer pressure Impaired body image
growth (lanugo)
perfectionist
hair
•
Abnormal

* cause of death : Hypokalemia

loss 15 -25%
* total weight :

Bulimia Nervosa
-

Binge eating Followed by purging

cause : stress eating
slsx :

Binge eating
Vomiting
•
-

•
episode of purge -
laxatives
Diuretics
-

Russel sign callus

Formation
-
•

•
Chipmunk Face
• Dental carries

management :
verbalization
1-
Encourage death : Hypokalemia
cause of
2. Food journal
3. check patient post meal
bed
4- check Foods under
esophageal varices
Due to Hel causes
taken Blakemore tube
=

5- Songs
 Schizophrenia
- A condition that is related to Disrupted reality
Cause : Unknown

theories : lack -

OF nurturing caregivers
-
Vulnerable to life stressors
-

Folie a deux genetics level )

Abnormal dopamine
-
Neurotransmitter problem [

Pathophysiology :

Abnormal in Dopamine
① Dopamine ,#→

/
,

in the ¥ T Dopamine
substantia Dopamine all over
t,
E brain
Nigra y, alter the senses
and
Parkinson's prefrontal cortex control / content

|
Disease thought
-

Analyzation I
organization
-

positive symptoms
-
critical
thinking [ Bizarre ) involve
perception
]
-

Judgement , > Hallucination - senses are

stimuli
sensory
No
perspective
-

✗
problems
-

2. llvsion
-
senses involvement
① -
stimuli is now present
Hypo frontality
" " " " " ""

Negative symptoms present reality

1- Anhedonia -
lack OF pleasure Acknowledge Feelings
Allow verbalization
2- Awgia poverty of speech belief
false
-

Delusion Fixed
motivation 3.
-

A volition lack OF
Delusion of Grandeur
-

3.
social interaction
\
lack OF Common :

g. A social
-

persecution (Paranoid)
pension of
lack OF energy
g- A her gig T reference
-

Delusion of
.

6. Affect (Flat) Do not

Management
:

present
1. Focus on reality indirectly /Distraction
reality
2- Focus on client's feelings

association
4. looseness OF
-

rapid shifting of topics without pattern

5. Insomnia
Flexibility)
6. catatonia ( waxy period
stay in one position For long
-

7. Echolalia
-

repetition of words
8. E-Chopra a- a

to schizo repeat in actions ( mirroring)

management
-

1. Acceptance

]
behavior set limits Initiate
2. For aggressive
behavior encourage verbalization safety
For paranoid
For withdrawn behavior accept

3. Consider res traits

in side rails
-

on the bed Frame not

-
check every 2 hrs the circulation
-
order should be signed within 24 hrs

4 '

Antipsychotic