CA2: MENTAL HEALTH AND PSYCHIATRIC NURSING
Lance Lambert G. Ayson, RN, MAN, MHPEd
Brain Warm Up
1. Mental health promotion encompasses all of
the following except:
A. Promotion of mental health among
individuals and groups
B. Assessment of potential causes of
breakdown and when necessary
conduct possible preventive action
C. Assisting the community to better
understand basic emotional needs
D. Conducting health teaching classes
for parents about the importance of
providing emotional support to their
children
Rationale:
● The primary responsibility in health promotion
is health teaching. Health promotion and
health teaching are letters A, C, and D.
Therefore the correct answer is letter B.
2. Marco was taking lithium carbonate. Health
teaching plan for Marco should include:
A. Eskalith will be taken for the rest of his
life
B. A diuretic will also be prescribed for
better outcome
C. Lithium blood levels should be
monitored
D. An intake of 2-3 L of fluids and no
sodium diet should be strictly
followed
Rationale:
● 2-3 L of fluids is correct but no sodium diet is
wrong. It should be a normal or high sodium
diet, since no sodium diet is deadly.
● The best answer is letter C because lithium
carbonate has a narrow therapeutic range
making the patient at risk for toxicity.
3. Nurse Nher knows that according to Erikson’s
developmental tasks, children aged 3-5
years old have the task of achieving:
A. Autonomy
B. Automobility
C. Initiative
D. Industry
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Rationale:
● 3 to 5 is preschool.
4. Establishing trust and acceptance is the goal
of which of the following phases of nurse-
patient relationship?
A. Working
B. Orientation
C. Pre interaction
D. Termination
5. Nurse Chuck is assisting in developing a plan
of care for the client in crisis state. When
developing the plan, the nurse will consider
which of the following?
A. Presenting symptoms of a crisis are
similar for all individuals experiencing
a crisis
B. A crisis state is an emotional illness
C. A client’s response to a crisis is highly
individualized
D. A crisis indicates that the individual is
suffering from a mental illness
Rationale:
● We are not similar when it comes to
responding to it, when it comes to our
reaction to it. We are all different. Therefore
the correct answer is letter C.
6. The primary objective in the treatment of the
hospitalized anorexic client is to:
A. Challenge the client’s irrational
beliefs
B. Force the client to eat and gain
weight
C. Decrease the client’s delusion and
anxiety
D. Increase the client’s insight into the
disorder
Rationale:
● Anorexic patients are usually not aware of
their psych condition or they are in denial.
● Increase the client’s awareness or insight
about their condition, then they will comply
with the treatment.
7. Which of the following are considered
positive signs of schizophrenia?
 A. Delusions, hallucinations, disordered PSYCHIATRIC NURSING
thinking ● According to the American Psychiatric
B. Delusions, apathy, hallucinations Association, psychiatric nursing is an
C. Apathy, anhedonia, avolition, “interpersonal process whereby the
ambivalence professional nurse practitioner through the
D. Illusion, delusion, premonition therapeutic use of self, assist an individual,
family, group or community to promote
8. A nurse working in the psychiatric unit knows mental health, to prevent mental illness and
very well that the most common side effect suffering, to participate in the treatment and
of ECT is: rehabilitation of the mentally ill and if
A. Hypertension and delusions necessary find meaning in these
B. Temporary memory loss and experiences.”
confusion
C. Nausea and vomiting Simplifying:
D. Headache and dizziness
● Interpersonal Process
○ AKA interpersonal relationship
9. Which of the following is true of Alzheimer's
○ Original theory of Harry Stack Sullivan
disease?
○ It was adapted in nursing by the
A. A risk factor is family history of disease
mother of modern psychiatric
B. There should be no occurrence of
nursing, Hildegard Peplau.
hallucinations or delusions
○ Interpersonal means we are
C. It is more common among males
interacting with other people.
D. It is a curable but not treatable
○ The first person included in the
disease
interpersonal process is the nurse and
Rationale:
we interact with the client.
● There are hallucinations and delusions, even
○ The role of the nurse in psychiatric
illusions.
nursing is to assist or help the client.
● It is equally common in males and females
○ How can we assist the client? In
● Curable but not treatable is not possible. It
psychiatric nursing the nurse has
should be the other way around. The disease
three tools.
is treatable but not curable.

3 Tools:
10. Nurse Jagger would do which of the
1. Therapeutic use of self
following initial intervention for a client who is
 The main tool of the nurse in the
in panic level of anxiety?
practice of psychiatric nursing.
A. Leave the client alone to provide
 It is the most important tool among
privacy
the three.
B. Stay with the client
 Before the nurse can use himself or
C. Encourage the client to verbalize his
herself therapeutically, the nurse
feelings
should first attain or gain self-
D. Teach relaxation techniques for this is
awareness.
the perfect time to learn it
Rationale:
2. Psychotropic medications /
 The levels of anxiety are mild,
psychiatric medications /
moderate, severe, and panic. Panic
psychopharmacologic agents, or simply
is the highest priority and the priority is
meds
safety therefore the nurse should stay
 Antipsychotic, antidepressants,
with the patient.
antianxiety, antimanic

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 3. Therapeutic milieu developing PTSD. Stress debriefing or crisis
o Milieu pertains to the environment. intervention prevents PTSD.
 In primary prevention, the main task is health
● Self-awareness activities include Johari education, client teaching, or
window and sharing of childhood empowerment.
experiences or life challenges experienced in  Empowerment: We give the patient power.
the past. From there, you will be able to We give them knowledge through client
understand yourself. education.
● When you have self-awareness, you can now  If you are developing a mental health plan
use yourself to assist your patient. for a community, the focus is primary
● Another term for assist is help. prevention because it is efficient and cost-
● The clientele in psychiatric nursing are the effective.
following:  The goal in the primary level of prevention is
1. Individual to decrease the rate of cases of mental
● According to Virginia illness.
Henderson, the unique
function of the nurse is to assist 2) Secondary Prevention
the individual either sick or  For sick individuals
well.  Early detection and prompt treatment
● In psychiatric nursing, the  Early diagnosis include health screening
clients are the mentally ill and  Prompt treatment in psychiatric nursing
the mentally healthy. include psych drugs, ECT, psych treatment
2. Family such as cognitive behavioral therapy,
3. Group cognitive therapy, and occupational
4. Community treatment.
 The goal of secondary prevention is to
How do we assist them? We use our self. minimize the severity of signs and symptoms
of mental illness.
Where do we assist them? We assist clients in the  We are trying to prevent complications.
three levels of prevention.
3) Tertiary Prevention
3 LEVELS OF PREVENTION  Rehabilitation
 For patients who are recovering from an
1) Primary Prevention illness or for patients who have undergone
 For healthy individuals without the signs and treatment. This is after the treatment.
symptoms of mental illness.  The goal in rehabilitation is to make the
 It focuses on health promotion and disease patient achieve optimum level of functioning
prevention. (OLOF).
 Health promotion are the activities that  Examples of tertiary prevention in psychiatric
promote or improve an individual’s health, nursing include drug rehab or occupational
like proper nutrition, activity and exercise, therapy for schizophrenia.
adequate sleep, stress management,  It also includes hospice care and palliative
avoiding illicit drugs. care.
 Disease prevention includes immunization.
But in psychiatric nursing we don’t have Summary:
vaccines against psychiatric illnesses. ● Interpersonal process is the theory of
 Example of disease prevention in psychiatric Hildegard Peplau.
nursing is stress debriefing, otherwise known ● Interpersonal process is the interaction
as crisis intervention, for those who between the nurse and the client.
experienced trauma who are at risk for

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 ● The nurse has three tools. These are
therapeutic use of self, medication, and
environment.
● The most important tool of the nurse in
psychiatric nursing is the therapeutic use of
self.
● A major requirement before the nurse can
use himself or herself therapeutically is self-
awareness.
● Once you have self-awareness, you can help
the client.
● Help means assisting the client.
● The four clienteles in psychiatric nursing are
individual, family, group, and community.
● The three levels of prevention are primary
level, secondary level, and tertiary level.
Examples:
Primary
● Health promotion
● Goal is decrease the rate of mental illness
● Mental health promotion
● Mental illness prevention
Secondary
● Electroconvulsive therapy
● Goal is to minimize the severity of the signs
and symptoms
● Early detection
● Prompt treatment
Tertiary
● Rehabilitation
● Goal is to help the patient achieve OLOF.
All of the activities that are performed in the three
levels of prevention are called mental hygiene.
MENTAL HYGIENE
● Pertains to the science that deals with the
promotion of mental health, prevention of
mental illness, and achievement of optimum
level of functioning.
● Anything that you do to take care of your
mental health.
● Physical health is equally important as
mental health.
● If there is a problem with physical health or
mental health, the quality of life will
decrease.
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Other Definitions of Psychiatric Nursing:
● Gail Stuart: “An interpersonal process that
strives to promote and maintain behavior
which contributes to integrated functioning.
It employs the theories of human behavior as
its science and purposeful use of self as its art.
Psychiatric Nursing is directed toward both
preventive and corrective impacts on
mental disorders and their sequelae and is
concerned with the promotion of optimum
mental health for society, the community,
and the individuals who live within it.”
Simplifying:
● Psychiatric nursing is both an art and a
science.
● Art in psychiatric nursing means therapeutic
use of self.
○ How we use the aspects of our
personality in helping the patient.
○ We have our own style because the
practice of nursing is a form of self-
expression by the nurses.
● Different nurses will have different styles. We
differ in practice, performance, and delivery
of nursing care. But all nurses have the
knowledge of the same science.
● Science uses theories to build the nursing
knowledge for us to practice psychiatric
nursing.
● We all have the same knowledge of nursing.
● American Nurses Association: “The diagnosis
and treatment of human responses to actual
or potential mental health problems.”
○ Nurses don’t focus directly on mental
health problems. We focus on the
human responses.
○ Example: Our focus is not depression
or schizophrenia, but the responses to
depression and schizophrenia. Our
focus is risk for suicide, altered
thought process, and disturbed
sensory perception because these
are the client’s human responses to
the illness.
Nursing Diagnosis vs Psychiatric Diagnosis
● Nurses have separate diagnosis with
psychiatric diagnosis.
 ● Nurses use NANDA to formulate nursing 1. Productive Activities
diagnosis. ● Perform the role at home or
● Doctors use DSM-5 for psychiatric diagnosis. occupation productively.
● When you do things, they are
DIFFERENCES BETWEEN DSM-4 AND DSM-5 all purposeful.
● ADHD in DSM-5 can be a diagnosis for adults
as well. 2. Fulfilling Relationships
● Wala nang types ng schizophrenia sa DSM-5 ● Satisfying relationships with
because the differences between the people ex. family, co-workers,
different types are not clear. Because the friends, classmates.
symptoms overlap, it is not necessary
anymore. The doctors will just state 3. Coping with Stress
schizophrenia then specify which symptom is ● Mentally healthy individuals
present in the patient. are dynamic, meaning they
● Mental retardation is not used anymore can adapt and change
because it is offensive, derogative, and depending on the situation.
diminutive. The new term is intellectual ● Coping is adaptation to
disability. situation or change.

What is the CORE of psychiatric nursing? Summary:

Interpersonal relationship. ● Mental health is the successful performance
● Interpersonal relationship is the theory of of mental functions.
Hildegard Peplau ● The three mental functions are productive
● If walang interpersonal relationship, then activity, fulfilling relationships, and coping
human to human relationship by Joyce with stress.
Travelbee
MENTAL HEALTH ACCORDING TO ABRAHAM
MENTAL HEALTH MASLOW
● Traditional definition: Mental health is the Maslow’s Hierarchy of Needs
absence of mental illness. 1. Physiologic needs
● We now view clients as holistic individuals. 2. Safety and security needs - Priority for
We are all biopsychosociospiritual psychiatric patient
individuals. 3. Love and belonging needs
● Better definition: Mental health is the person’s 4. Self-esteem needs
state of social, psychological, and emotional 5. Self-actualization needs
wellness. ● Physiological needs are the priority.
● Mental health can be manifested in 3 things: ● Psychiatric needs are secondary to
○ Social: Mental health can be physiological needs.
manifested with the way you interact ● Everything above physiological needs are
with other people or your psychological needs.
relationships with other people. ● In psychiatric nursing, the priority is safety and
○ Psychological: The way you think, security.
your state of mind, your thoughts ● To say an individual is healthy, they must
○ Emotional: Expression of your achieve self-actualization.
emotions ● Self-actualization is achieving the highest
● Another definition of mental health: potential.
Successful performance of age-appropriate ● Healthy = Self-actualized
mental functions:
Priority:
MS: Airway

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MHN: Safety
OB: Baby
6 INDICATORS OF MENTAL HEALTH
Mental Health according to Marie Jahoda
Must have all six indicators of mental health to be
considered a healthy individual. If may kulang you
can be considered mentally ill.
1. Attitude of Self Acceptance
 According to Townsend, it is the loving
acceptance of self.
 Acceptance of strengths and flaws.
 Self-acceptance is the first step of being
mentally healthy.
 Be kind to yourself.
2. Growth and Development and Actualization
 Not physical growth and development
but cognitive growth, mental growth.
 Improvement and maturation of a
person.
3. Integrative Capacity
o The ability to balance the id, ego and
superego.
4. Autonomous Behavior
 Autonomy is being independent or self-
determination. It means being responsible for
actions. Having the ability to make decisions
to take your own actions and be responsible.
 Making decisions, taking action, and being
responsible with these actions.
 May sariling pag iisip at hindi kayang
diktahan.
5. Perception of Reality
 The ability to distinguish what is real and what
is not real.
 Mentally healthy individuals sometimes have
transient or temporary symptoms of mental
disorders, such as auditory hallucination,
which is normal.
6. Environmental Mastery
 The ability to adapt with the environment.
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MENTAL ILLNESS
● Traditional definition: Mental illness is a state
of imbalance of psychological homeostasis.
● For a person to develop mental illness, there
are three main factors that can contribute to
it.
Three (3) Influences:
1) Interpersonal Factor -
social environment
 The individual’s mental health can
deteriorate and develop mental
illness if it is affected by the people
around them.
 Interaction with others.
o Example: Bullied, harrassed,
sexually abused
2) Intrapersonal Factor Inside the person
-
 Factor inside your head,
psychological factors, the way you
think.
 Genetics, individual factors personality ,
temperament
3) Physical Environment environment
 Example: Drought and war can
affect mental health.
Definitions of Mental Illness:
“Is any disease or condition affecting the brain that
influences the way a person thinks, feels, perceives,
behaves, and or relate to others and to his or her
environment.”
APA: “A clinically significant behavioral or
psychological syndrome or pattern that occurs in an
individual that is associated with present distress or
disability with significantly increased risk for suffering,
death, pain, disability or an important loss for
freedom.”
Simplifying:
● Mental illness affects our brain.
● The factors that can affect the development
of mental illness are interpersonal factors
(interaction with others), intrapersonal
factors (happens inside our mind,
psychological aspect), and physical
environment (surroundings that you live in).
● The brain can be chemically affected,
causing problems in our neurotransmitters, or
physiologically affected, where certain
 functions or parts of the brain are affected,
causing problems in our psychological
aspect.
● If the brain is affected, we will have problems
in thinking, feelings (depression, mania),
perception (hallucination), relationships, and
behavior. And if there is a problem with
these, it is a psychopathological condition, or
simply psychopathology.
● MS: Pathophysiology
● Psychiatric Nursing: Psychopathology
● If a person develops a psychopathological
condition, or simply mental illness or mental
disorder, that person will experience the
three D’s.
● 3 D’s of Mental Illness:
1. Distress
● Psychological or emotional
suffering
● If a person is in distress
(patients with generalized
anxiety or PTSD), that person
will suffer from the experience
of that illness.
2. Disability
● Inability to perform activities
of daily living (ADL).
3. Danger to harm either the self or
others.
● Not all mentally ill individuals
will have harm to self or
others.
● But all of them will have some
form of distress or disability to
function normally.
↳
wo intention , w/ intention
Summary:
● If there is mental illness, the brain is affected.
● The three factors that can affect the brain
are interpersonal factors, intrapersonal
factors, and physical environment.
● The affectation of the brain will cause
problems with thought processes, including
thinking, feelings, perceptions, and
relationships.
● If there are manifestations in our thinking,
feelings, perceptions, and relationships, it
means there is mental illness or
psychopathology.
● If there is psychopathology, we will
experience three Ds. These are distress
(psychological or emotional suffering),
disability (inability to perform activities of
daily living that the patient can previously
perform), and harm to self or others.
Classification of Mental Illness
Mood d/o
Schizophrenia spectrum and other psychotic d/o
Anxiety d/o
Obsessive compulsive d/o
Personality d/o
Substance related and addictive d/o
Somatic symptom d/o
Trauma and stressor related d/o
Neurocognitive d/o
Eating d/o
Childhood and adolescent d/o
Issues on human sexuality and gender dysphoria d/o
THERAPEUTIC RELATIONSHIP
● Therapeutic relationship is the foundation of
psychiatric nursing.
Types of Relationship
1) Social Relationship
Initiated for the purpose of friendship,
companionship, or socializing an
individual.
Relationship with classmates, friends,
teachers, neighbors.
This type of relationship is allowed but
limited in psychiatric nursing.
to harm
Start with light topics and eventually in
more serious problems.
Social relationships are allowed to initiate
the interaction but should not stay like
that.
fo accomplishment of task
2) Intimate Relationship
Relationship between two individuals
that involves emotional and sexual
intimacy.
This is not allowed in the practice of
psychiatric nursing.
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 rate !
100n passing
3) Therapeutic Relationship ● Rapport
Nurse-patient relationship ○ Harmony
It is not just exclusive to nurses, but also ○ Having a common perspective or
applied to other health care providers. commonality of perspective.
Foundation of psychiatric nursing. ⑳
○ The opposite of rapport is chaos.
-

Patient-centered. Focuses on the ● Acceptance

patient's experiences, problems, needs, ● Positive Regard
ideas, feelings. ○ Acceptance and Positive Regard:
Promotes growth and healing Accepting the patient as a unique
Planned and purposeful individual with worth and dignity no
Time limited. Eventually the nurse-patient matter what his behavior is.
relationship will end if the patient no ● Yuse of self Most important
-

longer has needs, treatment is no longer ○ Use of self to help the patient.
effective, or needs other services. ○ It is the main tool of the nurse in the
practice of psychiatric nursing.
COMPONENTS OF A THERAPEUTIC RELATIONSHIP
TERAPY NURSE-PATIENT RELATIONSHIP
● Trust -integrity , reliability 4 Phases according to Hildegard Peplau OIER
○ The patient's confidence towards the ● Orientation
nurse. ● Identification
○ It is the nurse’s responsibility to ● Exploitation
establish and maintain trust in a ● Resolution
relationship.
○ Most crucial part of the nurse-patient MODERN POWT
relationship.
○ The nurse-patient relationship should ● Pre-interaction
be founded on trust.
○ The only phase in the nurse-patient
○ Trust is essential in building a nurse-
relationship that does not involve the
patient relationship. To establish and
patient’s active participation.
maintain trust, you will need
○ Here the nurse has just been assigned
confidence, consistency, and
to a new patient.
congruence.
○ The main goal is to develop or gain
○ Have congruence with what you feel
self-awareness.
anxiety
-

and what you express.

○ Another task is to gather information
● Empathy
about the patient. Read the patient’s
○ Understanding the situation from the
notes, ask nurses or doctors who have
patient’s point of view.
worked with the patient to
○ The following best exemplified
understand the patient better.
empathy: Putting yourself in someone
○ The more knowledge you have with
else shoes, seeing the world through
the patient, the more confidence
some else's eyes
you will have in taking care of or
Empathy Sympathy
dealing with that patient.
Understanding of the Develop the same feelings
patient’s feelings. with the patient.
The nurse can help the The nurse needs help. ● Orientation
patient.
○ Main task is to formulate a mutually
There is personal
involvement of emotion. agreeable contract with the patient.
○ The contract contains
The nurse needs self- ■ The rules of the relationship -
awareness by consulting
colleagues. Mga pwede at hindi
pwedeng gawin
Page 8 of 33
 ■ Duration - Kelan matatapos
ang relationship, saan
magmimeet ang nurse at
patient
○ Other tasks include
■ Establishing trust and rapport
with the patient. Trusting
relationship between the
nurse and patient is known as
therapeutic alliance.
■ Perform initial assessment so
we can formulate initial
diagnosis upon admission.
■ The nurse should inform the
patient about the end of the
relationship in the first
meeting. So the patient won’t
be frustrated when the nurse
leaves. The patient can
prepare themselves
emotionally.
● Working
○ Helping the client to identify and
resolve problems.
○ The nurse and patient identify the
problem.
○ The patient solves the problem.
○ We don’t think of solutions for the
client but we help them think of their
own solution with their problems.
○ This is where most therapeutic
interactions happen between the
nurse and patient.
○ Longest and most productive phase.
○ The problem with the patient during
this phase is resistance. It means the
patient is having ambivalence on
whether to proceed or not with the
treatment. To resolve this problem, set
firm limits.
○ Example: Remind the patient about
the contract.
● Termination
○ The end phase
○ The conclusion of the relationship
○ Also known as the resolution phase.
○ The patient’s main problem is clinging
behavior or stalling maneuver
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wherein the patient brings out his or
her previous problems because they
are not confident to live outside the
hospital.
○ The root cause of clinging behavior is
anxiety.
■ The patient has no
confidence.
■ The patient does not know
what he or she is capable of.
○ Solution is to summarize or review all
the patient's previous achievements.
This will increase the patient’s
confidence, ease their anxiety, and
resolve the clinging behavior.
○ Another task is to provide a
therapeutic closure or goodbye.
○ Example: “So this is where our
professional relationship will end. We
cannot meet outside the hospital. I
cannot give you my personal number
because our relationship ends as we
discharge you today. We do not
want to see you back in the hospital,
but that’s in a good way because we
don’t want you to go back to your
previous behaviors.” “Rest assured, all
the memories I will forever remember
how we worked together in making
you a better person.”
BARRIERS IN NURSE-PATIENT RELATIONSHIP
1. Transference and Countertransference
Transference Countertransference
The patient develops The nurse develops
feelings towards the feelings towards the
nurse. patient.
● The feelings involved in transference and
countertransference are feelings from
previous relationships or experiences.
● Example of Transference: Takot na takot
yung patient kay nurse dahil nakikita ng
patient kay nurse ang tatay niyang abusive.
Hindi na nagiging effective ang relationship
dahil dito.
● These are both unconscious behaviors. Both
the nurse and patient are unaware.
● If the patient develops transference, the
nurse should increase the patient’s insight
about what he or she is feeling or
experiencing.
● To minimize countertransference, increase
self-awareness.
● If the nurse develops countertransference,
seek the help of a more experienced
colleague, ward manager, or nurse
supervisor.
2. Boundary Violation
● Going beyond the limits of the
therapeutic relationship.
● Example: Nakipagdate ang nurse sa
patient, pinapautang ng nurse ang
patient, hiningan ng nurse ng pera
ang patient
● According to Mary Townsend, if the
patient gives the nurse money, do not
accept. If the return of money is not
possible, the best thing to do is to
share that gift to the other team
members who have cared for the
patient or donate it to charity.
● Can accept simple things as long as
the patient is not using it to bribe you
Communication can be:
3. Resistance
● Patient is having ambivalent feelings
towards treatment or recovery.
● Resistance is the client’s struggle
against change.
● The patient is not resisting the nurse
but the big change that will happen
to him or her after the treatment or
procedure.
3. Channel
● Method of communication
● Example: Texting, virtual meetings,
messaging, email, snailmail, phone
calls, face to face conversation,
television, radio, magazines,
newspaper
4. Receiver (Decoder)
● The one that receives the message.
● The role of the receiver is to
understand and decipher the
message.
5. Feedback
● Once the receiver understands the
message, the receiver can give a
message back to the sender. That
message is called feedback.
CONTENT VS. CONTEXT
Content Context
Actual words that are The setting of the
being said or discussed conversation.
in the conversation.
PART 2
Verbal
● From the word verbo, meaning words.
● Communication with the use of words.
● Words can either be spoken or written.
● Sign language is part of verbal.
○ Every movement of the hand
corresponds to a specific word or
phrase.
● Example: Text messages

COMMUNICATION
● Exchange of information between
individuals or two parties.
● Communication is a two-way process.
Elements of Communication
1. Sender (Encoder)
● The one that gives information or the
message.
2. Message
● The information
Non-verbal
● Gestures is non-verbal. It doesn’t mean
two
anything.
● Type of communication that uses wordless
messages.
● Vague, needs interpretation
● More than 90% of messages are non-verbal.
● More reliable than verbal communication.
○ Example: when a person says I love
you but their gestures do not
correspond to their words.
● Can emphasize verbal communication.
Page 10 of 33
● It can also contradict verbal communication.
If they contradict each other, we must
believe the non-verbal.
● It can substitute verbal communication.
○ Example: Not replying to a message
is a message itself, kapag mahaba
magreply, kapag sunod sunod
magreply, using all caps
● Non-verbal includes emojis, emoticons, and
stickers.
● Non-verbal messages has an FPEKT on our
communication
FPEKT
Facial Expression
● We express our moods through our facial
expressions. Affect is the outward expression
of our mood.
● Facial expressions can convey different
messages.
Paralanguage/Proxemics
● Proxemics is the distance between two
individuals who are communicating.
● 4 Distance Zone
○ Intimate zone (0-18 inches)
■ Commonly used by lovers
■ Lovers having an intimate
time together, friends
whispering to each other,
parents carrying their children
■ Can be used in nursing in rare
cases.
■ It is not always applicable.
■ It is dangerous for the nurse to
use the intimate zone when
interacting with the patient.
■ Nurse-patient relationships
usually fall under personal
and social zones.
○ Personal zone (18-36 inches)
■ Commonly used by family
and friends
○ Social zone (4-12 feet)
■ Business or work setting
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■ Doctor’s appointment,
applying for a bank account
○ Public zone (12-25 feet)
■ Distance between a speaker
and an audience
■ Teacher in a classroom,
politician attending their
campaign rally
● Paralanguage: words change meaning
depending on how it is said.
● Paralanguages include volume, speed,
intonation, and pitch.
Eye Contact
● Eye contact conveys truth, honesty, and
integrity.
● Do not stare at your patient because it
causes fear and anxiety.
● Break eye contact every now and then.
Kinesics
● Kinesics is the use of gestures and body
movements.
● The way you walk, stand, sit, and move
● Maintain an open posture when interacting
with the client.
● Active Listening SOLER
○ Sit squarely - Dapat pantay ang
kamay at paa, do not cross arms and
legs
○ Open posture - Accepting gestures,
not defending
○ Lean towards the client - It means you
are interested. If you are leaning
back, it shows disinterest.
○ Eye contact - Do not stare
○ Relax - No fidgeting.
Touch
5 Types of Touches
1. Functional
● The touch you do when performing
nursing intervention or assessment
● Example: Palpation and massage
2. Social Polite
● Touch used in social circumstances
● Example: Mano, shake hands
3. Friendship Warmth
 ● Example: Beso beso, fist bump NON-THERAPEUTIC COMMUNICATION TECHNIQUES
4. Love Intimacy ● Barriers to an open communication
● Touch used for special persons ● Hinders the exchange of information
5. Sexual Arousal between the nurse and the patient.
● Sexual intercourse between two False Reassurance
people. ● Giving false hope
● False reassurance is different from giving
THERAPEUTIC COMMUNICATION information.
● The effective exchange of information ● Example of giving false hope: The patient
between the nurse and the client. with stage 4 cancer asks the nurse, “Nurse, sa
tingin mo gagaling pa ako?” and the nurse
Characteristics of Therapeutic Communication answers, “Ay oo naman. Dasal lang yan,
tapos inom ka lang ng gamot, pahinga ka.
1. Patient-Focused
Baka next week makakalabas ka din.
● The expression of the patient’s
Mawawala din yang cancer mo.”
thoughts, feelings, and ideas is the
● Assurance: Realistic
focus of therapeutic communication.
● False reassurance: Unrealistic
● It does not focus on the nurse’s
needs, but the patient’s needs.
Approval
2. Promotes Trust
● This technique may sound therapeutic, but it
● Do not lie to the patient. They can
is not. Example: wow, very good, I like what
easily detect it and it can destroy the
you did there, I approve of that, fantastic,
trust in the relationship.
absolutely.
● The nurse can divulge personal
● In nursing, we promote independence as
information but not too much.
much as possible. Saying words of approval
● Self-disclosure: Nurse shares personal
makes the patient dependent on the nurse’s
information to the patient.
comments. Nagiging purpose ng patient is to
● Self-disclosure is okay, but it should be
please the nurse.
limited. After telling information
about yourself, go back to the
Rejecting/Belittling
patient’s problems.
● Example: I don’t like that
3. Prejudice is avoided
● Belittling: Invalidating the patient's feelings.
● Do not judge the patient.
● Belittling the patient’s needs and wants.
4. Promotes healing/change
● Belittling or rejecting can mean belittling or
5. Purpose
rejecting the patient’s feelings.
● The purpose of therapeutic
information for the nurse is to gather
Giving Advice
information about the patient.
● If the patient has problems, do not give
● If the nurse knows more information
advice. We don’t want our patients to be
about the patient, the nurse will
dependent on our advice.
understand the patient better, the
more the nurse can help the patient.
Why
Therefore promoting a change in the
● If there is why, it is usually non-therapeutic
behavior of the client.
because why demands an answer.
● The purpose of therapeutic
● It will make the patient feel that he or she has
communication for the patient is to
done something wrong.
express emotions or feelings.
● It will make them defensive on their answer.
Therefore it promotes healing.
● Instead of bakit, say “Ano po ang dahilan?”
● Can be used in an actual conversation.

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Threat
● The patient will follow you not because she
trusts you but because she is scared of you
because you threatened her.
Simplifying:
● Nurse's opinion, why, and threats are non-
therapeutic.
THERAPEUTIC COMMUNICATION TECHNIQUES
Exploring
● Digging deeper into a subject or idea,
especially if the patient’s answers are
superficial.
● Example: “Please explain that situation in
more detail” “Tell me more about that
particular situation.” “Can you give more
information about that?”
● Exploring is somewhat different from focusing
but technically they are the same technique.

Broad Opening
Offering Self
● This technique allows the client to take
● “I’ll stay with you awhile.” “I will accompany
initiative on what topic he or she wants.
you to the X-RAY room.” “We can eat our
● Makes the patient decide on what he or she
lunch together.”
wants to discuss.
● Making oneself available for the patient.
● For example, the nurse asks, "what do you like
● Giving time for the patient increases the
to talk about today?" This emphasizes the
patient’s self worth.
client's role in the conversation, that he or she
is the focus of the communication.
Observation
● It engages the patient in a very meaningful
● Example: “You seem tense.” “I notice you are
conversation.
pacing a lot.” “You seem uncomfortable
● This technique is a good way of starting a
when you..”
conversation.
● Saying what you see, stating the obvious, or
○ Example: “Hi, is there anything you
simply acknowledging.
would like to talk about today? Is
● Observation should be used instead of
there anything you want to tell me?”
rejecting, invalidating, approval.
● Increases the patient’s self worth.
General Leads
● This offers the client to continue.
Stating the Obvious
● Example: Uh huh, and then, and after that,
yes, I see, go on
Giving Information
● It encourages the client to continue.
● Health teaching
● Example: Giving information about the
Silence
disorder, medication, schedule of the patient
● Silence can’t be used to start a conversation.
for today.
● It gives the patient an opportunity to think. If
the nurse is silent, then the patient can
Presenting Reality
organize his thoughts and convert his
● Example: The patient says, “Nurse I’m hearing
thoughts to feelings or the other way around.
voices.” The appropriate nursing response
Then the patient can understand his feelings
should be “I understand that the voice seems
or organize his thoughts and know what to
real to you, but I do not hear any voices.”
say.
● It gives the patient a signal that it is his or her
Focusing
time to talk.
● Do not overuse silence. It will give the patient
Accepting
anxiety.
● Example: “Yes, I understand what you said.”
● Eye contact, nodding

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Clarifying ● The first six years of life are crucial
● We use clarifying if the patient said years in the development of
something vague, mumbles, or neologism. personality.
● Neologism: Newly coined word or expression
● Example: “I’m not sure that I understand. 3 LEVELS OF CONSCIOUSNESS
Would you please explain?” “Tell me if my Stores our thoughts, feelings, and ideas.
understanding agrees with yours.” “Do I 1. Conscious
understand correctly that you said..?” ● This is where we store our thoughts,
feelings, and ideas here and now.
Reflecting ● Whatever you are feeling, doing or
● Throwing back questions smelling in this very moment is part of
● Example: Patient asks, “Nurse, sa tingin mo our conscious awareness
ba kailangan ko to sabihin kay doctor?”
Nurse replies, “Sa tingin mo kailangan mo 2. Preconscious
sabihin?” ● Memory that can be easily recalled.
● Example: Dinner yesterday
Restating
○ Paraphrasing 3. Unconscious
○ Repeating the patient's idea in your ● Memory that cannot be easily
own words or using their own words. recalled.
○ Patient: Nurse gusto ko na kumain. ● Example: Dinner 10 years ago
○ Nurse: Ah nagugutom ka na! ● Can still apply knowledge and skills in
practice because it is now automatic
responses.
THEORETICAL MODELS OF PERSONALITY ● Childhood memories occupy the
DEVELOPMENT biggest part of our mind and
although we cannot remember
SIGMUND FREUD them, they are the biggest influence
● Father of Modern Psychology in our behavior.
● Father of Psychiatry ● Psychologists can access the
● Theory is Psychoanalysis unconscious part of the mind using
● The stages of development according to hypnosis or hallucinogens.
Sigmund Freud is psychosexual stages.
Summary:
A. PSYCHOANALYTIC THEORY Conscious
● Supports the notion that all behavior ● Here and now
can be explained. In other words, all Preconscious
personalities, whatever their ● Memory that is easy recalled
behavior is, is caused by something. Unconscious
● Every behavior has meaning, ● Biggest part of our mind
explanation ● Cannot recalled
● Behavior is motivated by unconscious
processes. PERSONALITY COMPONENTS
● The unconscious processes in our
1. ID
mind were acquired during our
● Id signifies pleasure
childhood years.
● It is the part of the personality that
● Our behavior, personality is rooted in
focuses on pleasurable experiences.
our childhood experiences.
● It is the part of the personality that is
impulsive.
● Id is our instinct.
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 ● ID: “I want it and I want it now.”
○ It cannot wait
● It wants all pleasurable things.
● Example: Eat, sleep, coitus
● Pleasure seeking part of
personality.
2. EGO
● The balance between id and
superego.
● Ego is yourself.
● Always based on reality.
● Always wants what is true, real, or
practical.
● It reflects mature or adaptive
behavior.
3. SUPEREGO
● Exact opposite of id.
● Corresponds to ethics or morals.
● Develop based on parents' teachings
and societal norms.
● Preoccupied with rules and
regulations.
● SUPEREGO: “I should not do that kasi
bawal.” “I should do this because this
is the right thing to do.”
● Always follow what is right.
What age do they develop?
ID: Present at birth, id-driven at birth, all infants want
pleasure
Ego: Develops within the first 4 to 6 months of life,
when a person develops concepts of self, realize self
is a separate entity from the environment
Superego: Develops within 1 to 6 years old.
Id, Ego, and Superego from the Concept of
Procrastination
● Integrative Capacity: Balance of pleasure
and morals
● Id is a fake pleasure, because behind the
pleasure is guilt, anxiety, fear, and dread.
the
DYNAMICS OF PERSONALITY
● The 3 personality components hold psychic
energy called LIBIDO.
● Id is the first to appear.
● At birth, id will have most of the libido.
● Id ang nasusunod this is why all infants do is
eat, sleep, and cry.
● After 6 months, the child will have the
concept of self.
● Ego will appear and take more than half of
the libido from the id.
● Ego can then control the id.
● Superego is the last to appear.
● Superego develops within the first to sixth
years based on the teachings of parents,
society, teachers
● Once superego appears, the power is equal
between id, ego, and superego
● If there is an imbalance
○ If id has more libido, id is more
dominant, that person can develop
mania, ADHD, narcissistic personality,
and antisocial personality.
○ If superego is more dominant, that
person can develop depression,
anxiety disorders, eating disorders,
and avoidant personality.
- If ego is weak and cannot balance id
and superego, it leads to psychosis
and that person will lose touch with
reality, or anxiety in simple situations
In situations that cause anxiety, the ego uses ego
defense mechanisms.
EGO DEFENSE MECHANISM
● Ego defense mechanism is normal.
● If it is overused it becomes abnormal.
● It is both conscious or unconscious behavior.
● Purpose
○ Protects the ego
○ Protect the self-esteem
○ Decreases anxiety
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● Denial: Refusal to admit an unacceptable
idea or behavior or situation.
○ Refusal to accept something that
causes anxiety.
○ Denial is normal
○ If it is overused it is abnormal.
● Displacement: Discharging pent-up feelings
to a less threatening object.
○ Discharging pent-up feelings to an
object, animal, or person.
○ Example: Pag inutusan tas ayaw
sumunod magdadabog
○ Pinagbuntungan ng galit
○ Displacement is the defense
mechanism used by abusers, bullies
○ The patient removed herself from her
conscious awareness.
○ Normal dissociation: If the patient
regains awareness after a few days.
○ Abnormal Dissociation: If the patient
develops dissociative amnesia,
dissociative identity disorder.
● Identification: Conscious patterning of self
from a respected person to increase self-
worth.
○ Imitating your idol
○ Example: May idol ka na professor
and you pattern your life with that
professor para masundan mo mga
achievements niya.

● Repression: Unconscious and involuntary ● Sublimation: Channeling instinctual drives

forgetting of painful ideas, events, and into acceptable activities
conflicts. ○ Channeling instinctual drives to less
○ Hindi sinasadyang paglimot, threatening or socially acceptable
nakalimutan actions.
○ Without conscious effort
● Reaction Formation: Expressing behavior that
● Suppression: Conscious and voluntary is the exact opposite of an unconscious
forgetting of painful ideas, events, situations. feeling.
○ Forgetting, sadyang pagkalimot, ○ Telling another person the opposite of
kinalimutan what you are feeling.

● Rationalization: Attempts to prove that one’s ● Introjection: Incorporating values and

behaviors are justifiable. attitudes of others.
○ Simple reasoning
○ Bakit ka late? Traffic eh ● Compensation: Covering up for weakness by
making up a desirable trait.
● Intellectualization: Using logical
explanations/intellectual concepts without ● Undoing: Doing something to make up for a
feelings. wrongdoing.
○ Detailed or logical reasoning
○ Bakit ka late? Kasi ang ekonomiya ng ● Projection: Placing one’s unethical desires,
pilipinas ay napakasama etc. thoughts or wishes to someone else.

● Dissociation: Separation of painful feelings ● Conversion: Emotional problems are

and emotions from an unacceptable idea, converted into symptoms
situation or object.
○ Common in victims of traumatic ● Regression: Returning to an earlier
events, such as witnessing a murder, developmental phase in the face of stress.
being physically abused and or
raped
○ Paglilibang, watching a movie,
reading a book are also dissociation

Page 16 of 33
 PSYCHOSEXUAL STAGES DEVELOPMENT ○ The child develops object
Phase Age permanence because of peek a
Oral 0 - 1 y/o boo.
Anal 1 - 3 y/o ○ The child will also have a sense of self
Phalic/Oedipal 3 - 5 y/o that is separate from the environment.
Latency 6 - 12 y/o ○ What type of play is appropriate for
Genital 13 y/o - above
children to develop self that is
separate from the environment?
Mobiles.
ERIK ERIKSON
○ It is called sensorimotor because we
use senses to move things so that we
PSYCHOSOCIAL THEORY can understand better.
● The social struggles we experience as we
grow or mature influences our personality.
● 2nd Stage: Pre-Operational (2-7 y/o)
● Social processes influence personality.
○ Egocentrism: Self-centeredness
● In each stage, the person will undergo a
○ Can only see the world through their
developmental crisis.
own perspective.
■ Ikaw lang lagi ang tama
Age Stage
■ Dapat ikaw ang masusunod
0 - 1 y/o Trust vs. Mistrust
1 - 3 y/o Autonomy vs. Shame & ○ What type of play is appropriate?
Doubt Parallel play
3 - 5 y/o Initiative vs. Guilt ■ Magkasama silang naglalaro
6 - 12 y/o Industry vs. Inferiority pero magkahiwalay.
12 - 18 y/o Identity vs. Role ■ Pareho ng laruan pero
Confusion magkahiwalay silang
18 - 25 y/o Intimacy vs. Isolation naglalaro.
25 - 65 y/o Generativity vs.
■ Hindi sila pwedeng magsama
Stagnation
kasi nag aaway.
65 above Ego Integrity vs. Despair
■ Bakit magkapareho sila ng
laruan? Para walang inggitan
○ The child will also have the concept
JEAN PIAGET
of irreversibility.
○ Irreversibility: They cannot reverse
THEORY OF COGNITIVE DEVELOPMENT
mathematical equations, what they
● Father of Child Psychology
know or learned.
● As children grow up, we acquire a better
○ Can use language or symbols
understanding of the world.
■ They can understand the
gesture of their parents.
Age Stage
0-2 Sensorimotor
2-7 Pre-Operational ● 3rd Stage: Concrete-Operational (7-12 y/o)
7 - 12 Concrete - Operational ○ Concrete thinking: Can use early
12 - Adulthood Formal Operational logic but can only apply it to
concrete situations.
● 1st Stage: Sensorimotor (0-2 y/o) ○ Cannot imagine logic
○ The child will learn about object ○ Still think literally.
permanence. ○ The child will have the concept of
○ Object permanence: The object conservation.
exists whether they can see it or not. ○ Conservation: Knowing that the
essence of something remains

Page 17 of 33
 constant, knowing that the surface
feature will change.
○ Classification: Classify objects,
people, animals, work
● 4th Stage: Formal-Operational (12 y/o -
Adulthood)
○ Can think in abstract terms.
○ Attention is improved.
○ Memory is becoming more efficient.
○ Sanay na sa logical thinking not in
concrete terms.
○ Can use imagination, hypothesis,
scientific methods
○ Adolescent Egocentrism: They can
have an imaginary audience.
■ Feeling nila pinapanood sila
ng lahat ng tao.
● Personal fable: They think they are
indestructible.
○ Adolescents usually engage
in risk taking behaviors
because they think nothing
will happen to them.
PART 3
Difference Between Freud and Erikson’s Theory
Freud: Psychosexual Stages of Development
Erikson: Psychosocial Stages of Development
Psychosexual Theory – 5 Stages
The child will have a body part of focus
wherein the child will gain sexual gratification
of his needs.
For example, the first stage is oral. The body
part of focus is the mouth.
In every stage, there is a body part of focus.
Psychosocial Theory – 8 Stages
o Social interaction, social involvement is
critical in the development of the personality.
o Per stage, there is a developmental task we
achieve through social interaction.
o For example, the first stage is trust vs mistrust.
The task is to develop trust in the primary
caregiver.
0 - 1 INFANCY
ORAL STAGE
o The body part of focus is the mouth.
Page 18 of 33
o The infant satisfy their oral needs through
biting, sucking, chewing
o Breastfeeding is better in satisfying the oral
needs of an infant.
TRUST VS MISTRUST
o The primary caregiver, for example
the parents, must attend to the child’s needs
to develop trust.
1 - 3 TODDLER
ANAL STAGE
The body part of focus is the anus.
AUTONOMY VS SHAME AND DOUBT
The child will develop autonomy by
achieving a sense of control.
The toddler can learn to control the bowel
and bladder
The major task in the toddlerhood stage is
toilet training.
Signs that the child is ready for toilet training
are if the child can walk, if the child can sit
because the leg muscles for standing and
sitting develop at the same time with the
muscles that control the bowel and bladder.
In other words, the toddler must learn about
excretory functions.
Toilet training is important in the
development of id and superego.
Depending on how the parent will train the
child, the child can grow into an obedient or
a disobedient person or something in
between.
The three types of toilet training are:
1) Strict or Rigid: Type of toilet training that is
punishing to the child
 Strict or rigid toilet training usually
results to fecal retention or
constipation and adult retentive
personality in adulthood.
 Superego is dominant.
 The person with adult retentive
personality is obedient, clean,
organized, and stingy.
2) Loose: Defecate in inappropriate places or
time.
  They will develop adult expulsive
personality as an adult.
 The person with adult expulsive
personality is disobedient, dirty,
disorganized, and malevolent.
 This is the id dominant personality,
underdeveloped superego.
3) Permissive: The parents are accepting of
whatever the child is doing or experiencing
during the toilet training.
 Permissive is in between strict and
loose training.
 Since the parent is accepting, the
child will feel important.
 Since the child feels important, the
child will have a desire for feces
production to satisfy the parents.
 The child as a grownup will be an
extrovert, productive, and even
selfless.
3 - 6 PRESCHOOL
PHALLIC STAGE
 The body part of focus is the penis.
 Both girls and boys will focus on the penis.
 They will discover the difference in sex
organs.
Oedipus Complex:
 The boy is in love with the mother and wants
to compete with the father for her attention.
 Oedipus complex is usually resolved if the
boy identifies with the father.
o This defense mechanism
identification.
 Castration Complex: Fear of castration
o Castration complex develops if the
male child is threatened with
castration.
 This is the root cause of exhibition disorder in
adults.
Elektra Complex:
o The girl is in love with the father.
o Elektra complex is resolved if the girl identifies
with the mother.
o The child as an adult will develop penis envy.
o Oedipus attachment or elektra attachment:
Oedipus complex or elektra complex is not
resolved and that child is now an adult.
The child as an adult will look for a potential partner
with the same characteristics as the mother or
father.
INITIATIVE VS GUILT
The teacher, parents is the most significant person in
the preschool years.
6 - 12 SCHOOL-AGE
LATENCY STAGE
 There is no body part of focus.
 Sexual desire is latent because children focus
on school, sports, play, and socialization.
 School-age children have same-sex friends.
INDUSTRY VS INFERIORITY
 The child will develop industry if they
get satisfying grades.
12 - 18 ADOLESCENT
GENITAL PHASE
o The body part of focus is penis and vagina.
o Boys and girls have different focus.
o This is the last stage of psychosexual stages of
development.
IDENTITY VS ROLE CONFUSION
o The main task is to develop self-identity.
o This is where most big decisions are made.
o Adolescents achieve sexual maturation.
They are now capable of achieving orgasm.
o They want to have a sense of uniqueness.
They want to be unique.
is o Ex. They want to have different outfit
from others
18 - 25 YOUNG ADULT
INTIMACY VS. ISOLATION
o The main task is to develop intimacy.
o The person will develop intimacy through
commitment with other people, career job or
pet.
25 - 65 MIDDLE ADULT
GENERATIVITY VS STAGNATION
o The main task is to help establish the next
generation.
o Generativity is wanting to contribute to the
next generation.
Page 19 of 33
 o Stagnation is being selfish and not wanting to o Moderate anxiety is also focused but
share with other people. sometimes it can focus on the wrong
thing
65 - ABOVE OLD ADULT OR ELDERLY o It is good if the focus is on the right solution to
EGO INTEGRITY VS DESPAIR the upcoming problem.
o Must achieve tasks before death. o If the patient is focused on the wrong thing,
o Persons with ego integrity are satisfied with redirect the attention.
their life.
o These people are not afraid of death Severe
and are ready to die. Manifestations: Focused on Signs and Symptoms
o Persons in despair are not ready to die, regret o Stomachache
the life they have lived, and want to live o Difficulty of breathing
longer because they feel they want to o Headache
achieve more. o Sweating
No longer focused on the problem.
The person is focused on the s/sx you are
ANXIETY AND OTHER RELATED DISORDERS experiencing

ANXIETY VS FEAR Panic

Anxiety Fear Manifestation: Personality Disorganization
Vague feeling of dread Being afraid or o Cannot think clearly anymore.
or apprehension. threatened by
o Most dangerous level of anxiety.
something.
o The person becomes irrational.
Emotional response It is not an emotion, but
a cognitive or o Ex. Di ka na nakagalaw pag may fire sa
There is no real threat intellectual response. harap mo
but feels
uncomfortable Therefore, it is a product Interventions for: Severe and Panic
of thinking. o Safety is the priority
Example: Examination
o The initial action is to stay with the patient.
UNCLEAR Cause Has a clearly
o Next option is to minimize the environmental
identifiable cause.
The reason is usually stimuli.
unknown.
Notes:
PEPLAU’S LEVEL OF ANXIETY
Mild Anxiety Priority
Manifestations: Attentive and Alert If the question asks for priority intervention, safety is
o It is good to have mild anxiety when studying. incorrect.
o It makes learning faster, thinking clearer, and
solving problems easier. o Priority concern: Safety
o Intervention: No need for intervention o Priority nursing diagnosis: Risk for injury
because mild anxiety is an asset o Priority nursing intervention: Stay with the
patient
Moderate: o Initial goal for patient with high level of
anxiety: Decrease the level of anxiety
Manifestations: Selective Attention/Tunnel
o How will you minimize or decrease the
Vision/Decreased or Diminished Perceptual Field
patient’s level of anxiety? Minimize
o Selective attention is focused on the task.
environmental stimuli.
o Focused on one task at a time.
o Anxiety is normal if it is related to a realistic
o Tunnel vision can see the big picture.
threat or danger.
o Intervention: Redirect attention

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 o If anxiety disappears once the threat o If the disorder worsens, the patient will
disappears, then the anxiety is normal. eventually have agoraphobia.
o Agoraphobia is the worst panic disorder.
o Agoraphobia: Fear of open spaces
Anxiety is pathological: o Most literal definition: Fear of
1. If out of proportion to the situation that is marketplace
creating it.  Agora means market
2. Interferes with social, occupational, or ADL  Phobia means fear
performance.  Another definition of
agoraphobia: Fear of being
TYPES OF ANXIETY DISORDERS alone outside of home

GENERALIZED ANXIETY DISORDER (GAD)

o The worst type of anxiety.
o Has anxiety on everything.
o Chronic, unrealistic, excessive anxiety and
worry.
o This disorder lasts for a minimum of 6 months
or more.
o It can last for years.
o The patient becomes anxious about
everything in life. Treatment for Panic Disorder
o Most of the time the patient suffers from 1. Cognitive Behavioral Therapy
anxiety. More than 50% of the time. 2. Medications

PANIC DISORDER
o Recurrent episodes of panic attacks PHOBIA
o Panic attacks: Main manifestation of patients o Illogical, intense, persistent fear cued by the
with panic disorder. presence or anticipation of an object or
o Possible: situation
o elevated blood pressure o Illogical fear of an object or situation
o Difficulty of breathing o The fear is not a result of a previous bad
o Dilated pupils experience.
o Shortness of breath o The fear is just there, without any reason.
o Episodes that usually last for 15 to 30 minutes o Can cause extreme distress to a person
of intense and rapidly escalating anxiety. o There are three general types of phobia.
o Panic attacks are usually unprovoked,
happen out of nowhere, unpredictable
3 Types
o For example: Nasa trinoma ka ng 10 am at
A. Agoraphobia
ikaw pinakauna tao kaya wala dahilan na
- Fear of being outside the home, fear
maging anxious ka. Bibili ka ng t-shirt tapos
of open spaces, marketplace
naisip mo may something na di ka sure na
mangyayari kasya nagpasundo ka nalang
B. Social phobic
sa parents mo kasi di mo na alam gagawin.
- Fear of anything public
o Followed by 1 month of excessive worry for
- Public space, public speaking, eating
future attacks
at a restaurant, using public
o Anticipatory anxiety: Worry for future attacks
transportation, public toilet
o Avoidance behavior: Avoiding the place of
- Anything that has to do with people
previous panic attack.
interaction.

Page 21 of 33
 C. Specific Phobia o There's actual exposure to the
4 Subtypes: actual phobia.
1) Animal type o The snake will expose to you
until the fear or phobia
o Includes people, bacteria
mawala
o Living things ● Goal is to treat the phobia in 1 to 2
o Zoophobia sessions only.
● Contraindicated in patients with
2) Natural environment heart problems.
o Dagat, madadamong lugar, ● Exposure is based on the level of
takot tumapak sa lupa progress.
● Eventually the patient will realise that
3) Blood-injection there is nothing to fear.
o Hemophobia and takot sa injection
2. Systematic desensitization
4) Situational ● Serial desensitization
- Fear of the dark, fear of enclosed ● Gradual or progressive exposure
space ● First is exposure to pictures, second is
exposure to video, third is realistic
Naming of Phobia toys, then finally the object.
Latin term of specific object + phobia ● Anxiety must be resolved per stage.
● Learn relaxation techniques
● 1 session

OBSESSIVE-COMPULSIVE DISORDER
Two Problems:
1. Obsessions
2. Compulsions

Obsession: Unwanted, rude, intrusive, persistent

idea, though, or mental image, or simply thoughts
o These thoughts cause the person high levels
of anxiety.
o The person will decrease anxiety by
Acrophobia: Fear of heights performing repetitive behaviors.
Murophobia: Fear of rats
Ophidiophobia: Fear of snake Compulsion: Repetitive behaviors or ritualistic
Coulrophobia: Fear of clowns actions
Hippopotomonstrosesquippedaliophobia: Fear of o It is abnormal if it affects ADL
long words
The appropriate nursing diagnosis for patients who
cannot control their rituals is powerlessness.
Treatment of Phobia

The patient uses undoing or displacement as a

Exposure Therapy
defense mechanism.
2 types:
1. Flooding or Implosion
Undoing - a person tries to cancel out or remove an
● Rapid desensitization
unhealthy, destructive or otherwise threatening
● Exposure to the actual phobia until
thought or action by engaging in contrary behavior.
the fear dissipates.
Source: Google
 Implosion

Page 22 of 33
Displacement - Kapag meron siya unexpressed Social Isolation
emotion, dina-direct niya sa ibang gawain like Powerlessness
handwashing Fear - For phobia

Common Compulsions
Nursing Interventions CALMER approach
Cleaning
For Anxiety
Hand washing  Calm Manner (approach px with this
Checking attitude)
Hoarding o Use low pitched, calm and soothing
Being meticulous voice
Ordering
 Administer medications
(DSM 5, 2013)
o Antianxiety (clonazepam, diazepam)
Praying o Antidepressants (SSRI, TCA)
Counting o Antihypertensive medications
Repeating words silently (clonidine)
 Let the patient verbalized their feelings or
OCD Treatment emotions
 Minimize environmental stimuli
1. Ordered medications  Quiet environment
o Antianxiety and antidepressants  Far from the nurses’ station
o Common antidepressant for OCD is  Ensure safety
anafranil o If a patient is in a severe or panic
attack of anxiety, do not leave the
2. Cognitive Behavioral Therapy patient.
 Remain or stay with the px/ Restrain
2 Parts:
If these are all ineffective for calming the patient and
Exposure: Cognitive part that targets obsession can be seen as danger to others or self, the last resort
o The therapist will ask the patient with then will be the RESTRAIN
germophobia to touch things that are Restraint - need doctor’s order
unsterile and will not allow them to perform
rituals.
o After exposure, teach patient to perform POST-TRAUMATIC STRESS DISORDER (PTSD)
relaxation techniques A syndrome that develops after exposure to a
traumatic event.
Response Prevention: Targets compulsion
o Not allowed to perform rituals Exposure to a Traumatic Event
o Performs deep breathing exercises and o Seen
guided imagery. o Heard
o Involved in
3. Do not interrupt the rituals
o If the patient is not undergoing cognitive Examples of Traumatic Events
behavioral therapy War, Violence, Sexual Abuse, Accidents, Witnessing
o The patient uses the ritual to decrease Deaths (shell shock) - (common in nurses and
the anxiety If the ritual is affecting ADL, soldiers), Terrorism, Fire, Natural Disasters, other
the nurse can: crimes
o Adjust the schedule of the patient
o Minimize the time for ritual Criteria
performance Must have exposure to a traumatic event before
onset of behavioral manifestations.
Nursing Diagnoses for Patients with Anxiety
Anxiety
Ineffective Coping
Ineffective Role Performance
Page 23 of 33
 Manifestations:
 Persistent recurrent:
o Reexperiecing the trauma
 Unwanted thoughts,
Nightmares, flashbacks
 Arousal symptoms
 You are easily startled and
agitated
 Hypervigilance (praning)
 Avoidance and Numbing* (tinanggal
nasa DMV-5 yung *)
 Numbing misinterpret as
decreased sensation
 What they mean is decreased
in emotion, and persistent
negative thoughts and mood
 Avoidance - avoiding anything
associated with trauma
 Persistent Negative Thought and Mood
 Negative emotional state
 Inhale for 2 seconds → stop breathing
for 2 seconds → exhale for 2 seconds
→ stop breathing for 2 seconds
B. Progressive muscle tensing and relaxation
 tense and relax group of muscles.
 Ex. face gradual tense the
muscle… then 1,2,3,4 gradual
relax
 Rationale: You will focus on
the task. Therefore
makakalimutan mo yung
anxiety.
C. Guided Imagery
 Assist the patient in imagining a
peaceful or relaxed scenario.
 The patient will be instructed to close
their eyes and help them to imagine
a peaceful scenario.

The time of the onset of symptoms should be Medications

specific. Anxiolytics
Anti-depressants
EXPOSURE TO A TRAUMATIC EVENT SSRI
Acute Stress Disorder (ASD) The sx occurred within 1 TCA
month after an accident/traumatic event Anti-hypertensives
 Disappears without treatment. Propranolol
 Normal reaction from traumatic event Clonidine

PTSD - within the 1st month there are no symptoms

SOMATIC SYMPTOM DISORDERS
 After 1 month or within a year after the
traumatic events, lumalabas ang mga Malingering Somatoform Psychosomatic
symptoms Pretending Not pretending Not pretending
 Delayed onset PTSD - kapag lumabas within Can control the Cannot control Cannot control
symptoms. the symptoms. the symptoms.
6 months
No real illness No real illness Possible real
illness
Treatment for PTSD Five Types:
1. Psychotherapy 1. Somatization Stress-related
1. Cognitive-behavioral Therapy Pain illnesses
2. Prolonged Exposure Therapy Conversion
Hypochondriasis Common
Body causes are
2. Psychopharmacology
Dysmorphic stomach ulcer,
o Antidepressants Disorder hypertension,
o Antiadrenergic Agents. asthma, and
o Anti anxiety migraine.
o Anti-hypertensive

Nursing Diagnosis for Patients with PTSD

SOMATOFORM
Post Trauma Syndrome
o Real experience of symptoms but there is no
real illness, there is no evidence of physical or
Relaxation Techniques
mental health condition
A. Breathing exercises
o Main characteristic: Presence of somatic
 Deep breathing (square breathing)
symptoms

Page 24 of 33
o Somatic symptoms: Real experience of 5. Body Dysmorphic Disorder *
symptoms and there is no physical or mental o classified now as Anxiety Disorder
illness  Dysmorphobia (new term)
o Somatoform disorders are usually chronic  Preoccupation with imagined or
and recurrent exaggerated body defects.
 Common in actresses or artists.
Normal ka tignan sa ibang tao pero
Types: sa sarili mo may problema ka sa lips,
1. Somatization Disorder nose, eyes
 a.k.a. Somatic Symptom Disorder (new term)  They undergo relentless plastic
 Main characteristic: Multiple somatic surgery.
symptoms. This symptoms starts before the o Because everytime na
age of 30 ipapaayos niya yung
a. Involves GI functions, sexual function, something sa mukha niya,
heart, respiratory symptoms (sabay may bago siyang makikita na
sabay) mali ulit sa mukha niya
b. Patient may have persistent thoughts
c. If the person is always experiencing
symptoms then the person will
Etiology of Somatoform Disorders
experience also an anxiety where it
affects his life
1. Neurobiological Theory
2. Pain Disorder*  Problem with serotonin and other
endorphins (low levels)
o not included in DSM-5 anymore
 These two decrease the level of pain
 Characterized by pain that is
 Decrease level of these two
unrelieved by pain medications
neurotransmitters increased the pain
 It just involve one part - headache
or exaggerating something that
(most common)
causes this disorder

2. Psychological Theory
3. Conversion Disorder
 According to Sigmund Freud, they
o a.k.a Functional Neurological Disorder / are experiencing internalization or
Pseudoneurological (new term) cannot express their emotions.
o Sudden Unexplained neurological condition  The more unexpressed emotions we
o Usually this is because of psychological have, one day these emotions will
conflict burst and may result in psychiatric
o La belle indifférence - lack of concern with disorders.
the sudden deficit  Can’t expressed emotions→ body
expressed emotions→ signs and
4. Hypochondriasis symptoms
o Illness Anxiety Disorder (new term)  Patients may have primary gain and
o It's not experiencing any somatic symptoms. secondary gain
o Doctor Shopping - iniisip niya meron siyang a. Primary gain - for example nagsakit-
sakit pag sinabi ng doctor na wala siyang sakitan yung patient kaya naiwasan
sakit hindi naniniwala ang px so lilipat siya ng niya yung source of anxiety which is
ibang doctor para mag pacheck up ulit then your teacher
mauulit lang ulit kasi same opinion lang  Relief of anxiety
naman b. Secondary gain - attention that you
 There is a minor symptom then the will receive from your family
patient will interpret it as a serious  Excuse ka sa lahat ng gawain
illness ex. May headache lang pero c. Psychosomatic
yung tingin ng patient may brain  Not pretending to be sick
tumor siya.  Cannot control the symptoms
 Minor sx intreprets as serious illness  Upon assessment, there is a
possible of present of real illness
 Stress related illness


Page 25 of 33
  Examples: (SHAM)
o Stomach Ulcer After thoroughly assessing and there are no signs
o Hypertension and symptoms, return back to focus.
o Asthma
o Migraine
Focus of Care: Emotional expression
PHARMACOLOGIC TREATMENT Do not focus on the symptoms anymore.
SSRI - increases the levels of serotonin
Psychosomatic
Develop real illness because of stress
FACTITIOUS DISORDER
2 Types
PART IV
1. Munchausen Syndrome: Fake symptoms will
EATING DISORDERS
appear on self
Purpose is to gain attention Eating
2. Munchausen Syndrome by Proxy: Fake 2 major things we consider when we eat:
symptoms will appear on others 1. Food - Type, amount, sweet, salty, sour,
- Purpose is to gain attention and be a healthy, not so healthy
hero 2. Weight Control

Nursing Diagnosis for Somatoform Disorders Eating Disorders

Ineffective Coping  Excessive concern about food and weight
Anxiety control
Pain 2 Main type of eating disorder
Body Image Disturbance
1. ANOREXIA NERVOSA
Anorexia is simply loss of appetite. It is a
Interventions for Somatoform Disorders
symptom
Health teaching
1. Connection between unexpressed emotions Anorexia is not a disorder, but a symptom of
and signs and symptoms an abnormal condition.
o The more unexpressed emotions, the
Anorexia Nervosa on the other hand, is a disorder.
more symptoms
 Self-starvation syndrome
o The more the emotions are  Relentless pursuance of thinness
expressed, the more symptoms will  BMI: < 17.5
decrease  Normal: 18 - 24.9
 Weight: <85% of their ideal body weight
2. Alternative coping mechanisms  Sometimes anorexic patients may binge and
o Example: Music, poetry, dance, exercise, purge as well.
anything that the patient can do to
Two Types of Anorexia Nervosa
express emotions
A. Restrictive Type
 Not eating
Initial action: Assess first  Excessive exercise
Initial action for patients with hypochondriasis or
illness anxiety disorder:
B. Vomiter/Purger Type laxatives/ diuretic
 Extreme weight losing diet and ema
 Thoroughly assess the patient baka kasi may excessive exercise
real sx na like chest pain (heart attack)  They sometime binge/purge
Focus of care for patients with somatoform disorder
 Emotional expression Difference between vomiter type and bulimia
nervosa is frequency. If less than the requirement for
If the patient is complaining about any physical bulimia nervosa, then it is anorexia nervosa
illness, the first step is to assess.
Sa AN-Ilang BIP
Thoroughly assess the complaint.
Page 26 of 33
 CLINICAL MANIFESTATIONS: ANOREXIA Personal Profile of patients with Anorexia Nervosa
Amenorrhea - Absence of menstruation PAYAT
 Because they are severely malnourished, Perfectionist
their body is unable to produce the Achievers in School
hormones or proteins they need to produce Yearns thinness
menstruation. A Good Daughter/Son
 Not included as a manifestation for anorexia  More common in girls
nervosa in the DSM-5 because anorexia can  According to Mary Townsend, girls are more
also happen to males. D
conscious with their body.
Teens
No organic cause for weight loss  Common age group where they are
 Does not have any other disorder that causes diagnosed with anorexia nervosa, teens.
severe malnutrition  Toddler: Developmental stage crucial in root
 They don’t eat because of loss appetite, in cause of anorexia nervosa
fact they don't lose their appetite, its their  Because of the type of toilet training.
choice not to eat at all Rootcause:  Restrictive types have dominant
 They do not lose their appetite, ayaw lang
talaga nila kumain. S
upEREGOS superegos. That is the root cause of
anorexia nervosa
 Lose their desire to eat.  Not eating or losing weight is their
way of achieving self-control.
Obviously thin but feels fat
 Nursing diagnosis: Disturbed/Altered Body Etiology
Image

Refusal to maintain normal weight/ Refusal to Eat/ Psychoanalytic Theory

 Refusal to eat  Person with anorexia nervosa fear growing
 Consciously forget they want to eat up or achieving sexual maturity.
 The defense mechanism used by anorexic  Girls will try to reject the feminine features
patients is suppression that they have (chest and hips), they want to
 They also refused to acknowledge the achieve their pre-pubertal body.
seriousness of their problem  They will make themselves smaller by not
 They are usually unaware or in denial eating.
 Intense fear of weight gain - Main problem
Family Systems Theory
Epigastric pain a) Overprotective family
 When you are not eating, you can have  A.k.a Family enmeshment
ulcer or hyperacidity  Family that has no clear
 Even if you don't eat your stomach is still boundaries
producing hydrochloric acid  Lahat pinapakialaman ng
 Because they are not eating, their stomach is parents sa anak nila.
constantly producing gastric acid.  In attempt to be autonomous
and independent, they
EXcessive Exercise control their eating habits
 Anorexic patients usually die because of thus, weight loss can be
excessive exercise, purging because they will observe
have fluid and electrolyte imbalance that
may cause hypokalemia and hyponatremia
b) Chaotic Family - magulong family
Intense fear of weight gain o Many emotional problems
 Main problem o For them to forget or express their
emotional problems, they will focus
Always thinking about food on not eating and weight losing.
 They are obsessed about food but they don't o They unconsciously forget their
want to eat. problems while losing weight.
 Patients have a high knowledge about
nutrients, caloric diet… because they are c) Achievement Oriented Family
obsessed, they research about it. o Very strict family
o Family obsessed with perfection

Page 27 of 33
Behavioral Theory  Another type of binge eating is restaurant
 It always connected to learned behavior hopping - pupunta sa ibat ibang resto to eat
(nakagawian)  They ashamed of what they are
 If they have emotional problems, their doing so konti lang each restaurants
coping style is not eating or weight losing.
 Weight loss or not eating is a learned
behavior of coping.
 According to Pillitteri, food should not be
used in reward and punishment because it
can turn into an eating disorder in adulthood.

Sociocultural Theory
 Effects of mass media and social media
 Pageants/Kpop Artist - they are thin and sexy  Purging: Induced vomiting, excessive use of
 Px thinks that being successful and to laxatives and or diuretics
be accepted by the society, she/he
needs to be like those people in Under strict dieting
social media
-
 According to Mary Townsend,
 They are usually within normal BMI range.
 They also control their food consumption.
famous psychiatric author, the real
beauty of the person is in the totality
of the person. Lack Control n Bingeing and Purging
 According to Sister Callista Roy, man  Because the more they control it, the more
is a biopsychosociospiritual being. they will do it.
 Appropriate Nursing Diagnosis:
Powerlessness
Neurological Theory
o High Serotonin Levels - the reason why their
Induced Vomiting
appetite immediately satisfied (madaling
 Manifestations:
mabusog)
 First observed is dental caries - due to
stomach acid from vomit
 Posterior aspect of the teeth has the
2. BULIMIA NERVOSA
most contact with the vomit. This is
where most of the dental caries are.
Bulimia
 Dentists usually discover bulimia
 Insatiable appetite
nervosa because of dental caries.
 Walang kabusugan
 Next to observe are the knuckles, if
there are lesions. This is called Russell's
Bulimia Nervosa
sign.
 Main characteristics are binging and
 Mallory Weiss Sign - Damage of the
purging.
Esophagus
 Binging and purging is not specific to bulimia
Requirement of DSM-5 to diagnose bulimia nervosa
nervosa.
is Minimum of at least 1 per week of binging and
 Patients with bulimia nervosa have normal
weight.
purging for 3 consecutive months.
1/wis for 3mos.
In DSM-4 it is a minimum of twice per week.
COMMON MANIFESTATIONS: BULIMIA
Bingeing → purging Increased Concern about food
 Bingeing: Consume a large amount of  Like anorexic patients, they are very
something in a very short period knowledgeable about food and diet.
 Binge eating: Eating a large amount
of food in a short period Aware
 They do this in private because they  They know they have a problem.
are ashamed of what they are doing.
They are aware of their eating
problem.
 They will eat it immediately

Page 28 of 33
 ETIOLOGY
1. Psychoanalytic Theory
 It starts during infancy because of their
UNMET ORAL NEEDS.
 They compensate during adult years by
overeating.
Ambivalent Feelings
 Having two opposite thoughts or feelings
 They will feel WORTHY or UNWORTHY
 Worthy - they think they deserve to eat food
that leads to over eat
 Unworthy - after overeating they will feel
guilty that leads to purging
 Defense mechanism: undoing - doing
something to make up for wrongdoing.
2. Family Systems Theory
 They have a chaotic family (due to
family problems) or over productive
family (they don’t have sense of
independence)
3. Behavioral Theory
 Binging and purging is a learned
behavior to cope with emotional
problems.
4. Sociocultural theory
 Effects of social & mass media.
5. Neurochemical Theory
 Low serotonin levels
 Appetite is slow to satisfy
NURSING DIAGNOSIS FOR ANOREXIA NERVOSA AND
BULIMIA NERVOSA
 Altered Nutrition
 Fluid Volume Deficit*
 Priority
 Self-Esteem Disturbance
 Disturbed Body Image
 Ineffective Individual Coping
NURSING INTERVENTIONS FOR ANOREXIC PATIENTS
AND BULIMIC PATIENTS
1. Educate client about the disorder and
alternate coping mechanism
 Patients with anorexia nervosa are not
aware or in denial of their condition.
 Alternative coping mechanism: Art, pets,
poetry, and any leisure activities that do
not include sleeping and eating.
2. Encourage the client to express their feelings
 Anorexic and bulimic patients have
alexithymia: difficulty expressing feelings
and concerns.
Page 29 of 33
3. Monitor the patient’s weight
 SAME TIME, SAME TYPE OF CLOTHES,
and SAME WEIGHING SCALE
 Morning after defecating and
voiding, but usually only after voiding
because it is difficult to defecate in
the morning.
4. Supervise the client during meal time
 To make sure that the patient eat all
the required food she needed
 It is better to eat with a companion.
5. Encourage patient to remain in public places
after meals (1-2 hours)
 To avoid binging and purging
 For anorexic and bulimic patients
TREATMENT OF CHOICE:
 Main treatment: Behavior modification
therapy
 Giving rewards for desired behaviors
so that it will be repeated
 Other treatments include cognitive therapy
to increase awareness of their condition
PSYCHOPHARMACOLOGY FOR ANOREXIC PATIENTS
SSRI
 Prozac
 Paxil
 Zoloft
DEPRESSIVE DISORDERS
Depression
 Mood Disorders: Alteration with emotions
 Mood - inner emotions that you have,
pervasive and enduring emotions
 We expressed mood through affect.
Mood Disorders
1. Depression
 An alteration in mood that is expressed by
feelings of extreme sadness, despair, and
pessimism.
TWO MAJOR TYPES OF DEPRESSION
1. Major Depression SEVERIT
 Disorder of SEVERITY
 Duration is shorter than Dysthymia
 Must have anhedonia for at least 2
weeks up to months for diagnosis
 Patient will have a psychotic features
such as hallucination
 Level of Depression: Mild to Sever
2. Dysthymia CARONICIM 5. Nutritional Deficiencies
• Disorder of Chronicity • Reduced Vitamin B complex, Iron,
• In DSM-5, dysthymia is persistent Calcium etc can lead to depression
• Long mood - 2 years or even more
• No psychotic features 6. Psychological Theory
• Level of Depression: Mild a. Behavioral Theory
• MILD than major depression BUT IT IS • Learned helplessness
CHRONIC • Common in people who
experienced a series of
ETIOLOGY failures.
1. Physiological theory b. Cognitive Theory
• There is a presence of clinical • Thinking
conditions • Pessimism - Patients with depression
• Not all will have depression and not think negatively. They have negative
all with depression will have this thoughts about everything
clinical condition. • Depression is a product of negative
• Neuro - CVA, MS, PD, HD, AD thinking
• F & E imbalances: Sodium
bicarbonate, potassium. Ca c. Psychoanalytic theory LAS
• Hormonal imbalances: Addison’s, • Loss of a loved object
Cushing’s Disease, Thyroid Problem • Anger turned inwards
(hypo / hyperthyroidism) • Common to people with
• Decreased vitamins - Vitamin B depression experienced
complex, iron being a dormant
• Medications: Steroids, • Unconsciously, they want to
chemotherapeutic agents, AA, AP, hurt themselves.
hormones (pills- can alter the • Superego is harsh - Hypercritical of
neurochemicals in your brain), themselves. This is why they are
antianxiety & antipsychotic. always negative

2. Neurochemical Theories
• Related to neurotransmitters CLINICAL MANIFESTATION
• Serotonin, dopamine and ⑳
Depressed Mood
norepinephrine - decrease levels with Energy loss
depressed patient Psychomotor retardation
• Cortisol - Stress hormone • Monotonous speech
• Slow movements - due to decrease brain
3. Genetic Theories activity (electrical impulse)
• Inherited/ Family History Recurrent thoughts of death/suicide
• Not all depressed patients are suicidal, but
most of them have morbid thoughts.
4. Changes in Brain Anatomy • As nurses, we must consider all depressed
• Decreased brain mass patients as suicidal so we can implement
• The brain activity of depressed measures if the person tries suicide.
patient is decreased than a normal Excessive or Diminished Sleep
patient • Insomnia or Hypersomia
• Blue and green areas of the brain in Social Isolation (withdrawal)
PET scans means there is a decreased • Have no energy to socialize with other
brain activity. people.
Significant weight loss/gain
Excessive Guilt
• Always blaming the self
⑧
Diminished Pleasure (Anhedonia)

Legend: Orange are the main requirements for

diagnosis of depression. -
=

Page 30 of 33
 NURSING DIAGNOSIS • Ex. It stated in the contract that the px will call
• Imbalanced nutrition a friend or HOPE hotline numbers whenever
• Risk for violence d/t self* - Suicide; Priority she/he has a suicidal ideation
• Ineffective Coping
• Low self-esteem Frequent UNSCHEDULED visits
• Impaired Social Interaction • To monitor the patient and avoid suicide
• Self-care Deficit plan of the patient
• No fix schedule in visiting the patients
Borderline Personality Disorder - Risk for self- • If scheduled, the patient can plan.
harm/self-mutilation
• They want to feel the pain One-to-one supervision
Risk for violence d/t self is now specific in NANDA. • May bantay ang patient. 24 hours mo
binabantayan kahit magccr siya.
TREATMENTS
Remove items that can be use as a weapon
1. Antidepressants
• Ex: ligatures, sharp objects, deadly weapons
• SSRI- safest
• TCA - most potent
Monitor clues
• MAOI- most dangerous
CLUES:
• Avoid tyramine rich foods
1.Suicidal ideation: thinking
o Passive - Iniisip mo pero wala ka plano
2. Cognitive Behavioral Therapy (CBT)
o Active- kinuha mo na mga gamit at may
• It targets two things:
plano ka.
▪ Cognitive - The way a person
2. Suicidal threats - Words or threats
thinks highly affects how you
3. Suicidal Gestures - actions
behave.
• Giving away possessions, pets, making last
▪ Behavior - it affects their
willa nd testamenst and writing suicidal
behavior for example they
notes
talk less, want to be isolated
4. Suicidal attempts- actual attempt of suicide
o Reframing the patient's thinking so
that the behavior will also changed.
Positive thinking→ positive behavior
2. Spend time with the client
3. Electroconvulsive Therapy (ECT) - not allowed in • Stay with the patient even the patient does
the PH not want to talk
• If the px does not want to talk and requested
What is the most effective treatment for depression? to be left alone
Combination of antidepressants and CBT. • Nurse will leave for the meantime and
will go back
KEY NURSING INTERVENTIONS • These actions will increase the self esteem of
the patient because they will feel important
Priority - Safety
3. Promote Nutrition
1. Suicide Precautions (INFORM)
• Recommendation: Small, frequent feeding
• If three large meals, the patient will lose
I will be here
appetite. They will think they cannot finish it
• If the px is extremely suicidal, you need to
and consider it another failure
stay with the patient in order to stop them
from suicideI
• You should make the patient feel you are 4. Promote Completion of ADL by Assisting only PRN
there and you will not leave them. • Kung kaya ng patient, ipagawa mo sa
kanya.
No suicide contract • Ex: Mabagal magsuklay ang patient tapos
• This will not guarantee that the patient will sasabihin mo “Ako na nga, ang bagal mo”
not take suicide, but it helps. WAG MO YON gagawin kasi ma-ddecrease
• It can minimize the suicidal tendencies of the ang self-esteem ng patients at will trigger
patient. him/her.

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 5. Provide a daily schedule of activities Depression - Lower than sadness
• Simple methods of accomplishments
• Ex. washing the plates, watering the plants 3 Types of Bipolar Disorder
• To keep the patient more active D M
M D H
+
+ +
-

• The more active, the better feeling • Bipolar I

you have • Most extreme form of bipolar
• 3 months of exercise is equivalent to 1 month disorder
of antidepressant • From mania to depression to
hypomania to depression to mania
6. Encourage verbalization of feelings
• Teach them assertiveness techniqueness H D -
-

H D
+

• Assertiveness is expressing feelings without • Bipolar II

violation • Same as bipolar 1 but there are no
• If you are expressing feelings and hurting manic episodes.
others, that is violence. • Hypomania to depression to
hypomania then depression
BIPOLAR DISORDER
Notes: H 3 -H S
+
+

Bi means two, polar means ends • Cyclothymia

Bipolar has two ends • Hypomania to sadness to hypomania
• First pole - Mania (high levels of energy) to sadness
• Second pole- Depression • 2⑧ years of cycling between
Mania - depression - mania - depression hypomania and sadness
Bipolar Disorder is also known as Manic-Depressive
Disorder ETIOLOGY
↑ scrotonin, D, Nove
If depression only, it is called unipolar 1. Neurochemical
• Manic episodes are caused by Increased
Bipolar Episodes Serotonin, Dopamine and
Normal mood - According to Mary Townsend, Norepinephrine
normal mood is happiness. 2. Psychodynamics
• Psychoanalytic Theory
Happiness - Normal Mood • All px with bipolar disorder - deep inside
• No mood is a manifestation of a psychiatric have depression
disorder. • They will attempt to cover up this
underlying depression by having a
0
Mania - Higher than being happy high levels of mood or energy (Manic
• Elevated mood episode)
⑳normal and mania,
Hypomania - between • When their energy nasa low levels na
slightly higher than happy babalik sila sa Depressed State (mag
• Both mania and hypomania patient may iipon ulit ng energy)
experience hyperactivity • From depressed states they will
MANIA HYPOMANIA DELIROUS become manic again
MANIA 3. Genetics
Severe Less Severe =
Hyperactive but • Inherited condition
unaware
-
or
unconscious of
-

behavior. The MEDICATIONS

patient will • Medications that causes MANIA: Steroids,
continue amphetamine, narcotics (cocaine),
moving antidepressants (SSRI, MAOI),
⑧
Need No
-
anticonvulsants
hospitalization hospitalization
O
At least 1 week C
At least 1 week
-
Affect School, No
- >
significant CLINICAL MANIFESTATIONS (GRANDIOSE)
Works or effect on school,
Relationships
-

work and Grandiosity

relationship • Manic: Erotomania (they think all the people
are in love to them)

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Rapid and Pressured Speech this hospital is a non-smoking zone.
• Flight of Ideas - jumping topic to one You can smoke if you are already
another discharged.”
• Looseness of Association- jumping topic to
one another with no association to each 3. Provide clear and concise instructions
other • Manic px is hyperactive and have a
Agitation short attention span
• Madami silang energy
• They are not always violent but they can be 4. Promote sleep
violent. • Avoid beverages: Coffee,
Not thinking of food and sleep Chocolate, Energy Drinks, Tea
• Risk for water and electrolytes imbalances • Schedule the patients activities
and nutritional deficiencies • AM: More activities
• Physiological aspect • PM: Less/ none
• Priority: Risk for Violence • Appropriate activities:
Dress is colorful/ Delusions & Hallucinations 1 Socially Acceptable
Impaired judgment 2. Non-competitive
• They are impulsive. Pag gusto gagawin 3. Need consumption of
agad energy (dapat
Overwhelming Energy nakakapagod)
Shopping Spree/Sexually Indiscretion
• Promiscuity 5. Promote Nutrition/ Hydration
• Because of high energy, they will have • Finger food - ex. Potato chips, french
sexual contacts with different individuals fries, hamburgers etc.
Elation • For Manic px finger foods high in
• Elevated mood protein and Calorie
• Cheeseburger
NURSING DIAGNOSIS
• Risk for violence*
• Risk for injury*
• Imbalanced nutrition
• Disctrubed thought process BONUS ITEMS:
• Disurbed speech pattern
• Impaired Social Interaction 69. A - Risk factor is family history
• Insomia 70. B - Develop over a long period
71. B - Confabulation TAMA B??
72. B - Identifying the underlying cause
TREATMENTS 73. B - Say it's time for you to eat your dinner
1. Lithium - Treatment of choice for bipolar
96. B rocking back and forth
disorder
97. A - 2 years of age
2. Anticonvulsant
98. D - Their own self stimulate acts
• Lamotrigine, Valproic Acid,
99. C - Seems unresponsive to the environment
Carbamazepine
100. D - Responsiveness to parents
3. ECT

NURSING INTERVENTIONS Read:

Priority: Safety Autism
1. Promote Safety Dementia
• Safety of the nurse is the primary
• Secondary - Patient Sir Earl’s Review Center
2. Be matter of fact
• Manic patients can be manipulative
• Matter of fact approach is for manic
and manipulative patients.
• If a patient asks for a cigarette, the
nurse must answer “It is not
appropriate to our relationship and

Page 33 of 33
Alzheimer's common type of
-

Dementi a

to think or make
-

impaired ability
decisions

Autism -

differences in brain