COURSE OUTLINE

PSYCHIATRIC NURSING BSN III Other Disorder of Infancy, Childhood or Adolescent

Course outline 1. Separation Anxiety Disorder 3. Reactive Attachment Disorder
Orientation to the course 2. Selective Mutism 4. Stereotypic Disorder
a. Course Content c. Grading system Disorder of Infants and Early Childhood
b. Requirements of the Course 1. Tic Disorder (Tourette’s and Chronic Motor Tic)
2. Elimination Disorder (Encopresis and Enuresis)
I. INTRODUCTION TO PSYCHIATRIC NURSING
a. Benchmarks in psychiatric history. FIRST TERM EXAM
b. Definition of mental Health and mental Illness
c. DSM IV TR 2. Eating Disorders (Anorexia Nervosa and Bulimia)
d. Self-Awareness issues
e. Most common adopted patient’s rights 3. Abuse - Child/Spouse/Elder (1. Sexual 2. Physical 3.
f. Methods of Psychiatric Admission Emotional)
g. Interdisciplinary Mental Health Care Team
h. Roles and Functions of a Psychiatric Nurse 4. Crisis
1. Maturational/Developmental
II. THEORETICAL MODELS 2. Situational
a. Psychoanalytical Models 3. Cultural
b. Psychosocial Model 4. Adventitious
c. Cognitive Model Phases Precrisis – Crisis – Adaptive - Postcrisis
d. Behavioral Models Suicide
e. Humanistic Model
f. Personality Temperament 5. Anxiety 1. GAD 2. Panic 3. OCD 4. Phobic 5. PTSD

III. THERAPEUTIC NURSE-PATIENT RELATIONSHIP 6. Anxiety Related Disorders

a. Elements involved in Nurse-Patient Relationship 1. Somatoform Disorder 4. Hypochondriasis
b. Phases of Nurse-Patient Relationship 2. Somatization Disorder 5. Conversion Disorder
c. Types of Nurse-Patient Relationship 3. Pain Disorder 6. Body Dysmorphic Disorder
d. Self-Awareness and Therapeutic use of Self
e. Factors that diminish N-P relationship 7. Dissociative Identity Disorders
1. Dissociative Amnesia 3. Depersonalization
IV. THERAPEUTIC COMMUNICATION 2. Dissociative Fugue 4. Dissociative Identity Disorder
a. Components of a Communication
b. Types of Communication 8. Sexual Dysfunctions
c. Levels of Communication 1. Sexual Desire Disorder 3. Orgasm Disorder
d. Goals of Therapeutic Communication 2. Sexual Arousal Disorder 4. Sexual Pain Disorder
e. Characteristic of a Successful communication Gender Identity Disorder
f. Essential Ingredients
g. Blocks to Communication Paraphilia
h. Process Recording 1. Pedophilia 6. Voyeurism
2. Incest 7. Fretteurism
V. THERAPEUTIC MILIEU 3. Exhibitionist 8. Transvestic
a. Purpose of TM 4. Fetishism 9. Sexual Masochism
b. Role of Nurse in TM 5. Zoophilia 10. Sexual Sadism
c. Goals of Therapeutic Milieu
d. Character of TM 9. Mood Disorders
e. Elements of a Effective Milieu Depressive Disorder
f. Democratic Environment 1. Seasonal Affective Disorder 3. Post partum psychosis
2. Post-partum Blues 4. Post partum depression
VI. DYNAMICS OF ADJUSTMENT Bipolar Disorder
a. Coping Mechanism 1. Bipolar 1 Disorder 2. Bipolar 2 Disorder 3. Cyclothymic Disorder

VII. PSYCHIATRIC THERAPIES SECOND TERM EXAM

a. Somatic Therapy
b. Psychotherapy 10. Personality Disorders
c. Pharmacotherapy 1. Cluster A Odd/Eccentric
d. Management Therapy 2. Cluster B Dramatic/Erratic
e. ECT 3. Cluster C Anxiety and fearful

VIII. PSYCHIATRIC ASSESSMENT 11. Schizophrenia and other Psychosis

a. Identify factors influencing assessment 1. Catatonic Schizo. 4. Undifferentiated Schizo.
b. Explain contents of assessment 2. Disorganized Schizo. 5. Residual Schizo.
c. Analyzing data collected 3. Paranoid Schizo.
Other Psychosis
IX. MENTAL DISORDERS 1. Schizoaffective 2. Delusional Disorder 3. Schizophreniform Dis
1. Child and Adolescent Psychiatric Disorders
Developmental Disorder 12. Cognitive Disorders
1. MR 2. Pervasive Dev. Disorder 1. Delirium
Specific Dev. Disorders 2. Dementia
1. Autistic 3. Asperger Disorder 3. Alzheimer’s Disease
2. Rett’s 4. Childhood Disintegrative Dis. 4. Parkinson’s Disease
Disruptive Disorders
 1. Conduct Disorder
2. Oppositional Defiant Disorder
3. Attention Deficit Hyperactive Dis.
PSYCHIATRIC TERMINOLOGY
13. Substance Related Disorder
1. Substance abuse
2. Substance dependence
3. Substance intoxication
4. Substance withdrawal
FINAL TERM EXAM
  Abuse - excessive use of a substance that differs from
societal norms.
 Affect - emotional range attached to ideas outwardly
manifested.
 Blunt - slow or dull.
 Flat - absence or near absence of any signs of
affective expression.
 Inappropriate - incongruent between the
emotional feeling
 Labile - unstable mood with rapid change.
 Broad – shows full range of emotional
expression.
 Restricted – shows one type of expression.
 Agitate - to excitement with severe motor restlessness.
 Akathisia - motor restlessness generally expressed as
the inability to sit still.
 Akinesia – absence of movement.
 Alogia - inability to speak.
 Ambivalent – opposing feelings/emotions. (love and
hate)
 Anhedonia - feeling of no joy.
 Anxiety - feeling of apprehension or tension. (fear of the
unknown)
 Apathy - lack of feeling, interest, concern or emotion.
 Associative looseness - disorganized thinking that jumps
from one idea to another with no evident relation
between the thoughts. (“cannot see the sky…oh my
love…just asking…mmm maybe tomorrow”)
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 Bipolar disorder/manic-depressive - a mood disorder
characterized by one episode of manic behavior with or
without a
history of depression.
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 Circumstantiality - client eventually answers the
question being asked, but only after giving an excessive
amount of unnecessary details.
 Nurse: “Where are you going for the
weekend?”
 Patient: “I feel like visiting my sister…I just
remembered she ask me a favor…a picnic
maybe, in the beach, in hours it gets crowded.
That is why I don’t prefer in that place. So, I
decided instead to go to my brothers place a
nice and big house but now I prefer to stay in
my own house.”)
 Clang association-rhyming of words
 (“I am reading a book, in a shady nook, with
the food I cooked”)
 Confused - bewildered, unclear.
 Coprolalia – repeating words socially unacceptable.
 Confabulation - unconscious filling of gaps in memory or
untrue experiences that a person believes but have no
basis in reality. Detailed fantasy.
 Nurse: “How are you Tess?” (who spent the
day in her apartment)
 Tess: “Well, I came from my friend’s house
who just arrived from Canada. She gave me a
lot of gifts, we ate out…it was a wonderful day.
I will be going with her when she goes back.
 Cyclothymia - mood swings of hypomania and
depression.
 Dependence - a state where a drug user takes or
increases dose of a drug in order to prevent the onset of
symptoms or withdrawal.
 Disinhibited - a state in which a person is unable to
suppress urges or statement which is socially
unacceptable.
 Disorientation – disturbances in orientation of time,
place or person.
 Dysthymia – a 2 years chronic depressed mood
disturbances.
 Delusion - fixed false beliefs that have no basis in reality.
 Paranoid – (“somebody is going to kill me”)
 Grandiose – false belief that one is powerful
(“I am the most handsome male in my class”)
 Religious – (“The devil told me to do this”)
 Somatic – (“I might get sick”)
 Ideas of reference – (“I hurt my neighbor. The
lady I saw in the television told me to do it”)
 Depression - a mood disorder characterized by sadness,
despair, apathy and discouragement.
 Denial - avoidance of disagreeable realities, refused to
recognize.
 Desensitization – gradual exposure to stress-provoking
stimuli.
 Dyskinesia – abnormal involuntary skeletal movement
usually producing a jerky motion.
 Dystonia – rigidity of muscle that controls posture, gait
and ocular movement.
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 Echolalia - repetition of words heard.
 Nurse: “Can you please keep the door open.”
 Patient: “Can you please keep the door open.”
 Echopraxia - repetitive, meaningless movement or
imitating others.
 ECT Electro convulsive therapy – doses of electric shock
administered to clients with Manic Depressive
Disorders.
 Euphoria - a subjective, exaggerated feeling of well-
being characterized by confidence, elation and
assurance.
 EPSE – Extra Pyramidal side effects. A drug induced
parkinsonism.
 Exhibitionism – display of body parts to attract others.
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 Fear – a response to objective threat/external. Fear of
the known.
 Fetishism – adoring something which serves as a
substitute of the original love object.
 Flight of ideas - flow of verbalization jumps from
unrelated one topic to another. There is a connection
between some topics but it is difficult to identify.
 (“What is today?…might not be taking a bath…
I will be cooking at home…the dog kept on
barking… there are flowers around me…the
food for sure will be delicious)
 Flooding – exposure to fear.
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 Gait – manner of progression in walking.
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 Hallucination - false sensory perception without
external stimuli.
 Visual: (seeing thing that are not there)
 Auditory: (hearing voices which is not present)
 Olfactory: (smelling things that does not exist)
 Tactile: (feeling touched but absence of
stimuli)
 Gustatory: (experiencing taste in the absence
of stimuli)
 Helplessness – incapable and powerless.
 Hopelessness - despairing, no hope.
 Hypervigilant - alert to danger.
  Hypomania – elevated state that is less intense than full  Somatic – adjective referring to the body.
mania.  Somnambulism – it is when a person sleepwalks.
 Hypersomnia – increased and prolonged sleeping.  Stereotype - persistent repetition of senseless act or
--------------------------------------------------------------------------------- words.
 Insomnia – inability to sleep or disrupted sleep patterns.  Suicide - a self-inflicted death.
 Illusion - misinterpretation of the real sensory stimulus.  Sialorrhea – excessive drooling of saliva
 (Patient insists a gray sock on the floor is a  Xerostomia – reduction of saliva
mouse) ---------------------------------------------------------------------------------
---------------------------------------------------------------------------------  Tardive Dyskinesia (TD)– an irreversible neurologic
 Libido – energy usually associated with sexual instinct. disorder.
 Limit setting – establishing a structured environment  TCA – Tricyclic Antidepressant
with clear ground rules.  Tolerance - to increase amount of substance to achieve
 Lucid intervals – patients reasoning and judgment the same effects.
appears to be normal for a brief period.  Transference – unconscious emotional reaction to a
--------------------------------------------------------------------------------- current situation that is actually based on previous
 Malingering – deliberately pretends an illness or experience.
disability.  Countertransference – a reaction based on the nurses
 Mania - a mood disorder characterized by irritability, past experience.
elation and hyperactivity.  Thought blocking - sudden cessation of thought in the
 Masochism – gaining sexual pleasure from being middle of a sentence, unable to continue the train of
physically hurt. thought. (“I am going to buy a new bag.”………
 Mutism - refusal to speak. I forgot to say what is next)
---------------------------------------------------------------------------------  Thought broadcasting – a delusional belief that others
 Negativism – motiveless resistance to all instruction. can hear or know what the client is thinking.
---------------------------------------------------------------------------------  Thought control – a delusional belief that others can
 Oculogyric Crisis – eyes rolled back in a locked position. control a person’s thoughts against his will.
 Obsession - recurrent disturbing thoughts which is  Thought insertion - a delusional belief that others have
difficult to push out of the mind. the ability to put thoughts in a person’s mind against his
 Compulsion - repetitive behavior that a person is will.
obliged to do to decrease anxiety.  Thought stopping – a technique to stop a client thinking
 Neologism – inventing new words which is meaningful of unwelcoming thoughts.
only to the person.  Tic - involuntary, recurrent muscular spasm. Motor and
 (“I cannot stay with you because you are a nic- vocal tics.
no-kets”) ---------------------------------------------------------------------------------
---------------------------------------------------------------------------------  Word salad - combining of words or phrases that do not
 Paranoid – extreme suspiciousness of others and their have connection & no sense.
action.  (I am fine….apple tree…books…toys
 Pica – ingestion of non-edible food. for sale…be okay)
 Phobia – exaggerated fear of non-dangerous object or  Worthlessness - having no value.
situation.
 Postpartum depression – occurs 30 days or less in the
postpartum period.
 Psychomotor retardation - slow speech and body
movement.
 Psychosis - mental illness during which the patients lose
contact with reality and demonstrate bizarre behavior.
 Psyche – the mind.
 Primary gain – relieving anxiety by an individual to feel
better.
 Perseveration - resistance to change the topic, verbally
repeating of a sentence.
 N – How are you? N –
From, where are you? N –
What is your name?
 P - I am fine.
P – I am fine.
P – I am fine
 Preoccupied - engrossed.
 Religiosity - preoccupied of or with religious idea or
content.
 Resilience - it is the capacity of the individual to move
forward despite psychosocial diversity or genetic
vulnerability.
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 Secondary gain – relieving anxiety with the help of
others. INTRODUCTION TO PSYCHIATRIC NURSING
 SSRI – Selective Serotonin Reuptake Inhibitors. Historical Perspective
 Sadism – gaining sexual pleasure by inflicting pain to the
partner.
  mentally ill persons were treated by tribal rites. If
this failed, they were left alone to die of starvation
or to be attacked by wild animals.
Greek and Roman Era
 Their temples were used to house mentally ill
persons that have fresh air, pure water and
sunlight. Sometimes they were treated with
kindness, while at times treatment was harsh and
barbaric. They were treated by bleeding and
purging.
Middle ages
 The treatment of the mentally ill was left to the
priests, the superstitious beliefs flourished. They
were flogged, fettered scourged and starved in the
belief that the devils that possessed them could be
driven out.
Sixteenth century
 The mentally ill were locked up in jails, dungeons,
or lunatic asylum where the curious could pay to
watch the “performance” of the sick inmates. The
harmless inmates were forced to seek charity on
the streets as beggars.
Seventeenth century
 God and Satan were still thought to be engaged in
a battle for the possession of one’s soul. The
dungeons were the only place where violent
mentally ill person could be committed. Purging
and bleeding was the favorite therapeutic
procedures done. The whip was religiously applied
by the cell keepers.
Eighteenth century
 In 1792, Frenchman Philippe Pinel was
instrumental in proving the error of treating
mentally ill persons inhumanely. Benjamin Rush,
the “Father of American Psychiatry,” began
working in 1783. He believed that the phases of
the moon influenced the person’s behavior which
he called “The Lunar Theory of Insanity.” At the
same time he invented the “tranquilizer.”
Although mentally ill patients were relegated to
the cellar, they were assured clean beddings and
warm rooms. .
Nineteenth century
 The most shocking to people of today was placing
the poor and the mildly demented on the auction
block, where those with a strongest back and the
weakest mind were sold to the highest bidder. The
returns of the sale are being kept in the town’s
treasury.
Dorothea Dix, a teacher raised money to build suitable
hospital for mentally ill persons. The institution was
designed to provide a homelike environment that would
also be safe. And because of the remoteness of the setting
the institution had to produce its own food, heat and other
necessities. Patients were able to work on the farm, in the
kitchen, laundry, machine shop, on the grounds or wards.
For some patients, this responsibility proved therapeutic
because it provided meaningful activity, which increased
their sense of self-esteem and group cohesiveness. Having
no contact with the outside world the patient adapted to
their surroundings and their roles in the hospital to the
extent that they resisted returning to their homes.
Twentieth century
 overt change in the hospital system of mental
health care began. The government believed that
it was necessary to acquire more knowledge
concerning the cause, prevention and treatment of
mental illness and professionally trained workers
were needed to improve the care and treatment of
the mentally ill persons.
MENTAL HEALTH
 Is a “state of complete physical, mental, and social
wellness, not merely the absence of disease” The
person is in a state of emotional, physical, and
social well-being fulfills life responsibilities,
function effectively in daily life, and are satisfied
with their interpersonal relationships and to
themselves.
MENTAL ILLNESS
 Mental disorder is a behavior or pattern that
occurs in an individual associated with present
distress or with an increased risk of suffering
death, pain, disability or an important loss of
freedom.
FACTORS CONTIBUTING TO MENTAL ILLNESS:
A. INDIVIDUAL:
1. Biological
2. Anxiety
3. Worries
4. Fears
5. Loss of meaning in one’s life.
6. Disharmony in life.
B. INTERPERSONAL:
1. Ineffective communication
2. Excessive dependency
3. Withdrawal from relationship
4. Loss of emotional control
C. CULTURAL AND SOCIAL:
1. Lack of resources
2. Violence
3. Homelessness
4. Poverty
5. Discrimination
PSYCHOPATHOLOGY:
 It is a systemic study of mental disorder.
PSYCHIATRIC NURSING:
 It is a process where in a nurse assist a person,
individual, or in group to develop a positive self-
 concept, satisfying interpersonal relationship and
satisfactory role in a society.
PSYCHOTHERAPEUTIC MANAGEMENT IN THE
CONTINUUM OF CARE:
A. THERAPEUTIC NURSE-PATIENT RELATIONSHIP:
1. Communication skills
2. Mental mechanism
3. Adaptation styles
4. Coping strategies
5. Therapeutic intervention skills.
B. PSYCHOPHARMACOLOGY:
1. Therapeutic and the toxic effect.
2. Drug used during pregnancy.
3. Drug used with the elderly.
4. Drug’s side effects.
5. Patient health teaching.
C. MILIEU MANAGEMENT:
1. Safety
2. Structure
3. Norms
4. Setting limits
5. Balance between independence and
dependence 6. Environmental modification.
MOST COMMON ADOPTED PATIENT RIGHTS:
1. Right to treatment using the least restrictive
alternative environment.
2. Right to confidentiality of records.
3. Right to freedom from restraints and
seclusion.
4. Right to give or refuse consent to treatment.
5. Right to access to personal belongings.
6. Right to daily exercise.
7. Right to have visitors.
8. Right to use of writing materials and
uncensored mail.
9. Right to use of telephone.
10. Right to access courts and attorneys.
11. Right to employment compensation.
12. Right to be informed of rights.
13. Right to refuse ECT or psychosurgery.
RESTRAINING:
 It is a direct application of physical force to a
person with or without their permission with the
use of a mechanical device to control their physical
activity.
SECLUSION:
 It is an involuntary confinement or isolation of a
person.
NURSING RESPONSIBILITY OF A PSYCHIATRIC NURSE IN
RESTRAINING AND ISOLATING A PATIENT:
1. Documentation has to be justified.
2. Alternative was considered and attempted.
3. It has to be ordered by the physician.
4. Note the type of restraint used.
5. Note the time and duration.
6. Check the patient every 15 min.
7. Check every 2 hrs. for continued needs.
8. Offer fluid every hour.
9. Exercise patient’s limb every 2 hrs.
10. Snacks and meals are offered to the patient.
11. Assist the patient to the comfort room.
TYPES OF PSYCHIATRIC ADMISSION:
1. Voluntary- the patient or guardian request for
treatment and willingly signed an application
for treatment.
2. Involuntary- the patient refuses to sign consent
and is involuntarily detained for
treatment.
TYPES OF INVOLUNTARY TREATMENT:
1. Emergency- the patient is admitted because he is
dangerous to others and to himself.
2. Temporary- the patient is involuntarily hospitalized for
a maximum of 6 months.
3. Extended- the patient is admitted with unspecified
period of time.
MEMBERS OF THE MENTAL HEALTH CARE TEAM:
 The health care team consists of health care
professionals who have their own specialties:
1. Psychiatric nurse- a registered nurse that gives
comprehensive care to the patient.
2. Psychiatrist- a physician is the leader of the
team, ordering the medication and
making the medical diagnosis.
3. Clinical psychologist- a person involve in
diagnosing and treating an emotionally
person. They use a complex device to assist
them in diagnosing a patient. Which is
called the “Rorschach test” that consist of 10
pictures of ink blots,5 black and white, 3 black
and red, 2 multi-coloured.
4. Psychiatric social worker- a person skilled in
assessing a family, environment, and
social factor that can contribute to the
dysfunctional behavior of the individual and
the family.
They plan and implement follow up care for the
patient.
 5. Activity therapist- a skilled nurse who provides Setting limits – limitations in the ward
activities to a specific patient to assess
their behavior. Balance – independent and dependent
behavior
ROLES AND FUNCTIONS OF THE NURSE: Modification – physical features of the ward
1. A creator of a therapeutic environment Norms – client’s behavior
2. A socializing agent
3. A counselor
4. A teacher
B. Medication: Therapeutic effect
5. A surrogate
Side effects
6. A therapist
7. Technical nursing role Health teaching

NURSE’S RESPONSIBILITY:
 The nurse caring for a mentally ill patient is
expected to know and anticipate the various types
of hazards which may develop as a result of the
individual patient’s mental status. The nurse can
be held liable if, in the opinion of the court, the
nurse was negligent in providing protection and
care constituting prevention against the
development of any situation injurious to the
patient. Suicide attempts as well as accidental
injuries, occurring in the hospital.
Duty to warn: To inform health care team of any harm the
patient might do/plan.
C. Therapeutic N-P relationship
Communication skills
Coping strategies
Therapeutic intervention
Triad of Needs:
A. Physical – nutrition, clothing, shelter, exercise
and protection from body harm.
B. Psychological – love, trust and affection.
C. Social – feeling of being a member of a group
and feeling of being valued member of a
family.

SELF AWARENESS:

 It is the process by which the nurse gains

recognition of his own feelings, beliefs, and
attitudes.
 The nurse must learn to accept the differences
among people and view the patient as a
worthwhile person regardless of his opinion or
lifestyle.
 Self-awareness can be accomplished through
reflection, spending time focusing on how one
feels, their values and beliefs.
 The nurse needs to discover himself, what he
believes in before trying to help others with
different views. As a student nurse make sure
personal feelings and beliefs do not interfere with
or hinder the client’s care.
 As a psychiatric nurse you need to be prepared to
make positive use of your own personality, your
primary tool as you work therapeutically with
clients.

Psychotherapeutic therapeutic management in the

continuity of patient care.

A. Environment:
Safe – avoid danger/harm

Structure – settings and ward schedules