. Psychiatric Nursing teruel Beliefs Feelings Behavior Therapeutic Communication Techniques What you see, you say What you hear, you say restating Sigmund Freud Father of Psychoanalysis Structure of Personality (Id, Ego, Superego) Dominant ID Mania D eat Antisocial mpulsive drink Narcissistic want to urinate want PLEASURE defecate PLEASURABLE PRINCIPLE Pain Avoidance It’s all “I” DOMINANT SUPER EGO Obsessive - compulsive UPER EGO Anorexia Nervosa hould not mall voice of God CONSCIENCE PRINCIPLE GO Xecutive Secretary Impaired Reality Schizophrenia REALITY PRINCIPLE LIBIDO sexual energy responsible for survival PSYCHOSEXUAL THEORY 1. ORAL STAGE 0 – 18 Months old Survival I want to eat, sleep, urinate, defecate ID formation Cry & Suck mouth I S E I S E
Transcript
. Psychiatric Nursing
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Beliefs Feelings Behavior Therapeutic Communication Techniques
What you see, you say
What you hear, you say restating Sigmund Freud
Father of Psychoanalysis
Structure of Personality (Id, Ego, Superego)
Dominant ID Mania
D eat Antisocial mpulsive drink Narcissistic want to urinate want PLEASURE defecate PLEASURABLE PRINCIPLE Pain Avoidance It’s all “I” DOMINANT SUPER EGO Obsessive - compulsive UPER EGO Anorexia Nervosa hould not mall voice of God CONSCIENCE PRINCIPLE GO Xecutive Secretary Impaired Reality Schizophrenia REALITY PRINCIPLE
LIBIDO sexual energy responsible for survival PSYCHOSEXUAL THEORY
1. ORAL STAGE
0 – 18 Months old
Survival
I want to eat, sleep, urinate, defecate
ID formation
Cry & Suck mouth
I
S
E
I
S
E
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Child Cries
Feed the Infant Ignore the Infant
Successful Unsuccessful
Narcissistic Defense Mechanism:
o FIXATION when a person is stuck in a certain developmental stage
o REGRESSION return to an earlier developmental stage
Identification boy associates with daddy, girl assoc. with mommy
Castration fear of the little boy to daddy
Penis Envy envy of little girl towards daddy
Dr. Karen Horney opposition to penis envy
Level of Awareness o Conscious highest level of awareness o Preconscious Tip of the tongue o Unconscious deepest level of awareness
Birth Trauma First traumatic experience of child
REPRESSION unconscious forgetting of an anxiety provoking concept
SUPPRESSION conscious forgetting of an anxiety provoking concept
4. LATENCY STAGE
6 – 12 years old
SCHOOlatency
Sexual energy is dormant
Reading, Riting, Rithmetic
SUBLIMATION placing sexual energies toward a more productive endeavors
5. GENITAL STAGE
12 y. o. – above
Gising
Genital
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PHARMA MOMENTS
ANTIANXIETY VLAST ME VAIB Valium – ate V Miltown - Meal Vistaril - largavista Libreum - L Equanil – Aqua Kneel Attarax – Mga bato (rocks) Ativan - Ate Guy Inderal – hindi ralph Seraks – Sera Ulo Busfar – sasakay ng bus Tranxene - Transit ERIK ERIKSON
PSYCHOSOCIAL THEORY OF DEVELOPMENT
Age + - Affecting Major Factor
0-18 mos. Trust Mistrust Feeding
18 mos. – 3 y.o. Autonomy AU nal TO ilet training NO favorite word MY
Shame/ doubt Toilet Training
3 – 6 y.o. Initiative Guilt Independence
6 – 12 y.o. Industry Inferiority In da-school
12 – 20 y.o. Identity Role confusion Peer
20 – 25 y.o. Intimacy Isolation Love
25 – 45 y.o. Generativity Stagnation Parenting
45 y.o. and above Ego Integrity Despair Reflection
MASLOW’S HEIRARCHY OF NEEDS
1. Physiologic Needs o Air, food, water, shelter, rest, sleep, activity and temperature
maintenance that are crucial for survival 2. Safety and Security Needs
o Safe in physical and psychological aspects 3. Love and Belonging Needs
o Giving and receiving affection, attaining a place in a group, maintaining the feeling of belonging
4. Self – esteem Needs o Self esteem – feelings of independence, competence and self
respect o Esteem from others – recognition, respect, appreciation
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5. Self Actualization o One’s maximum potential and realize one’s abilities and qualities
BEHAVIORAL MODELS 1. Ivan Pavlov
Classical Conditioning Model
All behavior are learned Food dog Salivation Bell Food Dog Salivation Bell Salivation
2. B.F. Skinner
Operant Conditioning
All behaviors are unlearned
Reward (+ reinforcement) and Punishment (- Reinforcement)
POST TRAUMATIC STRESS DISORDER Trauma Disaster Accident Flashbacks War VICTIMS Survivors Rape Nightmares Earthquake
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Soldier
6 years old Anxiety SOMATOFORM
> no pretension Assignments/ “I am sick” > no organic
Homeworks basis
MALINGERING > unconscious No Assignments/ pretending to be sick Homeworks (Conscious) PSYCHOSOMATIC
> Real pains/ illness You Think Absent > Real symptoms “Teacher may > 4 major types get angry” * Hypertension * Migraine Escape from Mama Care * Stress Ulcer
Teacher * Asthma
PRIMARY GAIN Attention
(Behavior anxiety) SECONDARY GAIN
SOMATOFORM DISORDERS
SOMATOFORM Nervous System Illusion of structural defect CONVERSION DISORDER BODY DYSMHORPIC DISORDER La Belle Indifference emotional disattachment from disability
Minor Discomfort Interpreted as major illness
HYPOCHONDRIASIS “Maliit na butas, pinalalaki”
Favorite Past Time: Doctor Hopping Nursing Focus: Feelings
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PSYCHOSOMATIC DISORDERS
Anxiety
SNS PNS
BP Vasoconstriction Bronchoconstriction
Hypertension Cerebral Artery Left Gastric Artery Asthma
Migraine Stress Ulcer
OBSESSIVE – COMPULSIVE
Belief/ thought Feelings
Door Open Anxiety Burglar may go inside
Obsession anxiety
(thought) Returns to house (Action)
Anxiety Compulsion
PHOBIA
Irrational fears
Etiology o Knowledge o Experience
Immediate Nursing Intervention remove the stimuli
SYSTEMATIC DESENSITIZATION o Gradual exposure to feared object
PHARMA MOMENTS
ANTIPSYCHOTIC AGENT SSTTCMHP Stelazine - sexy star Clozaril – closed reel Serentil – serena Mellaril – maraming reel Thorazine – babaeng Tora Haldol – hahaha Trilafon - tri-band phone Prolixin – pero lick scene
Communication talkative, blurts out in class Nx Dx
Risk for injury
Impaired social interaction Planning/ Implementation
tructure separate room for eating, playing, sleeping and etc chedule time for everything et limits
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afety Evaluation
Minimize Risk for Injury
Improved social interaction
Safety Residual ADHD grows up not antisocial Meds: Ritalin, dexedrin, pemoline, adderal Best time to give: once a day: AFTER MEALS: prevent lost of appetite Don’t give at bedtime STIMULANT causes insomnia Give 6 hours prior bedtime if bid
EATING DISORDERS 18 mos. – 3 y.o. 6 y.o. class valedictorian/ model student
Toilet Training social inactive/ no BF
Clean weighing Obedient Organized Thought Feeling Behavior
L evel 0.6 – 1.2 mEq/L ausea, vomiting, diarrhea Increase urination Lithium Toxicity Tremors, fine hand a+ Hydration 3 L/day Increase Kidney Uu diarhea Mouth, dry
ANTIPARKINSON ANTICHOLINERGIC
ABC DOPAMINERGIC
PLSE
Artane Parlodel
Akineton Larodopa
Benadryl Symmetyl
Cogentin Eldepryl
SCHIZOPHRENIA Ego disintegration
Impaired reality perception
Genetic vulnerability
Stress – Diathesis Model o Too much stress in the reality will lead client to escape it and go to
the fantasy world
Biological Theory o Dopamine level is High
The exact cause is unknown
ffect appropriate, inappropriate, flat, blunt (incomplete emotion) mbivalence torn between 2 opposing forces utism ssociative Looseness
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Symptoms
Negative Positive
Hypoactive Hyperactive
Withdrawn Sociable
Apathy Flight of Ideas
Talkative
Assess : Content of Thought Nx Dx : Disturbed thought process Planning/ Implementation:
Present reality
Provide safety Evaluation : Improve thought process Assess : Hallucination/ Illusions Nx Dx : Disturbed sensory perception Planning/ Implementation:
Present reality
Provide safety Evaluation : Improve sensory perception Assess : Suspicious Nx Dx : Risk for other directive behavior Planning/ Implementation:
Present reality
Provide safety Evaluation : Eliminate/ minimize risk for other-directed violence Assess : Suicidal Nx Dx : Risk for self directive behavior Planning/ Implementation:
Present reality
Provide safety Evaluation : Eliminate/ minimize risk for self-directed violence
Flight or Looseness
I am going to the mall. I am going to the mall. Where is the light? The mall is big. Go here. Big is the tree. Mineral Water. The tree is tall.
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Magical Thinking
Believes to have a magical power
I can turn you into a frog Echolalia I repeat what you say Parrots Echopraxia I repeat what you do Word Salad words, no rhyme Clang Association words with rhyme : Dunk, plank, sunk Neologism creation of new words Plinking, hustash
Clarification done in case of neologism Delusion: Persecutory NBI is out to get me/ someone will harm the client Religious I am Jesus Christ Grandeur I am the queen of the world. Ideas of reference Nurses are talking about me. Concrete Association pilosopo “what will you wear?” “clothes” Thought Blocking
Halucinations Illusion
Stimulus Absent Present
Visual X
Auditory X
Tactile X
In case of hallucinations do:
Hallucinations
Acknowledgment
I know you the voices are real to you
Reality orientation
But I don’t hear them
Diversion
Lets go to the garden But if nothing in the preceeding intervention are seen
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Assess what the voices are saying SCHIZOPRENIA
Normally Acetylcholine = ON Dopamine = OFF Your always ON High Dopamine= Schizophrenia With parkinsON
Disorganized
Sad but smiles o Inappropriate affect
No reaction o Flat affect
Flight of ideas o HEBEPHRENIC
Giggling
Positive and Negative S/Sx
Catatonic Ambivalence
Waxy Flexibility o Iniwan na posture,
ganun forever
No – favorite word
Negativism
Paranoid Suspicious
Tendency to be violent
MistrustScaredWithdrawn Nrsg. Int: Develop trust
1 to 1
short interaction
frequent visit
foods in sealed container
meds wrapped for violent pt.
Doors open
Near the door
Don’t touch the pt.
Eye contact
1 arms length away
call reinforcement
Residual
No more positive s/sx, just withdrawn
classified differentiated
Mixed classification
Can’t be classified
1st paranoid, then disorganized then catatonic, etc etc
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Antipsychotics = makes Dopamine goes down
ON Extrapyramidal Side Effects
AKATHISIA o Restless, inability to sit o Makati siya, ahh kati siya
AKINESIA o Muscle rigidity o Ahh kiniss siya
DYSTONIA o 3 features
TORTICOLLIS
Wry neck OCULOGYRIC CRISIS
Fixed stare OPISTHOTUNOS
Arched back
TARDIVE DYSKINESIA o Irreversible side effects of
antipsychotics o Lip smacking o Tongue protruding o Cheeks puffing
NEUROLEPTIC MALIGNANT SYNDROME
o Hyperthermia among client taking antipsychotic
o Hyperthermia with muscle rigidity
Other Side Effects
Photosensitivity o Sunscreen o Wide brimmed hat
Agranulocytosis o Report immediately Sore throat
1st sign to appear
Anticholinergic
Drugs that will make the AcH down
o Artane o Akineton o Benadryl o Cogentin
Dopaminergic
Dopamine goes up o Parlodel o Larodopa o Symmetryl o Eldepryl
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PHARMAMOMENTS
ANTIDEPRESSANTS ANTSAAVE PPZ
Asendin – ascending
Norpramin – sabaw ng knorr
Tofranil – Tofu
Sinequan – nood ng Sine Quan ang title
Anafranil – kina Ana Praning
Aventyl – kina Aven Til Midnight tayo
Vivactil – Bye Back till next week
Elavil – Eh love mo ba ako
Prozac – Pero saka na
Paxil - Taksil
Zoloft – mag Solo ka
BIPOLAR DISORDER – Mania more common
Female
20 years old and above
Stressful life
Obese
TASK Caregiver Role Strain Safety Safety Lithium – 2 – 4 weeks before effect
Self Actualization
Self Esteem
Impaired social interaction
Risk for injury/ other directed violence
Eating Sleep Hyperactive Sex finger food Private room Anxiety
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SE Compensation interfere ADLs, harm others
SE Compensation interfere ADLs, harm others
TASK increases client’s self esteem
Gross motor skills via sublimation
Escorted walk outdoors
Punching bag No group games compition will increase anxiety 3 or more signs confirms disorder
G F S P E E D
randiose light of ideas leeplessness ressured speech xagerated SE xtraneous stimuli (easily distracted) istractibility
PERSONALITY DISORDERS SCHIZOID
I don’t want people
Believes he can stand on his own
Never had a best friend
Avoid groups and social activities no enjoyment
Cares more about computers and pets
AVOIDANT
I avoid people, I fear criticism
Have talent but no confidence
ANTISOCIAL
I break the law as motto
As a child,: steal, lie, always get reprimanded
Adult – grand robbery, illegal activitist against the law, drug addiction, drives fast, unsafe sex, thrill seeker
1st Line of Drug Prescribed wo – 4 weeks wo neurotransmitter afest RI ONO ELECTIVE ide effects low CYCLIC MINE EROTONIN EUPTAKE NTIDEPRESSANT XIDASE Higher incidence of Side effects to 4 weeks Serotonin/ Epi affected NHIBITOR NHIBITOR PPZ ANTSAVE MNP
All neurotransmitter affected Highest Side effects Avoid tyramine rich food
may lead to HYPERTENSIVE CRISES
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oy Sauce
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Antidepressant no effect ECT ELECROCONVULSIVE THERAPY
Pre o Informed consent o NPO 6 – 8 hours prior
Meds
o Atropine dry mouth
o Barbituate Sedative
o Succinylcholine muscle relaxant, prevent seizure
Post o Side-lying – lateral o S/E
headache, dizziness, TEMPORARY MEMORY LOSS distinct sign
Psych well being NARCAN Narcotic Antagonist narcotic overdose DETOXIFICATION withdrawal with MD Supervision METHADONE Withdrawal reverse of effect or opposite of overdose
DEPRESSION Serotonin, if unresponsive to drugs, ECT
The Grief Process
Denial no! this can’t be true
Anger why me, why me, why now
Bargaining if something happens, then I’ll give something back
Depression I’m down 2 weeks or more s/sx major depression
Acceptance client acts according to situation
C TASK Stay
Bradycardia Bradypnea
Pupil constriction
Moist mouth Constipation Hypotension
Coma Asleep
Weight gain
Tachycardia Tachypnea
Pupil Dilation Dry mouth
Hypertension Seizure Awake
Weight Loss
EUPHORIA
Self Actualization
Self Esteem
withdrawn
Risk for self directed violence
Eating Sleep Hypoactive Sex
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Sensitivity to client needs
SUICIDE
Verbal Non Verbal
I wont be a problem anymore
This is my last day on earth
I’ll soon be gone
Take this ring, its yours (giving of valuable)
Sudden change in mood
Who will commit Suicide? Sex – Male (more successful)/ female (hesitant) Age – 15 –24 y/o or above 45 Depression Patient with previous attempt ETOH – ethanol - alcoholics Rirrational Social support lacking Organized plan greater risk No family Sickness, terminal SUICIDE TRIAD
Loss of spouse
Loss of job
Aloneness Is Patient is SUICIDAL; nurse should: DIE
Direct question – “Are you going to commit suicide?”
Irregular interval of visit to pt. room
Early AM and period of endorsement – the time pt’s commit suicide Best approach for suicidal pt. : Direct approach Nursing Management: Close surveillance Hospital area majority sucide will happens at:
weekends 1- 3 am Sunday
Weekend less staff personnel
Early AM every one is asleep Give simple task. Don’t give complex may cause depression ex. Jigsaw
Water plants
Wash the dishes except sharps
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CHILD ABUSE (think B)
Burns, bruise, bone fractures, BUNGI!
Don’t bathe the child, don’t brush teet. Body of evidence will be lost
Bantay Bata 163 LEVELS OF MENTAL RETARDATION
Profound o < 20 o thinks like an infants o can’t be trained o stay with the patient
Severe o 20 – 35
Moderate o 35 – 50 o can be train o mental age is 2 – 7 y/o o pre-operational stage
Mild o 50 – 70 o meantal age is 7 – 12 o educable o can go to school
Borderline o 70 - 90
Normal o 90 – 100
JOHN PIAGET’S COGNITIVE THEORY
0 – 2 Sensorimotor Baby can sense, see, perceive and hear. Object permanence
2 – 4 Preconceptual Language
4 – 7 Intuitive Unidimentional classification characteristic. Child can fix toys according to size, color, height = one at a time
7 – 12 Conservation Concrete Association
Multidimensional
12 Formal Operation
Good abstract thinking. Can interpret words
ALZHEIMER NOMIA don’t know name of objects GNOSIA problem with senses PHASIA can’t say it PRAXIA can’t do it Cocaine Nasal Septum perforation Marijuana impaired Lung Structure
ero – 2 y/o ensorimotor evere
Modera e hirtyfive – 50 rainable wo – 7 y/o
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eroine withdrawal ikab
atsing u hu hu
CRITICAL REVIEW
TEST TAKING TECHNIQUES
1. Assess the answer, use circle 2. Initial priority TRUST
ABC ASSESS
3. Good Word/ Bad Word 4. S Technique
eek support it tay upervised ee = observed eem = notice
assi t feeling
5. 2 same answer/ 2 same mistake 6. Words to watch out for
Resistance PRACTICE OF NURSING Level of Prevention 1 2 3 Healthy Ill Relapse Community Demog. Crisis Intervention AA SELF HELP GROUPS
nique niversality r not alone RESTATE exact words REFLECT use other words DEPRESSION Endogenous Reactive Internal external Chemical Barbituate withdrawal LIBRIUM (Chloridiazepoxide) TOFRANIL Antidepressant/ Anticholinergic pupil dilation midriasis Catharsis Feelings Free Association Ideas ATTITUDE THERAPIES Active friendliness ask permission
assive Friendliness aranoid anipulative nic atter of Fact
No Demand Depressed Kind Firmness Anorexic Crisis 4 – 6 weeks Goal Return the client to the pre-crisis level of functioning PSC Perception what do you think about it?
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Coping what will you do about it? Support who will be there for you? Kulit kulit kulit kulit Perseveration stick to 1 topic Ulit Ulit Ulit Verbigeration DISSOCIATION Dissociative Amnesia don’t know themselves Fugue Far Dissociative Identity Disorder Multiple Personality D.O.
