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PSYCHIATRIC NURSING
LECTURE 1
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PSYCHOSOCIAL INTEGRITY
COPING AND ADAPTATION
MENTALLY HEALTHY INDIVIDUAL
ATTITUDE OF SELF ACCEPTANCE
AUTONOMY ABILITY TO ABSTRACT,TRUST ,COPE
WITH STRESS
ACCURATE SELF PERCEPTION
AWARENESS OF SELF
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MENTAL HEALTH balance in a
persons internal life and adaptation
to reality
Mental ILL Health state of imbalancecharacterized by a disturbance in a personsthoughts, feelings and behavior
Poverty and abuses are major risk factors
Psychiatric nursing interpersonal processwhereby the professional nurse practitioner,through the therapeutic use of self(art) andnursing theories (science), assist clients toachieve psychosocial well being.
Core of psych nursing interpersonal processhuman to human relationship(both for mentally
healthy and ill)
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Neurosis
any long term mental or behavioral d/o in which
contact with reality is retained the condition isrecognized by the patient as abnormal.
Essentially features anxiety or behavior
exagerrated designed to avoid anxiety
( anxiety d/o ; hysteria to conversion
d/o,amnesia,fugue,multiple personality and
depersonalization- dissociative d/o
;oc d/o)Result of inappropriate early
programming(psychoanalysis little value)
Benefits from Behavior Therapy
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Psychos is
Mental or behavioral disorder wherein
patient looses contact with realityPresence of delusions,hallucinations,severe thought
disturbances,alteration of mood, poverty ofthought and abnormal behavior
(schizophrenia , major disorder of affect (mania depression), major paranoidstates and organic mental disorder
Benefits from psychoanalysis andantipsychotics
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Mental hygiene measures to promotemental health , prevent mental illness and
suffering and facilitaterehabilitation.(and if necessary findmeaning in these experiences)
Main tool therapeutic use of self
It requires self-awareness
Methods to increase self-awareness:
Introspection
Discussion Experience
Role play
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Mental health concepts
Assessment (psychosocial processes )
Appearance , behavior or mood
Speech , thought content and thought process
Sensorium
Insight and judgement
Family relationships and work habits
Level of growth and development
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Common Behavioral Signs and
Symptoms
1) Disturbances in perception
Illusion- misinterpretation of an actual
external stimuli
Hallucinations false sensory perception in
the absence of external stimuli
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2) Disturbances in thinking and speech
neologism coining of words that people donot understand
Circumstantiality over inclusion ofinappropriate thoughts and details
Word salad incoherent mixture of words andphrases with no logical sequence
Verbigeration meaningless repetition ofwords and phrases
Perseveration persistence of a response to aprevious question
Echolalia pathological repetition of words ofothers
Aphasia speech difficulty and disturbance Expressive , receptive or global
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Flight of ideas- shifting of one topic from
one subject to another in a somewhat
related wayLooseness of association-incoherent
,illogical flow of thoughts(unrelated way)
Clang association sound of word givesdirection to the flow of thought
Delusion persistent false belief,rigidly
heldDelusions of grandeur- special /important in a way
Persecutory-threatened
Ideas of reference-situation/events involve them
Somatic- body reacting in a particular way
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Magical thinking primitive thought
process thoughts alone can change
eventsAutistic thinking regressive thought
process-subjective interpretations not
validated with objective reality
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3) Disturbances of affect
Inappropriate disharmony between the
stimuli and the emotional reaction Blunted affect severe reduction in
emotional reaction
Flat affect absence or near absence of
emotional reaction Apathy dulled emotional tone
Depersonalization feeling of strangenessfrom ones self
Derealization feeling of strangenesstowards environment
Agnosia lack of sensory stimuli integration
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4) Disturbances in motor activity
Echopraxia imitation of posture of others
Waxy flexibility maintaining position for along period of time
Ataxia loss of balance
Akathesia extreme restlessness Dystonia- uncoordinated spastic movements
of the body
Tardive dyskenisia involuntary twitching or
muscle movements
Apraxia involuntary unpurposeful
movements
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5) Disturbances in memory
Confabulation filling of memory gaps
Dj vu 2nd time-like feeling
Jamais vu- not having been to the place
one has been before
Amnesia memory loss (inability to
recall past events)
Retrograde-distant past
Anterograde immediate past
Anomia lack of memory of items
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Dynamics of Human Behavior
Behavior the way an individual reacts to acertain stimulus
Conflict situation arising from the presence oftwo opposing drives
Need - organismic condition that requires acertain activity
Stress life events in which a demandingsituation (warrants a response )taxes a persons
resources( support systems or copingmechanisms/strategiesdistress and eustress
Adaptation process of interacting with theenvironment to maintain homeostatic equilibrium
Maladaptation ineffective coping
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Dynamics of Human Behavior
Personality integration of systems and
habits representing anindividuals
characteristic adjustment to his
environment expressed through behavior
Individualistic, unique, predictable(stability
and consistency)
Determinants: psychological,cultural,
biological ( not inhereted) and familial
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Analysis
Potential support systems or stressors
Potential risk factor
Satisfaction of human needs
Physiological(oxygen , fluids, nutrition,
temp.,elimination,shelter,rest,sex)
Safety and security(physical and psychological)
Love and belongingness
Self esteem
Self -actualization
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3 divisions of the mind
Conscious focussed on awareness
Subconscious recalled at will
Unconscious never recalled / largest part
Learning change in behavior throughinsight , relearning and remotivation
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Theories of personalitydevelopment
Psychosexual
PsychosocialCognitive
Developmental tasks
MoralInterpersonal
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Freuds psychosexual theory
Libido inner drive
Parts of bodyfocus of gratification
Unsuccesful resolution - fixation
Structures of personality
Id pleasure principle-instinct
Ego controls action and perceptionreality principle
Superego moral behavior - conscience
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0-18 m0s ;oral mouth trust and
discriminating
18 mos. 3 years ; anal bowelsholding on or letting go
Negativism and toilet training age
3 -6 years phallic ; genitalsexplorationand discovery ( inc. sexual tension)
Gender identification and genital awareness
Oedipus and Electra complex // Castration anxiety and penis envy
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6-12 yearslatency (quiet stage) sexual
energy diverted to play. Institution of
superegocontrol of instinctual impulses
12 young adult genital ; reawakening
of sexual drivesrelationships
Sexual maturation
Sexual identity ,ability to love and work
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Psychosocial Erickson
developmental milestones/delay
0-12mos; TRUST VS. MISTRUST
1-3y AUTONOMY VS. SHAME AND DOUBT
3-6 INITIATIVE VS. GUILT
6-12 INDUSTRY VS. INFERIORITY12-18 IDENTITY VS. ROLE DIFFUSION
18-25 INTIMACY VS ISOLATION
25-60 GENERATIVITY VS. STAGNATION
60 and above EGO INTEGRITY VS. DESPAIR
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INFANCY
CONSISTENT MATERNALCHILD
INTERACTION TRUST
INNER FEELING OF SELF WORTH
HOPE
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TODDLER
ALLOW EXPLORATION
PROVIDE FOR SAFETY
NO NO NEGATIVISM
OFFER CHOICES / REVERSE PSYCHOLOGYTOILET TRAINING 18 MOS.-BOWELDAYTIME BLADDER -2 Y
NIGHTIME BLADDER 3 Y
REWARD W/ PRAISE AND AFFECTION
INDEPENDENCE
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PRE-SCHOOL
PROVIDE PLAY MATERIALS
SATISFY CURIOSITY
TEACH ANDREINFORCE(HYGIENE,SOCIAL
BEHAVIOR)
SIBLING RIVALRY
WILLPOWER
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SCHOOL AGE
HOW TO DO THINGS WELL-SUPPORT
EFFORTS
CHUMS AND HOBBIES
NEEDS TO EXCEL/ACCOMPLISH
NEED FOR PRIVACY AND PEER
INTERACTION
COMPETENCE
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ADOLESCENCE
MAKE DECISION,EMANCIPATION
FROM PARENTS
BODY IMAGE CHANGES
NEED TO CONFORM BUT KEEP
INDIVIDUALITY
SELF - AWARENESS
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YOUNG ADULT
COMMITMENT AND FIDELITY
RESPONSIBILITY
ACHIEVEMENT OF INDEPENDENCE
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MIDDLE ADULTHOOD
SUPPORT-PERIOD OF ROLE TRANSITIONS
MIDLIFE CRISIS
ADJUSTMENT AND COMPROMISE
MOST PRODUCTIVE AND CREATIVE
ALTRUISM
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LATE ADULTHOOD
SELF ACCEPTANCE
SELF WORTH
WISDOM
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PIAGETS COGNITIVE
THEORY
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0-2 SENSORIMOTOR
REFLEXES
IMITATIVE REPETITIVE BEHAVIOR
SENSE OF OBJECT PERMANENCEAND SELF SEPARATE FROM ENVT.
TRIAL AND ERROR RESULTS IN
PROBLEM SOLVING
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2-7Y PRE-OPERATIONAL
SELF-CENTERED,EGOCENTRIC
CANNOT CONCEPTUALIZE OTHERS VIEW
ANIMISTIC THINKING
IMAGINARY PLAYMATE SYMBOLIC
MENTAL REPRESENTATION CREATIVITY
2-4 PRE-CONCEPTUAL (PRE-LOGICAL)
4-7 INTUITIVE (UNDERSTANDING OF ROLES)
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7-12Y CONCRETE
OPERATIONAL
LOGICAL CONCRETE THOUGHT
INDUCTIVE RESAONING (SPECIFIC TO
GENERAL)
CAN RELATE ,PROBLEM SOLVING
ABILITY
REASONING AND SELF-REGULATION
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12-ABOVE FORMAL
OPERATIONAL THOUGHT
Abstract thinking
Separation of fantasy and fact
Reality orientedDeductive reasoning
Apply scientific method
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HavighurstDevelopmental Tasks
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Early adulthood Career
Selecting a mate
Finding Civic or social responsibility
Middle age Achieving Civic or social responsibility
Adjusting to changes
Satisfactory career performance
Adjusting to aging parents
Adjusting to parental roles
Old age Adjusting to changes
Establishing satisfactory living arrangements andaffiliations
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Baby to early childhood
Right from wrong and Conscience
Late childhood Physical skills,wholesome attitude,social roles
Conscience morality and values
Fundamental skills in academics
Personal independence
Adolescence
Sexual social roles
Relationships Independence and ideology
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Kohlberg MORAL
DEVELOPMENT/
THINKING/ JUDGEMENT
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PRE-CONVENTIONAL (0-6)
PUNISHMENT AND OBEDIENCE
OBEDIENCE TO RULES TO AVOIDPUNISHMENT
CONVENTIONAL ( 6-12 )
MUTUAL INTERPERSONAL
EXPECTATIONS,RELATIONSHIPS ANDCONFORMITY
SOCIAL SYSTEM AND CONSCIENCEMAINTENANCE
BEING GOOD IS IMPORTANT SELFRESPECT OR CONSCIENCE
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POSTCONVENTIONAL (12 18 Y)
PRIOR RIGHT OR SOCIAL CONTRACT
UNIVERSAL ETHICAL PRINCIPLE
ABIDE FOR COMMON GOOD
RATIONAL PERSON-VALIDITY OF
PRINCIPLES-AND BECOMECOMMITTED TO THEM
INNER CONTROL OF BEHAVIOR
UNDERSTANDING THE EQUALITY OFHUMAN RIGHTS AND DIGNITY OFHUMAN BEINGS AS INDIVIDUALS
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SULLIVANSINTERPERSONALTHEORY
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INFANCY
NEED FOR SECURITY-INFANT LEARNS
TO RELY ON OTHERS TO GRATIFY
NEEDS AND SATISFY WISHES,
DEVELOPS A SENSE OF BASIC TRUST,SECURITY AND SELF WORTH WHEN
THIS OCCURS
O OO /
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TODDLERHOOD / EARLY
CHILDHOOD
CHILD LEARNS TO COMMUNICATE
NEEDS THROUGH USE OF WORDS
AND ACCEPTANCE OF DELAYED
GRATIFICATION AND INTERFERENCEOF WISH FULFILLMENT
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PRE-SCHOOL
DEVELOPMENT OF BODY IMAGE AND SELF-
PERCEPTION
ORGANIZES AND USES EXPERIENCES IN
TERMS OF APPROVAL AND DISAPPROVALRECEIVED
BEGINS USING SELCTIVE INATTENTION AND
DISASSOCIATES THOSE EXPERIENCES
THAT CAUSE PHYSICAL OR EMOTIONALDISCOMFORT AND PAIN
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SCHOOL AGE
THE PERIOD OF LEARNING TO FORM
SATISFYING RELATIONSHIPS WITH
PEERS-USES
COMPETITION,COMPROMISE ANDCOOPERATION
THE PRE-ADOLESCENT LEARNS TO
RELATE TO PEERS OF THE SAME SEX
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ADOLESCENCE
LEARNS INDEPENDENCE AND HOW
TO ESTABLISH SATISFACTORY
RELATIONSHIPS WITH MEMBERS OF
THE OPPOSITE SEX
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YOUNG ADULTHOOD
BECOMES ECONOMICALLY,
INTELLECTUALLY AND EMOTIONALLY
SELF SUFICIENT
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LATER ADULTHOOD
LEARNS TO BE INTERDEPENDENT
AND ASSUMES RESPONSIBILITY FOR
OTHERS
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SENESCENCE
DEVELOPS AN ACCEPTANCE OF
RESPONSIBILITY FOR WHAT LIFE IS
AND WAS AND OF ITS PLACE IN THE
FLOW OF HISTORY
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FORMATION OF PERSONALITY
CERTAIN GOALS MUST BEACCOMPLISHED, IF THIS GOALS ARE
NOT ACCOMPLISHED AT A CERTAIN
STAGE,.PERSONALITY WILL BEWEAKENED.FACTORS IN EACH
STAGE PERSISTS AS A PERMANENT
PART OF PERSONALITY.
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EACH STAGE HAS MAJOR
TRAUMAS AND FRUSTRATIONS THAT
MUST BE OVERCOME.SUCCESSFUL RESOLUTION OF
CONFLICTS ASSOCIATED WITH EACH
STAGE IS ESSENTIAL TODEVELOPMENT..UNRESOLVED
CONFLICTS REMAIN IN THE
UNCONSCIOUS AND MAY, AT TIMES,RESULT IN MALADAPTIVE BEHAVIOR