Psychiatric Nursing

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MENTAL HEALTH "A state of well-being where a person can realize his or her own abilities to cope with the normal stresses of life and work productively." productively." ( WHO) WHO) Balance in persons internal life and adaptation to reality. !tate of well-being in which a person is able to realize his potentials.

riteria for #ental $ealth% Self-awareness ♦  Ability to% recognize ones thoughts feelings& asset potentials and weakness.  e'perience genuine feelings as anger& happiness& happiness& resentment  leads to self-acceptance& self-understanding in order to understand  others ⊗ Autonomy% Autonomy% ability to function independently and function with others ⊗ Perceptive ability stimuli& reality orientation. orientation.   Awareness of stimuli& rientation to% ime& ime& *lace& *erson  ⊗ Integral capacity % Ability to harmonize psychic forces (id& ego& super ego). ⊗ Self-actuation changes& happy to work work with others   Ability to adopt to life changes& !atisfaction in every endeavor   +enuine cooperation  ⊗ Mastery of ones environment!  Awareness of the the changes around around him

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/issatisfaction with% ones characteristics& abilities and accomplishments  ones place in the world  0neffective% interpersonal interpersonal relationship  coping or adaptation to the events in ones life 

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MENTAL H"#IENE a science that deals with% *romotive& *reventive& urative& ,ehabilitative aspects of care.

MENTAL $IS%&$E&  A medically diagnosable illness which results in significant impairment of  ones cognitive& affective or relational abilities and is euivalent to mental illness.

riteria for #ental /isorder%

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MENTAL ILLNESS  A state in which an individual shows deficit in functioning and is unable to maintain personal relationship. relationship. !tate of imbalance characterized by a disturbance in a persons thoughts& feelings and behavior  1actors that increase the risk are% rises& Abuses& *overty

Historical 'iew of Mental Illness 0n the past& mental illness has been viewed as% /emonic possession  0nfluence of ancestral spirits  ,esult of violating taboo or neglecting cultural& ritual& and spiritual  condemnation ⊗ Perio( of Enlig)tenment Enlig)tenment *+,.-+//01 2unatics were restrained in iron menacles  #entally ill were e'hibited as diversion and entertainment for the  public 3stablishment of asylums  pening of state hospitals for mentally ill.  ⊗ Perio( of Scientific Stu(y *sychoanalysis *sychoanalysis by !igmund 1reud  ⊗ Psyc)otropic $rugs *+2.31 4se of chlorpromazine chlorpromazine and imipramine  #ental illness is caused by chemical imbalance in the brain.  ⊗ T)e $eca(e of t)e 4rain *+2231 1ocused on the connections between mental illness and biological  malfunction in the brain and the neuroendocrine-immune system. ⊗

*age 6 of 78

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Biologica Biologicall views views holds holds that biological biological defects defects are responsi responsible ble for  certain serious mental illness.

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$iagnosis of Mental Illness ⊗ 4se of the /iagnostic and !tatistical #anual of #ental 0llness (/!#-09) ⊗ *rovides diagnostic criteria for each mental disorder and a system of : a'es to give a comprehensive comprehensive view of the clients mental illness. A7is I% I% he clinical disorder that is the focus of treatment  A7is II% II% *ersonality disorders and mental retardation  A7is III% III% #edical conditions  A7is I'% I' % *sychosocial and environmental problems  A7is '% '% +lobal assessment of functioning (+A1) 

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ounselor  $ealthy role model *arent surrogate *atient advocate ,eality based ,esearcher  !ocializing agent eacher  echnician herapist =ard manager

Levels of Interventions in Psyc)iatric Nursing PS"5HIAT&I5 N6&SIN# ⊗ ⊗ ⊗

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Level Primary

$escription  Aimed at altering the stressors through% promotion of mental health  lowering the rate of cases  Secon(ary 0nterventions 0nterventions that limits the severity of  a disorder thorugh% ase finding  *rompt treatment  Tertiary  Aimed at reducing the disability after  a disorder through% *revention of complication  of rehabilitation rehabilitation   Active program of

 An interpersonal interpersonal process oncerned with all the aspects of care Both a !cience and an Art !cience ; uses different theories  use of self    Art - therapeutic use lientele% 0ndividual& family and the community  Both mentally healthy and mentally ill 

#ain tool of the nurse% herapeutic use use of !elf  haracteristics haracteristics of a +ood *sychiatric
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E7amples $ealth education 0nformation dissemination ounseling risis intervention /rug administration

 Alcoholics anonymous ccupational therapy

THE PS"5HIAT&I5 SETTIN# A(mitting a 5lient in t)e Psyc)iatric Setting  Areas to be assessed% assessed% ⊗ Health perception ⊗ %rientation ⊗ Metabolic pattern

,oles of the
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*age 8 of 78

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Biologica Biologicall views views holds holds that biological biological defects defects are responsi responsible ble for  certain serious mental illness.

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$iagnosis of Mental Illness ⊗ 4se of the /iagnostic and !tatistical #anual of #ental 0llness (/!#-09) ⊗ *rovides diagnostic criteria for each mental disorder and a system of : a'es to give a comprehensive comprehensive view of the clients mental illness. A7is I% I% he clinical disorder that is the focus of treatment  A7is II% II% *ersonality disorders and mental retardation  A7is III% III% #edical conditions  A7is I'% I' % *sychosocial and environmental problems  A7is '% '% +lobal assessment of functioning (+A1) 

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ounselor  $ealthy role model *arent surrogate *atient advocate ,eality based ,esearcher  !ocializing agent eacher  echnician herapist =ard manager

Levels of Interventions in Psyc)iatric Nursing PS"5HIAT&I5 N6&SIN# ⊗ ⊗ ⊗

⊗

Level Primary

$escription  Aimed at altering the stressors through% promotion of mental health  lowering the rate of cases  Secon(ary 0nterventions 0nterventions that limits the severity of  a disorder thorugh% ase finding  *rompt treatment  Tertiary  Aimed at reducing the disability after  a disorder through% *revention of complication  of rehabilitation rehabilitation   Active program of

 An interpersonal interpersonal process oncerned with all the aspects of care Both a !cience and an Art !cience ; uses different theories  use of self    Art - therapeutic use lientele% 0ndividual& family and the community  Both mentally healthy and mentally ill 

#ain tool of the nurse% herapeutic use use of !elf  haracteristics haracteristics of a +ood *sychiatric
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E7amples $ealth education 0nformation dissemination ounseling risis intervention /rug administration

 Alcoholics anonymous ccupational therapy

THE PS"5HIAT&I5 SETTIN# A(mitting a 5lient in t)e Psyc)iatric Setting  Areas to be assessed% assessed% ⊗ Health perception ⊗ %rientation ⊗ Metabolic pattern

,oles of the
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*age 8 of 78

5%MM%N 4EHA'I%&AL SI#NS AN$ S"MPT%MS

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Elimination pattern

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5ognitive pattern% >udgment& 0nsight& #emory Activity and e'ercise pattern Thought process Sleep-rest pattern LE#AL ASPE5TS %8 PS"5HIAT&I5 N6&SIN#

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ypes of Admissions% 'oluntary *ersons admit themselves  lient consents to all treatment  lient can refuse treatment& including drugs& unless danger to self or   others ⊗ Involuntary 9u(icial process   0nitiated when someone files a petition  ertification of the likelihood of serious harm to self or others& or  unable to care for self   4nder 6?& parents can confine with confirmation by a neutral fact finder  released at end of statutory statutory time or put on voluntary voluntary  #ust be released status or have a hearing @

$isturbance in Perception ⊗ Illusion - misperception of an actual e7ternal stimuli

Hallucination tion - false false sensory sensory perception perception in t)e absence absence of e7ternal e7ternal ⊗ Hallucina stimuli

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#anagement% ⊗  Acknowledge the feelings ⊗ ,eorient to reality ⊗ *rovide distractions ⊗ ⊗ ⊗ ⊗ ⊗ ⊗ ⊗ ⊗

9u(icial Prece(ents Unless incompetent, client maintains all previous rights

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Insanity as a $efense ⊗ 0nsanity % determined in court legal terminology McNaug)ten &ule “At the time of the crime, the individual didn’t know the nature and quality of the act or didn’t know right from wrong! 

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Neologism Neologism - pathological coining of new words 5ircumstantiality 5ircumstantiality - over inclusion of details :or( sala( sala(  - incoherent mi'ture of words and phrases 8lig)t of i(eas  - shifting of one topic from one subect to another in a somewhat related way Looseness of Association Association  - shifting of a topic from one subect to another  in a completely unrelated way 'erbigeration  - meaningless repetition of word or phrases Perseveration Perseveration - persistence of a response to a previous uestion Ec)olalia Ec)olalia - pathological repetition of words of others 5lang association  - the sound of the word gives direction to the flow of  thought $elusion - false false belief belief which is inconsisten inconsistentt with ones knowledge knowledge and culture +randeur - is an e'aggerated belief of identity 
*age 7 of 78

$isturbance s of Affect ⊗ Inappropriate affect  - disharmony between the stimuli and the emotional reaction ⊗ 4lunte( affect - severe reduction in emotional reaction ⊗ 8lat affect - absence or near absence of emotional reaction ⊗ Apat)y - dulled emotional tone $isturbances in Motor Activity ⊗ Ec)opra7ia - the pathological imitation of posture5action of others ⊗ :a7y fle7ibility  - maintaining the desired position for long periods of time without discomfort ⊗ A;inesia - loss of movement ⊗ 4ra(y;inesia - slowness of all voluntary movement including speech. ⊗ Ata7ia - loss of coordinated movement $isturbance s in Memory ⊗ 5onfabulation - filling in of memory gaps ⊗ Amnesia - inability to recall past events • Anterogra(e - immediate past • &etrogra(e - distant past ⊗ $e
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refers to acute change or disturbance in a persons% 2& cognition& emotion & perception ⊗ $epression - feeling of sadness ⊗ $ereali>ation - feeling of strangeness towards the environment. ⊗ $yst)ymia - persistent state of sadness ⊗ Elation  (euphoria)- a feeling of high degree of confidence& boastfulness

and oy with increase motor activity. sleep disorder characterized by freuent irresistible urge to sleep with episodes of cataple'y (sudden loss of muscle power)

⊗ Narcolepsy -

6SE %8 APP&%P&IATE 5%MM6NI5ATI%N TE5HNI?6ES 5ommunication% reciprocal e'change of ideas between or among persons #odes% ⊗ 9erbal - written5spoken ⊗
*age 67 of 78

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3'amples% • $aloperidol ($aldol) • *rochlorperazine (ompazine) Si(e effects! Blurred vision /ry mouth achycardia& palpitation& constipation& urinary retention *hotosensitivity rthostatic hypotension 3'tra *yramidal !ymptoms *seudoparkinsonism o pill-rolling tremors o mask-like face cog-wheel rigidity o propulsive gait o  Akathisia - restless leg syndrome o /ystonia - defect in muscle tone o

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1luphenazine (*roli'in) hlorpromazine (horazine)

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hlorazepate /ipotassium (ran'ene)  Alprazolam (Pana')


Nursing Action Avoid driving +ive sugarless gum #onitor M report /on’t e#pose skin to sunlight  (onitor )*   Advise gradual change in position ,eport at once

ANTI$EP&ESSANTS /esired effects% increased appetite& adeuate sleep

Tricyclic Anti(epressants 3'amples% • 0mipramine (ofranil)

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 Amitriptyline (3lavil)


 Adverse effect% report promptly  • ardive dyskinesia - lip smacking •  Agranulocytosis  Assess for% o 1ever   !ore throat  2ab data% =B count  • $epatoto'icity  Assess for A2 M A! o

MA% INHI4IT%&S 0ndication% refractory depression

MIN%& T&AN?6ILIE&SB ANI%L"TI5S ⊗ ommon indication% An'iety disorders ⊗ /esired 3ffect% /ecreased an'iety& adeuate sleep 3'amples%

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/iazepam (9alium) 'azepam (!era') hlordiazepo'ide (2ibrium)

3'amples% • ranylcypromine (*arnate) • *henelzine (
PS"5HIAT&I5 N6&SIN#

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a

a *age 6D of 78

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2ithane& 2ithobid)

0socarbo'azid (#arplan)


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*aro'etine (*a'il) 1luvo'amine (2uvo')

Nursing implications! ⊗ Best taken after meals ⊗ 0ncrease intake of% • fluids (7 2 5day) • sodium (7 gm5day) ⊗  Avoid activities that increase perspiration ⊗

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ANTI-MANI5 A#ENT E7amples! • 2ithium itrate (ibalith ; !)

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2ithium arbonate (3skalith&

PS"5HIAT&I5 N6&SIN#

 A nonspecific response of the body to any demand made upon it. ($ans !elye& 6N7L)  A state produced by a change in the environment that is perceived as challenging& threatening or damaging to the persons dynamic euilibrium. (!meltzer& 6NN8)

A(aptation •  A constant ongoing process that occurs along time continuum& beginning with birth and ending with death. (!meltzer& 6NN8) •  A continuous process of seeking harmony in an environment.

*age 6: of 78

Types of A(aptation!

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#eneral A(aptation Syn(rome *#AS1 • 0nvolves the whole body in response to stress. • ompared to life process as it focuses on the Jwear and tear of the body tissues. P)ases! • Alarm  Acute phase of the syndrome o haracterized as the Jflight and fightK reaction o /efensive by nature but self-limiting o 0f stress is intense& it may lead to death. o • &esistance haracterized as the state of adaptation o *erson moves back to homeostasis o • E7)austion ,esult of a prolonged e'posure to stress and adaptive mechanisms can o no longer persist. Local A(aptation Syn(rome • ,efers to inflammatory response and repair processes that occur at the local site of tissue inury. Eustress - positive stress $istress •
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2eads to potentially dangerous& self-destructive or socially unacceptable behavior.

5)aracteristics • $ighly individualized • !elf-limiting% D-L weeks • *erson affected becomes passive and submissive •  Affects a persons support system

Type #aturational5developmental crisis

$escription e'pected& predictable and internally motivated

! ituational5accidental

4ne'pected& unpredictable and e'ternally motivated

E7ample *uberty& adolescence& young adulthood& marriage& or the aging process. 3conomic difficulty& illness& accident& rape& divorce or death

!ocial crisis

/ue to acts of nature


P)ases • /enial • 0ncreased ension • /isorganization •  Attempts to reorganize • !tage for full reorganization

5&ISIS INTE&'ENTI%N • #aor +oal% ,estore the ma'imum level of functioning (pre-crisis state) o 0t is an active but temporary entry into the life situation of an individual o or a family during a period of stress.

*age 6L of 78

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 A way of entering into the situation to help them mobilize their resources and to decrease the effect of stress.

$omestic 'iolence &e@uiring 5risis Intervention! &APE •
5omponents of %mission! • hild abandonment ; leaving the child physically • hild neglect - lack of provision of those things which are necessary for the childs growth and development ypes of ommission% P)ysical Abuse • 0s an intentional physical harm inflicted on a child by a parent or other person. Emotional abuse - insult and undermining ones confidence Se7ual abuse - abuse in the form of se'ual contact haracteristics of Abusive *arents% • hey come from violent families • hey were also abused by their parents • hey have inadeuate parenting skills • hey are socially isolated because they dont trust anyone

4attere( :ife Syn(rome *4:S1 •  A form of cyclic domestic violence • #en% low self-esteem • =omen% /ependent personality disorder 

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5)il( Abuse • 0s an act of omission of responsibility or commission in which intentional harm is inflicted on a child.

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*age 6G of 78

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hey are emotionally immature hey have negative attitude towards the management of the abused

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=arning signs of hild Abuse 5
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 Apathy Bruised or swollen genitalia tears or bruising of rectum or vagina 4nusual inuries for the childs age and development !erious inuries (fractures& burns& lacerations) 3vidence of old inuries not reported

&epublic Act ,0+3 *Anti 5)il( Abuse Law1 • ,euired reporting of suspected cases • ,eport cases to the nearest authorities within D? hours AssessmentF Planning an( Nursing Actions for 5risis • *rimary concerns% *hysical inuries o  Alleviation of psychological trauma o •
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mouth or anal smears containing semen 0ntervention focuses family as a unit. 0f the victim is a child% *lay and art therapy $E8ENSE ME5HANISM o

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hese are automatic and usually unconscious processes or act by the individuals to% reduce or cope an'iety or fear  o resolve emotional or mental conflict o protect ones self-esteem o protect ones sense of security o Becomes pathologic when overused. 4sed by both mentally healthy and mentally ill individuals

ommon /efense #echanisms 4sed ! • 5ompensation  An attempt to overcome a real or imagined short coming& inferiority& o inabilities and weaknesses.  A blind woman becomes proficient in playing piano. o •

5onversion 3motional problems are converted to physical symptoms o  A student unprepared for a report suffered headache the day she is o supposed to deliver her report.

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$enial 1ailure to acknowledge an intolerable thought& feeling& e'perience or o reality  A middle-aged man after being admitted to the 4 because of an A#0& o insists that he is in the hospital for ust a diagnostic work-up.

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$isplacement the redirection of feelings to a less threatening obect o  An adolescent boy& after an argument with his father& goes to the room o and kicked his rooms door .

*age 6? of 78

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8antasy onscious distortion of unconscious feelings or wishes o  A boy who is being bullied by his friends wished he had the power of o =olverine.

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8i7ation  An unhealthy mechanism which is an arrest of maturation at certain o stages of development.  A boy never overcame being fully reliant from his mother. o

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I(entification  An individual integrates certain aspects of someone elses personality o into ones own.  A young school teacher adopts his former mentors teaching style when o conducting class sessions . Intellectuali>ation  An overuse of intellectual concepts by an individual to avoid e'pression o of feelings  A man who was asked to share a memorable e'perience about his o grandmother who died discussed the stages of death and dying by 3lizabeth Cubler ,oss. Pro
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&eaction  8ormation 3'pression of feeling that is the direct opposite of ones real feeling. o  Also referred to as overcompensation. o  A student who dislikes one of her classmates may act or show concern o toward her.

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&ationali>ation  An individual finds a ustifiable cause and acceptable reasons ust to be o saved from an embarrassing and an'iety producing thoughts or situations.  A basketball player claims that he missed the shot and lost the game o because of the distractions made by the audience.

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&egression 0s the turning back to earlier patterns of behavior in solving personal o conflicts. ommonly seen to schizophrenic patients o  A person who becomes ill in the face of disappointment has regressed o to a form of childish behavior.

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&epression 0t is the involuntary or unconscious forgetting of an unpleasant ideas or o impulses. /uring the nurse-patient relationships& patients often unconsciously o avoid discussing those e'periences producing an'iety which are emotionally difficult to verbalize.

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Suppression *ermits the individual to store away or consciously forget the o unpleasant& painful and unacceptable thoughts& desires& e'periences and impulses. "0ll think it about tomorrow"& "0d rather go now"& "an we change the o topicF"  A boy walked out from the group and said "0 have to go now"& when he o was asked what was happened to their relationship with his girlfriend.

*age 6N of 78

Substitution ,eplacing the desired unattainable goal with one that is attainable o  A woman who failed the nursing board e'am 7 times& worked as a o nursing aide ust to be in the hospital.

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Sublimation he redirection of unacceptable instinctual drive with one that is socially o acceptable 0nstead of harming his mother& a man e'pressed his anger by o composing a song.

SE'E&E ⊗ *hysical - s5s' becomes the flow of attention ⊗ ognitive ; perceptual field is greatly narrowed& focus of attention is trivial events ⊗ 3motional ; defense m echanism operate

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Symboli>ation 2ess threatening obect is used to represent another  o  A woman& missing her husband finds comfort in hugging her son who o looks like his father.

PANI5 ⊗ *hysical ; s5s' of e'haustion ignored ⊗ ognitive ; personality disorganized ⊗ 3motional ; defense mechanism fail

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6n(oing  An attempt to erase an act& thought& feeling& guilt or desire o  A man gives her wife a bunch of roses after their argument last night. o

Nursing $iagnoses! ⊗ 0neffective individual coping ⊗  An'iety Nursing Management! ⊗ alm ⊗  Administer medications ⊗ 2isten ⊗ #inimize environmental stimuli ANIET" $IS%&$E&S

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ANIET" ⊗ 9ague sense of impending doom ⊗ !ubective response to stress ⊗ 0s a state of apprehension& uneasiness& uncertainty or tension e'perienced by an individual in response to an unknown obect or situation.

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Panic $isor(er  ⊗  An individual may suddenly e'perience frightening and uncomfortable symptoms ⊗ #ay include terror& sense of unreality or fear of loosing control ⊗  Attack% 6 minute and 6 hour 

!igns and symptoms% Mil( ⊗ *hysical - R*,& ,,& B*& pupillary dilatation& sweating ⊗ ognitive - Attentive and alert ⊗ 3motional - #inimal use of defenses

P)obic $isor(er  ⊗ *hobia is an irrational fear of an obect& place& activity or situation. ⊗  Avoidance will allow the individual to be free from an'iety.

Mo(erate

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*hysical -
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*age 8H of 78

3'amples%   Agoraphobia - fear of open places and of being alone in public places.  !ocial phobia - irrational fear of criticism& humiliation or embarrassment.   Acrophobia - fear of heights   Algophobia - fear of pain  laustrophobia - fear of enclosed place  hanatophobia - fear of crowds  *athophobia - fear of disease  #onophobia - fear of being alone #enerali>e( An7iety $isor(er *#A$1 ⊗ 4nrealistic& e'cessive an'iety and is unable to control worry. ⊗ lients may e'perience% fatigue& irritability& restlessness& muscle tension& sleep disturbance %bsessive 5ompulsive $isor(er  ⊗ 0s characterized by recurrent obsessions and compulsions that interfere with normal life. %bsession ⊗ ,efers to persistent& painful intrusive thought& emotion or urge that one is unable to suppress or ignore. 5ompulsion ⊗ ,efers to repetitious uncontrollable act and sometimes a purposeful act to prevent a certain mistake in an event or situation. Post-Traumatic Stress $isor(er *PTS$1 ⊗ 0s the delayed reaction of the person who has been involved or e'posed to a traumatic events. ⊗ !ymptoms of this disorder are% intense psychological distress  feeling of detachment or estrangement from others  insomnia  decreased concentration 

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avoidance of thoughts and feelings recurrent distressing dreams inability to recall an important aspect of the trauma

Nursing Interventions ⊗ alm and nonudgmental approach to convey acceptance. ⊗ 4se short and simple sentences or words. ⊗ $elp the client develop an increase tolerance to an'iety. ⊗ $elp the client to% develop a problem-solving and coping skills of the client.  develop the ability to remain calm in an'iety-producing situations.  ⊗  Approach% kind-firmness ⊗ !ystematic desensitization (phobic disorders) ⊗ lients with ritualistic behavior (obsessive-compulsive disorder) should not be prohibited or reprimanded. ⊗ Biofeedback& change of the scenery& therapeutic touch& hypnosis& massage or rela'ation e'ercises. ⊗  Administer medications& as ordered.

ANIET" &ELATE$ $IS%&$E&S Somati>ation $isor(er  ⊗ 1ree floating an'iety disorder ⊗ lients% e'press emotional turmoil or conflict through physical symptoms.  usually seek for repeated medical attention.  may e'hibit antisocial behavior and may attempt suicide.  ⊗  Associated with an'iety and depression 5onversion $isor(er  ⊗  A condition in which an an'iety-provoking impulse is converted unconsciously into functional symptoms. ⊗ onscious counterpart of malingering ⊗ 3'amples% *aralysis& blindness& loss of touch or pain sensation& dyspnea& seizures or convulsions

*age 86 of 78



Hypoc)on(riasis ⊗  An individual presents an unrealistic or e'aggerated physical complaints. ⊗ he person becomes& preoccupied with the fear of developing or having already a disease or illness in spite of medical reassurance. 4o(y $ysmorp)ic $isor(er  ⊗ *reoccupation with an imagined defect in his or her appearance. ⊗ !light physical abnormality O e'cessive concern 5 an'iety $issociative Amnesia ⊗ 0nability to recall e'tensive amount of important information ⊗ aused by trauma ⊗ haracterized by% /isorientation  *urposeless wandering  0mpairment in ability to perform A/2  ⊗ ,apid recovery generally occur 

PE&S%NALIT" $IS%&$E&S ⊗  Are pervasive and infle'ible patterns of functioning that is stable overtime& and leads to distress or impairment. ypes of *ersonality /isorders% Eccentric Personality $isor(er *Type A1 ⊗ Paranoi( (!uspicious and distrustful) *ersons who display pervasive and long stand suspiciousness  #ore common in men  ⊗ Sc)i>oi( (!ocially distant and detached) *attern of detachment from social relationship  hooses solitary activities  opics are inanimate obects and ideas  ⊗ Sc)i>otypal (dd and eccentric) Jmild schizophreniaK 

a.n.g.5n.a.l.

PS"5HIAT&I5 N6&SIN#



 Acute discomfort in close relationships ognitive or perceptual distortion

$ramatic-Erratic Personality $isor(er *Type 41 ⊗ Antisocial *aggressive an( manipulative1 *attern of disregard for the violation of the rights of others  2ow self-esteem  ⊗

⊗

4or(erline (destructive and unstable) haracterized by patterns of instability in relationships& self image and  mood !elf-mutilating behavior     Affective instability #ore common in women  Narcissistic (boastful 5 superiority comple') +randiosity and need for constant admiration  3'ploitation of others for fulfillment of own desire 

An7ious or 8earful Personality $isor(er *Type 51 ⊗ Avoi(ant (inferiority comple') !ocial inhibition  1eelings of inadeuacy and sensitivity  2ow self-esteem  !ocial withdrawal in spite of a desire for affection and acceptance  ⊗ $epen(ent (submissive) !ubmissive clinging behavior related to e'cessive need to be cared for  by others 2ack of self-confidence  *erceive self as helpless and stupid  ⊗ %bsessive-5ompulsive (perfectionist) *reoccupied with orderliness& perfectionism& infle'ibility& need to be in  control 1ormal and serious interpersonal relationship  >udgmental of self and others  ⊗ Passive-Aggressive

*age 88 of 78

 

0ntentional inefficiency *assive resistance to demands for adeuate performance in both occupational and social functioning

Nursing $iagnosis! • 0neffective individual coping • !elf-esteem disturbance

$IS%&$E&S 5%MM%NL" $IA#N%SE$ T% 5HIL$&EN A6TISM ⊗ haracterized by% impairment in communication skills  presence of stereotyped behavior& interests and activities.  associated with impairment on social interactions  ⊗ treatable but not curable ⊗ more common among boys ⊗ usually diagnosed at age 8 ⊗ #ain problem% 0nterpersonal functioning ⊗ #ost acceptable cause% Biological factors - brain ano'ia& intake of drugs Signs an( Symptoms ⊗ dd play ⊗
a.n.g.5n.a.l.

⊗ ⊗ ⊗

0nsensitive to pain
Nursing Interventions ⊗ 3nvironment% safe M consistent ⊗ 3ncourage the client to participate for self-care ⊗ !peak calmly when giving instructions ⊗ 4se simple words or phrases ⊗ ,epeat instructions as necessary. ⊗ $aloperidol - symptomatic relief for hyperactivity& stereotypical and selfdestructive behavior 

MENTAL &ETA&$ATI%N ⊗
PS"5HIAT&I5 N6&SIN#

*age 87 of 78

⊗ piate into'ication ⊗
Levels% Level Mil(Bmoron

I? :6-GH

Mo(erateBImbecile

7L-:H

SevereBI(iot

8H-7:

Below 8H

Implication /ifficulty adapting to school 3ducable ; needs assistance o *oor awareness of needs of others rainable ; needs moderate supervision 4nable to learn academic skills o *oor motor development and minimal o speech
ATTENTI%N $E8I5IT H"PE&A5TI'IT" $IS% &$E& ⊗ ommon in boys ⊗ 4sually diagnosed before age G ⊗ *roblems% ⊗ 0nattention ⊗ $yperactivity ⊗ 0mpulsivity 5auses! Intranatal factors Signs an( Symptoms ⊗ bstinacy ⊗
Principles of Nursing 5are ⊗ *rotective care 3ducation of the family heir involvement is an important factor in the plan of care to promote  progress and to minimize the stress. ⊗ ,epetition ⊗ ,ole modeling ⊗ ,estructuring ⊗ 1ocus of 3ducation  ,eading   Arithmetic  =riting

a.n.g.5n.a.l.

PS"5HIAT&I5 N6&SIN#

⊗ ⊗ ⊗ ⊗ ⊗

1ighting syndrome  Aggressiveness olerance is low /ifficulty concentrating 3'cessive talking 1idgeting 0nterrupt5intrudes on others hild e'hibits hyperactivity 0ndulges in destructive behavior  emper tantrums

Nursing $iagnosis • *otential for inury Principles of Nursing 5are! ⊗ *rovide nutrition and safety

*age 8D of 78

⊗

⊗

3nvironment% structured enable appropriate reaction to the environmental stimuli *lan a firm and consistent environment in which limits and standards are set.

$rug of c)oice  % #ethylphenidate (,italin)

 ⊗

⊗

$IS%&$E&S 5%MM%NL" $IA#N%SE$ T% A$6LTS

purges after eating e'treme e'ercise !igns of purging swelling of the cheeks or aw area  cuts and calluses on the back of the hands and knuckles  teeth that look clear  *eculiar signs depression  loss of interests in activities  

EATIN# $IS%&$E&S ⊗ #ore common among females. 5auses! ⊗ *sychological factors *arental factors (domineering parents)  0ndividual factors (conflict about growing up)  !ociocultural factors  Anore7ia Nervosa ⊗ #ain sign% #orbid fear of gaining weight ⊗ ther signs% Sensitivity to cold temperatures  Amenorrhea  $eliberate self-starvation with weight loss     

8in(ings! *for bot)1 ⊗ =eight loss of 6:T or more of original body weight

$enial of hunger %bvious thinness but feels fat Lanugo all over the body Loss of scalp hair

⊗  Amenorrhea ⊗ !ocial withdrawal and poor family and individual coping ⊗ $istory of high activity and achievement in academics& athletics ⊗ 3lectrolyte imbalance

4ulimia Nervosa ⊗ 3'treme measures to lose weight uses diet pills& diuretics or la'atives 

a.n.g.5n.a.l.

⊗ /epression 5 distorted body image

Nursing $iagnosis!

PS"5HIAT&I5 N6&SIN#

*age 8: of 78

⊗ ⊗



Nursing Interventions! ⊗ 3stablish a trusting relationship ⊗ #onitor vital signs ⊗ ,einforce% dieticians prescription to accomplish realistic weight gain  treatment plan that establishes privileges and restrictions based on  compliance ⊗ /ecrease emphasis on foods& eating& weight loss or gain ⊗ =eigh client daily at the same time ⊗ ,emain with the client after meal and for 6st four hours ⊗ !et limit on time allotted for eating ⊗ 3ncourage client to e'press feelings ⊗ *romote feeling of control by participation in treatment  independent decision making 

SE6AL $IS%&$E&S ⊗ !e'uality - is the result of biologic& psychological& social and e'perimental factors that mold an individuals se'ual development& self-concept& body image and behavior. P)ases of t)e Se7ual &esponse 5ycle ⊗ /esire the ability& interest and willingness to receive se'ual stimulation  ⊗ 3'citement 5 Arousal ,esult of psychological stimulation  3'ample is fantasizing during the desire phase and foreplay which  involves petting and fondling of erogenous zones or areas of the body that are particularly sensitive to erotic stimulation. ⊗ *lateau ⊗ rgasm

a.n.g.5n.a.l.

formerly termed as clima' the shortest stage in the se'ual response cycle occurs when stimulation proceeds through the plateau stage to a point  where the body suddenly discharges accumulated se'ual tension ,esolution phase the final phase of se'ual response  organs and body systems gradually return to the unaroused state  

Body image disturbance 0neffective individual coping

PS"5HIAT&I5 N6&SIN#

⊗

Se7ual $ysfunction $isor(ers ⊗ Se7ual $esire $isor(ers! ) ave little or no se'ual desire or have an aversion to se'ual contact. ⊗ Se7ual Arousal $isor(er! 0ndividuals cannot complete the physiologic reuirements for se'ual intercourse 3'amples =omen cannot maintain lubrication  #en cannot maintain an erection  ⊗ %rgasm $isor(ers! 0nability to achieve orgasm phase 3'ample% *remature eaculation ⊗ Se7ual Pain $isor(ers! 0ndividuals suffer genital pain (dyspareunias) 3'ample% 9aginismius Parap)ilia *Se7ual $ eviation1 ⊗  A term which generally refers to abnormal se'ual behavior  ⊗ 2asts for L months leading to distress or impairment to functioning.

3'amples  Anilingus Bestiality or Qoophilia oprophilia unnillingus 3'hibitionism

tongue brushing the anus contact with the animals smearing feces on the partner   tongue brushing the vulva 0nvolves e'posing ones genitals to unsuspecting  strangers. 9ictims are usually women or children.

*age 8L of 78

hey are stimulated by the effect of shocking the victim. inserting the penis into the mouth inanimate 5 non-living obects or articles ouching or rubbing against the unsuspecting  people. 4sually occurs in crowded places where escape is  into the crowd is possible. !e'ual gratification from e'periencing pain   0nvolves the acts of being humiliated beaten& restrained& or otherwise made to suffer  involves the use of corpses  inserting the penis into the other parts of the body  use of prepubertal children  could be an actual se'ual act or a fantasy   child is generally 67 years of age or younger  inflicting pain 0nvolves telephoning someone and making lewd&  obscene remarks or conversation.   ACA se' on phone se'ual e'citement through wearing the clothing of a woman urinating on the partner   Act of observing unsuspecting person who is naked& in the process of disrobing& or engaging in se'ual activity 0ncludes cyber-voyeurism 

1ellatio 1etishism 1rotteurism

#asochism


!adism elephone !catalogia

ransvestism 4rophilia 9oyeurism

#en(er I(entity $isor(er ⊗  ACA ranse'ualism ⊗ Believe that they were born as the wrong se' ⊗ 2eads to persistent discomfort and feels inappropriate in the role of the assigned se'.

⊗

⊗ ⊗ ⊗ ⊗ ⊗

 Attitude%   Accepting 3mpathic 
S64STAN5E-&ELATE$ $IS%&$E&S Alco)olism ⊗ 0s a chronic disease or a disorder characterized by e'cessive alcohol intake and interference in the individuals health& interpersonal relationship and economic functioning. (=$) ⊗ onsidered to be present when there is .6T or 6H ml for every 6HHH ml of blood Signs of use% ⊗ .6-.8T - low coordination ⊗ .8-.7T - presence of ata'ia& tremors& irritability& stupor  ⊗ .7 and above - unconsciousness Progression% ⊗ *re-alcoholic *hase - starts with social drinking tolerance begins to develop ⊗ *rodromal !tage - alcohol becomes a need blockouts occur denial begins to develop ⊗ rucial - cardinal symptoms of alcoholism develops (loss of control over drinking) ⊗ hronic *hase - the person becomes into'icated all day

Nursing Interventions %

a.n.g.5n.a.l.

PS"5HIAT&I5 N6&SIN#

*age 8G of 78

%utcome! ⊗ Brain damage

⊗

⊗  Alcoholic hallucinosis

orsa;offJs Psyc)osis ⊗ 0s a form of amnesia ⊗ characterized short-term memory loss  /isorientation  inability to learn new skills  confabulation  ⊗ /eficiency in vitamin B comple'& especially B6 and B68.

⊗ /eath

4e)avioral problems! ⊗ /enial ⊗ /ependency ⊗ /emanding ⊗ /estructive ⊗ /omineering

Alco)ol :it)(rawal ⊗ ccurs when an individual abruptly stops drinking after alcohol has become a necessity of life to maintain functioning. ⊗ !ymptoms include% autonomic hyperactivity  grand mal seizures  psychomotor agitation and an'iety  increased hand tremors  sleep disturbances (insomnia and nightmares)  illusions hallucinations  hyperthermia   tachycardia (impending delirium tremens) Alco)ol :it)(rawal $elirium ⊗  ACA delirium tremens e'perienced within 8D to G8 hours after the last intake%  agitation o elevated vital signs o illusions and hallucinations o restlessness o hyperalertness o incoherent speech o

a.n.g.5n.a.l.

serious medical complications may occur if the client is left untreated

PS"5HIAT&I5 N6&SIN#

:ernic;eJs Encep)alopat)y ⊗  An inflammatory hemorrhagic degenerative condition of the brain ⊗ caused by B6 deficiency ⊗ !ymptoms include% double vision  involuntary and rapid eye movements  lack of muscular coordination  decreased mental function  Nursing $iagnosis % 0neffective individual coping Principles of Nursing 5are % ⊗ =ell lighted room ⊗ /iet as tolerated ⊗ #onitor vital signs ⊗  Administration of glucose ⊗ 9itamins

Alco)ol $eto7ification % ⊗ /rug of hoice% /isulfiram (Antabuse) - delays the metabolism of alcohol ⊗  Avoid alcohol-containing products ⊗ 7 !s of deto'ification%

*age 8? of 78

  

!afety !edation !upplement (#ultivitamins& 9itamin B-comple'& 9itamin )

⊗

⊗

$&6#-&ELATE$ $IS%&$E&S

⊗

5ocaine-&elate( $isor(ers *Stimulants1 ⊗ 5ocaine is a white powdered stimulant substance ⊗ 4sually sniffed& snorted& smoked in a pipe or inected into a vein or subcutaneous tissue. ⊗ *oor mans cocaine% !habu (sha-boo)  ⊗

⊗ ⊗

!igns of use% panic attacks  insomnia  loss of appetite  impaired thinking  cocaine psychosis  agitation  dilation of the pupils  diaphoresis  increase 9!  lassic sign% *erforated nasal septum +an cause a sudden heart attack even in healthy young people

5annabis-&elate( $isor(ers *5annabinoi(s1 Mari
a.n.g.5n.a.l.

PS"5HIAT&I5 N6&SIN#

⊗

⊗ ⊗

,outes of use% rally (capsules& tablets& on sugar cubes)  =ith food  !moked in a pipe or rolled as cigarette.   Acts within 6: minutes 3ffects lasts appro'imately 8 to D hours *hysiologic symptoms include increased appetite  e'citement  drowsiness  lowered body temperature  depression  unsteady gait  reduced coordination and refle'es  inability to think clearly  impaired udgment  lassic sign% bloodshot eyes 0n large doses& it may cause% $allucination  !uicidal ideations  /elusions of invulnerability 

Long-term #oals! ⊗ 5ommunity resources ⊗ %ther coping means aside from denial ⊗ Personal responsibility for not drinking 5 drugs taking ⊗ Isolation ⊗ Nutrition ⊗ #roup therapy

S5HI%PH&ENIA AN$ %THE& PS"5H%SES S5HI%PH&ENIA

*age 8N of 78

• • • • •

• •

0s a serious psychiatric disorder  ne of the most profound disabling illness
Manifestations! Eugene 4leuler  •  Associative looseness •  Autism •  Apathy •  Ambivalence •  Auditory hallucination Types $istinguis)ing features /isorganized *eculiar 5 bizarre behavior  0ncoherence !tereotyping

*aranoid

*rognosis% *oor  /efense #echanism% ,egression $allucinations 0deas of reference /elusion of persecution !uspiciousness *rognosis% +ood /efense #echanism% Pro
Nursing Interventions ⊗  Assist with A/2 ⊗ 3ncourage activity ⊗ *resent reality

=a' fle'ibility !tupor 
⊗ ⊗ ⊗

*riority% nutrition M circulation *rovide distraction 3ncourage activity

*rognosis% +ood /efense #echanism% &epression

6n(ifferentiate( • *atients whose manifestation cannot be easily fitted into one or the other type &esi(ual • *atients with minimal symptoms

#eneral Nursing Interventions! ⊗ 3stablish% a trusting relationship and provide acceptance  a clear& consistent and open communication  ⊗ !et limits ⊗ /ecrease environmental stimuli ⊗ bserve for suicidal ideation ⊗  Administer medications& as ordered. M%%$ $IS%&$E&S

⊗ ⊗ ⊗ ⊗ ⊗ ⊗

a.n.g.5n.a.l.

atatonic

*riority% safety of others /eal with the $0/ ffer sealed foods 5 unopened medicines
PS"5HIAT&I5 N6&SIN#

Precipitating 8actors ⊗ 2oss of a loved one ⊗ #aor life events ⊗ ,ole strain ⊗ /ecreased coping resources ⊗ *hysiological changes 5ommon Types of Moo( $isor(er 

*age 7H of 78

⊗ ⊗ ⊗ ⊗

⊗ ⊗

4ipolar I $isor(er! #ay e'perience one or more of symptoms of manic episode 4ipolar II $isor(er! #ay e'perience one or more symptoms of maor depressive episode with hypomania Ma
5linical Symptoms of Ma
5linical Symptoms of Manic Episo(e ⊗ alkative or pressured to keep talking ⊗ 0nflated self-esteem or grandiosity ⊗ *sychomotor agitation ⊗ 3'hibit flight of ideas ⊗ /ecreased need for help ⊗ /istractibility

a.n.g.5n.a.l.

Cind firmness


#onotonous

Priority N$7 Nursing Management

,isk for inury% selfdirected +roup therapy  Antidepressants 3

Suici(e ⊗ thought or act of taking ones own life ⊗ ultimate form of self-destruction ⊗ "cry for helpJ ⊗ reunion wish or fantasy ⊗ progressive failure to adapt feelings of anger or hostility ⊗ a way to end feelings of hopelessness and helplessness ⊗ an attempt "to save face" or seek a release to a better life

Nursing $iagnosis! ,isk for inury-!elf directed

Summary! Appearance $M

#atter of fact

Activity

&is; 8actors ⊗ Se' (more female attempts suicide but more male commits suicide) ⊗ 6nsuccessful previous attempt ⊗ Identification with a dead family member ⊗ 5hronic ⊗ Illness (e.g. ancer) ⊗ $epression5/ependent personality ⊗ Age (6?-8: and DH)5Alcoholism) ⊗ Lethality of previous attempt52ooses

⊗ Memory loss

Mania 3lated *roection

Attitu(e t)erapies

$epression !ad 0ntroection

PS"5HIAT&I5 N6&SIN#

Nursing care! ⊗ Safe environment ⊗ Always take overt or covert threats or attempts seriously

*age 76 of 78