PSYCHIATRIC NURSING terminologies
General Knowledge Peter Glen L. Reyes
MENTAL HEALTH – balance in a persons internal life and adaptation to reality Mental ILL Health – state of imbalance i mbalance characterized by a disturbance in a persons thoughts, feelings and behavior Poverty and abuses are major risk factors Psychiatric nursing – interpersonal process whereby the professional nurse practitioner ,through the therapeutic use of self(art) and nursing theories (science), assist clients to achieve psychosocial well being. Core of psych nursing – interpersonal process – human to human relationship(both for mentally healthy and ill)
Neurosis any long term mental or behavioral d/o in which contact with reality reality is retained the condition is recognized by the patient as abnormal. Essentially features anxiet anxiety y 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 Therapy
Psychosis Mental or behavioral disorder wherein patient looses contact with reality realit y Presence of delusions, hallucinations,severe thought disturbances,alteration of mood, poverty of thought and abnormal behavior (schizophrenia , major disorder of affect ( mania – depression), major paranoid states and organic mental disorder Benefits from psychoanalysis and a ntipsychotics antipsychotics
Mental hygiene – measures to promote mental health , prevent mental illness and suffering and facilitate rehabilitation……. (and if necessary find meaning in these experiences) Main tool – therapeutic use of self It requires self-awareness Methods to increase self-awareness: – Discussion – Experience – Role play
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
1)
Disturbances in thinking thinking and speech neologism – coining of words that people do not understand Circumstantiality – over inclusion of inappropriate thoughts and details Word salad – incoherent mixture of words and phrases with no logical sequence Verbigeration – meaningless repetition of words and phrases Perseveration – persistence of a response to a previous question Echolalia – pathological repetition of words of others Aphasia – speech difficulty and disturbance
Expressive , receptive or global
Flight
of ideas- shifting of one topic from one subject to another in a somewhat related way Looseness of association-incoherent ,illogical flow of thoughts(unrelated way) Clang association – sound of word gives direction to the flow of thought Delusion – persistent false belief,rigidly held Delusions of grandeur- special /important in a way Persecutory-threatened Ideas of reference-situation/ev reference-situation/events ents involve them Somatic- body reacting in a particular way
Magical
thinking – primitive thought process thoughts alone can change events Autistic thinking – regressive thought process-subjective interpretations not validated with objective reality
1) 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 strangeness from one’s self Derealization – feeling of strangeness towards environment Agnosia – lack of sensory stimuli integration
activity 1) Disturbances in motor activity Echopraxia – imitation of posture of others ot hers Waxy flexibility – maintaining position for a long 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
memory 1) Disturbances in memory Confabulation – filling of memory gaps Déjà 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
Dynamics of Human Behavior Behavior – the way an individual reacts to to a certain stimulus Conflict – situation arising from the presence of two opposing drives Need - organismic condition that requires a certain activity Stress – life events in which a demanding situation (warrants a response )taxes a person’s pers on’s resources( support systems or coping mechanisms/strategies…distress and eustress Adaptation – process of interacting with the environment to maintain homeostatic equilibrium Maladaptation – ineffective coping
Dynamics of Human Behavior Personality – integration of systems and habits representing anindividuals characteristic adjustment to his environment expressed through behavior
3 divisions of the mind Conscious – focussed on awareness Subconscious – recalled at will Unconscious – never recalled / largest part Learning – change in behavior through – insight , relearning and remotivation
Freuds psychosexual theory Libido – inner drive Parts of body –focus of gratification Unsuccesful resolution - fixation Structures of personality – Id – pleasure principle-instinct principle-instinct – Ego – controls action and perception –reality principle – Superego – moral behavior - conscience
0-18 m0s ;oral – mouth – trust and discriminating 18 mos. – 3 years ; anal – bowels – holding on or letting go – Negativism and toilet training age
3 -6 years phallic ph allic ; genitals –exploration and discovery ( inc. sexual tension) – Gender identification and genital awareness – Oedipus and Electra complex // – Castration anxiety and penis envy
6-12 years –latency (quiet stage) sexual energy diverted to play. Institution of superego…control of instinctual impulses 12 – young adult – genital ; reawakening of sexual drives –relationships – Sexual maturation – Sexual identity ,ability to love and work
Psychosocial – Erickson developmental milestones //delay 0-12mos; 1-3y
TRUST AUTONOMY
3-6 6-12
INITIATIVE INDUSTRY
12-18 18-25
IDENTITY INTIMACY
25-60 60 and above
GENERATIVITY EGO INTEGRITY
INFANCY CONSISTENT MATERNAL –CHILD INTERACTION – TRUST INNER FEELING OF SELF WORTH
HOPE
TODDLER ALLOW EXPLORATION EXPLORATION PROVIDE FOR SAFETY NO NO – NEGATIVISM OFFER CHOICES / REVERSE PSYCHOLOGY TOILET TRAINING – 18 MOS.-BOWEL DAYTIME BLADDER -2 Y NIGHTIME BLADDER 3 Y
REWARD W/ PRAISE AND AFFECTION INDEPENDENCE
PRE-SCHOOL PROVIDE PLAY MATERIALS SATISFY CURIOSITY TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR) SIBLING RIVALRY WILLPOWER
SCHOOL AGE HOW TO DO THINGS WELL-SUPPORT EFFORTS CHUMS AND HOBBIES NEEDS TO EXCEL/ACCOMPLISH NEED FOR PRIVACY AND PEER INTERACTION COMPETENCE
ADOLESCENCE MAKE DECISION,EMANCIPATION FROM PARENTS BODY IMAGE CHANGES NEED TO CONFORM BUT KEEP INDIVIDUALITY SELF - AWARENESS
YOUNG ADULT COMMITMENT AND FIDELITY RESPONSIBILITY ACHIEVEMENT OF INDEPENDENCE
MIDDLE ADULTHOOD SUPPORT-PER SUPPORT-PERIOD SUPPORT-PERIIOD OD OF ROLE TRANSITIONS MIDLIFE CRISIS ADJUSTMENT AND COMPROMISE MOST PRODUCTIVE AND CREATIVE ALTRUISM
LATE ADULTHOOD SELF ACCEPTANCE SELF WORTH WISDOM
PIAGET’S COGNITIVE THEORY
0-2 SENSORIMOTOR REFLEXES IMITATIVE REPETITIVE BEHAVIOR SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT. TRIAL AND ERROR RESULTS IN PROBLEM SOLVING
2-7Y PRE-OPERATIONAL SELF-CENTERED,EGOCENTRIC CANNOT CONCEPTUALIZE OTHER’S VIEW ANIMISTIC THINKING IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY 2-4 PRE-CONCEPTUAL (PRE-LOGICAL) 4-7 INTUITIVE (UNDERSTANDING OF ROLES)
7-12Y CONCRETE OPERATIONAL LOGICAL CONCRETE THOUGHT INDUCTIVE RESAONING (SPECIFIC TO GENERAL) CAN RELATE ,PROBLEM SOLVING ABILITY REASONING AND SELF-REGULATION
12-ABOVE FORMAL OPERATIONAL OPERATIONAL THOUGHT Abstract thinking Separation of fantasy and fact Reality oriented Deductive reasoning Apply scientific method
Havighurst Developmental Tasks
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
Early adulthood – – –
Career Selecting a mate Finding Civic or social responsibility
Middle age – – – – –
Achieving Civic or social responsib responsibility ility Adjusting to changes Satisfactory career performance Adjusting to aging parents Adjusting to parental roles
Old age – Adjusting to changes – Establishi Establishing ng satisfactory living arrangements and affiliations
Kohlberg – MORAL DEVELOPMENT/ THINKING/ JUDGEMENT
PRE-CONVENTIONAL (0-6) – PUNISHMENT AND OBEDIENCE – OBEDIENCE TO RULES TO AVOID PUNISHMENT
CONVENTIONAL ( 6-12 ) – MUTUAL INTERPERSONA INTERPERSONAL L EXPECTATIONS,RELATIONSHIPS EXPECTATIONS EXPECTATIONS,,RELATIONSHIPS RELATIONSHIPS AND CONFORMITY – SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE – BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE
POST –CONVENTIONAL (12 – 18 Y) PRIOR RIGHT OR SOCIAL CONTRACT UNIVERSAL ETHICAL PRINCIPLE ABIDE FOR COMMON GOOD RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS
SULLIVANS INTERPERSONAL THEORY
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
TODDLERHOOD / EARLY CHILDHOOD CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION GRATIFICATIO N AND INTERFERENCE OF WISH FULFILLMENT
PRE-SCHOOL DEVELOPMENT OF BODY IMAGE AND SELFDEVELOPMENT PERCEPTION ORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL AND DISAPPROVAL DISAPPROVAL RECEIVED BEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES DISASSOCIA TES THOSE T HOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN
SCHOOL AGE THE PERIOD OF LEARNING TO FORM SATISFYING RELATIONSHIPS WITH PEERS-USES COMPETITION,COMPROMISE AND COOPERATION THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE SAME SEX
ADOLESCENCE LEARNS INDEPENDENCE AND HOW TO ESTABLISH SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE OPPOSITE SEX
YOUNG ADULTHOOD BECOMES ECONOMICALLY, INTELLECTUALLY AND EMOTIONALLY SELF SUFICIENT
LATER ADULTHOOD LEARNS TO BE INTERDEPENDENT AND ASSUMES RESPONSIBILITY FOR OTHERS
SENESCENCE DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY
FORMATION OF PERSONALITY CERTAIN GOALS MUST BE ACCOMPLISHED, IF THIS GOALS ARE NOT ACCOMPLISHED AT A CERTAIN STAGE,….PERSONALITY STAGE,….PERSONALIT Y WILL BE WEAKENED….FACTORS WEAKENED….FACTO RS IN EACH STAGE PERSISTS AS A PERMANENT PART OF PERSONALITY….
EACH STAGE HAS MAJOR TRAUMAS AND FRUSTRATIONS THAT MUST BE OVERCOME …….SUCCESSFUL RESOLUTION OF CONFLICTS ASSOCIATED WITH EACH STAGE IS ESSENTIAL TO DEVELOPMENT…..UNRESOLVED CONFLICTS REMAIN IN THE UNCONSCIOUS AND MAY, AT TIMES, RESULT IN MALADAPTIVE BEHAVIOR
PROMOTING PSYCHOSOCIAL HEALTH
SELF- AWARENESS SELF CONCEPT – COLLECTION OF FEELING BELIEFS ABOUT ONE’S SELF SELF ESTEEM – CONFIDENCE IN ONE’S ABILITIES AND JUDGEMENT ASSERTIVENESS + SELF - EVALUATION
STRESS GAS – ALARM-RESISTANCE ALARM-RESISTANCE-EXHAUSTION -EXHAUSTION COPING AND STRESS MANAGEMENT ANXIETY – MILD – SLIGHT AROUSAL AND INCREASED PERCEPTION – MODERATE MODERATE-INC. -INC. TENSION AND SELECTIVE INATT. – SEVERE – DEC. PERCEPTION AND FOCUSSED ENERGY – PANIC – OVERPOWERING AND LOSS OF CONTROL
GRIEF AND LOSS Loss is a universal experience that occurs oc curs throughout life span Grief is a form of sorrow sorrow so rrow involving involving feelings, feelings, thoughts, thoughts, and and behaviors caused by bereavement Responses to loss are strongly influenced by one’s cultural background The grief process involves a sequence of affective, cognitive, and psychological states as a person responds to, and finally accepts a loss. Responses to loss and patterns pa tterns of patterns of coping with loss are developed early in life. Stages of Grieving (Kubler-Ross) Denial- refuses to believe that the loss has occurred Anger- the individual resists the loss and and may “act out” feelings. Bargaining- the individual attempts to make a deal in an attempt to postpone the reality of loss. Depression- overwhelming feeling of loneliness and withdrawal from others Acceptance- the individual comes to terms with loss, or impending impending loss, psychological reactions to loss to the loss cease, and the interaction to other people resumed.
LOSS ,GRIEVING AND DEATH DEATH CONCEPTS – 1-5Y.O – IMMOBILITY AND INACTIVITY Wishes and unrelated action responsible for action – 5-10 – final but can be avoided – 9-12 – understands own mortality and fears death – 12 – 18 – fears and fantasizes avoidance – 18-45 – increased attitude awareness – 45-65 – accepts mortality – Above 65 – multiple meanings, encounters encounters and and
KUBLER ROSS – STAGES OF GRIEF D – SUPPORTIVE S UPPORTIVE A- PROVIDE STRUCTURE AND CONTINUITY B – LISTEN AND ENCOURAGE D- ALLOW EXPRESSION AND PROVIDE FOR SAFETY A- ENCOURAGE PARTICIPATION
CONCEPTS 6 MOS – 2 YEARS PROVISION OF DIGNIFIED PAIN FREE DEATH( QUEST. ANSWERED AND EMT. SUPPORT) DNR- COMFORT AND HYGIENE NEEDS ON-GOING CURE GOALS ----- COMFORT GOALS
