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Lecture Aid: Mental Health and Psychiatric Nursing 1: Lester R. L. Lintao
Lecture Aid: Mental Health and Psychiatric Nursing 1: Lester R. L. Lintao
Lintao 1
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." (WHO)
· ________________
· Autonomy
· Perceptive ability
· Integral capacity
· _________________
· Mastery of one’s environment
MENTAL HYGIENE
· Study of mental health
COMMUNICATION
• ______________ exchange of ideas between or among persons
• Modes:
· VERBAL- written/spoken
· NON-VERBAL- posture, tone of voice and facial expression.
o Types:
▪ Kinesis
▪ Paralanguage
▪ Proxemics
▪ Touch
THERAPEUTIC COMMUNICATION
▪ A way of interacting in a purposeful manner to promote the client’s ability to express his
thoughts and feelings openly.
Essentials:
Genuineness
Respect
Empathy
Attentive listening
Trust & rapport
Barriers:
Belittling
Interrupting / ignoring
Giving advice
Social response
Changing the subject
Approving / disapproving
Moralizing
NURSE-PATIENT RELATIONSHIP
(Hildegard Peplau)
Stages:
PRE-ORIENTATION
▪ Begins when the nurse is assigned/chooses a patient
▪ Anxiety: ______________
▪ Major task of the nurse: develop self-awareness
▪ Other tasks:
▪ Data gathering
▪ Planning for first interaction
ORIENTATION
Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 2
WORKING / THERAPEUTIC
▪ Anxiety: ______________
▪ Major task: identification and resolve problems by reinforcing coping: __________,
________, ________
▪ Highly individualized
▪ More structured
▪ The longest and most productive
▪ Other tasks: planning and implementation
Problems)
• ________________
o the development of an emotional attitude towards the nurse
o positive or negative
• Counter transference
o experienced by the nurse / therapist
TERMINATION
• Reinforce, reward and ____________
• Encourage verbalization
– Anxiety: Patient
· Summarize the progress
· Terminate
STRESS
· A ___________response of the body to any demand made upon it. (Hans Selye, 1936)
· Stressors: _________, _________, ____________
Adaptation
· A constant ongoing process that occurs along time ___________, beginning with birth and ending with
death. (Smeltzer, 1992)
Types:
I. Physical
A. General Adaptation Syndrome
B. Local Adaptation Syndrome
DEFENSE MECHANISM
• Are automatic and usually unconscious processes
• Pathologic when _______________
• Used by both the healthy and ill
Commonly used:
Compensation
· An attempt to a real or imagined short coming, inferiority, inabilities and weaknesses
Conversion
· Emotional problems are converted to __________ symptoms
Denial
· Failure to acknowledge an intolerable thought, feeling, experience or reality
Displacement
· The redirection of feelings to a ___________ threatening object.
Fantasy
· Conscious distortion off unconscious feelings or wishes
Fixation
· "Arrest of maturation"
Introjection
· “Self-blaming
Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 3
Identification
· An individual integrates certain aspects of someone else's personality into one's own
Intellectualization
· An overuse of intellectual concepts by an individual to avoid expression of feelings
Projection
· "Blaming others"
Reaction – Formation
· Expression of feeling that is the direct opposite of one's real feeling.
Rationalization
· Making justifiable reasons
Regression
· The turning back to earlier patterns of behavior in solving personal conflicts.
Repression
· ___________ forgetting
Suppression
· ___________ forgetting
Substitution
· Unattainable goal replaced with attainable
Sublimation
· Unacceptable replaced with socially acceptable drives
Symbolization
· A ___________ threatening object is used to represent another
Undoing
· An attempt to erase an act, thought, feeling, guilt or desire
CRISIS
• Ineffective individual coping
• A ___________ interruption and disturbance of one's equilibrium or homeostasis
• Leads to potentially dangerous, self-destructive or socially unacceptable behavior.
Characteristics:
• Highly-individualized
• Self-limiting: ___________
• Victims: ___________ and submissive
• Affects a person's support system
Types:
Maturational / Developmental
• Expected, predictable and internally motivated
• Examples: puberty, adolescence, young adulthood, marriage, or the aging process.
Situational / Accidental
• Unexpected, unpredictable and externally motivated
• Example: economic difficulty, illness, accident, rape, divorce or death
Social / Adventitious
• Due to acts of ___________
• Example: natural calamities
ANXIETY
· ___________ response to stress
· An unpleasant emotional state
consisting of psychophysiological responses.
Manifestations:
Physical Cognitive Emotional
Mild Increase in VS Increased attentiveness and Minimal use of defenses
Pupillary dilatation alertness
Diaphoresis
Muscular weakness
Nursing Management:
Priority: ___________
Encourage ventilation
Administer medications as ordered
Carefully listen
Environmental stimuli must be controlled
ANXIETY DISORDERS
Panic Disorder Generalized Anxiety Disorder
Cause
Level
Progression
Length
Manifestations
PHOBIC DISORDER
• Phobia ______________
• Most common:
• Social phobia - ________________
SELECTIVE MUTISM
• Mutism on specific topics.
• Mistaken as a language disorder
• Duration: _____________
Hoarding Disorder
Trichotillomania /
Trichotillosis
Excoriation Disorder /
Dermatillomania
TRAUMA-AND-STRESSOR-RELATED DISORDER
Symptoms:
• Akinesia
• Mutism
• Numbness
• Symptoms same with PTSD
ADJUSTMENT DISORDER
(Exogenous, Reactive or Situation Depression)
• May be acute or chronic
• More common to ___________
Common characteristics:
• depressive symptoms
• anxiety symptoms
• traumatic stress symptoms
PAIN DISORDER
• Chronic pain experienced by a patient
in one or more area
• Alters ADL
• Often occurs after an accident or
during an illness that has caused pain
DISSOCIATIVE DISORDERS
NEURODEVELOPMENTAL DISORDERS
• Onset: ___________
• IQ below ___________
• Sub-average intellectual functioning
LEVELS:
Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 7
IQ Capabilities
Mild • Difficulty
adapting to school
• Educable
Moderate • Trainable
Severe • Needs
complete and close supervision
Profound • Minimal capacity for sensorimotor function
• Needs custodial care
COMMUNICATION DISORDERS
Types:
Difficulty
Language Disorder
ASPERGER’S DISORDER
• Age: _________________
• Predisposing factor: _________________
• Hallmark: _________________
• Motor development may be delayed
AUTISM
• Treatable but not curable
• Hallmark: Stereotypical behavior
• Gender: _______________
• Age: ___________
• Language pattern: _________________
• Diagnostic: _________________
• Diet: _______________
MOTOR DISORDERS
Types:
Manifestations
Developmental
Coordination Disorder
Stereotypic Movement
Disorders
Tourette Syndrome
CONDUCT DISORDER
• ___________ delinquents
• Precursor to antisocial personality disorder
• Kleptomania
• Pyromania
• Intermittent ___________ Disorder
Causes:
• Psychological factors
– Parental
– Individual
– Sociocultural
ANOREXIA NERVOSA
• Denial of hunger
• Obviously thin but feels fat
• Lanugo all over the body
• Loss of scalp hair
BULIMIA NERVOSA
• Extreme measures to lose weight
o uses diet pills, diuretics or laxatives
o purges after eating
o swelling of the cheeks or jaw area
o cuts and calluses on the back of the hands and knuckles (___________ sign)
o clear teeth
o extreme exercise
• Peculiar signs
o Depression
o loss of interest in activities
• Pathognomonic: __________________
NURSING INTERVENTION:
• Reinforce treatment and ___________ prescriptions
• Establish a trusting relationship
• Monitor weight and vital signs
• Encourage ventilation
• Decrease emphasis on foods, eating, weight
• Involve in decision making
• Employ ___________ setting
• Stay with the client after meal
SUBSTANCE-RELATED DISORDERS
ALCOHOLISM
1._______________
2._______________
3._______________
Progression:
• ___________
o starts with social drinking
o tolerance begins to develop
• ___________
o alcohol becomes a need
o blackouts occur
o denial starts
• ___________ - cardinal symptoms of develop
• ___________ - intoxicated all day
Behavioral problems:
• Denial
• Dependency
• Demanding
• Destructive
Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 10
• Domineering
Alcohol Withdrawal
• Occurs when an individual abruptly stops drinking
• Symptoms develop within few hours
Chronic Problems:
• Korsakoff's Psychosis
o A form of ___________
o Deficiency in vitamin B1 and B12
· Wernicke's ___________
o An inflammatory hemorrhagic degenerative condition of the brain
o Caused by B1 deficiency
Alcohol Detoxification:
• Drug of Choice: ___________ (Antabuse)
• 3 S’s of detoxification:
o ___________
o Sedation
o Supplementation
DRUG-RELATED DISORDERS
Cocaine-Related Disorders
• Cocaine is a white powdered substance
• Usually sniffed, snorted, smoked in a pipe or injected into a vein or subcutaneous tissue.
• Poor man’s cocaine: ___________
• Classic Sign: ___________ nasal septum
SEXUAL DISORDERS
· Sexuality - is the result of biologic, psychological, social and experimental factors that mold an individual's
sexual development, self-concept, body image and behavior.
Examples:
• Anilingus- tongue brushing the anus
• Bestiality or Zoophilia - contact with animals
• Coprophilia - smearing feces on the partner
• Cunnillingus - tongue brushing the vulva
• Exhibitionism - exposing one’s genitals to unsuspecting strangers (usually women or children)
• Felatio - inserting the penis into the mouth
• Fetishism - inanimate / non-living objects or articles
• Frotteurism - Touching or rubbing against the unsuspecting people.
• Masochism
• Sexual gratification from experiencing pain
• Necrophilia - use of corpses
• Partialism - inserting penis into the other parts of the body
• Pedophilia
o use of prepubertal children (13 years of age or younger)
o actual sexual act or a fantasy
• Sadism – inflicting pain
• Telephone Scatalogia (sex on phone) - calling someone and making lewd, obscene remarks or
conversation.
• Transvestism – wearing the clothing of a woman
• Urophilia - urinating on the partner
• Voyeurism
o Act of observing unsuspecting person who is naked, in the process of disrobing, or engaging in sexual
activity.
o Includes cyber-voyeurism
GENDER DYSPHORIA
• AKA ___________
• Persistent discomfort on the assigned sex.
Nursing Interventions:
· Attitude:
o ___________
o Non-judgmental
· Accept his feelings related to sexuality
· Have a private area for discussion
o Employ limit setting
· Intervene to discuss self-esteem issues, anxiety, guilt, and empathy for victims.
· Refer to the correct clinic.
NEUROCOGNITIVE DISORDER
PERSONALITY DISORDERS
• ___________ and ___________ patterns of functioning that is stable overtime, and leads to distress or
impairment.
• Incidence:
• ___________ of the general population
• In all socio-economic classes
Diagnostic Criteria:
· Deviating from culture
· Alters ADL
· Onset: adolescence to early adulthood
· Not associated with other mental illness
· Not associated with other physical illness
Types
TYPE A (___________)
PARANOID - _____________________
SCHIZOID - _____________________
SCHIZOTYPAL - _____________________
Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 12
TYPE B
(Dramatic-Erratic-Egocentric)
ANTI SOCIAL - _____________________
BORDERLINE - _____________________
HISTRIONIC - _____________________
NARCISSISTIC - _____________________
TYPE C
(Anxious / Fearful)
AVOIDANT - ______________
DEPENDENT - ______________
OBSESSIVE-COMPULSIVE - ______________
PASSIVE-AGGRESSIVE - ______________
SCHIZOPHRENIA
• Not a single disease entity
• "___________ ___________"
• Characterized by:
o impaired communication
o Altered reality
o deterioration from a previous level of functioning
· Incidence:
· Men: 15 to 25
· Women: 25 to 35
Theories:
• Biological
• Neuroanatomical and neurodevelopmental
• Immunovirological
Shared Psychotic Disorder (folie a deux) • 2 or more people share a similar delusion
MOOD DISORDERS
Mania Depression
Biological Hereditary Hereditary
Neurochemica High Low norepinephrine and serotonin levels
l norepinephrine
and serotonin
levels
Psyhoanalytic Defense Rigid superego
mechanism
against
depression
Bipolar Disorder
• A person’s mood cycles between mania and depression for 1 week
Bipolar I Disorder
Bipolar II Disorder
Dysthymic Disorder
• 2 weeks or more
• Does not alter ADL
Cyclothymic Disorder
Mania Depression
Appearance ___________ ___________
DM ___________ ___________
Priority NDx Risk for injury: Risk for injury: self-directed
Directed at others
Nursing Management Individual therapies Group therapy
Lithium Antidepressants
Diet ECT