2007-Introduction to Psych Nursing

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Mercedes A Perez-Millan MSN, ARNP

INTRODUCTION TO PSYCHIATRIC

NURSING


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Mental Health???????

MENTAL ILLNESS


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Seven Signs of Mental Health

HappinessControl over behavior

Appraisal of realityEffectiveness in work

Healthy self-conceptSatisfying relationships(give and receive love)

Effective coping strategies


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Traits of Mental Health

Ability tooDeal with conflicting emotionsoLive without undue fear, guilt, or

anxiety

oTake responsibility for one's ownactions

oThink clearly

oNegotiate each developmental task


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Prevalence of Psychiatric Disorders

USAThe Department of Health and Human Servicesand the National Institute of Mental Health

(2004) provide the following statistics:

57.7 million Americans have a mental illness. That is26.2 per cent of Americans 18 or older.

Four of the ten leading causes of disability include:major depression, bipolar disorder, schizophrenia andobsessive compulsive disorder.

The economic burden of mental illness in the USA,

exceeds $ 170 billion.


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National Institute of Mental Health

2002 USA StatisticsAffective Disorders- 9.5 pre-cent. 18.8 millionSuicide- 29,350 people committed suicideSchizophrenia- 1.1 percent, 2.2 millionAnxiety disorders- 13.3 percent, 19.1 million

Eating disorders- 2- 5 percent of populationADHD- 4.1 percent of youth ages 9 to 17Substance abuse- 11.3 percent of the population


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Theories of Mental Illness

PSYCHOBIOLOGICAL

PSYCHOLOGICAL


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PSYCHOBIOLOGICAL

Genetic

Other Biological Influences

The Role of the Environment


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PSYCHOBIOLOGICAL

Overview of the Brain

Forebrain

CerebrumoFrontal lobe- Voluntary movement, language,

executive function

oParietal lobe- Sensory impulses, tactile sensations

oTemporal lobe- Memory, emotions, taste, smell,auditory

oOccipital lobe- Vision, visual perception

DiencephalonsoThalamus- Pathway of motor & sensory impulses

oHypothalamus- Regulates hormonal functioning

PSYCHOBIOLOGICAL


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PSYCHOBIOLOGICAL

Overview of the Brain (cont.)

MIDBRAIN

Mesencephalon- Processes visual &auditory information

HINDBRAIN

Pons- Visceral & somatic motor controlMedulla- Autonomic functioning of major

organs

Cerebellum- Modulates movement


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PSYCHOBIOLOGICALNEURON

CONDUCTION OF ELECTRICAL IMPULSES

NEUROTRANSMITTERS

RECEPTORS


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PSYCHOBIOLOGICALNEUROTRANSMITTER

CHEMICAL MESSANGERSRELEASED AT PRESYNAPTIC NEURONDIFFUSES ACROSS SYNAPSE TO POST

SYNAPSE

ATTACHES TO SPECIALIZED RECEPTORSINHIBITS OR STIMULATESRELEASED AND THEN DESTROYED OR

TAKEN BACK FOR RECYCLING


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Dopamine DA Schizophrenia, ManiaParkinsons, Depression

Norepinephrine NE ManiaDepression

Serotonin 5-HT AnxietyDepression

Gamma-amino- GABA Reduction ofbuturic acid anxiety

Anxiety

Acetyl-Choline Ach DepressionAlzheimers

PSYCHOBIOLOGICALNeurotransmitter/ Receptor/ Disorder


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PSYCHOLOGICAL

Freud's Psychoanalytic TheoryoConscious, preconscious, unconscious

oId, ego, superego

oDefense mechanisms and Anxiety

oTheories of personality

PSYCHOLOGICAL


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PSYCHOLOGICALPSYCHOANALYTICAL EGO FUNCTIONS

1.

1.REALITY TESTING

2.SENSE OF REALITY

3.JUDGEMENT

4.IMPULSE CONTROL

5.THOUGHT PROCESS

6.ARISE

1.

1.DEFENSIVE FUNCTIONING

2.OBJECT RELATIONS

3.AUTONOMOUS FUNCTIONING

4.STIMULOUS BARRIER

5.MASTERY COMPETENCE

6.SYNTHETIC INTEGRATIVE

FUNCTIONING

EGO


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PSYCHOLOGICAL

FreudPsychosexual Stages of Development

Oral (0-18mosAnal (18mos-3yrs)Phallic (3-6yrs.)

Latency (6-12yrs)Genital (13-20yrs)


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PSYCHOLOGICAL

ERIKSON

Psychosocial Stages of Development

Trust vs Mistrust

Autonomy vs Shame and Doubt

Initiative vs Guilt


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PSYCHOLOGICAL

ERIKSON (cont)

Industry vs Inferiority

Identity vs Role Confusion

Intimacy vs Isolation


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PSYCHOLOGICAL

ERIKSON (cont)

Generativity vs Stagnation

Ego Integrity vs Despair


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Maslows Hierarchy of Needs

6. Self-Transcendent Needs 5.Self- Actualization Needs

4. Esteem Needs

3. Love and Belonging Needs 2. Safety Needs 1.Physiological Needs

Emphasis on human potential and clients strengths

Establishes what is most important in sequences ofnursing actions Sets PrioritiesVarcarolis p. 20-21


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Psychiatric Mental Health Nursing and the

Nursing Process

1. Assessment 2. Nursing Diagnosis

6. Evaluation 3. Outcome Identification

4. Planning

5. Implementation

Factors Affecting Mental Health


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Factors Affecting Mental Health

and Nursing Assessment

Support systemsFamily influencesDevelopmental events

Cultural beliefs and valuesHealth practices

Negative influences


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PSYCHIATRIC ASSESSMENT

Construct databaseoMental status examination (MSE)

oPsychosocial assessment

oPhysical examination

oHistory taking

oInterviews

oStandardized rating scales

Verifying the data


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DIAGNOSIS OF PSYCHIATRIC

ILLNESS

Medical- DSM-IV-TV (Diagnostic andStatistical Classification of Mental Disorders)

Nursing- NANDA (North American NursingDiagnosis Association)


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DSM-IV-TR

Mental disorders are considered a

manifestation of a

BehavioralPsychologicalBiologicaldysfunction of the individual

DSM- IV- TR MULTI-AXIAL


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DSM- IV- TRMULTI-AXIAL

CLASSIFICATION

Axis I- All major psychiatric disordersAxis II- Personality disorders; Mental

retardationAxis III- Current medical conditions that are

relevant to the mental disorder

Axis IV- Psychosocial and environmentalproblems

Axis V- Global Assessment of Function(GAF)


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Therapeutic Approaches

PsychoanalysisShort term psychotherapyCognitive TherapyBehavior TherapyoModeling

oOperant Conditioning

oSystemic desensitization

oAversion Therapy

Milieu Therapy


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CULTURAL BIASES

Consider cultural differences that influencehealth

Be accepting of changing families

Be open, consider differences in order toprovide sensitive, competent care


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GOALS and Interventions of

Psychiatric Care Directed to

Anxiety+

Reality testing+

Self esteem =

Level of functioning and manage diseaseprocess

2007-Introduction to Psych Nursing

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