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PSYCHIATRIC NURSING
WHO IS CRAZY NOW
GILBERT T. SALACUP,RN,MSN “ Sir G”
Reference BOOK
Sheila L. VidebeckAlice M. Stain
NET: www.psychcenter.com
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Psychiatric Nursing
-branch of nursing care with aim of assisting
1.Individual 2. Family 3. Community To:
P - revent mental illness
A –ttain and maintain mental health
Co – pe with mental illness
Fi – nding meaning in mental illness
experience and suffering
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Self Awareness The process of knowing ones ownR - esponses in different situations
A - ttitudes
Per - sonality,
Pre - conceptions
S - trengths,Wea - knesses,
P - rinciple,
Be - liefs, s
Fee - lings,
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Significance 1.Self awareness differs from self - understand 2.The major therapeutic tool of the n is nurse is the
use of self
Goal of Self awareness To decrease the size of blind and
private quadrants
2 Major Advantage in working toward goal
1. Increase in self – awareness and self – disclosure2. Gain more control over own behavior
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Therapeutic Nurse- 1. Pre – Interaction B-egin before the nurse first contact with the
PT S-elf awareness
Therapeutic Task of the Nurse 1.Self Exploration feelings, fears, fantasies
2. Gathering Data about Pt available information
3. Planning for the 1st interaction with the patient
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2. Orientation Stage- A - ssessment and diagnosis phase- D-evelopment of mutually acceptable
contact
Therapeutic Task of the Nurse
Rapport Trust is built by demonstrating acceptance and non-judgmental attitude.
Identify Patients Problem Mutually defined Goals with patients Formulate Nursing Diagnosis set priorities Explore the patients feelings thoughts and
actions encourage to share it with the nurse
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3. Working Phase - I - dentification and declaration of
patients problems
- R - esistance observe
Therapeutic Task of the Nurse
Explore relevant stressor Listening and Observing – tools use in this phase Realize theirs somebody appears interested to him
who is warm and accepting can relate Develop a plan of action and implement then evaluate Assess client readiness for independent functioning Assist patient change maladaptive behavior
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4. Termination Phase T - ermination has been started in initial
phase A - ssumed that Pt is already with more understanding
Therapeutic Task of the Nurse - Review progress of the therapy and
attainment of goal - Explore feelings of rejection, loss sadness,
anger - Space contacts dec. time, visits, each
contact- Established more relax environment- Privide necesarry referals
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Sigmund Freud Father of Psychoanalysis Structure of Personality (Id, Ego, Superego)
IDPLEASURABLE PRINCIPLE Dominant ID Pain Avoidance Nar -
cisistic Puro “I”/ ako Ma – nia An -
tisocial want to Eat Want to drink Want to party Want pleasure
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EGO REALITY PRINCIPLE
Impaired Reality Schizophrenia
Impaired
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E
SUPER EGOCONSCIENCE PRINCIPLE
houldn't be ense the voice of God
DOMINANT SUPER EGOObsessive – compulsiveAnorexia Nervosa
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Therapeutic Communication Effective Communication: A - daptiveN - eutral responsesA – ppropriateR - eflect, restate, rephrase verbalization of
patient
S - tate behaviors observedFo - cus on feelingsSi - mpleCo - nciseC - redibleO - pen ended questions
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Therapeutic relationship
Relationship between health care professional and client
Purpose : assisting the client to solve his problems.
Components of a Therapeutic Relationship1.TRUST2. GENUINE INTEREST - he or she should be open,
honest and display a congruent behavior3.ACCEPTANCE - Situation: A client tries to kiss the nurse.
Inappropriate response: What the hell are you doing?! I’m leaving maybe I’ll see you tomorrow.
Appropriate response: Adam, do not kiss me. We are working on your relationship with your girlfriend and that does not require you to kiss me. Now let us continue.
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4. EMPATHY It is simply being able to put oneself in the client’s
shoes. However, it does not require that the nurse should have the same or exact experiences as of the patient.
Client’s statement: “I am so sad today. I just got the news that my
father died yesterday. I should have been there, I feel so helpless.”
Nurse’s Sympathetic Response: “I know how depressing that situation is. My father
also died a month ago and until now I feel so sad every time I remember that incident. I know how bad that makes you feel.”
Nurse’s Empathetic Response: “I see you are sad. How can I help you?
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5. POSITIVE REGARD unconditional and nonjudgmental attitude
where the nurse appreciates the client.
Calling the client by name Spending time with the client Listening to the client Responding to the client openly Considering the client’s ideas and preferences
when planning care
6. SELF-AWARENESS
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THERAPEUTIC USE OF SELF Therapeutic Technique1. Offering Selfmaking self-available and showing interest and
concern.“I will walk with you”2. Active listeningpaying close attention to what the patient is saying by
observing both verbal and non-verbal cues.Maintaining eye contact and making verbal remarks to
clarify and encourage further communication.3. Exploring“Tell me more about your son”4. Giving broad openingsWhat do you want to talk about today?
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5. Silence - Planned absence of verbal remarks6. Stating the observedverbalizing what is observed in the patient to, for
validation and to encourage discussion “You sound angry”7. Encouraging comparisons
describe similarities and diff.feelings,behaviors,& events.
· “Can you tell me what makes you more comfortable, working by yourself or working as a member of a team?”
8. Identifying themesasking to identify recurring thoughts, feelings, and
behaviors.“When do you always feel the need to check the locks
and doors?”
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9. Summarizingmaking appropriate conclusions.“During this meeting, we discussed about what you
will do when you feel the urge to hurt your self again and this include…”
10. Placing the event in time or sequenceasking for relationship among events.“When do you begin to experience this ticks? Before or
after you entered grade school?”11. Voicing doubt uncertainty about the reality of statements,
perceptions and conclusions. “I find it hard to believe…”
12. Encouraging descriptions of perceptions feelings, perceptions and views of their situations“What are these voices telling you to do?”
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13. Presenting reality or confrontingstating what is real and is not without arguing “I know you hear these voices but I do not hear them”.“I am G, your nurse,and this is a hospital and not a
beach resort.14. Seeking clarificationasking patient to restate, elaborate, or give examples
of ideas or feelings to seek clarification of what is unclear.
“I am not familiar with your work, can you describe it further for me”.
15. Verbalizing the impliedrephrasing patient’s words to highlight an underlying
message to clarify statements.Patient: I wont be bothering you anymore soon.Nurse: Are you thinking of killing yourself?
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16. Reflectingthrowing back the patient’s statement in a form of
questionPatient: I think I should leave now.Nurse: Do you think you should leave now?17. Restatingrepeating the exact words of patients Patient: I can’t sleep. I stay awake all night.Nurse: You can’t sleep at night?18. General leadsusing neutral expressions to encourage patients to
continue talking.“Go on…”“You were saying…”
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19. Asking questionusing open-ended questions to achieve relevance
and depth in discussion.“How did you feel when the doctor told you that you
are ready for discharge soon?”20. Empathy 21. Focusingpursuing a topic until its meaning or importance is
clear.“Let us talk more about your best friend in college”“You were saying…”22. Interpreting - providing a view of the
meaning or importance of something.Patient: I always take this towel wherever I go.Nurse: That towel must always be with you.
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23. Encouraging evaluationasking for patients views of the meaning or importance
of something.“What do you think led the court to commit you here?”“Can you tell me the reasons you don’t want to be
discharged?24. Suggesting collaborationoffering to help patients solve problems.“Perhaps you can discuss this with your children so
they will know how you feel and what you want”.25. Encouraging goal settingasking patient to decide on the type of change needed.“What do you think about the things you have to
change in your self?”
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26. Encouraging formulation of a plan of action
probing for step by step actions that will be needed.
“If you decide to leave home when your husband beat you again what will you do next?”
27. Encouraging decisionsasking patients to make a choice among options.“Given all these choices, what would you prefer to
do.28. Encouraging consideration of optionsasking patients to consider the pros and cons of
possible options.“Have you thought of the possible effects of your
decision to you and your family?”
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29. Giving information - providing information will help patients make better choices.
“Nobody deserves to be beaten and there are people who can help and places to go when you do not feel safe at home anymore”.
30. Limit settingdiscouraging nonproductive feelings and behaviors,
and encouraging productive ones.“Please stop now. If you don’t, I will ask you to leave
the group and go to your room.31. Supportive confrontationacknowledging the difficulty in changing, but pushing
for action.“I understand. You feel rejected when your children
sent you here but if you look at this way…”
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32. Role playing - both the nurse and patient play particular role.
“I’ll play your mother, tell me exactly what would you say when we meet on Sunday”.
33. Rehearsingasking the patient for a verbal description of what
will be said or done in a particular situation.“Supposing you meet these people again, how would
you respond to them when they ask you to join them for a drink?”.
34. Feedbackpointing out specific behaviors and giving
impressions of reactions.“I see you combed your hair today”.
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35. Encouraging evaluationasking patients to evaluate their actions and
their outcomes.“What did you feel after participating in the
group therapy?”.
36. Reinforcementgiving feedback on positive behaviors.
“Everyone was able to give their options when we talked one by one and each of waited patiently for our turn to speak”.
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Non-therapeutic TechniqueAvoid pitfalls:
1. Giving advise2. Talking about your self3. Telling client is wrong4. Entering into hallucinations and delusions of client5. False reassurance6. Cliché7. Giving approval8. Asking WHY?9. Changing subject10.Defending doctors and other health team members.
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Non-therapeutic Technique1. Overloadingtalking rapidly, changing subjects too often, and asking
for more information than can be absorbed at one time.
“What’s your name? I see you like sports. Where do you live?”
2. Value Judgmentsgiving one’s own opinion, evaluating, moralizing or
implying one’s values by using words such as “nice”, “bad”, “right”, “wrong”, “should” and “ought”.
“You shouldn’t do that, its wrong”.3. Incongruencesending verbal and non-verbal messages that contradict
one another.The nurse tells the patient “I’d like to spend time with
you” and then walks away.
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4. Under loadingremaining silent and unresponsive, not picking up cues,
and failing to give feedback.The patient ask the nurse, simply walks away.5. False reassurance/ agreementUsing cliché to reassure client. “It’s going to be alright”.6. InvalidationIgnoring or denying another’s presence, thought’s or feelings.
Client: How are you?Nurse responds: I can’t talk now. I’m too busy.7. Focusing on selfresponding in a way that focuses attention to the nurse
instead of the client.“This sunshine is good for my roses. I have beautiful
rose garden”.
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8. Changing the subjectintroducing new topic inappropriately,The client is crying, when the nurse asks “How many
children do you have?”9. Giving advice giving opinions or making decisions for the client, “If I were you… Or it would be better if you do it this
way…”10. Internal validationmaking an assumption about the meaning of
someone else’s behavior that is not validated by the other person (jumping into conclusion).
The nurse sees a suicidal clients smiling and tells another nurse the patient is in good mood.
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Other ineffective behaviors and responses:1. Defending – Your doctor is very good.
2. Requesting an explanation – Why did you do that?
3. Reflecting – You are not suppose to talk like that!
4. Literal responses – If you feel empty then you should eat more.
5. Looking too busy.
6. Appearing uncomfortable in silence.
7. Being opinionated.
8. Avoiding sensitive topics
9. Arguing and telling the client is wrong
10. Having a closed posture - crossing arms on chest
11. Making false promises I’ll make sure to call you when you get home.
12. Ignoring the patient – I can’t talk to you right now
13. Making sarcastic remarks
14. Laughing nervously
15. Showing disapproval – You should not do those things
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DEFENSE MECHANISMS
DISPLACEMENT Transfer of feelings to a less threatening object rather than the one who provoke it
Boss shouts at you, you shout at your subordinate
A patient yells at a nurse after becoming angry at his mother for not calling him.
DENIAL Failure to acknowledge an unacceptable trait or situation
“I’m not an alcoholic” A woman newly
diagnosed with end-stage-cancer says, “I’ll be okay, it’s not a big deal”.
DISSOCIATION Psychological flight from self A type of amnesia
“Sino ka, Sino ako?”
Acting Out Acting out refers to repeating certain actions to ward off anxiety without weighing the possible consequences of those action.
Example: A husband gets angry with his wife and starts staying at work later.
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INTROJECTION Assume another person’s trait as
your own “ako din” Not just you, me
too
SUPPRESSION Conscious forgetting of an anxiety
provoking concept Hindi ko alam yan
SUBLIMATION Placing sexual energies toward a
more productive endeavours may channel
his sex drive into his sports or hobbies.
CONVERSION Repressed angers put towards
physical symptoms affecting nervous system leading to sensory numbness and motor paralysis
Biglang mangingig
COMPENSATION Overachievement in one area
to cover a defective part Pilay pero magaling
kumanta
SUBSTITUTION Replacing a difficult goal with a
more accessible one Gusto ko .
Enchanted nalang.
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UNDOING Doing the opposite of what you have done due to guilt
plastic
“ay pinatid kita, halika punta kita sa clinic
A patient who says something bad about a friend may try to undo the harm by saying nice things about her or by being nice to her and apologizing.
IDENTIFICATION Assume trait for personal, social, occupational role
Tulad nya An adolescent girl
begins to dress and act like her favorite pop star.
PROJECTION Attributing to others one’s acceptable trait
Pasa load
“hindi ako alcoholic, sila yon”
RATIONALIZATION Illogical reasoning for a socially unacceptable trait
“sayang ang beer sa ref, kaya ko ininum”
I drink because I don’t want to waste the beer in the ref
An individual states that she didn’t win the race because she hadn’t gotten a good night’s sleep
REACTION FORMATION doing the opposite of your intention
Plastic
sasabunutan kita. . . ay kuklulutin lang kita
Love turns to hate and hate into love.
REGRESSION Return to an earlier developmental stage
Return to thumbsucking
REPRESSION Unconscious forgetting of an anxiety provoking concept
Hindi ko maalala A woman who was
sexually abused as a young child can’t remember the abuse but experiences uneasy feelings when she goes near the place where the abuse occurred.
ANXIETY
ANXIETY Definition:Subjective, individual experience
characterized by a feeling of apprehension, uneasiness, uncertainty, or dread.
Occurs as result of threats may be - Actual or imagined, - misperceived or misinterpreted, - threat to identity or self-esteem.It often precedes new experiences.
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Types of Anxiety:Normal
A healthy type of anxiety that mobilizes a person to action.
AcutePrecipitated by imminent loss or
change that threatens the sense of security.
ChronicAnxiety that the individual has lived
with for a long time.
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Levels of Anxiety: 1.Mild/ Alertness Level (+1)- Normal Type of Anxiety
P -erceptual field increasedA - lertR - estlessI - ncreases learning
Nursing Interventions:- Recognize the anxiety by statements such as “I notice you being restless today”.-Explore causes of anxiety and ways to solve
problems “Let’s discuss ways to…”
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2. Moderate/ Apprehension Level (+2)
The response of the body to immediate danger and focus is directed to immediate concerns.
S - elective inattentiveness occurs
I - ncreased tension optimal time for learning
N - arrows the perceptual field
U - ses palliative coping mechanisms.
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Nursing Interventions:1. Provide outlets for anxiety such as crying or
talking.2. Tell client “It’s all right to cry”.3. Encourage in motor activity to reduce tension.4. Make client be aware of his behavior and feelings
by statements such as “ I know you feel scare…”5. Encourage client to move from affecting (feeling)
to cognitive mode (thinking).6. Refocus attention7. Encourage the client to talk about feelings and
concerns.8. Help the client identify thoughts and feelings that
occurred prior to the onset of anxiety.9. Provide anti-anxiety oral medications.PRN Meds
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3. Severe/ Free-floating Level (+3)Creates a feeling that something bad is about to happen, or feeling of an impending doom.
D - ilated pupils, fixed visionF - ight and flight response sets inA - ll behaviors are directed at alternative the anxiety
N - arrow perceptual field occurs.T - he person uses maladaptive coping mechanisms.I - ndividual needs direction to focus Don’t know what to do Don’t know what to say
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Nursing Interventions:1.Do not focus on coping mechanisms2.Stay calm and stay with the client3.Give short and explicit direction4.Provide IM anti anxiety medications.5.Modify the environment byS- etting limits or seclusion, I -nteraction limit with others, R - educe environmental stimuli to
calm client.
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4. Panic Level (+4)I- f prolonged, panic can lead to exhaustion and death
S - uicide
P-ersonality and behavior is disorganized
I - nability to concentrate
T-he person uses dysfunctional coping mechanisms.F- eelings of helplessness and terror U - nable to communicate or function effectivelyL - essens perception of the environment to protectNursing Interventions:Safety Guide patient step by step to actionRestrain if necessary.
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ANTI-ANXIETY drugsBenzodiazepines - Zolam – Zepam1. F - lurazepam(dalamne) 7. T - riazolam(Halcion)
2. O - xazepam(Serax) 8. A - lpraZolam (Xanax)
3. L - orazepam(Antivan) 9.Chlo -rdiazepoxide(librium)
4. D - iazepam(Valium) 10.Chlo - razepate(Tranxene)
5. C - lonazepam(Klonopin)
6. T - emazepam(Restoril)
Non Benzodiazepines:
Buspirone (Buspar)
Meprobamate ( Miltown, Equanil)
Assess: Level of Anxiety
Nx Dx: Ineffective Individual Coping Powerlessness Impaired Skin Integrity
Planning/ Implementation: level of anxiety environmental StimuliRelaxation Technique
Evaluation : Effective individual coping
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GENERALIZED ANXIETY DISORDER - 6months excessive worrying
- Might be mild, moderate and severe anxiety
S/SxS - leep DisordersP - alpitationsE - dge of the seatE - asy fatigabilityR - estlessD - ifficulty of concentration
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PANIC DISORDER - recurring severe panic attacks
15 – 30 Minutes escalation of Somatic NS
Phobia
Phóbos, meaning "fear" or "morbid fear"Types of Phobias1. Agoraphobia - fear of open space/ public places2. Social Phobia - Also called Social Anxiety Disorder
fear of public /presence of others.
3. Specific Phobia - Also called Simple PhobiaA persistent fear of a specific object or situation, other
than of two phobias mentioned above.
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Risk FactorsLearning theory phobias are learned and become conditioned
responsesCognitive theory
anxiety-inducing self-instructions of faulty cognitions.
Life experiences Certain life experiences, such as traumatic events
Signs and SymptomsW - ithdrawalH - igh levels of anxietyI - nappropriate behavior used to avoid the feared
situation, object or activityD - ysfunctional social interactions and relationshipsE - nability to function and meet self-care needs
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Nursing DiagnosesAnxietyPowerlessIneffective individual copingImpaired verbal communicationAltered thought processesSelf-esteem disturbanceImpaired social interactionRisk for injuryTherapeutic Nursing Management Systematic desensitization
This process of gradual exposure to phobic object or situation
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POST TRAUMATIC STRESS DISORDER
S - oldier T - raumaE – arthquakeW – ar VICTIMS Survivors
A - ccident R - ape FlashbackD – isaster Nightmares
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SOMATOFORM - no pretension, suggest medical diseases -no organic basis to support the illness.
Types of Disorder1. Somatization disorder - chronic syndrome is
characterized by multiple somatic symptoms that cannot be explained medically.
The physical symptoms are associated with psychological stress.
2. CONVERSION DISORDERNervous SystemLa Belle Indifference emotional disattachment from disability
Sleep disorder This is characterized by difficulty initiating or
maintaining sleep.Hypersomnia - or excessive sleepiness,
Narcolepsy - is a chronic sleep disorder, or dyssomnia, --- excessive sleepiness and sleep attacks at inappropriate times, such as while at work
Parasomnias - involve abnormal and unnatural movements, behaviors, emotions, perceptions,
- dreams that occur while falling asleep- sleeping, between sleep stages, - during arousal from sleep.
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Hypochondriasis This is a person’s unwanted fear or belief that
he or she has a serious disease without significant pathology.
Minor Discomfort Interpreted as major illness
Body dysmorphic disorders The client is preoccupied with an image defect in appearance
when there is no abnormality. Illusion of structural defect Client obsesses about imaged bodily defects (facial flaws,
heavy buttocks or thighs)
Pain disorder The pain is unrelated to a medical disease. The individual experiences severe pain that is in
disproportion to the originating source.
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Risk FactorsGender: FemaleAge: Children and older adults
Nursing DiagnosesImpaired adjustmentChronic painSleep pattern disturbance
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PSYCHOSOMATIC 1. to a physical disorder that is caused by or notably
influenced by emotional factors. 2. pertaining to or involving both the mind and the
body.
4 major types H - ypertension A - sthma M - igraine
S - tress Ulcer
- Real pains/ illness- Real symptoms
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Obsessive Compulsive Disorder (OCD)persistent thought and urges to perform repeated
acts or rituals releasing tension Obsession
recurrent and persistent thoughts, impulses, images that are intrusive, disturbing, inappropriate, and
usually triggered by anxiety.Compulsion
Repetitive behaviors or mental acts that a person feels driven to perform, specifically defined routine.
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Thinking (Belief) Mind-setWindows open Anxiety
Akyat bahay gang magnanakaw
Obsession (thought/thinking ) anxiety(thought)
Compulsion (Action) Anxiety Check the house
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Specific Biological Factor OCD is linked to a deficiency in serotonin. Abnormalities in frontal lobes and basal ganglia
Signs and SymptomsRuminations – forced preoccupation with thoughts about a
particular topic, associated with brooding and inconclusive speculation.
Cognitive rituals – mental acts the client feels compelled to complete.
Compulsive motor rituals – elaborate rituals of everyday functioning such as grooming, dressing, eating,
Other symptoms – chronic anxiety, low self-esteem, difficulty expressing positive feelings and depressed mood.
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4 Defense Mechanism by OCD
R - epresionI - solationR - eaction formationU - ndoing
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Nursing Interventions Provide time to perform the rituals Limit, but do not interrupt, the compulsive acts. Teach to use alternate methods to decrease
anxiety. Client’s behavior maybe frustrating to staff and
family. Power struggles often result. Consistency to the approach to care is critical.
Assess the client’s needs carefully. Provide an environment that has structure and
predictability as a strategy to decrease anxiety. Risk associated with the use of alcohol and drug
abuse.
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BER
T T. S
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CU
P R
N,
MS
N
defined as the totality of a person’s unique biopsychosocial and spiritual traits that consistently influence behavior.
1. Interpersonal relations that ranges from distant to overprotective.
2. Suspiciousness3. Social anxiety4. Failure to conform to social
norms.5. Self-destructive behaviors6. Manipulation and splitting.
PERSONALITY DISORDERS
Cluster A:Personality Disorders(The Eccentric and Mad group)
Paranoid – Moto wag magtiwala Sa iba
overly suspicious and mistrustful behaviorNX. Management Psychotheraputic task on dealing trust Issues Low dose Phenothiazine
SCHIZOID – Moto little emotionN - ever had a best friendB - elieves he can stand on his ownI - don’t want peopleC - ares more about computers and petsA - void groups and social activities no enjoymentNX management Gradual involvement Milleu and group therapy Focus on building trust
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Schizotypal Personality Disorder- pervasive pattern of social and interpersonal deficits, with
cognitive and perceptual distortions and behavioral eccentricities.
Clinical Manifestations: R - estricted range of emotions O - dd appearance (stained or dirty clothes, unkempt and disheveled)
L - oose, bizarre or vague speech E - xpresses ideas of suspicions regarding the motives of others
E - xperiences anxiety with people W - ander aimlessly I - deas or reference and magical thinking is noted
Nx Management Low dose of neuroleptic Involved activity with others
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Cluster B: Personality Disorders ( The Erratic and Bad group)
ANTI - SOCIAL M - otto I break the law A - s a child,: steal, lie, always get reprimanded G - ood talker, charmer, witty manipulator A - dult – grand robbery, illegal activitist against
the law, drug addiction, drives fast, unsafe sex, thrill seeker
Nx Management Firm Limit Setting Confront behaviors consistently Enforce consequences Group therapy
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
BORDERLINE PERSONALITY DISORDER
- Most common personality disorder found in clinical settings.
- Marked impulsivity. - It is more common in females than
in males. - Self-mutilation injuries such
as cutting or burning Moto my life is an empty glassNx Management Promote safety Help client to cope and control
emotions Teach social skills , Set limits Behavioral contracts decrease
mutilation Empathy and group therapy
GIL
BER
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ALA
CU
P R
N,
MS
NNarcissistic I love myself Moto I am famous
Insensitive, arrogant, use rationalization I am the best lack of empathy. Ambitious and confident
Nx management Teach client that mistake are acceptable Focus on here and now Teach client imperfection do not decrease worth
Histrionic Excessive emotionality and attention-seeking behaviors excited, dramatic but manipulative Center of attention Highly suggestible and will agree with almost
anyone to gain attention Uses colorful speech, Tends to overdress Concerned with impressing others
Motto Ako ang bidaNx management Facilitate expression + reinforcement for unselfish behavior
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Cluster C: Personality Disorders ( The anxious and Sad group)
AVOIDANT = No people No trouble I avoid people, I fear criticism Have talent but no confidence
3 Pattern Social uneasiness and reticence Very Low self-esteem Hypersensitivity to negative reaction
Nx Management Promote Self Esteem Gradually confront fears Increase exposure to small groups
GIL
BER
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CU
P R
N,
MS
N
Dependent Moto I can’t live without you self esteem , Pessimistic Poor decision making skills Uncomfortable and helpless when alone Has difficulty initiating or completing simple daily
tasks on their own
Nx management Teach problem solving and decision making skills NPR Goal increase assertiveness
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
GIL
BER
T T. S
ALA
CU
P R
N,
MS
NObsessive – Compulsive
I am Perfect, moto I am organized Perfectionist Provide time to do rituals Precise and detail-orientedNx Management Explore the feelings Teach patient mistakes are acceptable
Other related disorder Depressive – Moto I think I'm gonno die again
Pattern of depressive cognition and behavior in variety of context
Occurs equally in men and woman Same behavior characteristic in major depression but
less severe . Recurrent thought of death Total disinterest in all activity Inability to express joy Self Criticism
Nx Management Assess self harm risk, provide safety Promote self esteem Increase involvement in activity
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Passive Aggressive Moto Oh yes Oh your not Always say yes but resistance is hidden 1-3% IN GEN, POP. 2-8% IN CLINICALSET UP May appear cooperative even ingratiating Blame others for misfortune
Nursing management Teach relaxation techniques Assertiveness Teach expressing the feelings directly
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
SchizophreniaS - tress – Diathesis Model
Too much stress in the reality will lead client to escape it and go to the fantasy world
I - mpaired reality perception
G - enetic vulnerability
E - go disintegration
B - iological TheoryDopamine level is High
A - exact cause is unknown
GIL
BER
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ALA
CU
P R
N,
MS
N
Extremely complex mental disorder Recent research reveals that schizophrenia may be
a result of faulty neuronal development in the fetal brain, which develops into full-blown illness in late adolescence or early adulthood.
Diagnosed in late adolescence or early adulthood.
Peak incidence of onset MEN - 15 to 25 years of age WOMEN - 25 to 35 years of age Rarely In childhood.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Negative or Soft symptoms
Positive or Hard symptoms
Flat affect Delusion
Lack of volition Hallucinations,
Social withdrawal or discomfort
Grossly disorganized thinking, speech, and behavior
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
1. Assess : Content of ThoughtNx Dx : Disturbed thought processPlanning/ Implementation:Present realityProvide safetyEvaluation : Improve thought process 2. Assess : Hallucination/ IllusionsNx Dx : Disturbed sensory perceptionPlanning/ Implementation:Present realityProvide safetyEvaluation : Improve sensory perception
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
3. Assess : SuspiciousNx Dx : Risk for other directive behaviorPlanning/ Implementation:Present realityProvide safetyEvaluation : Eliminate/ minimize risk for other-
directed violence4. Assess : SuicidalNx Dx : Risk for self directive behaviorPlanning/ Implementation:Present realityProvide safetyEvaluation : Eliminate/ minimize risk for self-
directed violence
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Flight or Looseness
I am super star I am super star. Gulay is malungay? Super star is Nora Were are you. Nora is a gay I love beer. Gay is man
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
4 A’s ffect appropriate, inappropriate,
flat, blunt (incomplete emotion) mbivalence torn between 2
opposing forces
utism ssociative Looseness
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Magical Thinking - Believes to have a magical power
Echolalia I repeat what you say Parrots
Echopraxia I repeat what you do
Word Salad words, no rhyme
Clang Association words with rhyme : Doom, Kaboom, Bromm
Neologism creation of new words olasta, labidada
Clarification done in case of neologism
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Delusion: fixed falls belief with no basis in realityPersecutory FBI will get me/ someone will
harm the Patient Religious I am Jesus, allah, budahGrandeur I am the king of the world.Ideas of reference MD are talking about me.
Concrete Association pilosopo “ what will u use in txting your calculator?”
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Hallucinations IllusionStimulus Absent PresentVisual X Auditory X Tactile X
Hallucinations Management: H - allucinationsA – cknowledgment - I know the voices are real to
youR - eality orientation - But I don’t hear themD - iversion - Lets walk
Take note But if nothing in the preceding intervention are seen= Assess what the voices are saying
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
TYPES OF SCHIZOPHRENIA1. Paranoid - Suspicious Ideas of reference Tendency to be violent - Defense
mechanism MistrustScaredWithdrawn Projection
Nrsg. Int:Build up trust: 1 to 1 short interaction frequent visit foods in sealed container meds wrapped
For violent pt.- Doors open - Near the door - Don’t touch the pt.- Eye contact - 1 arms length away -call reinforcement
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Catatonic – abnormal motor behaviorOnset - Acute DFM - RepressionNo – favorite word
I - niwan na posture, ganun foreverW - axy FlexibilityA - mbivalenceN - egativism
Treatment ECT Benzodiazepines (such as diazepam or lorazepam)
for catatonic schizophrenia.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Unclassified / undifferentiated Mixed Manifestation Can’t be classified 1st paranoid, then disorganized then catatonic, etc
etc
DFM – Regression
ResidualRecovering/ decrease S/S
No more positive s/sx, just withdrawn
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Disorganized/HEBEPHRENIC Bizarre behavior
DFM- Regression and Fantasy Sad but smiles Inappropriate affect No reaction Flat affect Flight of ideas Giggling Positive and Negative S/Sx
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
High Dopamine= Schizophrenia
Dopamine Acetylcholine
Antipsychotics = Dopamine goes down
If Acetylcholine Dopamine
Extra pyramidal Side EffectsAKATHISIA AKINESIARestless, inability to sit Muscle rigidityMakati siya, ahh kati siya Ahh kiniss siya
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
DYSTONIA3 features
TORTICOLLIS Wry neckOCULOGYRIC CRISIS Fixed stareOPISTHOTUNOS Arched back
TARDIVE DYSKINESIA Irreversible side effects of antipsychoticsLip smackingTongue protrudingCheeks puffing
NEUROLEPTIC MALIGNANT SYNDROMEHyperthermia among client taking antipsychoticHyperthermia with muscle rigidity
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Other Side Effects Photosensitivity
SunscreenWide brimmed hat
AgranulocytosisReport immediately Sore throat
1st sign to appear
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
ANTIPSYCHOTIC AGENT–major tranc/nueroleptics Sub classification:
Phenothiazines: Non Phenothiazines: Thorazine – Tora Tora Haldol – Ha Idol Prolixin – Pro ang lixi n Navane – Sundalo pangdagat
Mellaril – Mella nmaril Tegretol – Hayop yan Tegre tol
Serentil – on seren til mawalaTrilafon - Trila in Fonila
Stelazine - Nanood si stela Zine
AtypicalClozaril – close sa reel! yehSeroquel – Sero kal talagaInvega – in vega n natin mga sisterIsigaw ntin ang - Geodon
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
ANTI PARKINSON'S –management anti psychotic induce EPS
A tivan(lorazepam) - Ati - van
D iazepam(valium)- ang tunog nyan Dia - zepammmmm
I nderal(propanolol) – Inde – Ral ral rallK emadrin(procyclidine)- Keme – Drin drin drin
A- akineton (biperiden)- ay nako mga baliw akin ne to
B- benadryl(diphenhydramine)- ben that’s a dryl
L- larodopa(Levodopa)- mmm Laro kc kau ng laro! D pa
E- Eldepryl (Selegilene)- ang sbi bi ni elde p reel kc kau akin n nga ung
S- symmetrel-(amantadine)- Sym Motor ko hmm bulol symmetrel
C- cogentin(Benztropine)-Sakay nlang kau sa coge tin
A- artane(trihexyphenidyl)- ang a artane kc nila
P- parlodel(Bromocriptine)- Para Lodel at nkarating na silang lhat end
Increase protein and give B6
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Mood DisorderDisturbance in mood ( Affect) that is either depression or elation
(mania = persistent hyperactive)
Bipolar - Mania more commonResults from disturbances in the areas of the brain that regulate mood
It involves periods of excitability (mania) alternating with periods of depression
Men and women equally Usually appears between ages 15 – 25Cause Unknown Stressful life Obese
It occurs more often in relatives of people with bipolar disorder
Ref. Videbeck Page 317
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Risk factors Biochemical imbalances Family genetics – one parent, child has 25% risk; two parents, 50-75%
risk.
Environmental factors-such as stress, losses, poverty, social isolation.
Psychological influences–inadequate coping, denial of disordered behavior
Specific Biological Factors Possible excess of norepinephrine, serotonin, and
dopamine. Increased intracellular sodium and calcium Neurotransmitters supersensitive to transmission of
impulses
Defective feedback mechanism in limbic system.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
1. BIPOLAR MIXED – PERIODS OF MANIA, NORMAL, DEPRESION, NORMAL, MANIA2. BIPOLAR TYPE I – MANIC EPISODES AT LEAST 1 DEPRESSIVE EPISODE3. BIPOLAR TYPE II – RECURRENT DEPRESSIVE EPISODE AT LEAST 1 HYPOMANIC EPISODE
Self Actualization =Task
Self Esteem = Nursing Role Restrain
Impaired social interaction = safety
Risk for injury/ other directed violence= safety
Eating Sleep Hyperactive Sexfinger food Private room Anxiety
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
SE Compensation interfere ADLs, harm othersSE Compensation interfere ADLs, harm othersTASK increases client’s self esteem Escorted walk outdoors Punching bagNo group games compitition will increase anxiety
3 or more signs confirms disorderS - leeplessnessP- ressured speechE - xaggerated SEE - xtraneous stimuli (easily distracted)D - istractibilityG - randioseF - light of ideas
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Therapeutic Nursing Management Environment Psychological treatment
Individual Psychotherapy – may be used to identify stressors and pattern of behavior.
Group therapy – establishes a supportive environment and redirect inappropriate behavior.
Family therapy – verbalizes family frustration and establishes a treatment plan for outpatient use.
Somatic and Psychopharmacologic treatmentselectroconvulsive therapy Psychopharmacology
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
DEPRESSION Serotonin if unresponsive to drugs, ECT
Kubbler-Ross Stages of Dying / Grief ProcessDenial “No not me”, “Its not true”, “Its not impossible”Anger why me, why now, What did I do to deserve
this?”Bargaining “If I live until Christmas or until my child’s graduation ( So many if’s), I will do
this…”Depression “Yes, I’m dying”Acceptance “Yes, I am ready”
Self Actualization Self Esteem = Task
Withdrawn = stayRisk for self directed violence
Eating Sleep Hypoactive Sex
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Major Depressive Disorder2 or more weeks of sad mood
9 Symptoms S –leep disturbance (insomia/hypersomia)O – Vert Suicidal Ideation (Recurrent thoughts of
deaths)M – emory Disturbance (Indecisiveness)E – nergy loss or Fatigue
A – gitation psychomotor L – ost of interest/ PleasureO – bvious Wt Significance N – ihilism – feeling of worthlessnessE – motional blanting and sad effect – depress mood5/9 symptoms present 2 or more weeks 1 of which is depressed
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Risk Factors Biological factors – brainchemicals Family genetics – parent with depression, child 10-13% risk of
depression.
Gender – higher rate for women Age – often less than 40 when begins Marital status – more frequently single, widowed Season of year – Seasonal Affective Disorder (SAD)
occurs when client experiences recurrent depression that occurs annually at the same time.
Psychological influences – low self-esteem, unresolved grief.
Environmental factors – lack of social support, stressful life events.
Medical co-morbidity – clients with chronic or terminal illness, postpartum, and current substance abuse are especially prone to becoming depresses.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Therapeutic Nursing Management Safe environment Psychological treatment
Individual psychotherapy – long –term therapeutic approach or short term solution-oriented, may focus on in-depth exploration, specific stress situations, or problem solving.
Behavioral therapy – modifying behavior to assist in reducing depressive symptoms and increasing coping skills.
Behavioral contacts – focus on specific client problems and need to help the client resolve them.
Social treatment Milieu therapy – day to day living experiences in a therapeutic
environment Family therapy – aimed at assisting the family cope with the client’s
illness and supporting the client in therapeutic ways.
Group therapy – focuses on assisting clients with interpersonal communication, coping, and problem-solving skills.
Psychopharmacologic and Somatic treatments Administer antidepressant medications Continued assessment interms of agitation and suicidal ideation. Electroconvulsive therapy
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Nursing Interventions1.Priority for care is always the client’s
safety.2. Use of behavioral contacts. “no self-harm” or no suicidal ideation or
plan.
3. Assess regularly for suicidal ideation or plan.4. Observe client for distorted, negative thinking.5. Assist client to learn and use problem solving and stress management
skills.
6. Avoid doing too much for the client, as this will only increase client’s dependence and decrease self-esteem.
7.Explore meaningful losses in the client’s life.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
ANTIDEPRESSANTSS - inequan – Watch tau ng Sine Quan A - nafranil – Ana Franil PalaV - ivactil – Bi back tau agad after nuod ngE - lavil – Ela evil
P - rozac – Pero sak a naA - ventyl – Aveeen Til Midnight tayoN - orpramin – Nor T - ofranil – Tofra an kita
P - axil – Taksil kaA - sendin – asan n din kau Z - oloft – yan mag Solo ka
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
1st Line of Drug Prescribed afest
ELECTIVE Prozac(Fluxetine)
ide effects low EROTONIN Paxil (Paroxetine)
EUPTAKE Zoloft(Sertraline)
note: No suicidal or
to 4 weeks Homicidal NHIBITOR take in am to avoid
insomnia
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Two – 4 wks Sendin (Amoxapine)
Tri
orpramine (Desipramine)
CYCLIC ofranil (Imipramine)
inequan (Doxepine)
NTIDEPRESSANT Lavil
amelor Higher incidence of Side effects Serotonin/ Epi affectedNeuro and hepatotoxisity,Cardiac Arrytmias
Suicide Precausion 10 -15 days precausion
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
ONO arplan (isocarboxazid)
ardil ( Phenelzine) Mine arnate
(Tranylcypromine)
Xidase
Nhibitor All neurotransmitter affected Highest Side effectsAvoid tyramine rich food may lead to HYPERTENSIVE CRISES
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
TYRAMINE RICH FOODS vocado ged Cheese eer hocolate
ermented Foods ickles
reserved Foods oy Sauce
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
LITHIUML evel 0.5 – 1 mEq/LI ncrease urinationT remors, fine hand H ydration 3 L/dayI ncrease Na+Uu diarhea M outh, dry
Maintenace level 0.5 – 1 mEq/L Treatment level – 0.8 – 1.5 mEq/L
Toxic level – 1.5 aboveLithium Toxicity Nausea, vomiting, diarrhea
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
ELECROCONVULSIVE THERAPY
Nowadays, ECT is not only used for major depression,
but also for the treatment of: mania (in bipolar disorder) Catatonia (motion less or excessive motion) quick relief for self-destructive behavior
ECT only be indicated for the treatment of severely depressed clients that needs fast relief
Can pregnant women undergo ECT?
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Contraindications and precautions recent myocardial infraction stroke sever hypertension presence of intracerebral mass Mechanism of action The therapy induces a therapeutic tonic seizure (a seizure where the person loses consciousness and
has convulsions) which lasts for about 15 seconds.
It is believed that the shock intensifies brain chemistry to correct the chemical imbalance in depression
(decrease serotonin and norepinephrine).
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Frequency of treatment 6-15 treatments are scheduled three times a
week. 6 treatments are needed to observe a sustained
improvement of depressive symptoms. Maximum effect or benefit is achieved in 12 to 15
treatments. 70 – 150 volts .5-2 seconds Duration 6-15 treatments 48hrs interval
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Nursing Interventions Before ECT1. Informed consent should be signed.
2. NPO post midnight.
3. Remove fingernail polish.
4. IV line initiation.
1. Atropine dry mouth
2. Barbituate short-acting anesthetic.
3. Succinylcholine muscle relaxant, prevent seizure
5. Let the client void before the procedure.
During ECT1. Place electrodes on the client’s head on one side (unilateral)
or both (bilateral).
2. Brain monitoring through electroencephalogram (EEG).
3. Oxygen administration with an Ambu-bag.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
After ECT1. When the client is awake, reorient the client.2. Obtain vital signs.3. Assess client for the return of gag reflex.4. Allow the client to eat (with a positive gag reflex).
Side-lying – lateralS/E
headache, dizziness, TEMPORARY MEMORY LOSS distinct sign
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
GIL
BER
T T. S
ALA
CU
P R
N, M
SN
SuicideDefinitionSelf imposed death stemming from depression
Verbal Non Verbal
I wont be a problem anymore
This is my last day on earth
I’ll soon be gone
Take this ring, its yours (giving of valuable)
Sudden change in mood
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Who will commit Suicide?S - ex – Male (more successful)/ female (hesitant)A ge – 15 –24 y/o or above 45D epression
P atient with previous attemptE ethanol - alcoholicsR irrationalS ocial support lackingO rganized plan greater riskN o familyS ickness, terminal
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
SUICIDE TRIAD1. Loss of spouse2. Loss of job3. Aloneness
Nursing Intervention 1.D irect question – “Are you going to commit
suicide?”2. I rregular interval of visit to pt. room3.E arly AM and period of endorsement – the time
pt’s commit suicide
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Best approach for suicidal pt. : Direct approachNursing Management: Close surveillance
Hospital quarter common suicide will come about
weekends - 1- 3 am Sunday - few staff personnelEarly AM - every one is asleep
Simple task Water plants Wash the dishes except sharps
Don’t give complex - may cause depression ex. Puzzle
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Cyclothymic disorderMilder symptoms of both mania
and depressions often separated by long periods of normal moods
Dysthymic DisorderLong standing symptoms of depression
alternating with short periods of normal moods clients can maintain normal roles and jobs
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
EATING DISORDERS
Bulimia Nervosa The Diet-Binge-Purge Disorder”.
dieting, binging and purging through vomiting
Rapid eating for about two hours (over 8000 calories in 2 hours and 50,000 in 1 day)
Methods of controlling weight (diet pills, excessive exercise, enemas, diuretics, laxatives),
Weight normal or fluctuations are due to alternating fasting and binging
Ages 15-24 years. Bulimic often belong to a family and society that
place great value on external appearance. self hatred low self-esteem, symptoms of depression, fear of losing control, suicide tendencies. Perfectionist, achievers scholastically and
professionally. They hide their disorder because of fear of
rejection. Person is aware that the behavior is abnormal, b. After the episode she becomes guilty and
depressed
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
GIL
BER
T T
. SA
LA
CU
P R
N,
MS
N
Nursing Diagnosis1. Alterations in health maintenance.2. Altered nutrition: Less than body requirements.3. Altered nutrition: More than body requirements4. Anxiety5. Body image disturbance6. Ineffective family coping; compromised7. Ineffective individual coping8. Self-esteem disturbance
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
During interview Nursing Interventions to gain trust and acceptance of nurses. Create an
atmosphere of trust. Develop strength to cope with problems.
Encourage patient to discuss positive qualities about themselves to increase self-esteem.
Help patient identify feelings and situations associated with or that triggers binge eating.Encourage making a journal of incident and
feelings before-during and after a binge episode.Make a contract with the patient to approach the
nurse when they feel the urge to binge Encourage adhering to meal and snack schedule of
hospital. Cognitive behavioral therapy is the ideal therapy
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
ANOREXIA NERVOSAStarvation and
Emaciation is a disorder with an insidious
onset that often affects adolescent girls.
upper middle class families. youngest child is affected.
uses denial 10-20 % of anorexics die and
half of these deaths are due to suicide.
Nursing Interventions Cognitive and Behavioral therapy to positive and negative
reinforcement: focus is on client’s responsibility to gain weight.
Privileges are gained with weight gain. Privileges are lost with weight loss.
Increase self-esteem Teach about the disorder. Monitor weight three times a week but weigh with the patient facing
away from the weighing scale As soon as the ideal weight is gained, allow patient to regulate his or
her own progression and program. High protein and high carbohydrate diet, serve foods the patient
prefer in small frequent feedings. NGT if the patient refuses to eat. Setting limits to avoid manipulative behavior:
Restrict use of bathroom for 2 hour after eating. Accompany to the bathroom to ensure that they will not self induce
vomiting. Stay with client during meals. Do not accept excuses to leave eating area.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Anorexia Nervosa
Eating Disorders
Bulimia
Diet, diet, diet Eating Pattern Eat, eat, vomit
<85% of expected body
Weight Normal weight
3 mos. amenorrhea
Menstruation Irregular menstruation
Karen Carpenter Dao Ming SuDa Ming Sugat/ suka
VomitingDental caries
Wounded knucklesMetabolic alkalosisMetabolic acidosis
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Paraphilias Paraphilias are complex psychiatric disorders that
are manifested as unusual sexual behavior.
Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) defined it as a “recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors generally involving:
S = uffering or humiliation of oneself or partner I = nanimate objects (non-human objects) N = onconsenting person C = hildren
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Eight specific disorders of paraphilia Exhibitionism – Exposing one’s genitals to strangers
or masturbating in public areas.
Fetishism – (Pa suot) inanimate objects to achieve orgasm women’s undergarments (brassiere, lingerie, and panty), shoes and other apparels.
Frotteurism – (Pa Touch) urges of touching or
rubbing against a non consenting.
Pedophilia – a sexual activity done with a child 13 years younger is a characteristic of this disorder. at least 16 years old or at least 5 years older than the victim.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Sexual masochism – (Saktan mo ako) the intense and persistent sexual urge involving acts of suffering (beaten or bound) and being humiliated.
Sexual sadism – (Sasaktan kita) sexual urge involving acts in which the pain, suffering or humiliation of a partner is arousing a person.
Transvestic fetishism – sexual fantasies, urge and behaviors involving cross-dressing by a heterosexual male.
Voyeurism – sexual arousal by observing an unsuspecting person who is naked, in the process of undressing or engaging in sexual activity.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
SUBSTANCE ABUSE
ALCOHOLISM - state of alcohol addictionEtiology:Intergenerational TransmissionFrom one generation to another generationAlcohol Blackout awake but unaware Confabulation inventing stories to self-esteem Denial “I am not an alcoholic”Dependence “I can’t live without it”
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Enabling significant other tolerates abusersAnother term CO – DEPENDENCY
TOLERANCE Substance to achieve a previous
effect DETOXIFICATION Withdrawal with MD supervision Safe withdrawal is accomplished through the
administration of benzodiazepines such as Chlordiaxepoxide (Librium), Lorazepam (Ativan) or Diazepam (Valium) to suppress the withdrawal symptoms
Check Alcohol, Mouthwash, Elixir
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
void alcohol version therapy lcoholics Anonymous self help group ntabuse DISULFIRAM Never drink alcohol
12 hour interval/ 12 h last alcohol intakeB1 Vitamin Deficiency or else: nausea, vomiting and hypotension
Wernicke’s Encephalopathy motorComplications
Korsakoff’s Psychosis memoryDelirium Tremens 24 – 72 h after last dose of alcohol untreated withdrawal syndrome ormocation bugs crawling under the skin amily Therapy mother, father, brother
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
SUBSTANCE ABUSEDowners - B - arbituates MorphineO - piates Codeine NARCAN
antidoteN - arcotics HeroineA – lcohol
Uppers (Hac - S) Hallucinogens Amphetamines Cocaines
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
LEVELS OF MENTAL RETARDATIONProfound Less 20 IQ thinks like an infants can’t be trained Some speech
Severe - 20 – 35 IQ May learn Talk and communicate Perform simple task elementary hygiene
Moderate - 35 – 50 IQ can be train mental age is 2 – 7 y/o pre-operational stage
P 434 videbeck
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
4. Mild50 – 70meantal age is 7 – 12educablecan go to school
5. Borderline70 - 90
6. Normal90 – 100
Mental Retardation IQ Less than 70 Onset before 18 yrs/old Not often detected until school age Impaired learning and social adjustment
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Nursing Intervention Role Modeling Repetition Remorivation Provide sensory stimulationAUTISM/Kanner Syndrome/ Pervasive devt. Dis. With a special talent /Head banging and head
rocking Diagnose at 2 Y.O. Appears at 3 y.o. 4x more common in male than in femaleAssessAppearance - flat affect, consistent movementBehavior - repetitive, ritualisticCommunication - echolalia, incomprehensible
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Nursing diagnosis S -elf mutilation I - mpaired verbal communication R -isk for injury I - mpaired social interactionNursing Intervention Priority Safety,security supervision Counseling Education Expressive therapy - drawing, muscic etc Improved social interactionMeds:Anti Psychotics: Haldol,risperidone=tempertantrums
Naltrexone(revia)Anafranil,Clonidine(catapres)= hyperactivity
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
ATTENTION DEFICIT HYPERACTIVE DISORDER Onset : before 7 y.o. Episode : 6 months and above Settings : 2 House and school Id Dominant : Mom or RN will act as superegoAssessC - ommunication - talkative, blurts out in classR - estlessI - mpulsiveD - ecrease attention spanE - asy distractibility
Nursing DiagnosisRisk for injury Impaired social interaction
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Nursing Intervention Priority safety and Nutrition Structure separate room for eating, playing, sleeping
and etc Schedule - time for everything Slimits Ignore Temper tantrums Finger foordsMeds: for 6 Y.O. Ritalin,, pemoline, adderal 3 Y.O and Above dexedrinBest time to give: once a day: AFTER MEALS: prevent lost of appetiteDon’t give at bedtime STIMULANT causes
insomnia Give 6 hours prior bedtime if bid
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
ALZHEIMER NOMIA don’t know name of objects GNOSIA problem with senses PHASIA can’t say it PRAXIA can’t do it
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Domestic ViolenceCHILD ABUSE Burns, bruise, bone fracturesExcessive Knowledge of sex/Violence
DepressionApathy no reactionsBantay Bata 163Don’t bathe the child, don’t brush teet. Body of evidence will be lost
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
TypesViolence- implies only the use of physical forceNeglect – Child abandonment, insufficient Childs
needs for survival
Physical Abuse – abuse in the form of inflicting pain Emotional abuse – form of insults mind gameSexual abuse- unwanted sexual contact
Nursing management Safe , secutiy, supervision Proper reporting of child abuse – w/ in 48hrs Brgy captain, DSWD, Police Play therapy
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
RapeCrime lack of consent, treat, force and sexual penetration
Sexual assault - Forcible sexual acts lack of consent, against his or her will
3 essential elements of rape Vaginal penetration Use of force , intimidation, treat Lack of consent
Rape trauma syndrome Immediate acute phase
Displays 2 type of emotion (disorganization)
Controlled
Expressed
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Long term process (reorganization) 3-4wks Flash backs in dreams and night mares Development of phobia Self guilt
Crisis InterventionCrisis is a situation or period in an
individual’s life that produces an overwhelming emotional response.
stressor that he or she cannot effectively manage by using his or her usual coping skills.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Type of Crisis Maturational crisis – also called developmental
crisis. These are predictable events in a person’s life which includes getting married, having a baby and leaving home for the first time.
Situational crises – unexpected or sudden events that imperils ones integrity. Included in this type of crisis are: loss of a job, death of a loved one or relative and physical and emotional illness of a family member or an individual.
Adventitious crisis – also called social crisis. Included in this category are: natural disasters like floods, earthquakes or hurricanes, war, terrorist attacks, riots and violent crimes such as rape and murder.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N
Guide for an effective crisis intervention:
Assist the person to view the event or issue in a different perspective.
Assist the individual to use the existing support systems. It is vital to help the person find new sources of support that can help in decreasing the feelings of being alone or overwhelmed.
Assist the individual in learning new methods of coping that will help resolve the current crisis and give him or her new coping skills to be used in the future when dealing with another overwhelming situation.
GIL
BER
T T. S
ALA
CU
P R
N,
MS
N