MENTAL HEALTH

"A state of we-beng where a person can reaze hs or her own

abtes to cope wth the norma stresses of fe and work
productvey." (WHO)
Baance n persons nterna fe and adaptaton to reaty.
State of we-beng n whch a person s abe to reaze hs potentas.
Crtera for Menta Heath:
Self-awareness
Abty to:
recognze ones thoughts feengs, asset potentas and
weakness.
experence genune feengs as anger, happness, resentment
eads to sef-acceptance, sef-understandng n order to
understand others
Autonomy: abty to functon ndependenty and functon wth
others
Perceptive ability
Awareness of stmu, reaty orentaton.
Orentaton to: Tme, Pace, Person
Integral capacity: Abty to harmonze psychc forces (d, ego,
super ego).
Self-actuation
Abty to adopt to fe changes, happy to work wth others
Satsfacton n every endeavor
Genune cooperaton
Mastery of ones environment! Awareness of the changes
around hm
MENTAL H"#IENE
a scence that deas wth: Promotve, Preventve, Curatve,
Rehabtatve aspects of care.
MENTAL $IS%&$E&
A medcay dagnosabe ness whch resuts n sgnfcant
mparment of one's cogntve, affectve or reatona abtes and s
equvaent to menta ness.
Crtera for Menta Dsorder:
Dssatsfacton wth:
ones characterstcs, abtes and accompshments
ones pace n the word
Ineffectve:
nterpersona reatonshp
copng or adaptaton to the events n ones fe
MENTAL ILLNESS
A state n whch an ndvdua shows defct n functonng and s
unabe to mantan persona reatonshp.
State of mbaance characterzed by a dsturbance n a persons
thoughts, feengs and behavor
Factors that ncrease the rsk are: Crses, Abuses, Poverty
Historical 'iew of Mental Illness
In the past, menta ness has been vewed as:
Demonc possesson
Infuence of ancestra sprts
Resut of voatng taboo or negectng cutura, rtua, and
sprtua condemnaton
Perio( of Enlig)tenment *+,-.-+//01
Lunatcs were restraned n ron menaces
Mentay were exhbted as dverson and entertanment for
the pubc
Estabshment of asyums
Openng of state hosptas for mentay .
Perio( of Scientific Stu(y
Psychoanayss by Sgmund Freud
Psyc)otropic $rugs *+2.31
Use of chorpromazne and mpramne
Menta ness s caused by chemca mbaance n the bran.
T)e $eca(e of t)e 4rain *+2231
Focused on the connectons between menta ness and
boogca mafuncton n the bran and the neuroendocrne-
mmune system.
Boogca vews hods that boogca defects are responsbe
for certan serous menta ness.
$iagnosis of Mental Illness
Use of the Dagnostc and Statstca Manua of Menta Iness (DSM-
IV)
Provdes dagnostc crtera for each menta dsorder and a system
of 5 axes to gve a comprehensve vew of the cents menta
ness.
A5is I: The cnca dsorder that s the focus of treatment
A5is II: Personaty dsorders and menta retardaton
A5is III: Medca condtons
A5is I': Psychosoca and envronmenta probems
A5is ': Goba assessment of functonng (GAF)
PS"6HIAT&I6 N7&SIN#
Importance:
An nterpersona process
Concerned wth a the aspects of care
Both a Scence and an Art
Scence - uses dfferent theores
Art - therapeutc use of sef
Centee:
Indvdua, famy and the communty
Both mentay heathy and mentay
Man too of the nurse: Therapeutc use of Sef
Characterstcs of a Good Psychatrc Nurse:
Empathy
Genuneness
Congruence
Uncondtona postve regard
Roes of the Nurse n Psychatrc Settng:
Cncan
Coaborator
Counseor
Heathy roe mode
Parent surrogate
Patent advocate
Reaty based
Researcher
Socazng agent
Teacher
Techncan
Therapst
Ward manager
Levels of Interventions in Psyc)iatric Nursing
Level $escription E5amples
Primary Amed at aterng the stressors
through:
promoton of menta heath
owerng the rate of cases
Heath educaton
Informaton
dssemnaton
Counseng
Secon(a Interventons that mts the
Crss
ry severty of a dsorder
thorugh:
Case fndng
Prompt treatment
nterventon
Drug
admnstraton
Tertiary Amed at reducng the
dsabty after a dsorder
through:
Preventon of compcaton
Actve program of
rehabtaton
Acohocs
anonymous
Occupatona
therapy
THE PS"6HIAT&I6 SETTIN#
A(mitting a 6lient in t)e Psyc)iatric Setting
Areas to be assessed:
Heath percepton
%rentaton
Metaboc pattern
Emnaton pattern
6ogntve pattern: |udgment, Insght, Memory
Actvty and exercse pattern
Thought process
Seep-rest pattern
LE#AL ASPE6TS %8 PS"6HIAT&I6 N7&SIN#
Types of Admssons:
'oluntary
Persons admt themseves
Cent consents to a treatment
Cent can refuse treatment, ncudng drugs, uness danger to
sef or others
Involuntary
9u(icial process
Intated when someone fes a petton
Certfcaton of the kehood of serous harm to sef or
others, or unabe to care for sef
Under 18, parents can confne wth confrmaton by a
neutra fact fnder
Must be reeased at end of statutory tme or put on
vountary status or have a hearng
9u(icial Prece(ents
Unless incompetent, client maintains all previous rights
Insanity as a $efense
Insanty : determned n court; ega termnoogy
McNaug)ten &ule
At the time of the crime, the individual didnt know the nature and
quality of the act or didnt know right from wrong!
6%MM%N 4EHA'I%&AL SI#NS AN$ S"MPT%MS
$isturbance in Perception
Illusion - misperception of an actual e5ternal stimuli
Hallucination - false sensory perception in t)e absence of
e5ternal stimuli
Management:
Acknowedge the feengs
Reorent to reaty
Provde dstractons
Neologism - pathoogca conng of new words
6ircumstantiality - over ncuson of detas
:or( sala( - ncoherent mxture of words and phrases
8lig)t of i(eas - shftng of one topc from one sub|ect to another
n a competey unreated way
Looseness of Association - shftng of a topc from one sub|ect to
another n a somewhat reated way
'erbigeration - meanngess repetton of word or phrases
Perseveration - persstence of a response to a prevous queston
Ec)olalia - pathoogca repetton of words of others
6lang association - the sound of the word gves drecton to the
fow of thought
$elusion - fase beef whch s nconsstent wth one's knowedge
and cuture
Grandeur - s an exaggerated beef of dentty
Nhstc - the cent denes the exstence of sef or part of sef
Persecuton - beef that he or she s the ob|ect of
envronmenta attenton and beng snged out for harassment
Sef-deprecaton - worthessness or hopeessness
Somatc - fase beef to body functon.
$isturbances of Affect
Inappropriate affect - dsharmony between the stmu and the
emotona reacton
4lunte( affect - severe reducton n emotona reacton
8lat affect - absence or near absence of emotona reacton
Apat)y - dued emotona tone
$isturbances in Motor Activity
Ec)opra5ia - the pathoogca mtaton of posture/acton of others
:a5y fle5ibility - mantanng the desred poston for ong perods
of tme wthout dscomfort
A;inesia - oss of movement
4ra(y;inesia - sowness of a vountary movement ncudng
speech.
Ata5ia - oss of coordnated movement
$isturbances in Memory
6onfabulation - fng n of memory gaps
Amnesia - nabty to reca past events
Anterogra(e - mmedate past
&etrogra(e - dstant past
$e<a vu - feeng of havng been to pace whch one has not yet
vsted
9amais vu - feeng of not havng been to a pace whch one has
vsted
$ementia
gradua deteroraton of nteectua functonng
resuts n the decreased of capacty to perform ADL
%t)er be)avioral signs = symptoms
Agitation - severe anxety assocated wth motor restessness.
Agnosia - nabty to recognze and nterpret sensory stmu.
A;at)isia - sub|ectve feeng of muscuar tenson, restessness and
pacng repeated sttng and standng.
Ambivalence - presence of two opposng feengs at the same
tme.
Ap)asia - nabty or dffcuty to speak or reca words
Apra5ia - nabty to carry out specfc task or actvty.
$elirium
refers to acute change or dsturbance n a person's: LOC,
cognton, emoton , percepton
$epression - feeng of sadness
$ereali>ation - feeng of strangeness towards the envronment.
$yst)ymia - persstent state of sadness
Elation (euphora)- a feeng of hgh degree of confdence,
boastfuness and |oy wth ncrease motor actvty.
Narcolepsy - seep dsorder characterzed by frequent rresstbe
urge to seep wth epsodes of catapexy (sudden oss of musce
power)
7SE %8 APP&%P&IATE 6%MM7NI6ATI%N TE6HNI?7ES
6ommunication: recproca exchange of deas between or among
persons
Modes:
Verba - wrtten/spoken
Non-verba - posture, tone of voce, faca expresson
Types of Non-verba communcaton:
Kness
body movement
eye contact
gestures
Paraanguage
voce quaty
non-anguage vocazaton (cryng, sobbng, moanng)
Proxemcs - aw of space reatonshp
Touch - physca act
Cutura artfacts
Meta communcaton
based on roe expectatons
hdden meanng of words
T)erapeutic 6ommunication! a way of nteractng n a purposefu
manner to promote the cents abty to e5press hs t)oug)ts an(
feelings openly.
Essentials for a T)erapeutic 6ommunication!
#enuneness
&espect
Empathy
Attentve stenng
Trust (rapport)
4arriers to a T)erapeutic 6ommunication
4ettng
Interruptng / gnorng
#vng advce
Soca response
6hangng the sub|ect
Approvng / dsapprovng
Morazng
E5amples! T)erapeutic Tec)ni@ue
Tec)ni@ue E5ample
Accepting Yes, that must have been dffcut for
you.
Ac;nowle(ging or
giving recognition
I notced that you've fxed your bed.
As;ing (irect
@uestions
How does your wfe fee about your
hosptazaton?
6larifying I'm not sure that I understand what
you are tryng to say.
6onfronting or
presenting reality
I see no bats fyng n ths
room.
Encouraging
comparison
Has ths ever happened before?
Encouraging
(escription
How do you fee when you take your
medcaton?
Encouraging
evaluation
Does partcpatng n group therapy
enabe you to dscuss your feengs?
E5ploring Te me more about your |ob. Woud
you descrbe your responsbtes?
8ocusing "assisting a patient to e#plore specific
topic$
#iving broa(
openings or as;ing
open-en(e(
@uestions
Is there somethng you'd ke to do?
Informing "giving needed facts$
I' be your nurse for today, from 7:00
unt 3:00 ths afternoon.
Ma;ing
observations
You appear to be angry. / I notced that
you're trembng.
%ffering general
lea(s
Go on. / You were sayng.
&estating Cent: I can't seep, I stay awake a
nght. Nurse: You can't seep at nght,
(restatng)
Summari>ing Durng the past hour, we taked about
your pans for the future, they
ncude...
7sing silence "to induce thought, pacing,
acceptance)
'ali(ating "confirming one%s o&servation$
"So you mean . . ."
'oicing (oubt I fnd that hard to beeve.
E5amples! Non-t)erapeutic Tec)ni@ue an( Ineffective
6ommunication
Agreeing an(
(isagreeing
"I thnk you dd the rght thng."
A(vice "You shoud..."
4elittling "Don't be concerned, evervone fees
ke that".
$efen(ing "A doctors here are smpy great".
8alse reassurance "Don't worry, everythng w be a
rght".
8ocus on caregivers
feeling
"I fee that way too."
9u(ging "It's your own mstake".
N7&SE A PATIENT &ELATI%NSHIP
Hdegard Pepau
P)ases!
Pre-Interaction P)ase
begns when the nurse s assgned/chooses a patent
patent s excuded as an actve partcpant
nurse fees certan degree of anxety
ncudes a of what the nurse thnks and does before nteractng
wth the patent
deveop sef-awareness
data gatherng, pannng for frst nteracton
%rientation p)ase
when the nurse-patent nteracts for the frst tme
estabsh of contract wth the patent
estabsh of trust and rapport
earn about the patent and hs nta concerns and needs
encourage the patent to fee comfortabe wth the meetng
conduct nta ntervew
manage present emoton of the patent
provde support and empathy of the patents feengs
assure of confdentaty
:or;ing B T)erapeutic P)ase!
t s hghy ndvduazed
dentfcaton and resouton of the patent's probems
more structured than the orentaton phase
the ongest and most productve phase
mt settng must be empoyed
pannng and mpementaton
Probems:
Transference
the deveopment of an emotona atttude towards the nurse
postve or negatve
Counter transference - experenced by the nurse / therapst
Termination P)ase
Evauate the summary of progress
Renforce change and strength of patent
Gve rewards for the cooperaton durng nteracton
Encourage expresson of feengs about termnaton of the
reatonshp
Termnate the reatonshp wthout gvng promses
THE%&IES %8 H7MAN $"NAMI6S
Psyc)ose5ual $evelopment ! Sigmun( 8reu(
Levels of 6onsciousness
C Psyc)ic Energies
Libi(o - are the nstnctua drves
&egression and fi5ation are common terms n ths theory.
Gave promnence to sexua feengs: defned "sex" as anythng that
gves gratfcaton
Stages!
%ral Stage *3-D years1
The area of gratfcaton s the mouth
Peasures: suckng actvtes ke fngers, toes or nppes
Dssatsfacton: resurface at a ater
overeatng, smokng, na-btng
Nursng Impcaton:
Provde ora stmuaton by gvng pacfers
Breastfeedng may provde more stmuaton.
Do not dscourage thumb suckng
Anal Stage *D-- years1
Chdren's attenton s focused on the ana regon.
Peasure: emnaton.
Covers the dea age for "toet tranng" (2 1/2 years)
2 concepts:
Hodng on
Lettng go
Possbe probems:
Compusve need to be cean and ordery.
Frugaty and stngness
Greed
Insstence on dong thngs at one's own rate at the expense of
others
Rgd tranng
Excessve messness and dsordery habts.
Nursng Impcaton: Hep chdren acheve bowe and badder contro
wthout undue emphass on ts mportance.
P)allic Stage *--0 years1
Peasure: genta regon.
actvtes assocated wth strokng and manpuatng ther sex
organs.
Oedipus comple#
'lectra comple#
Concepts
Onset of "norma homosexuaty"
Nursng mpcatons:
Accept chd's sexua nterest
Hep the parents answer chd's questons about brth or sexua
dfferences.
Latency Stage *0 to +D years1
Perod of camness / stabe perod.
Many of the dsturbng behavors are bured n the subconscous
mnd.
Ther energes are absorbed by the concerns n schoo, peers, sports
and other recreatona actvtes
Nursng Impcaton: Hep the chd have postve experences.
#enital Stage *+D years = up1
Oedpa feengs are reactvated toward opposte sex
The person s on hs way n estabshng a satsfyng fe of hs own
Nursng Impcaton:
Provde approprate opportuntes for the chd to reate wth
opposte sex.
Aow chd to verbaze feengs about new reatonshps.
Psyc)osocial $evelopment T)eory! Eri; Eri;son
Chdhood s very mportant n personaty deveopment.
Re|ected Freud's attempt to descrbe personaty soey on the bass
of sexuaty,
beeved that soca factors greaty affect
fet that personaty contnued to deveop beyond fve years of
age.
Identfed 8 deveopmenta stages throughout the whoe fe cyce.
Stages 1-5 - chdhood and adoescent
Stages 6-8 - Aduthood
Stages!
Stage 1:
Perod of Lfe Infant, 0-18 months, (Hope)
Psychosoca
Crss
Trust vs. Mstrust
Reatonshp wth Materna person
Postve
Resouton
o Reance on the caregver
o Deveopment of trust n the envronment
Negatve
Resouton
o Fear, anxety and suspcon
o Lack of care, both physca &
psychoogca by caretaker eads to
mstrust of envronment
Stage 2:
Perod of Lfe Todder, 18 mos. to 3 years
(Wpower)
Psychosoca
Crss
Autonomy vs. Shame/doubt
Reatonshp wth Paterna person
Postve
Resouton
o Sense of sef-worth
o Asserton of choce and w
o Envronment encourages ndependence,
eadng to sense of prde
Negatve
Resouton
o Loss of sef-esteem
o Sense of externa contro may produce
sef-doubt n others
Stage 3:
Perod of Lfe Preschoo, 3 to 6 years (Purpose)
Psychosoca
Crss
Intatve vs. Gut
Reatonshp wth Famy
Postve
Resouton
The abty to earn to ntate actvtes, to
en|oy achevement and competence
Negatve
Resouton
o The nabty to contro newy deveoped
power
o Reazaton of potenta faure eads to
fear of punshment and gut
Stage 4
Perod of Lfe Schooer, 6 to 12 yrs. (Competence)
Psychosoca
Crss
Industry vs. Inferorty
Reatonshp wth Neghbors/Schoo
Postve
Resouton
o Learnng the vaue of work
o Acqurng sks and toos of technoogy
o Competence heps to order fe and make
thngs work
Negatve
Resouton
Repeated frustratons and faures ead to
feengs of nadequacy and nferorty that
may affect ther vew of fe
Stage 5:
Perod of Lfe Adoescent, 12 to 18 yrs, (Fdety)
Psychosoca
Crss
Identty vs. Roe confuson
Reatonshp wth Peer group
Postve
Resouton
Experments wth varous roes n
deveopng mature ndvduaty
Negatve
Resouton
Pressures and demands may ead to
confuson about sef
Stage 6:
Perod of Lfe Young Adut, 18 to 54 yrs., (Love)
Psychosoca
Crss
Intmacy vs. Isoaton
Reatonshp wth Partners n frendshp
Postve
Resouton
o A commtment to others
o Cose heterosexua reatonshp and
procreaton
Negatve
Resouton
Wthdrawa from such ntmacy, soaton,
sef-absorpton and aenaton from others
Stage 7:
Perod of Lfe Mdde Adut, 24 to 54 yrs., (Care)
Psychosoca
Crss
Generatvty vs. Sef-absorpton
Reatonshp wth Partner
Postve
Resouton
o The care and concern for the next
generaton
o Wdenng nterest n work and deas
Negatve
Resouton
Sef-ndugence and resutng psychoogca
mpovershment
Stage 8:
Perod of Lfe Late Adut, 54 yrs. to death, (Wsdom)
Psychosoca
Crss
Integrty vs. Despar
Reatonshp wth Manknd
Postve
Resouton
o Acceptance of ones fe
o Reazaton of the nevtabty of death
o Feeng of dgnty and meanng of
exstence
Negatve
Resouton
Dsappontment of ones fe and desperate
fear of death
6ognitive $evelopment T)eory! 9ean Piaget
Stages!
Sensorimotor *3-D years1
Refex to compex
Begns to organze vsua mages and contro motor responses.
Coordnates sensory mpressons.
Pre-verba stage
Preoperational Stage *D-, years1
Transtona perod
Egocentrc and rreversbe thnkng
Words become symbos for ob|ects - symboc thnkng
Formaton of deas of categorzaton.
Lack of abty to go back and rethnk a process or concept.
Menta mage - the symboc process whch are evdent n pays
Constructon of verba schemas - preconcepts
6oncrete %perations *, A ++ years1
Thnkng appears to be stabzed
o abty to thnk of the possbe consequences of actons
Logca mpcatons
8ormal %perations
*++ years to a(ult)oo(1
Fu patterns of thnkng
Abty to use ogc and symboc processes
o mathematca and scentfc reasonng
Combnatora thnkng - mutdmensona approach
o hypothetc or hypothetco-deductve reasonng
Moral $evelopment T)eory! Laurence Eo)lberg
Level %ne
*Preconventional
Morality1
Chdrens
|udgments are
based on externa
crtera.
Standards of
Stage 1
Behavor s based on the desre to
avod severe physca punshment
by a superor power.
Rght or wrong s based on
consequences to hm.
Punshment = wrong act
rght and wrong are
absoute and ad
down by authorty.
Level Two
*6onventional
Morality1
Chdrens
|udgments are
based on the norms
and expectatons of
the group.
Stage 2
Actons are based argey on
satsfyng ones own persona
needs.
Stage 3
Good behavor s that whch peases
others and |udgments are based on
ntentons.
Chdren conform to rues to wn the
approva of others and to mantan
good reatonshps.
Stage 4
What s rght s what s
accepted.
If the soca accepts rues as
approprate for a group members,
chdren w conform to them to avod
soca dsapprova and censure
Level T)ree
*Post 6onventional
Morality1
The ndvdua
recognzes the
arbtrarness of
soca and ega
conventons.
The ndvdua
attempts to defne
mora vaues that
are separate from
group norms.
Stage 5
Behavor recognzes the aws as
arbtrary and changeabe.
For aspects of fe not governed
by aws, rght and wrong are
persona decsons based on
agreement and contracts.
Stage 6
Moraty s based on respect for
others rather than on persona
desres.
The ndvdua conforms to both
soca standards and to
nternazed deas to avod sef-
condemnaton rather than to
avod soca censure.
%t)er T)eories
4e)avioral Mo(el *Ivan PavlovF 9o)n :atsonF 4G 8G S;inner1
Behavor s:
a response to a stmuus from the envronment
earned and retaned by postve renforcement
Interpersonal Mo(el *Harry Stac; Sullivan1
Focused on the roe of the envronment and nterpersona reatons as
the most sgnfcant nfuences on a ndvduas deveopment.
Anxety s communcated nterpersonay.
Human Motivational Nee( Mo(elG *Abra)am Maslow1
Herarchy of needs n order of mportance
Prmary needs (physoogc) need to be met pror to deang wth
hgher eve needs.
Psyc)obiologic Mo(el
Focus s n menta ness as a bophysca mparment.
Human behavor s nfuenced by genetcs, bochemca ateratons
and functon of bran and CNS.
The stress response s a neuroendoctne response.
Important structure *limbic system1!
Thaamus - reguates actvty, sensaton, emoton
Hypothaamus - themoreguaton, appette contro, endocrne
functon, appette contro, mpusve behavor assocated wth
feengs of anger, rage or exctement.
Hppocampus and amygdae - emotona arousa and memory
Neurons - basc functonng unt of the CNS
Neurotransmtters
Chemca substances manufactured n the neuron
Ad transmsson of nformaton throughout the body
Dopamne
An exctatory neurotransmtter
Located prmary at the bran stem
Invoved n contro of compex movements, motvaton,
cognton and reguaton of emotona responses
Assocated wth pyschoss and Parknsons dsease
Catechoamnes (norepnephrne and epnephrne)
Norepnephrne
Attenton, earnng and memory, seep and wakefuness
Excess of ths s assocated wth anxety, memory oss, soca
wthdrawa and depresson.
Epnephrne - responsbe n the fght or fght mechansm
Serotonn
An nhbtory neurotransmtter
Derved from tryptophan
Invoved n contro of food ntake, seep and wakefuness, pan
contro, sexua behavor and emotons
Invoved n anxety and mood dsorders, schzophrena and ts
symptoms
Hstamne
Prmary nvoved n mmunty and aergc reactons
Some psychotropc drugs are bock by hstamne
Acetychone
Affects seep-wake cyce
Assocated wth Azhemers dsease
Gutamate
An exctatory neurotransmtter
At hgh eves, t can cause neurotoxcty.
Assocated wth Azhemers and Huntngtons dsease
Gama-Amnobutyrc Acd
An nhbtory neurotransmtter
Assocated to treat anxety and nduce seep.
PS"6H%THE&AP"
Is a process n whch a person enters nto a contract to nteract wth
a therapst to reeve symptoms, resove probems n vng, seek
persona growth
IN$I'I$7AL THE&AP"! Is a confdenta reatonshp between cent
and therapst.
Hypnot)erapy! Invoves varous methods and technques to
nduce a trance state where the patent becomes submssve to
nstructons
Humor t)erapy! Use of humor to factate expresson of feengs
and to enhance nteracton
Psyc)oanalysis! Focuses on the exporaton of the unconscous, to
factate dentfcaton of the patent's defenses
#&%7P THE&AP"
mnmum number : 3
Idea number :8-10
Advantages:
o decreases soaton
o decreases dependence
o deveops copng sks
o deveops nterpersona earnng
o deveops opportuntes for hepng others
o deveops abty to sten to other members
&emotivation T)erapy! Promotes expresson of feeng through
nteracton factated by dscusson of neutral topics
8amily t)erapy! A method n whch famy members gan:
o nsght nto the probems
o mprove communcaton
o mprove functonng of ndvdua members as we as the
famy as a whoe.
o It focuses on the tota famy as an nteractona system
Milieu T)erapy
A therapeutc envronment s organzed to:
o encourage and assst the cent to contro
probematc behavor
o functon wthn the range of soca norms
Play t)erapy
Effectve for chdren sufferng from maad|ustment or behavor
dsorder.
The chd s usuay paced n a pay room
Purpose - to dscover the causes of the chd's confct through
observaton of hs pay and to nterpret t to the chd.
&ecreational t)erapy
Uses actvtes whch vtaze the patent's nterest and hep hm
or her to reax and fee refreshed.
Exampe: Payng baseba may be prescrbed for as a means of
expressng hostty n a group.
%ccupational t)erapy! Uses any menta or physca actvty
prescrbed or guded to ad an ndvdua's recovery from a dsease
or n|ury.
Musical t)erapy
Invovng the musc whch aows the chd or adoescent to
express hersef or hmsef.
Aso effectve wth those who have dffcuty communcatng.
Art t)erapy! Cents are encouraged to express ther feengs or
emotons by pantng, drawng or scupture.
Psyc)o(rama t)erapy! Patents dramatzes ther emotona
probems n a group settng.
4e)avior T)erapy
Is a mode of treatment that focuses on modfyng observabe
(overt) and quantfabe behavor
Systematc manpuaton of the envronment and varabes
thought to be functonay reated to the behavors.
Limit Setting
o Therapst gves an advanced warnng of the mt and the
consequences w foow f the cent does not adhere to the
mt.
o The consequences shoud occur mmedatey after the cent
has exceeded the mt
o Consstency must occur wth a personne.
o Purposes:
o Mnmzes manpuaton and spttng of the staff.
o Provde a framework for the cent to functon n and
enabe a cent to earn to make requests.
Systematic $esensiti>ation
o Cents are exposed sowy to a feared ob|ect or a thng that
nhbts anxous responses and taught ways to reax.
o Effectve n treatng phobas.
Implosive t)erapy
o The cents are exposed abrupty to ntense forms of anxety
producers, ether n magnaton or n rea fe
6ognitive 4e)avior t)erapy
o Uses confrontaton as a means of hepng the cents
restructure or rearrange rratona beefs, maadaptve
thnkng, percepton-, and behavors.
o Used for depresson and ad|ustment dffcutes.
4iofee(bac;
o Teaches the cent to contro or change aspects of ther
nterna envronment.
Aversion t)erapy
o Uses unpeasant or noxous stmu to change napproprate
behavor.
o Exampes
o Antabuse to treat acohocs
o Showng fms to drvers who are arrested for speedng or
drvng whe under the nfuence of acoho or drugs.
Assertiveness Training
o Cents are encouraged and taught how to appropratey reate
to others
o Teaches the ndvdua to ask for what s benefca to both
mentay and mentay heathy persons.
To;en-economy! Utzes the prncpe of rewardng desred
behavor to factate change.
ELE6T&%6%N'7LSI'E THE&AP" *E6T1
Exact mechansm s unknown
Requres a consent
Usuay gven at 70-150 vots for about .5-2 seconds
Effectvty: 6-12 treatments wth at east 48 hour nterva
Indcator of effectveness: tonc-conc sezure
Indcatons of use:
Depresson
Mana
Catatonc schzophrena
Contrandcatons (not absoute)
Fever
Increased ICP
Cardac condtons
TB wth hstory of
hemorrhage
Unheaed fracture
Retna detachment
Pregnancy
Before the procedure:
Dagnostc procedures
o X-ray
o ECG
o EEG
Drugs gven
o Atrophne sufate (decrease secretons)
o Anectne (Succnychone) - reax musces
o Methohexta Na (Brevta) - anesthetc
Durng the procedure:
Observe for tonc-conc sezure
After the procedure:
Poston
Check vta sgns
Reorent the cent
Watch out for compcatons:
o Memory oss
o Headache
o Apnea
o Respratory depresson
o Fracture
4ASI6 6%N6EPTS %N PS"6H%PHA&MA6%L%#"
MA9%& T&AN?7ILIHE&SB ANTIPS"6H%TI6S
Indcaton: Schzophrena and Other Psychoss
Desred effect: contro of symptoms
Best taken after meas
Exampes:
Haoperdo (Hado)
Prochorperazne
(Compazne)
Fuphenazne (Proxn)
Chorpromazne
(Thorazne)
Si(e effects! Nursing Action
Burred vson Avod drvng
Dry mouth Gve sugaress gum
Tachycarda, paptaton,
constpaton, urnary retenton
Montor & report
Photosenstvty Dont e#pose skin to sunlight
Orthostatc hypotenson (onitor )*
Advise gradual change in
position
Extra Pyramda Symptoms
o Pseudoparknsonsm
o p-rong tremors
mask-ke face
o cog-whee rgdty
o propusve gat
o Akathsa - restess eg
syndrome
o Dystona - defect n musce
tone
Report at once
Adverse effect: report promptly
Tardve dysknesa - p smackng
Agranuocytoss
o Assess for:
Fever
Sore throat
Lab data: WBC count
Hepatotoxcty
o Assess for ALT & AST
MIN%& T&AN?7ILIHE&SB ANII%L"TI6S
Common ndcaton: Anxety dsorders
Desred Effect: Decreased anxety, adequate seep
Exampes:
Dazepam (Vaum)
Oxazepam (Serax)
Chordazepoxde
(Lbrum)
Chorazepate Dpotassum
(Tranxene)
Aprazoam (Xanax)
Nursng Impcatons:
Best taken before meas
Advse to avod drvng
Avod acoho and caffene-contanng foods
Admnster t separatey wth any drug
ANTI$EP&ESSANTS
Desred effects: ncreased appette, adequate seep
Tricyclic Anti(epressants
Exampes:
Impramne (Tofran) Amtrptyne (Eav)
Nursng Impcatons:
Best gven after meas
Effectvty: after 2-3 weeks
Check the BP, t causes hypotenson
Check the heart rate, t causes cardac arrythmas
Montor I & O
Montor for sgns of ncreased IOP
MA% INHI4IT%&S
Indcaton: refractory depresson
Exampes:
Tranycypromne (Parnate)
Phenezne (Nard)
Isocarboxazd (Marpan)
Nursng Impcatons:
Best taken after meas
Report headache; t ndcates hypertensve crss
Avod tyramne contanng foods ke:
Avocado
Banana
Cheddar and aged cheese
Soysauce
Preserved foods
Effectvty: 2-3 weeks
Montor the BP
There shoud be at east a two-week nterva when shftng from one
ant-depressant to another
Selective Serotonin &eupta;e In)ibitors
Exampes:
Fuoxetne (Prozac)
Ceatopram (Ceexa)
Sertrane (Zooft)
Paroxetne (Pax)
Fuvoxamne (Luvox)
Nursng Impcatons:
Avod the use of:
dazepam
Acoho
Tryptophan
Montor PTT, PT
Never gve to pregnant / actatng mothers.
ANTI-MANI6 A#ENT
E5amples!
Lthum Ctrate
(Cbath - S)
Lthum Carbonate
(Eskath, Lthane, Lthobd)
Nursing implications!
Best taken after meas
Increase ntake of:
fuds (3 L /day)
sodum (3 gm/day)
Avod actvtes that ncrease perspraton
Never gve to pregnant mothers
Effectvty: 10-14 days
Antpsychotc s admnstered durng the frst 2 weeks
Therapeutc eve:G.-+G. me@BL
If ineffective! Tegretol
Sgns of toxcty:
o 'omtng
o Anorexa
o Nausea
o $arrhea
o Abdomna cramps
o Lghtheadedness (ate)
Antdote: Mannitol
ST&ESS
A nonspecfc response of the body to any demand made upon t.
(Hans Seye, 1936)
A state produced by a change n the envronment that s perceved
as chaengng, threatenng or damagng to the persons dynamc
equbrum. (Smetzer, 1992)
A(aptation
A constant ongong process that occurs aong tme contnuum,
begnnng wth brth and endng wth death. (Smetzer, 1992)
A contnuous process of seekng harmony n an envronment.
Types of A(aptation!
#eneral A(aptation Syn(rome *#AS1
Invoves the whoe body n response to stress.
Compared to fe process as t focuses on the "wear and tear of the
body tssues.
P)ases!
Alarm
o Acute phase of the syndrome
o Characterzed as the "fght and fght" reacton
o Defensve by nature but sef-mtng
o If stress s ntense, t may ead to death.
&esistance
o Characterzed as the state of adaptaton
o Person moves back to homeostass
E5)austion
o Resut of a proonged exposure to stress and adaptve
mechansms can no onger persst.
Local A(aptation Syn(rome
Refers to nfammatory response and repar
processes that occur at the oca ste of tssue n|ury.
Eustress - postve stress
$istress
Negatve stress
Damagng stressors whch may resut n varous physca and
emotona dsorders such as: anxety, frustraton, nsecurty,
amessness
6&ISIS AN$ 6&ISIS INTE&'ENTI%N
A stuaton that occurs when an ndvdua's habtua copng abty
becomes neffectve to meet the demands of a stuaton.
As a serous nterrupton and dsturbance of one's equbrum or
homeostass
Leads to potentay dangerous, sef-destructve or socay
unacceptabe behavor.
6)aracteristics
Hghy ndvduazed
Sef-mtng: 4-6 weeks
Person affected becomes passve and submssve
Affects a persons support system
Type $escription E5ample
Maturatona/deveopme
nta crss
expected,
predctabe and
nternay
motvated
Puberty,
adoescence,
young aduthood,
marrage, or the
agng process.
Stuatona/accdenta Unexpected,
unpredctabe
and externay
motvated
Economc
dffcuty, ness,
accdent, rape,
dvorce or death
Soca crss Due to acts of
nature
Natura
caamtes
P)ases
Dena
Increased Tenson
Dsorganzaton
Attempts to reorganze
Stage for fu reorganzaton
6&ISIS INTE&'ENTI%N
Ma|or Goa:
o Restore the maxmum eve of functonng (pre-crss state)
o It s an actve but temporary entry nto the fe stuaton of an
ndvdua or a famy durng a perod of stress.
o A way of enterng nto the stuaton to hep them mobze ther
resources and to decrease the effect of stress.
$omestic 'iolence &e@uiring 6risis Intervention!
&APE
Nonconsensua sexua penetraton of an ndvdua, obtaned by
force or threat, or n cases n whch the vctm s not capabe of
consent.
Ein(s of &ape
Power - to prove mascunty
Anger - means of retaaton
Sadstc - to express erotc feengs
Silent &ape Syn(rome
Is a maadaptve reacton to rape
The vctm:
fas to dscose nformaton about the rape
s unabe to resove feengs about the sexua assaut
Resuts to ncrease anxety and may deveop a sudden phobc
reacton.
&ape Trauma Syn(rome *&TS1
Refers to a group of sgns and symptoms experenced by a vctm n
reacton to rape
Phases:
Acute Phase - shock, numbness, dsbeef
Dena - refusa to dscuss the event
Heghtened Anxety - fear, tenson, nghtmares
Stage of Reorganzaton
4attere( :ife Syn(rome *4:S1
A form of cycc domestc voence
Men: ow sef-esteem
Women: Dependent personaty dsorder
6)il( Abuse
Is an act of omsson of responsbty or commsson n whch
ntentona harm s nfcted on a chd.
6omponents of %mission!
Chd abandonment - eavng the chd physcay
Chd negect - ack of provson of those thngs whch are necessary
for the chd's growth and deveopment
Types of Commsson:
P)ysical Abuse
Is an ntentona physca harm nfcted on a chd by a parent or
other person.
Emotional abuse - nsut and undermnng one's confdence
Se5ual abuse - abuse n the form of sexua contact
Characterstcs of Abusve Parents:
They come from voent fames
They were aso abused by ther parents
They have nadequate parentng sks
They are socay soated because they don't trust anyone
They are emotonay mmature
They have negatve atttude towards the management of the
abused
Warnng sgns of Chd Abuse / Negect:
Chds excessve knowedge on sex and abusve words
Har growth n varous engths
Inconsstent stores from the chd and parent/s
Low sef-esteem
Depresson
Apathy
Brused or swoen gentaa; tears or brusng of rectum or vagna
Unusua n|ures for the chds age and deveopment
Serous n|ures (fractures, burns, aceratons)
Evdence of od n|ures not reported
&epublic Act ,0+3
*Anti 6)il( Abuse Law1
Requred reportng of suspected cases
Report cases to the nearest authortes wthn 48 hours
AssessmentF Planning an( Nursing Actions for 6risis
Prmary concerns:
o Physca n|ures
o Aevaton of psychoogca trauma
Nurse shoud dspay:
o Senstvty
o Atttude (Non|udgmenta)
o 6onfdentaty
o &espect
o Empathy
o $gnty
Evdences are mportant:
o staned cothng
o fngerna scrapngs
o mouth or ana smears contanng semen
Interventon focuses famy as a unt.
If the vctm s a chd: Pay and art therapy
$E8ENSE ME6HANISM
These are automatc and usuay unconscous processes or act by
the ndvduas to:
o reduce or cope anxety or fear
o resove emotona or menta confct
o protect one's sef-esteem
o protect one's sense of securty
Becomes pathoogc when overused.
Used by both mentay heathy and mentay ndvduas
Common Defense Mechansms Used!
6ompensation
o An attempt to overcome a rea or magned short comng,
nferorty, nabtes and weaknesses.
o A bnd woman becomes profcent n payng pano.
6onversion
o Emotona probems are converted to physca symptoms
o A student unprepared for a report suffered headache the day she
s supposed to dever her report.
$enial
o Faure to acknowedge an ntoerabe thought, feeng,
experence or reaty
o A mdde-aged man after beng admtted to the CCU because of
an AMI, nssts that he s n the hospta for |ust a dagnostc work-
up.
$isplacement
o the redrecton of feengs to a ess threatenng ob|ect
o An adoescent boy, after an argument wth hs father, goes to the
room and kcked hs rooms door.
8antasy
o Conscous dstorton of unconscous feengs or wshes
o A boy who s beng bued by hs frends wshed he had the
power of Woverne.
8i5ation
o An unheathy mechansm whch s an arrest of maturaton at
certan stages of deveopment.
o A boy never overcame beng fuy reant from hs mother.
Intro<ection
o Symboc assmaton or takng nto onesef a ove/hatred ob|ect.
Derved from the word "ntro|ect" whch teray means to take
nto or ngest.
o Common to depressed cents.
I(entification
o An ndvdua ntegrates certan aspects of someone ese's
personaty nto one's own.
o A young schoo teacher adopts hs former mentor's teachng
stye when conductng cass sessons.
Intellectuali>ation
o An overuse of nteectua concepts by an ndvdua to avod
expresson of feengs
o A man who was asked to share a memorabe experence about
hs grandmother who ded dscussed the stages of death and
dyng by Ezabeth Kuber Ross.
Pro<ection
o Attrbutng to others one's unconscous wshes/fear.
o Lteray, ths means to "throw off.
o A student who faed a sub|ect bames hs faure on poor
teachng.
&eaction A 8ormation
o Expresson of feeng that s the drect opposte of one's rea
feeng.
o Aso referred to as overcompensaton.
o A student who dskes one of her cassmates may act or show
concern toward her.
&ationali>ation
o An ndvdua fnds a |ustfabe cause and acceptabe reasons |ust
to be saved from an embarrassng and anxety producng
thoughts or stuatons.
o A basketba payer cams that he mssed the shot and ost the
game because of the dstractons made by the audence.
&egression
o Is the turnng back to earer patterns of behavor n sovng
persona confcts.
o Commony seen to schzophrenc patents
o A person who becomes n the face of dsappontment has
regressed to a form of chdsh behavor.
&epression
o It s the nvountary or unconscous forgettng of an unpeasant
deas or mpuses.
o Durng the nurse-patent reatonshps, patents often
unconscousy avod dscussng those experences producng
anxety whch are emotonay dffcut to verbaze.
Suppression
o Permts the ndvdua to store away or conscousy forget the
unpeasant, panfu and unacceptabe thoughts, desres,
experences and mpuses.
o "I' thnk t about tomorrow", "I'd rather go now", "Can we
change the topc?"
o A boy waked out from the group and sad "I have to go now",
when he was asked what was happened to ther reatonshp wth
hs grfrend.
Substitution
o Repacng the desred unattanabe goa wth one that s
attanabe
o A woman who faed the nursng board exam 3 tmes, worked as
a nursng ade |ust to be n the hospta.
Sublimation
o The redrecton of unacceptabe nstnctua drve wth one that s
socay acceptabe
o Instead of harmng hs mother, a man expressed hs anger by
composng a song.
Symboli>ation
o Less threatenng ob|ect s used to represent another
o A woman, mssng her husband fnds comfort n huggng her son
who ooks ke hs father.
7n(oing
o An attempt to erase an act, thought, feeng, gut or desre
o A man gves her wfe a bunch of roses after ther argument ast
nght.