MENTAL HEALTH

"A state of well-being where a person can realize his or her own abilities to
cope with the normal stresses of life and work productively." (WHO)
Balance in persons internal life and adaptation to reality.
!tate of well-being in which a person is able to realize his potentials.
"riteria for #ental $ealth%
Self-awareness
Ability to%
recognize ones thoughts feelings& asset potentials and weakness.
e'perience genuine feelings as anger& happiness& resentment
leads to self-acceptance& self-understanding in order to understand
others
Autonomy% ability to function independently and function with others
Perceptive ability
Awareness of stimuli& reality orientation.
(rientation to% )ime& *lace& *erson
Integral capacity% Ability to harmonize psychic forces (id& ego& super ego).
Self-actuation
Ability to adopt to life changes& happy to work with others
!atisfaction in every endeavor
+enuine cooperation
Mastery of ones environment! Awareness of the changes around him
MENTAL H"#IENE
a science that deals with% *romotive& *reventive& "urative& ,ehabilitative
aspects of care.
MENTAL $IS%&$E&
A medically diagnosable illness which results in significant impairment of
one-s cognitive& affective or relational abilities and is e.uivalent to mental
illness.
"riteria for #ental /isorder%
/issatisfaction with%
ones characteristics& abilities and accomplishments
ones place in the world
0neffective%
interpersonal relationship
coping or adaptation to the events in ones life
MENTAL ILLNESS
A state in which an individual shows deficit in functioning and is unable to
maintain personal relationship.
!tate of imbalance characterized by a disturbance in a persons thoughts&
feelings and behavior
1actors that increase the risk are% "rises& Abuses& *overty
Historical 'iew of Mental Illness
0n the past& mental illness has been viewed as%
/emonic possession
0nfluence of ancestral spirits
,esult of violating taboo or neglecting cultural& ritual& and spiritual
condemnation
Perio( of Enlig)tenment *+,-.-+//01
2unatics were restrained in iron menacles
#entally ill were e'hibited as diversion and entertainment for the
public
3stablishment of asylums
(pening of state hospitals for mentally ill.
Perio( of Scientific Stu(y
*sychoanalysis by !igmund 1reud
Psyc)otropic $rugs *+2.31
4se of chlorpromazine and imipramine
#ental illness is caused by chemical imbalance in the brain.
T)e $eca(e of t)e 4rain *+2231
1ocused on the connections between mental illness and biological
malfunction in the brain and the neuroendocrine-immune system.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 6 of 78
Biological views holds that biological defects are responsible for
certain serious mental illness.
$iagnosis of Mental Illness
4se of the /iagnostic and !tatistical #anual of #ental 0llness (/!#-09)
*rovides diagnostic criteria for each mental disorder and a system of :
a'es to give a comprehensive view of the clients mental illness.
A7is I% )he clinical disorder that is the focus of treatment
A7is II% *ersonality disorders and mental retardation
A7is III% #edical conditions
A7is I'% *sychosocial and environmental problems
A7is '% +lobal assessment of functioning (+A1)
PS"5HIAT&I5 N6&SIN#
An interpersonal process
"oncerned with all the aspects of care
Both a !cience and an Art
!cience ; uses different theories
Art - therapeutic use of self
"lientele%
0ndividual& family and the community
Both mentally healthy and mentally ill
#ain tool of the nurse% )herapeutic use of !elf
"haracteristics of a +ood *sychiatric <urse%
3mpathy
+enuineness
"ongruence
4nconditional positive regard
,oles of the <urse in *sychiatric !etting%
"linician
"ollaborator
"ounselor
$ealthy role model
*arent surrogate
*atient advocate
,eality based
,esearcher
!ocializing agent
)eacher
)echnician
)herapist
=ard manager
Levels of Interventions in Psyc)iatric Nursing
Level $escription E7amples
Primary Aimed at altering the stressors
through%
promotion of mental health
lowering the rate of cases
$ealth education
0nformation
dissemination
"ounseling
Secon(ary 0nterventions that limits the severity of
a disorder thorugh%
"ase finding
*rompt treatment
"risis intervention
/rug administration
Tertiary Aimed at reducing the disability after
a disorder through%
*revention of complication
Active program of rehabilitation
Alcoholics
anonymous
(ccupational therapy
THE PS"5HIAT&I5 SETTIN#
A(mitting a 5lient in t)e Psyc)iatric Setting
Areas to be assessed%
Health perception
%rientation
Metabolic pattern
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 8 of 78
Elimination pattern
5ognitive pattern% >udgment& 0nsight& #emory
Activity and e'ercise pattern
Thought process
Sleep-rest pattern
LE#AL ASPE5TS %8 PS"5HIAT&I5 N6&SIN#
)ypes of Admissions%
'oluntary
*ersons admit themselves
"lient consents to all treatment
"lient can refuse treatment& including drugs& unless danger to self or
others
Involuntary
9u(icial process
0nitiated when someone files a petition
"ertification of the likelihood of serious harm to self or others& or
unable to care for self
4nder 6?& parents can confine with confirmation by a neutral fact
finder
#ust be released at end of statutory time or put on voluntary
status or have a hearing
@
9u(icial Prece(ents
Unless incompetent, client maintains all previous rights
Insanity as a $efense
0nsanity % determined in courtA legal terminology
McNaug)ten &ule
At the time of the crime, the individual didnt know the nature and quality of the
act or didnt know right from wrong!
5%MM%N 4EHA'I%&AL SI#NS AN$ S"MPT%MS
$isturbance in Perception
Illusion - misperception of an actual e7ternal stimuli
Hallucination - false sensory perception in t)e absence of e7ternal
stimuli
Neologism - pathological coining of new words
5ircumstantiality - over inclusion of details
:or( sala( - incoherent mi'ture of words and phrases
8lig)t of i(eas - shifting of one topic from one subBect to another in a
somewhat related way
Looseness of Association - shifting of a topic from one subBect to another
in a completely unrelated way
'erbigeration - meaningless repetition of word or phrases
Perseveration - persistence of a response to a previous .uestion
Ec)olalia - pathological repetition of words of others
5lang association - the sound of the word gives direction to the flow of
thought
$elusion - false belief which is inconsistent with one-s knowledge and
culture
+randeur - is an e'aggerated belief of identity
<ihilistic - the client denies the e'istence of self or part of self
*ersecution - belief that he or she is the obBect of environmental
attention and being singled out for harassment
!elf-depreciation - worthlessness or hopelessness
!omatic - false belief to body function.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 7 of 78
#anagement%
Acknowledge the feelings
,eorient to reality
*rovide distractions
$isturbances of Affect
Inappropriate affect - disharmony between the stimuli and the emotional
reaction
4lunte( affect - severe reduction in emotional reaction
8lat affect - absence or near absence of emotional reaction
Apat)y - dulled emotional tone
$isturbances in Motor Activity
Ec)opra7ia - the pathological imitation of posture5action of others
:a7y fle7ibility - maintaining the desired position for long periods of time
without discomfort
A;inesia - loss of movement
4ra(y;inesia - slowness of all voluntary movement including speech.
Ata7ia - loss of coordinated movement
$isturbances in Memory
5onfabulation - filling in of memory gaps
Amnesia - inability to recall past events
Anterogra(e - immediate past
&etrogra(e - distant past
$e<a vu - feeling of having been to place which one has not yet visited
9amais vu - feeling of not having been to a place which one has visited
$ementia
gradual deterioration of intellectual functioning
results in the decreased of capacity to perform A/2
%t)er be)avioral signs = symptoms
Agitation - severe an'iety associated with motor restlessness.
Agnosia - inability to recognize and interpret sensory stimuli.
A;at)isia - subBective feeling of muscular tension& restlessness and pacing
repeated sitting and standing.
Ambivalence - presence of two opposing feelings at the same time.
Ap)asia - inability or difficulty to speak or recall words
Apra7ia - inability to carry out specific task or activity.
$elirium
refers to acute change or disturbance in a person-s% 2("& cognition&
emotion & perception
$epression - feeling of sadness
$ereali>ation - feeling of strangeness towards the environment.
$yst)ymia - persistent state of sadness
Elation (euphoria)- a feeling of high degree of confidence& boastfulness
and Boy with increase motor activity.
Narcolepsy - sleep disorder characterized by fre.uent irresistible urge to
sleep with episodes of cataple'y (sudden loss of muscle power)
6SE %8 APP&%P&IATE 5%MM6NI5ATI%N TE5HNI?6ES
5ommunication% reciprocal e'change of ideas between or among persons
#odes%
9erbal - written5spoken
<on-verbal - posture& tone of voice& facial e'pression
)ypes of <on-verbal communication%
Cinesis
body movement
eye contact
gestures
*aralanguage
voice .uality
non-language vocalization (crying& sobbing& moaning)
*ro'emics ; law of space relationship
)ouch ; physical act
"ultural artifacts
#eta communication
based on role e'pectations
hidden meaning of words
Elements!
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age D of 78
(Channel)
(Context)
Message

FEEDBACK
T)erapeutic 5ommunication! a way of interacting in a purposeful manner to
promote the clients ability to e7press his t)oug)ts an( feelings openly.
Essentials for a T)erapeutic 5ommunication!
#enuineness
&espect
Empathy
Attentive listening
Trust (rapport)
4arriers to a T)erapeutic 5ommunication
4elittling
Interrupting 5 ignoring
#iving advice
Social response
5hanging the subBect
Approving 5 disapproving
Moralizing
E7amples! T)erapeutic Tec)ni@ue
Tec)ni@ue E7ample
Accepting Ees& that must have been difficult for you.
Ac;nowle(ging or giving
recognition
0 noticed that you-ve fi'ed your bed.
As;ing (irect @uestions $ow does your wife feel about your
hospitalizationF
5larifying 0-m not sure that 0 understand what you are
trying to say.
5onfronting or presenting
reality
0 see no bats flying in this room.
Encouraging comparison $as this ever happened beforeF
Encouraging (escription $ow do you feel when you take your
medicationF
Encouraging evaluation /oes participating in group therapy enable you
to discuss your feelingsF
E7ploring )ell me more about your Bob. =ould you
describe your responsibilitiesF
8ocusing "assisting a patient to e#plore specific topic$
#iving broa( openings or
as;ing open-en(e(
@uestions
0s there something you-d like to doF
Informing "giving needed facts$
0-ll be your nurse for today& from G%HH until 7%HH
this afternoon.
Ma;ing observations Eou appear to be angry. 5 0 noticed that you-re
trembling.
%ffering general lea(s +o on. 5 Eou were sayingI
&estating "lient% 0 can-t sleep& 0 stay awake all night.
<urse% Eou can-t sleep at night& (restating)
Summari>ing /uring the past hour& we talked about your plans
for the future& they include...
6sing silence "to induce thought, pacing, acceptance)
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age : of 78
G
R
E A
T
'ali(ating "confirming one%s o&servation$
J!o you mean . . .K
'oicing (oubt 0 find that hard to believe.
E7amples! Non-t)erapeutic Tec)ni@ue an( Ineffective 5ommunication
Agreeing an( (isagreeing J0 think you did the right thing.K
A(vice JEou should.I.K
4elittling "/on-t be concerned& evervone feels like that".
$efen(ing "All doctors here are simply great".
8alse reassurance "/on-t worry& everything will be all right".
8ocus on caregivers
feeling
J0 feel that way too.K
9u(ging "0t-s your own mistake".
N6&SE A PATIENT &ELATI%NSHIP
$ildegard *eplau
P)ases!
Pre-Interaction P)ase
begins when the nurse is assigned5chooses a patient
patient is e'cluded as an active participant
nurse feels certain degree of an'iety
includes all of what the nurse thinks and does before interacting with the
patient
develop self-awareness
data gathering& planning for first interaction
%rientation p)ase
when the nurse-patient interacts for the first time
establish of contract with the patient
establish of trust and rapport
learn about the patient and his initial concerns and needs
encourage the patient to feel comfortable with the meeting
conduct initial interview
manage present emotion of the patient
provide support and empathy of the patients feelings
assure of confidentiality
:or;ing B T)erapeutic P)ase!
it is highly individualized
identification and resolution of the patient-s problems
more structured than the orientation phase
the longest and most productive phase
limit setting must be employed
planning and implementation
*roblems%
)ransference
the development of an emotional attitude towards the nurse
positive or negative
"ounter transference ; e'perienced by the nurse 5 therapist
Termination P)ase
3valuate the summary of progress
,einforce change and strength of patient
+ive rewards for the cooperation during interaction
3ncourage e'pression of feelings about termination of the relationship
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age L of 78
)erminate the relationship without giving promises
THE%&IES %8 H6MAN $"NAMI5S
Psyc)ose7ual $evelopment ! Sigmun( 8reu(
Levels of 5onsciousness
C Psyc)ic Energies
I(
Ego
Superego
Libi(o - are the instinctual drives
&egression and fi7ation are common terms in this theory.
+ave prominence to se'ual feelings% defined "se'" as anything that gives
gratification
Stages!
%ral Stage *3-D years1
)he area of gratification is the mouth
*leasures% sucking activities like fingers& toes or nipples
/issatisfaction% resurface at a later
overeating& smoking& nail-biting
<ursing 0mplication%
*rovide oral stimulation by giving pacifiers
Breastfeeding may provide more stimulation.
/o not discourage thumb sucking
Anal Stage *D-- years1
"hildren-s attention is focused on the anal region.
*leasure% elimination.
"overs the ideal age for "toilet training" (8 658 years)
8 concepts%
$olding on
2etting go
*ossible problems%
"ompulsive need to be clean and orderly.
1rugality and stinginess
+reed
0nsistence on doing things at one-s own rate at the e'pense of others
,igid training
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age G of 78
3'cessive messiness and disorderly habits.
<ursing 0mplication% $elp children achieve bowel and bladder control without
undue emphasis on its importance.
P)allic Stage *--0 years1
*leasure% genital region.
activities associated with stroking and manipulating their se' organs.
Oedipus comple#
'lectra comple#
"oncepts
(nset of Jnormal homose'ualityK
<ursing implications%
Accept child-s se'ual interest
$elp the parents answer child-s .uestions about birth or se'ual differences.
Latency Stage *0 to +D years1
*eriod of calmness 5 stable period.
#any of the disturbing behaviors are buried in the subconscious mind.
)heir energies are absorbed by the concerns in school& peers& sports and
other recreational activities
<ursing 0mplication% $elp the child have positive e'periences.
#enital Stage *+D years = up1
(edipal feelings are reactivated toward opposite se'
)he person is on his way in establishing a satisfying life of his own
<ursing 0mplication%
*rovide appropriate opportunities for the child to relate with opposite se'.
Allow child to verbalize feelings about new relationships.
Psyc)osocial $evelopment T)eory! Eri; Eri;son
"hildhood is very important in personality development.
,eBected 1reud-s attempt to describe personality solely on the basis of
se'uality&
believed that social factors greatly affect
felt that personality continued to develop beyond five years of age.
0dentified ? developmental stages throughout the whole life cycle.
!tages 6-: - childhood and adolescent
!tages L-? - Adulthood
Stages!
!tage 6%
*eriod of 2ife 0nfant& H-6? months& ($ope)
*sychosocial "risis )rust vs. #istrust
,elationship with #aternal person
*ositive ,esolution o ,eliance on the caregiver
o /evelopment of trust in the environment
<egative ,esolution o 1ear& an'iety and suspicion
o 2ack of care& both physical M psychological by
caretaker leads to mistrust of environment
!tage 8%
*eriod of 2ife )oddler& 6? mos. to 7 years
(=illpower)
*sychosocial "risis Autonomy vs. !hame5doubt
,elationship with *aternal person
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age ? of 78
*ositive ,esolution o !ense of self-worth
o Assertion of choice and will
o 3nvironment encourages independence& leading to
sense of pride
<egative ,esolution o 2oss of self-esteem
o !ense of e'ternal control may produce self-doubt in
others
!tage 7%
*eriod of 2ife *reschool& 7 to L years (*urpose)
*sychosocial "risis 0nitiative vs. +uilt
,elationship with 1amily
*ositive ,esolution )he ability to learn to initiate activities& to enBoy
achievement and competence
<egative ,esolution o )he inability to control newly developed power
o ,ealization of potential failure leads to fear of
punishment and guilt
!tage D
*eriod of 2ife !chooler& L to 68 yrs. ("ompetence)
*sychosocial "risis 0ndustry vs. 0nferiority
,elationship with <eighbors5!chool
*ositive ,esolution o 2earning the value of work
o Ac.uiring skills and tools of technology
o "ompetence helps to order life and make things
work
<egative ,esolution ,epeated frustrations and failures lead to feelings of
inade.uacy and inferiority that may affect their view of
life
!tage :%
*eriod of 2ife Adolescent& 68 to 6? yrs& (1idelity)
*sychosocial "risis 0dentity vs. ,ole confusion
,elationship with *eer group
*ositive ,esolution 3'periments with various roles in developing mature
individuality
<egative ,esolution *ressures and demands may lead to confusion about
self
!tage L%
*eriod of 2ife Eoung Adult& 6? to :D yrs.& (2ove)
*sychosocial "risis 0ntimacy vs. 0solation
,elationship with *artners in friendship
*ositive ,esolution o A commitment to others
o "lose heterose'ual relationship and procreation
<egative ,esolution =ithdrawal from such intimacy& isolation& self-
absorption and alienation from others
!tage G%
*eriod of 2ife #iddle Adult& 8D to :D yrs.& ("are)
*sychosocial "risis +enerativity vs. !elf-absorption
,elationship with *artner
*ositive ,esolution o )he care and concern for the ne't generation
o =idening interest in work and ideas
<egative ,esolution !elf-indulgence and resulting psychological
impoverishment
!tage ?%
*eriod of 2ife 2ate Adult& :D yrs. to death& (=isdom)
*sychosocial "risis 0ntegrity vs. /espair
,elationship with #ankind
*ositive ,esolutiono Acceptance of ones life
o ,ealization of the inevitability of death
o 1eeling of dignity and meaning of e'istence
<egative ,esolution /isappointment of ones life and desperate fear of
death
5ognitive $evelopment T)eory! 9ean Piaget
Stages!
Sensorimotor *3-D years1
,efle' to comple'
Begins to organize visual images and control motor responses.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age N of 78
"oordinates sensory impressions.
*re-verbal stage
Preoperational Stage *D-, years1
)ransitional period
3gocentric and irreversible thinking
=ords become symbols for obBects ; symbolic thinking
1ormation of ideas of categorization.
2ack of ability to go back and rethink a process or concept.
#ental image ; the symbolic process which are evident in plays
"onstruction of verbal schemas ; preconcepts
5oncrete %perations *, A ++ years1
)hinking appears to be stabilized
o ability to think of the possible conse.uences of actions
2ogical implications
8ormal %perations
*++ years to a(ult)oo(1
1ull patterns of thinking
Ability to use logic and symbolic processes
o mathematical and scientific reasoning
"ombinatorial thinking - multidimensional approach
o hypothetic or hypothetico-deductive reasoning
Moral $evelopment T)eory! Laurence Eo)lberg
Level %ne
*Preconventional Morality1
"hildrens Budgments
are based on e'ternal
criteria.
!tandards of right and
wrong are absolute and
laid down by authority.
!tage 6
Behavior is based on the desire to avoid
severe physical punishment by a superior
power.
,ight or wrong is based on conse.uences to
him.
*unishment O wrong act
Level Two *5onventional
Morality1
"hildrens Budgments
are based on the norms
and e'pectations of the
group.
!tage 8
Actions are based largely on satisfying ones
own personal needs.
!tage 7
+ood behavior is that which pleases others
and Budgments are based on intentions.
"hildren conform to rules to win the approval
of others and to maintain good relationships.
!tage D
=hat is right is what is accepted.
0f the social accepts rules as appropriate for all
group members& children will conform to them to
avoid social disapproval and censure
Level T)ree
*Post 5onventional
Morality1
)he individual
recognizes the
arbitrariness of social
and legal conventions.
)he individual attempts
to define moral values
that are separate from
group norms.
!tage :
Behavior recognizes the laws as arbitrary
and changeable.
1or aspects of life not governed by laws&
right and wrong are personal decisions
based on agreement and contracts.
!tage L
#orality is based on respect for others
rather than on personal desires.
)he individual conforms to both social
standards and to internalized ideals to
avoid self-condemnation rather than to
avoid social censure.
%t)er T)eories
4e)avioral Mo(el *Ivan PavlovF 9o)n :atsonF 4G 8G S;inner1
Behavior is%
a response to a stimulus from the environment
learned and retained by positive reinforcement
Interpersonal Mo(el *Harry Stac; Sullivan1
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 6H of 78
1ocused on the role of the environment and interpersonal relations as
the most significant influences on a individuals development.
An'iety is communicated interpersonally.
Human Motivational Nee( Mo(elG *Abra)am Maslow1
$ierarchy of needs in order of importance
*rimary needs (physiologic) need to be met prior to dealing with higher
level needs.
Psyc)obiologic Mo(el
1ocus is in mental illness as a biophysical impairment.
$uman behavior is influenced by genetics& biochemical alterations and
function of brain and "<!.
)he stress response is a neuroendoctine response.
Important structure *limbic system1!
)halamus ; regulates activity& sensation& emotion
$ypothalamus ; themoregulation& appetite control& endocrine function&
appetite control& impulsive behavior associated with feelings of anger& rage
or e'citement.
$ippocampus and amygdale ; emotional arousal and memory
<eurons ; basic functioning unit of the "<!
<eurotransmitters
"hemical substances manufactured in the neuron
Aid transmission of information throughout the body
/opamine
An e'citatory neurotransmitter
2ocated primarily at the brain stem
0nvolved in control of comple' movements& motivation& cognition and
regulation of emotional responses
Associated with pyschosis and *arkinsons disease
"atecholamines (norepinephrine and epinephrine)
<orepinephrine
Attention& learning and memory& sleep and wakefulness
3'cess of this is associated with an'iety& memory loss& social
withdrawal and depression.
3pinephrine ; responsible in the fight or flight mechanism
!erotonin
An inhibitory neurotransmitter
/erived from tryptophan
0nvolved in control of food intake& sleep and wakefulness& pain
control& se'ual behavior and emotions
0nvolved in an'iety and mood disorders& schizophrenia and its
symptoms
$istamine
*rimarily involved in immunity and allergic reactions
!ome psychotropic drugs are block by histamine
Acetylcholine
Affects sleep-wake cycle
Associated with Alzheimers disease
+lutamate
An e'citatory neurotransmitter
At high levels& it can cause neuroto'icity.
Associated with Alzheimers and $untingtons disease
+ama-Aminobutyric Acid
An inhibitory neurotransmitter
Associated to treat an'iety and induce sleep.
PS"5H%THE&AP"
0s a process in which a person enters into a contract to interact with a
therapist to relieve symptoms& resolve problems in living& seek personal
growth
IN$I'I$6AL THE&AP"! 0s a confidential relationship between client and
therapist.
Hypnot)erapy! 0nvolves various methods and techni.ues to induce a
trance state where the patient becomes submissive to instructions
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 66 of 78
Humor t)erapy! 4se of humor to facilitate e'pression of feelings and to
enhance interaction
Psyc)oanalysis! 1ocuses on the e'ploration of the unconscious& to
facilitate identification of the patient-s defenses
#&%6P THE&AP"
minimum number % 7
0deal number %?-6H
Advantages%
o decreases isolation
o decreases dependence
o develops coping skills
o develops interpersonal learning
o develops opportunities for helping others
o develops ability to listen to other members
&emotivation T)erapy! *romotes e'pression of feeling through interaction
facilitated by discussion of neutral topics
8amily t)erapy! A method in which family members gain%
o insight into the problems
o improve communication
o improve functioning of individual members as well as the family as a
whole.
o 0t focuses on the total family as an interactional system
Milieu T)erapy
A therapeutic environment is organized to%
o encourage and assist the client to control problematic behavior
o function within the range of social norms
Play t)erapy
3ffective for children suffering from maladBustment or behavior disorder.
)he child is usually placed in a play room
*urpose - to discover the causes of the child-s conflict through
observation of his play and to interpret it to the child.
&ecreational t)erapy
4ses activities which vitalize the patient-s interest and help him or her to
rela' and feel refreshed.
3'ample% *laying baseball may be prescribed for as a means of
e'pressing hostility in a group.
%ccupational t)erapy! 4ses any mental or physical activity prescribed or
guided to aid an individual-s recovery from a disease or inBury.
Musical t)erapy
0nvolving the music which allows the child or adolescent to e'press
herself or himself.
Also effective with those who have difficulty communicating.
Art t)erapy! "lients are encouraged to e'press their feelings or emotions
by painting& drawing or sculpture.
Psyc)o(rama t)erapy! *atients dramatizes their emotional problems in a
group setting.
4e)avior T)erapy
0s a mode of treatment that focuses on modifying observable (overt) and
.uantifiable behavior
!ystematic manipulation of the environment and variables thought to be
functionally related to the behaviors.
Limit Setting
o )herapist gives an advanced warning of the limit and the
conse.uences will follow if the client does not adhere to the limit.
o )he conse.uences should occur immediately after the client has
e'ceeded the limit
o "onsistency must occur with all personnel.
o *urposes%
o #inimizes manipulation and splitting of the staff.
o *rovide a framework for the client to function in and enable a
client to learn to make re.uests.
Systematic $esensiti>ation
o "lients are e'posed slowly to a feared obBect or a thing that inhibits
an'ious responses and taught ways to rela'.
o 3ffective in treating phobias.
Implosive t)erapy
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 68 of 78
o )he clients are e'posed abruptly to intense forms of an'iety
producers& either in imagination or in real life
5ognitive 4e)avior t)erapy
o 4ses confrontation as a means of helping the clients restructure or
rearrange irrational beliefs& maladaptive thinking& perception-& and
behaviors.
o 4sed for depression and adBustment difficulties.
4iofee(bac;
o )eaches the client to control or change aspects of their internal
environment.
Aversion t)erapy
o 4ses unpleasant or no'ious stimuli to change inappropriate
behavior.
o 3'amples
o Antabuse to treat alcoholics
o !howing films to drivers who are arrested for speeding or driving
while under the influence of alcohol or drugs.
Assertiveness Training
o "lients are encouraged and taught how to appropriately relate to
others
o )eaches the individual to ask for what is beneficial to both mentally
ill and mentally healthy persons.
To;en-economy! 4tilizes the principle of rewarding desired behavior to
facilitate change.
ELE5T&%5%N'6LSI'E THE&AP" *E5T1
3'act mechanism is unknown
,e.uires a consent
4sually given at GH-6:H volts for about .:-8 seconds
3ffectivity% L-68 treatments with at least D? hour interval
0ndicator of effectiveness% tonic-clonic seizure
0ndications of use%
/epression
#ania
"atatonic schizophrenia
"ontraindications (not absolute)
1ever
0ncreased 0"*
"ardiac conditions
)B with history of hemorrhage
4nhealed fracture
,etinal detachment
*regnancy
Before the procedure%
/iagnostic procedures
o P-ray
o 3"+
o 33+
/rugs given
o Atrophine sulfate (decrease secretions)
o Anectine (!uccinylcholine) ; rela' muscles
o #ethohe'ital <a (Brevital) - anesthetic
/uring the procedure%
(bserve for tonic-clonic seizure
After the procedure%
*osition
"heck vital signs
,eorient the client
=atch out for complications%
o #emory loss
o $eadache
o Apnea
o ,espiratory depression
o 1racture
4ASI5 5%N5EPTS %N PS"5H%PHA&MA5%L%#"
MA9%& T&AN?6ILIHE&SB ANTIPS"5H%TI5S
0ndication% !chizophrenia and (ther *sychosis
/esired effect% control of symptoms
Best taken after meals
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 67 of 78
3'amples%
$aloperidol ($aldol)
*rochlorperazine ("ompazine)
1luphenazine (*roli'in)
"hlorpromazine ()horazine)
Si(e effects! Nursing Action
Blurred vision Avoid driving
/ry mouth +ive sugarless gum
)achycardia& palpitation& constipation&
urinary retention
#onitor M report
*hotosensitivity /ont e#pose skin to sunlight
(rthostatic hypotension (onitor )*
Advise gradual change in position
3'tra *yramidal !ymptoms
o *seudoparkinsonism
o pill-rolling tremors
mask-like face
o cog-wheel rigidity
o propulsive gait
o Akathisia - restless leg syndrome
o /ystonia - defect in muscle tone
,eport at once
Adverse effect% report promptly
)ardive dyskinesia - lip smacking
Agranulocytosis
o Assess for%
1ever
!ore throat
2ab data% =B" count
$epatoto'icity
o Assess for A2) M A!)
MIN%& T&AN?6ILIHE&SB ANII%L"TI5S
"ommon indication% An'iety disorders
/esired 3ffect% /ecreased an'iety& ade.uate sleep
3'amples%
/iazepam (9alium)
('azepam (!era')
"hlordiazepo'ide (2ibrium)
"hlorazepate /ipotassium
()ran'ene)
Alprazolam (Pana')
<ursing 0mplications%
Best taken before meals
Advise to avoid driving
Avoid alcohol and caffeine-containing foods
Administer it separately with any drug
ANTI$EP&ESSANTS
/esired effects% increased appetite& ade.uate sleep
Tricyclic Anti(epressants
3'amples%
0mipramine ()ofranil) Amitriptyline (3lavil)
<ursing 0mplications%
Best given after meals
3ffectivity% after 8-7 weeks
"heck the B*& it causes hypotension
"heck the heart rate& it causes cardiac arrythmias
#onitor 0 M (
#onitor for signs of increased 0(*
MA% INHI4IT%&S
0ndication% refractory depression
3'amples%
)ranylcypromine (*arnate)
*henelzine (<ardil)
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 6D of 78
P a N a M a
0socarbo'azid (#arplan)
<ursing 0mplications%
Best taken after meals
,eport headacheA it indicates hypertensive crisis
Avoid tyramine containing foods like%
Avocado
Banana
"heddar and aged cheese
!oysauce
*reserved foods
3ffectivity% 8-7 weeks
#onitor the B*
)here should be at least a two-week interval when shifting from one anti-
depressant to another
Selective Serotonin &eupta;e In)ibitors
3'amples%
1luo'etine (*rozac)
"elatopram ("ele'a)
!ertraline (Qoloft)
*aro'etine (*a'il)
1luvo'amine (2uvo')
<ursing 0mplications%
Avoid the use of%
diazepam
Alcohol
)ryptophan
#onitor *))& *)
<ever give to pregnant 5 lactating mothers.
ANTI-MANI5 A#ENT
E7amples!
2ithium "itrate ("ibalith ; !) 2ithium "arbonate (3skalith&
2ithane& 2ithobid)
Nursing implications!
Best taken after meals
0ncrease intake of%
fluids (7 2 5day)
sodium (7 gm5day)
Avoid activities that increase perspiration
<ever give to pregnant mothers
3ffectivity% 6H-6D days
Antipsychotic is administered during the first 8 weeks
)herapeutic level%G.-+G. me@BL
If ineffective! Tegretol
!igns of to'icity%
o 'omiting
o Anore'ia
o Nausea
o $iarrhea
o Abdominal cramps
o Lightheadedness (late)
Antidote% Mannitol
ST&ESS
A nonspecific response of the body to any demand made upon it. ($ans
!elye& 6N7L)
A state produced by a change in the environment that is perceived as
challenging& threatening or damaging to the persons dynamic e.uilibrium.
(!meltzer& 6NN8)
A(aptation
A constant ongoing process that occurs along time continuum& beginning
with birth and ending with death. (!meltzer& 6NN8)
A continuous process of seeking harmony in an environment.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 6: of 78
Types of A(aptation!
#eneral A(aptation Syn(rome *#AS1
0nvolves the whole body in response to stress.
"ompared to life process as it focuses on the Jwear and tear of the body
tissues.
P)ases!
Alarm
o Acute phase of the syndrome
o "haracterized as the Jflight and fightK reaction
o /efensive by nature but self-limiting
o 0f stress is intense& it may lead to death.
&esistance
o "haracterized as the state of adaptation
o *erson moves back to homeostasis
E7)austion
o ,esult of a prolonged e'posure to stress and adaptive mechanisms can
no longer persist.
Local A(aptation Syn(rome
,efers to inflammatory response and repair processes that occur at the
local site of tissue inBury.
Eustress - positive stress
$istress
<egative stress
/amaging stressors which may result in various physical and emotional
disorders such as% an'iety& frustration& insecurity& aimlessness
5&ISIS AN$ 5&ISIS INTE&'ENTI%N
A situation that occurs when an individual-s habitual coping ability becomes
ineffective to meet the demands of a situation.
As a serious interruption and disturbance of one-s e.uilibrium or
homeostasis
2eads to potentially dangerous& self-destructive or socially unacceptable
behavior.
5)aracteristics
$ighly individualized
!elf-limiting% D-L weeks
*erson affected becomes passive and submissive
Affects a persons support system
Type $escription E7ample
#aturational5developmental
crisis
e'pected& predictable
and internally
motivated
*uberty& adolescence&
young adulthood&
marriage& or the aging
process.
!ituational5accidental 4ne'pected&
unpredictable and
e'ternally motivated
3conomic difficulty&
illness& accident& rape&
divorce or death
!ocial crisis /ue to acts of nature <atural calamities
P)ases
/enial
0ncreased )ension
/isorganization
Attempts to reorganize
!tage for full reorganization
5&ISIS INTE&'ENTI%N
#aBor +oal%
o ,estore the ma'imum level of functioning (pre-crisis state)
o 0t is an active but temporary entry into the life situation of an individual
or a family during a period of stress.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 6L of 78
o A way of entering into the situation to help them mobilize their resources
and to decrease the effect of stress.
$omestic 'iolence &e@uiring 5risis Intervention!
&APE
<onconsensual se'ual penetration of an individual& obtained by force or
threat& or in cases in which the victim is not capable of consent.
Ein(s of &ape
*ower ; to prove masculinity
Anger ; means of retaliation
!adistic ; to e'press erotic feelings
Silent &ape Syn(rome
0s a maladaptive reaction to rape
)he victim%
fails to disclose information about the rape
is unable to resolve feelings about the se'ual assault
,esults to increase an'iety and may develop a sudden phobic reaction.
&ape Trauma Syn(rome *&TS1
,efers to a group of signs and symptoms e'perienced by a victim in
reaction to rape
*hases%
Acute *hase ; shock& numbness& disbelief
/enial ; refusal to discuss the event
$eightened An'iety ; fear& tension& nightmares
!tage of ,eorganization
4attere( :ife Syn(rome *4:S1
A form of cyclic domestic violence
#en% low self-esteem
=omen% /ependent personality disorder
5)il( Abuse
0s an act of omission of responsibility or commission in which intentional
harm is inflicted on a child.
5omponents of %mission!
"hild abandonment ; leaving the child physically
"hild neglect - lack of provision of those things which are necessary for the
child-s growth and development
)ypes of "ommission%
P)ysical Abuse
0s an intentional physical harm inflicted on a child by a parent or other
person.
Emotional abuse - insult and undermining one-s confidence
Se7ual abuse - abuse in the form of se'ual contact
"haracteristics of Abusive *arents%
)hey come from violent families
)hey were also abused by their parents
)hey have inade.uate parenting skills
)hey are socially isolated because they don-t trust anyone
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 6G of 78
)hey are emotionally immature
)hey have negative attitude towards the management of the abused
=arning signs of "hild Abuse 5 <eglect%
"hilds e'cessive knowledge on se' and abusive words
$air growth in various lengths
0nconsistent stories from the child and parent5s
2ow self-esteem
/epression
Apathy
Bruised or swollen genitaliaA tears or bruising of rectum or vagina
4nusual inBuries for the childs age and development
!erious inBuries (fractures& burns& lacerations)
3vidence of old inBuries not reported
&epublic Act ,0+3
*Anti 5)il( Abuse Law1
,e.uired reporting of suspected cases
,eport cases to the nearest authorities within D? hours
AssessmentF Planning an( Nursing Actions for 5risis
*rimary concerns%
o *hysical inBuries
o Alleviation of psychological trauma
<urse should display%
o Sensitivity
o Attitude (<onBudgmental)
o 5onfidentiality
o &espect
o Empathy
o $ignity
3vidences are important%
o stained clothing
o fingernail scrapings
o mouth or anal smears containing semen
0ntervention focuses family as a unit.
0f the victim is a child% *lay and art therapy
$E8ENSE ME5HANISM
)hese are automatic and usually unconscious processes or act by the
individuals to%
o reduce or cope an'iety or fear
o resolve emotional or mental conflict
o protect one-s self-esteem
o protect one-s sense of security
Becomes pathologic when overused.
4sed by both mentally healthy and mentally ill individuals
"ommon /efense #echanisms 4sed!
5ompensation
o An attempt to overcome a real or imagined short coming& inferiority&
inabilities and weaknesses.
o A blind woman becomes proficient in playing piano.
5onversion
o 3motional problems are converted to physical symptoms
o A student unprepared for a report suffered headache the day she is
supposed to deliver her report.
$enial
o 1ailure to acknowledge an intolerable thought& feeling& e'perience or
reality
o A middle-aged man after being admitted to the ""4 because of an A#0&
insists that he is in the hospital for Bust a diagnostic work-up.
$isplacement
o the redirection of feelings to a less threatening obBect
o An adolescent boy& after an argument with his father& goes to the room
and kicked his rooms door.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 6? of 78
8antasy
o "onscious distortion of unconscious feelings or wishes
o A boy who is being bullied by his friends wished he had the power of
=olverine.
8i7ation
o An unhealthy mechanism which is an arrest of maturation at certain
stages of development.
o A boy never overcame being fully reliant from his mother.
Intro<ection
o !ymbolic assimilation or taking into oneself a love5hatred obBect.
/erived from the word "introBect" which literally means to take into or
ingest.
o "ommon to depressed clients.
I(entification
o An individual integrates certain aspects of someone else-s personality
into one-s own.
o A young school teacher adopts his former mentor-s teaching style when
conducting class sessions.
Intellectuali>ation
o An overuse of intellectual concepts by an individual to avoid e'pression
of feelings
o A man who was asked to share a memorable e'perience about his
grandmother who died discussed the stages of death and dying by
3lizabeth Cubler ,oss.
Pro<ection
o Attributing to others one-s unconscious wishes5fear.
o 2iterally& this means to "throw off.
o A student who failed a subBect blames his failure on poor teaching.
&eaction A 8ormation
o 3'pression of feeling that is the direct opposite of one-s real feeling.
o Also referred to as overcompensation.
o A student who dislikes one of her classmates may act or show concern
toward her.
&ationali>ation
o An individual finds a Bustifiable cause and acceptable reasons Bust to be
saved from an embarrassing and an'iety producing thoughts or
situations.
o A basketball player claims that he missed the shot and lost the game
because of the distractions made by the audience.
&egression
o 0s the turning back to earlier patterns of behavior in solving personal
conflicts.
o "ommonly seen to schizophrenic patients
o A person who becomes ill in the face of disappointment has regressed
to a form of childish behavior.
&epression
o 0t is the involuntary or unconscious forgetting of an unpleasant ideas or
impulses.
o /uring the nurse-patient relationships& patients often unconsciously
avoid discussing those e'periences producing an'iety which are
emotionally difficult to verbalize.
Suppression
o *ermits the individual to store away or consciously forget the
unpleasant& painful and unacceptable thoughts& desires& e'periences
and impulses.
o "0-ll think it about tomorrow"& "0-d rather go now"& ""an we change the
topicF"
o A boy walked out from the group and said "0 have to go now"& when he
was asked what was happened to their relationship with his girlfriend.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 6N of 78
Substitution
o ,eplacing the desired unattainable goal with one that is attainable
o A woman who failed the nursing board e'am 7 times& worked as a
nursing aide Bust to be in the hospital.
Sublimation
o )he redirection of unacceptable instinctual drive with one that is socially
acceptable
o 0nstead of harming his mother& a man e'pressed his anger by
composing a song.
Symboli>ation
o 2ess threatening obBect is used to represent another
o A woman& missing her husband finds comfort in hugging her son who
looks like his father.
6n(oing
o An attempt to erase an act& thought& feeling& guilt or desire
o A man gives her wife a bunch of roses after their argument last night.
ANIIET"
9ague sense of impending doom
!ubBective response to stress
0s a state of apprehension& uneasiness& uncertainty or tension e'perienced
by an individual in response to an unknown obBect or situation.
!igns and symptoms%
Mil(
*hysical - R*,& ,,& B*& pupillary dilatation& sweating
"ognitive - Attentive and alert
3motional - #inimal use of defenses
Mo(erate
*hysical - <ausea& Anore'ia& 9omiting& /iarrhea& "onstipation&
,estlessness
"ognitive - narrowed perceptual field M selective inattention
3motional - use of any defense mechanism available
SE'E&E
*hysical - s5s' becomes the flow of attention
"ognitive ; perceptual field is greatly narrowed& focus of attention is trivial
events
3motional ; defense mechanism operate
PANI5
*hysical ; s5s' of e'haustion ignored
"ognitive ; personality disorganized
3motional ; defense mechanism fail
Nursing $iagnoses!
0neffective individual coping
An'iety
Nursing Management!
"alm
Administer medications
2isten
#inimize environmental stimuli
ANIIET" $IS%&$E&S
Panic $isor(er
An individual may suddenly e'perience frightening and uncomfortable
symptoms
#ay include terror& sense of unreality or fear of loosing control
Attack% 6 minute and 6 hour
P)obic $isor(er
*hobia is an irrational fear of an obBect& place& activity or situation.
Avoidance will allow the individual to be free from an'iety.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 8H of 78
3'amples%
Agoraphobia - fear of open places and of being alone in public places.
!ocial phobia - irrational fear of criticism& humiliation or embarrassment.
Acrophobia - fear of heights
Algophobia - fear of pain
"laustrophobia - fear of enclosed place
)hanatophobia - fear of crowds
*athophobia - fear of disease
#onophobia - fear of being alone
#enerali>e( An7iety $isor(er
*#A$1
4nrealistic& e'cessive an'iety and is unable to control worry.
"lients may e'perience% fatigue& irritability& restlessness& muscle tension&
sleep disturbance
%bsessive 5ompulsive $isor(er
0s characterized by recurrent obsessions and compulsions that interfere
with normal life.
%bsession
,efers to persistent& painful intrusive thought& emotion or urge that one is
unable to suppress or ignore.
5ompulsion
,efers to repetitious uncontrollable act and sometimes a purposeful act to
prevent a certain mistake in an event or situation.
Post-Traumatic Stress $isor(er *PTS$1
0s the delayed reaction of the person who has been involved or e'posed to
a traumatic events.
!ymptoms of this disorder are%
intense psychological distress
feeling of detachment or estrangement from others
insomnia
decreased concentration
avoidance of thoughts and feelings
recurrent distressing dreams
inability to recall an important aspect of the trauma
Nursing Interventions
"alm and nonBudgmental approach to convey acceptance.
4se short and simple sentences or words.
$elp the client develop an increase tolerance to an'iety.
$elp the client to%
develop a problem-solving and coping skills of the client.
develop the ability to remain calm in an'iety-producing situations.
Approach% kind-firmness
!ystematic desensitization (phobic disorders)
"lients with ritualistic behavior (obsessive-compulsive disorder) should not
be prohibited or reprimanded.
Biofeedback& change of the scenery& therapeutic touch& hypnosis& massage
or rela'ation e'ercises.
Administer medications& as ordered.
ANIIET" &ELATE$ $IS%&$E&S
Somati>ation $isor(er
1ree floating an'iety disorder
"lients%
e'press emotional turmoil or conflict through physical symptoms.
usually seek for repeated medical attention.
may e'hibit antisocial behavior and may attempt suicide.
Associated with an'iety and depression
5onversion $isor(er
A condition in which an an'iety-provoking impulse is converted
unconsciously into functional symptoms.
"onscious counterpart of malingering
3'amples% *aralysis& blindness& loss of touch or pain sensation& dyspnea&
seizures or convulsions
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 86 of 78
Hypoc)on(riasis
An individual presents an unrealistic or e'aggerated physical complaints.
)he person becomes& preoccupied with the fear of developing or having
already a disease or illness in spite of medical reassurance.
4o(y $ysmorp)ic $isor(er
*reoccupation with an imagined defect in his or her appearance.
!light physical abnormality O e'cessive concern 5 an'iety
$issociative Amnesia
0nability to recall e'tensive amount of important information
"aused by trauma
"haracterized by%
/isorientation
*urposeless wandering
0mpairment in ability to perform A/2
,apid recovery generally occur
PE&S%NALIT" $IS%&$E&S
Are pervasive and infle'ible patterns of functioning that is stable overtime&
and leads to distress or impairment.
)ypes of *ersonality /isorders%
Eccentric Personality $isor(er *Type A1
Paranoi( (!uspicious and distrustful)
*ersons who display pervasive and long stand suspiciousness
#ore common in men
Sc)i>oi( (!ocially distant and detached)
*attern of detachment from social relationship
"hooses solitary activities
)opics are inanimate obBects and ideas
Sc)i>otypal ((dd and eccentric)
Jmild schizophreniaK
Acute discomfort in close relationships
"ognitive or perceptual distortion
$ramatic-Erratic Personality $isor(er *Type 41
Antisocial *aggressive an( manipulative1
*attern of disregard for the violation of the rights of others
2ow self-esteem
4or(erline (destructive and unstable)
"haracterized by patterns of instability in relationships& self image and
mood
!elf-mutilating behavior
Affective instability
#ore common in women
Narcissistic (boastful 5 superiority comple')
+randiosity and need for constant admiration
3'ploitation of others for fulfillment of own desire
An7ious or 8earful Personality $isor(er *Type 51
Avoi(ant (inferiority comple')
!ocial inhibition
1eelings of inade.uacy and sensitivity
2ow self-esteem
!ocial withdrawal in spite of a desire for affection and acceptance
$epen(ent (submissive)
!ubmissive clinging behavior related to e'cessive need to be cared for
by others
2ack of self-confidence
*erceive self as helpless and stupid
%bsessive-5ompulsive (perfectionist)
*reoccupied with orderliness& perfectionism& infle'ibility& need to be in
control
1ormal and serious interpersonal relationship
>udgmental of self and others
Passive-Aggressive
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 88 of 78
0ntentional inefficiency
*assive resistance to demands for ade.uate performance in both
occupational and social functioning
Nursing $iagnosis!
0neffective individual coping
!elf-esteem disturbance
$IS%&$E&S 5%MM%NL" $IA#N%SE$ T% 5HIL$&EN
A6TISM
"haracterized by%
impairment in communication skills
presence of stereotyped behavior& interests and activities.
associated with impairment on social interactions
treatable but not curable
more common among boys
usually diagnosed at age 8
#ain problem% 0nterpersonal functioning
#ost acceptable cause% Biological factors - brain ano'ia& intake of drugs
Signs an( Symptoms
(dd play
<ot cuddly
3cholalia
"rying tantrums
$ead towards anything
0nanimate obBect attachment
2oves to spin obBects 5 self
/ifficulty interacting with others
=ants blocks
Acts as deaf
,esists normal teaching method 5 routine changes
<o fear of danger
0nsensitive to pain
<o eye contact
+iggling or silly laughing
Nursing Interventions
3nvironment% safe M consistent
3ncourage the client to participate for self-care
!peak calmly when giving instructions
4se simple words or phrases
,epeat instructions as necessary.
$aloperidol - symptomatic relief for hyperactivity& stereotypical and self-
destructive behavior
MENTAL &ETA&$ATI%N
<ot a mental illness.
*roblem of inade.uate mental functioning.
(nset% 6?
0S below GH
#anifested by sub-average intellectual functioning in%
"ommunication
!elf-care
$ome living
!ocial skills
$ealth and safety
5auses
$095 A0/! 5 rubella infection
Alcoholic mother
)hyroid deficiency
3'cessive lead poisoning
/amage to the brain
<eurological 5 neurodevelopmental impairment
3'act gestational age is not reached (premature)
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 87 of 78
(piate into'ication
<utritional deficiency (lack in 1olic Acid)
Ano'ia
)o'emia (pregnancy-induced hypertension)
3nvironmental factors
!evere ,$ incompatibility
Levels%
Level I? Implication
Mil(Bmoron :6-GH o /ifficulty adapting to school
o 3ducable ; needs assistance
Mo(erateBImbecile 7L-:H *oor awareness of needs of others
)rainable ; needs moderate supervision
SevereBI(iot 8H-7: o 4nable to learn academic skills
o *oor motor development and minimal
speech
o <eeds complete and close supervision
Below
8H
o $as minimal capacity for sensorimotor
function
o <eeds custodial care with a totally
structured environment
Principles of Nursing 5are
*rotective care
3ducation of the family
)heir involvement is an important factor in the plan of care to promote
progress and to minimize the stress.
,epetition
,ole modeling
,estructuring
1ocus of 3ducation
,eading
Arithmetic
=riting
ATTENTI%N $E8I5IT H"PE&A5TI'IT" $IS%&$E&
"ommon in boys
4sually diagnosed before age G
*roblems%
0nattention
$yperactivity
0mpulsivity
5auses! Intranatal factors
Signs an( Symptoms
(bstinacy
<egativism
3gocentrism
1ighting syndrome
Aggressiveness
)olerance is low
/ifficulty concentrating
3'cessive talking
1idgeting
0nterrupt5intrudes on others
"hild e'hibits hyperactivity
0ndulges in destructive behavior
)emper tantrums
Nursing $iagnosis
*otential for inBury
Principles of Nursing 5are!
*rovide nutrition and safety
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 8D of 78
3nvironment%
structured
enable appropriate reaction to the environmental stimuli
*lan a firm and consistent environment in which limits and standards are
set.
$rug of c)oice % #ethylphenidate (,italin)
$IS%&$E&S 5%MM%NL" $IA#N%SE$ T% A$6LTS
EATIN# $IS%&$E&S
#ore common among females.
5auses!
*sychological factors
*arental factors (domineering parents)
0ndividual factors (conflict about growing up)
!ociocultural factors
Anore7ia Nervosa
#ain sign% #orbid fear of gaining weight
(ther signs%
Sensitivity to cold temperatures
Amenorrhea
$eliberate self-starvation with weight loss
$enial of hunger
%bvious thinness but feels fat
Lanugo all over the body
Loss of scalp hair
4ulimia Nervosa
3'treme measures to lose weight
uses diet pills& diuretics or la'atives
purges after eating
e'treme e'ercise
!igns of purging
swelling of the cheeks or Baw area
cuts and calluses on the back of the hands and knuckles
teeth that look clear
*eculiar signs
depression
loss of interests in activities
8in(ings! *for bot)1
=eight loss of 6:T or more of original body weight
Amenorrhea
!ocial withdrawal and poor family and individual coping
$istory of high activity and achievement in academics& athletics
3lectrolyte imbalance
/epression 5 distorted body image
Nursing $iagnosis!
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 8: of 78
Body image disturbance
0neffective individual coping
Nursing Interventions!
3stablish a trusting relationship
#onitor vital signs
,einforce%
dieticians prescription to accomplish realistic weight gain
treatment plan that establishes privileges and restrictions based on
compliance
/ecrease emphasis on foods& eating& weight loss or gain
=eigh client daily at the same time
,emain with the client after meal and for 6st four hours
!et limit on time allotted for eating
3ncourage client to e'press feelings
*romote feeling of control by
participation in treatment
independent decision making
SEI6AL $IS%&$E&S
!e'uality - is the result of biologic& psychological& social and e'perimental
factors that mold an individual-s se'ual development& self-concept& body
image and behavior.
P)ases of t)e Se7ual &esponse 5ycle
/esire
the ability& interest and willingness to receive se'ual stimulation
3'citement 5 Arousal
,esult of psychological stimulation
3'ample is fantasizing during the desire phase and foreplay which
involves petting and fondling of erogenous zones or areas of the body
that are particularly sensitive to erotic stimulation.
*lateau
(rgasm
formerly termed as clima'
the shortest stage in the se'ual response cycle
occurs when stimulation proceeds through the plateau stage to a point
where the body suddenly discharges accumulated se'ual tension
,esolution phase
the final phase of se'ual response
organs and body systems gradually return to the unaroused state
Se7ual $ysfunction $isor(ers
Se7ual $esire $isor(ers! )ave little or no se'ual desire or have an
aversion to se'ual contact.
Se7ual Arousal $isor(er! 0ndividuals cannot complete the physiologic
re.uirements for se'ual intercourse
3'amples
=omen cannot maintain lubrication
#en cannot maintain an erection
%rgasm $isor(ers! 0nability to achieve orgasm phase
3'ample% *remature eBaculation
Se7ual Pain $isor(ers! 0ndividuals suffer genital pain (dyspareunias)
3'ample% 9aginismius
Parap)ilia *Se7ual $eviation1
A term which generally refers to abnormal se'ual behavior
2asts for L months leading to distress or impairment to functioning.
3'amples
Anilingus tongue brushing the anus
Bestiality or Qoophilia contact with the animals
"oprophilia smearing feces on the partner
"unnillingus tongue brushing the vulva
3'hibitionism 0nvolves e'posing ones genitals to unsuspecting
strangers.
9ictims are usually women or children.
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 8L of 78
)hey are stimulated by the effect of shocking the
victim.
1ellatio inserting the penis into the mouth
1etishism inanimate 5 non-living obBects or articles
1rotteurism )ouching or rubbing against the unsuspecting
people.
4sually occurs in crowded places where escape is
into the crowd is possible.
#asochism !e'ual gratification from e'periencing pain
0nvolves the acts of being humiliated beaten&
restrained& or otherwise made to suffer
<ecrophilia involves the use of corpses
*artialism inserting the penis into the other parts of the body
*edophilia use of prepubertal children
could be an actual se'ual act or a fantasy
child is generally 67 years of age or younger
!adism inflicting pain
)elephone !catalogia 0nvolves telephoning someone and making lewd&
obscene remarks or conversation.
ACA se' on phone
)ransvestism se'ual e'citement through wearing the clothing of a
woman
4rophilia urinating on the partner
9oyeurism Act of observing unsuspecting person who is naked& in
the process of disrobing& or engaging in se'ual activity
0ncludes cyber-voyeurism
#en(er I(entity $isor(er
ACA )ranse'ualism
Believe that they were born as the wrong se'
2eads to persistent discomfort and feels inappropriate in the role of the
assigned se'.
Nursing Interventions%
Attitude%
Accepting
3mpathic
<on-Budgmental
Accept his feelings related to se'uality
$ave a private area to discuss fears or concerns about se'uality
0ntervene to discuss self-esteem issues& an'iety& guilt& and empathy for
victims.
3mploy limit setting.
,eferral to the correct clinic.
S64STAN5E-&ELATE$ $IS%&$E&S
Alco)olism
0s a chronic disease or a disorder characterized by e'cessive alcohol intake
and interference in the individuals health& interpersonal relationship and
economic functioning. (=$()
"onsidered to be present when there is .6T or 6H ml for every 6HHH ml of
blood
Signs of use%
.6-.8T - low coordination
.8-.7T - presence of ata'ia& tremors& irritability& stupor
.7 and above - unconsciousness
Progression%
*re-alcoholic *hase - starts with social drinkingA tolerance begins to
develop
*rodromal !tage - alcohol becomes a needA blockout-s occurA denial
begins to develop
"rucial - cardinal symptoms of alcoholism develops (loss of control over
drinking)
"hronic *hase - the person becomes into'icated all day
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 8G of 78
%utcome!
Brain damage
Alcoholic hallucinosis
/eath
4e)avioral problems!
/enial
/ependency
/emanding
/estructive
/omineering
Alco)ol :it)(rawal
(ccurs when an individual abruptly stops drinking after alcohol has become
a necessity of life to maintain functioning.
!ymptoms include%
autonomic hyperactivity
grand mal seizures
psychomotor agitation and an'iety
increased hand tremors
sleep disturbances (insomnia and nightmares)
illusions hallucinations
hyperthermia
tachycardia (impending delirium tremens)
Alco)ol :it)(rawal $elirium
ACA delirium tremens
e'perienced within 8D to G8 hours after the last intake%
o agitation
o elevated vital signs
o illusions and hallucinations
o restlessness
o hyperalertness
o incoherent speech
serious medical complications may occur if the client is left untreated
Eorsa;offJs Psyc)osis
0s a form of amnesia
characterized
short-term memory loss
/isorientation
inability to learn new skills
confabulation
/eficiency in vitamin B comple'& especially B6 and B68.
:ernic;eJs Encep)alopat)y
An inflammatory hemorrhagic degenerative condition of the brain
caused by B6 deficiency
!ymptoms include%
double vision
involuntary and rapid eye movements
lack of muscular coordination
decreased mental function
Nursing $iagnosis% 0neffective individual coping
Principles of Nursing 5are%
=ell lighted room
/iet as tolerated
#onitor vital signs
Administration of glucose
9itamins
Alco)ol $eto7ification%
/rug of "hoice% /isulfiram (Antabuse) - delays the metabolism of alcohol
Avoid alcohol-containing products
7 !s of deto'ification%
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 8? of 78
!afety
!edation
!upplement (#ultivitamins& 9itamin B-comple'& 9itamin ")
$&6#-&ELATE$ $IS%&$E&S
5ocaine-&elate( $isor(ers
*Stimulants1
5ocaine is a white powdered stimulant substance
4sually sniffed& snorted& smoked in a pipe or inBected into a vein or
subcutaneous tissue.
*oor mans cocaine%
!habu (sha-boo)
!igns of use%
panic attacks
insomnia
loss of appetite
impaired thinking
cocaine psychosis
agitation
dilation of the pupils
diaphoresis
increase 9!
"lassic sign% *erforated nasal septum
+an cause a sudden heart attack even in healthy young people
5annabis-&elate( $isor(ers *5annabinoi(s1
Mari<uana
"an act as stimulant or depressant and is often considered to be a mild
hallucinogen with some sedative properties
0s not physically addicting but may lead to psychological dependence
*lant % cannabis sativa
Active component is )etrahydocannabinol
,outes of use%
(rally (capsules& tablets& on sugar cubes)
=ith food
!moked in a pipe or rolled as cigarette.
Acts within 6: minutes
3ffects lasts appro'imately 8 to D hours
*hysiologic symptoms include
increased appetite
e'citement
drowsiness
lowered body temperature
depression
unsteady gait
reduced coordination and refle'es
inability to think clearly
impaired Budgment
"lassic sign% bloodshot eyes
0n large doses& it may cause%
$allucination
!uicidal ideations
/elusions of invulnerability
Long-term #oals!
5ommunity resources
%ther coping means aside from denial
Personal responsibility for not drinking 5 drugs taking
Isolation
Nutrition
#roup therapy
S5HIH%PH&ENIA AN$ %THE& PS"5H%SES
S5HIH%PH&ENIA
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 8N of 78
0s a serious psychiatric disorder
(ne of the most profound disabling illness
<ot a single disease entity but a combination of disorders
"split mind"
characterized by%
o impaired communication
o loss of contact into reality
o deterioration from a previous level of functioning
<ursing /iagnosis% Altered thought process
#ost acceptable theory% Biologic )heory
Manifestations! Eugene 4leuler
Associative looseness
Autism
Apathy
Ambivalence
Auditory hallucination
Types $istinguis)ing features Nursing Interventions
/isorganized *eculiar 5 bizarre behavior
0ncoherence
!tereotyping
*rognosis% *oor
/efense #echanism%
,egression
Assist with A/2
3ncourage activity
*resent reality
*aranoid $allucinations
0deas of reference
/elusion of persecution
!uspiciousness
*rognosis% +ood
/efense #echanism%
Pro<ection
*riority% safety of others
/eal with the $0/
(ffer sealed foods 5
unopened medicines
<ever displace outbursts of
emotions
3'plain procedures in
simple ways
<ever argue with the patient
"atatonic =a' fle'ibility
!tupor
<egativism ; mutism& rigidity&
lack of response
*rognosis% +ood
/efense #echanism%
&epression
*riority% nutrition M
circulation
*rovide distraction
3ncourage activity
6n(ifferentiate(
*atients whose manifestation cannot be easily fitted into one or the
other type
&esi(ual
*atients with minimal symptoms
#eneral Nursing Interventions!
3stablish%
a trusting relationship and provide acceptance
a clear& consistent and open communication
!et limits
/ecrease environmental stimuli
(bserve for suicidal ideation
Administer medications& as ordered.
M%%$ $IS%&$E&S
Precipitating 8actors
2oss of a loved one
#aBor life events
,ole strain
/ecreased coping resources
*hysiological changes
5ommon Types of Moo( $isor(er
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 7H of 78
4ipolar I $isor(er! #ay e'perience one or more of symptoms of manic
episode
4ipolar II $isor(er! #ay e'perience one or more symptoms of maBor
depressive episode with hypomania
Ma<or $epressive $isor(er! #ay be coded as mild& moderate or severe
with or without psychotic features.
$yst)ymic $isor(er
2esser severe than maBor depression
<o symptoms such as impaired communication& delusions and
hallucinations
5yclot)ymic $isor(er
$N%S *$epression Not %t)erwise Specifie(1 - lasts for 8 days-8 weeks
5linical Symptoms of Ma<or $epressive Episo(e
Affect flat
:eight change (gain or loss)
Energy loss
Sad feelings 5 !ocial withdrawal
%bvious sleep disturbances
Memory loss
Emotional blunting
5linical Symptoms of Manic Episo(e
)alkative or pressured to keep talking
0nflated self-esteem or grandiosity
*sychomotor agitation
3'hibit flight of ideas
/ecreased need for help
/istractibility
Summary!
Mania $epression
Appearance 3lated !ad
$M *roBection 0ntroBection
Attitu(e t)erapies #atter of fact Cind firmness
Activity <on-stimulating
<ever give anything that
re.uires attention
#onotonous
Priority N$7 ,isk for inBury%
/irected at others
,isk for inBury% self-
directed
Nursing
Management
0ndividual therapies
2ithium
/iet
+roup therapy
Antidepressants
3")
Suici(e
thought or act of taking ones own life
ultimate form of self-destruction
"cry for helpJ
reunion wish or fantasy
progressive failure to adapt feelings of anger or hostility
a way to end feelings of hopelessness and helplessness
an attempt "to save face" or seek a release to a better life
&is; 8actors
Se' (more female attempts suicide but more male commits suicide)
6nsuccessful previous attempt
Identification with a dead family member
5hronic
Illness (e.g. "ancer)
$epression5/ependent personality
Age (6?-8: and DH)5Alcoholism)
Lethality of previous attempt52ooses
Nursing $iagnosis! ,isk for inBury-!elf directed
Nursing care!
Safe environment
Always take overt or covert threats or attempts
seriously
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 76 of 78
'entilation of feelings
Encourage activities
Monitor closely (one-on-one& 8D5G)
Empathy (show acceptance M appreciation)
5%N$ITI%NS 5%MM%NL" $IA#N%SE$ IN THE EL$E&L"
Al>)eimers $isease
A chronic& progressive degenerative cognitive disorder.
#arked by /ementia
#ain *athology% presence of senile pla.ues - destroys neurons (decreased
acethylcholline)
Signs an( Symptoms!
Ap)asia ; deterioration of language function
Apra7ia ; impaired motor function
Agnosia ; inability to recognize obBects 5 people
E7ecutive functioning - loss of abstract thinking
C PHASES!
1orgetfulness - difficulty of remembering appointments
Advance - difficulty of remembering past events but not recent events
)erminal - death occurs in 6 year
Nursing $iagnosis% Altered thought processes
Nursing 5are!
*riority% safety M security
Always reorient the client (clock M calendar)
4se color instead of numbers M letters
"onsistency ; 6 nurse to lessen confusion
5%N5EPTS %N $EATH AN$ $"IN#
$EATHB$ "IN#! Eli>abet) Eubler-&oss
Stages!
/enial - "<( <() #3"
Anger - "=$E #3"
Bargaining - "01 (<2E"
/epression - stage of silence
Acceptance - "Ees& it-s me"
Nursing $iagnosis! 0neffective individual coping
Nursing 5are!
Be physically present
Be non-Budgmental
3ncourage verbalization of feelings
Allow the patient to cry
,ecognize your own thoughts about death and dying
---3</---
a.n.g.5n.a.l. PS"5HIAT&I5 N6&SIN# *age 78 of 78