MENTAL HEALTH ⊗ Factors that increase the risk: Crises, Abuses, Poverty

⊗ "A state of well-being where a person can realize his or her own abilities to Criteria for Mental Disorder / Mental Illness:
cope with the normal stresses of life and work productively." (WHO) ⊗ Dissatisfaction with:
⊗ A balance in person’s internal life and adaptation to reality.  one’s characteristics, abilities and accomplishments
⊗ A state of well-being in which a person is able to realize his potentials.  one’s place in the world
Criteria for Mental Health: ⊗ Ineffective:
⊗ Self-awareness  interpersonal relationship
♦ Ability to:  coping or adaptation to the events in one’s life
 recognize one’s thoughts feelings, asset potentials and Diagnosis of Mental Illness
weakness. ⊗ Use of the Diagnostic and Statistical Manual of Mental Illness (DSM-IV)
 experience genuine feelings as anger, happiness, resentment Axis
♦ Leads to self-acceptance, self-understanding in order to understand I Clinical disorder that is the focus of treatment
others II Personality disorders and mental retardation
⊗ Autonomy: ability to function independently and function with others III Medical conditions
⊗ Perceptive ability IV Psychosocial and environmental problems
 Awareness of stimuli, reality orientation. V Global assessment of functioning (GAF)
 Orientation to: Time, Place, Person ⊗ Provides diagnostic criteria for each mental disorder and a system of 5 axes
⊗ Integral capacity: Ability to harmonize psychic forces (id, ego, super ego). to give a comprehensive view of the client’s mental illness.
⊗ Self-actuation
PSYCHIATRIC NURSING
 Ability to adopt to life changes, happy to work with others
 Satisfaction in every endeavor ⊗ An interpersonal process
 Genuine cooperation ⊗ Concerned with all the aspects of care
⊗ Mastery of one’s environment: Awareness of the changes around him ⊗ Both a Science and an Art
 Science – uses different theories
MENTAL HYGIENE
 Art - therapeutic use of self
⊗ A science that deals with: Promotive, Preventive, Curative, Rehabilitative ⊗ Clientele:
aspects of care.
 Individual, family and the community
MENTAL DISORDER  Both mentally healthy and mentally ill
⊗ A medically diagnosable illness which results in significant impairment of
Main tool of the nurse: Therapeutic use of self
one's cognitive, affective or relational abilities and is equivalent to mental
illness. Characteristics of a Good Psychiatric Nurse:
⊗ Empathy
MENTAL ILLNESS
⊗ Genuineness
⊗ A state in which an individual shows deficit in functioning and is unable to
⊗ Congruence
maintain personal relationship.
⊗ Unconditional positive regard
⊗ A state of imbalance characterized by a disturbance in a person’s thoughts,
feelings and behavior Roles of the Nurse in Psychiatric Setting:
 Clinician  Researcher
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 Collaborator  Socializing agent
 Counselor  Teacher Management:
 Healthy role model  Technician ⊗ Acknowledge the feelings
 Parent surrogate  Therapist ⊗ Reorient to reality
 Patient advocate  Ward manager ⊗ Provide distractions
 Reality based
Levels of Interventions in Psychiatric Nursing ⊗ Neologism - pathological coining of new words
Level Description Examples ⊗ Circumstantiality - excessive inclusion of details
Primary Aimed at altering the stressors  Health education ⊗ Word salad - incoherent mixture of words and phrases
through:  Information ⊗ Flight of ideas - shifting of one topic from one subject to another in a
 promotion of mental health dissemination somewhat related way
 lowering the rate of cases  Counseling ⊗ Looseness of Association - shifting of a topic from one subject to another
Secondary Interventions that limit the severity of  Crisis intervention in a completely unrelated way
a disorder through:  Drug administration ⊗ Verbigeration - meaningless repetition of word or phrases
 Case finding ⊗ Perseveration - persistence of a response to a previous question
 Prompt treatment ⊗ Echolalia - pathological repetition of words of others
Tertiary Aimed at reducing the disability after  Alcoholics ⊗ Stilted language – use of flowery words
a disorder through: anonymous ⊗ Clang association - the sound of the word gives direction to the flow of
 Prevention of complication  Occupational therapy thought
 Active program of rehabilitation
⊗ Delusion – fixed, false belief which cannot be corrected by appeal or logical
reasoning
THE PSYCHIATRIC SETTING
 Grandeur - an exaggerated belief of identity
Admitting a Client in the Psychiatric Setting
 Nihilistic - the client denies the existence of self or part of self
Areas to be assessed:  Persecution - belief that he or she is the object of environmental
⊗ Health perception attention and being singled out for harassment
⊗ Orientation  Self-depreciation - worthlessness or hopelessness
⊗ Metabolic pattern  Somatic - false belief to body function
⊗ Elimination pattern Disturbances of Affect
⊗ Cognitive pattern: Judgment, Insight, Memory ⊗ Inappropriate affect - disharmony between the stimuli and the emotional
⊗ Activity and exercise pattern reaction
⊗ Thought process ⊗ Blunted affect - severe reduction in emotional reaction
⊗ Sleep-rest pattern ⊗ Flat affect - absence or near absence of emotional reaction
⊗ Apathy - dulled emotional tone
COMMON BEHAVIORAL SIGNS AND SYMPTOMS
⊗ Lability of affect – rapid “mood swings”
Disturbance in Perception
Disturbances in Motor Activity
⊗ Illusion - misperception of an actual external stimuli
⊗ Echopraxia - the pathological imitation of posture/action of others
⊗ Hallucination - false sensory perception in the absence of external stimuli
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⊗ Waxy flexibility - maintaining the desired position for long periods of time Communication: reciprocal exchange of ideas between or among persons
without discomfort Modes:
⊗ Akinesia - loss of movement ⊗ Verbal - written/spoken
⊗ Bradykinesia - slowness of all voluntary movement including speech ⊗ Non-verbal - posture, tone of voice, facial expression
⊗ Ataxia - loss of coordinated movement Types of Non-verbal communication:
⊗ Automatism - repeated purposeless behavior ⊗ Kinesis
Disturbances in Memory • body movement
⊗ Confabulation - filling in of memory gaps • eye contact
⊗ Amnesia - inability to recall past events • gestures
• Anterograde - immediate past ⊗ Paralanguage
• Retrograde - distant past • voice quality
• non-language vocalization (crying, sobbing, moaning)
⊗ Déjà vu - a subjective feeling that an experience which is occurring for
the first time has been experienced before ⊗ Proxemics – law of space relationship
⊗ Touch – physical act
⊗ Jamais vu – a feeling that the familiar does not seem familiar
⊗ Cultural artifacts
⊗ Dementia
⊗ Meta communication
• gradual deterioration of intellectual functioning
• based on role expectations
• results in decreased capacity to perform ADL
• hidden meaning of words
Other behavioral signs & symptoms
Elements:
⊗ Agitation – a state of anxiety associated with motor restlessness
⊗ Agnosia - inability to recognize and interpret sensory stimuli FEEDBACK
⊗ Akathisia - a feeling of muscular quivering, an urge to move about
constantly and an inability to sit still
M
essage
⊗ Ambivalence - presence of two opposing feelings at the same time (Ch
ann
el)
⊗ Delirium - refers to acute change or disturbance in a person's: LOC, (Con
tex
t)
cognition, emotion , perception
Therapeutic Communication: a way of interacting in a purposeful manner to
⊗ Derealization - feeling of strangeness towards the environment promote the client’s ability to express his / her thoughts and feelings openly.
⊗ Dysthymia - persistent state of sadness
Essentials for a Therapeutic Communication:
⊗ Elation (euphoria)- feeling of expression of excitement
⊗ Genuineness E A T
⊗ Mutism – refusal to speak G R
⊗ Respect
⊗ Narcolepsy - sleep disorder characterized by frequent irresistible urge to
sleep with episodes of cataplexy (sudden loss of muscle power) ⊗ Empathy
⊗ Insomnia – inability to attain enough sleep ⊗ Attentive listening
⊗ Hypersomnia – excessive sleep ⊗ Trust (rapport)
⊗ Parasomnia – abnormal sleep behavior Barriers to Therapeutic Communication
USE OF APPROPRIATE COMMUNICATION TECHNIQUES
⊗ Belittling

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⊗ Interrupting / ignoring
⊗ Giving advice
⊗ Social response
⊗ Changing the subject
⊗ Approving / disapproving
⊗ Moralizing
NURSE – PATIENT RELATIONSHIP
Hildegard Peplau
Phases:
Phase
Pre-Interaction Phase
⊗ begins when the nurse
is assigned/chooses a
patient
⊗ patient is excluded as
an active participant
Orientation phase Patient
⊗ when the nurse-patient
interacts for the first
time
Working / Therapeutic
Phase
⊗ it is highly individualized
⊗ more structured than
Psychiatric Nursing: Lecture Aid
the orientation phase Learn
⊗ the longest and most Change
productive phase
⊗ limit setting must be
employed
Problems:
⊗ Transference
 the development of an
emotional attitude towards
the nurse
 positive or negative
⊗ Counter transference –
experienced by the nurse /
therapist
Anxiety Tasks
Nurse ⊗ Major task: develop self- Phase Anxiety Tasks
awareness
⊗ includes all of what the nurse Termination Phase Patient ⊗ Reinforce and reward change and
thinks and does before interacting strength of patient
with the patient ⊗ Encourage expression of feelings
⊗ data gathering, planning for first about termination of the
interaction relationship
⊗ Major task: establish trust and ⊗ Summarize the progress
rapport ⊗ Terminate the relationship without
⊗ conduct initial interview giving promises
⊗ establish contract with the patient
⊗ learn about the patient and his THEORIES OF HUMAN DYNAMICS
initial concerns and needs
⊗ encourage the patient to feel Psychosexual Development: Sigmund Freud
comfortable with the meeting
⊗ manage present emotions of the Levels of Consciousness and the Psychic Forces
patient
⊗ provide support and empathy of
the patient’s feelings
⊗ assure confidentiality
None ⊗ Major task: identification and
resolution of the patient's problems
⊗ planning and implementation
Teach
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 ⊗ Libido - the instinctual drives
⊗ Regression and fixation are common terms in this theory.
⊗ Gave prominence to sexual feelings: defined "sex" as anything that gives
gratification
Stages:
Oral Stage (0-2 years)
⊗ The area of gratification is the mouth
⊗ Pleasures: sucking activities like fingers, toes or nipples
⊗ Dissatisfaction: resurface at a later age
 overeating, smoking, nail-biting
Nursing Implication:
⊗ Provide oral stimulation by giving pacifiers
 Breastfeeding may provide more stimulation
⊗ Do not discourage thumb sucking
Anal Stage (2-4 years)
⊗ Children's attention is focused on the anal region.
⊗ Pleasure: elimination
⊗ Covers the ideal age for "toilet training" (2 1/2 years)
⊗ 2 concepts:
 Holding on
 Letting go
Possible problems:
⊗ Compulsive need to be clean and orderly
⊗ Frugality and stinginess
⊗ Greed
Ego Superego Id ⊗ Insistence on doing things at one's own rate at the expense of others
(Reality) (Moral) (Pleasure) ⊗ Rigid training
⊗ Excessive messiness and disorderly habits
Nursing Implication: Help children achieve bowel and bladder control without
undue emphasis on its importance.
Phallic Stage (4-6 years)
⊗ Pleasure: genital region

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  activities associated with stroking and manipulating their sex organs o Reliance on the caregiver
Positive Resolution
⊗ Oedipus complex o Development of trust in the environment
⊗ Electra complex o Fear, anxiety and suspicion
⊗ Concept: Negative Resolution o Lack of care, both physical & psychological by
 Onset of “normal homosexuality” caretaker leads to mistrust of environment
Stage 2:
Nursing implications: Toddler, 18 mos. to 3 years
⊗ Accept child's sexual interest Period of Life
(Willpower)
⊗ Help the parents answer child's questions about birth or sexual differences Psychosocial Crisis Autonomy vs. Shame/Doubt
Latency Stage (6 to 12 years) Relationship with Paternal person
⊗ Period of calmness / stable period. o Sense of self-worth
⊗ Many of the disturbing behaviors are buried in the subconscious mind o Assertion of choice and will
Positive Resolution
⊗ Their energies are absorbed by the concerns in school, peers, sports and o Environment encourages independence, leading to
other recreational activities sense of pride
Nursing Implication: Help the child have positive experiences o Loss of self-esteem
Genital Stage (12 years & up) Negative Resolution o Sense of external control may produce self-doubt in
⊗ Oedipal feelings are reactivated toward opposite sex others
Stage 3:
⊗ The person is on his/her way in establishing a satisfying life of his/her own
Period of Life Preschool, 3 to 6 years (Purpose)
Nursing Implication:
Psychosocial Crisis Initiative vs. Guilt
⊗ Provide appropriate opportunities for the child to relate with opposite sex
Relationship with Family
⊗ Allow child to verbalize feelings about new relationships
The ability to learn to initiate activities, to enjoy achievement
Psychosocial Development Theory: Erik Erikson Positive Resolution
and competence
⊗ Childhood is very important in personality development.
o The inability to control newly developed power
⊗ Rejected Freud's attempt to describe personality solely on the basis of
Negative Resolution o Realization of potential failure leads to fear of punishment
sexuality
and guilt
 believed that social factors greatly affect
Stage 4
 felt that personality continued to develop beyond five years of age.
Period of Life Schooler, 6 to 12 yrs. (Competence)
Identified 8 developmental stages throughout the whole life cycle.
Psychosocial Crisis Industry vs. Inferiority
⊗ Stages 1-5 - Childhood and Adolescence
⊗ Stages 6-8 - Adulthood Relationship with Neighbors/School
o Learning the value of work
Stages: Positive Resolution o Acquiring skills and tools of technology
Stage 1:
o Competence helps to order life and make things work
Period of Life Infant, 0-18 months, (Hope) Repeated frustrations and failures lead to feelings of
Negative Resolution
Psychosocial Crisis Trust vs. Mistrust inadequacy and inferiority that may affect their view of life
Relationship with Maternal person Stage 5:
Period of Life Adolescent, 12 to 18 yrs, (Fidelity)
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Psychosocial Crisis Identity vs. Role confusion ⊗ Begins to organize visual images and control motor responses
Relationship with Peer group ⊗ Coordinates sensory impressions
Experiments with various roles in developing mature ⊗ Pre-verbal stage
Positive Resolution
individuality
Preoperational Stage (2-7 years)
Negative Resolution Pressures and demands may lead to confusion about self ⊗ Transitional period
⊗ Egocentric and irreversible thinking
Stage 6: ⊗ Words become symbols for objects – symbolic thinking
Period of Life Young Adult, 18 to 24 yrs., (Love)
⊗ Formation of ideas of categorization
Psychosocial Crisis Intimacy vs. Isolation
⊗ Lack of ability to go back and rethink a process or concept.
Relationship with Partners in friendship ⊗ Mental image – the symbolic process which are evident in plays
o A commitment to others ⊗ Construction of verbal schemas – preconcepts
Positive Resolution
o Close heterosexual relationship and procreation
Withdrawal from such intimacy, isolation, self-absorption and Concrete Operations (7 – 11 years)
Negative Resolution ⊗ Thinking appears to be stabilized
alienation from others
Stage 7: o ability to think of the possible consequences of actions
Period of Life Middle Adult, 24 to 54 yrs., (Care) ⊗ Logical implications
Psychosocial Crisis Generativity vs. Self-absorption Formal Operations
(11 years to adulthood)
Relationship with Partner
⊗ Full patterns of thinking
o The care and concern for the next generation ⊗ Ability to use logic and symbolic processes
Positive Resolution
o Widening interest in work and ideas o mathematical and scientific reasoning
Negative Resolution Self-indulgence and resulting psychological impoverishment ⊗ Combinatorial thinking - multidimensional approach
Stage 8: o hypothetic or hypothetico-deductive reasoning
Period of Life Late Adult, 54 yrs. to death, (Wisdom) o
Psychosocial Crisis Integrity vs. Despair Moral Development Theory: Laurence Kohlberg
Relationship with Mankind Level One Stage 1
o Acceptance of one’s life (Preconventional • Behavior is based on the desire to avoid
Positive Resolution o Realization of the inevitability of death Morality) severe physical punishment by a superior
o Feeling of dignity and meaning of existence • Children’s power.
judgments are based • Right or wrong is based on consequences
Negative Resolution Disappointment of one’s life and desperate fear of death on external criteria. to him.
• Standards of right • Punishment = wrong act
Cognitive Development Theory: Jean Piaget and wrong are absolute
and laid down by
Stages: authority.
Sensorimotor (0-2 years) Level Two (Conventional Stage 2
⊗ Reflex to complex Morality) • Actions are based largely on satisfying
• Children’s judgments one’s own personal needs.
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 are based on the norms Stage 3 ⊗ Focus is in mental illness as a biophysical impairment.
and expectations of the • Good behavior is that which pleases others ⊗ Human behavior is influenced by genetics, biochemical alterations and
group. and judgments are based on intentions. function of brain and CNS.
• Children conform to rules to win the ⊗ The stress response is a neuroendocrine response
approval of others and to maintain good
relationships.
Stage 4 PSYCHOTHERAPY
• What is right is what is accepted. ⊗ A process in which a person enters into a contract to interact with a
Level Three Stage 5 therapist to relieve symptoms, resolve problems in living and seek personal
(Post Conventional • Behavior recognizes the laws as arbitrary growth
Morality) and changeable.
INDIVIDUAL THERAPY: Is a confidential relationship between client and
• The individual • For aspects of life not governed by laws, therapist.
recognizes the right and wrong are personal decisions
arbitrariness of social based on agreement and contracts.
⊗ Hypnotherapy: Involves various methods and techniques to induce a
and legal conventions. trance state where the patient becomes submissive to instructions
Stage 6
• The individual attempts • Morality is based on respect for others ⊗ Humor therapy: Use of humor to facilitate expression of feelings and to
to define moral values rather than on personal desires. enhance interaction
that are separate from • The individual conforms to both social ⊗ Psychoanalysis: Focuses on the exploration of the unconscious, to
group norms. standards and to internalized ideals to avoid facilitate identification of the patient's defenses
self-condemnation rather than to avoid GROUP THERAPY
social censure. • minimum number : 3
• Ideal number :8-10
Other Theories • Advantages:
o decreases isolation
Behavioral Model (Ivan Pavlov, John Watson, B. F. Skinner)
o decreases dependence
⊗ Behavior is:
o develops coping skills
• a response to a stimulus from the environment o develops interpersonal learning
• learned and retained by positive reinforcement o develops opportunities for helping others
o develops ability to listen to other members
Interpersonal Model (Harry Stack Sullivan)
⊗ Focused on the role of the environment and interpersonal relations as ⊗ Remotivation Therapy: Promotes expression of feeling through interaction
the most significant influences on a individual’s development facilitated by discussion of neutral topics
⊗ Anxiety is communicated interpersonally ⊗ Family therapy: A method in which family members gain:
Human Motivational Need Model. (Abraham Maslow) o insight into the problems
o improve communication
⊗ Hierarchy of needs in order of importance
o improve functioning of individual members as well as the family as a
⊗ Primary needs (physiologic) need to be met prior to dealing with higher
whole.
level needs o It focuses on the total family as an interactional system
Psychobiologic Model

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⊗ Milieu Therapy o The consequences should occur immediately after the client has
• A therapeutic environment is organized to: exceeded the limit
o encourage and assist the client to control problematic o Consistency must occur with all personnel.
behavior o Purposes:
o function within the range of social norms o Minimizes manipulation and splitting of the staff.
o Provides a framework for the client to function in and enable
⊗ Play therapy
a client to learn to make requests.
• Effective for children suffering from maladjustment or behavior disorder.
• The child is usually placed in a play room • Systematic Desensitization
• Purpose - to discover the causes of the child's conflict through o Clients are exposed slowly to a feared object or a thing that inhibits
observation of his play and to interpret it to the child. anxious responses and taught ways to relax.
o Effective in treating phobias.
⊗ Recreational therapy
• Uses activities which vitalize the patient's interest and help him / her to • Implosive therapy
relax and feel refreshed. o The clients are exposed abruptly to intense forms of anxiety
• Example: Playing baseball may be prescribed for as a means of producers, either in imagination or in real life
expressing hostility in a group.
• Cognitive Behavior therapy
⊗ Occupational therapy: Uses any mental or physical activity prescribed or o Uses confrontation as a means of helping the clients restructure or
guided to aid an individual's recovery from a disease or injury. rearrange irrational beliefs, maladaptive thinking, perception-, and
behaviors.
⊗ Musical therapy o Used for depression and adjustment difficulties.
• Involves music which allows the child or adolescent to express herself or
himself. • Biofeedback
• Also effective with those who have difficulty communicating. o Teaches the clients to control or change aspects of their internal
environment.
⊗ Art therapy: Clients are encouraged to express their feelings or emotions
by painting, drawing or sculpture. • Aversion therapy
o Uses unpleasant or noxious stimuli to change inappropriate
⊗ Psychodrama therapy: Patients dramatizes their emotional problems in a behavior.
group setting. o Examples
⊗ BEHAVIOR MODIFICATION THERAPY o Antabuse to treat alcoholics
• A mode of treatment that focuses on modifying observable (overt) and • Assertiveness Training
quantifiable behavior o Clients are encouraged and taught how to appropriately relate to
• Systematic manipulation of the environment and variables thought to be others
functionally related to the behaviors.
• Token-economy: Utilizes the principle of rewarding desired behavior to
facilitate change.
• Limit Setting ELECTROCONVULSIVE THERAPY (ECT)
o Therapist gives an advanced warning of the limit and the • Exact mechanism is unknown
consequences will follow if the client does not adhere to the limit. • Requires a consent
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Voltage : 70-150 volts
Length : .5-2 seconds
Frequency : 6-12 treatments BASIC CONCEPTS ON PSYCHOPHARMACOLOGY
Interval : 48 hours
MAJOR TRANQUILIZERS/ ANTIPSYCHOTICS
Indicator : tonic-clonic seizure
⊗ Indication: Schizophrenia and Other Psychosis
Indications of use: ⊗ Desired effect: control of symptoms
• Depression • Catatonic schizophrenia ⊗ Best taken after meals
• Mania ⊗ MOA: Block selected dopamine receptors à decrease dopamine à reduce
Contraindications: symptoms
• Fever • Unhealed fracture Types Typical Atypical
• Increased ICP • Retinal detachment Before 1990’s After 1990’s
• Cardiac conditions • Pregnancy Advantages • Cheaper • Less or no EPS
• TB with history of hemorrhage • Osteoporosis • More available • For both (-) & (+) symptoms
Disadvantages • EPS • Expensive
Before the procedure: • Treats (+) symptoms • Less available
• Take vital signs only • More agranulocytosis
• Diagnostic procedures Examples • Haloperidol • Risperdal
o X-ray • Mellaril • Seroquel
o ECG • Thorazine • Clozaril
o EEG
Side effects Nursing Action
• Drugs given Blurred vision Avoid driving
o Atropine sulfate (decrease secretions) Dry mouth Give sugarless gum
o Anectine (Succinylcholine) – relax muscles Tachycardia, palpitation, constipation, Monitor & report
o Methohexital Na (Brevital) - anesthetic urinary retention
During the procedure: Photosensitivity Don’t expose skin to sunlight
• Observe for tonic-clonic seizure Orthostatic hypotension Monitor BP
• Priority: Safety Advise gradual change in position
Extra Pyramidal Symptoms Discontinue the next dose
After the procedure: o Pseudoparkinsonism Report at once
• Position o pill-rolling tremors Give antidote:
• Check vital signs mask-like face Anticholinergics
• Reorient the client o cog-wheel rigidity • Akineton
• Watch out for complications: o propulsive gait • Artane
o Memory loss o Akathisia - restless leg syndrome • Benadryl
o Headache o Dystonia - defect in muscle tone • Cogentin
o Apnea Dopaminergics: L- Dopa
o Respiratory depression • Espequel
o Fracture • Sporadel

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 Side effects Nursing Action Tricyclic Antidepressants
Neuroleptic Malignant Syndrome Withhold the next dose
Examples:
(NMS) Notify the physician
• Muscle rigidity + high grade Cooling measures • Imipramine (Tofranil) • Amitriptyline (Elavil)
fever Nursing Implications:
Adverse effect: report promptly ⊗ Best given after meals
• Tardive dyskinesia - lip smacking ⊗ Effectivity: after 2-3 weeks
• Agranulocytosis ⊗ Check the BP, it causes hypotension
o Assess for: ⊗ Check the heart rate, it causes cardiac arrythmias
 Fever ⊗ Monitor I & O
 Sore throat ⊗ Monitor for signs of increased IOP
 Lab data: WBC count MAO INHIBITORS
• Hepatotoxicity Indication: refractory depression
o Assess for ALT & AST Examples:
• Tranylcypromine (Parnate)

P a N a M
MINOR TRANQUILIZERS/ ANXIOLYTICS
⊗ Common indication: Anxiety disorders • Phenelzine (Nardil)
⊗ Desired Effect: Decreased anxiety, adequate sleep • Isocarboxazid (Marplan)
⊗ Have sedative effects Nursing Implications:
⊗ Best taken after meals
Examples: (XL VASET)
⊗ Report headache; it indicates hypertensive crisis
Xanax (Alprazolam)
Librium (Chlordiazepoxide ) ⊗ Avoid tyramine containing foods like:
• Avocado
Valium (Diazepam) • Banana
Ativan (Lorazepam)
• Cheddar and aged cheese
Serax (Oxazepam)
• Soysauce
Esquanile
Tranxene (Chlorazepate Dipotassium) • Preserved foods
Nursing Implications: ⊗ Effectivity: 2-3 weeks
• Best taken before meals ⊗ Monitor the BP
• Advise to avoid driving ⊗ There should be at least a two-week interval when shifting from one anti-
• Administer it separately with any drug depressant to another
Anxiolytics + Selective Serotonin Reuptake Inhibitors
• Alcohol = severe hypotension / hypersedation Examples:
• Another anxiolytic = respiratory depression à death • Fluoxetine (Prozac) • Paroxetine (Paxil)
• Other drugs = CNS depression • Celatopram (Celexa) • Fluvoxamine (Luvox)
• Stimulants = less effective • Sertraline (Zoloft)
ANTIDEPRESSANTS Nursing Implications:
Desired effects: increased appetite, adequate sleep
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⊗ Avoid the use of: • A state produced by a change in the environment that is perceived as
• Diazepam • Tryptophan challenging, threatening or damaging to the person’s dynamic equilibrium.
• Alcohol (Smeltzer, 1992)
⊗ Monitor PTT, PT Adaptation
⊗ Never give to pregnant / lactating mothers. • A constant ongoing process that occurs along time continuum, beginning
ANTI-MANIC AGENT with birth and ending with death. (Smeltzer, 1992)
Examples: • A continuous process of seeking harmony in an environment.
• Lithium Citrate (Cibalith – S) • Lithium Carbonate (Eskalith,
Types of Adaptation:
Lithane, Lithobid)
General Adaptation Syndrome (GAS)
Nursing implications:
• Involves the whole body in response to stress.
⊗ Never give to pregnant mothers
⊗ Best taken after meals
• Compared to life process as it focuses on the “wear and tear of the body
tissues.”
⊗ Increase intake of:
• fluids (3 L /day) Phases:
• sodium (3 gm/day) • Alarm
⊗ Avoid activities that increase perspiration o Acute phase of the syndrome
⊗ Effectivity: 10-14 days o Characterized as the “flight and fight” reaction
⊗ Antipsychotic is administered during the first 2 weeks o Defensive by nature but self-limiting
o If stress is intense, it may lead to death
Level (mEq/L) Status S/Sx Nursing Interventions
.5 – 1.5 Therapeutic Monitor • Resistance
Increase sodium & fluid intake o Characterized as the state of adaptation
1.6 Abnormal D/C next dose o Person moves back to homeostasis
Report
*IV NSS
1.7 – 1.9 Toxic Vomiting D/C next dose • Exhaustion
Anorexia Report o Result of a prolonged exposure to stress and adaptive mechanisms can
Nausea *MANNITOL (antidote) no longer persist.
Diarrhea Local Adaptation Syndrome
Abdominal
• Refers to inflammatory response and repair processes
cramps
that occur at the local site of tissue injury.
2.0 and above Fatally toxic Lethargy D/C next dose
(Altered Report Eustress - positive stress
LOC) *Dialysis Distress - negative stress and damaging stress
STRESS CRISIS AND CRISIS INTERVENTION
• A situation that occurs when an individual's habitual coping ability becomes
• A nonspecific response of the body to any demand made upon it. (Hans ineffective to meet the demands of a situation.
Selye, 1936)
• A serious interruption and disturbance of one's equilibrium or homeostasis
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• Leads to potentially dangerous, self-destructive or socially unacceptable • A way of entering into the situation to help them mobilize their resources
behavior. and to decrease the effect of stress.
Characteristics
Domestic Violence Requiring Crisis Intervention:
• Highly-individualized
• Self-limiting: 4-6 weeks RAPE
• Person affected becomes passive and submissive • Nonconsensual sexual penetration of an individual, obtained by force or
• Affects a person’s support system threat, or in cases in which the victim is not capable of consent.
Type Description Example Kinds of Rape
Maturational / expected, predictable Puberty, adolescence, • Power – to prove masculinity
Developmental and internally young adulthood,
• Anger – means of retaliation
motivated marriage, or the aging
• Sadistic – to express erotic feelings
process.
Situational / Accidental Unexpected, Economic difficulty, illness, Silent Rape Syndrome
unpredictable and accident, rape, divorce or • A maladaptive reaction to rape
externally motivated death • The victim:
Social / Adventitious Due to acts of nature Natural calamities o fails to disclose information about the rape
o is unable to resolve feelings about the sexual assault
PHASE o Results to increase anxiety and may develop a sudden phobic
reaction.
DENIAL
Rape Trauma Syndrome (RTS)
• Refers to a group of signs and symptoms experienced by a victim in
INCREASED
TENSION reaction to rape
Phases:
DISORGANIZATION
• Acute / Impact – shock, numbness, disbelief
REORGANIZATION • Repression / Denial – refusal to discuss the event
• Heightened Anxiety – fear, tension, nightmares
• Stage of Resolution
FULL
REORGANIZATION BATTERED WIFE SYNDROME (BWS)
• A form of cyclic domestic violence
• Men: low self-esteem
• Women: Dependent personality disorder
CRISIS INTERVENTION
• Major Goal: Restore the maximum level of functioning (pre-crisis state)
• It is an active but temporary entry into the life situation of an individual or a
family during a period of stress.

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 • Low self-esteem
• Depression
• Apathy
• Bruised or swollen genitalia; tears or bruising of rectum or vagina
• Unusual injuries for the child’s age and development
• Serious injuries (fractures, burns, lacerations)
• Evidence of old injuries not reported
Republic Act 7610
(taken from the book of Shiela Videbeck) (Anti Child Abuse Law)
• Required reporting of suspected cases
Characteristics of Abusive Husbands:
• Report cases to the nearest authorities within 48 hours
• They usually come from violent families
• They are immature, dependent and non-assertive Assessment, Planning and Nursing Actions for Crisis
• They have strong feelings of inadequacy • Primary concerns:
•
o Physical injuries
CHILD ABUSE o Alleviation of psychological trauma
• An act of omission of responsibility or commission in which intentional harm • Nurse should display:
is inflicted on a child. o Sensitivity
Components of Omission:
o Attitude (Nonjudgmental)
• Child abandonment – leaving the child physically
o Confidentiality
• Child neglect - lack of provision of those things which are necessary for the
o Respect
child's growth and development
o Empathy
Types of Commission: o Dignity
Physical Abuse - is an intentional physical harm inflicted on a child by a parent • Evidences are important:
or other person. o stained clothing
Emotional abuse - insult and undermining one's confidence o fingernail scrapings
Sexual abuse - in the form of sexual contact o mouth or anal smears containing semen
Characteristics of Abusive Parents: • Intervention focuses on family as a unit
• They come from violent families • If the victim is a child: Play and art therapy
• They were also abused by their parents
• They have inadequate parenting skills DEFENSE MECHANISM
• They are socially isolated because they don't trust anyone • These are automatic and usually unconscious processes or act by the
• They are emotionally immature individuals to:
• They have negative attitude towards the management of the abused o reduce or cope anxiety or fear
Warning signs of Child Abuse / Neglect: o resolve emotional or mental conflict
• Child’s excessive knowledge on sex and abusive words o protect one's self-esteem
• Hair growth in various lengths o protect one's sense of security
• Inconsistent stories from the child and parent/s • Becomes pathologic when overused
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• Used by both mentally healthy and mentally-ill individuals • Intellectualization
•
o An overuse of intellectual concepts by an individual to avoid expression
Common Defense Mechanisms Used: of feelings
• Compensation
o An attempt to overcome a real or imagined short coming, inferiority, o A man who was asked to share a memorable experience about his
inabilities and weaknesses. grandmother who died discussed the stages of death and dying by
o A blind woman becomes proficient in playing piano. Elizabeth Kubler Ross.
• Conversion • Projection
o Emotional problems are converted to physical symptoms o Attributing to others one's unconscious wishes/fears
o A student unprepared for a report suffered headache the day she is o Literally, this means to "throw off” or to blame others
supposed to deliver her report. o A student who failed a subject blames his failure on poor teaching.
• Denial • Reaction – Formation (AKA overcompensation)
o Failure to acknowledge an intolerable thought, feeling, experience or o Expression of feeling that is the direct opposite of one's real feeling.
reality o A student who dislikes one of her classmates may act or show concern
o After being admitted to the CCU because of an AMI, a middle-aged man toward her.
insists that he is in the hospital for just a diagnostic work-up. • Rationalization
• Displacement o An individual finds a justifiable cause and acceptable reasons just to be
o The redirection of feelings to a less threatening object saved from an embarrassing and anxiety producing thoughts or
o After an argument with his father, a boy goes to the room and kicked his situations.
door. • Regression
• Fantasy o The turning back to earlier patterns of behavior in solving personal
o Conscious distortion of unconscious feelings or wishes conflicts
o A boy who is being bullied by his friends wished he had the power of o Commonly seen to schizophrenic patients
Wolverine. o A person who becomes ill in the face of disappointment has regressed
• Fixation to a form of childish behavior.
o An unhealthy mechanism which is an arrest of maturation at certain • Repression
stages of development o The involuntary or unconscious forgetting of unpleasant ideas or
• Introjection impulses.
o Symbolic assimilation or taking into oneself a love/hatred object. Derived • Suppression
from the word "introject" which literally means to take into or ingest o Permits the individual to store away or consciously forget the
o Common to depressed clients unpleasant, painful and unacceptable thoughts, desires, experiences
o “Self-blaming” and impulses.
o "I'll think it about tomorrow", "I'd rather go now", "Can we change the
• Identification topic?"
o An individual integrates certain aspects of someone else's personality o A boy walked out from the group and said "I have to go now", when he
into one's own was asked what happened to their relationship with his girlfriend.
o A young school teacher adopts his former mentor's teaching style when
conducting class sessions • Substitution
o Replacing the desired unattainable goal with one that is attainable
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 o After failing the board exam 3 times, a woman worked as a nursing aide
just to be in the hospital.
• Sublimation
o The redirection of unacceptable instinctual drive with one that is socially
acceptable
o Instead of harming his mother, a man expressed his anger by
composing a song.
• Symbolization
o A less threatening object is used to represent another
o Missing her husband, a woman finds comfort in hugging her son who
looks like his father.
• Undoing
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.

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