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PSYCHIATRIC NURSING Interpersonal relationship: client but also the family Nurse self-awareness How you perceived How

you value Self - analysis: to know your strength and Weaknesses Main focus of psych: behavior(response to the changes to the environment meaningful that will reflect the feeling. 3 level of prevention: I. Primary remove the factor before causing illness Goals: 1. Promote mental health by: Stress reduction Health teaching Support system(family) Accident prevention Mother given adequate prenatal care 2. Prevent mental illness II. Secondary- sick client Goal: to lessen the duration of mental illness by: Suicide prevention Crisis intervention

III.

Providing the patient minute /psychotheraphy: antipsychotic/ ECT Tertiary rehabilitation ( let the client to function at fullest capacity, independent, productive)

Mentally healthy: state of mind Define the ff. concept: 1. Self-awareness 2. Self-actualization Self fulfillment Self realization Achievements 3. Perception of reality(accept realities of life) 4. Adaptation to the environment: adjustment 5. Self esteem: how worthy are you?; self reliance 6. Autonomous behavior: time you learn to become independent in making decision 7. Integrative capacity: making yourself a whole and holistic individual to tolerate frustration Unmet goals Unmet expectation Ability to solve conflict Balance and fx. To meet the ego and superego

OPERATES the level of the MIND ID: animal in man - Primitive disires - Instinct to one - Fx. According to pleasure - A moral and illogical - Uneducated - Babies are all ID I want it and I want it now - Avoids pain Ego: self - Deals with reality - Part that will give you the sense of responsibility - Reasonable - Oriented to PTT - Make judgement - Decision - Memory - Solve conflicts/problems - Integrate frustration - Integrator of our personality Mediator between ID and superego and to self and environment I can wait for what I want Superego: higher self 2 aspects: conscience and wrong - Sensoring part of our body - Tells right and wrong - Righteous - Perfectionist

Moral values that concern in PUNISHMENT Exercise _____defense mechanism _____direct motor skills _____inhibits the ID impulses _____sense of guilt _____reduces anxiety; frustration; conflicts LEVELS OF THE MIND a. Conciousness: awareness - Logical and contains all experience that you can recall voluntarily. b. Subconscious: pre-conscious (part of the mind that contain all experience partly remember) Ex. alamkopoyungsagotkasonasadulo ngdilako . c. Unconscious : unpleasant experience that you cannot recall voluntarily. Evidences: (product) Slip of the tongue and pen Accidents products of unconscious mind Forgetfulness Dreams Anxieties Phobias Hallucination, illusion.delusions

ID: UNCONSCIOUS EGO: conscious if dealing with REALITY DEFENSE MECHANISMS: Use to reduce anxiety to maintain self-esteem - Mental mechanisms - Patterns of adjustment - Uses in unconscious process that is utilize by the ego in order to maintain its EQUILIBRIUM a. COMPENSATION: over coming - Inferiority - Superior you may not be beautiful but you graduated CUM LAUDE b. CONVERSION: solve conflicts by means of physical symptoms you do not want to go to the class next day and suddenly you have headache c. DENIAL: you cannot accept reality of life - Lack awareness of the realities of life whn a 75 yrs. Old man and the man tell you I can dance as if of a 25 yrs. Old

d. DISPLACEMENT: transfer your feeling from one to another person to another person/objetcs. e. FANTASY: the use of imagination day dreaming f. FIXATION: the behavior is not resolve - Remain stagnant in one stage of development - Persistent of a behavior - An arrest in MATURATION g. REGRESSION: the behavior was resolve - Individual goes back in an early pattern of behavior - Solve an immature manner you are 21 suddenly you have temper tantrums h. IDENTIFICATION: imitating another person, attitude and feelings you see a 5 yr old daughter putting lipstick i. INTROJECTION: putting into one self putting the blame on self - Ex. Committing suicide j. ISOLATION: separate your feelings from the situation/emotions the cinema has drama everyone is crying suddenly you are laughing k. PROJECTION: escape goal - To throw it off

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Blaming other people for on e failure I failed ANA &pHYsio because my teacher is lazy RATIONALIZATION: give reason to avoid embarrassment COMMONLY USED REPRESSION: unconsciously forgetting unpleasant experiences SELECTIVE FORGETTING - Ex. DREAMS SPPRESSION: consciously forgetting unpleasant experiences - Voluntary forgetting - Intentional REACTION FORMATION: over compensation - Doing the opposite on how you feel(common in Hippocrates person) UNDOING: you made a mistake but you try to overcome by doing positive reaction SUBLIMATION: redirect your feelings into a socially acceptable manner You are hungry but you clean the house SUBSTITUTION: a replacement of an attainable goal you cannot buy MM, nips nalang the guywas busted by a girl and substitute to another girl

s. SYMBOLISM: giving meaning to an object when a guy was late for a date and give you a bouquet of roses t. DISSOCIATION: unconscious separation of certain parts of our personality of our personality - Alteration in the persons memory. Identity and consciousness. 4 Categories: 1. Psychogenic loss memeory but nothing is wrong in the brain cells - Disoriented PTT - Confuse 2. Fuged physical flight Person goes into a new place and assumed a new identity 3. Multi-disciplinary dissociative identity disorder(the person will have two or more personality) 4. Depersonalization: feeling of unreality of one self or simply means altered sense of self. I cannot feel two hands in my body

ADAPTIVE: Sublimation Rationalization Fantasy Compensation Identification Substitution Personality dev t: sum total of all your traits that makes you a unique person - To sound though I. Sigmund Freud father of modern psychiatrics Father of psychoanalysis

-Is a tx where in there is exploration of the unconscious mind -role of the unconscious conflict -development of maladaptive behavior conflicts happen during childhood 2 principles related to psychoanalysis 1. Free association: ask the client to talk anything under the sun no matter how irrelevant. 2. Dream analysis: productof the unconscious mind; every dream is meaningful

DIFFERENT THEORIES: 1. Dreams: meaningful 2. Libido: sexual desires - Represents amn s sexual desires and urgents - Our personality is developed because of libidiman striving that on every stage there is an area of gratification/satisfaction 3. Structure of our personality: ID, ego, superego 4. 3 levels of acre: most important is unconscious mind Psychosexual stage a. Oral 0-1 Yr Focus: mouth Enjoys: sucking, swallowing, crying, biting, thumb sucking, nailbiting, all ID, Narcissistic, dependent, distinguished the self from the mother - Developed sense of trust - RESIDUALS:over eating, over talkativeness/gossiping,smoki ng,chewing gums/alcohol b. Anal stage 1-3 yrs old

Focus: elimination both bowel/bladder - First developed is bowel because of bed wetting which is normal - Toilet training stage - Tempered tantrums - Sense of autonomy; developed by negativistic/stubborn; commonly abuse word NO - RESIDUALS: person is perfectionist very righteous person/meticulous -colectors/houders -compulsive cleaners OC c. Phallic 3-6 Focus:genitalias: girls penis envy boys castration fear - Developed gender identity(whether masculine/feminine) - Sense of iniative - Sense of masturbation - Genital exhibitionist - The use of imaginative playmate - Inquisitive(asking anything/why stage) - Oedipal(son to mother) - Electra(daughter to father)

RESIDUAL: sexual deviates(phedophiles, exhibitionism, vouerysm( d. Latency 6-12 Focus: school/fear - Competitive - Quiet stage bec. The sexual activities are redirect to school - Normal homosexual stage(affinity with the same sex - RESIDUAL: loner/withdrawn/no best friend e. Genital 12-18 Focus:genital(penis/vagina) - Heterosexual stage(opposite sex) - Developed sense of identity - Ambivalent feeling(wanted to become a child/adult) - Sense of identity9learn to plan for the future) - They know what they want - Self determination/ actualization - RESIDUALS: identity crisis

Jan. 20, 2011 Erick Erickson: Psychosocial Belived personality development 8 developmental tasks

d. Schooler 6-12 SO: teacher/peer INDUSTRY VS. INFERIORITY Competitive anxiety is developed Sense of mastery e. Adolescent 12-20 SO: opposite sex IDENTITY VS. ROLE CONFUSION Self- actualization gender identity Self-determination f. Young adult 20-40 SO: husband/wife/children INTIMACY VS ISOLATION

h. Late adulthood 60-death SO: husband/wife EGO INTEGRITY VS. DESPAIR Sense of worthiness useless Feel of death Feel unworthy Regrets

a. Infancy 0-18 mos Significant others: mother TRUST vS MISTRUST Loving/friendly suspicious Withdrawn Introvert Envious

NOTES: SUPER EGO developed: latency Begin: phallic ROLE identification developed in PHALLIC PIAGET Cognitive development - Ability to learn and think Divided into 4 stages a. SENSORY MOTOR 0-2 yr PRE VERBAL STAGE - Adapts environment/motor skills - Recognizes using senses - OBJECT PERMANENCE b. Pre operational 2-7 yrs old EDO CENTRIC (use language excessively)

b. Toddler 19 -3yr old Significant other: parents AUTONOMY VS. SHAME & DOUBT Independent overly compliant Self -direction Self- control c. Preschooler 3-6 yr old SO: family INIATIVE VS. Responsible Role- identification

Relationship unstable relationship Commitment Successful career g. Middle adult 40-60 SO: children/grand children GENERATIVE VS. STAGNATION Productive Creative self-center selfish

GUILT denial restriction

Can name objects but cannot classify them(ANIMISTIC THINKING) Self centered Give power and meaning to those objects The love to imitate adults

c. Concrete operational 7-14 CONCEPT OF CAUSE AND EFFECT - Developed logical thinking - Classify objects d. Formal operational 14 & above - Idealistic - Test hypothesis - Ego centric

ANXIETY
FEAR Presence of external nature you know what afraid you Afraid of the unknown There s apprehension Discomfort Uncertainty Anticipation

LEVELS OF ANXIETY a. Mild - normal 0 ATRAXIA (absence of anxiety) - Client is using drugs (shabu, marijuana..) 1-mild (alertness level) - Perception (perceived more, see more, hear more) - Aware in the environment - Rightly motivated - Thinking more - Comprehend more - Solve the problem - Normal level b. Moderate apprehension -reduction in perception - see less; hear less -selective in attention Physical symptoms: tachycardia, excessive sweating, frequent urination, diarrhea, dry lips. c. Severe/free floating anxiety -cannot perceived -cannot think -no learning - increase muscle tension d. Panic level (highest level) -personality disorganization -irrational thinking -terror/frightening

TREATMENT FOR SEVERE AND PANIC: anti-anxiety(minor tranquilizer) -valium -ativan(larazepam) -tranxine TRANQUILIZER - Emotional calmness - Relaxation 2 DIVISION: MINOR/ANXIOLYTIC (drug tolerance/dependent) - Reduce anxiety acting on the limbic system(emotional brain) Valium (Diazepam) Ativan (lorazepam) Tranxine (chlorazepine) Librium (chlordiazepoxide) Xanax (alprazolam) Serax (oxazepam) Equinil and miltown MAJOR/ANTI PSYCHOTIC EPS-affected the motor NEUROLEPTIC: reduce psychotic symptoms by decreasing dopamine level in the brain cells. - Dopamine antagonist

EPS conventional antipsychotic - Thoraxine (oldest) - Haldol (haloperidol) - Melaril (thiridaxine) - Prolixin medeate (fluphenazine) - Trilafon (perpherazine) ATYPICAL EPS Voluntary movements of the skeletal muscles

dopamine level that leads to TREMOR, rigidity of the extremities Snaffing gait/mask like face

Treatment: minor tranquilizer/ psychotheraphy PSYCHOSIS - Disturbance of the mind - Ego is unconscious level (no reality) -behavior is socially inappropeiate - Main sx.: pt. experience hallucination, delusions, illusions ex. schizophrenia, bi polar disorder Treatment: major tranquilizer, ECT, psychotheraphy ANXIETY RELATED DISORDER

Clorazil (clozapine) Reperdol ( resperidone) Zyprexa (olanzepine)

4. Tardive dyskinesia - Irreversible EPS - Affect the muscle and the face - Lips(involuntary kissing, smacking, chewing) - Eyes(involuntary blinking) - Tongue(involuntary licking, worm like) ANTI PARKINSONIANS DRUG - Drugs to reduce EPS except for the tardive dyskinesia Drugs given: Arhane (trihexyphenidyl) Akineton (biperidime Congentin(benzotropine) NON PSYCHOTIC

1. -

4 types: 1. Dystonia: earliest - 1 5 days after receiving a drug - Muscle contracted: occulo gyric, stiff neck, opisthotonus 2. Akatesia: common - Motor restlessness - Cannot sit still - FOOT TAPPING 3. Parkinsonism: - Degenerative condition - Degeneration of the vaso ganglia that result to decrease

phobia (unirrational fear of harmless object/ situation) aware DM: isolation/displacement

NEUROSIS - maladaptive - ego is conscious (individual has reality) - the behavior is socially acceptable - main symptoms: Anxiety Ex. Phobia, OC

Types: a. Agoraphobia: fear of being alone b. Social phobia (fear of situation where people are present like eating in restaurant c. Simple phobia(specific phobia) - Claustrophobia close phobia - Acrophobia height 2. Obsessive Compulsive Obsession recurrent of unwanted thoughts/ideas/feelings

Compulsion ritualistic behavior desire to do an action repeatedly Ex. Obsession: cleanliness due to contamination, guilt feelings, suicidal/ sexual thoughts Murder of hand washing ritual (fixated at the anal stage brought about Strict toilet training) DM: undoing/symbolism Guilt

The patient only experience that anxiety after they experience traumatic events like rape, torture, calamities, war Manifestation: nightmare -recurrent dreams -change in sleep Pattern -develop insomnia -flash backs -aloof/withdrawn -violent NURSING MANAGEMENT: Provide the pt. safe environment Assure the client Treatment: environmental changes systematic desensitization (gradual exposure) in systematic desensitization the client is ask: to tell the story of the event repeatedly until it will not cause anxiety -to watch a movie related to traumatic event repeatedly

5.

Panic disorder Acute anxiety lasting for seconds, minutes, hours.. -sudden onset -anxiety reaction Physical symptoms: SOMATOFORM Manifested by physical symptoms Real No organ pathologic (physical symptoms are real but no medical evidence They have history of visiting doctor shouting Frequent visit doctors and try all cures Not sick Sx are inconsistent Ex. The pt complains of neurologic sx. And one set of sx. -complains paralysis, blindness, deafness, seizure but there is no findings

Dominant: Super ego NSG. CONSIDERATION: - Allow them to do the ritual - Lear to accept their ritual - Provide them a privacy - Set limit on the ritual because some ritual can be harmful How: provide the client social & physical activities to divert attention; make the client busy or provide a schedule - St limit to reduce of anxiety - Let the client verbalize and remove stressor. 3. Post- traumatic stress disorder -

4.

Generalized anxiety Disorder Chronic anxiety (it had been there for 6 months)

KINDS: 1. Tics: involuntary movement - Spasms: painful muscle contraction

They enjoy the sx. Called label indifference (lack of concern to the physical symptoms 2. Hypochondriasis: the client id preoccuopied with the physical sx - They have fear of having serious illness - They exaggerated their physical sx. 3. Body dysmorphic: with body defect NSG. MANAGEMENT: - Never ask the patient how are you? - Always put the patient in a private room, never put them with another patient NOT: when you remove the stressor, you relieved the sx. PHYSIOLOGIC DISORDERS - Sx consistent - Sick - Real - There is an organ pathologis test where done - There is a management basis - Life threatening which require surgery - Common among women with a type A - Suffers different oragn of the body

a. Nervous system: migraine, headache, seizures b. Cardiovascular: MI/ hypertension c. Respiratoty: asthma d. GIT: peptic ulcer, gastritis, colitis, diarrhea e. Genito urinary: dysmenorrhea;impotent f. Integumentary: allergy, eczema, dermatitis, pruritis, rashes g. Musculo skeletal:arthritis, muscle cramps, back aches h. Endocrine:diabetes mellitus, hyperthyroidism NSG management: they must learn to follow the medical treatment NOTE: relieve the symptoms before you relieve the anxiety MALINGERING: when the physical symptoms presented is unreal, whenthey pretend

February 09, 2011 Substance abuse disorders DRUG ADDICTION (ORAL) DM: denial and projection Criteria: chronic disorder Overwhelming desire to take drug(habit forming) Withdrawal symptoms appear 812 hours after the last dose and peak 36-12 hours and disappear 36-72 hours Ex. Tremors, restlessness, nervousness, sleepness, muscle twitching, excessive sweating, dilated pupils Later part: convulsion, fever, tachycardia Physical dependents Psychological dependence Drug tolerance Relapsing after detoxification

1. 2.

Ex. Demerol, morphine sulfate, herdin, opium, codein, methadol 2. Sedatives: sleeping pills a. Barbiturates (phenobarbital) b. Secobarbital (seconab) c. Non barniturates (sinox 3. Tranquilizers: calmness: non emotional relaxation 4. Volatile substance: called solvents II. Stimulant/appers/denies/spee d pills/pep-pills: insomnia; hyperactivity a. Methamphetamines shabu b. Cocaine/coke/snow c. Amphetamines: diet pills Ex benzindrine, dexidrin, methergin Hallucinogens: produce hallucination a. Marijuana (cannabis sativa) b. LSD c. Phencyclidine

ALCOHOL CNS depressant in large amount that we cannot tolerate Impairs the function of the cerebral cortex (the person is disoriented, confuse, intellectual capacity down) Forms: beer, wine, liquior Overcome inferiority/inhibitions Fluid and electrolytes imbalance o Improve nutritional satus

3. 4. 5. 6.

III.

Classification: I. Depressants/downers/ Rainbows 1. Narcotics :use to relieve pain - Opiate/opiods

TREATMENT: detoxification & rehabilitation