PSYCHIATRIC NURSING

By Jason Arellano

PSYCHOSOCIAL INTEGRITY

COPING AND ADAPTATION

MENTALLY HEALTHY INDIVIDUALATTITUDE OF SELF ACCEPTANCEAUTONOMYABILITY TO ABSTRACT,TRUST ,COPE

WITH STRESSACCURATE SELF PERCEPTIONAWARENESS OF SELF

MENTAL HEALTH – balance in a persons internal life and adaptation to reality

Mental ILL Health – state of imbalance characterized by a disturbance in a persons thoughts, feelings and behaviorPoverty and abuses are major risk factorsPsychiatric nursing – interpersonal process whereby the professional nurse practitioner ,through the therapeutic use of self(art) and nursing theories (science), assist clients to achieve psychosocial well being.Core of psych nursing – interpersonal process – human to human relationship(both for mentally healthy and ill)

Neurosisany long term mental or behavioral d/o in which contact with reality is retained the condition is recognized by the patient as abnormal. Essentially features anxiety or behavior exaggerated designed to avoid anxiety

( anxiety d/o ; hysteria to conversion d/o, amnesia, fugue,multiple personality and depersonalization- dissociative d/o;oc d/o)

Result of inappropriate early programming(psychoanalysis little value)

Benefits from Behavior Therapy

Psychosis

Mental or behavioral disorder wherein patient looses contact with realityPresence of delusions, hallucinations, severe thought disturbances, alteration of mood, poverty of thought and abnormal behavior(schizophrenia , major disorder of affect ( mania – depression), major paranoid states and organic mental disorderBenefits from psychoanalysis and antipsychotics

Mental hygiene – measures to promote mental health , prevent mental illness and suffering and facilitate rehabilitation…….(and if necessary find meaning in these experiences)Main tool – therapeutic use of selfIt requires self-awarenessMethods to increase self-awareness:

IntrospectionDiscussionExperienceRole play

Mental health concepts

Assessment

(psychosocial processes )Appearance , behavior or mood

Speech , thought content and thought process

Sensorium

Insight and judgement

Family relationships and work habits

Level of growth and development

Common Behavioral Signs and Symptoms

1) Disturbances in perception Illusion- misinterpretation of an actual

external stimuli Hallucinations – false sensory

perception in the absence of external stimuli

2) Disturbances in thinking and speech neologism – coining of words that people do

not understand Circumstantiality – over inclusion of

inappropriate thoughts and details Word salad – incoherent mixture of words and

phrases with no logical sequence Verbigeration – meaningless repetition of

words and phrases Perseveration – persistence of a response to a

previous question Echolalia – pathological repetition of words of

others Aphasia – speech difficulty and disturbance

Expressive , receptive or global

Flight of ideas- shifting of one topic from one subject to another in a somewhat related way

Looseness of association- incoherent ,illogical flow of thoughts(unrelated way)

Clang association – sound of word gives direction to the flow of thought

Delusion – persistent false belief,rigidly held Delusions of grandeur- special /important in a way Persecutory-threatened Ideas of reference- situation/events involve them Somatic- body reacting in a particular way

Magical thinking – primitive thought process thoughts alone can change events

Autistic thinking – regressive thought process-subjective interpretations not validated with objective reality

3) Disturbances of affect Inappropriate – disharmony between the

stimuli and the emotional reaction Blunted affect – severe reduction in

emotional reaction Flat affect – absence or near absence of

emotional reaction Apathy – dulled emotional tone Depersonalization – feeling of strangeness

from one’s self Derealization – feeling of strangeness

towards environment Agnosia – lack of sensory stimuli integration

4) Disturbances in motor activity Echopraxia – imitation of posture of others Waxy flexibility – maintaining position for a

long period of time Ataxia – loss of balance Akathesia – extreme restlessness Dystonia- uncoordinated spastic movements

of the body Tardive dyskenisia – involuntary twitching or

muscle movements Apraxia – involuntary unpurposeful

movements

5) Disturbances in memory Confabulation – filling of memory gaps Déjà vu – 2nd time-like feeling Jamais vu- not having been to the place

one has been before Amnesia – memory loss (inability to

recall past events) Retrograde-distant past Anterograde – immediate past Anomia – lack of memory of items

Dynamics of Human Behavior

Behavior – the way an individual reacts to a certain stimulusConflict – situation arising from the presence of two opposing drivesNeed - organismic condition that requires a certain activityStress – life events in which a demanding situation (warrants a response )taxes a person’s resources( support systems or coping mechanisms/strategies…distress and eustressAdaptation – process of interacting with the environment to maintain homeostatic equilibriumMaladaptation – ineffective coping

Dynamics of Human Behavior

Personality – integration of systems and habits representing anindividuals characteristic adjustment to his environment expressed through behavior

Individualistic, unique, predictable(stability and consistency)

Determinants: psychological,cultural, biological ( not inhereted) and familial

Analysis

Potential support systems or stressors

Potential risk factor

Satisfaction of human needsPhysiological(oxygen , fluids, nutrition, temp.,elimination,shelter,rest,sex)

Safety and security(physical and psychological)

Love and belongingness

Self esteem

Self -actualization

3 divisions of the mind

Conscious – focussed on awareness

Subconscious – recalled at will

Unconscious – never recalled / largest part

Learning – change in behavior through – insight , relearning and remotivation

Theories of personality development

PsychosexualPsychosocialCognitiveDevelopmental tasksMoralInterpersonal

Freuds psychosexual theory

Libido – inner driveParts of body –focus of gratificationUnsuccesful resolution - fixationStructures of personality

Id – pleasure principle-instinct

Ego – controls action and perception –reality principle

Superego – moral behavior - conscience

0-18 m0s ;oral – mouth – trust and discriminating

18 mos. – 3 years ; anal – bowels – holding on or letting go

Negativism and toilet training age

3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual tension)

Gender identification and genital awareness

Oedipus and Electra complex //

Castration anxiety and penis envy

6-12 years –latency (quiet stage) sexual energy diverted to play. Institution of superego…control of instinctual impulses

12 – young adult – genital ; reawakening of sexual drives –relationships

Sexual maturation

Sexual identity ,ability to love and work

Psychosocial – Ericksondevelopmental milestones //delay

0-12mos; TRUST

1-3y AUTONOMY

3-6 INITIATIVE

6-12 INDUSTRY

12-18 IDENTITY

18-25 INTIMACY

25-60 GENERATIVITY

60 and above EGO INTEGRITY

INFANCY

CONSISTENT MATERNAL –CHILD INTERACTION – TRUST

INNER FEELING OF SELF WORTH

HOPE

TODDLER

ALLOW EXPLORATIONPROVIDE FOR SAFETY

NO NO – NEGATIVISMOFFER CHOICES / REVERSE PSYCHOLOGYTOILET TRAINING – 18 MOS.-BOWEL

DAYTIME BLADDER -2 YNIGHTIME BLADDER 3 Y

REWARD W/ PRAISE AND AFFECTION

INDEPENDENCE

PRE-SCHOOL

PROVIDE PLAY MATERIALS

SATISFY CURIOSITY

TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR)

SIBLING RIVALRY

WILLPOWER

SCHOOL AGE

HOW TO DO THINGS WELL-SUPPORT EFFORTS

CHUMS AND HOBBIES

NEEDS TO EXCEL/ACCOMPLISH

NEED FOR PRIVACY AND PEER INTERACTION

COMPETENCE

ADOLESCENCE

MAKE DECISION,EMANCIPATION FROM PARENTS

BODY IMAGE CHANGES

NEED TO CONFORM BUT KEEP INDIVIDUALITY

SELF - AWARENESS

YOUNG ADULT

COMMITMENT AND FIDELITY

RESPONSIBILITY

ACHIEVEMENT OF INDEPENDENCE

MIDDLE ADULTHOOD

SUPPORT-PERIOD OF ROLE TRANSITIONSMIDLIFE CRISIS

ADJUSTMENT AND COMPROMISE

MOST PRODUCTIVE AND CREATIVE

ALTRUISM

LATE ADULTHOOD

SELF ACCEPTANCE

SELF WORTH

WISDOM

PIAGET’S COGNITIVE THEORY

0-2 SENSORIMOTOR

REFLEXES

IMITATIVE REPETITIVE BEHAVIOR

SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT.

TRIAL AND ERROR RESULTS IN PROBLEM SOLVING

2-7Y PRE-OPERATIONAL

SELF-CENTERED,EGOCENTRIC

CANNOT CONCEPTUALIZE OTHER’S VIEW

ANIMISTIC THINKING

IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY

2-4 PRE-CONCEPTUAL (PRE-LOGICAL)

4-7 INTUITIVE (UNDERSTANDING OF ROLES)

7-12Y CONCRETE OPERATIONAL

LOGICAL CONCRETE THOUGHT

INDUCTIVE RESAONING (SPECIFIC TO GENERAL)

CAN RELATE ,PROBLEM SOLVING ABILITY

REASONING AND SELF-REGULATION

12-ABOVE FORMAL OPERATIONAL THOUGHT

Abstract thinking

Separation of fantasy and fact

Reality oriented

Deductive reasoning

Apply scientific method

Havighurst

Developmental Tasks

Early adulthoodCareerSelecting a mateFinding Civic or social responsibility

Middle ageAchieving Civic or social responsibilityAdjusting to changesSatisfactory career performanceAdjusting to aging parentsAdjusting to parental roles

Old ageAdjusting to changesEstablishing satisfactory living arrangements and affiliations

Baby to early childhood Right from wrong and Conscience

Late childhoodPhysical skills,wholesome attitude,social rolesConscience morality and valuesFundamental skills in academicsPersonal independence

AdolescenceSexual social rolesRelationshipsIndependence and ideology

Kohlbergs’

MORAL DEVELOPMENT THEORY

PRE-CONVENTIONAL (0-6)PUNISHMENT AND OBEDIENCEOBEDIENCE TO RULES TO AVOID PUNISHMENT

CONVENTIONAL ( 6-12 )MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITYSOCIAL SYSTEM AND CONSCIENCE MAINTENANCEBEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE

POST –CONVENTIONAL (12 – 18 Y)PRIOR RIGHT OR SOCIAL CONTRACTUNIVERSAL ETHICAL PRINCIPLEABIDE FOR COMMON GOODRATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEMINNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS

SULLIVANSINTERPERSONAL THEORY

INFANCY

NEED FOR SECURITY-INFANT LEARNS TO RELY ON OTHERS TO GRATIFY NEEDS AND SATISFY WISHES, DEVELOPS A SENSE OF BASIC TRUST, SECURITY AND SELF WORTH WHEN THIS OCCURS

TODDLERHOOD / EARLY CHILDHOOD

CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION AND INTERFERENCE OF WISH FULFILLMENT

PRE-SCHOOL

DEVELOPMENT OF BODY IMAGE AND SELF-PERCEPTIONORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL AND DISAPPROVAL RECEIVEDBEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES THOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN

SCHOOL AGE

THE PERIOD OF LEARNING TO FORM SATISFYING RELATIONSHIPS WITH PEERS-USES COMPETITION,COMPROMISE AND COOPERATION

THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE SAME SEX

ADOLESCENCE

LEARNS INDEPENDENCE AND HOW TO ESTABLISH SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE OPPOSITE SEX

YOUNG ADULTHOOD

BECOMES ECONOMICALLY, INTELLECTUALLY AND EMOTIONALLY SELF SUFICIENT

LATER ADULTHOOD

LEARNS TO BE INTERDEPENDENT AND ASSUMES RESPONSIBILITY FOR OTHERS

SENESCENCE

DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY

FORMATION OF PERSONALITY

CERTAIN GOALS MUST BE ACCOMPLISHED, IF THIS GOALS ARE NOT ACCOMPLISHED AT A CERTAIN STAGE,….PERSONALITY WILL BE WEAKENED….FACTORS IN EACH STAGE PERSISTS AS A PERMANENT PART OF PERSONALITY….

EACH STAGE HAS MAJOR TRAUMAS AND FRUSTRATIONS THAT MUST BE OVERCOME

…….SUCCESSFUL RESOLUTION OF CONFLICTS ASSOCIATED WITH EACH STAGE IS ESSENTIAL TO DEVELOPMENT…..UNRESOLVED CONFLICTS REMAIN IN THE UNCONSCIOUS AND MAY, AT TIMES, RESULT IN MALADAPTIVE BEHAVIOR

Maraming Salamat Po…

Saglit lang Sir…my ititxt lang ako