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1. PSYCHIATRIC NURSING 2. 3.

Mental Health A state of emotional, psychological and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept and emotional stability. 4. COMPONENTS OF MENTAL HEALTH Autonomy and Independence - can work interdependently without losing autonomy Maximization of Ones Potentialoriented towards growth and self-actualization Tolerance of Lifes Uncertaintiescan face the challenges of day-to-day living with hope & positive look Selfesteem- has realistic awareness of her abilities and limitations Mastery of the Environment- can deal with and influence the environment Reality Orientationcan distinguish the real world from a dream, fact from fantasy 5. MENTAL ILLNESS - State of imbalance characterized by a disturbance in a persons thoughts, feelings and behavior 6. Criteria to Diagnose Mental Disorders Dissatisfactions with ones characteristics, accomplishments, abilities Ineffective or dissatisfying relationships Dissatisfaction with ones place in the world Ineffective coping with lifes events Lack of personal growth 7. PSYCHIATRIC NURSING Interpersonal process whereby the nurse through the therapeutic use of self assist an individual family, group or community to promote mental health, to prevent mental illness and suffering, to participate in the treatment and rehabilitation of the mentally ill and if necessary to find meaning in these experiences 8. CORE OF PSYCHIATRIC NURSING Interpersonal relationship FOCUS: Patient 9. Foundation Central Nervous System Cerebrum Frontal lobe control organization of thought, body movement, memories, emotions and moral behavior. Associated with schizophrenia, attention deficit / hyperactive disorder and dementia Parietal lobe interpret sensations of taste and touch and assist is spatial orientation . 10. Foundation Central Nervous System Temporal lobes are centers for the sense of smell, hearing, memory, and expression of emotions. Occipital lobes assist in coordinating language generation and visual interpretation, such as depth perception.

11. Neurotransmitters Dopamine- controls complex movements, motivation, cognition, regulates emotional responses Serotonin- regulation of emotions, controls food intake, sleep and wakefulness, pain control, sexual behaviors Acetylcholine- controls sleep and wakefulness cycle (decreased in Alzheimers) Histamine- controls alertness,peripheral allergic reactions, cardiac stimulations GABA- modulates other neurotransmitters Norepinephrine / Epinephrine- causes changes in attention, learning and memory, mood 12. Foundation Neurotransmitters Sympathetic Parasympathetic Increase v/s Decrease v/s Decrease GI motility Increase GI motility Decrease GU function Increase GU function Moist mouth Dry mouth 13. Genetics and Hereditary Alzheimers disease linked with defects in chromosomes 14 and 21 Schizophrenia Mood disorders (depression) Autism and AD/HD 14. Sigmund Freud Father of Psychoanalysis - Your behavior today is directly or indirectly affected by your childhood days or experiences. - STRUCTURE Personality Structure 15. Personality Structure ID ( 4-5MONTHS) Impulsive / Instinctual drive I want to PLEASURE PRINCIPLE I want to PHYSIOLOGIC NEEDS I want to PRIMARY PROCESS 16. Personality Structure SUPEREGO Should not Small voice of GOD Set norms, standards and values MORAL PRINCIPLE Conscience 17. Personality Structure EGO Executive REALITY PRINCIPLE Conscious Competencies Decision Maker; Problem-Solving; Critical and Creative thinking 18. Imbalances between Personality Elements ID SE M anic A nti-social N arcissistic 19. Imbalances between Personality Elements ID SE O bsessive Compulsive A norexia nervosa 20. Imbalances between Personality Elements EGO Schizophrenia 21. Libido Sexual energy responsible for survival of human beings Psychosexual Theory of Freud 22. ORAL STAGE 18 months Cry, suck, mouth EGO @ 6 months Child cries fed successful Child cries ignored unimportant - narcissistic

23. FIXATION occurs when a person is stuck in a certain developmental stage 24. REGRESSION Returning to an earlier developmental stage Infantile behavior 25. ANAL STAGE 18 months 3 years old SUPEREGO develops Toilet training Good Mother Normal Bad Mother Clean, organized, obedient OC (anal retentive) Dirty, disorganized Anti-social (anal expulsive) 26. PHALLIC STAGE Preschooler (3 6 years old) Parent Oedipus Complex Castration Fear Electra Complex Penis Envy 27. REPRESSION UNCONSCIOUS forgetting of an anxiety provoking concept 28. SUPRESSION CONSCIOUS forgetting of an anxiety provoking situation 29. IDENTIFICATION attempts to resemble or pattern the personality of a person being admired of 30. INTROJECTION acceptance of another values and opinion as ones own 31. LATENCY STAGE 6 to 12 years old School Reading, writing, arithmetic Ability to care about and relate to others outside home 32. SUBLIMATION placing sexual energies toward more productive activities 33. SUBSTITUTION replace a goal that cant be achieved for another that is more
realistic. 34. GENITAL STAGE 12 years old and above Developing satisfying sexual and emotional relationships with members of the opposite sex Planning lifes goals 35. EGO DEFENSE MECHANISMS Function-To ward off anxiety *without defense mechanisms, anxiety might overwhelm and paralyze us and interfere with daily living 2 Features: 1. 1. they operate on an unconscious level (Except suppression) 2. 2. they deny, falsify or distort reality to make it less threatening 36. EGO DEFENSE MECHANISMS Repression vs. Suppression REPRESSION Unconscious forgetting of an anxiety provoking concept SUPRESSION Conscious forgetting of an anxiety provoking situation 37. EGO DEFENSE MECHANISMS Regression vs. Fixation Regression Returning to an earlier developmental stage Fixation occurs when a person is stuck in a certain developmental stage 38. EGO DEFENSE MECHANISMS Rationalization vs. Intellectualization RATIONALIZATION Selfsaving with incorrect illogical explanation INTELLECTUALIZATION Excessive use of abstract thinking; technical explanation

39. EGO DEFENSE MECHANISMS Displacement vs. Projection vs. Introjection DISPLACEMENT Feelings are transferred or redirect to other person or object that is less threatening PROJECTION Blaming; Falsely attributing to another his/her own unacceptable feelings. INTROJECTION Acceptance of anothers values and opinions as ones own 40. EGO DEFENSE MECHANISMS Sublimation vs. Substitution SUBLIMATION Transfer of sexual energy to a more productive activity. SUBSTITUTION Replaces a goal that cant be achieved for another that is more realistic. 41. EGO DEFENSE MECHANISMS Dissociation vs. Isolation DISSOCIATION Separating and detaching idea, situation from its emotional significance. ISOLATION Individual strips emotion when talking or responding about it. 42. EGO DEFENSE MECHANISMS Conversion Anxiety converted to physical symptoms Compensation Overachievement in one area to overpower weaknesses or defective area. Undoing Doing the opposite of what have done 43. EGO DEFENSE MECHANISMS Denial Failure to acknowledge an unacceptable trait or situation Fantasy Magical thinking Reaction Formation Opposite of intention 44. EGO DEFENSE MECHANISMS Acting out Deals with emotional conflict or stressors by ACTION rather than reflection or feelings. Symbolization Creates a representation to an anxiety provoking thing or concept Splitting Labile emotions; all bad all good 45. DEFENSE MECHANISMS COMMONLY USED IN EACH RESPECTIVE DISORDERS Paranoid Projection Phobia Displacement Amnesia Dissociation Anorexia Supression Bipolar Disorder Reaction Formation Borderline Splitting Schizophrenia Regression Substance Abuse Denial Depression Introjection OC Undoing Catatonic - Repression 46. Woman who is angry with her boss writes a short story about a heroic woman. 47. Woman who is angry with her boss writes a short story about a heroic woman. 48. Four-year old with new baby brother starts sucking his thumb and wanting a bottle. 49. Patient criticizes the nurse after her family failed to visit. 50. Man who is unconsciously attracted to other women teases his wife about flirting 51. Short man becomes assertively verbal and excels in business. 52. Recovering alcoholic constantly preaches about the evils of drink. 53. Man reacts to news of the death of a loved one No, I dont believe you. The doctor said he was fine. 54. Student is unable to take a final exam because of a terrible headache. 55. After flirting with her male secretary, a woman brings her husband tickets to a show. 56. I didnt get the raise because my boss doesnt like me. 57. Five-year old girl dresses in her mothers shoes and dress and meets daddy at the door.

58. After his wifes death, husband has transient complaints of chest pain and difficulty breathingthe symptoms his wife had before she died 59. Man forgets wifes birthday after a marital fight. 60. Businessman who is preparing to make an important speech that day is told by his wife that morning that she wants a divorce. Although visibly upset, he puts this incident aside until after his speech, when he can give the matter his total concentration. 61. A man cannot accept his physician's diagnosis of cancer is correct and seeking a second opinion 62. slamming a door instead of hitting as person, yelling at your spouse after an argument with your boss 63. focusing on the details of a funeral as opposed to the sadness and grief 64. stating that you were fired because you didn't kiss up the the boss, when the real reason was your poor performance 65. having a bias against a particular race or culture and then embracing that race or culture to the extreme 66. sitting in a corner and crying after hearing bad news; throwing a temper tantrum when you don't get your way 67. forgetting sexual abuse from your childhood due to the trauma and anxiety 68. lifting weights to release 'pent up' energy 69. Erik Erickson Psychosocial Theory of Development 70. PSYCHOSOCIAL THEORY Eriksons 0-18 mos. T rust vs. M istrust -attachment to mother which lays foundations for later trust in others -conflict: general difficulties relating to others. suspicion, fear of the future 71. PSYCHOSOCIAL THEORY Eriksons 18 m0s 3 yrs A utonomy vs. S hame/Doubt Gaining some basic control of self and environment Conflict: independence-fear conflict, severe feelings of self-doubt 72. PSYCHOSOCIAL THEORY Eriksons 3 yrs 6 yrs I nitiative vs. G uilt -becoming purposeful and directive -conflict: aggression-fear conflict; sense of inadequacy and guilt 73. PSYCHOSOCIAL THEORY Eriksons 6 yrs 12 yrs Industry vs. Inferiority Developing social, physical and school skills, competence Conflict: sense of inferiority; difficulty learning and working 74. PSYCHOSOCIAL THEORY Eriksons 12 yrs 20 yrs Identity vs. Role Diffusion Making transition from childhood to adulthood; developing a sense of identity Conflict: confusion of who one is, identity submerged in relationships or group memberships 75. PSYCHOSOCIAL THEORY Eriksons 21 yrs 35 yrs Intimacy vs. Isolation -establishing intimate bonds of love and friendship -conflict: emotional isolation

76. PSYCHOSOCIAL THEORY Eriksons 35 yrs 55 yrs Generativity vs. Stagnation -fulfilling lifes goals that involve family, career and society, developing concerns that embrace future generations conflict: self-absorption. Inability to grow as a person 77. PSYCHOSOCIAL THEORY Eriksons 55 yrs above Integrity vs. Despair Looking back into ones life and accepting its meaning Conflict: dissatisfaction with life, denial of or despair over prospect of death 78. Jean Piaget Cognitive Theory of Development 79. assimilation people transform incoming information so that it fits within their existing schemes or thought patterns 80. accommodation people adapt their schemes to include incoming information 81. PIAGETS COGNITIVE THEORY SENSORIMOTOR STAGE - development proceeds from reflex activity to representation and sensorimotor solutions to problems 0 to 18 months PREOPERATIONAL STAGE- development proceeds from sensorimotor representation to prelogical thought and solutions to problems can use these representational skills only to view the world from their own perspective. Understand the meaning of symbolic gestures 2 to 7 years 82. CONCRETE OPERATIONAL- development proceeds from prelogical thought to logical solutions to concrete problems understand concrete problems cannot yet contemplate or solve abstract problems 7 to 12 years FORMAL OPERATIONAL- development proceeds from logical solutions to concrete problems to logical solutions to all classes of problems cannot yet contemplate or solve abstract problems can also reason theoretically 12 and above 83. Harry Stack Sullivan Interpersonal Theory 84. SULLIVANS INTERPERSONAL THEORY Infancy- anxiety develops as a result of unmet needs by the mother (bodily needs ); needs met, the child has sense of well-being 0 to 18 months Childhood- anxiety as a result of lack of praise/acceptance from parents -gratification leads to positive self-esteem - moderate anxiety leads to uncertainty and insecurity; - severe anxiety results in self-defeating patterns of behavior 18 months to 6 years Juvenile- severe anxiety may result in a need to control or restrictive, prejudicial attitudes -learns to negotiate own needs 6 to 9 years 85. Pre-adolescence - capacity to attachment, love and collaboration emerges or fails to develop move to genuine intimacy with friend of the same sex 9 to 12 years Adolescence- if self-system is intact, areas of concern expand to include values, career decisions and social concerns -lust is added to interpersonal equation -need for special sharing relationship shifts to opposite sex -new opportunities for social experimentation lead to consolidation or self-ridicule 12 to adulthood 86. Hildegard Peplau Nurse Patient Relationship 87. PEPLAUS NPR PRE-INTERACTION Major task of nurse- to develop self-awareness ORIENTATION Major task of the nurse: to develop a mutual acceptable contract WORKING Major task: identification and resolution of patients problem TERMINATION Major task: to assist the patient to review what he has learned and transfer his learning to his relationship with others 88. THERAPEUTIC COMMUNICATIONS ORIENTATION Broad Opening Recognition Giving information Silence Offering Self Do you want me to sit beside you? 89. THERAPEUTIC COMMUNICATIONS WORKING Focusing Let us discuss this topic more. Exploring Tell me more about it. Encourage Evaluation IS this what you want? Reflecting

same idea Restating same statement Verbalizing Implied Are you going to kill yourself? Seeking Clarification May you please repeat that statement General lead Please continue.; And then? Limit setting Stop. Interpreting Maybe that thing is very significant to you.

90. THERAPEUTIC COMMUNICATIONS TERMINATION Summarizing Let us now sum up. You have stated earlieretc. Do you have any questions? Our next therapy Look for changes in behavior Resistance is a common problem 91. Therapeutic Communication Techniques Accepting-indicating reception Eg.Yes I follow what you said Nodding.. 92. Broad Openings Allowing the client to take the initiative in introducing the topic Eg. is there something youd like to talk about? Where would you like to begin? 93. Consensual Validation Searching for mutual understanding, for accord in the meaning of the words Eg. Tell me whether my understanding of it agrees with yours Are you using this word to convey that. . .? 94. Encouraging Comparison Asking that similarities and differences be noted Eg. was it something like..? Have you had similar experiences? 95. Encouraging Description of Perceptions Asking the client to verbalize what he or perceives Eg.Tell me when you feel anxious What is happening? What does the voice seem to be saying? 96. Encouraging Expression Asking client to appraise the quality of his or her experience Eg. what are your feelings in regard to..? Does this contribute to your distress? 97. Exploring Delving further into a subject or idea Eg. Tell me more about that. Would you describe it more fully? What kind of work? 98. Focusing Concentrating on a single point Eg. This point seems worth looking at more closely Of all the concerns youve mentioned, which is most troublesome? 99. Formulating a Plan of Action -Asking the client to consider kinds of behavior likely to be appropriate in future situations Eg. What could you do to let your anger out harmlessly? Next time this comes up, what might you do to handle it? 100. General Leads Giving encouragement to continue Eg. Go on And then? Tell me about it 101. Giving Information Making available the facts that the client needs Eg. My name is Visiting hours are My purpose in being here is 102. Giving Recognition Acknowledging, indicating awareness Eg. Good morning, Mr. S Youve finished your list of things to do. I noticed that youve combed your hair 103. Making Observations Verbalizing what the nurse perceives Eg. You appear tense.. I notice that your biting your lips 104. Offering Self Making oneself available Eg. Ill sit with you awhile Ill stay here with you Im interested in what you think 105. Placing Event in Time or Sequence Clarifying the relationship of events in time Eg. what seemed to lead up to? Was this before or after?

106. Presenting Reality Offering for consideration that which is real Eg. I see no one else in the room. Your mother is not here; I am a nurse. 107. Reflecting Directing client actions, thoughts, and feelings back to client Eg. Client: Do you think I should tell the doctor? Nurse: Do you think you should? 108. Restating Repeating the main idea expressed Eg. Client: I cant sleep. I stay awake all night. Nurse:You have difficulty sleeping. Client:Im really mad, and upset Nurse: Youre really mad and upset. 109. Seeking Information Seeking to make clear that which is not meaningful or that which is vague Im not sure that I follow. Have I heard you correctly? 110. Silence Absence of verbal communication, which provides time for for the client to put thoughts or feelings into words, regain composure, or continue talking Eg. Nurses says nothing but continues to maintain eye contact and conveys interest. 111. Suggesting Collaboration Offering to share , to strive, to work with the client for his or her benefit Eg. Perhaps you and I can discuss and discover the triggers for your anxiety 112. Summarizing Organizing and summing up that which has gone before Eg. Have I got this straight? 113. Translating into Feelings seeking to verbalize clients feelings that he or she expresses only indirectly Eg. Client: Im dead Nurse: Are you suggesting that you feel lifeless? 114. Verbalizing the Implied Voicing what the client has hinted at or suggested Eg. Client: I cant talk to you or anyone. Its a waste of time. Nurse: Do you feel that no one understands 115. Voicing Doubt Expressing uncertainty about the reality of the clients perceptions Isnt that unusual? Really? Thats hard to believe. 116. Nontherapeutic Communication Techniques Advising-telling the client what to do Agreeingindicating accord with the client Eg. I think you should. Thats right 117. Agreeing Indicating accord with the client thats right. I agree 118. Belittling Feelings expressed Misjudging the degree of the clients comfort Client: I have nothing to live for..I wish I was dead Nurse: Everybody gets down in the dumps. 119. Challenging Demanding proof from the client But how can you be President of the Philippines? 120. Defending Attempting to protect someone or something from verbal attack This hospital has a fine reputation. 121. Disagreeing Opposing the clients ideas Eg. Thats wrong 122. Disapproving Denouncing the clients behavior or ideas Thats bad Id rather you wouldnt 123. Giving approval Sanctioning the clients behavior or ideas Thats good. Im glad that.. 124. Giving Literal Responses Responding to a figurative comment as though it were a statement of fact Client: Theyre looking in my head with television camera. Nurse: Try not to watch television.

125. Indicating the existence of an external source What makes you say that? 126. Interpreting Asking to make conscious that which is unconscious What you really mean is.. 127. Introducing an unrelated topic Changing the subject Client: Id like to die. Nurse: did you have visitors last night? 128. Making stereotyped comments Offering meaningless cliches or trite comments Keep your chin up. Just have a positive outlook. 129. Probing Persistent questioning of the client Now tell me about this problem. I need to know. 130. Reassuring Indicating there is no reason for anxiety Everything will be alright. 131. Rejecting Refusing to consider or showing contempt for the clients behavior, ideas Lets not discuss.. 132. Requesting an explanation Asking the client to provide reasons for thoughts, feelings, behaviors, events Why do you think that? 133. Testing Appraising the clients degree of insight Do you know what kind of hospital this is? 134. Using Denial Refusing to admit that a problem exists Client: I am nothing. Nurse: Of course, youre something. 135. NON-THERAPEUTIC COMMUNICATIONS Overloading blah, blah, blah Underloading ignoring Value Judgment use of adjectives False Reassurance Dont worry, you will be fine later. Focusing on Self I gave you meds so you are now feeling good Incongruence - Internal Validation biased judgment Giving Advice If I were you, ill Changing Subject 136. LOSS AND GRIEVING 137. GRIEF- refers to the subjective emotions and affect that are a normal response to the experience of loss ANTICIPATORY GRIEVING- when people facing an imminent loss begin to grapple with the very real possibility of the loss or death in the near future 138. DISENFRANCHISED GRIEF-grief over a loss that is not or cannot be acknowledged openly, mourned publicly or supported socially COMPLICATED GRIEVING-when a person is void of emotion, grieves for prolonged periods, has expressions of grief that seem disproportionate to the event 139. Physiologic Loss Safe and Security Loss Love and Belongingness Loss Self-Esteem Loss Selfactualization Loss LOSS 140. Denial Anger Bargaining Depression Acceptance Dysfunctional grieving grieving which extends from 4 to 6 weeks leading to CRISIS GRIEVING PROCESS 141. Interventions Explore clients perception and meaning of the loss Allow adaptive denial Assist client to reach out for and accept support Encourage client to examine patterns of coping in past and present situation of loss Encourage client to care for himself Offer client food without pressure to eat Use effective communication 142. CRISIS AND ITS MANAGEMENT

143. situation that occurs when an individuals habitual coping ability becomes ineffective to merit demands of a situation TYPES OF CRISES: MATURATIONAL / DEVELOPMENTAL Normal expected crisis that runs through age SITUATIONAL Unexpected and sudden event in life ADVENTITIOUS Calamities, war CRISIS 144. Characteristics of a Crisis state Highly individualized Lasts for 4-6 weeks Self-limiting Person affected becomes passive and submissive Affects a persons support system 145. PHASES OF A CRISIS Pre-crisis: State of equilibrium Initial Impact (may last a few hours to a few days): High level of stress, helplessness, inability to function socially Crisis (may last a brief or prolonged period of time): Inability to cope, projection, denial, rationalization Resolution: attempts to use problem-solving skills Post crisis: may have OLOF or may have symptoms of neurosis, psychosis 146. Role of the nurse is to return the client to its pre-crisis state by assisting and guiding them until they achieved their OLOF. Goal: to enable patient to attain an OLOF Nurses Primary Role: Active and Directive CRISIS MANAGEMENT 147. Steps in Crisis Intervention Identify the degree of disruption the client is experiencing Assess the clients perception of the event Formulate nursing diagnoses Involve the patient and family if applicable with planning Implement interventions- new and old coping mechanisms Evaluatereassessment, reinforcement 148. TYPES OF THERAPIES Treatment Modalities 149. Individual Psychotherapy 150. Individual Psychotherapy One to one relationship between therapist and client For dissociative, anorexia, paranoid, narcissistic Change is achieved by the exploration of feelings, attitudes, thinking behavior and conflict 151. SEVEN SUBTYPES: CLASSICAL PSYCHOANALYSIS Based on Freuds theory To uncover unconscious feelings and thoughts that interfere with the clients living a fuller life Free associationclient is encouraged to say anything that comes to mind, without censoring thoughts or feelings Dream analysis Working through(transference)-process of repeated interpretation to the person of his or her unconscious processes has the effect of bringing about change 152. Al relationship PSYCHOANALYTICAL PSYCHOTHERAPY Uses dream analysis, transference and free association Therapist is much more involved and interacts with the client more freely Done through intimate professional relationship between the nurse/therapist and the client over a period of time (introductory, working and termination phase) 153. SHORT TERM DYNAMIC PSYCHOTHERAPY Indication-persons with specific symptom or interpersonal problem that he/she wants to work on Therapist directs the content Use of transference and dream analysis Weekly sessions (total number-12 to 30) Successful for highly motivated individuals who have insight and with positive relationship with the therapist 154. TRANSACTIONAL ANALYSIS Eric Berne Each person has three ego states and change from one to another frequently Parent-concepts of standards of behavior and how things should be done e.g. Go and take out the garbage. Adult-rational thinking and data analyzing part of the personality e.g.Would you please take out the garbage Child- feelings associated with persons, things or incidents represent the need-gratifying aspects of the personality. E.g. Is that why you married me?To be your garbage man? For group, family and individual Client to identify ego states for each

given situation Rewarding of positive or negative behaviors with strokes Client work through these behaviors

155. COGNITIVE PSYCHOTHERAPY Restructuring or changing ways in which people think bout themselves Thought stopping Positive self-talk Decatastrophizing Therapists help patients identify these thoughts 156. BEHAVIORAL THERAPY Changes in maladapted behavior can occur without insight into the underlying cause Based on learning theory Modeling Operant conditioning Self-control therapycombination of cognitive & behavioral approaches talking to self Systematic desensitization Aversion therapy 157. GESTALT THERAPY Emphasis on the here and now Only present behavior can be changed, not history Uncover repressed feelings and needs Techniques: have a person behave the opposite of the way he/she feels, presuming that a person can then come in contact with a submerged part of the self; in dreams, person is ask to play the roles of persons in the dream to get in touch with different repressed feelings 158. Milieu Therapy 159. Milieu Therapy Total environment has an effect on the individuals behavior Components Physical Environment Interpersonal relationships Atmosphere of safety, caring, and mutual respect For alcoholics 160. PROGRAMS FOR MILIEU SHOULD HAVE: an emphasis on group and social interaction No rules and expectations mediated by peer pressure A view of patients roles as responsible human beings An emphasis on patients rights for involvement in setting goals Freedom of movement and informality of relationships with staff Emphasis on interdisciplinary participation Goal-oriented, clear communication 161. Group Therapy 162. Group Therapy Number of people coming together, sharing a common goal, interest or concern, staying together and developing relationships For PTSD and Alcoholics Phases Orientation Working Termination 163. Characteristics of Group Therapy Universality You are not alone Instilling hope and inspiration Developing social skills by interacting with one another Feeling of acceptance and belonging Altruism Giving of ones self 164. Psychoanalytically oriented group therapy Psychodrama Family therapy 165. Assumption of Family Therapy For alcoholic and schizophrenic 166. Assumption of Family Therapy Client: Whole family Concepts: The family is the most fundamental unit of the society. Adaptive or maladaptive patterns of behavior are learned from the family Dysfunction in the family = dysfunction in the individual Purpose Improve relationships among family members Promote family function Resolve family problems 167. OTHER TYPES OF THERAPIES SUPPORT GROUPS For those with AIDS, Mother-AgainstDrug Dependence SELF-HELP GROUPS Alcoholic Anonymous 168. RULES FOR PSYCHOTHERAPEUTIC MANAGEMENT Provide support, treat patients with respect and dignity Do not place patients in situations wherein they will feel inadequate or

embarrassed Treat patients as individuals Provide reality testing Handle hostility therapeutically Provide psychopharmacologic treatment

169. BEHAVIORAL THERAPIES Treatment Modalities 170. BEHAVIORAL THERAPY Pavlovs Classical Conditioning All behavior are learned B.F. Skinners Operational Conditioning Reinforcements 171. BEHAVIORAL THERAPY Behavioral Modification Substance Abuse Token Economy Anorexia / Schizo Systematic Desensitization - Phobia 172. ATTITUDE THERAPY Treatment Modalities 173. ATTITUDE THERAPY Paranoid Passive Friendliness Withdrawn Active Friendliness Depressed / Anorexia Kind Firmness Manipulative Matter of Fact Assaultive No Demand Antisocial Firm, consistent 174. PSYCHOSOMATIC THERAPY Treatment Modalities 175. Electroconvulsive Therapy 176. Electroconvulsive Therapy Effective in most affective disorders The induction of a grandmal seizure in the brain. Abnormal firing of neurons in the brain causes an increase in neurotransmitters Number of Treatments: 6-12 ,3 times a week, about .5-2seconds Unilateral or bitemporal 177. Electroconvulsive Therapy Indications: Patients who require rapid response Patients who cannot tolerate pharmacotherapy or cannot be exposed to pharmacotherapy Patients who are depressed but have not responded to multiple and adequate trials of medication 178. Electroconvulsive Therapy Preparations for ECT: Pretreatment evaluation and clearance Consent NPO from midnight until after the treatment Atropine Sulfate-to decrease secretions, succinylcholine (Anectine)- to promote muscle relaxation, Methohexital Sodium(Brevital)anesthethic Empty bladder Remove jewelry, hairpins, dentures and other accessories Check vital signs Attempt to decrease patients anxiety 179. Electroconvulsive Therapy Care after ECT: O2 therapy of 100% until patient can breathe unassisted Monitor for respiratory problems, gag reflex Reorient patient Observe until stable Careful documentation. Male erectile dysfunction 180. OTHER THERAPIES NEUROSURGERY 181. ANXIETY 182. Peplaus Levels of Anxiety 183. Peplaus Levels of Anxiety Mild Associated with the tension of day-today living Perceptual field increased More alert than usual Adaptive Moderate Narrowed perception Difficulty focusing Selective inattention Mild somatic complaints: stomachache and butterflies in the stomach 184. Interventions for Mild to Moderate Anxiety Assist the client in identifying anxiety. Anticipate anxiety provoking situations. Use nonverbal language to demonstrate interest Encourage the client to talk about his or her feelings. Avoid closing off avenues of communication (refrain from offering advice or changing the topic). Encourage problem-solving Explore past and present coping behaviors Provide outlets for working off excess energy.

185. Levels of Anxiety 186. Levels of Anxiety Severe Very narrowed perception Unable to focus on problem solving Increased physical discomfort All behavior is aimed at relieving anxiety Direction is needed to focus attention Panic Awe, dread and terror Unable to see the whole situation or reality Distortion of perception Disorganization of the personality A frightening and paralyzing experience 187. Inter ventions for Severe and Panic Levels of Anxiety Maintain a calm manner. Remain with the person. Minimize environmental stimuli. Reinforce reality. Listen for themes in communication. Attend to physical safety and medical needs first. Physical limits may need to be set. Provide opportunities for exercising. Assess the persons need for medication or seclusion . 188. ANTI ANXIETY DRUGS VALIUM LIBRIUM ATIVAN SERAX TRANXENE MILTOWN EQUANIL VISTARIL ATARAX INDERAL XANAX BUSPAR 189. ANTI ANXIETY DRUGS Used only in a short time (1-2 weeks) Tolerance (after 7 days) and dependence (after 1 month) Liver function test Monitor for side effects. Avoid machines, activities needing concentration Z tract if given parenterally Avoid mixing with alcohol, antihistamines, antipsychotics Dont stop abruptly but gradually for 2-6 weeks Avoid caffeine 190. Categories of ANXIETY DISORDERS Anxiety Disorders Basic Anxiety Disorder Somatoform 191. Categories of ANXIETY DISORDERS Basic Anxiety Disorders Somatoform Disorders Dissociative Disorders 192. BASIC ANXIETY DISORDER 193. Basic anxiety disorders Generalized Anxiety Disorder Panic Phobia PTSD Obsessive

Compulsive

194. Chronic Anxiety Disorder or Generalized Anxiety Disorder Excessive worry and anxiety for days but not more than 6 months Difficulty in controlling the worry Anxiety and worry are evident by 3 or more of the following : Restlessness, Keyed up Fatigue and irritability Decreased ability to concentrate Muscle tension Disturbed sleep Anxiety or worry causes significant impairment in interpersonal relationship or activities of daily living 195. Post Traumatic Stress Disorders 196. Post Traumatic Stress Disorders Disturbing pattern of behavior occurring after a traumatic event that is outside the range of usual experience. Characteristics Persistent re-experiencing of the trauma through recurrent intrusive recollections of the event, through dreams or flashbacks Persistent avoidance of the stimuli Feeling of detachment of estrangement from others Chemical abuse to relieve anxiety 197. Phobias Definition Persistent, irrational fear of a specific object, activity or situation that leads to a desire for avoidance or actual avoidance of the object of fear Specific Phobia Experience of high level of anxiety or fear provided by a

specific object or situation Treatment: Systematic Desensitization Defense mechanisms Repression and displacement

198. Major Types of Phobias 199. Major Types of Phobias Agoraphobia Comes from the Greek word Agora Meaning market place Fear of being alone in open or public spaces Social Phobia Fear of situations where one might be seen and embarrassed or criticized Specific Phobias Fear of a single object, situation or activity that cannot be avoided 200. Obsessive Compulsive Disorder Obsessions Preoccupation with persistent intrusive thoughts, impulses or images Compulsions > Repetitive behaviors or mental acts that the person feelds driven to perform in order t reduce distress or prevent a dreaded event or situation Cues: Ritualistic behavior Constant doubting if he/she has performed the activity 201. Examples Obsessions Compulsions Washing or cleaning Wash away my sins. Thought appeared after sexual encounter with a married man Young woman repeatedly washes hands Need for order Everything must be in place. Arranges and rearranges items Germs or dirt Everything is contaminated Avoids touching all objects. Scrubs hands if she is forced to touch any object Symmetry Secretaries who practice neatness never gets fired Secretary lines up objects in rows on her desk, then realigns them repeatedly during the day 202. Care Strategies Be nonjudgmental and honest; offer empathy and support Help patient to recognize the connections between the trauma experience and their current feelings, behaviors and problems. Encourage verbalizations of feelings, especially anger. Encourage adaptive coping strategies and techniques Encourage patients to establish or reestablish relationships Explore shattered assumptions. Im a good person. This is a safe world. Promote discussion of possible meaning of the events. 203. SOMATOFORM DISORDERS 204. Somatoform Disorders Body Dysmorphic Disorder Somatization Conversion Disorders Hypochondriasis Psychogenic pain 205. Body Dysmorphic Disorder Preoccupation with an imagined defect in his or her appearance 206. Somatization A client expresses emotional turmoil or conflict through a physical system, usually with a loss or alteration of physical functioning

207. Conversion Disorders A psychological condition in which an anxietyprovoking impulse is converted unconsciously into functional symptoms 208. Hypochondriasis Presentation of unrealistic or exaggerated physical complaints 209. DISSOCIATIVE DISORDERS 210. Dissociative Disorders Dissociative amnesia Dissociative fugue Depersonalization Dissociative Identity Disorder / Multiple Identity Disorder 211. Dissociative amnesia Characterized by the inability to recall an extensive amount of important personaal information because of physical or psychological trauma 212. Dissociative fugue The person suddenly and unexpectedly leaves home or work and is unable to recall the past 213. Depersonalization Person experiences a strange alteration in the perception or experience of the self, often associated with a sense of unreality 214. Dissociative Identity Disorder / Multiple Identity Disorder A person is dominated by at least one of two or more definitive personalities at one time 215. PSYCHOSOMATIC DISORDER 216. Psychosomatic Disorder True / unconscious because of hormonal and bodily changes Increase anxiety may result to asthma, stress ulcers or migraine 217. SCHIZOPHRENIA A major form of psychotic disorder that affects a persons thinking, language, emotions, social behavior and ability to perceive reality At least 2 of 5 types of positive and negative symptoms Characteristic Symptoms Social or occupational dysfunction IPR Self care Duration Continuous for at least 6 months 218. Positive and Negative Symptoms Positive Symptoms Hallucinations Delusions Illusions Abnormal thought patterns or perceptions Bizarre behavior 219. Negative Symptoms Negative Symptoms Affective flattening Anhedonia Attention impairment Asocial behavior Anergia Autism Avolition 220. SCHIZOPHRENIA

221. DELUSIONS PERSECUTORY RELIGIOUS GRANDEUR IDEAS OF REFERENCE 222. DISTURBED THOUGHT PROCESSES Looseness of Association Flight of Ideas Ambivalence Magical Thinking Echolalia / Echopraxia Word salad Clang association Neologism Thought blocking Concrete association Delusion, hallucination, illusion 223. Bleulers Four As of Schizophrenia Affective Disturbances Autism Associative looseness Ambivalence Other As Attention defects Disturbances of activities 224. SCHIZOPHRENIA Brief Psychotic Disorder -maybe seen when a person exhibits clinical symptoms of illogical thinking, incoherent speech, delusions, or disorganized behavior after psychological trauma Induced Psychotic Disorder develops in a second person as a result of a close relationship with a person who has psychosis Delusional Psychotic Disorder Schizoaffective disorder characterized by depression or elation as the psychosis symptoms of schizophrenia and MDD Schizophreniform -when a person exhibits features of schizophrenia for more than one week but less than 6 months 225. Subtypes: Paranoid-most common form of the illness Suspicious Promote trust Short interaction but frequent Food in containers (sealed) Prepare food in front of them Let them seed preparation of drugs Violent Keep door open Position near door and with distance of 1 arm length (patient-nurse) Dont touch Maintain eye contact Call reinforcements 226. Subtypes: Disorganized-absence of systematized delusions; presence of incoherence & inappropriate affect Inappropriate, flat affect Herbephrenic, flight of ideas Catatonic Risk for suicide Catatonic stupor, rigidity Waxy flexibility 227. Subtypes: Undifferentiated unclassified Residual No more positive symptoms but withdrawn 228. NURSING PROCESS Disturbed Thought Process Disturbed Sensory Process Risk for self-directed violence Risk for other directed violence Present safety Present reality 229. ANTI- PSYCHOTIC Tara, look natin sina Stella, Mel, at Thor na nag momoulin rouge. Sssh , alam nyo ba na ang trio na yan na akala mo may halo ay mga closet queens pala, namen ( Taractan, Loxitane, Stelazine, Mellaril, Thorazine, Molindone, Seroquel, Serlect, Trilafon, Haloperidol, Clozapine, Navane )

230. SCHIZOPHRENIA STELAZINE MILLARIL SERENTIL HALDOL THORAZINE LOXITANE TRILAFON RISPERDOL CLOZARIL PROLIXIN 231. ANTI PSYCHOTIC DRUGS Watch for side-effects Increase v/s Constipation / dry mouth Postural hypotension Photophobia / photosensitivity Drowsiness Agranulocytosis Extrapyramidal symptoms Parkinsons syndrome Akathisia Akinesia Dystonia oculogyric crisis, torticollosis, opistothonus Tardive dyskinesia NMS 232. UNDESIRABLE EFFECTS S-edation/sunlight sensitivity/sleepiness T-ardive dyskinesia A-nticholinergic/aganulocytosis/akathisia N-euroleptic malignant syndrome C-cardiac effects(Orthostatic hypotension) E-xtrapyramidal(dystonia 233. Parkinsonism Motor retardation or akinesia characterized by mask-like appearance, rigidity, tremors, pill-rolling, salivation Generally occurs after 1 st week of treatment or before second month Administer anticholinergic agent, antiparkinson medication (Akineton) 234. Akathisia Constant state of movement, characterized by restlessness, difficulty sitting still, or strong urges to move about Generally occurs two weeks after treatment begins Rule out anxiety or agitation before administration of an anticholinergic agent 235. Acute Dystonic reactions Irregular, involuntary spastic muscle movement, wryneck or torticollis, facial grimacing, abnormal eye movements, backward rolling of eyes in the sockets May occur anytime from a few minutes to several hours after first dose of antipsychotic drug Administer anticholinergic agent, have respiratory support equipment available 236. Tardive Dyskinesia Most frequent serious side effect resulting from termination of the drug, during reduction in dosage, or after long term high dose therapy. Characterized by involuntary rhytmic, stereotyped movements, tongue protrusion, cheek puffing, involuntary movements of extremities and trunk Occurs in approximately 20-25% of patients taking antipsychotics for over two years No treatment except discontinuation of the antipsychotic agent 237. Neuroleptic Malignant Syndrome A potentially fatal syndrome May occur anytime during therapy Seen during the initiation of therapy, change of therapy, After a dosage increase or when a combination of meds is used. Early sign: rigidity or mental status changes catatonia, tachycardia, tachypnea, labile blood pressure, dysphagia, diaphoresis, incontinence, rigidity, myoclonus, tremors, low grade fevers Discontinue antipsychotic agent. Have cardiopulmonary support

available; administer skeletal muscle relaxant(e.g. dantrolene) or central acting dopamine agonist (e.g. bromocriptine)

238. NOTES on SCHIZOPHRENIA Distorted EGO Disturbed thought process Disorganized personality Dopamine increase Autism Ambivalence Associative looseness Affect flat Stimulation Structure Socialization Support 239. Manifestations: S -social isolation C -catatonic behavior H -hallucinations I Incoherence Z -zero/lack of interest and initiative O -obvious failure in development P -peculiar behavior H -hygiene and grooming impaired R recurrent illusions E- exacerbations and remissions N -no organic factor account S/S I -inability to return to functioning A -affect is inappropriate 240. ANTI-PARKINSONIAN DRUGS Dopaminergic Drugs To live (Levodopa), you need a car (carbidopa) and a man (Amantidine) not your brother (bromocriptine) per (pergolide) se (selegiline) ANTI-CHOLENERGIC BACPAK ( BENADRYL, ARTANE, COGENTIN, PARSIDOL, AKINETON, KEMADRIN) 241. Other Treatments Psychotherapy-individual, group, behavioral, supportive or family therapy maybe used depending on the clinical symptoms Milieu therapy- a structured environment to minimize environmental and physical stress and to meet the individual needs of the patients until they are able to assume responsibility for themselves 242. Concepts & Principles of Hallucination Possible to replace hallucination with satisfying interactions Can re-learn to focus attention on real things and people Hallucinations originate during extreme emotional stress when the patient is unable to cope Hallucinations are very real to the patient Patient will react as the situation is perceived Concrete experiences, not argument on confrontation will correct sensory distortion Hallucinations are a substitute for human relations 243. BIPOLAR DISORDER MOOD DISORDER/ AFFECTIVE DISORDER 244. Bipolar Disorders 245. Bipolar Disorders A distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week 3 or more of the following Psychomotor overexcitability or excitement Insomnia with fatigue Euphoria or elated mood Distractability Pressured speech Flight of ideas Manipulative or demanding behavior Destructive or combative behavior Delusions of grandeur Impaired judgment

246. Bipolar Disorders Risk Female 20 years old and above Stressful life Obese Care giver role restrain 247. Mania Vs Depression Mania Depression Appearance Colorful, flamboyant Sad and gray Behavior Psychomotor agitation Psychomotor retardation Communication Pressured speech Stuttering Cluttering Monotonous speech 248. Mania Vs Depression Mania Depression Nx Risk for Injury (others) Risk for injury (self) suicidal precaution Nursing priority Safety and nutrition Safety and Nutrition Nutrition Finger foods and high in calories Increased in nutrients Treatment Lithium; ECT TCA; SSRI; MAOIs ECT 249. Mania Vs Depression Mania Depression Milieu Non-stimulating environment Stimulating Appropriate activity Quiet type; non-competitive Monotonous; Noncompetitive Attitude therapy Matter of fact Kind firmness; active friendliness 250. LITHIUM Level of lithium (0.5 to 1.5 meq/L) Increase urination (polyuria) Tremors fine hand Hydration Increase peristalsis U2 4 weeks effective Increased bowel movements Mouth is dry Assess function of kidney Toxicity: nausea and vomiting, diarrhea 251. PHARMACOLOGY MOMENTS ANTIDEPRESSANTS 252. ANTIDEPRESSANTS ASENDIN NORPRAMIN TOFRANIL SINEQUAN ANAFRANIL AVENTIL VIVACTIL ELAVIL PROZAC LUVOX PAXIL ZOLOFT 253. ANTIDEPRESSANTS SSRI Selective Serotonin Reuptake Inhibitor Safest Side effects are low 1 to 4 weeks Prozac, Paxil, Zoloft, Luvox 254. ANTIDEPRESSANTS TCA Tricyclic Antidepressants 2 to 4 weeks Anticholinergic amitriptyline, nortiptyline, doxepin trimipramine, amoxapine, anafranil, venlafaxine 255. ANTIDEPRESSANTS MAOIs Increases all neurotransmitters 2 to 6 weeks Hypertensive crisis Dont take: Avocado Aged cheese Beer/ B6 (tyramine) Chocolate Fermented foods Soy sauce Pickles and preserved foods 256. ANTI- DEPRESSANT A. TCA knock! Knock! Whos there? SEVANA to gagah!-------- (Sinequam, Elavil, Vivactil, Ascendin, Norpramin, Aventyl, Tofranil) B. SSRI Ngongo: Paxil ka! Paxil ka! Prozoleta ka lang, kala ko luv mo ko! (PRAXIL, PROZAC, ZOLOFT, LUVOX) C. MAO Naman, parnate ko pa (NARDIL, MANERIX, PARNATE)

257. SUICIDE The intentional act of killing oneself Suicidal Ideation - means thinking about oneself Passive suicidal ideation -when a person thinks about wanting to die or wishes he/she were dead but has no plans to cause his/her death (e.g. reckless driving, heavy smoking, overeating, self-mutilation, drug abuse) Active suicidal ideation- when a person thinks about and seeks to commit suicide. 258. SAD PERSONS SCALE S-Sex Men kill themselves 3x more than women though women make attempts 3x more often than men A-Age High risks groups:19 years or younger; 45 years or older, especially the elderly 65 and above D-Depression Studies report that 35-79% of those who attempt suicide manifested a depressive syndrome 259. P-Previous Attempts Of those who commit suicide, 65-70% have made previous attempts E-ETOH Alcohol is associated with up to 65% of successful suicides R-Rational Thinking Loss People with functional or organic psychoses are more apt to commit suicide than those in the general population S-Social Supports Lacking A suicidal person often lacks significant others, meaningful employment and religious supports O-Organized Plan The presence of a specific plan for suicide signifies a person at high risk N-No Spouse repeated studies indicate that persons who are widowed, separated, divorced or single at greater risk than those who are married S-Sickness Chronic, debilitating and severe illness is a risk factor 260. Scoring 0-2 Home with follow up care 3-4 Close follow up and possible hospitalization 5-6 Strongly consider hospitalization 7-10 Hospitalize 261. Situation: Charles Brown, age 52 lost his wife in a car accident few months ago. Since that time, he has been severely depressed and has taken to drinking to numb the pain How many points according to the SAD PERSONS SCALE? 262. Theories of SUICIDE Psychodynamic theories describe suicide as a wish to be at peace with the internalized significant person Wish to be reunited with a deceased loved object Suicide is an attempt to escape from an intolerable situation or intolerable state of mind 263. Theories of Suicide Sociological Theories Durkheim-pioneer of sociological research in the study of suicide 3 Principal types: Egotistic suicide -occurs when a person is insufficiently integrated into society Anomic suicide -occurs when a person is isolated from others through abrupt changes in social norms/status Altruistic suicide - occurs as a response to societal demands (deaths of Buddhist monks who set themselves on fire to protest the Vietnam war)

264. Theories of Suicide Biochemical Low serotonin levels 265. Precipitating factors Social isolation-have difficulty forming and maintaining relationships Norman Cousins Story: a woman who committed suicide had written in her diary everyday during the week before her death Nobody called today. Nobody called today. Nobody called today. Nobody called today 266. Precipitating factors Severe lifes events- divorce, death, sickness, legal problems, interpersonal discord Sensitivity to Loss -may react tragically to separation or loss of a loved one ( had insecure or unreliable childhood experiences) 267. ASSESSING VERBAL & NONVERBAL CLUES Verbal Clues: Overt Statements: I cant take it anymore!; Lifes isnt worth living anymore.; I wish I were dead.; Everyone will be better off if I am dead. Covert Statements: Its ok now, soon everything will be fine, Things will never work out. I wont be a problem much longer. Nothing feels good to me anymore. How can I give my body to medical science? 268. Nonverbal Clues Behavioral Clues: sudden behavioral changes especially when depression is lifting and when the person has more energy available to carry out the plan Signs: giving away prized possessions, writing farewell notes, making out a will and putting personal affairs in order 269. Nonverbal Clues Somatic clues: physiological complaints can mask psychological pain and internalized stress Headaches, muscle aches, trouble sleeping, irregular bowel habits, unusual appetite or weight loss 270. Nonverbal Clues Emotional clues Social withdrawal, feelings of hopelessness and helplessness, confusion, irritability and complaints of exhaustions 271. Suicide Precautions Execute a no suicide contract. The client will inform the nurse when he/she has suicidal ideations Ask direct questions. Find out if the person has specific plan for suicide. Determine what method. Be alert for cries for suicide Provide a safe environment and protect client from self Encourage to ventilate feelings and thoughts 272. Suicide Precautions Give emotional support Make the patient realize that the tendency to commit suicide is due to the disturbance in the brain chemistry and is treatable-once they know that an episode of suicidal thinking will pass, they will likely not act on the impulse Provide structured schedule and involve in activities with others to increase self-worth and divert attention On discharge:

help patient create plan for Life(list of warning signs of suicidal ideation and actions to take)

273. Suicide Precautions Always remember: That a suicidal person want to die only during the period of suicidal crisis-during this time the person is ambivalent about living and dying Suicidal people gives warning Persons recovering from depression are high risk for 9-15 months after recovery Suicidal people are extremely unhappy but not always mentally ill 274. Personality behaviors 275. SAD PERSONS SCALE Personality problems Schizoid Dependent Antisocial Avoidant Histrionic Borderline 276. Paranoid Personality Disorder A pervasive pattern of distrust and suspiciousness of others such that their motives are interpreted as malevolent Suspicious (e.g. others are exploiting or deceiving him) Doubt trustworthiness of others Fear of confiding in others Fear personal information will be used against him Interpret remarks as demeaning or threatening Hold grudges toward others Becomes angry and threatening when they perceive to be attacked by others Intervention: centered on building trust 277. Schizoid Personality Disorder A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings Lacks desire for close relationships or friends including family Chooses to be alone Lack of sexual experiences Avoids activities Appears cold and detached Interventions: building trust followed by identification and appropriate verbal expression 278. Schizotypal Personality Disorder A pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior Interventions: Improving Interpersonal relationships, social skills., and appropriate behaviors Ideas of reference Magical thinking or odd beliefs Unusual perceptual experiences, including bodily illusions Peculiar thinking Vague, stereotypical, over elaborate speech Suspiciousness Blunted or inappropriate affect Eccentric appearance or behavior Few close relationships Uncomfortable in social situations 279. Anti-social Personality Disorder Characterized by deceit, manipulation, revenge and harm to others with an absence of guilt or anxiety Violates rights of others Engages in illegal activities Aggressive behavior Lack of guilt or remorse Irresponsible in work and with finances Impulsiveness Recklessness

Manipulative Interventions: Consistency Kind firmness in confronting behaviors and enforcing rules and policies Limit setting Decrease impulsivity Enhance role performance Effective use of confrontation

280. Borderline Personality Disorder Characterized by pervasive pattern of unstable interpersonal relationships; self-image and affect; and marked impulsivity Frantic avoidance of abandonment; real or imagined Unstable and intense interpersonal relationships Identity disturbances Impulsivity Selfmutilating behavior Rapid mood shifts Chronic feelings of emptiness Problems with anger Transient dissociative and paranoid symptoms 281. Other important information Priority nursing diagnosis: High risk for injury directed to self related to self-mutilation behaviors Coping mechanisms used: Splitting Classifying people as either good or bad 282. Interventions Use of empathy. Recognize the reality of the patient s pain. Offer support Empower and work with the patient to understand control and change dysfunctional behaviors. Provide safe environment Teach social skills Make a list of solitary activities to combat boredom 283. Narcissistic Personality Disorder Grandiose self importance Fantasies of unlimited power, success or brilliance Believes he or she is special Needs to be admired Sense of entitlement Takes advantage of others for own benefit Lacks empathy Envious of others or others are envious of him Arrogant Interventions Supportive confrontation on what the patient says and what exists. Limit setting and consistency to decrease manipulation and entitlement behaviors. Remain neutral, avoid power struggles, or becoming defensive. A pervasive pattern of grandiosity, need for admiration and lack of empathy 284. Histrionic personality Disorder A pervasive pattern of excessive emotionality and attentive seeking Overly dramatic Draws attention to self Extroverted and thrives on being the center of attraction Uses somatic complaints to avoid responsibility and support dependency Dissociation Interventions: Positive reinforcement in the form of attention, recognition or praise are given for unselfish or other-centered behaviors 285. Dependent Personality Disorder A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation Needs others to be responsible for important areas of life. Problems with initiating with projects or doing things on his own because of little self confidence Performs unpleasant tasks to obtain support from others Urgently seeks another relationship for support and care after a close relationship ends

Preoccupied with fear of being alone to care for self Interventions: increase responsibility for self in day to day living; assertiveness training

286. Avoidant Personality Disorder A pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation Avoids occupations involving interpersonal contact due to fears of disapproval or rejection Preoccupied with being criticized or rejected in social situations Inhibited and feels inadequate in new interpersonal situations Very reluctant to take risks or engage in new activities due to the possibility of being embarrassed 287. Obsessive Compulsive Personality Disorder A pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control at the expense of flexibility, openness and efficiency Preoccupied with details, lists, rules, organization Perfectionist Too busy working to have friends or leisure activities Unable to discard worthless or worn-out objects Reluctant to spend and hoards money Rigid and stubborn 288. End of First Module Thank you! 289. Delirium Characterized by disturbance of consciousness and a change in cognition such as impaired attention span and disturbances in consciousness that develop over a short period of time. Always secondary to another condition (medical condition or substance abuse) Frequent among the elderly and young febrile children Fluctuations of consciousness and inoculation through out the day Classified as mild to severe. Sundowning 290. Dementia Characterized by multiple cognitive deficits that include impairment of memory which develops slowly 80-90% irreversible Reversible due to pathologic process Most common: Alzheimers Dementia 4 Symptoms of Dementia Loss of memory Deterioration of language function Loss of ability of think abstractly, plan, initiate, sequence, monitor or stop complex behavior Loss of ability to perform ADLs 291. Stages of Dementia Stage 2 Moderate (Confusion) Progressive memory loss ST memory loss interferes with ADLs Withdrawn, Denial, Fear of Losing their minds Depression, Confabulation Problems increase when stressed Needs home care or in-home assitance Stage 1 Mild (Forgetfulness) Losses in short term memory Memory aids compensate Aware of the problem, disturbed Not diagnosable at this time 292. Stages of Dementia Stage 3 Moderate to Severe (Ambulatory Dementia) Loss of reasoning ability, planning and verbal communication Frustrated, withdrawn, self-absorbed Depression decreases Reduced stress threshold

Institutional care required Stage 3 Late (EndStage) Family recognition disappears Doesnt recognize self Nonambulatory Little purposeful activity Often mute, may scream spontaneously Forgets most ADLs Problems associated with immobility Institutional care required Return of primitive reflexes

293. Delirium Vs Dementia Delirium Dementia Onset Usually sudden Usually gradual Course Usually brief with return to usual level of functioning Usually longterm and progressive, occasionally maybe arrested or reversed Age group any elderly 294. Sexual Disorders Homosexuality Heterosexuality Bisexuality Masochism Sadism Frotteurism Pedophilia Necrophilia Voyeurism Transvestism Transexualism 295. ALCOHOL 296. ALCOHOLISM Intergenerational Transmission Awake but unconscious Blackout Confabulation Denial, dependence Enabling, co-dependence Tolerance increases Detoxification - doctor 297. Stages of Alcohol Withdrawal I 8 hours after the last drink Mild tremors, tachycardia, increased BP, diaphoresis, nervousness 2 8-12 hours after the last drink Gross tremors, hyperactivity, profound confusion, loss of appetite, insomnia, weakness disorientation, illusions, hallucinations and delusions 3 1248 hours after the last drink * severe hallucinations, grand mal seizures 4 3-4 days after the last drink Delirium tremens, confusion, agitation, hallucinations, insomnia and tachycardia 298. ALCOHOLISM Avoid alcohol during therapy Aversion therapy Antabuse disulfiram Belongings check for alcohol, mouthwash, elixir etc. B1 deficiency Complication Wernickes Encephalopathy (Motor) Korsakoffs Pychosis (Mind) Deliruim Tremens Fornication 299. AUTISM Living in their own world Appearance flat (consistent) Behavior ritualistic, repetitive Communication echolalia, incomprehensible NX: Impaired Verbal Communication Impaired Social Interaction Self Mutilation Risk for Injury 300. ADHD Attention-deficit / hyperactive disorder 7 years old and above Duration: 6 months and above Requires 2 settings: home and school Appearance: Dirty child Behavior: Clumsy, hyperactive, impatient Communication: talkative, bursts out Structure Setting limits Schedule Safety

301. Eating Disorders Anorexia Nervosa Bulimia Nervosa Pica Compulsive Eating Behavior 302. EATING DISORDERS 303. Anorexia Nervosa Symptoms: Refusal to maintain body weight over a minimum normal weight for age and height Intense fear of gaining weight or becoming fat, even though underweight Disturbance in the way in which ones bodyweight, shape or size is experienced In females, absence of menses of at least 3 consecutive cycles Inability or refusal to acknowledge the seriousness of the problem Onset: 12-15, 17-21 years of age 304. Etiology Cultural pressure Serotonin imbalance controls appetite and the satiety control center Family Patterns Perfectionist Does not permit verbalization of feelings Marital problems 305. Clinical Presentation Terrified of gaining weight Pre-occupied with thoughts of food See themselves as fat even when emaciated Peculiar handling of food Cutting food into small bits Pushing pieces of food around the table May develop rigorous exercise program Self-induced vomiting, laxatives and diuretics Cognition so disturbed that they judge their self-worth by their weight. 306. Clinical Presentation Low weight Amennorrhea Yellow skin Cold extremities Peripheral edema Muscle weakening Constipation Low T3 and T4 Hypotension Bradycardia Hypokalemia Anemia Pancytopenia Decreased bone density 307. Signs related to Purging Behaviors Gastrointestinal Parotid gland tenderness, Pancreatitis, esophageal and gastric erosion or rupture Metabolic Electrolyte abnormalities hypokalemia Dental Erosion of dental enamel of the front teeth 308. Objectives of care: Increasing body weight to at least90% of average weight for age and height Reestablishing good eating behavior Increasing self esteem 309. Nursing Interventions: Monitor daily caloric intake, activity level, weight and electrolyte status. Establish nutritional eating patterns Sit with client during meals Offer liquid protein supplement if unable to complete a meal Observe signs of purging 1-2 hours after meals Provide accurate information on nutrition and discuss realistic and healthy diet Help the client identify emotions and develop non-food related strategies. Convey warmth and sincerity Ask the client to identify feelings Assist the client to change stereotypical beliefs

310. Nursing Interventions Assist in identifying at least three positive characteristics Teach patient about their illness Behavior modification : reward increase in weight with meaningful privileges Identify patients non weight related interests to reduce anxiety and refocus attention. 311. Bulimia Nervosa Symptoms: Recurrent episodes of binge eating Feeling of lack of control over eating behaviors during the eating binges Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self induced vomiting Binge eating and inappropriate eating behaviors Persistent over concern with body shape and weight 312. Clinical Presentation Binge and Purging behaviors Have depressive signs and symptoms Disturbed home life Major concerns Interpersonal relationships Self-concept Impulsive behaviors Chemical dependence is also common 313. Clinical Presentation Normal to slightly low weight Dental carries Parotid swelling Gastric swelling and rupture Callusses or scars on the hand Peripheral edema Hypokalemia, Hyponatremia 314. Management: Trust Help patient identify feelings associated with bingepurge behaviors Accept patient as worthwhile human beings because they are often ashamed of their behavior Encourage patient to discuss positive qualities about themselves Teach about bulimia nervosa Encourage to explore interpersonal relationships Encourage patients to adhere to meal and snack schedules 315. Management: Encourage the patient to approach the staff if she feels like binging or purging Encourage to attend group sessions Encourage family therapy Encourage participation in art, recreation and occupational therapy Encourage the patient to describe their body image at different ages of their lives. 316. Thank you!