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A- affect 2.

SECONDARY
B- behavior - reducing the effects of mental illness
C- communication ex:
a. psychiatric screening/evaluation
Alteration HOMEOSTATIS b. crisis intervention
P- perception c. suicide prevention: suicidal
P- personality ideation
B- behavior d. counseling
E- emotions e. emergency nursing care
T- thought
3. TERTIARY
Affect - minimizing the long term residual
S- self-awareness effects of mental illness
I- interpersonal relationship
R- reality presentation (+ affirmation) ex:
A- activities of daily living a. rehabilitation program
b. vocational training
A. MENTAL HEALTH c. after care support
- ability of the individual, family and community d. partial hospitalization
to respond adaptively to the internal and external
stressors CONCEPTUAL FRAMEWORK of PSYCH
CARE
B. POPULATION is at RISK to DEVELOP - organizing and better understanding of
1. Genetic predisposition the psychiatric care
2. Poor access to health care - helps the nurse to make a rational
3. Poverty systematic approach of the nursing care
4. Misusing substances
5. Undergoing lifestyle changes Classification:
Ex. : early pregnancy 1. PSYCHODYNAMIC FRAMEWORK
6. Victims of violence - focuses on the conflict, anxiety and
7. Elderly people defenses
Ex.: dementia, delirium, alzheimer’s dse. - process that makes the patient
conscious (dream analysis)
C. PSYCHIATRIC NURSING - TRANSFERENCE ANALYSIS
- interpersonal process between the nurse and - focuses on intrapsychic
patient to promote and maintain optimum level process
of functioning a. Psychosexual Stages- Freud
b. 8 Developmental Stages- Erickson
D. CONCEPT of PSYCHIATRIC NURSING c. Personality Dynamics-
Psychiatric Mental Health Nursing psychoanalytic
8 Human Responses: - topography/ iceberg of the
1. activity mind
2. cognitive level - components of personality
3. environment *ID, EGO, SUPEREGO
4. emotions - defense mechanism
5. interpersonal
6. intrapersonal: talking to self; visual imaging 2. BEHAVIORAL FRAMEWORK (Skinner)
7. own perception - focuses on learned behavior
8. physiologic - person is shaped by own environment
- behavior: REWARD and
Levels of Care PUNISHMENT
1. PRIMARY - anxiety, behavioral problems
- altering risk factors to hinder *systematic desensitization
development of mental illness
ex: 3. INTERPERSONAL FRAMEWORK (Sullivan)
a. client and family teaching - personality development
b. stress reduction - result to interaction with significant
c. psychosocial support others
- focus in interpersonal relationship

4. HUMANISTIC/EXISTENTIAL FRAMEWORK
- focuses on human experiences
- human beings are responsible for their - unhappy
own behavior b. WEAK/DEFECTIVE SUPEREGO- guilt feeling
- lack of self-awareness - antisocial behavior;
* GESTALT THERAPY * if superego is dominant, it needs the
- patient is assisted by means of role id
playing to express feeling *disorder: Obsessive-Compulsive Disorder and
5. BIOMEDICAL FRAMEWORK Anorexia Nervosa
- focuses on the disease process or approach AGE FREUD ERICKSON SULLIVAN PIAGET
0-18 mos. - ORAL - TRUST vs. - need for - Sensorimotor
- brought about by STAGE MISTRUST security - gradual
a. Neurotransmitter Theory - gratification - special or increase in the
by means of significant ability to think
- depression: ↓ serotonin’ mania: ↑ serotonin taking person: and use
- dementia: ↓ dementia everything in Mother language
- depression: ↓ epinephrine; mania: ↑ - needs of - tolerates
infants are small doses of
norepinephrine primarily frustration
centered into
the lips,
TOPOGRAPHY of the MIND mouth and
1. CONSCIOUS tongue
- ID is
- awake dominant
- part of the mind that functions during thinking *maternal
- here and now; responds to self or “I” deprivation:
infant is not
- memories or ideas can be recalled without given milk
exerting effort 1 ½- 3 - ANAL - - develop self- - Pre-
yrs. STAGE AUTONOMY esteem operational
- gratification vs. SHAME & - Pre-
2. SUBCONSCIOUS through DOUBT conceptual
elimination - principle of - use of
- stored in the mind but partially forgotten and retention struggling of symbols with
- ideas can be recalled but with exerting effort of feces holding on literal
- tip-of-the-tongue experience - mother: and letting go interpretation
superego - special
- Ambivalence figure:
3. UNCONSCIOUS - toilet PARENTS
training: when
- largest part of the mind present, child
- gives greatest influence in the personality of becomes OC
the person 3-6 yrs. - PHALLIC - INITIATIVE
STAGE vs. GUILT
- serves as storehouse of all the memories - interest is
- can be expressed by means of dreams, slip of focused on
his/her own
the tongue, unexplained behavior, jokes or lapse body
of memories - penis envy
- Oedipus or
Electra
COMPONENTS of PERSONALITY Complex
6-12 yrs.
12-18
1. ID- unconscious part of the person yrs.
- focuses on biologic drives; primitive 18-25
yrs.
- part of the personality in which we are born 25-45
because it was developed during the infancy yrs.
stage of development 45 &
above
- PLEASURE PRINCIPLE
* if id is dominant, it needs superego or “conscience”
* disorders: Mania, Antisocial and Narcissism
THERAPEUTIC COMMUNICATION
- process in which the nurse consciously utilizes
2. EGO- REALITY PRINCIPLE
the principle of communication in a goal-directed
- corresponds to self or “I”
framework
- integrator of the personality
- mediator between the id and superego
Best responses:
- develops during toddlerhood stage
1. here and now events
* disorder: Schizophrenia (ego distortion)
2. more of the “what” than the “why” questions
3. orientation and presentation of reality
3. SUPEREGO
4. description rather than judging
- conscience
5. maintenance of biological integrity
- MORALITY PRINCIPLE
6. actual observation
- with parental directions of censoring force
7. nursing intervention
- develops during PRE-SCHOOL AGE
8. sharing of information exploring alternatives
a. STRICT SUPEREGO- personality is rigid
NURSE-PATIENT REALTIONSHIP - involuntary; automatic; submerging of the
painful experiences
Therapeutic vs. Social Relationship - called UNCONSCIOUS FORGETTING
- usually used by patients with Catatonic
Therapeutic Relationship Schizophrenia
- focuses on personal and emotional needs of B. SUPPRESSION
the client - also called extensional exclusion of forbidden
ideas
Social Relationship - called CONSCIOUS FORGETTING
- focuses on the needs and emotions of both the - ex: a rape victim consciously forgets the
nurse and patient experience
C. RECATION-FORMATION
PHASES of NURSE-PATIENT INTERACTION - assuring the attitude or behavior that one
consciously regrets
1. ORIENTATION PHASE - usually used by manic patients
- introduction and role definition D. RATIONALIZATION
- establishment of trust - attempting to modify or justify the unacceptable
- clarify therapeutic parameters needs
a. Assessment - always use the word “because” to maintain
- must be completed within 24 hours self- respect
- set the contract with the client E. UNDOING
- start the establishment of discharge plan - actual or symbolic attempt
- brief but frequent interactions - erase previous experiences that cause the guilt
feelings
2. WORKING PHASE - repair feelings that created the guilt feelings
- promotes problem-solving approach F. PROJECTION
- discussion between the nurse and patient - attributing ones own unacceptable behavior to
- nurse had established trust from the patient others
- patient is cooperative - blames others
- nurse already teaches patient the new coping - “escape goat”
strategies G. COMPENSATION
- attempting to make-up or off-set deficiencies
3. TERMINATION PHASE by means of developing other personal qualities
- time of evaluation H. INTELLECTUALIZATION
- nurse already start summarizing the - overuse of intellectual concepts to avoid the
accomplishment and regrets real or effective expressions of the feelings
- called SOLIDIFICATION of SEPARATION I. IDENTIFICATION
- nurse says “good bye” - attempting to pattern or resemble the
- patient feels grief and anger towards the nurse personality of the admired person
- circumstance: SUICIDE due to anxiety J. CONVERSION
- transforming an emotional problem into
physical signs and symptoms

EGO DEFENSE MECHANISM


- unconscious protective barriers that are used Manifestations of MI
to manage instinct and affect in facing difficult situations
- except for the defense mechanism of 1. Alteration n Perception
suppression (because it’s the only defense mechanism a. Hallucination
operating in the conscious level) - false sensory perception
- involve any of the 5 senses
Purpose:
1. self security protection a.1. Auditory- command hallucination
2. anxiety reduction - (Schizophrenia)
3. mental conflict resolution a.2. Tactile- common among alcoholics and drug
4. increase self-esteem protection addicts
- “bugs are crawling under my skin”
A. REPRESSION a.3. Visual- common among alcoholics and drug
addicts
a.4. Gustatory- common among patients with
delirium h. Concrete Association
a.5. Olfactory- common among patients with - philosophical answering
delirium
- “I smell scents of roses” 3. Disturbance in Memory
a. Anterograde Amnesia
Nursing Interventions: - recent memory loss
1. Assess auditory hallucination: “What are the - common to patients who have just undergone
voices telling you?” ECT
2. Acknowledge the feelings of the client: “It
must be frightening to you” Nursing Ix.:
3. Present reality - Re-orientation: use of clock or calendar
4. Distract the patient
b. Retrograde Amnesia
b. Illusion - remote memory loss
- misinterpretation of an external stimuli - common among patients with dementia
- ex: “white lady is staring at me”—pointing to
the window Nursing Ix;:
- REMINISCNECE THERAPY
Nursing Interventions: * use of diary and photographs
1. Remove the stimulus
2. Disturbance in cognition or thought process 4. Disturbance in Affect
a.Flat- giving no response to questions
2. Disturbance in Cognition or thought process b. Blunt- giving minimal response to questions
a. Delusion c. Inappropriate- giving response opposite to the
- false belief with or without the stimulus questions
d. Labile- characterized by mood changes with an
a.1. Reference- everything that occurs in the exaggerated affect
environment has a direct significance of oneself
a.2. Persecution- directed to the people or 5. Disturbance in Behavior
institution a, Negativism
a.3. Erotomania- everybody is in love with him or - doing the exact opposite of what’s being said
her or asked
a.4. Gradiosity- inflated with self worth, power b. Automatic Obedience
and knowledge b.1. Echolalia- repeats the last word said by the
nurse
b. Ideas of Reference b.2. Echopraxia- repeats the last action done by
- misinterpretation of other people’s actions the nurse
- with stimulus c. Stereotyping
- ex: “they talk and write about me” c.1. Verbigeration- repeats the particular words or
“ I will not touch this food because when I phrases
touch it, you might hurt me” c.2. Manerisms- peculiar movement or gesture

c. Looseness of Association
- shifting from one topic to another which has no
meaning

d. Flight of Ideas CRISIS


- has context or content - situation that occurs when an individual’s
habitual coping ability becomes ineffective to meet the
e. Neologism demands of the situation
- coining of new words
- common in Schizophrenia patients Characteristics:
1. highly individualized
f. Word Salad 2. lasts from 4-6 weeks
- chaining of new words 3. person becomes passive and submissive
- without coherent thought 4. affects the support system

g. Clang Association Types of Crisis


- rhyming of the words 1. MATURATIONAL/ DEVELOPMENTAL
- poetic responses - crisis that is expected or predictable
- motivated by interval environment 1. Let the patient verbalize his or her feelings
- ex: parenthood and emotions
2. Preserve the evidence**
2. SITUATIONAL/ACCIDENTAL
- unexpected or unpredictable B. Battered Wife Syndrome (BWS)
- motivated by external factors or environment - a cycle of violence characterized by wife
- ex: car accident beaten by the husband as a sign of humiliation and
aggression
3. SOCIAL
- due to acts of nature Decreased Self-esteem:
common trait of
- ex: typhoon or earthquake abusive husband
Dependency: common trait if an abused wife
Phases of Crisis
1. Denial- initial reaction Elements of Battered Wife Syndrome
2. Increased tension- person recognizes the 1. Men usually came from violent families
presence of crisis but still continues the ADLs 2. Husbands/men who are immature,
3. Disorganization- person is preoccupied with the dependent and non-assertive
crisis situation 3. Husbands are with strong feeling of
4. Attempt to reorganize- person mobilizes the inadequacies or insecurities
previous coping mechanism
Stages of the Battered Wife Syndrome
Conditions requiring intervention 1. TENSION-BUILDING PHASE- involvement of
the minor battering incident
A. Rape Trauma Syndrome (RTS) 2. ACUTE BATTERING INCIDENT- characterized
- group of signs and symptoms experienced by by a more serious form of battering
the victim in reaction to rape 3. AFTERMATH/HONEYMOON PHASE- husband
becomes loving and gives wife hope
RAPE
- insertion of the penis into the vagina, Crisis Intervention:
mouth or anus as a sign of violence and/or 1. Provision of the shelter
aggression (RA 8353)
- sign of retaliation PSYCHOSIS NEUROSIS
- insertion of any object into the vagina, Reality Absent Present
mouth or anus orientation
- act of hostility or violence Etiology Organic psychosocial Due to anxiety
Types a. organic- cause is a. anxiety related
specific disorders
Elements of Rape b. psychoactive b. different phobic
1. use of threat substances disorders
2. lack of consent from the victim c. medical c. somatoform
3. actual penetration of the penis into the d. functional- cause is disorders
vagina unknown;
mood/thought
Signs and Hallucination Compulsion
symptoms Illusion Obsession
Types of Rape Delusion Phobia
1. POWER- done to prove one’s masculinity Interventions Present reality Explore feelings
2. ANGER- done as a means of retaliation Acknowledge feelings
3. SADISTIC- done to express erotic feelings Hospitalization In Out
Treatment Administration of Antianxiety
Antipsychotics Psychotherapy
ECT
Psychotherapy
Stages of RTS
1. Acute- characterized by shock, numbness
and disbelief ANXIETY- subjective emotional state occurring when the ego is
2. Denial- characterized by the victim’s refusal to being threatened by the unknown condition
talk about the incident
Levels of Anxiety
3. Heightened Anxiety- characterized by fear, t a. MILD- patient is still alert, motivated and
and nightmare attentive
4. Re- organization- characterized by the b. MODERATE- patient has narrowing
normalization of the victim’s life perception, selective inattention and physical
discomfort
c. SEVERE- patient has automatic behavior but
Crisis Interventions:
with r marked reduction of senses
d. PANIC- patient is overwhelmed
c. Borderline- impulsive, self-damaging, unstable
Anxiety Related Disorders interpersonal relationship, chronic feeling of
1. Generalized Anxiety Disorders (GAD) emptiness/boredom
- characterized by restlessness, fatigue, irritability and d. Antisocial- evil personality
inability to concentrate - resists the authority, without rules and
- lasts for 6 months regulations; inability to feel guilt feelings
- does not learn from past experience
Nursing ix: - charming, lacks judgment, self-centered
* Provide a calm and quiet environment - uses RATIONALIZATION

2. Obsessive-Compulsive Disorder (OCD) 3. Class C


- characterized by ritualistic behavior - with fear and anxiety
- defense mechanism of undoing - dev’t root: TODDLERHOOD STAGE

Nursing ix: a. Avoidant- loner, fear of negative evaluation, timid, with


* Never interfere with the behavior of the client social discomfort
b. Dependent- submissive, decreased self-esteem, passive
3. Post-traumatic Stress Disorders and helpless
- characterized by flashback and recurrent recollection of c. Passive-Aggressive- frequent outburst, temper tantrums
traumatic events (happens if person is
frustrated), resist demands for
Nursing ix: adequate performance
* Provide a safe environment d. Obsessive-Compulsive- perfectionist, pre-occupied with the
rules and regulations, inflexible
Anxiety Reducing Techniques characteristics
1. Cognitive-Behavioral techniques - behavior contains many rituals
- assesses the client’s belief system
- done by means of dialogue or self-talk Nursing Diagnoses:
a. Anxiety r/t difficulty in interpersonal relationship
2. Systematic Desensitization b. Ineffective individual coping r/t inability to tolerate
- slowly and progressively exploring the client to the frustrations
situation that evokes anxiety c. Social isolation r/t absence of meaningful
relationship
3. Progressive Relaxation d. Ineffective family coping
- visual imagery- allows relaxation response
Planning and Implementation:
a. Place realistic limits on the client’s behavior
PERSONALITY DISORDERS b. Maintain consistency and concern
- spectrum of maladaptive traits influenced by c. Protect individual from others
psychological and emotional disturbance and impaired d. Accept individual as a person
interpersonal relationship
- EGO SYNTONIC- comfortable for the individual but not
for others SEX- something we do
SEXUAL HEALTH- integration of somatic, intellectual, social
1. Class A aspects of social being
- odd/ eccentric behavior
- dev’t root: INFANCY STAGE SEXUAL DISORDERS
Types:
a. PARANOID- suspiciousness, fear, irritability, jealousy 1. Alteration in gender identity
- secretive individuals a. Transexualism
- blames others - persistent discomfort about sex assignment
- argumentative- uses PROJECTION - characterized by confusion in learning about
b. SCHIZOID- alone, cold, aloof, introverted personality since gender or roles
childhood b. Gender Identity Disorder in Childhood
- humorless, daydreaming - characterized by persistent and intense
- with outside thinking due to emotional distress at ones sex
detachment
c. SCHIZOTYPAL- intellectually diminished, withdrawn, 2. Alteration in Sexual Orientation
unattached to society a. Ego-dystonic Homosexuality
- characterized by weak heterosexual arousal
2. Class B - unwanted homosexual pattern
- dramatic/ erratic personality disorder
- dev’t root: SCHOOL AGE 3. Alteration in Sexual Behavior
a. Sexual acting-out
a. Histrionic- OC, dramatic, seductive, flirty with others, - characterized by distured conduct by means
manipulative, seeks attention of making sexually provocative remarks
b. Narcissistic- I, me, myself - with extramarital affairs
- sense of self-importance - inadequate interpersonal skills
- with grandiosity - with high sexual drive
- exhibitionist, lack of empathy, pre-occupation b. Paraphilias
with fantasies, power, beauty - more of the sexual urge or fantasies which are
(because of strong need for admiration) directed to non-human objects, pain, non-
concepting person, children
Types:
b.1. Fetishism
- sexual fantasies or gratification by means of
substitution of inanimate objects
which are connected to the genitals
b.2. Pedophilia
- sexual fantasies or gratification by means of
attraction to children which serve as
the sex objects
b.3. Voyeurism
- sexual fantasies or gratification by means of
watching the sexual play of others,
accompanied by masturbation
b.4. Necrophilia
- sexual fantasies or gratification by means of
sexual relations with a dead body
b.5. Zoophilia
- sexual fantasies or gratification is directed to
animals
b.6. Telephone Scatologia/Scalogia (SOP)
- sexual fantasies or gratification is directed
towards lewdness on the telephone
b.7. Frotteurism
- sexual fantasies or gratification by means of
touching or rubbing the non-
consenting person
- usually done in crowds or public transporation

SEXUAL ADDICTION
- characterized by recurrent, compulsive, self-distarctive
behavior
- includes compulsive masturbation

Nursing Diagnoses:
1. Anxiety r/t threat to security and fear
discovery
2. Altered sexual patterns
3. Sexual dysfunction
4. Altered family process
5. Ineffective individual coping

Plan of Care:
1. Accept individual as a person who is in emotional pain
2. Protect individual from others
3. Avoid punitive remarks
4. Set limits on the individual’s sexual acting-out
5. Provide diversional activities
6. Sexual counseling