Psychiatric nursing lec sir g


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Psychiatric nursing lec sir g

  2. 2. Reference MSN GILBERT BOOKSheila L. Videbeck T. SALACUP Alice M. Stain
  3. 3. Psychiatric Nursing MSN GILBERT-branch of nursing care with aim of assisting1. Individual 2. Family 3. Community To:P - revent mental illness T. SALACUPA –ttain and maintain mental healthCo – pe with mental illnessFi – nding meaning in mental illness experience and suffering
  4. 4. Self Awareness MSN GILBERT The process of knowing ones ownR- esponses in different situationsA- ttitudesPer - sonality, T. SALACUPPre - conceptionsS- trengths,Wea - knesses,P - rinciple,Be - liefs, sFee - lings,
  5. 5. MSN GILBERT Significance1. Self awareness differs from self - understand2. The major therapeutic tool of the n is nurse is the use of self Goal of Self awareness T. SALACUP To decrease the size of blind and private quadrants 2 Major Advantage in working toward goal1. Increase in self – awareness and self – disclosure2. Gain more control over own behavior
  7. 7. Therapeutic Nurse- MSN GILBERT1. Pre – Interaction B-egin before the nurse first contact with the PT S-elf awareness Therapeutic Task of the Nurse T. SALACUP1.Self Exploration feelings, fears, fantasies2. Gathering Data about Pt available information3. Planning for the 1st interaction with the patient
  8. 8. 2. Orientation Stage MSN GILBERT- A - ssessment and diagnosis phase- D-evelopment of mutually acceptable contact Therapeutic Task of the Nurse T. SALACUP Rapport Trust is built by demonstrating acceptance and non-judgmental attitude. Identify Patients Problem Mutually defined Goals with patients Formulate Nursing Diagnosis set priorities Explore the patients feelings thoughts and actions encourage to share it with the nurse
  9. 9. 3. Working Phase MSN GILBERT- I - dentification and declaration of patients problems- R - esistance observe T. SALACUPTherapeutic Task of the Nurse Explore relevant stressor Listening and Observing – tools use in this phase Realize theirs somebody appears interested to him who is warm and accepting can relate Develop a plan of action and implement then evaluate Assess client readiness for independent functioning Assist patient change maladaptive behavior
  10. 10. MSN GILBERT4. Termination PhaseT - ermination has been started in initial phaseA - ssumed that Pt is already with more understanding Therapeutic Task of the Nurse T. SALACUP- Review progress of the therapy and attainment of goal- Explore feelings of rejection, loss sadness, anger- Space contacts dec. time, visits, each contact- Established more relax environment- Privide necesarry referals
  11. 11. MSN GILBERT Sigmund Freud Father of Psychoanalysis Structure of Personality (Id, Ego, Superego) ID T. SALACUPPLEASURABLE PRINCIPLE Dominant ID Pain Avoidance I Nar - cisistic Puro “I”/ ako Ma – nia tisocial E An - S want to Eat Want to drink
  12. 12. MSN GILBERT EGOREALITY PRINCIPLE T. SALACUP Impaired Reality Schizophrenia Impaired E
  13. 13. MSN GILBERT SUPER EGO CONSCIENCE PRINCIPLE houldnt be T. SALACUP ense the voice of God   SDOMINANT SUPER EGOObsessive – compulsiveAnorexia Nervosa E I
  14. 14. Therapeutic Communication MSN GILBERT Effective Communication: A - daptive N - eutral responses A – ppropriate T. SALACUP R - eflect, restate, rephrase verbalization of patient S - tate behaviors observed Fo - cus on feelings Si - mple Co - ncise C - redible O - pen ended questions
  15. 15. Therapeutic relationship MSN GILBERTRelationship between health care professional and clientPurpose : assisting the client to solve his problems.Components of a Therapeutic Relationship1. TRUST T. SALACUP2. GENUINE INTEREST - he or she should be open, honest and display a congruent behavior3. ACCEPTANCE - Situation: A client tries to kiss the nurse. Inappropriate response: What the hell are you doing?! I’m leaving maybe I’ll see you tomorrow. Appropriate response: Adam, do not kiss me. We are working on your relationship with your girlfriend and that does not require you to kiss me. Now let us continue.
  16. 16. 4. EMPATHY MSN GILBERTIt is simply being able to put oneself in the client’s shoes. However, it does not require that the nurse should have the same or exact experiences as of the patient.Client’s statement: “I am so sad today. I just got the news that my father T. SALACUP died yesterday. I should have been there, I feel so helpless.” Nurse’s Sympathetic Response: “I know how depressing that situation is. My father also died a month ago and until now I feel so sad every time I remember that incident. I know how bad that makes you feel.” Nurse’s Empathetic Response: “I see you are sad. How can I help you?
  17. 17. 5. POSITIVE REGARD MSN GILBERT unconditional and nonjudgmental attitude where the nurse appreciates the client. Calling the client by name Spending time with the client T. SALACUP Listening to the client Responding to the client openly Considering the client’s ideas and preferences when planning care6. SELF-AWARENESS
  18. 18. MSN GILBERT THERAPEUTIC USE OF SELF Therapeutic Technique1. Offering Selfmaking self-available and showing interest and concern.“I will walk with you” T. SALACUP2. Active listeningpaying close attention to what the patient is saying by observing both verbal and non-verbal cues.Maintaining eye contact and making verbal remarks to clarify and encourage further communication.3. Exploring“Tell me more about your son”4. Giving broad openingsWhat do you want to talk about today?
  19. 19. 5. Silence - Planned absence of verbal remarks MSN GILBERT6. Stating the observedverbalizing what is observed in the patient to, for validation and to encourage discussion “You sound angry”7. Encouraging comparisons T. SALACUP describe similarities and diff.feelings,behaviors,& events.· “Can you tell me what makes you more comfortable, working by yourself or working as a member of a team?”8. Identifying themesasking to identify recurring thoughts, feelings, and behaviors.“When do you always feel the need to check the locks and doors?”
  20. 20. 9. Summarizing MSN GILBERTmaking appropriate conclusions.“During this meeting, we discussed about what you will do when you feel the urge to hurt your self again and this include…”10. Placing the event in time or sequence T. SALACUPasking for relationship among events.“When do you begin to experience this ticks? Before or after you entered grade school?”11. Voicing doubt uncertainty about the reality of statements, perceptions and conclusions. “I find it hard to believe…”12. Encouraging descriptions of perceptions feelings, perceptions and views of their situations“What are these voices telling you to do?”
  21. 21. 13. Presenting reality or confronting MSN GILBERTstating what is real and is not without arguing “I know you hear these voices but I do not hear them”.“I am G, your nurse,and this is a hospital and not a beach resort.14. Seeking clarification T. SALACUPasking patient to restate, elaborate, or give examples of ideas or feelings to seek clarification of what is unclear.“I am not familiar with your work, can you describe it further for me”.15. Verbalizing the impliedrephrasing patient’s words to highlight an underlying message to clarify statements.Patient: I wont be bothering you anymore soon.Nurse: Are you thinking of killing yourself?
  22. 22. 16. Reflecting MSN GILBERTthrowing back the patient’s statement in a form of questionPatient: I think I should leave now.Nurse: Do you think you should leave now?17. Restating T. SALACUPrepeating the exact words of patientsPatient: I can’t sleep. I stay awake all night.Nurse: You can’t sleep at night?18. General leadsusing neutral expressions to encourage patients to continue talking.“Go on…”“You were saying…”
  23. 23. 19. Asking question MSN GILBERTusing open-ended questions to achieve relevance and depth in discussion.“How did you feel when the doctor told you that you are ready for discharge soon?”20. Empathy T. SALACUP21. Focusingpursuing a topic until its meaning or importance is clear.“Let us talk more about your best friend in college”“You were saying…”22. Interpreting - providing a view of the meaning or importance of something.Patient: I always take this towel wherever I go.Nurse: That towel must always be with you.
  24. 24. 23. Encouraging evaluation MSN GILBERTasking for patients views of the meaning or importance of something.“What do you think led the court to commit you here?”“Can you tell me the reasons you don’t want to be discharged? T. SALACUP24. Suggesting collaborationoffering to help patients solve problems.“Perhaps you can discuss this with your children so they will know how you feel and what you want”.25. Encouraging goal settingasking patient to decide on the type of change needed.“What do you think about the things you have to change in your self?”
  25. 25. 26. Encouraging formulation of a plan of action MSN GILBERTprobing for step by step actions that will be needed.“If you decide to leave home when your husband beat you again what will you do next?”27. Encouraging decisions T. SALACUPasking patients to make a choice among options.“Given all these choices, what would you prefer to do.28. Encouraging consideration of optionsasking patients to consider the pros and cons of possible options.“Have you thought of the possible effects of your decision to you and your family?”
  26. 26. 29. Giving information - providing information will help MSN GILBERT patients make better choices.“Nobody deserves to be beaten and there are people who can help and places to go when you do not feel safe at home anymore”.30. Limit setting T. SALACUPdiscouraging nonproductive feelings and behaviors, and encouraging productive ones.“Please stop now. If you don’t, I will ask you to leave the group and go to your room.31. Supportive confrontationacknowledging the difficulty in changing, but pushing for action.“I understand. You feel rejected when your children sent you here but if you look at this way…”
  27. 27. 32. Role playing - both the nurse and patient play MSN GILBERT particular role.“I’ll play your mother, tell me exactly what would you say when we meet on Sunday”.33. Rehearsingasking the patient for a verbal description of what will be T. SALACUP said or done in a particular situation.“Supposing you meet these people again, how would you respond to them when they ask you to join them for a drink?”.34. Feedbackpointing out specific behaviors and giving impressions of reactions.“I see you combed your hair today”.
  28. 28. 35. Encouraging evaluation MSN GILBERTasking patients to evaluate their actions and their outcomes.“What did you feel after participating in the group therapy?”. T. SALACUP36. Reinforcementgiving feedback on positive behaviors.“Everyone was able to give their options when we talked one by one and each of waited patiently for our turn to speak”.
  29. 29. Non-therapeutic Technique MSN GILBERT Avoid pitfalls:1. Giving advise2. Talking about your self T. SALACUP3. Telling client is wrong4. Entering into hallucinations and delusions of client5. False reassurance6. Cliché7. Giving approval8. Asking WHY?9. Changing subject10.Defending doctors and other health team members.
  30. 30. Non-therapeutic Technique MSN GILBERT1. Overloadingtalking rapidly, changing subjects too often, and asking for more information than can be absorbed at one time.“What’s your name? I see you like sports. Where do you live?” T. SALACUP2. Value Judgmentsgiving one’s own opinion, evaluating, moralizing or implying one’s values by using words such as “nice”, “bad”, “right”, “wrong”, “should” and “ought”.“You shouldn’t do that, its wrong”.3. Incongruencesending verbal and non-verbal messages that contradict one another.The nurse tells the patient “I’d like to spend time with you” and then walks away.
  31. 31. 4. Under loading MSN GILBERTremaining silent and unresponsive, not picking up cues, and failing to give feedback.The patient ask the nurse, simply walks away.5. False reassurance/ agreementUsing cliché to reassure client. “It’s going to be alright”. T. SALACUP6. InvalidationIgnoring or denying another’s presence, thought’s or feelings.Client: How are you?Nurse responds: I can’t talk now. I’m too busy.7. Focusing on selfresponding in a way that focuses attention to the nurse instead of the client.“This sunshine is good for my roses. I have beautiful rose garden”.
  32. 32. 8. Changing the subject MSN GILBERTintroducing new topic inappropriately,The client is crying, when the nurse asks “How many children do you have?”9. Giving advice giving opinions or making decisions for the client, T. SALACUP“If I were you… Or it would be better if you do it this way…”10. Internal validationmaking an assumption about the meaning of someone else’s behavior that is not validated by the other person (jumping into conclusion).The nurse sees a suicidal clients smiling and tells another nurse the patient is in good mood.
  33. 33. Other ineffective behaviors and responses: MSN GILBERT1. Defending – Your doctor is very good.2. Requesting an explanation – Why did you do that?3. Reflecting – You are not suppose to talk like that!4. Literal responses – If you feel empty then you should eat more.5. Looking too busy. T. SALACUP6. Appearing uncomfortable in silence.7. Being opinionated.8. Avoiding sensitive topics9. Arguing and telling the client is wrong10. Having a closed posture - crossing arms on chest11. Making false promises I’ll make sure to call you when you get home.12. Ignoring the patient – I can’t talk to you right now13. Making sarcastic remarks14. Laughing nervously15. Showing disapproval – You should not do those things
  35. 35. DISPLACEMENT • Transfer of feelings • Boss shouts at you, you shout at your subordinate MSN GILBERT to a less threatening • A patient yells at a object rather than nurse after becoming angry at his the one who mother for not provoke it calling him.DENIAL • Failure to acknowledge an • “I’m not an alcoholic” T. SALACUP unacceptable trait or • A woman newly situation diagnosed with end- stage-cancer says, “I’ll be okay, it’s not a big deal”.DISSOCIATION • Psychological flight from self • “Sino ka, Sino ako?” • A type of amnesiaActing Out • Acting out refers to repeating Example: A husband certain actions to ward off gets angry with his anxiety without weighing the wife and starts staying possible consequences of those at work later. action.
  36. 36. INTROJECTION • Assume another person’s trait as • “ako din” MSN GILBERT your own • Not just you, me tooSUPPRESSION • Conscious forgetting of an anxiety • Hindi ko alam yan provoking conceptSUBLIMATION • Placing sexual energies toward a • may channel his more productive endeavours sex drive into his sports or T. SALACUP hobbies.CONVERSION • Repressed angers put towards • Biglang mangingig physical symptoms affecting nervous system leading to sensory numbness and motor paralysisCOMPENSATION • Overachievement in one area • Pilay pero magaling to cover a defective part kumantaSUBSTITUTION • Replacing a difficult goal with a • Gusto ko . more accessible one Enchanted nalang.
  37. 37. UNDOING • Doing the opposite of • “ay pinatid kita, halika punta kita sa clinic what you have done • A patient who says due to guilt something bad • plastic about a friend may try to undo the harm by saying nice things about her or by being nice to her and apologizing.IDENTIFICATION • Assume trait for personal, social, • Tulad nya occupational role • An adolescent girl begins to dress and act like her favorite pop star.PROJECTION • Attributing to others one’s • “hindi ako alcoholic, acceptable trait sila yon” • Pasa load
  38. 38. RATIONALIZATION • Illogical reasoning for a • I drink because I don’t socially unacceptable trait want to waste the beer in • “sayang ang beer sa ref, kaya the ref ko ininum” • An individual states that she didn’t win the race because she hadn’t gotten a good night’s sleepREACTION FORMATION • doing the opposite of your • sasabunutan kita. . . ay intention kuklulutin lang kita • Plastic • Love turns to hate and hate into love.REGRESSION • Return to an earlier • Return to thumbsucking developmental stageREPRESSION • Unconscious forgetting of an • Hindi ko maalala anxiety provoking concept • A woman who was sexually abused as a young child can’t remember the abuse but experiences uneasy feelings when she goes near the place where the abuse occurred.
  39. 39. ANXIETY
  40. 40. ANXIETY MSN GILBERTDefinition: Subjective, individual experience characterized by a feeling of T. SALACUP apprehension, uneasiness, uncertainty, or dread. Occurs as result of threats may be - Actual or imagined, - misperceived or misinterpreted, - threat to identity or self-esteem. It often precedes new experiences.
  41. 41. MSN GILBERT Types of Anxiety: Normal A healthy type of anxiety that mobilizes a person to action. T. SALACUP Acute Precipitated by imminent loss or change that threatens the sense of security. Chronic Anxiety that the individual has lived with for a long time.
  42. 42. MSN GILBERT Levels of Anxiety: 1.Mild/ Aler tness Level (+1)- Nor mal Type of Anxiety P -erceptual field increased A - lert T. SALACUP R - estless I - ncreases learningNursing Interventions:- Recognize the anxiety by statements such as “I notice you being restless today”.-Explore causes of anxiety and ways to solve problems “Let’s discuss ways to…”
  43. 43. 2. Moder ate/ A pprehension Level MSN GILBERT (+2)The response of the body to immediate danger and focus is directed to immediate concerns. T. SALACUPS - elective inattentiveness occursI - ncreased tension optimal time for learningN - arrows the perceptual fieldU - ses palliative coping mechanisms.
  44. 44. MSN GILBERTNursing Interventions:1. Provide outlets for anxiety such as crying or talking.2. Tell client “It’s all right to cry”.3. Encourage in motor activity to reduce tension.4. Make client be aware of his behavior and feelings by T. SALACUP statements such as “ I know you feel scare…”5. Encourage client to move from affecting (feeling) to cognitive mode (thinking).6. Refocus attention7. Encourage the client to talk about feelings and concerns.8. Help the client identify thoughts and feelings that occurred prior to the onset of anxiety.9. Provide anti-anxiety oral medications.PRN Meds
  45. 45. 3. Severe/ Free-floating Level MSN GILBERT (+3) Creates a feeling that something bad is about to happen, or feeling of an impending doom. T. SALACUPD - ilated pupils, fixed visionF - ight and flight response sets inA - ll behaviors are directed at alternative the anxietyN - arrow perceptual field occurs.T - he person uses maladaptive coping mechanisms.I - ndividual needs direction to focus Don’t know what to do Don’t know what to say
  46. 46. Nursing Interventions: MSN GILBERT1. Do not focus on coping mechanisms2. Stay calm and stay with the client3. Give short and explicit direction T. SALACUP4. Provide IM anti anxiety medications.5. Modify the environment by S- etting limits or seclusion, I -nteraction limit with others, R - educe environmental stimuli to calm client.
  47. 47. 4. Panic Level (+4) MSN GILBERTI- f prolonged, panic can lead to exhaustion and deathS - uicideP-ersonality and behavior is disorganized T. SALACUPI - nability to concentrateT-he person uses dysfunctional coping mechanisms.F- eelings of helplessness and terrorU - nable to communicate or function effectivelyL - essens perception of the environment to protectNursing Interventions:SafetyGuide patient step by step to actionRestrain if necessary.
  48. 48. ANTI-ANXIETY drugsBenzodiazepines - Zolam – Zepam1. F - lurazepam(dalamne) 7. T - riazolam(Halcion)2. O - xazepam(Serax) 8. A - lpraZolam (Xanax)3. L - orazepam(Antivan) 9.Chlo -rdiazepoxide(librium)4. D - iazepam(Valium) 10.Chlo - razepate(Tranxene)5. C - lonazepam(Klonopin)6. T - emazepam(Restoril)Non Benzodiazepines:Buspirone (Buspar)Meprobamate ( Miltown, Equanil)
  49. 49. Assess: Level of Anxiety MSN GILBERTNx Dx: Ineffective Individual Coping Powerlessness Impaired Skin Integrity T. SALACUPPlanning/ Implementation: ↓ level of anxiety ↓ environmental Stimuli Relaxation TechniqueEvaluation : Effective individual coping
  50. 50. MSN GILBERTGENERALIZED ANXIETY DISORDER - 6months excessive worrying - Might be mild, moderate and severe anxiety S/SxS - leep Disorders T. SALACUPP - alpitationsE - dge of the seatE - asy fatigabilityR - estlessD - ifficulty of concentration
  51. 51. MSN GILBERT PANIC DISORDER - recurring severe panic attacks 15 – 30 Minutes escalation of Somatic NS Phobia Phóbos, meaning "fear" or "morbid fear" T. SALACUPTypes of Phobias1. Agoraphobia - fear of open space/ public places2. Social Phobia - Also called Social Anxiety Disorder fear of public /presence of others.3. Specific Phobia - Also called Simple Phobia A persistent fear of a specific object or situation, other than of two phobias mentioned above.
  52. 52. Risk Factors MSN GILBERTLearning theoryphobias are learned and become conditioned responsesCognitive theory anxiety-inducing self-instructions of faulty cognitions.Life experiences T. SALACUP Certain life experiences, such as traumatic eventsSigns and SymptomsW - ithdrawalH - igh levels of anxietyI - nappropriate behavior used to avoid the feared situation, object or activityD - ysfunctional social interactions and relationshipsE - nability to function and meet self-care needs
  53. 53. Nursing Diagnoses MSN GILBERTAnxietyPowerlessIneffective individual copingImpaired verbal communication T. SALACUPAltered thought processesSelf-esteem disturbanceImpaired social interactionRisk for injuryTherapeutic Nursing Management Systematic desensitization This process of gradual exposure to phobic object or situation
  54. 54. POST TRAUMATIC STRESS DISORDER MSN GILBERTS - oldier T - raumaE – arthquake T. SALACUPW – ar VICTIMS  SurvivorsA - ccidentR - ape FlashbackD – isaster Nightmares
  55. 55. SOMATOFORM - no pretension, suggest medical diseases -no organic basis to support the illness. Types of Disorder1. Somatization disorder - chronic syndrome is characterized by multiple somatic symptoms that cannot be explained medically. The physical symptoms are associated with psychological stress.2. CONVERSION DISORDERNervous SystemLa Belle Indifference  emotional disattachment from disability
  56. 56. Sleep disorder MSN GILBERT This is characterized by difficulty initiating or maintaining sleep.Hypersomnia - or excessive sleepiness, T. SALACUPNarcolepsy - is a chronic sleep disorder, or dyssomnia, --- excessive sleepiness and sleep attacks at inappropriate times, such as while at workParasomnias - involve abnormal and unnatural movements, behaviors, emotions, perceptions,- dreams that occur while falling asleep- sleeping, between sleep stages,- during arousal from sleep.
  57. 57. Hypochondriasis MSN GILBERT This is a person’s unwanted fear or belief that he or she has a serious disease without significant pathology. Minor Discomfort Interpreted as major illness Body dysmorphic disorders T. SALACUP The client is preoccupied with an image defect in appearance when there is no abnormality. Illusion of structural defect  Client obsesses about imaged bodily defects (facial flaws, heavy buttocks or thighs) Pain disorder  The pain is unrelated to a medical disease.  The individual experiences severe pain that is in disproportion to the originating source.
  58. 58. MSN GILBERT Risk FactorsGender: FemaleAge: Children and older adults T. SALACUP Nursing DiagnosesImpaired adjustmentChronic painSleep pattern disturbance
  59. 59. PSYCHOSOMATIC MSN GILBERT1. to a physical disorder that is caused by or notably influenced by emotional factors.2. pertaining to or involving both the mind and the body. 4 major types T. SALACUP H - ypertension A - sthma M - igraine S - tress Ulcer - Real pains/ illness- Real symptoms
  60. 60. Obsessive Compulsive Disorder (OCD) MSN GILBERTpersistent thought and urges to perform repeated acts or rituals releasing tension Obsession recurrent and persistent thoughts, impulses, images that are intrusive, disturbing, inappropriate, and usually T. SALACUP triggered by anxiety. Compulsion Repetitive behaviors or mental acts that a person feels driven to perform, specifically defined routine. 
  61. 61. Thinking (Belief) → Mind-set MSN GILBERT Windows open → ↑ Anxiety Akyat bahay gang magnanakaw T. SALACUP Obsession (thought/thinking ) ↑ anxiety(thought) ↓Compulsion (Action) ↓ Anxiety Check the house
  62. 62. Specific Biological Factor MSN GILBERT OCD is linked to a deficiency in serotonin. Abnormalities in frontal lobes and basal ganglia Signs and SymptomsRuminations – forced preoccupation with thoughts about a particular topic, associated with brooding and inconclusive T. SALACUP speculation.Cognitive rituals – mental acts the client feels compelled to complete.Compulsive motor rituals – elaborate rituals of everyday functioning such as grooming, dressing, eating,Other symptoms – chronic anxiety, low self-esteem, difficulty expressing positive feelings and depressed mood.
  63. 63. MSN GILBERT4 Defense Mechanism by OCD R - epresion T. SALACUP I - solation R - eaction formation U - ndoing
  64. 64. Nursing Interventions MSN GILBERT Provide time to perform the rituals Limit, but do not interrupt, the compulsive acts. Teach to use alternate methods to decrease anxiety. Client’s behavior maybe frustrating to staff and family. T. SALACUP Power struggles often result. Consistency to the approach to care is critical. Assess the client’s needs carefully. Provide an environment that has structure and predictability as a strategy to decrease anxiety. Risk associated with the use of alcohol and drug abuse.
  65. 65. DISORDERS  defined as the totality of a person’s unique biopsychosocial and spiritual traits that consistently influence behavior. 1. Interpersonal relations that ranges from distant to overprotective. 2. Suspiciousness 3. Social anxiety 4. Failure to conform to social norms. 5. Self-destructive behaviors 6. Manipulation and splitting.
  66. 66. Cluster A:Personality Disorders(The Eccentric and Mad group) MSN GILBERT Paranoid – Moto wag magtiwala Sa iba overly suspicious and mistrustful behaviorNX. Management Psychotheraputic task on dealing trust Issues Low dose Phenothiazine T. SALACUPSCHIZOID – Moto little emotionN - ever had a best friendB - elieves he can stand on his ownI - don’t want peopleC - ares more about computers and petsA - void groups and social activities  no enjoymentNX management Gradual involvement Milleu and group therapy Focus on building trust
  67. 67. Schizotypal Personality Disorder- MSN GILBERT pervasive pattern of social and interpersonal deficits, with cognitive and perceptual distortions and behavioral eccentricities. Clinical Manifestations: R - estricted range of emotions T. SALACUP O - dd appearance (stained or dirty clothes, unkempt and disheveled) L - oose, bizarre or vague speech E - xpresses ideas of suspicions regarding the motives of others E - xperiences anxiety with people W - ander aimlessly I - deas or reference and magical thinking is notedNx Management Low dose of neuroleptic Involved activity with others
  68. 68. MSN GILBERT Cluster B: Personality Disorders ( The Erratic and Bad group)  ANTI - SOCIAL M - otto I break the law A - s a child,: steal, lie, always get reprimanded T. SALACUP G - ood talker, charmer, witty manipulator  A - dult – grand robbery, illegal activitist against the law, drug addiction, drives fast, unsafe sex, thrill seekerNx Management Firm Limit Setting Confront behaviors consistently Enforce consequences Group therapy
  69. 69. BORDERLINE PERSONALITY DISORDER- Most common personality disorder found in clinical settings.- Marked impulsivity.- It is more common in females than in males.- Self-mutilation injuries such as cutting or burningMoto my life is an empty glassNx Management Promote safety Help client to cope and control emotions Teach social skills , Set limits Behavioral contracts decrease mutilation Empathy and group therapy
  70. 70. MSN GILBERT Narcissistic I love myself Moto I am famous Insensitive, arrogant, use rationalization I am the best T. SALACUP lack of empathy. Ambitious and confident Nx management Teach client that mistake are acceptable Focus on here and now Teach client imperfection do not decrease worth
  71. 71. MSN GILBERT HistrionicExcessive emotionality and attention-seeking behaviors excited, dramatic but manipulative Center of attention Highly suggestible and will agree with almost anyone T. SALACUP to gain attention Uses colorful speech, Tends to overdress Concerned with impressing others Motto Ako ang bidaNx management Facilitate expression + reinforcement for unselfish behavior
  72. 72. Cluster C: Personality Disorders MSN GILBERT ( The anxious and Sad group) AVOIDANT = No people No trouble I avoid people, I fear criticism Have talent but no confidence T. SALACUP 3 Pattern Social uneasiness and reticence Very Low self-esteem Hypersensitivity to negative reactionNx Management Promote Self Esteem Gradually confront fears Increase exposure to small groups
  73. 73. MSN GILBERT Dependent Moto I can’t live without you ↓ self esteem , Pessimistic Poor decision making skills Uncomfortable and helpless when alone T. SALACUP Has difficulty initiating  or completing simple daily tasks on their ownNx management Teach problem solving and decision making skills NPR Goal increase assertiveness
  74. 74. Obsessive – Compulsive MSN GILBERT I am Perfect, moto I am organized Perfectionist Provide time to do rituals T. SALACUP Precise and detail-orientedNx Management Explore the feelings Teach patient mistakes are acceptable
  75. 75. MSN GILBERTOther related disorderDepressive – Moto I think Im gonno die again Pattern of depressive cognition and behavior in variety of context Occurs equally in men and woman T. SALACUP Same behavior characteristic in major depression but less severe . Recurrent thought of death Total disinterest in all activity Inability to express joy Self Criticism Nx Management Assess self harm risk, provide safety Promote self esteem Increase involvement in activity
  76. 76. MSN GILBERT Passive Aggressive Moto Oh yes Oh your not Always say yes but resistance is hidden 1-3% IN GEN, POP. 2-8% IN CLINICALSET UP May appear cooperative even ingratiating T. SALACUP Blame others for misfortuneNursing management Teach relaxation techniques Assertiveness Teach expressing the feelings directly
  77. 77. Schizophrenia MSN GILBERTS - tress – Diathesis Model  Too much stress in the reality will lead client to escape it and go to the fantasy world T. SALACUP I - mpaired reality perception G - enetic vulnerability E - go disintegration B - iological Theory  Dopamine level is High A - exact cause is unknown
  78. 78. Extremely complex mental disorder MSN GILBERT Recent research reveals that schizophrenia may be a result of faulty neuronal development in the fetal brain, which develops into full-blown illness in late adolescence or early adulthood. Diagnosed in late adolescence or early adulthood. T. SALACUP Peak incidence of onset MEN - 15 to 25 years of age WOMEN - 25 to 35 years of age Rarely In childhood.
  79. 79. Negative or Soft Positive or Hard MSN GILBERT symptoms  symptoms Flat affect Delusion T. SALACUPLack of volition Hallucinations,Social withdrawal or Grossly disorganizeddiscomfort thinking, speech, and behavior
  80. 80. 1. Assess : Content of Thought MSN GILBERTNx Dx : Disturbed thought processPlanning/ Implementation:Present realityProvide safetyEvaluation : Improve thought process T. SALACUP 2. Assess : Hallucination/ IllusionsNx Dx : Disturbed sensory perceptionPlanning/ Implementation:Present realityProvide safetyEvaluation : Improve sensory perception
  81. 81. 3. Assess : Suspicious MSN GILBERTNx Dx : Risk for other directive behaviorPlanning/ Implementation:Present realityProvide safety T. SALACUPEvaluation : Eliminate/ minimize risk for other-directed violence4. Assess : SuicidalNx Dx : Risk for self directive behaviorPlanning/ Implementation:Present realityProvide safetyEvaluation : Eliminate/ minimize risk for self-directed violence
  82. 82. MSN GILBERT Flight or Looseness  I am super star I am super star. T. SALACUP Gulay is malungay? Super star is Nora Were are you. Nora is a gay I love beer. Gay is man 
  83. 83. 4 A’s MSN GILBERT ffect  appropriate, inappropriate, flat, blunt (incomplete emotion) mbivalence  torn between 2 opposing forces T. SALACUP utism ssociative Looseness 
  84. 84. MSN GILBERTMagical Thinking - Believes to have a magical powerEcholalia  I repeat what you say  ParrotsEchopraxia  I repeat what you do T. SALACUPWord Salad  words, no rhymeClang Association  words with rhyme : Doom, Kaboom, BrommNeologism  creation of new words olasta, labidadaClarification  done in case of neologism
  85. 85. Delusion: fixed falls belief with no basis in reality MSN GILBERT Persecutory  FBI will get me/ someone will harm the Patient Religious  I am Jesus, allah, budah Grandeur  I am the king of the world. Ideas of reference  MD are talking about me. T. SALACUPConcrete Association  pilosopo “ what will u use in txting your calculator?” Hallucinations IllusionStimulus Absent PresentVisual X √Auditory X √Tactile X √
  86. 86. Hallucinations Management: MSN GILBERT H - allucinationsA – cknowledgment - I know the voices are real to youR - eality orientation - But I don’t hear them T. SALACUPD - iversion - Lets walk  Take noteBut if nothing in the preceding intervention are seen= Assess what the voices are saying
  87. 87. TYPES OF SCHIZOPHRENIA MSN GILBERT1. Paranoid - Suspicious Ideas of reference Tendency to be violent - Defense mechanism Mistrust→Scared→Withdrawn Projection Nrsg. Int:Build up trust: T. SALACUP 1 to 1 short interaction frequent visit foods in sealed container meds wrapped For violent pt.- Doors open - Near the door - Don’t touch the pt.- Eye contact - 1 arms length away -call reinforcement 
  88. 88. MSN GILBERTCatatonic – abnormal motor behaviorOnset - Acute DFM - RepressionNo – favorite wordI - niwan na posture, ganun forever T. SALACUPW - axy FlexibilityA - mbivalenceN - egativism Treatment ECT Benzodiazepines (such as diazepam or lorazepam) for catatonic schizophrenia.
  89. 89. MSN GILBERT Unclassified / undifferentiated Mixed Manifestation Can’t be classified 1st paranoid, then disorganized then catatonic, etc etcDFM – Regression T. SALACUP Residual Recovering/ decrease S/SNo more positive s/sx, just withdrawn
  90. 90. MSN GILBERTDisorganized/HEBEPHRENIC  Bizarre behavior DFM- Regression and Fantasy Sad but smiles T. SALACUP Inappropriate affect No reaction Flat affect Flight of ideas Giggling Positive and Negative S/Sx
  91. 91. High Dopamine= Schizophrenia MSN GILBERT Dopamine AcetylcholineAntipsychotics = Dopamine goes down T. SALACUPIf Acetylcholine Dopamine Extra pyramidal Side EffectsAKATHISIA AKINESIARestless, inability to sit Muscle rigidityMakati siya, ahh kati siya Ahh kiniss siya
  92. 92. DYSTONIA MSN GILBERT 3 features TORTICOLLIS Wry neck OCULOGYRIC CRISIS Fixed stare OPISTHOTUNOS Arched back TARDIVE DYSKINESIA T. SALACUP  Irreversible side effects of antipsychotics  Lip smacking  Tongue protruding  Cheeks puffing NEUROLEPTIC MALIGNANT SYNDROME  Hyperthermia among client taking antipsychotic  Hyperthermia with muscle rigidity
  93. 93. MSN GILBERT Other Side Effects Photosensitivity Sunscreen Wide brimmed hat Agranulocytosis T. SALACUP Report immediately Sore throat 1st sign to appear 
  94. 94. ANTIPSYCHOTIC AGENT–major tranc/nueroleptics MSN GILBERT Sub classification: Phenothiazines: Non Phenothiazines:Thorazine – Tora Tora Haldol – Ha IdolProlixin – Pro ang lixi n Navane – Sundalo pangdagat T. SALACUPMellaril – Mella nmaril Tegretol – Hayop yan Tegre tolSerentil – on seren til mawalaTrilafon - Trila in FonilaStelazine - Nanood si stela Zine AtypicalClozaril – close sa reel! yehSeroquel – Sero kal talagaInvega – in vega n natin mga sisterIsigaw ntin ang - Geodon
  95. 95. ANTI PARKINSONS –management anti psychotic induce EPS MSN GILBERTA tivan(lorazepam) - Ati - vanD iazepam(valium)- ang tunog nyan Dia - zepammmmmI nderal(propanolol) – Inde – Ral ral rallK emadrin(procyclidine)- Keme – Drin drin drin T. SALACUPA- akineton (biperiden)- ay nako mga baliw akin ne toB- benadryl(diphenhydramine)- ben that’s a drylL- larodopa(Levodopa)- mmm Laro kc kau ng laro! D paE- Eldepryl (Selegilene)- ang sbi bi ni elde p reel kc kau akin n nga ungS- symmetrel-(amantadine)- Sym Motor ko hmm bulol symmetrelC- cogentin(Benztropine)-Sakay nlang kau sa coge tinA- artane(trihexyphenidyl)- ang a artane kc nilaP- parlodel(Bromocriptine)- Para Lodel at nkarating na silang lhat end Increase protein and give B6
  96. 96. Mood Disorder MSN GILBERT Disturbance in mood ( Affect) that is either depression or elation (mania = persistent hyperactive) Bipolar - Mania more common T. SALACUP Results from disturbances in the areas of the brain that regulate moodIt involves periods of excitability (mania) alternating with periods of depression Men and women equally Usually appears between ages 15 – 25Cause Unknown Stressful life ObeseIt occurs more often in relatives of people with bipolar disorder Ref. Videbeck Page 317
  97. 97. MSN GILBERT Risk factors Biochemical imbalances Family genetics – one parent, child has 25% risk; two parents, 50-75% risk. Environmental factors-such as stress, losses, poverty, social isolation. Psychological influences–inadequate coping, denial of disordered behavior T. SALACUP Specific Biological Factors Possible excess of norepinephrine, serotonin, and dopamine. Increased intracellular sodium and calcium Neurotransmitters supersensitive to transmission of impulses Defective feedback mechanism in limbic system.
  99. 99. Self Actualization =Task MSN GILBERT Self Esteem = Nursing Role Restrain Impaired social interaction = safety T. SALACUP Risk for injury/ other directed violence= safety ↓ Eating ↓ Sleep Hyperactive ↑ Sexfinger food Private room Anxiety
  100. 100. ↓SE → ↑Compensation → ↑interfere ADLs, ↑ harm others MSN GILBERT↑SE → ↓Compensation → ↓interfere ADLs, ↓ harm othersTASK → increases client’s self esteem Escorted walk outdoors Punching bagNo group games  compitition will increase anxiety T. SALACUP 3 or more signs confirms disorderS - leeplessnessP- ressured speechE - xaggerated SEE - xtraneous stimuli (easily distracted)D - istractibilityG - randioseF - light of ideas
  101. 101. Therapeutic Nursing Management MSN GILBERT Environment Psychological treatment  Individual Psychotherapy – may be used to identify stressors and pattern of behavior.  Group therapy – establishes a supportive T. SALACUP environment and redirect inappropriate behavior.  Family therapy – verbalizes family frustration and establishes a treatment plan for outpatient use. Somatic and Psychopharmacologic treatments  electroconvulsive therapy  Psychopharmacology
  102. 102. DEPRESSION  ↓ Serotonin MSN GILBERT if unresponsive to drugs, ECT Kubbler-Ross Stages of Dying / Grief ProcessDenial “No not me”, “Its not true”, “Its not impossible”Anger why me, why now, What did I do to deserve this?”Bargaining  “If I live until Christmas or until my child’s T. SALACUP graduation ( So many if’s), I will do this…”Depression  “Yes, I’m dying”Acceptance  “Yes, I am ready” ↓Self Actualization ↓Self Esteem = Task Withdrawn = stay Risk for self directed violence   Eating Sleep Hypoactive ↓Sex
  103. 103. MSN GILBERT Major Depressive Disorder 2 or more weeks of sad mood 9 SymptomsS –leep disturbance (insomia/hypersomia)O – Vert Suicidal Ideation (Recurrent thoughts of deaths) T. SALACUPM – emory Disturbance (Indecisiveness)E – nergy loss or FatigueA – gitation psychomotorL – ost of interest/ PleasureO – bvious Wt SignificanceN – ihilism – feeling of worthlessnessE – motional blanting and sad effect – depress mood 5/9 symptoms present 2 or more weeks 1 of which is depressed
  104. 104. Risk Factors MSN GILBERT Biological factors – brainchemicals Family genetics – parent with depression, child 10-13% risk of depression. Gender – higher rate for women Age – often less than 40 when begins Marital status – more frequently single, widowed T. SALACUP Season of year – Seasonal Affective Disorder (SAD) occurs when client experiences recurrent depression that occurs annually at the same time. Psychological influences – low self-esteem, unresolved grief. Environmental factors – lack of social support, stressful life events. Medical co-morbidity – clients with chronic or terminal illness, postpartum, and current substance abuse are especially prone to becoming depresses.
  105. 105. Therapeutic Nursing Management MSN GILBERT Safe environment Psychological treatment  Individual psychotherapy – long –term therapeutic approach or short term solution-oriented, may focus on in-depth exploration, specific stress situations, or problem solving.  Behavioral therapy – modifying behavior to assist in reducing depressive symptoms and increasing coping skills. T. SALACUP  Behavioral contacts – focus on specific client problems and need to help the client resolve them. Social treatment  Milieu therapy – day to day living experiences in a therapeutic environment  Family therapy – aimed at assisting the family cope with the client’s illness and supporting the client in therapeutic ways.  Group therapy – focuses on assisting clients with interpersonal communication, coping, and problem-solving skills. Psychopharmacologic and Somatic treatments  Administer antidepressant medications  Continued assessment interms of agitation and suicidal ideation.  Electroconvulsive therapy
  106. 106. MSN GILBERT Nursing Interventions1. Priority for care is always the client’s safety.2. Use of behavioral contacts. “no self-harm” or no suicidal ideation or plan.3. Assess regularly for suicidal ideation or plan.4. Observe client for distorted, negative thinking. T. SALACUP5. Assist client to learn and use problem solving and stress management skills.6. Avoid doing too much for the client, as this will only increase client’s dependence and decrease self-esteem.7. Explore meaningful losses in the client’s life.
  107. 107. MSN GILBERT ANTIDEPRESSANTSS - inequan – Watch tau ng Sine QuanA - nafranil – Ana Franil PalaV - ivactil – Bi back tau agad after nuod ngE - lavil – Ela evil T. SALACUPP - rozac – Pero sak a naA - ventyl – Aveeen Til Midnight tayoN - orpramin – NorT - ofranil – Tofra an kitaP - axil – Taksil kaA - sendin – asan n din kauZ - oloft – yan mag Solo ka 
  108. 108. 1st Line of Drug Prescribed MSN GILBERT afest ELECTIVE Prozac(Fluxetine) ide effects low T. SALACUP EROTONIN Paxil (Paroxetine) EUPTAKE Zoloft(Sertraline) note: No suicidal or to 4 weeks HomicidalNHIBITOR take in am to avoid insomnia
  109. 109. Two – 4 wks Sendin (Amoxapine) MSN GILBERT Tri orpramine (Desipramine) CYCLIC ofranil (Imipramine) T. SALACUP inequan (Doxepine) NTIDEPRESSANT Lavil amelor Higher incidence of Side effects Serotonin/ Epi affectedNeuro and hepatotoxisity,Cardiac Arrytmias Suicide Precausion 10 -15 days precausion
  110. 110. ONO MSN GILBERT arplan (isocarboxazid) ardil ( Phenelzine) Mine T. SALACUP arnate (Tranylcypromine) Xidase NhibitorAll neurotransmitter affected Highest Side effectsAvoid tyramine rich food may lead to HYPERTENSIVE CRISES 
  111. 111. TYRAMINE RICH FOODS MSN GILBERT vocado ged Cheese  eer   hocolate T. SALACUP  ermented Foods  ickles reserved Foods  oy Sauce
  112. 112. LITHIUM MSN GILBERTL evel 0.5 – 1 mEq/LI ncrease urinationT remors, fine handH ydration 3 L/day T. SALACUPI ncrease Na+Uu diarheaM outh, dry Maintenace level 0.5 – 1 mEq/L Treatment level – 0.8 – 1.5 mEq/L Toxic level – 1.5 above Lithium Toxicity Nausea, vomiting, diarrhea
  114. 114. Nowadays, ECT is not only used for major depression, MSN GILBERTbut also for the treatment of: mania (in bipolar disorder) Catatonia (motion less or excessive motion) quick relief for self-destructive behavior T. SALACUPECT only be indicated for the treatment of severely depressed clients that needs fast relief Can pregnant women undergo ECT?
  115. 115. MSN GILBERT Contraindications and precautions recent myocardial infraction stroke sever hypertension presence of intracerebral mass T. SALACUP Mechanism of action The therapy induces a therapeutic tonic seizure(a seizure where the person loses consciousness and has convulsions) which lasts for about 15 seconds.It is believed that the shock intensifies brain chemistry to correct the chemical imbalance in depression (decrease serotonin and norepinephrine).
  116. 116. Frequency of treatment MSN GILBERT 6-15 treatments are scheduled three times a week. 6 treatments are needed to observe a sustained improvement of depressive symptoms. Maximum effect or benefit is achieved in 12 to 15 treatments. T. SALACUP 70 – 150 volts .5-2 seconds Duration 6-15 treatments 48hrs interval
  117. 117. MSN GILBERT  Nursing Interventions Before ECT1. Informed consent should be signed.2. NPO post midnight.3. Remove fingernail polish.4. IV line initiation. T. SALACUP 1. Atropine  dry mouth 2. Barbituate  short-acting anesthetic. 3. Succinylcholine  muscle relaxant, prevent seizure5. Let the client void before the procedure. During ECT1. Place electrodes on the client’s head on one side (unilateral) or both (bilateral).2. Brain monitoring through electroencephalogram (EEG).3. Oxygen administration with an Ambu-bag.
  118. 118. After ECT MSN GILBERT1. When the client is awake, reorient the client.2. Obtain vital signs.3. Assess client for the return of gag reflex.4. Allow the client to eat (with a positive gag reflex). T. SALACUP  Side-lying – lateral  S/E  headache, dizziness,  TEMPORARY MEMORY LOSS  distinct sign
  119. 119. SuicideGILBERT Definition Self imposed deathT. SALACUP RN, MSN stemming from depression
  120. 120. MSN GILBERT Verbal Non Verbal• I wont be a problem • Take this ring, its T. SALACUP anymore yours (giving of• This is my last day valuable) on earth • Sudden change in• I’ll soon be gone mood
  121. 121. Who will commit Suicide? MSN GILBERTS - ex – Male (more successful)/ female (hesitant)A ge – 15 –24 y/o or above 45D epression T. SALACUPP atient with previous attemptE ethanol - alcoholicsR irrationalS ocial support lackingO rganized plan  greater riskN o familyS ickness, terminal 
  122. 122. SUICIDE TRIAD MSN GILBERT1. Loss of spouse2. Loss of job3. Aloneness T. SALACUPNursing Intervention1. D irect question – “Are you going to commit suicide?”2. I rregular interval of visit to pt. room3. E arly AM and period of endorsement – the time pt’s commit suicide
  123. 123. Best approach for suicidal pt. : Direct approach MSN GILBERTNursing Management: Close surveillanceHospital quarter common suicide will come aboutweekends - 1- 3 am Sunday T. SALACUP - few staff personnelEarly AM - every one is asleep  Simple task Water plants Wash the dishes except sharpsDon’t give complex - may cause depression ex. Puzzle
  124. 124. MSN GILBERT Cyclothymic disorder Milder symptoms of both mania and depressions often separated by long periods of normal moods T. SALACUP Dysthymic DisorderLong standing symptoms of depression alternating with short periods of normal moods clients can maintain normal roles and jobs
  125. 125. EATING DISORDERS  Bulimia Nervosa The Diet-Binge-Purge Disorder”.  dieting, binging and purging through vomiting Rapid eating for about two hours (over 8000 calories in 2 hours and 50,000 in 1 day) Methods of controlling weight (diet pills, excessive exercise, enemas, diuretics, laxatives), Weight normal or fluctuations are due to alternating fasting and binging
  126. 126. Ages 15-24 years. MSN GILBERT Bulimic often belong to a family and society that place great value on external appearance. self hatred low self-esteem, symptoms of depression, T. SALACUP fear of losing control, suicide tendencies. Perfectionist, achievers scholastically and professionally. They hide their disorder because of fear of rejection. Person is aware that the behavior is abnormal, b. After the episode she becomes guilty and depressed
  128. 128. Nursing Diagnosis MSN GILBERT1. Alterations in health maintenance.2. Altered nutrition: Less than body requirements.3. Altered nutrition: More than body requirements4. Anxiety T. SALACUP5. Body image disturbance6. Ineffective family coping; compromised7. Ineffective individual coping8. Self-esteem disturbance
  129. 129. During interview Nursing Interventions MSN GILBERT to gain trust and acceptance of nurses. Create an atmosphere of trust. Develop strength to cope with problems. Encourage patient to discuss positive qualities about themselves to increase self-esteem. T. SALACUP Help patient identify feelings and situations associated with or that triggers binge eating.  Encourage making a journal of incident and feelings before-during and after a binge episode.  Make a contract with the patient to approach the nurse when they feel the urge to binge Encourage adhering to meal and snack schedule of hospital. Cognitive behavioral therapy is the ideal therapy
  130. 130. ANOREXIA NERVOSAStarvation and Emaciation is a disorder with an insidious onset that often affects adolescent girls. upper middle class families. youngest child is affected. uses denial 10-20 % of anorexics die and half of these deaths are due to suicide.
  131. 131. Nursing Interventions MSN GILBERT Cognitive and Behavioral therapy to positive and negative reinforcement: focus is on client’s responsibility to gain weight.  Privileges are gained with weight gain.  Privileges are lost with weight loss. Increase self-esteem Teach about the disorder. T. SALACUP Monitor weight three times a week but weigh with the patient facing away from the weighing scale As soon as the ideal weight is gained, allow patient to regulate his or her own progression and program. High protein and high carbohydrate diet, serve foods the patient prefer in small frequent feedings. NGT if the patient refuses to eat. Setting limits to avoid manipulative behavior:  Restrict use of bathroom for 2 hour after eating.  Accompany to the bathroom to ensure that they will not self induce vomiting.  Stay with client during meals.  Do not accept excuses to leave eating area.
  132. 132. Anorexia Eating Bulimia MSN GILBERT Nervosa Disorders Diet, diet, diet Eating Pattern Eat, eat, vomit<85% of expected Weight Normal weight body T. SALACUP 3 mos. Menstruation Irregular menstruation amenorrheaKaren Carpenter Dao Ming Su Da Ming Sugat/ suka Vomiting Dental caries Wounded knuckles Metabolic alkalosis Metabolic acidosis
  133. 133. MSN GILBERT Paraphilias Paraphilias are complex psychiatric disorders that are manifested as unusual sexual behavior. Diagnostic and Statistical Manual of Mental Disorders, T. SALACUP Text Revision (DSM-IV-TR) defined it as a “recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors generally involving: S = uffering or humiliation of oneself or partner I = nanimate objects (non-human objects) N = onconsenting person C = hildren
  134. 134. Eight specific disorders of paraphilia MSN GILBERT Exhibitionism – Exposing one’s genitals to strangers or masturbating in public areas. Fetishism – (Pa suot) inanimate objects to achieve orgasm women’s undergarments (brassiere, lingerie, T. SALACUP and panty), shoes and other apparels. Frotteurism – (Pa Touch) urges of touching or rubbing against a non consenting. Pedophilia – a sexual activity done with a child 13 years younger is a characteristic of this disorder. at least 16 years old or at least 5 years older than the victim.
  135. 135.  Sexual masochism – (Saktan mo ako) the MSN GILBERT intense and persistent sexual urge involving acts of suffering (beaten or bound) and being humiliated. Sexual sadism – (Sasaktan kita) sexual urge involving acts in which the pain, suffering or T. SALACUP humiliation of a partner is arousing a person. Transvestic fetishism – sexual fantasies, urge and behaviors involving cross-dressing by a heterosexual male. Voyeurism – sexual arousal by observing an unsuspecting person who is naked, in the process of undressing or engaging in sexual activity.
  137. 137. ALCOHOLISM - state of alcohol addiction MSN GILBERTEtiology:Intergenerational TransmissionFrom one generation to another generationAlcohol T. SALACUP ↓Blackout  awake but unaware ↓Confabulation  inventing stories to ↑ self-esteem ↓Denial  “I am not an alcoholic”Dependence  “I can’t live without it” ↓
  138. 138. Enabling  significant other tolerates abusers MSN GILBERT Another term CO – DEPENDENCY TOLERANCE  ↑ Substance to achieve a previous effect  T. SALACUPDETOXIFICATION Withdrawal with MD supervision Safe withdrawal is accomplished through the administration of benzodiazepines such as Chlordiaxepoxide (Librium), Lorazepam (Ativan) or Diazepam (Valium) to suppress the withdrawal symptoms Check Alcohol, Mouthwash, Elixir
  139. 139.   void alcohol MSN GILBERT version therapy lcoholics Anonymous  self help group ntabuse  DISULFIRAM  Never drink alcohol ↓ 12 hour interval/ 12 h last alcohol intakeB1 Vitamin Deficiency or else: nausea, vomiting and hypotension T. SALACUP ↓ Wernicke’s Encephalopathy → motorComplications ↓ Korsakoff’s Psychosis → memoryDelirium Tremens  24 – 72 h after last dose of alcohol↓ untreated withdrawal syndrome ormocation  bugs crawling under the skin amily Therapy  mother, father, brother 
  140. 140. SUBSTANCE ABUSE MSN GILBERTDowners -B - arbituates MorphineO - piates Codeine NARCAN  antidoteN - arcotics HeroineA – lcohol T. SALACUP Uppers (Hac - S) Hallucinogens Amphetamines Cocaines
  141. 141. LEVELS OF MENTAL RETARDATION MSN GILBERTProfound Less 20 IQ thinks like an infants can’t be trained Some speech T. SALACUPSevere - 20 – 35 IQ May learn Talk and communicate Perform simple task elementary hygieneModerate - 35 – 50 IQ can be train mental age is 2 – 7 y/o pre-operational stage 
  142. 142. 4. Mild MSN GILBERT  50 – 70  meantal age is 7 – 12  educable  can go to school T. SALACUP5. Borderline  70 - 906. Normal  90 – 100 Mental Retardation IQ Less than 70 Onset before 18 yrs/old Not often detected until school age Impaired learning and social adjustment
  143. 143. Nursing Intervention MSN GILBERT Role Modeling Repetition Remorivation Provide sensory stimulation T. SALACUPAUTISM/Kanner Syndrome/ Pervasive devt. Dis. With a special talent /Head banging and head rocking Diagnose at 2 Y.O. Appears at 3 y.o. 4x more common in male than in femaleAssessAppearance - flat affect, consistent movementBehavior - repetitive, ritualisticCommunication - echolalia, incomprehensible
  144. 144. Nursing diagnosis MSN GILBERT S -elf mutilation I - mpaired verbal communication R -isk for injury I - mpaired social interactionNursing Intervention T. SALACUP Priority Safety,security supervision Counseling Education Expressive therapy - drawing, muscic etc Improved social interactionMeds:Anti Psychotics: Haldol,risperidone=tempertantrumsNaltrexone(revia)Anafranil,Clonidine(catapres)= hyperactivity 
  145. 145. ATTENTION DEFICIT HYPERACTIVE DISORDER MSN GILBERT Onset : before 7 y.o. Episode : 6 months and above Settings : 2 House and school Id Dominant : Mom or RN will act as superego T. SALACUPAssessC - ommunication - talkative, blurts out in classR - estlessI - mpulsiveD - ecrease attention spanE - asy distractibility Nursing DiagnosisRisk for injuryImpaired social interaction 
  146. 146. Nursing Intervention MSN GILBERT Priority safety and Nutrition Structure separate room for eating, playing, sleeping and etc Schedule - time for everything Slimits T. SALACUP Ignore Temper tantrums Finger foordsMeds: for 6 Y.O. Ritalin,, pemoline, adderal 3 Y.O and Above dexedrinBest time to give: once a day:AFTER MEALS: prevent lost of appetiteDon’t give at bedtime  STIMULANT  causes insomnia Give 6 hours prior bedtime if bid
  147. 147. ALZHEIMER MSN GILBERT NOMIA  don’t know name of objects GNOSIA  problem with senses PHASIA  can’t say it PRAXIA  can’t do it T. SALACUP
  150. 150. Domestic Violence MSN GILBERTCHILD ABUSEBurns, bruise, bone fracturesExcessive Knowledge of sex/Violence T. SALACUPDepressionApathy no reactionsBantay Bata 163Don’t bathe the child, don’t brush teet. Body of evidence will be lost
  151. 151. Types MSN GILBERTViolence- implies only the use of physical forceNeglect – Child abandonment, insufficient Childs needs for survivalPhysical Abuse – abuse in the form of inflicting pain T. SALACUPEmotional abuse – form of insults mind gameSexual abuse- unwanted sexual contact Nursing management Safe , secutiy, supervision Proper reporting of child abuse – w/ in 48hrs Brgy captain, DSWD, PolicePlay therapy
  152. 152. Rape MSNCrime lack of consent, treat, force and sexual penetrationSexual assault - Forcible sexual acts lack of consent, against his or her will 3 essential elements of rape Vaginal penetration Use of force , intimidation, treat Lack of consent Rape trauma syndromeImmediate acute phase Displays 2 type of emotion (disorganization)ControlledExpressed