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• These are study notes for Psychiatric Nursing, NCM 117, taught by professors Acuar and Bilog.

Week 1 - Outline

• The topics include basic principles of psychiatric nursing, the interdisciplinary team involved, criteria for mental health, psychosocial and psychosexual aspects, and elements of personality.

Orientation Additional Notes

• Neglect is a form of abuse, whether through omission or commission.
• Not everyone experiences psychiatric disorders; emotions like happiness and sadness are normal.
• The absence of emotions may indicate an abnormality.
• Psychiatric rotation requires consciousness, self-awareness, firmness, consistency, and awareness of institutional protocols.

Psychiatric Nursing

• Psychiatric nursing is a specialized area employing theories of human behavior.
• Focus is on promoting mental health, preventing mental illness, and managing mental disorders through continuous, comprehensive services.
• Joyce Travelbee theorized that psychiatric nursing helps individuals through the therapeutic use of self.
• Medications in psychiatry have many side effects.

Basic Principles

• Clients should be accepted and respected regardless of behavior
• Patients can refuse medication depending on admission status and mental stability
• If a voluntarily admitted patient becomes unstable, involuntary admission may be warranted
• Avoid using terms like "baliw" and use "mentally challenged" instead
• Inappropriate behavior should be rejected, not the individual
• Express feelings in a safe, non-judgmental environment to reduce anxiety
• Behaviors are learned through culture, society, religion, and environment
• All behaviors have meaning
• Being gay or LGBT community members are no longer considered abnormal

Interdisciplinary Primary Roles

• Psychiatrists are physicians who diagnose mental disorders and prescribe medical treatment, including somatic therapy
• Psychologists have doctorates in clinical psychology and conduct therapy and psychological tests
• Psychiatric nurses have a solid foundation in health promotion and rehabilitation, viewing the client holistically
• Psychiatric social workers are prepared at the master's level and work with families, community support, and referrals
• Occupational therapists focus on improving the client's functional abilities - recreation therapists help clients balance work and play with constructive leisure activities
• Vocational rehabilitation specialists determine clients' interests and match them with vocational choices

Criteria for Mental Health

• The parameters that define mental health is having well-adjusted coping mechanisms.

Reality Perception

• Empirical thought involves testing assumptions and social sensitivity (empathy).
• Discernment between reality
• Present reality without false assurance
• Empathy over Sympathy
• Sympathizing may blur professional boundaries

Growth, Development, & Self-Actualization

• Surrogate mothers(caregivers) nurture personas.
• Moderation is key
• Balance in needs encourages confidence and social skills.
• Rigid parents create "Bad me" personas of fear and disobedience.
• Situations should be understood before reacting.

Self-Actualization

• Core concept is self-awareness to integrate internal and external factors for adjustment.
• Autonomy is the ability to make decisions independently.

Autonomy

• Self-determination, responsibility, and balance between dependence and independence
• One must avoid impulsivity, develop action plans, and stay mindful towards others

Positive Attitude

• Requires self-identity, acceptance, awareness, belonging, security, and wholeness
• "Law of attraction" means your effort is required
• Misunderstandings can occur due to ignorance of personal experiences

Components of Mental Status Assessment

• Sensorium includes consciousness and orientation (Person, Place, Time)
• Attention & concentration for ADD/ADHD
• Comprehension involves digesting and understanding - Disorientation and Confusion (Dementia). Confirmation is by autopsy
• Appearance covers appropriateness, grooming, rigidity, and mannerisms
• Affect/Mood includes appropriateness, swing, duration, and intensity of emotions
• Flat affect is no emotions and blunted affect means limited smile
• Labile is sudden switching
• Broad is exaggerated
• Thought content includes self-concept, areas of concern, themes, obsessions, delusions, and hallucinations
• Thought processes includes the ability to understand abstracts/symbols with magical thinking and animism

Speech

• Coherency, relevancy, quantity, and quality must be assessed

Psychiatric Theories

• Diagnostic & Statistical Manual (DSM) diagnoses mental illness in detail.
• While nurses use NANDA
• DSM V uses a more holistic approach.

Axis of Assessment

• Axis I: Clinical disorders, signs, and symptoms must be ruled out, including psychosis vs. schizophrenia.
• Axis II: Personality disorders or mental retardation, including pervasive developmental disorder and Autism.
• Axis III: Medical conditions affecting organic / structural changes or imbalances like hormones.
• Axis IV: Contributing environmental or psychosocial factors, such as environmental problems. Assess ADLs.
• Axis V: Global Assessment of Functionality: deals with holistic condition

Models of Treatment

• The psychoanalytical model focuses on intrapsychic processes like conflict and anxiety.
• The behavioral framework focuses on learned behaviors and conditioning.
• The interpersonal model emphasizes interpersonal relationships.
• The psychosocial theory of Erik Erikson focuses on psychosocial tasks throughout the life cycle.
• The existential/humanistic model focuses on conscious human experience, and belief

Biomedical Model

• More on the pathologic side for organic and structural changes of the client
• Focus on brain atrophy from Alzheimers and abnormal functioning of the prefrontal cortex that impacts schizophrenia

Erik Erikson’s Stages

• Psychosocial tasks focus socialization
• Stages of growth:
  • Infancy: trust vs. mistrust
  • Toddler: autonomy vs. shame and doubt
  • Preschool: initiative vs. guilt
  • School age: industry vs. inferiority
  • Adolescence: identity vs. role confusion
  • Early adulthood: intimacy vs. isolation
  • Middle adulthood: generativity vs. stagnation
  • Later years/old age: integrity vs. despair

Behavioral Framework

• Classical conditioning connects neutral stimuli with positive ones
• Operant conditioning uses rewards/punishments
• Adjusting or coping with the environment (coping mechanism)
• If coping and defense mechanisms no longer effective, it could lead to MALADAPTIVE cases such as: crisis, anxiety/panic attacks and sudden impulsive acts

Sigmund Freud

• Oral, anal, phallic, latency, genital stage
• Oedipal Complex(son) is attachment to mother and jealousy towards the father or Electra(daughter) is daughter’s attachment to father and jealousy towards the mother

Levels of Consciousness

Conscious self

• Aware of the activity
• Composed of past experience, and logical reasoning
• Reality principle
• 2% of our memory

Subconscious self

• Watchman of the personality, filters in/out memory, and can be remembered
• Composed of material that has been deliberately pushed out of conscious level
• The brain always store factual information
• 8% of our memory

Unconscious self

• Largest and it molds our memories
• Composed of largest thoughts that are repressed. More on the pleasure principle
• Memory may be distorted in dreams
• 90% of memory

Three Elements of Personality

• Id: pleasure principle, animal instinct (I want it), unconscious
• Ego: reality principle, adult (I wait), mediator
• Superego: induces guilt, and is a conscience of what one shall not do

Imbalance in 3 Elements

• High ld+ low SE = Conduct disorder+ Antisocial Personality disorder
• Low ld+ high SE = Obsessive+ Compulsive disorder

Week 2 - Outline

• Focus on nervous system, and related disorders

Neurobiologic Concepts

• The nervous system has a reaction to the body and effects different parts

Components

• CNS consists of brain and spinal cord.
• PNS has 12 cranial nerves and 31 spinal nerves

Autonomic Nervous System (ANS)

• Majority of medications take effect here
• Operates automatically and involuntarily
• Consists of the sympathetic (SNS)
• Parasympathetic (PNS)

SNS

• "Fight or Flight Response: uses energy to increase blood flow in the muscles, brain, heart and in the lungs.

PNS

• Conservation of energy is rest and digest functions
• Vagus Nerve Stimulation
• Decreases activation of the reflexes

Key Neurotransmitters

• Norepinephrine: produces epinephrine from adrenal gland
• Dopamine: an imbalance will produce psychosis, schizophrenia
• GABA: is counter part of epinephrine or norepinephrine, and if high, it will decrease
• Acetylcholine: counter part of dopamine

The Effect to the Body

• SNS neurotransmitters send high energy, increased oxygen to the cardiac, pulmonary areas and muscles (not in the GIT area) for heart contractions, blood pressure increase, and rapid breathing

Reaction to the Brain

• all reflexes are elevated besides that of the GIT

Week 2 Part 2

Anxiety

• Effective subjective response to imagined or real threats
• There are 4 levels of anxiety: mild, moderate, severe, panic attack

Mild anxiety

• Perceptual field allows focus; alert and attentive.
• Helps in understanding perception
• Nurse should explore clients emotions to prevent escalation to moderate. Why questions are NOT asked
• Nurse’s responsibilities: prevent escalation of mild anxiety into moderate anxiety and provide teachings. Give teachings, explore, and may ask "Tell me how you feel.."

Moderate Anxiety

• Patients try to avoid any activity or discussion leading to anxiety thru defense mechanisms
• Client is able to partially focus and can verbalize feelings

Severe Anxiety

• Unable to focus to what is happening so the Nurse must talk straight to the point and is no longer able to understand
• May not recognize verbalize anxiety
• Start of Sympathetic Symptoms - evident to the patient
• Provide a structured a none stimuli
• Elevated SNS Manifestations
• Drained energy
• Learning / problem solving not possible
• elevated Cetecholimines

Sympathetic Symptoms

• Cold Clammy Skin
• Tachycardia
• Dilated Pupils
• Palpitations
• Hyperventilation- give brown bag to rebreathe trapped CO2 prevent Respiratory Alkalosis + Numbness of soft tissues is released

Panic

• last most alarming stage because of severe reduction in perpetual vision
• Hallucinations: sensory perceptual
• Hallucinations that leads to delusions
• requires immediate actions: Stay- Do not leave the px

Diagnoses

Implementation

• Identify anxious behavior, level of anxiety, and institute measures to decrease with Structured, safe
• Promote least invasive procedures, what all Facilities can do and is DOABLE and APPLICABLE to
• Establish PERSON TO PERSON relationship, maintain an accepting attitude: accepting gratitude
• Administer medicine:

Week 5 - Outline

• Focus is on Anxiety (ARD) Related Disorders

ARD 4 main Categories

• Phobia
• PTSD
• OCD(but not OCPD)
• GAD(Geralized Anxiety Disorder)

Phobia

• Irrational fear where fear is not the real fear, just a Symbol: symbol of deep sea- or the water symbol
• Is a LEARNED experience: so its is fixable!
• This requires 2 defense mechs:

1. Symbol -
2. Displacement of feared object

ARD 3 Main problems

• Social: The real fear here is FEAR OF REJECTION/ABANDONMENT.
• Nurse is to be Active Friend: Nurse offer help
• Agora: The real fear here is FEAR OF NO IMMEDIATE HELP IN CASE OF EMERGENCY:
• Simple/Specific: Nurse need a Systematic desensitization

Treatment

Cogntive behavioral

• Talking to work thru the issues/behaviors/reactions

Systematic

• Evidence based therapy. Understand where it stems from by easing into the subject

Inplosion

• no good as there has to be gentle treatment

Remember

• Anxiety- anxiolytics
• CD, Ptsd- anti depress

Ptsd

• Psychiatric disorder comin directly from a traumatic event :

Conditions

• Crisis
• Less then 2 mnths in Asd More than 2 mnths in PTSD
• the development and what you need to use because of the crisis, temporary can cause disbelief
• 2 Main Causses

Devlopmental

• a matter of adjustment and happening

Gender

• F is sexual (unconsented entries that result from a rape).

Hallmark

• Nightmares

Manifest

• Anxeioty develops wen client experinces abnoral recurring thoughts.

OCD Needs

• Resolvee
• What do we do!

1. Do it!

Defence Mechanisms

• Defnce mechanisms are mechanisms a person uses for protection

Repression

• Subconsiously forgetting like Aizhierms;

Supression

• Consciously forgetting
• Voluntarily thinking thoughts
• Dids- dissociiative is most severe form
• "Ayuko na..." "Ako ahaha.."

Compensation

• Over achivin to compensate
• Ex: I drink but very good work!

Rationzlims

• A DEFENSE MECHANISM WHERE AN INDIOVUSL DEDLS W. BLAMINING AND RATIONAL

Interlectuizatio

Reaction formations

• Over componsating ir demonstaing the opposute.