Problems with the Psyche Factor: Nursing Management & Treatments PDF

### Problems with the Psyche factor #### PROBLEMS WITH THE PSYCHE FACTOR (GENERAL) * Women without adequate support can have an experience so frightening and stressful they can develop a posttraumatic stress syndrome (Tam & Chung, 2007). #### Problems with the Psyche Factors 1. Inability to b...

### Problems with the Psyche factor #### PROBLEMS WITH THE PSYCHE FACTOR (GENERAL) * Women without adequate support can have an experience so frightening and stressful they can develop a posttraumatic stress syndrome (Tam & Chung, 2007). #### Problems with the Psyche Factors 1. Inability to bear down properly – A pregnant mother whose psychosocial ability has significantly changed due to shocking and depressing experiences which has the propensity to diminish the quality of care she could give to herself and her unborn baby 2. Fear/Anxiety – is a feeling induced by perceived danger; a mental shackle that a pregnant mother may feel due to past experiences, or the fear of being not enough (as a caregiver), the fear of not having enough means to provide * her needs as well as the child's; fear of being alone. #### INABILITY TO BEAR DOWN * Possible diagnoses: Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual's adaptive and defensive resources, which may compromise health. * Ineffective Individual Coping: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources. #### Risk factors * Alteration of muscle tone/contractile pattern. * Maternal fatigue. * Mechanical obstruction to fetal descent. #### Nursing Management * Optimize uterine activity. Monitor uterine contractions for dysfunctional patterns; use palpation and an electronic monitor. * Prevent unnecessary fatigue. Check the client's level of fatigue and ability to cope with pain. * Prevent complications of labor for the client and infant. * Assess urinary bladder; catheterize as needed. * Assess maternal vital signs, including temperature, pulse, respiratory rates, and blood pressure. * Check maternal urine for acetone (an indication of dehydration and exhaustion). * Assess condition of fetus by monitoring FHR, fetal activity, and color of amniotic fluid. * Provide physical and emotional support. * Promote relaxation through bathing and keeping the client and bed clean, back rubs, frequent position changes (sidelying), walking (if indicated), and by keeping the environment quiet. * Coach the client in breathing and relaxation techniques. * Provide client and family education. #### Medical Managements * Narcotic or sedative, such as morphine, pentobarbital (Nembutal), or secobarbital (Seconal), for sleep #### ANXIETY/FEAR: SIGNS AND SYMPTOMS 1. Anger 2. Poor impulse control 3. Emotional detachment or numbness 4. Hyper alertness, hyperarousal, and exaggerated startle reflex 5. Social withdrawal 6. Self-destructive behavior 7. Survivor's guilt 8. Relationship problems 9. Avoidance of people, places, and things associated with the traumatic experience 10. Depersonalization (sense of loss of identity as a person) 11. Relationship problems 12. Difficulty falling or staying asleep 13. Decreased self-esteem #### DIAGNOSTIC/LAB TEST * see psychiatrist for treatment * **Hamilton Rating Scale for Depression (Ham-D)**- The scale is widely available and has two common versions with either 17 or 21 items and is scored between 0 and 4 points. The first 17 items measure the severity of depressive symptoms and as examples the interviewer rates the level of agitation clinically noted during the interview or how the mood is impacting on an individual's work or leisure pursuits. The extra four items on the extended 21- point scale measure factors that might be related to depression, but are not thought to be measures of severity, such as paranoia or obsessional and compulsive symptoms. Scoring is based on the 17-item scale and scores of 0-7 are considered as being normal, 8-16 suggest mild depression, 17-23 moderate depression and scores over 24 are indicative of severe depression [3]; the maximum score being 52 on the 17-point scale * Ultrasonography #### NURSING DIAGNOSES 1. Anxiety related to fear of death and change in health status as evidenced by verbal expression of worry (Domain: Perception/cognition) 2. Hopelessness secondary to rape (Domain: Self-perception) 3. Risk for compromised human dignity (Domain: Self – perception) 4. Social isolation related to shame, secondary to rape trauma (Domain: Coping/ Stress Tolerance) 5. Rape- trauma syndrome (Domain: Coping/ Stress Tolerance) #### NURSING MANAGEMENT (Fear/Anxiety) 1. **Establish rapport** with client to gain trust. It is important that the nurse should accept client's current level of functioning. She should also be consistent, positive, and honest as well as adapt a nonjudgmental attitude when working with the client. 2. **Provide time** and opportunity for client to express feelings. It is essential that nurse should detect an ongoing grieving process and help client to find conclusion. 3. **To manage outbursts** of anger, assist client to identify sources of emotions. Assist client in regaining control. 4. **Assist** client in using displacement whenever emotional by providing things she can manipulate or destroy such as clay. 5. After every outburst, **discuss** with the client how fear or anxiety escalates. 6. **Desensitize client** to memories of traumatic event. 7. **Administer** prescribed medications as needed. Evaluate his responses to the medications and if client is taking and not hoarding them. 8. **Remind** patient that setbacks on the process of treatment are not failures but an expected part of the therapy. 9. **Encourage** client to accept forgiveness from self and others. 10. **Emphasize** with the client the importance of strict adherence to medications. 11. **Refer** client to other sources of support such as community organizations and support groups. 12. **Encourage** client to express emotions verbally rather than physically. #### Medical Management * Antidepressants * nortriptyline, desipramine * Psychotherapy- may be beneficial in women who prefer to avoid antidepressant medication. * Pain Management * Low-dose antipsychotic agents - Haloperidol #### Treatment #### Position and Posture * Can decrease pain/ increase comfort * Facilitate gravity * Change pelvic diameters * Help in cardinal movements * Facilitate descent #### Trust 1. Recognizing the client's feelings. 2. Honesty 3. Respect for the client 4. Non-judgmental attitude #### Emphasize Positive Results * Do not argue with the client. * Recognize that the client is experiencing pain but do not dwell on that pain. #### Medication prescribed by the Physicians: * Use of Buspirone (Buspar) which is pregnancy safe is an appropriate alternative medication option. * Cognitive behavioral therapy should an alternate treatment option * use of haloperidol (Haldol) is preferred during pregnancy as extensive data suggests it is not associated with any congenital malformations with first trimester exposure. * Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) have been shown to be relatively safe for use during pregnancy #### REFERENCES: * M. Belleza. (2017). Postpartum Depression. Retrieved February 15, 2021, fromL https://nurseslabs.com/postpartum-depression/ * Pillitteri, A. (2010). Maternal and Child Health Nursing Care of the Childbearing and Childrearing Family (6th Edition). Lippincott Williams & Wilkins. pp. 693-696 * Caliva, K. (2017). Problems with the Psyche Factors. Retrieved from https://prezi.com/mg-6wf8103i2/problems-with-the-psyche-factors/?fbclid=IwAR0zAh4HbeDIC6dsYBpw2f9ei92\_kYCyiwy\_S1896bPBU3ivKd2gS8KEHU