NCM 117 Psychiatric Nursing Prelims PDF

NCM 117 PSYCHIATRIC NURSING L E C / PROF. ACUAR & PROF. BILOG _________________________________________________________________________________...

NCM 117 PSYCHIATRIC NURSING L E C / PROF. ACUAR & PROF. BILOG ______________________________________________________________________________________________________________ PRELIMS BASIC PRINCIPLES OF PSYCHIATRIC NURSING WEEK 1 - OUTLINE 1. Accept and respect the client regardless of his behavior. Even if the client hurts others, is suicidal or depressed, it is our I. PSYCHIATRIC NURSING duty to still accept the patient for treatment. A. Basic Principles of Psychiatric Nursing Patients can and cannot refuse medications (depending on the B. Interdisciplinary Team instances). E.g. The patient is self-aware and voluntarily II. CRITERIA FOR MENTAL HEALTH submitted himself for rehabilitation is able to refuse A. Jahoda,1953; Staurt And Sundeen,1995 medication however, if patient is mentally unstable and is → Reality Perception posing threat to himself and others, he will be involuntarily → Growth, Development & Self-Actualization admitted and unable to refuse medication → Autonomy Patients can initially be voluntarily admitted but progress to being → Positive Attitude mentally unstable and pose threat to self and others—this case B. Components Of Assessment Of Mental Status warrants the shift to involuntary admission (as judged by the III. PSYCHOSOCIAL psychiatrist) IV. PSYCHOSEXUAL Avoid using the term “baliw” and “mentally retarded”, instead use V. ELEMENTS OF PERSONALITY mentally challenged or intellectually challenged 2. Limit or reject the inappropriate behavior but not the individual. ORIENTATION ADDITIONAL NOTES E.g. instead of: “Huy bawal ka manigarilyo dito”, use “Sir, according to the policies of the institution, noone is allowed to Neglect - Omission (A FORM OF ABUSE) smoke inside of the facility”. - Still neglect if you did but in a wrong way. Emphasize that no one is exempted from the rules - Ex: A kid na bungal bungal (with cavities/plaques) 3. Encourage and support expression of feelings in a safe and Neglect is a form of abuse non-judgmental environment. Increase verbalization, decreases Omission - you didn't give it anxiety. Commission - you give it but it causes harm Whenever you’re angry or you feel like doing something Not everyone has psychiatric disorder; all of us have normal impulsive—count 1 to 10, breathe in, breathe out. Because emotions (happy, sad, etc) whenever you’re angry, it’s not you that is talking, it’s your emotions, therefore you tend to say words that you don’t actually Not all people have psychiatric disorders. DO NOT generalize mean. the concept. Having emotions (sad or happy) does not mean It’s better to verbalize your feelings first rather than to act it out abnormalities. immediately. ○ NO emotions means there is an abnormality ○ Nursing responsibility - Check the emotion and how a 4. Behaviors are learned. person reacts to how they feel. Check their grooming as Behaviors apart from your mentation, behaviors are also well since this may be a sign of neglect influenced by the culture, society, religion and environment Even in the process of (child) rearing (kung ano ang itinanim sa Videbeck Book is very superficial isip mo nung bata ka) Having no thoughts or emotions = Disorder these things will influence your growing up pattern Anger that is out of control = Maladaptive Behavior 5. All behaviors have meaning. PSYCHIATRIC NURSING There is a reason why you are crying for example A specialized area of nursing practice employing theories of human For the record, being gay or LGBT community does not make you behavior as its science and purposely use of self as its art. abnormal, no longer a form of abnormality Includes the continuous and comprehensive services necessary for DSM 5- homosexuality is a preference or a choice since it is a the promotion of optimal mental health, prevention of mental behavior illness, health maintenance, management and referral of mental and physical health problems, the diagnosis and treatment of INTERDISCIPLINARY TEAM PRIMARY ROLES mental disorders and their sequelae, and rehabilitation → Psychiatrist Joyce Travelbee - nurse theorist which theorized that psychiatric ○ The psychiatrist is a physician certified in psychiatry by the nursing is the science of helping individuals by using self. American Board of Psychiatry and Neurology which requires - theory of therapeutic use of self: you can’t help others if they 3-year residency, 2-years of clinical practice, and completion of an don’t help themselves examination. The primary function of the psychiatrist is diagnosis of, mental disorders and prescription of medical treatment i. they can order somatic therapy Note: ii. IQ and EQ examination is done by psychologist Medications in psychiatry are considered as dirty medications (having more side effects than their therapeutic effect) → Psychologist Knowledge affects behavior ○ The clinical psychologist has a doctorate (Ph.D) in clinical You have to be conscious and self-aware of what you’re doing psychology and is prepared to practice therapy, conduct research, during Psychiatric rotations. You need to know where you’re at, and interpret psychological tests. Psychologists may also where your clients are and what they are doing. participate in the design of therapy programs for groups of Be firm and consistent. Present the rules. E.g. When invited individuals. inside patients’ rooms alone: “Ma’am/sir, we are not allowed to i. not medical doctors, only doctors of philosophy enter your rooms as per the policy.” ii. Group therapy can be administered by nurses who have a Be aware of the protocols imposed by the institution. BSN degree iii. high EQ is better than high IQ BSN-3C 1 → Psychiatric Nurse ○ Sympathy/naawa = pity ○ The registered nurse gains experience in working with clients with ○ When you sympathize with a client, there is a chance that you psychiatric disorders after graduation from an accredited program could go beyond your job description and get easily attached of nursing and completion of the licensure examination. The nurse ○ Set limits and boundaries has a solid foundation in health promotion, illness prevention, and rehabilitation in all areas, allowing him or her to view the client GROWTH, DEVELOPMENT & SELF-ACTUALIZATION holistically (by Maslow) which includes fully functioning person” (by Rogers) ○ The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications. Growth & Development Registered nurses who obtain a master’s degree in mental health During growth and developmental years, the most important may be certified as clinical specialists or licensed as advanced individuals are the people who helped us nurture our personas = practitioners, depending on the individual state nurse practice parents / immediate caregiver (surrogate mother) acts. Advanced practice nurses are certified to prescribe drugs in Surrogate mother - a person who acts as a mother when the child many states has no parents regardless who the person might be i.e i. Nurses are most in contact with the clients, overall nurses grandparents, aunts know the condition of the client most Promote moderation: anything excess or less can affect the → Psychiatric Social Worker alteration of personality and behavior ○ Most psychiatric social workers are prepared at the master’s level, ○ Balance in physiologic needs provided by parents help the child and they are licensed in some states. Social workers may practice maintain sense of confidence,sense of trust and increases the therapy and often have the primary responsibility for working with ability to develop social skills families, community support, and referral WHAT IF parents are strictly rigid in nature: child could develop → Occupational Therapists Bad me persona ○ Occupational therapists may have an associate degree (certified ○ Bad Me Persona - every time you hit, neglect and scold a child occupational therapy assistant) or a baccalaureate degree for no reason at all,the child will develop the likes of fear, (certified occupational therapist). Occupational therapy focuses disobedience and rebellious behavior on the functional abilities of the client and ways to improve client Everyone is going through something. We have to be functioning such as working with arts and crafts and focusing on understanding all the time. psychomotor skills. ○ Approach and make actions depends on the given situation i. hindi sila ang nagbibigay ng trabaho, they are responsible for ○ Understand first the situation before engaging the situation functional ability of a client ○ Read the history of the client and client’s case ii. ex. stroke- to reach or achieve to function normally within limits (mabagal na ang feeding ng client na may stroke) Self - actualization → Recreation Therapist Core concept of psychiatry is self-awareness. ○ Completes a baccalaureate degree, but in some instances Self awareness could actually pertain to self-actualization persons with experience fulfill these roles The ability of the person to integrate. Integration means the ability of ○ the recreation therapist helps the client to achieve a balance of the person for adjustment. work and play in his or her life and provides activities that promote Can Integrate internal and external factors constructive use of leisure or unstructured time ○ Internal factors: stress i. Utilize hobbies and items that cannot be used to harm others How do you manage stress? or self (bead making) How would you cope up with all the challenges and → Vocational rehabilitation specialist obstacles in your life? ○ Includes determining clients’ interests and abilities are matching ○ External factors them with vocational choices. Ability of the person to maintain autonomy = ability to decision ○ Clients are also assisted in job-seeking and job-retention skills, as making well as pursuit of further education if that is needed and desired. ○ Are you deciding for yourself or do you actually let other Vocational rehabilitation specialists can be prepared at the people decide for you? baccalaureate or master’s level and may have different level of ○ Could be with peers, parents autonomy and program supervision based on their education i. some institutions reject job seekers na may history of AUTONOMY psychiatric problem ii. should be a standard or protocol in all courses for example a Involves self-determination,self responsible for decisions, balance pilot between dependence and independence, and acceptance of the consequences of one's action CRITERIA FOR MENTAL HEALTH Impulsivity could harm another individuals or even yourself Parameters that could actually define or describe a person is actually Always have plan of action (series of actions) before dealing with having a well-adjusted means of coping or means of developing of the client coping mechanisms in his environment and/or challenges he’s Be mindful of what we are saying. Be mindful of our actions encountering towards other people. JAHODA,1953; STAURT AND SUNDEEN,1995 POSITIVE ATTITUDE toward self; includes self-identity, self acceptance, self- awareness, REALITY PERCEPTION belongingness, security and wholeness Ability to test assumptions about the world by empirical thought; “Law of Attraction” includes social sensitivity (empathy) Positive attitude requires you to do your part too. Help yourself. People might misunderstand us because they don’t know the The ability of the person to gauge what is real and what is actually things we went through. part of their disorders A person might be paranoid in nature because of multiple traumatic Hallucinations (what they feel, hear, see) could be manifestation of a experiences perceptual disturbance One thing we have to be intact is the ability to discern what is real COMPONENTS OF ASSESSMENT OF MENTAL STATUS and what is not “empirical” - what you actually observe SENSORIUM Empathy - ability of the person to relate to another individual consciousness? Present the reality to the client in order not to give false assurance Is the client awake?If the client can answer correctly and and encourage them to be strong despite of the things they’re going coherently? sleepy? lethargic?unconscious? through EMPATHY > SYMPATHY BSN-3C 2 orientation? If you have higher IQ or rigid ang personality - mahirap iplease kasi Orient the client. Introduce yourself. State your purpose. you’ll suffer -> major depressive disorder “Hello Ma'am Sir. I am _____. I’ll be dealing with you the whole THOUGHT CONTENT day. If there is any concern you can call me right away. You are self concept? here currently in the Psychiatric Facility. You are currently our How do you see yourself? client” You will have to perform Johari’s Window (psych rle) Ask the 3 spheres (PPT): ○ Person: What is your name? areas of concern? ○ Place: What is the name of this place? What are the things that stresses you? ○ Time: What is today's date? themes? obsessions? attention? concentration? measure attention deficiency i.e ADD and ADHD delusions? Attention Deficit Disorder or ADD- for adolescence “your dad can do everything because he is the law” Attention Deficit Hyperactivity Disorder or ADHD - For pediatrics; “makapangyarihan ang tatay mo” diagnosed at the age of 6-12 years old indigenous people -> cannibalism (they eat people) culture, it’s What to do? normal for them ○ Engage their attention all the time. ○ Call their name to call their attention. “Hey Alvin!” hallucinations? Example: comprehension? Delusion of grandeur (manic), The ability of the person to digest and understand information Relate to the level of education and status of the client Delusion of omnipotence (schizophrenia), ○ Associate things with play time or characters in dealing with You feel you have divine powers childrens I can walk through walls Do not child talk -> mahihirapan madevelop the ability of speaking delusion of persecution & delusion of reference (paranoid delusions) of the child Delusion of Persecution - tunog ng “wang wang” – you feel that you're going to be tortured; you feel that FBI agents are going to Example: Disorientation & Confusion (Dementia) get you and interrogate you Confirmation of Alzheimer’s disease: Autopsy (performed when the Delusion of Reference (paranoid delusions) - perceive that you person is already dead) are the subject of controversy; when you see two people talking Most common type of Dementia: Alzheimer’s Disease together and suddenly laugh then look at you (pero pinaguusapan Activities that are remained intact are their past memories yung pinanood kagabi) you will feel na “ako yata pinaguusapan ako ata pinagtatawanan” APPEARANCE appropriateness? grooming? THOUGHT PROCESS Is he or she dressing appropriately? ability to understand abstracts/symbols? ex: going to a ball, is it appropriate to wear shorts ba? depends on gestures – be careful because some gestures can be offensive to other the situation. countries ex: you’re going to go to a talk, are you going to wear a bikini? Example: Magical thinking and animism of Schizotypal personality rigidity? mannerisms? Is he or she stiff or relaxed? SPEECH When you talk in the classroom, you tend to become stiff, bite nails, click your pen or jerk your legs this could pertain that you are coherency? anxious or boredom Is the client able to use the word coherently? make sure that you don't misinterpret information Example: Poor grooming (Suicidal patients, Schizophrenia and Manic ○ native language niya pala yon pero kala mo abnormal Depression) Poor grooming - depressed individuals relevancy? meaning? “Taong grasa” - disorganized type of schizophrenia; has problems Document if the client has repetitive speech letting go not only emotions pero things din → hoarding May psychology behind every favorite color quality/ quantity? ○ PInk - submissiveness; compassive in terms of relationship Example: ○ Black - di naman ibig sabihin dark ang personality Slurring of Speech (alcoholism) Pressure speech (manic depression or bipolar disorder) AFFECT/MOOD Some people hide secrets → fast pace speech para walang matanong or walang masabing mali appropriateness? swing? duration? intensity? pertains to emotions, mas abnormal ang tao if hindi PSYCHIATRIC NURSING : THEORIES PPT nakakaramdam ng emotions Diagnostic statistical Manual for mental health - is the bible in diagnosing mental illness. Psychiatrist and Psychologist needs this → Flat Affect (no emotions): to diagnosis ○ Masaya daw siya pero not smiling ○ For us nurses, North American Nursing Diagnosis Association ○ Can be see to Schizophrenic individuals (NANDA ) is used. Schizophrenia & Major Depression. Transition of DSM4 to DSM5 manual Seen also in Parkinson’s Disease & Myasthenia Gravis ○ DSM IV - Focus : Specific content that is affected by the Parkinson’s Disease - neurologic approach; mentation; problems disorder like mood. in mood DSM V - Focus : Holistic approach to an Individual and not → Blunted Affect (there’s emotion but greatly diminished) just the mere content and much more general in approach. ○ Masaya pero limited ang smile (mood, thinking, perceiving things) → Labile Affect (sudden switching of emotions): Manic Depression or Bipolar Disorder Areas to assess under DSM V Manual Kanina mabait tapos nung hapon biglang nagsusungit Axis I: Clinical Disorders. → Broad Affect (exaggerated emotions) Clinical syndrome/ signs and symptoms “Hala di na ako mabubuhay” - pero nakagat lang ng langgam“ Rule out s/sx, be objective “Hala ang baba ko 99/100, magpapakamatay na ako” Psychosis vs schizophrenia Sometimes perfectionist kasi high ang standards Axis II: Personality Disorders or Mental Retardation. BSN-3C 3  Personality disorders and neurodevelopmental disorder behavior that is rewarded is likely to be repeated, and behavior that (formerly pervasive developmental disorder — ADHD, is punished will rarely occur Autism spec, conduct disorder, asperger’s syndrome) Axis III: Medical or Physical Conditions. INTERPERSONAL MODEL Pathological disorders ○ The most important concept in developing nurse-patient ○ Organic/ structural basis or changes or imbalance relationship is TRUST (bcs of hormones), neurotransmitter ○ How do we gain trust? Ex. High dopamine - predispose to schizophrenia High Be consistent norepinephrine and epinephrine - manic, aggressive Do exactly as you say to the client (E.g i'll be here at 7 am then disorders, anger probs be there at 7am ) Low level serotonin, nor epi, epi, dopa - depressive disorder Axis IV: Contributing Environmental or Psychosocial Factors. EXISTENTIAL MODEL OR HUMANISTIC MODEL (ROGERS) Psychosocial and environmental problems Likes of disasters, crisis, force of nature, pandemic Focus : Consciousness and Human Experience PTSD Believed that behavior is a learned experience. Schizophrenia The reason behind your reaction is based on your past experience *Assess mood, ADLs, physical activity, think, function effectively in the community BIOMEDICAL MODEL Axis V: Global Assessment of Functioning/ Functionality. (MOST They said that it's more on the pathologic side of the organic and Important area of DSM V) structural changes of the client. Deals with holistic condition of client The brain could atrophy (numipis) - alzheimer’s abnormal functioning of the prefrontal cortex of the lobe = CONCEPTUAL MODELS OF PSYCHIATRIC TREATMENT schizophrenia Elevation or Imbalance of GABA and Norepinephrine - Anxiety MODELS FOCUS Psychoanalytical or Intrapsychic Process (conflicts, anxiety, PSYCHOSOCIAL THEORY OF ERIC ERIKSON Psychosexual Model defense mechanisms, impulses) Most commonly used theory by health professionals. (Freud) Describes the human cycle as a series of eight EGO developmental stages from birth to death; Behavioral Framework Learned Behavior Focus: PSYCHOSOCIAL TASKS throughout the life cycle. Believed in the concept of Socialization that developmental Pavlov’s Theory milestone can be achieved through interpersonal experience, (Classical Conditioning) through conversation,discussion opening up your feelings Skinner’s Theory STAGES OF PSYCHOSOCIAL DEVELOPMENT (Operant Conditioning) STAGE AGE PSYCHOSOCIAL TASKS Interpersonal Model Interpersonal Relationships (Sullivan and Peplau) Infancy 0 - 18 mos Trust vs Mistrust Psychosocial Theory Psychosocial tasks Toddler 18 mos - 3 yrs Autonomy vs Shame and Doubt (Erik Erickson) Preschool 3 - 6 yrs Initiative vs Guilt Existential Model or Conscious Human Experience Age Humanistic Model (Rogers) School Age 6 - 12 yrs Industry vs Inferiority Biomedical Model Disease approach, syndromes, (Meyer, Kraeplin, diagnoses, etiologies Adolescence 12 - 20 yrs Identity vs Role Confusion Frances) Early 20 - 35 yrs Intimacy vs Isolation Classical Conditioning - behaviors are learned by connecting a Adulthood neutral stimulus with a positive one Operant Conditioning - method of learning that employs rewards and Middle 35 - 65 yrs Generativity vs Stagnation punishments for behavior Adulthood Most common task of 40 y/o FREUD includes developing Coping Mechanism is how you adjust or cope in you environment responsibility over their own If your coping and defense mechanisms are no longer effective, it lives could lead to MALADAPTIVE cases. Maladaptive case can lead to: Later Years / 65 and above Integrity vs Despair Crisis Old Age yrs Anxiety / PAnic attacks 76 y/o male who has a good Sudden Impulsive acts ego integrity is preoccupied with death BEHAVIORAL FRAMEWORK ○ Classical conditioning refers to learning that occurs when a neutral stimulus (e.g., a tone) becomes associated with a stimulus (e.g., food) that naturally produces a behaviour. After the association is learned, the previously neutral stimulus is sufficient to produce the behavior. ○ Operant conditioning, sometimes referred to as instrumental conditioning, is a method of learning that uses rewards and punishment to modify behavior. Through operant conditioning, BSN-3C 4  PSYCHOSEXUAL (PSYCHOANALYTICAL) THEORY FREUDIAN THEORY COMPONENTS OF SIGMUND FREUD STAGES OF PSYCHOSEXUAL THEORY AGE PHASE STAGE Infancy Oral Stage of Id Toddler Anal Stage of Ego Preschool Phallic Stage of SuperEgo Age (Conscience) Schooler Latency Stage of Strict SuperEgo LEVEL OF AWARENESS OR CONSCIOUSNESS CONSCIOUS SELF Adolescent Genital – ○ We are aware of and we perfectly know what is happening. ORAL STAGE: We satisfy the needs of the infant through the mouth ○ 2 % of our memory - all the things we remember at the ○ All the needs of the infant is through crying moment. ○ The child needs something like food the child cries ○ Composed of past experiences, logical and governed by ○ In some cases if the child is hungry or the diaper is wet the child REALITY PRINCIPLE cries due to Uncomfortability. ○ are remembered and easily recalled or available to the individual Priority: is to Maintain consistency in feeding the child SUBCONSCIOUS SELF (Watchman of the Personality) Toddler ○ Watchman means it filters information in and out of your ○ Priority : Toilet training , Defecation and Urination brain/memory ○ Libido in the Anal area You try to hide it but kusang lumalabas sa memory mo (eg. ○ Anal slip of the tongue or Freudian slip - meaning ○ we have toilet training unintentional errors brought by subconscious mind) PRESCHOOLER You will be bale to remember gradually by a certain stimuli ○ Focus: Exploration in sexual Organ ○ 8% of our memory ○ Libido in the Phallus or in the sexual organ (not literally sex) ○ the Preconscious (some calls it semi-conscious) ○ Phallic ○ composed of material that has been deliberately pushed out of ○ From the term Phallus it means sexual organs, so the area of conscious level (basically what you want to forget : Walang gratification would be either vagina or penis. However it DOES sikretong hindi nabubunyag) NOT literally mean sex. Its more of an Exploratory stage. Twitches on eyes, hands, or sudden movement of arms SCHOOLER could pertain that the person COULD be lying. ○ Focus : Peers and School activities ○ helps repress unpleasant thoughts or feelings and can examine ○ Latent or censor certain desires or thinking can be recalled with some ○ Libidido Fluctuates (bababa then tataas) since the libidinal effort energy is focused on the school activities that why it is called The brain always store factual information. age of life UNCONSCIOUS SELF (The one who molds the personality; ADOLESCENT Storage Bin of traumatic & meaningful memories. True desires & ○ Adolescent Motives are here) ○ Focus ○ 90% of our memory (largest memory) ○ Genital ○ Information you could no longer recall. ○ Increased Libidinal energy where the attraction is in the opposite Eg. A month old or year old birthday experience. sex Do you remember? ○ Crushes and admiration towards the opposite sex What activities? etc? ○ Energy is role performance and development of identity. We can remember some but it is not gradual remembering which requires HYPNOSIS (Therapy) - should be performed in a controlled environment. Phallic Stage We will be able to somehow recall those information Attachment of the child to the parent of the opposite sex and placed on unconscious thoughts. jealousy toward the parent of the same sex ○ It is more on the pleasure based on your personality. You dont Oedipal Complex: Attachment of the son to his mother and deliberately place this out. jealousy toward the father ○ It does manifest/disguise on your dreams (dreams have ○ To fix it: expose son to same sex parent meanings) ○ Complication: castration fear ○ Composed of the LARGEST BODY OF MATERIAL – the Electra Complex: Attachment of the daughter to her father and thoughts, memories and feelings that are repressed and not jealousy toward the mother available to the conscious mind, not logical and governed by ○ Complication: Penis envy PLEASURE PRINCIPLE; ○ and since it is usually painful and unacceptable to the individual, it cannot be deliberately brought unacceptable to the individual, it cannot be deliberately brought back into awareness unless in disguised or distorted form (dreams) BSN-3C 5  THREE ELEMENTS OF PERSONALITY IMBALANCE OR ABNORMAL FUNCTIONING OF THE THREE ELEMENT OF PERSONALITY FUNCTION PRINCIPLE LANGUAGE PERSONALITY ↑Id + ↓SE = Conduct Disorder and Antisocial Personality Disorder Id Animal Pleasure “I want it Infant / Child Instinct Principle when I want ↓Id + ↑SE = Obsessive Compulsive Disorder it.” Survival of *CD: difficult time following rules and behaving in a socially the fittest acceptable way. Hostile/violent APD: impulsive, irresponsible and often criminal behavior Ego Balances Reality “I can wait.” Adult (Mediator) Principle the desire of Id and Superego The ego acts as the integrator of the personality Super Induces Conscienc “Thou shall Parent Ego guilt → e Principle not.” undoing Imagine a Triangle with a seesaw = The Good and the Bad are being balanced by the Ego ID (Bad) ○ Psychoanalytic term for that part of the psyche that is UNCONSCIOUS ○ the reservoir of INSTINCTS, primitive drives governed by the PLEASURE PRINCIPLE and is SELF- CENTERED. ○ The Ids says, “I want, what I want, when I want it”. ○ For example: Having a cellphone is a necessity but having an expensive branded phone is more on the pleasure side even if you are too broke. Staying or eating always in a 5-star restaurant. Typical Serial Killer/Perpetrators/Abusers/violators Kids having Tantrums When they grow up NEVER ARGUE WITH THEM because when they notice you are debating, they will take that personally and over the line. BE CAREFUL and place some boundaries with these people. EGO: ○ Psychoanalytic term for that part of the psyche that is CONSCIOUS ○ The “I” that is shown to the environment and most in touch with REALITY and the MEDIATOR between the primitive, pleasure- seeking, instinctive drives of the ID and the self- critical, prohibitive forces of the SUPEREGO and is directed by REALITY PRINCIPLE. ○ This is the thinking-feeling part of personality. ○ The Ego says, “I would want to have it if only I can afford it;” “Not now, I am not yet ready; perhaps next week.” SUPEREGO (Good) ○ Psychoanalytic term for that part of the psyche that RESTRAINS, controls, inhibits and prohibits impulses and instincts, is self- critical, and is called the CONSCIENCE or EGO IDEAL. ○ The Superego says, “I should not want that; It is not good to even wish for it.” BSN-3C 6  NCM 117 PSYCHIATRIC NURSING L E C / PROF. ACUAR & PROF. BILOG ______________________________________________________________________________________________________________ PRELIMS ○ Norepinephrine: automatically comes together with epinephrine WEEK 2 - OUTLINE Rationale: because they are produced by the same gland which is the Adrenal Gland” I. NEUROBIOLOGIC CONCEPTS ○ Dopamine: A. Nervous System Excessive Dopamine in the brain can lead to Psychosis B. Reaction to the body Excessive consumption of methamphetamine (shabu) C. The effect in the different parts of the body promotes schizophrenia, delusional and hallucinatory D. Summary disorders. II. ANXIETY AND ITS RELATED DISORDERS A. Major Assessment Criterion for Degree of Anxiety 1. Mild TIP: IF “Amines” it is considered a SNS automatically. 2. Moderate Q: What part of the Adrenal Gland supplies the epinephrine and 3. Severe norepinephrine? Ans. Adrenal Medulla 4. Panic Where it produces Catecholamines B. Potential Nursing Diagnoses C. Nursing Intervention Implementation Note: SNS neurotransmitters will send you HIGH ↑ high energy = high VS NEUROBIOLOGIC CONCEPTS Focus will be increased oxygenation and blood supply in NERVOUS SYSTEM the cardiac area, pulmonary area and muscles (not in the CENTRAL NERVOUS SYSTEM (CNS) GIT area) ALL Reflexes will be elevated EXCEPT GIT & GUT Consist of 2 main parts: 1. Brain ○ Divided into different portions: Cerebrum, cerebellum, REACTION TO THE BODY hypothalamus… 2. Spinal Cord Heart: ↑ Contraction → ↑ blood flow → ↑ Oxygenation → ↑ Contraction → Increased HR ↑→ Tachycardia PERIPHERAL NERVOUS SYSTEM (PNS) Blood vessels: ↑ pressure → Vasoconstriction → ↑ Blood flow - ↑ Blood Pressure → HTN reaction Lungs: 12 Cranial Nerves (CN) 31 pairs Spinal nerves (SN) ○ vasonstrict ang blood vessel → bronchodilate ang airway Mnemonic: Oh, oh, oh, to touch and ○ bronchodilated → mas mabilis ang RR (tachypnea) feel a girl’s Vagina ah Heaven GIT ○ Peristalsis (bumabagal ang bowel movement) → Constipation 1. Olfactory nerve (CN I) 8 cervical nerve pairs → Dry mouth → Xerostomia 2. Optic nerve (CN II) (C1-C8) GUT 3. Oculomotor nerve (CN III) 12 thoracic nerve pairs ○ Closed Sphincter → Urinary Retention 4. Trochlear nerve (CN IV) (T1-T12) Liver 5. Trigeminal nerve (CN V) 5 lumbar nerve pairs 6. Abducens nerve (CN VI) (L1-L5) ○ ↑ production of Glucose (source of energy) 7. Facial nerve (CN VII) 5 sacral (S1-S5) ○ ↑ amount of glucose in blood streams 8. Vestibulocochlear nerve (CN VIII) a single coccygeal nerve 9. Glossopharyngeal nerve (CN IX) pair. PARASYMPATHETIC NERVOUS SYSTEM (PNS) 10. Vagus nerve (CN X) PAPARA (ka) - VAVAGAL (ang sasakyan) 11. Accessory nerve (CN XI) Conservation of energy: “Rest & Digest” 12. Hypoglossal nerve (CN XII) Cranial Nerve is responsible for this - Vagus Nerve Stimulating PNS - Vagal Nerve Stimulation AUTONOMIC NERVOUS SYSTEM (ANS) Para - Vavagal ang simulation majority of medications take effect Decrease activation of responses Auto -> automatic by nature -> involuntary by nature ; we can’t control these Receptors of PNS from the word “Autonomy” = has its own activity; controls its own ○ Both are downer effect function ○ Muscarinic ○ Cholinergic SYMPATHETIC NERVOUS SYSTEM (SNS) NEUROTRANSMITTERS “Flight & Fight Response”: Using energy into something that will increase blood flow in the muscles, brain, heart and in the lungs. ○ Walang counterpart si serotonin ○ Invade or Challenge? ○ Gamma Amino Butyric Acid (GABA) - Counterpart of Elevation of blood supply and increased oxygenation -> Increased Epinephrine and Norepinephrine All Vital Signs Rationale: because of the usage of energy If increase is norepinephrine at epinephrine, mag decrease Receptors: Adrenergic si GABA and vice versa ○ “Adrenaline Rush ○ Acetylcholine - Counterpart of dopamine, downer effect, look Neurotransmitters responsible for activating: “Amines” for other chemical symbol of ACH or Choline - downer products ○ neurochemicals that activates and increasing energy to the body ○ Serotonin: Responsible for Happiness :> THE EFFECT IN THE DIFFERENT PARTS OF THE BODY Feelings of Elation -> S/s of Anxiety Attack You are not easily aroused. ○ Epinephrine: All reflexes decreased except the GIT and the GUT. BSN-3C 1  Heart - Bradycardia = decrease of heart rate, conservation of ANXIETY AND ANXIETY-RELATED DISORDERS energy, samgyupsal, kumain ka, matic tulog ka Anxiety - effective subjective response to an imagined or real internal Blood Vessel - parang hose ng bumbero - Wider in diameter, or external threat mabagal ang filling time, mabagal at mahina ang pressure - feeling of apprehension/uneasiness of other people ○ Hypotension - Decrease in BP - perception that something bad is going to happen ○ Vasodilation - baliktad ang pulmonary function Lungs Note: ○ Bronchoconstriction = sumisikip ang daanan ng hangin, difficulty We have 4 levels of anxiety: Mild, Moderate, severe, panic attack in breathing, ○ Bradypnea - decrease in RR - perceived subjectively by the conscious mind is as painful, diffuse apprehension or vague uneasiness, but the causative conflict or GIT - Increase in peristaltic movement that causes episodes of threats is not in the conscious mind or awareness diarrhea, possible loss of fluid - low/mild level of anxiety is healthy and helps in individual growth ○ Kaya nag tendency ihi ka ng ihi kapag nakainom ka. and development, it pushes and motivates you to do better Mouth - Ptyalism - increase of salivation - may be from deadlines, external pressure from relatives, job Liver - Conservation of energy uncertainty, etc. ○ Glucogenogenesis - preservation of glucose, storage of glucose in liver MAJOR ASSESSMENT CRITERION FOR MEASURING DEGREE OF ANXIETY SUMMARY MILD The perceptual field is wide allowing the client to focus realistically on what is happening to him. Alert senses, increased attentiveness, SNS PNS and increased motivation Therapeutic/ widens your understanding/ perception Tachycardia Heart Bradycardia perfect opportunity for the nurse to explore client’s behavior Hypertension, Constricted 🩸 Blood Vessels Hypotension, Dilation Note: Is problem-solving skill a form of stress management? No, since it entails that the person needs to face the problem Bronchodilation Lungs Bronchoconstriction which could heighten the anxiety. But if you take it positively, it Tachypnea Bradypnea will not be a hindrance for you. Nursing Responsibility: Prevent escalation of mild anxiety into moderate anxiety. Give teachings, explore, you may ask Constipation GIT Diarrhea “Tell me how you feel..” Using ‘why’ questions is a barrier to effective Retention GUT Urination communication since it entails defensive explanations which Enuresis - ihi ka ng ihi can be anxiety-provoking to other individuals. Acknowledge Mydriasis Dilation of pupils- Eyes 👀 Miosis Constricted Pupils- the client’s feelings first then entail collaboration. ○ “You look sad, let’s know more on why you feel that way.” We all have our different burdens, don’t be judgy and dismissive towards others’ sentiments. better view of Limited vision, central surroundings Emotions are highly subjective and individualized, that’s why it’s important to understand other people’s feelings. Treatment is a collaboration between the health care worker AGONIST EFFECT and patient, strengthening relationships and goals. We work promote function of a substance hand in hand. This is the sole reason why therapeutic communication (also ANTAGONIST EFFECT known as psychotherapy) is preferred when it comes to psychiatric work/nursing. prevent the function of a substance/ medication block the function of the specific medication MODERATE ADRENERGIC AGONIST Another word is Selective Inattention common medication for difficulty of breathing (ex. COPD) ○ The reason it's called : The patient tries to avoid any activity or adrenergic — SNS FUNCTION discussion leading to anxiety agonist — PROMOTE ○ They utilize defense mechanism suppression – they salbutamol, ventolin intentionally forget any traumatic source of problem SNS Medication will cause dilation of the lungs (increase RR, increase HR, Increase Energy, Insomnia, Hyperactivity) Examination TWO RECEPTORS UNDER PNS Friend: What’s your grade? You: *knowing you failed* I don’t wanna talk about it. muscarinic cholinergic reception Marriage Friend: Kamusta kayo ng asawa mo? ANTICHOLINERGIC You: *Knowing you are now divorced* Ayoko pag SNS medication usapan block the activity of the SNS receptors equals manifestation of PNS Atropine Sulfate (SO4) (given to client with low HR -> increase HR) The perceptual field narrows and the client is able to partially focus on what is happening if directed to do so and can verbalize feelings ACETYLCHOLINESTERASE INHIBITOR of anxiety Levels of Anxiety: Their attention, sensitivity and sensory sensitivity a form of enzyme from the word erase are slower. inhibitor - inhibits breakdown of acetylcholine PNS medication (can promote diarrhea, salivation) PNS everything will decrease except GIT and GUT if you do not know the medication go to basics BSN-3C 2 SEVERE ○ If the client is hostile: Isolation is done but it isn’t the priority The perceptual field is significantly reduced and the client may not intervention because it requires doctor’s order. be able to focus on what is happening to him and may not be able ○ Placing the client alone in the room without doctor’s order is to recognize or verbalize anxiety. false imprisonment and illegal detention (could possibly ○ Can you still still ask them: “Tell me more” or “What brought lead to lawsuit) – We are promoting safety to patient and you here?” others NO, because these people have narrowed perception and they will no longer be able to understand complex, DO WE PUT THEM NEAR THE NURSE’S STATION? multistage concepts (Nursing responsibility: Talk No, we place them on the end of the hall or floor with continuous straight to the point) monitoring. These individuals could go up within seconds or a minute to panic attack (very much alarming because they will be We can decrease stimuli but prevent shadowy areas because unaware of their actions to himself or others) – It is a these individuals may be suicidal, so it is best to monitor. threat to self and others Restraining is NOT the priority intervention CAN A FAMILY MEMBER AID IN MONITORING THE PATIENT? We chose the least invasive activity – We could NO, they should not be assigned nor be inside the patient’s room. decrease the stimuli like dimming lights (bright light It is a BIG NO in psychiatric facilities. could make px agitated), promote calm and quiet environment (Florence Nightingale’s theory is Client may harm self and others applicable to psychology) – Composed and structured environment A patient stating, “Sometimes I feel like I’m going crazy and losing ○ Elevated vital signs = SNS Manifestations are elevated control over myself,” is showing symptoms of panic attack BP could spike up RR increased key terminology is fear of losing out and personality disorganization All senses affected (no longer aware) – we have to understand them because they may Decreased perceptual field or may not be influenced by their emotions (“Medyo nandilim yung Drained energy paningin ko” – probably brought by anger) Learning and problem solving not possible ○ Learning and problem solving will be true in mild level anxiety POTENTIAL NURSING DIAGNOSES START OF SYMPATHETIC SYMPTOMS (SNS) (evident to the 1. Ineffective Individual Coping - your coping and defense patient) mechanisms are no longer effective in resolving problems. ○ Tachycardia 2. Anxiety ○ Palpitations ○ Hyperventilation (Brown paper to prevent Respiratory NURSING INTERVENTION IMPLEMENTATION Alkalosis) 1. Identify anxious behavior (nail biting, hair pulling, thumb sucking, How to identify? – There will be rapid breathing pattern tantrums) and anxiety levels and institute measures to decrease like asthma anxiety at a level where learning can occur (Mild Anxiety) Complication is Respiratory ALkalosis – Numbness of 2. Provide appropriate environment where environmental stress and soft tissues, lips, fingers stimulation are low (First nursing Action) To manage or neutralize – Brown paper bag ○ Promote least invasive procedures When patient exhales, Carbon dioxide (CO2) is ○ Doable and Applicable to all facilities released (partly) and will also be re-inhaled to i. Decrease the light neutralize alkalosis ii. Prevent shadow Inhaling CO2 promotes increase in Hydrogen ions iii. Calming sound leading to neutralized changes in respiratory alkalosis iv. prevent group therapies (excess stimuli) – not for Alternative: Cupping of hands covering the nose and active anxiety mouth… Breathing in and out. According to Florence Nightingale, therapies should ○ Cold Clammy Skin promote an environment where they can heal not only physically but mentally and emotionally. Note: Sympathetic nervous system (Fight and flight response) For clients to be diagnosed with anxiety-related disorder, there must It must be Structured, NON-stimulating, uncluttered and be elevation of catecholamines significant to epinephrine and SAFE from physical exhaustion and harm (Threatening norepinephrine. environment. PANIC 3. STAY. Do not leave clients alone. Recognize if additional help is The last yet most alarming stage needed. Provide physical care necessary The perceptual field is severely reduced and the client experiences ○ There may be escalation or stress. feelings of panic and dread. ○ Self mutilation can be done leading to death. Client overwhelmed and helpless; personality may disintegrate → hallucinations and delusions. 4. Establish PERSON-TO-PERSON relationship and maintain an ○ Hallucinations - sensory perceptual alteration (something you accepting gratitude hear, see, feel that have no concept of reality = true for the ○ A relationship with no TRUST is like a building waiting to client) collapse (weak foundation) – it will collapse and they won't Validation: ask someone CAN YOU HEAR THAT disclose information if superficial relationships. YOU HAVE SOUND? if not? Hallucinations TO BUILD IT. PROFESSIONALLY. ○ Delusions - way of thinking ○ ACCEPT client. Show willingness to Listen Delusion is a fixed false belief that is ingrained during ○ Encourage, allow EXPRESSION OF FEELINGS at client’s childhood; how you were raised under culture, etc. OWN PACE avoid forcing verbalization Your parents may have mentioned that we are the most We want them to verbalize but own pace. Trust powerful clan, so you act like one. (fixed false belief) increases the ability of the person to disclose. Pathological conditions requiring immediate intervention Also the concept of Empathy ○ Best management (both true for severe and panic): Stay with the client, never leave them alone (if needed, 24/7) 5. Administer medications as directed and needed The patient will manifest suicidal ideation. Continuous ○ The pharmacology Therapy of Choice is the ANXIOLYTICS monitoring / ANTI-ANXIETY (reduces anxiety) so the client can ○ Never place the client in an area that has increased stimuli participate in psychotherapy. leading to more apprehensive and restless patients. BSN-3C 3  ○ If the client was able to control emotions, that is the perfect 3 MAIN PROBLEMS time to involve him/her in the activities preferred by them. 1. Social Phobia - Not necessarily the fear of engaging in From that, we are going to progress into interactions with conversations. According to Videbeck, afraid of public speaking others. (THERAPEUTIC COMMUNICATION) and stage fright 6. Assist to cope with anxiety more effectively. Assist to recognize ○ The real fear here is FEAR OF individual strengths realistically. REJECTION/ABANDONMENT. You are afraid that when ○ Assist the source of anxiety you present something, they might make fun of you ○ Help the client to develop strengths and focus on those with ○ Example: Someone approached you and binara mo “talk to activities aiding in improvements and developments the hand”. That person will start feeling fear of rejection. ○ NO MAN IS AN ISLAND but there are cases where you ○ Nurse’s Role: Active Friendliness. - be the one to initiate a have to rely on yourself and a realization of strengths and conversation., you don’t wait for the client’s readiness. weaknesses 2. AgoraPhobia - Will be fear of public spaces and open spaces. Irrational fear. 7. Encourage measures to reduce anxiety by having activities: ○ The real fear here is FEAR OF NO IMMEDIATE HELP IN Relaxation techniques, exercises (dancing, walking, jogging), CASE OF EMERGENCY. hobbies, talking with support groups (rehabilitation phase) , ○ Nurse’s Role: Offer Yourself. Never leave the client. Stay desensitization treatment program (you will be able to control). with the client. Make him/her feel that she’s not alone. ○ Means of diverting energy to something productive or 3. Simple/Specific Phobia - specific situations; objects; animal that positive. could lead to source of phobia; animate ○ Nurse’s Role: Systematic Desensitization - Therapy 8. Provide individual or group therapy to identify anxiety and new ways of dealing with it and develop more effective coping THERAPY interpersonal skills ○ Maybe what you were doing before is not effective for the a. Cognitive Behavioral Therapy - talking therapy that can help generation right now. you manage your problems by changing the way you think and ○ We have to find new ways to enhance problem solving and behave. coping - by correcting the abnormal thought pattern, we will be able to correct the behavior of the client to something more adjusted 9. If a patient can be redirected back to the topic after he gets - not the therapy of choice, but is usually used. anxious while the RN gives discharge teaching, it is an indication that discharge teaching can be resumed. b. Systematic Desensitization - therapy of choice (BOARD ○ We call this as FOCUSING: if you have a problem then QUESTION) patient is talking a lot, having circumstantial language and - evidence-based therapy approach that combines relaxation tangential language, it is best to redirect the statement back techniques with gradual exposure from the stimuli fear or to the main subject (ability to cope with problem) anxiety to help you slowly overcome a phobia. - understand the source of stimuli first ex. Suppose you’re afraid of birds. Your therapist might ask you to talk about birds in detail. As you feel more at ease with the topic, they may ask you to look at photos of birds while you focus on breathing WEEK 5 - OUTLINE deeply or practicing another relaxation technique. When you feel I. ANXIETY-RELATED DISORDERS (ARD) ready to move on, your therapist could ask you to watch a video of A. Phobia birds in different scenarios. As you become less reactive to this B. Post-Traumatic Stress Disorder (PTSD) exercise, your therapist may bring a real bird in a cage to the session C. Obsessive-Compulsive Disorder while you watch at a distance. Progressively, they may bring the bird closer while you continue to practice a relaxation technique to ANXIETY-RELATED DISORDERS (ARD) manage your anxiety. Eventually, you may feel less anxious about seeing or being close to a bird. 4 MAIN CATEGORIES 1. Phobia (also known as irrational Fear) c. Implosion therapy (Flooding) - no longer recommended type of 2. Post Traumatic Stress Disorder (PTSD) Related to anxiety therapy progressing to depression - sudden/abrupt exposure to stimuli which could lead to higher 3. Obsessive- Compulsive Disorder (OCD) levels of anxiety which could lead to depression ○ OCD vs Obsessive-Compulsive Personality Disorder ex. If you live with claustrophobia, a flooding session might involve (OCPD) sitting in an extremely small, crowded room for several hours. This OCPD is a personality trait might even involve an elevator or a closet. OCD is a method of stress-coping management. Repetitive and ritualistic actions. Note: 4. Generalized Anxiety Disorder (GAD) In acute cases of anxiety: anxiolytics are given (-zepam/-zolam) PHOBIA In chronic or long-standing phobia, PTSD, OCD: also known as Irrational Fear - it is never your real fear, just a antidepressants are given symbol ○ Example: Hydrophobia (not a fear of water) but water is the symbol of the fear of drowning or deep waters or what Post- Traumatic Stress Disorder (PTSD) lies beneath the water surface Psychiatric disorder coming directly from a traumatic event Phobia is a learned experience. VS PHOBIA: Phobia has a symbol of the fear Possible cause: Previous or Childhood trauma/abuse/activities Depending on the onset of the condition: ○ < 2 months of the crisis: Acute Stress Disorder (ASD) 2 MAIN DEFENSE MECHANISM ○ > 2 months: Post - Traumatic Stress Disorder (PTSD) 1. Displacement of feared object CRISIS 2. Symbolization Crisis from a traumatic event -> Temporary disbelief with reality, Ex: Fear of Heights = Fear of falling alterations of personality, disorganization of ADL Fear of clowns (coulrophobia) = Fear of being subject for Situational and Adventitious Crisis are the 2 main causes of jokes and pranks PTSD BSN-3C 4  Anal retentive person - person who pays such attention to detail that it becomes an obsession and may be an DEVELOPMENTAL SITUATIONAL ADVENTITIOUS annoyance to others “I have to find means in order to relieve this” = Maturational Accidents Disaster Compensation ○ Ex. Anal stage in life = I am overly obsessed with Puberty Death Of A Love Force Majeure cleanliness = my way of relieving my stress (compulsion) Marriage Murder Pandemic PSYCHOPATHOLOGY Parenthood Rape World War can start as early as childhood stage in life (Toddler years) Vehicular Accident PARENTS → Strict, Rigid, Stiff behaviors → Punishment → Anal Defecation → “Bad Me” Personification → Fear → OCD DEVELOPMENTAL CRISIS Parents should normally be encouraging and flexible in other term: Maturational meeting the needs of their child it is normal to people; happens to everybody Ex. Bata nadefecate bigla without the notice of the parent = e.g adjustment to puberty, adjustment to a marriage, newly pinapalo yung bata pregnant mom, adjustment to parenthood Childrens could adapt their behavior → naintroject nila into their personality and manifest that kind of behavior to their SITUATIONAL CRISIS future child Caused by accidents Fear leads to anxiety leading to OCD to avoid the Death of a loved one punishment Cases of murder, rape, vehicular accidents OCD becomes a problem if it affects their ADLs Does it happen to all people? No In cases na hindi fear ang nadedevelop after ng “Bad Me Personification”, Disobedience can also be developed ADVENTITIOUS CRISIS When disobedience developed, it can lead to infractures of Trauma not only to a specific individual but to a large population rules and regulations (like in serial killers) of the group are affected common cases of Disaster, Force Majeure (e.g Typhoon, Tsunami), Pandemic, Nuclear bombing, World war Disobedience → ASPD (Antisocial Personality Disorder) Situational and Adventitious Common Serial killers based on studies are CEOs, lawyers, Two main causes, developmental is a matter of adjustment and doctors (surgeons) happening to all individuals The rituals manifest during adolescent stage of life not being able to cope can lead to PTSD Defense mechanisms include: Main/ Most Causes of PTSD ○ Repression Male ○ Undoing ○ Mauling ○ Physical Fights Nursing Management ○ Brawls 1. What we want to do to avoid this from developing is that in Female early stages of kids, don’t interfere with them doing their ADLs ○ Sexual assault or rituals (e.g. defecating or washing of hands) ○ Rape (forceful unconsented entry of object through an orifice) 2. It’s best to actually tell them that the problem starts with the survivor a more fitting term rather than rape victim mind = Cognitive Behavioral Therapy ○ molestation a. Development of Insight or realization of the ○ power rape- there is authority over that individual (teacher and problem - “I know now that my problems start in students) my mind” Hallmark Manifestation of PTSD 3. Watch out for signs and symptoms of depression Nightmares 4. Primary medication for acute attack = Anxiolytics (most Flashbacks common: Diazepam (Valium) ○ when you close your eyes and your perpetrator is wearing 5. For chronic cases, use antidepressant medications (SSRIs) red, you feel that the event will happen again if you see someone wearing red Hypervigilance ○ kapag binagyo and it causes PTSD, whenever it rains you are now much more weary Paranoia Guilt Trauma ○ can lead to self mutilating behavior OBSESSIVE-COMPULSIVE DISORDER (OCD) REMEMBER: Anxiety starts to develop when client is having abnormal recurring thoughts (obsession) OBSESSION → Abnormal Recurring Thoughts → Anxiety → Increase Be careful in dealing OCD px: Need to primarily resolve their anxiety and thought process first before correcting their compulsion COMPULSION → Actions → Recurrent → Rituals → Cleanliness, Counting, Chanting, Collecting (Hoarding) BSN-3C 5  NCM 117 PSYCHIATRIC NURSING L E C / PROF. ACUAR & PROF. BILOG ______________________________________________________________________________________________________________ PRELIMS lost of connection between a person’s ideas, memories, WEEK 4 - OUTLINE feelings, and action. Depiction (Examples): I. DEFENSE MECHANISMS Counting to ten when angry before taking action is a good A. Repression example of suppression. As an adult the person who has B. Suppression repressed an incident cannot get to this material by a C. Compensation conscious act of will; it's simply not available. D. Rationalization “AYOKO NA MAALALA SI EX…” pero KABISADO KO E. Intellectualization NUMBER NIYA 09xxxxxx F. Reaction Formation. Ayoko muna alalahanin (pero internally iniisip mo how to G. Reaction Formation pass) H. Fantasy I. Identification III. COMPENSATION J. Introjection Definition: K. Sublimation Overachieving in one area to compensate for failures in L. Projection another. It emphasizes strengths to make up for M. Displacement weaknesses. N. Regression Lacking on one quality but not to excel on others O. Acting Out Overcompensation occurs when people overachieve in one P. Conversion area to make up for shortcomings in another aspect of life. Q. Dissociation Undercompensation happens when people deal with such R. Symbolization shortcomings by becoming overly dependent on others. S. Undoing Scenarios/Disorders that uses this: T. Splitting When someone has a bad habit, such as excessive alcohol U. Fixation intake, they eat a very healthy diet and exercise daily to V. Denial compensate for the unhealthy alcohol intake. Nurse with low self-esteem works double shifts so her GROUP 1 supervisor will like her. DEFENSE MECHANISMS Narcissistic people mute the feelings of low self-esteem by I. REPRESSION self-aggrandizement, for example by talking "highly", or Definition: contacting "highly admired" persons. Unconsciously forgetting like Azheimers; kusang nawawala Depiction (Examples): unconsciously putting unacceptable ideas, thoughts, and individuals with poor family lives may direct their energy into emotions out of awareness. It is the process and effect of excelling above and beyond what is required at work. keeping particular thoughts and wishes out of the conscious Some other nurses are not good in theoreticals but we do mind in order to defend or protect them excel in skills/RLE Scenarios/Disorders that uses this: Di ako magaling mag basketball pero MAKAKASHOOT AKO Those who have undergone overwhelming situations. :) A woman who was sexually abused as a young child can’t remember the abuse she went through but experiences IV. RATIONALIZATION uneasy feelings when she goes near the place where the Definition: abuse happened. a defense mechanism where an individual deals with A child is abused by a parent, represses the memories, and emotional conflict or stressors by justifying unacceptable or as an adult is completely unaware of them. difficult feelings through seemingly acceptable or reasonable ○ Repressed memories of abuse may continue to explanations. Simply put, it’s making excuses for one’s influence this person's behavior by making it mistakes to avoid condemnation difficult to form relationships. Bumagsak ka sa test (bat ka ba bumagsak?) - BLAMING Depiction (Examples): OTHER PEOPLE is not rationalization —- THIS IS The patient cannot remember certain painful memories as a PROJECTION (Blaming of other people) child. To protect himself, he unconsciously represses these Blaming oneself memories from his consciousness. Instead, he displays Scenarios/Disorders that uses this: anxious behaviors toward other items that he associates with Instead of admitting his own lack of effort and preparation, a these original painful memories. student may rationalize a poor exam score by blaming the instructor. II. SUPPRESSION Depiction (Examples): Definition: Stealing money from a wealthy person and thinking, “It’s Consciously forgetting; trying hard to forget makes it more okay, he’s rich anyway. It’s not much of a loss, he wouldn’t memorable on your part ; the more na you’re trying hard to mind it.” forget it, the more na it'll mark sayo “why ka late?” “kasi po traffic” Voluntarily denying unpleasant thoughts and feelings. Conscious exclusion of unacceptable thoughts and feelings V. INTELLECTUALIZATION from conscious awareness. By suppressing thoughts, Definition: feelings, perceptions, and memories from consciousness, Separation of emotions and logical facts when analyzing or the client is protected from experiencing emotional and coping with a situation or problem psychological distress. When someone intellectualizes, emotions seem like Scenarios/Disorders that uses this: obstacles, and they shut them out using logic and Dissociative Identity