copy of psychiatric nursing

7/30/2019 Copy of Psychiatric Nursing

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Largest part of the brain. Houses the nerve center that controls motor and sensory

functions intelligence

Divided as left and righthemispheres



Several fissures divide the

cerebrum into 4 lobes:Frontal lobePersonality

MemoryReasoning

Concentration

Motor control of speech



Parietal lobe sensation integration of sensory

information spatial relationships

Temporal lobe Hearing Speech Memory Emotion

Occipital lobe vision involuntary eye movements



Located deep in the brain

Consists of two oval-shapedparts, 1 each hemisphere.

“relay station of the brain”



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Located beneath the thalamus Controls:

sleep and wakefulness temperature respiration blood pressure

sexual arousal fluid balance emotional response



Located at the base of the brain

Functions:Coordinates muscle movements

Maintains balance

Controls posture



Connection between the spinalcord and the brain

Contains 3 sections:Midbrain

mediates papillary reflexes and eyemovements

reflex center for the third andfourth cranial nerves.



Pons

helps regulate perspiration reflex center for the fifth through

eighth cranial nerves

mediates chewing, tasting, salivasecretion, and equilibrium

Medulla oblongata

Vomiting, vasomotor, respiratory, andcardiac centers.



Neurons that communicate informations withone another by sending electrochemicalmessages from neuron to neuron



Dopamine – control complex movement ,motivation, cognition and regulation ofemotional responses

- excitatory Norepinephrine – plays a role in changes in

attention, learning and memory

- sleep and wakefulness and mood regulator



Serotonin – control of food intake , sleep andwakefulness

Acetylcholine – affect the sleep and wake cycle

- signals muscle to become active

Gamma-aminobutyric Acid (GABA)

- major inhibitory neurotransmitter



Genetics – multiple genes may interact with

other neurobiologic and psychosocial factors incontributing to increased vulnerability tocertain mental illness



1. Personality Structurea. Id – pleasure principle

- demand for immediate gratification

- develop during infancyb. Ego – reality principle- balancing impulses from id and

demands from superego

- toddlerc. Superego – moral principle- conscience



a. Oral Stage (0-18 mos.)

Areas of Gratification: mouth

Indicators of Fixation: gum chewers, alcoholics,

smokers, binge eaters, paranoia- origin of separat’n anxiety

b. Anal Stage (18 mos. - 3y.o.)

Areas of Gratification: anusIndicators of Fixation: OCD, passive-aggressive

D/O, borderline



c. Phallic Stage (3-6 y.o)

Area of gratification: Genitalia

Indicators of Fixation: Oedipus / Electra Complex- origin of exhibitionism/masturbat’n

d. Latency Stage (6-12 y.o)

Area of Gratification: energy diverted to play

Indicators of fixation: antisocial personality- normal homosexual period

e. Genital Stage (12-21 y.o)

Area of Gratification: sexual maturationIndicators of Fixation: gender identity problem

- normal heterosexual period



a. Trust vs Mistrust (0-1 y.o)

Activity: infant takes in food

Adult behavior reflecting mastery:

- Realistic trust of self and others- Confidence in others

- Optimism and hope

- Shares openly with others

- Relates to others effectively



Adult behavior reflecting developmentalproblems:

- Suspiciousness and testing others- Fear of criticism and affection- Dissatisfaction and hostility- Projection of blame and feelings- Withdrawal from others

OR- Overly trusting of others- Naïve and gullible- Shares to quickly and easily



Activity: Sense of control over interpersonalrelationship and self control

Mastery: self control and will power

- Realistic self concept and self esteem- Pride and a sense of goodwill

- Simple cooperativeness

- Generosity tempered by withholding

- Delayed gratification when necessary



- Self doubt / self conscious- Dependence on others for approval- Feeling of being exposed / attached- Sense of being out of control of the self and one’s life

- OCDOR- Excessive independence- Grandiosity-

Denial of problems- Unwillingness to ask for help- Impulsiveness- Recklessness regarding safety for self and others



Activity: ability ot move freely, acquiringlanguage, skills, curiosity, imagination andambition or setting of goals

Mastery: an adequate conscience- Initiative balance with restraints- Appropriate social behaviors- Curiosity and exploration- Healthy competitiveness- Sense of direction- Original and purposeful activities



- Excessive guilt / embarrassment- Passivity and apathy- Avoidance of activities and pleasures- Rumination and self pity- Assuming a role as victim- Reluctance to show emotions- Underachievement of potentialsOr- Lack of follow up of plans-

Little sense of guilt for actions- Excessive expression of emotions- Labile emotions- Showing off



Activity: child strives hard to read and write ,pursue his hobbies and be the best among therest.

Mastery: sense of competence- Completion of projects- Pleasure in efforts and effectiveness- Ability to cooperate and compromise- Identification with admired others- Joy of involvement in the world and with

others- Balance of work and play



Feeling of unworthiness and inadequacy

Poor work history

Inadequate problem solving skills

Manipulation of others

Lack of friends of the same sex

Or

Perfectionist / overly high achieving

Reluctance to try new things

Feeling unable to gain love or affection unless totallysuccessful

Being a workaholic



Activity: They try out new roles and beliefsduring their search of a sense of ego identity

Mastery: confident of self

- Emotionally stable- Commitment to career planning

- Sense of having a place in society

- Establishing an intimate relationship- Fidelity to friends



Feeling of confusion, indecision and alienation

Superficial, short-term relationship with otherperson

OR Dramatic over confident

Acting out behaviors

Flamboyant display of sex role behaviors



Activity: ability and willingness to share a mutualtrust

Mastery: ability to give and receive love

- Commitment and mutually with others- Collaboration in work and affiliation

- Sacrificing for others

- Responsible sexual behaviors



Activity: Procreation of children, production ofwork and creation of new ideas that impacts agreat no. of people

Mastery: productive, constructive and creativeactivity

- Personal and professional growth

-

Parental and societal responsibilities



Self centeredness / self indulge

Exaggerated concern of appearance andpossessions

Lack of interest in the welfare of others Lack of professional activities

Lack of interest in marriage or extramarital

affairs Too many professional / community activities

to the detriment of the family or self



Activity: intimate relationship established andcaring for others. They feel whole and coherent.

Mastery: person has satisfying past recollection

- Feeling of self acceptance- Sense of dignity, worth, and importance

- Adaptation to life according to limitations

- Valuing one’s life

- Sharing of wisdom

- Exploration of philosophy of life and death



Sense of helplessness, hopelessness, worthlessness ,meaninglessness

Withdrawal and loneliness Regression

Focusing on past mistake, failures and dissatisfaction Feeling too old to start over Suicidal ideas Inability to occupy self with satisfying activitiesOR Inability to reduce activities Feeling indispensable Denial of death as inevitable



a. Sensory Motor Stage – 0-2 y.o

- Learn about self and environment

by senses and motor activities- Child learns that he is separate from

the environment

- Child learns the concept of objectpermanence



b. Pre-operational Stage – 2-7 y.o

2-4

-

pre-conceptual dev’t proceeds from sensorymotor learning to pre-logical thought

- The child learns language and symbols

4-7

- Egocentrism- The child is able to think in terms of class

- The child is able to determine that individualshave roles



Learns to reason in a systematic way

Selfless

Ability to adjust / adapt to a certain situation

They now understand

Class inclusion



a. Infancy – learn to trust others

b. Childhood – accept influence of others

c. Juvenile – form peer relationship

d. Pre-adolescence- form friendship with same-sex peers

e. Early Adolescence – becoming more

independentf. Late Adolescence – develop enduring

relationships with member of opposite sex



1. Conscious- here and now

- part of the mind that is focus on awareness

2. Subconscious – part of the mind that contains

information that can be recalled at will- slips of the tongue

3. Unconscious – contains materials and

information that can never be recalled4. Pre-conscious – tip of the tongue

- experiences that can be recalled at will



DEFENSE MECHANISMS

- (a.k.a.coping mechanisms)

- unconsciously motivated (except suppression

) - to deal with anxiety/tension

AIM:

-Reduce level of anxiety-Preserve ego‟s integrity



1. REPRESSION

- „Burying alive mechanism‟

- “unconscious” forgetting

- exclude from awareness unpleasant

feelings2. SUPPRESSION

- the only “conscious” defense

- “conscious” forgetting (for themeantime)



3. REGRESSION- manifest a behavior of an earlier

stage of dev‟t

4. IDENTIFICATION- imitate/copy the characteristics

of an admired or hated person



5. INTROJECTION

- excessive identification (incorporate values

and norms of others)- - Used in depression , the turning of anger into

the self

6. RATIONALIZATION

- most commonly used of all def. mech.- give untrue or exaggerated explanat‟n to make

it appear logical



7. UNDOING - make up/atone for an unacceptable

behav’r by doing acceptable behav’r 8. DISPLACEMENT- transfer strong feelings from original

source to an object/ person



9. SUBLIMATION- redirect socially unacceptable

behav‟r (usually sexual) to a sociallyacceptable one10. CONVERSION

- express anxiety into sensory ormotor symptoms (blindness,paralysis)



11. PROJECTION- attribute own unacceptable

behav‟r/feelings to others - “blaming”

12. REACTION FORMATION- show the opposite behav‟r toone‟s true emotion



13. DENIAL

- not accepting the truth or reality- initial response to having a terminal illness or

dying

14. COMPENSATION

- make up for one‟s phy‟l defect by excelling inanother area

15. PRIMARY DISSOCIATION OR SPLITTING

- viewing people as either “all-good” or “all-bad”



16. Compensation

- the act of making up for a real / imagined inability / deficiency witha specific behavior to maintain selfrespect / self esteem

17. Fantasy

- imagined events to express

unconscious conflicts, gratifyunconscious wishes



18. Fixation

- Immobilization of a portion of thepersonality resulting fromunsuccessful completion of task inthe developmental stage.

19. Intellectualization- Separation of emotions of a painful

event from facts involved



20. Substitution

- Replacing the desired gratificationwith one that is more readilyavailable and acceptable

21. Symbolization

- Allows emotional self expression

- An external object is made tosymbolize an internal feeling / idea.



1. Adaptive

- solving the problem that causes

anxiety2. Palliative

- Temporarily resolve / decreaseanxiety but does not solve theproblem



Fear of the unknown

Feeling of dread / impending doom



1. Psychoanalytic (Freud)

- due to unconscious orrepressed conflicts

- chief def.mech:Repress‟n



2. Interpersonal(Sullivan)

- interpersonal conflictswith S.O.

- fear of rejection/ disapproval



I. MILD- healthy form

- increased alertness- Resources mobilized

- perceptual field (p.f.) wideopen



II. MODERATE

increased V/Sheadache (common

manifest.)

SELECTIVE INATTENTION

Needs direct‟n in problem

solving P.F. slightly narrowed



III. SEVERE

V/S very much increasedPalpitations

Pacing/agitationHandwringing/squeezing

Distorted communicat‟n P.f. very narrow

IV PANIC



IV. PANIC

out of control, irrational

terror/dread/goin crazy/heart

attack

purposeless mov’t

potential for violence (directed to

self or others) badly needs someone around

P.f. closed



1. INEFFECTIVE INDIVIDUALCOPING (priority)



1. reduce level of anxiety2. prevent any increase in level



I. For Moderate

1. Identify source of anxiety

2. Verbalizat‟n of feelings

3. Listen with empathy

4. Assist in developing newadaptive coping skills

II F S d P i



II. For Severe and Panic

1. Initially, DEEP BREATHS for Panic2. STAY w/ client/introduce 1self

3. LIMIT env’tal stimuli 4. SAFETY (priority);calm

reassur’nce

5. Short, specific, simple direct’ns 6. Give anxiolytic



I. OBSESSIVE-COMPULSIVEDISORDER(OCD)

- recurrent unwanted thoughtsalternating with behavior

- charac. by ritualistic(repetitive) behav‟r



DOING RITUAL REDUCESANX‟TY

PRIMARY GAIN: use of ritualto reduce anxiety

Secondary gain:Benefits/attention Common Rituals:

Handwashing,Cleaning Def. Mech: Undoing,Repres‟n



4 B h ‟ M difi i Th



4. Behav‟r Modification Therapy give reward for adaptive behav‟r w/draw privileges if ritual

interferes with ADL‟s 5. Let client perform ritual earlier

6. Develop insight (acknowledge it‟sin the mind)

* + outcome: adhere to schedule,perform ADL‟s

copy of psychiatric nursing

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